The Fatality Assessment and Control Evaluation program's role in the prevention of occupational fatalities.

OBJECTIVES: The objective of the Fatality Assessment and Control Evaluation (FACE) program is to prevent traumatic occupational fatalities in the United States by identifying and investigating work situations at high risk for injury and formulating and disseminating prevention strategies to those who can intervene in the workplace. SETTING: The FACE program is a research program located in the Division of Safety Research, a division of the National Institute for Occupational Safety and Health (NIOSH). NIOSH is an agency of the United States government and is part of the Centers for Disease Control and Prevention. NIOSH is responsible for conducting research and making recommendations for prevention of work related illnesses and injuries. FACE investigators conduct traumatic occupational fatality investigations throughout the United States and provide technical assistance to 15 state health or labor departments who have cooperative agreements with NIOSH to conduct traumatic fatality surveillance, targeted investigations, and prevention activities at the state level. METHODS: Investigations are conducted at the worksite using the FACE model, an approach derived from the research conducted by William Haddon Jr. This approach reflects the public health perspective that the etiology of injuries is multifactorial and largely preventable. FACE investigators gather information on multiple factors that may have contributed to traumatic occupational fatalities. Information on factors associated with the agent (energy exchange, for example, thermal energy, mechanical energy, electrical energy, chemical energy), host (worker who died), and the environment (the physical and social aspects of the workplace), during the pre-event, event, and post-event time phases of the fatal incident are collected and analyzed. Organizational, behavioral, and environmental factors contributing to the death are detailed and prevention recommendations formulated and disseminated to help prevent future incidents of a similar nature. RESULTS: Between 1982 and the present, more than 1,500 fatality investigations have been conducted and reports with prevention recommendations distributed. Findings have been published in scientific and trade journals; safety professionals and policy makers have used FACE findings for prevention efforts; and working partnerships have been formed to address newly emerging safety concerns. CONCLUSIONS: FACE investigations identify multiple factors contributing to fatal occupational injuries, which lead to the formulation and dissemination of diverse strategies for preventing deaths of a similar nature.

[Is there a correlation between optimism and quality of life in upper aerodigestive tract cancer Patients? Preliminary results]. / Recherche d'une corrélation entre tempérament optimiste et qualité de vie chez le malade atteint d'un cancer des voies aérodigestives supérieures: résultats préliminaires.

UNLABELLED: The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients. MATERIALS AND METHODS: Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment. PRELIMINARY RESULTS: 92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant. CONCLUSION: Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.

[Postoperative pain assessment in head and neck cancer surgery: benefit of patient controlled analgesia (PCA)]. / Evaluation de la douleur post-opératoire en chirurgie carcinologique cervico-faciale. Intérêt de l'analgésie auto-contrôlée.

Acute postoperative pain has seldom been assessed in head and neck cancer surgery. The estimation of actual pain is more difficult when communication is impaired by tracheotomy or tracheostomia. The aim of the present prospective study was the assessment of analgesia level during the first 48 postoperative hours after head and neck cancer surgery. The analgesic procedure involved intra-venous morphine injected by means of a PCA pump (Patient controlled analgesia). Thirty patients were thus treated after cancer surgery of the larynx or the oropharynx. The protocol included during 48 hours the assessment of pain, using a visual analogic scale (VAS) every fourth hour, while recording the total injected dose of morphine, the localisation of pains, as well as the occurrence of side-effects. The control of postoperative pain was shown to be satisfactory, with a VAS grade smaller than 3 at time zero and kept below this value during 48 hours. At the end of this period, the mean total dose of morphine injected was 38 mg. No case of respiratory depression was even seen. It can be concluded that PCA seems to be an efficient procedure for controlling postoperative pain in head and neck cancer surgery. This technique proved to be better than delivering analgesia on requirement.

The cholesterol-lowering effect of guar gum in rats is not accompanied by an interruption of bile acid cycling.

A viscous hydrocolloid (guar gum, GG; 2.5% of the diet) or a steroid sequestrant (cholestyramine; 0.5% of the diet) was included in semipurified diets containing 0.2% cholesterol to compare the cholesterol-lowering effects of each agent in rats. In the present model, GG significantly lowered plasma cholesterol (-25%), especially in the density < 1.040 kg/L fraction, whereas cholestyramine was less potent. Bile acid fecal excretion significantly increased only in rats fed cholestyramine, similar to the cecal bile acid pool; the biliary bile acid secretion was accelerated by GG, but not their fecal excretion, whereas GG effectively enhanced neutral sterol excretion. As a result, the total steroid balance (+13 micromol/d in the control) was shifted toward negative values in rats fed the GG or cholestyramine diets (-27 or -50 micromol/d, respectively). Both agents induced liver 3-hydroxy-3-methylglutaryl-CoA reductase, but cholestyramine was more potent than GG in this respect. The present data suggest that, at a relative low dose in the diet, GG may be more effective than cholestyramine in lowering plasma cholesterol by impairing cholesterol absorption and by accelerating the small intestine/liver cycling of bile acids, which is interestingly, accompanied by reduction of bile acid concentration in the large intestine.

[Parapharyngeal tumors. Apropos of 6 cases]. / Les tumeurs parapharyngées. A propos de 6 cas.

We conducted a retrospective study of six patients presenting a parapharyngeal tumor and an analysis of data of the literature and recall classification of these tumors and their anatomo-clinics characters, therapeutic and diagnostic problems highlighting. These tumors are rare and have various origins, their treatment is almost always surgical by cervical approach which can be undertaken only after a rigorous exploration, systematically associating computed tomography scan and magnetic resonance imaging. Transoral resection is strongly advised against as it is potentially harmful.

The cholesterol-lowering effect of guar gum is not the result of a simple diversion of bile acids toward fecal excretion.

The effects of partially hydrolyzed, nonviscous, guar gum (PHGG) on cholesterol metabolism and digestive balance have been compared with those of native guar gum (GUAR) in rats adapted to 0.4% cholesterol diets. Both types of guar gum elicited acidic fermentations in the large intestine, but only GUAR effectively lowered plasma cholesterol (P < 0.001), chiefly in the triglyceride-rich lipoprotein fraction. The biliary bile acid excretion was significantly enhanced in rats fed GUAR (P < 0.05), as well as the intestinal and cecal bile acid pool (P < 0.001). In rats fed GUAR and to a lesser extent in those fed PHGG, the fecal excretion of bile acids and neutral sterol was higher than in controls (P < 0.01). The digestive balance (cholesterol intake-steroid excretion) was positive in control rats (+47 mumol/d), whereas it was negative in rats fed GUAR (-20 mumol/d), which could involve a higher rate of endogenous cholesterol synthesis. In rats fed PHGG, the steroid balance remained slightly positive. Liver 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase activity was very low (22 pmol/min/mg protein), owing to cholesterol supplementation, in control rats or in rats fed PHGG, whereas it was markedly higher (+463%) in rats fed GUAR. In conclusion, even if PHGG does alter some parameters of the enterohepatic cycle of cholesterol and bile acids, its effects are not sufficient to elicit a significant cholesterol-lowering effect. The intestinal (ileal or cecal) reabsorption of bile acids was not reduced, but rather increased, by GUAR; nevertheless the intestinal capacities of reabsorption were overwhelmed by the enlargement of the digestive pool of bile acids. In the present model, induction of HMG-CoA reductase probably takes place in the presence of elevated portal bile acid concentrations.

Effects of color and pattern on implicit and explicit picture memory.

The degree to which repetition priming is perceptually specific is informative about the mechanisms of implicit memory as well as of perceptual processing. In 2 sets of experiments with pictures as stimuli, we tested the effects of color and pattern manipulations between study and test on implicit memory (i.e., naming facilitation) and explicit memory (i.e., 2 forms of recognition). These manipulations did not affect priming. However, participants were able to explicitly detect stimulus changes at above-chance levels. Changes in color also produced small decrements in participants' ability to judge that repeated stimuli were old on a recognition test. Experiment 2 showed diminished priming with changes in the stimulus exemplar (i.e., a different picture of the same named object) from study to test, which demonstrated that the picture-naming paradigm is sensitive to changes in physical attributes. The results suggest that physical attributes that are not essential to the formation of a shape representation do not influence repetition priming in a basic identification paradigm. Suggestions for how priming may be mediated are discussed.

[Postoperative pain evaluation in the surgery of head and neck cancers]. / Evaluation de la douleur post-opératoire en chirurgie carcinologique cervico-faciale.

UNLABELLED: Postoperative pain has rarely been assessed after ENT surgery for cancer. Its evaluation is difficult because of the frequent lack of speech after this type of surgery. OBJECTIVES: to assess postoperative pain after pharyngeal and laryngeal surgery for cancer. PATIENTS AND METHOD: prospective study in 13 men (38-71 ans) operated on by total laryngectomy with or without partial pharyngectomy. A standardised treatment using propacetamol and nalbuphine was systematically prescribed. Pain, anxiety and relief were assessed with the help of visual analogue scales (VAS). Heart rate, mean blood pressure and respiratory rate were evaluated too. RESULTS: mean postoperative pain was maximal just after recovery (6,64 +/- 2,14 cm) then decreased regularly. Initial mean score of anxiety was 3,14 +/- 3 cm and then was decreasing too. Anxiety and pain did not correlate except in 2 cases. None of the 3 objective parameters correlated with pain. CONCLUSION: postoperative pain can be assessed reliably after pharyngolaryngeal cancer surgery and is probably underrated. Its high initial score indicates that efforts must be focused on pre-emotive analgesia. Its high individual variability let us hypothesise that PCA systems should be effective.

Successful reduction of silica exposures at a sanitary ware pottery.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) conducted a joint survey with the New Jersey Department of Health (NJDOH) to measure crystalline silica exposures and evaluate the adequacy of the existing control measures for reducing these exposures at a sanitary ware pottery. This survey found that 95% of the personal and area samples from the Slip House, Casting, Glaze Spray, and Glaze Preparation Departments exceeded the NIOSH Recommended Exposure Level (87% exceeded the Occupational Safety and Health Administration Permissible Exposure Level) for crystalline silica. Three years later, a follow-up survey found statistically significant reductions in respirable crystalline silica exposures in two of four plant departments, and statistically significant reductions in area concentrations in all four plant departments. These reductions were accomplished through a combination of automating and enclosing the batching system in the Slip House and by replacing the mold parting compound with a nonsilica material, altering the method of dry sweeping, cleaning of castings while damp, improving exhaust ventilation at the spray booths, and improved housekeeping.

Silica exposure in hand grinding steel castings.

Exposure to silica dust was studied in the grinding of castings in a steel foundry that used conventional personal sampling methods and new real-time sampling techniques developed for the identification of high-exposure tasks and tools. Approximately one-third of the personal samples exceeded the National Institute for Occupational Safety and Health recommended exposure limit for crystalline silica, a fraction similar to that identified in other studies of casting cleaning. Of five tools used to clean the castings, the tools with the largest wheels, a 6-in. grinder and a 4-in. cutoff wheel, were shown to be the major sources of dust exposure. Existing dust control consisted of the use of downdraft grinding benches. The size of the casting precluded working at a distance close enough to the grates of the downdraft benches for efficient capture of the grinding dust. In addition, measurements of air recirculated from the downdraft benches indicated that less than one-half of the respirable particles were removed from the contaminated airstream. Previous studies have shown that silica exposures in the cleaning of castings can be reduced or eliminated through the use of mold coatings, which minimize sand burn-in on the casting surface; by application of high-velocity, low-volume exhaust hoods; and by the use of a nonsilica molding aggregate such as olivine. This study concluded that all these methods would be appropriate control options.

RP 55778, a PAF receptor antagonist, prevents and reverses LPS-induced hemoconcentration and TNF release.

Platelet-activating factor (PAF) and tumor necrosis factor (TNF) are present in the plasma of animals injected with endotoxin (LPS). Furthermore, when exogenously administered to animals, PAF and TNF induce similar pathological effects. Thus, in order to explore a possible link between these two factors, the effects of a PAF receptor antagonist, RP 55778, and a glucocorticoid, dexamethasone, were studied on LPS-induced hemoconcentration in rats and on the release of TNF induced by exposing isolated murine macrophages to LPS. RP55778 administered either before or after LPS inhibited these endotoxin effects whereas dexamethasone was effective only when given prior to the LPS challenge. Additionally, in murine macrophages the strong TNF mRNA signal induced by LPS was abolished by RP 55778 and dexamethasone treatment. These results indicate that PAF and TNF can mediate the functional manifestations associated with endotoxemia and only RP 55778 appears to show potential for activity against an already established LPS response.

Antibodies to synthetic peptide from the residue 33 to 42 domain of c-Ha-ras p21 block reconstitution of the protein with different effectors.

Residues 32 to 40, which are conserved among ras proteins from different species, are likely to participate in interactions with the p21 effector system. With the goal of understanding the structural basis of the regulatory functions of c-Ha-ras p21, we produced rabbit antisera against a synthetic peptide corresponding to amino acids 33 to 42 of the protein. The affinity-purified antibodies interacted specifically with p21 and with the antigenic peptide. The epitope recognized by the antibodies appeared to be centered on threonine 35. The antibodies inhibited both in vitro p21-induced production of cyclic AMP in detergent extracts of RAS-defective yeast membranes and GAP-stimulated GTPase activity. However, monoclonal anti-ras antibodies Y13-259 and Y13-238 were not capable of specifically inhibiting interactions of p21 with these two putative effector proteins. The apparent inhibitory effect of Y13-259 on stimulation of p21 by GAP was due to a greatly reduced rate of exchange of nucleotides in the binding pocket of the protein. These findings provide additional support for the essential role of the residue 32 to 40 domain as the true effector site and further evidence of the involvement of GAP as a cellular effector of ras proteins.

[A study of prescriptions for psychotropic drugs at a French psychiatric hospital]. / Etude des prescriptions de médicaments psychotropes dans un hôpital psychiatrique français.

The prescribing habits were studied in a psychiatric hospital which provides services for one district of Paris. The sample consisted of 175 inpatients. A mean of 2.1 psychotropic drugs was prescribed per patient, and more than two-thirds received two psychotropic drugs or more. Almost one-half had a PRN order. Major tranquilizers were frequently used in patients not having a psychotic disorder and were associated to anticholinergic drugs in 55% of the cases. Factors associated with drug prescriptions were diagnosis, age and unit of treatment. Our results are similar to those of previous studies on excessive polypharmacy. The discussion draws attention on the need to obtain data on the rationale for prescribing and the response to treatment. Emphasis is placed on the potential usefulness of studying drug prescriptions for psychiatric practice.

Studies on the cell-free biosynthesis of beta-lactam antibiotics.

Cell walls of Cephalosporium acremonium mycelia were lysed by enzyme preparations from either Helix pomatia (snail) digestive juice or Cytophaga. The yield of protoplasts depended on the lytic-enzyme preparation and the age of the culture, and it increased after the mycelia were pretreated with dithiothreitol. A cell-free preparation, obtained by osmotic lysis of protoplasts, synthesized labelled penicillin N from L-[14C]valine. Approx. 0.03-0.06% of the amino acid was incorporated into penicillin N. Under conditions of penicillin N synthesis, the broken-protoplast preparation failed to produce significant amounts of cephalosporin C or its precursors, deacetylcephalosporin C and deacetoxycephalosporin C.