Measured removal rates of chrysotile asbestos fibers from air and comparison with theoretical estimates based on gravitational settling and dilution ventilation.

CONTEXT: Industrial hygiene assessments often focus on activity-based airborne asbestos concentration measurements, but few empirical data exist regarding the fiber removal rate from air after activities cease. OBJECTIVE: Grade 7T chrysotile indoor fiber settling (FS) rates were characterized using air sampling (NIOSH Method 7402). MATERIALS AND METHODS: Six replicate events were conducted in a 58 m(3) study chamber (ventilation 3.5 ACH), in which chrysotile-contaminated work clothing was manipulated for 15 min followed by 30 min of no activity. The fiber concentration decay constant and removal rate were characterized using an exponential decay model based on the measurements. RESULTS: Breathing zone airborne chrysotile concentrations decreased by 86% within 15-30 min after fiber disturbance, compared to concentrations during active disturbance (p < 0.05). Estimated mean time required for 99% of the phase contrast microscopy-equivalent (PCME) fibers to be removed from air was approximately 30 min (95% CI: 22-57 min). The observed effective FS velocity was 0.0034 m/s. This settling velocity was between 4.5-fold and 180-fold faster than predicted by two different particulate gravitational settling models. Additionally, PCME concentrations decreased approximately 2.5-fold faster than predicted due to air exchange alone (32 versus 79 min to 99% decrease in concentration). DISCUSSION: Other measurement studies have reported similar airborne fiber removal rates, supporting the finding that factors other than gravitational settling and dilution ventilation contribute measurably to PCM fiber removal from air (e.g. impaction, agglomeration). CONCLUSION: Overall, the scientific weight of evidence indicates that the time necessary for removal of 99% of fibers greater than 5 µm in length (with aspect ratios greater than 3:1) is approximately 20-80 min.

Evaluation of take-home exposure and risk associated with the handling of clothing contaminated with chrysotile asbestos.

The potential for para-occupational (or take-home) exposures from contaminated clothing has been recognized for the past 60 years. To better characterize the take-home asbestos exposure pathway, a study was performed to measure the relationship between airborne chrysotile concentrations in the workplace, the contamination of work clothing, and take-home exposures and risks. The study included air sampling during two activities: (1) contamination of work clothing by airborne chrysotile (i.e., loading the clothing), and (2) handling and shaking out of the clothes. The clothes were contaminated at three different target airborne chrysotile concentrations (0-0.1 fibers per cubic centimeter [f/cc], 1-2 f/cc, and 2-4 f/cc; two events each for 31-43 minutes; six events total). Arithmetic mean concentrations for the three target loading levels were 0.01 f/cc, 1.65 f/cc, and 2.84 f/cc (National Institute of Occupational Health and Safety [NIOSH] 7402). Following the loading events, six matched 30-minute clothes-handling and shake-out events were conducted, each including 15 minutes of active handling (15-minute means; 0.014-0.097 f/cc) and 15 additional minutes of no handling (30-minute means; 0.006-0.063 f/cc). Percentages of personal clothes-handling TWAs relative to clothes-loading TWAs were calculated for event pairs to characterize exposure potential during daily versus weekly clothes-handling activity. Airborne concentrations for the clothes handler were 0.2-1.4% (eight-hour TWA or daily ratio) and 0.03-0.27% (40-hour TWA or weekly ratio) of loading TWAs. Cumulative chrysotile doses for clothes handling at airborne concentrations tested were estimated to be consistent with lifetime cumulative chrysotile doses associated with ambient air exposure (range for take-home or ambient doses: 0.00044-0.105 f/cc year).

Distinguishing objective from subjective assessments of the severity of medication-related safety events among people with Parkinson's disease: a qualitative study.

WHAT IS KNOWN AND OBJECTIVE: Safety events indicating medication-related errors in Parkinson's disease (PD) are common but seldom studied, particularly from lay perspectives. Our objective was to study the meaning and significance to people living with PD of their experience of safety events. METHODS: Twenty qualitative interviews were conducted by telephone with purposively sampled individuals with PD, a proxy, or both, throughout New Zealand. Themes identified from the data included joint assessments of the objective and subjective severity of the individual safety events. RESULTS AND DISCUSSION: Most of the events indicated minor objective errors, whose severity was sometimes perceived as major, especially in the face of callous communication. WHAT IS NEW AND CONCLUSION: Variation between objective and subjective assessments of the severity of possible errors indicated by safety events highlight the importance of distinguishing between, and using, both forms of assessment.

Enhancement of electric field-mediated gene delivery through pretreatment of tumors with a hyperosmotic mannitol solution.

Pulsed electric fields can enhance interstitial transport of plasmid DNA (pDNA) in solid tumors. However, the extent of enhancement is still limited. To this end, the effects of cellular resistance to electric field-mediated gene delivery were investigated. The investigation used two tumor cell lines (4T1 (a murine mammary carcinoma) and B16.F10 (a metastatic subline of B16 murine melanoma)) either in suspensions or implanted in two in vivo models (dorsal skin-fold chamber (DSC) and hind leg). The volume fraction of cells was altered by pretreatment with a hyperosmotic mannitol solution (1 M). It was observed that the pretreatment reduced the volumes of 4T1 and B16.F10 cells, suspended in an agarose gel, by 50 and 46%, respectively, over a 20-min period, but did not cause significant changes ex vivo in volumes of hind-leg tumor tissues grown from the same cells in mice. The mannitol pretreatment in vivo improved electric field-mediated gene delivery in the hind-leg tumor models, in terms of reporter gene expression, but resulted in minimal enhancement in pDNA electrophoresis over a few microns distance in the DSC tumor models. These data demonstrated that hyperosmotic mannitol solution could effectively improve electric field-mediated gene delivery around individual cells in vivo by increasing the extracellular space.

Definition of the specific roles of lysolecithin and palmitic acid in altering the susceptibility of dipalmitoylphosphatidylcholine bilayers to phospholipase A2.

Bilayers composed of phosphatidylcholine initially resist catalysis by phospholipase A2. However, after a latency period, they become susceptible when sufficient reaction products (lysolecithin and fatty acid) accumulate in the membrane. Temperature near the main bilayer phase transition and calcium concentration modulate the effectiveness of the reaction products. The purpose of this study was to examine the individual contributions of lysolecithin and palmitic acid to the susceptibility of dipalmitoylphosphatidylcholine vesicles and to rationalize the effects of temperature and calcium. Various fluorescent probes (Prodan, Laurdan, pyrene-labeled fatty acid, and dansyl-labeled phospholipid) were used to assess changes in the ability of the reaction products to perturb the bilayer and to affect the interactions with the enzyme. Un-ionized palmitic acid decreased bilayer polarity and perturbed the membrane surface exposing some of the Prodan to bulk water. Lysolecithin increased bilayer polarity and the rate of dipolar relaxation in response to the excited states of Laurdan and Prodan. A combination of the individual contributions of each product was observed when palmitic acid and lysolecithin were present together at low calcium, and the effects of lysolecithin dominated at high calcium. Palmitic acid, but not lysolecithin, promoted the binding of phospholipase A2 to the bilayer surface in the absence of calcium. Lysolecithin reduced the ability of fatty acid to enhance binding apparently by altering the structure of fatty acid domains in the membrane. Furthermore, increased temperature and ionization of the fatty acid tended to cause segregation of bound phospholipase A2 into domains poor in phospholipid content which presumably impeded bilayer hydrolysis. In contrast, un-ionized palmitic acid and lysolecithin promoted hydrolysis by augmenting a step distal to the adsorption of enzyme to the bilayer. This kinetic response to lysolecithin was calcium-dependent. A model accounting for these varied influences of the reaction products is presented.

Time-dependent chemical compositions of 13N and 15O induced in air by the operation of a high energy electron accelerator.

Time-dependent chemical compositions for 13N and 15O induced in the air atmosphere of a high energy electron accelerator room have been studied using a computer simulation method. A radiation chemistry model was developed to describe the chemical reactions of 13N and 15O species with the air molecules and their radiolytic products. By assuming several chemical forms of 13N and 15O generated by the (gamma, n) reaction, the variations of the concentrations of 13N and 15O species were simulated under a radiation field. From the comparison between the simulations and experiment in a 100 MeV electron linear accelerator (linac) facility, the following conclusions were obtained: (1) Just after the (gamma, n) reaction, 25-50% of 13N and 15O are present as atoms (13N, 15O) and/or their ions (13N+, 15O+) and the remainder as nitrogen and oxygen molecules (13NN, 15OO) and/or their ions (13NN+, 15OO+); (2) Neutralization of 13N+ and 15O+ ions into 13N and 15O atoms occurs instantaneously and the same is the case with the neutralization of 13NN+ and 15OO+ ions to 13NN and 15OO molecules; (3) The neutralized 13N and 15O atoms react with the air molecules and the radiolytic products to form nitrogen oxide compounds and ozone, while 13NN and 15OO remain as these molecules. Factors that control the chemical reactions of 13N and 15O are discussed.

General surgical practice patterns in Nova Scotia: the role of the "generalist" general surgeon.

OBJECTIVE: To determine the role of traditional "generalist" general surgeons in Nova Scotia. DESIGN: An anonymous mail survey. SETTING: The Province of Nova Scotia. PARTICIPANTS: Sixty-two active general surgeons listed on the Nova Scotia Provincial Medical Board Registry. INTERVENTIONS: A questionnaire to compare the practice patterns of community surgeons, regional surgeons and tertiary care surgeons. MAIN OUTCOME MEASURES: The availability of non-general-surgery subspecialty colleagues in the hospital setting, the extent of non-general-surgery subspecialty practices of the participating surgeons, the types of procedures they commonly perform and the adequacy of their general surgery training to meet their present practice requirements. RESULTS: The questionnaire response rate was 79%. Community surgeons had few non-general-surgery subspecialty colleagues, and the majority maintained broad "generalist" general surgical practices. Regional surgeons had more non-general-surgery subspecialty colleagues, but many still had surgical practices that included the non-general-surgery subspecialties. Tertiary surgeons had adequate non-general-surgery subspecialty colleagues and maintained narrow general surgery practices. CONCLUSIONS: In Nova Scotia, "generalist" general surgeons presently provide non-general-surgery subspecialty services in both regional and community hospital settings.

The ORLAU VCG (variable centre of gravity) swivel walker for muscular dystrophy patients.

Swivel walkers are being increasingly used for muscular dystrophy patients in order to prolong the period of their ambulation. Existing designs did not address the special problems of accommodating such patients comfortably and providing the easier and more assured ambulation which their weakened condition requires. The ORLAU VCG (variable centre of gravity) swivel walker has been developed so that the walking mechanics can be adjusted independently of patient posture. Additional patient support features permit the patient to be secured in their chosen position of comfort prior to setting the ambulation mechanics. Patients using the device, which is now approved for supply by the Department of Health in England and Wales, have improved their walking performance and extended their period of walking.

The 'induction' dose of thiopentone. A method of study and preliminary illustrative results.

Study of the minimal dose requirements for induction of anaesthesia poses great problems which are solved by the use of a standard administration technique and the abolition of the eyelash reflex as an endpoint. This has been used in 2206 consecutive unselected inductions, in which variables considered to be likely to influence the dosage were recorded. Milligram per kilogram is the most acceptable method of expressing the average dosage of thiopentone. Doses follow a right skew distribution. Women required a significantly lower average dose of thiopentone than men, while obese patients required less than others. Moderate or heavy drinking increased the induction dose but the use of tobacco did not have any influence. The most important factors governing dosage are the physical fitness of the patient and the premedication used. Patients in ASA grades 1 and 2 required significantly more thiopentone than those in grades 3 and 4. This effect is as great as that of premedication in which an opiate with a phenothiazine or hyoscine markedly reduced the induction dose. It was more important than the patient's pre-operative condition with respect to sedation or apprehension. Small doses of opiates or benzodiazepines do not have as much effect on dosage.

Clinical applications of the paraplegic swivel walker.

An account is given of ten years experience of swivel walkers in 135 paraplegics of all ages and types. The majority of patients were victims of spinal bifida. Reference is made to the importance of engineering design and proper maintenance of the orthosis. The degree to which the device is utilized is discussed and the particular value it has in young children is stressed. Further developments, especially those which satisfy the increasing demand for the device for adult use are mentioned, notably those needed to simplify the problems of transfer into and from the device.

'Walking' appliances for paraplegics and tetraplegics.

A range of 'walking' appliances suitable for child, adolescent and adult paraplegics and tetraplegics is described and some of the technical considerations discussed. A valuable development to the appliance in the form of a rising wheelchair is also breifly discussed.

Clinical assessment of a new weight-relieving brace.

A new cosmetic weight-relieving brace which utilises stainless steel and light alloy in its structure is described. A clinical assessment of thirty-six patients (four bilateral cases) has shown the Salford Cosmetic brace to be suitable for over 80 per cent of patients attending for assessment. Five patients rejected the brace, and the reasons are discussed. Contra-indications which emerged during the assessment included limb shortening of more than 5 centimetres; fixed equinus of more than 10 degrees; and fixed deformity of the knee of more than 10 degrees. The safety and durability of the brace, first demonstrated in laboratory tests, are confirmed. Further possible development is outlined.

The biomechanical design of a walking appliance for a paraplegic adult.

One of the major requirements of the medical consultant treating paraplegic patients is to have them upright for at least a few hours a day associated, if possible with some physical exercise. This paper deals with the construction and operation of an appliance which makes this possible.