Personal protective equipment training & lived experience for healthcare staff during COVID-19.

Objectives: To describe the lived experience of healthcare staff during the Coronavirus Disease 2019 (COVID-19) pandemic relating to the use of personal protective equipment (PPE) and investigate risks associated with PPE use, error mitigation and acceptability of mindfulness incorporation into PPE practice. Methods: A qualitative human factors' study at two Irish hospitals occurred in late 2020. Data was collected by semi-structured interview and included role description, pre-COVID-19 PPE experience, the impact of COVID-19 on lived experience, risks associated with PPE use, contributory factors to errors, error mitigation strategies and acceptability of incorporating mindfulness into PPE practice. Results: Of 45 participants, 23 of whom were nursing staff (51%), 34 (76%) had previously worn PPE and 25 (56%) used a buddy system. COVID-19 lived experience impacted most on social life/home-work interface (n=36, 80%). Nineteen staff (42%) described mental health impacts. The most cited risk concerned 'knowledge of procedures' (n=18, 40%). Contributory factors to PPE errors included time (n=15, 43%) and staffing pressures (n=10, 29%). Mitigation interventions included training/education (n=12, 40%). The majority (n=35, 78%) supported mindfulness integration into PPE practice. Conclusions: PPE training should address healthcare staff lived experiences and consider incorporation of mindfulness and key organisational factors contributing to safety.

What Is in the Caribbean Baby? Assessing Prenatal Exposures and Potential Health Outcomes to Environmental Contaminants in 10 Caribbean Countries.

OBJECTIVE: To assess prenatal exposures and potential health outcomes to environmental toxicants such as persistent organic pollutants (POPs), commonly used pesticides, and two heavy metals--mercury (Hg) and lead (Pb)--in 10 Caribbean countries. SUBJECTS AND METHODS: For each participating Caribbean island, approximately 50 maternal blood and urine samples were collected and analysed for POPs such as polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), other common classes of pesticides used in the Caribbean such as organophosphates (OP), carbamates, chlorophenols and pyrethroids, and for Hg and Pb. Data obtained from the participating countries were compared with those from the United States of America and Canada. RESULTS: A total of 438 samples were analysed from 10 Caribbean countries. Persistent organic pollutants was detected in almost all samples, however, these were generally low compared with comparable North American results. Evidence of exposure to PBDEs, OPs, carbamates and chlorophenols was also established. Caribbean pyrethroid concentrations were generally much higher than those recorded for North American women. Caribbean Pb maternal blood levels were generally lower than in North America, whereas Hg blood levels were two to three times higher. In almost all of the samples taken in this study, exposures to multiple chemicals were taking place at the same time. CONCLUSIONS: This first Caribbean-wide exploratory biomonitoring study on the concentrations of several toxicants in maternal samples taken from 10 Caribbean countries clearly reinforces the need for Caribbean primary care physicians and other public health officials to encourage their patients, and in particular pregnant women, to reduce their exposures to these environmental contaminants as far as it is feasible to do so.

Infective endocarditis and dentistry: the legal basis for an association.

OBJECTIVES: The objectives of this study were to determine on what evidence infective endocarditis (IE) could be legally linked to dental treatment. METHOD: The records of 319 legal cases involving dental treatment as the probable cause of IE were analysed. The medical history, type of dental operation, and whether antibiotic prophylaxis was provided were noted. The time taken for the onset of symptoms (incubation period) and hospitalisation was calculated. The identity of the infecting micro-organism was investigated and it was also noted whether litigation was successful for the patient. RESULTS: A total of 83 patients were successful in legally linking dental treatment to the onset of infective endocarditis. In all successful cases there was a short incubation period (circa nine days) and in 80 of the patients an oral Streptococcus was isolated. The dental operations included exodontia (28), scaling (29), endodontics (12) and minor oral surgery (11). CONCLUSIONS: Dental treatment was deemed to be the probable cause of IE in 26% of patients who sought litigation. In the majority of legal cases clinicians did not follow recognised guidelines or keep adequate clinical notes. The three main factors which link dental procedures legally were the dental operation, the isolation from the blood of an oral micro-organism and a short incubation period.

Stability of milrinone and epinephrine, atropine sulfate, lidocaine hydrochloride, or morphine sulfate injection.

The stability of both drug components of admixtures of milrinone and epinephrine, atropine sulfate, lidocaine hydrochloride, morphine sulfate, calcium chloride, or sodium bicarbonate injections was studied. Duplicate solutions of admixtures of milrinone injection 1 mg/mL and epinephrine injection 1:10,000, atropine sulfate injection 1 mg/mL, lidocaine hydrochloride injection 1%, morphine sulfate injection 8 mg/mL, calcium chloride injection 10%, or sodium bicarbonate injection 7.5% were prepared and stored in glass containers at 22-23 degrees C under fluorescent light. Samples were taken immediately and after 20 minutes for assay by high-performance liquid chromatography (HPLC). Milrinone at initial concentrations of 0.10-0.73 mg/mL showed no degradation in any of the solutions during the study period, nor was any degradation observed for lidocaine, morphine, atropine, or epinephrine. Milrinone 0.10-0.73 mg/mL is compatible with atropine sulfate, lidocaine hydrochloride, epinephrine, calcium chloride, or sodium bicarbonate in glass containers stored for 20 minutes at room temperature. These results support the use of milrinone in combination with these agents immediately after the preparation of admixtures.

Bone marrow transplantation for acute leukemia and Down syndrome: report of a successful case and results of a national survey.

We report a child with Down syndrome (DS) and acute lymphoblastic leukemia who is a healthy survivor 38 months after bone marrow transplantation (BMT). Psychometric evaluations performed before and after BMT indicate no demonstrable therapy-related change in intellectual function. A survey of BMT centers in the United States indicated that 16 leukemic DS children have had transplants at 10 BMT centers. Seven of these children survive at 11, 14, 17, 18, 22, 38, and 47 months, respectively, after BMT. Although these results are comparable to those for non-DS children, the number of DS children having transplants is only 20% to 25% of that predicted. We conclude that there is no justification for denial of BMT to otherwise appropriate candidates with DS and leukemia.

Stability of milrinone in 0.45% sodium chloride, 0.9% sodium chloride, or 5% dextrose injections.

The stability of milrinone in 0.45% and 0.9% sodium chloride injections and in 5% dextrose injection in glass and plastic containers was studied. Admixtures containing milrinone 0.2 mg/mL were prepared in three 500-mL glass containers, three 500-mL polyethylpolypropyl copolymer plastic containers, and three 1-L flexible plastic containers of each solution. Milrinone content was determined by high-performance liquid chromatography at intervals during 72 hours of storage at room temperature; one sample of each solution and container type was protected from light. Duplicate assays of each sample were performed, and samples were observed for visual and pH changes. In all samples milrinone concentrations were more than 97% of the initial concentration. No changes in pH or appearance occurred. Milrinone at a concentration of 0.2 mg/mL is stable for 72 hours at room temperature in 0.45% and 0.9% sodium chloride injections and in 5% dextrose injection in glass or plastic containers.

Metabolism of hexachlorobenzene (HCB) in the isolated perfused rat liver.

The metabolism of HCB in the isolated perfused rat liver was studied by administration of [14C]HCB diluted with unlabelled HCB at a total dose of 0.1 mg HCB/ml perfusate. Metabolites in bile, perfusate and liver were studied by GLC-mass spectrometry. Histological examination of the livers showed that no hepatic necrosis had developed, although there was a slight increase in ASAT and ALAT in the perfusate and about 50% decrease in hepatic glutathione. About 0.15% of administered radioactivity was recovered in the bile within 2 hr. In the bile, HCB together with the metabolites pentachlorothiophenol and pentachlorophenol, were identified and accounted for about 20% of the radioactivity excreted. In addition, eleven metabolites with 4 or 5 chlorines were isolated. In the perfusate and in the liver, unchanged HCB was responsible for most of the radioactivity. Traces of pentachlorothiophenol and pentachlorophenol were identified in the perfusate and the liver, respectively.

Simultaneous liquid chromatographic determination of glutaric acid, phenylephrine, and benzyl alcohol in a prototype nasal spray with application to di- and tricarboxylic acids.

A rapid reversed-phase high-performance liquid chromatographic method for the simultaneous determination of glutaric acid, phenylephrine, and benzyl alcohol in nasal spray has been developed. UV detection was utilized at 210 nm for the assay of glutaric acid and phenylephrine with an adjustment to 254 nm for the measurement of benzyl alcohol. Linearity and recovery data were obtained for each component in spiked placebo studies. An investigation of the retention mechanisms of the three components showed that phenylephrine was retained by ion-pairing with octanesulfonate anion while glutaric acid and benzyl alcohol partitioned as a suppressed ion and a neutral molecule, respectively. The method has been further extended to the reversed-phase separation of di- and tricarboxylic acids using a totally aqueous 0.0074 M phosphoric acid mobile phase. The retention of these acids was related to their octanol-water partition coefficients and structural variation.

Studies on the biliary excretion and metabolites of hexachlorobenzene in the rat.

1. The biliary excretion of metabolites of hexachlorobenzene (HCB) was studied in rats dosed intragastrically with 14C-HCB. Approx. 80% dose was absorbed from the gastrointestinal tract. An average of 3.6% dose was recovered in the bile of bile-duct-cannulated rats in 48 h. 2. By g.l.c.-mass spectrometry, 2.0 and 1.8% of the 14C excreted in the 24 h bile was shown to be due to unchanged HCB and pentachlorobenzene (PCB), respectively. The major metabolite pentachlorophenol (PCP) accounted for 24.2%. 3. Sulphur-containing metabolites were not identified. However, the hepatic GSH concn. decreased by 50% within 24 h following oral administration of HCB (200 mg/kg).

Isolation and characterization of a low-molecular weight seed protein from Ricinus communis.

A seed protein with an apparent molecular weight of 5000 has been isolated and purified from Ricinus communis. This protein has a very high content of glutamine and an unusual ultraviolet absorption spectrum. The amino-terminal sequence of 22 residues determined by automatic Edman degradation is: NH2-Pro-Ser-Gln-Gln-Gly-Cys-Cys-Gly-Gln-Ile-Gln-Glu-Gln-Gln-Asn-Leu-Arg-Gln-Cys-Gln-Glu-Tyr-.