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This study presents a quantitative validation of 15 Similar Exposure Groups (SEGs) that were derived via control bands inherent to the Risk Level Based Management System currently being used at the Lawrence Livermore National Laboratory. For 93% of the SEGs that were evaluated, statistical analyses of personal exposure monitoring data, through Bayesian Decision Analysis (BDA), demonstrated that the controls implemented from the initial control bands assigned to these SEGs were at least as protective as the controls from the control band outcomes derived from the quantitative data. The BDA also demonstrated that for 40% of the SEGs, the controls from the initial control bands were overly protective, thus allowing controls to be downgraded, which resulted in a significant saving of environmental safety and health (ES&H) resources. Therefore, as a means to both confirm existing controls and to identify candidate SEGs for downgrading controls, efforts to continuously improve the accuracy of Control Banding (CB) strategies through the routine quantitative validation of SEGs are strongly encouraged. Targeted collaborative efforts across institutions and even countries for both the development of CB strategies and the validation of discreetly defined SEGs of commonly performed tasks will not only optimize limited ES&H resources but will also assist in providing a simplified process for essential risk communication at the worker level to the benefit of billions of workers around the world.
Assuntos
Exposição Ocupacional , Teorema de Bayes , Humanos , Gestão da SegurançaRESUMO
BACKGROUND: Sarcopenia, which is a loss of skeletal muscle mass, has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant. Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures. However, there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation (re-OLT). AIM: To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT. METHODS: This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1, 2007 to January 1, 2017. We divided patients into sarcopenia and no sarcopenia groups. "TeraRecon AquariusNet 4.4.12.194" software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT, to calculate the Psoas muscle area at L3-L4 intervertebral disc. We defined cutoffs for sarcopenia as < 1561 mm2 for males and < 1464 mm2 for females. The primary outcome was to compare 90 d, one, and 5-year survival rates. We also compared complications after re-OLT, length of stay, and re-admission within 30 d. Survival analysis was performed with Kaplan-Meier survival analysis. Continuous variables were evaluated with Wilcoxon rank-sum tests. Categorical variables were evaluated with Fisher's exact tests. RESULTS: Fifty-seven patients were included, 32 males: 25 females, median age 50 years. Two patients were excluded due to incomplete information. Overall, 47% (26) of patients who underwent re-OLT had sarcopenia. Females were found to have significantly more sarcopenia than males (73% vs 17%, P < 0.001). Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups. Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant (36.5 mo vs 16.7 mo). Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-OLT at our center was noted to be twice as common (47%) as historically reported in patients undergoing primary liver transplantation. CONCLUSION: Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.
RESUMO
Due to the COVID-19 pandemic, current high demand for N95 filtering facepiece respirators has placed them in short supply. Filtering facepiece respirator wearers have traditionally been instructed to discard their respirator and don a new one should the respirator become saturated with perspiration or damp from exhaled breath. However, today's shortage may prohibit many N95 respirator wearers from replacing their filtering facepieces at this desired frequency. Previously unpublished research that evaluated the performance of N95 filtering facepiece respirators saturated with artificial perspiration and then dried out can help provide insight into making critical decisions about the change out frequency of N95 respirators that become damp with use. This study concluded that the collection efficiency of filtering facepiece respirators, containing electrostatic filter media, remained statistically unchanged or slightly improved after being dried out following harsh saturation conditions with artificial perspiration. Therefore, respirator wearers can continue to rely on their N95 filtering facepiece respirators to perform as intended.
