Nudging intensive care unit personnel towards sustainable behaviour.

BACKGROUND: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. AIMS: Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). STUDY DESIGN: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. RESULTS: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. CONCLUSIONS: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. RELEVANCE TO CLINICAL PRACTICE: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.

Changes in the Location of Cutaneous Melanoma Over the Past 30 Years. A Retrospective Observational Study. / Cambios en la localización del melanoma cutáneo en los últimos 30 años. Estudio observacional retrospectivo.

BACKGROUND: The location of cutaneous melanoma is associated with photoexposure. OBJECTIVES: To retrospectively analyze changes in the location of cutaneous melanoma over the past 30 years. PATIENTS AND METHODS: All patients treated at our hospital for cutaneous melanoma from 1988 through 2017 were prospectively collected. Data obtained in cases diagnosed from 1988 through June 2006 were compared to those diagnosed from July 2006 through 2017. RESULTS: A total of 1,937 patients (876 men and 1061 women; median age, 57 years; interquartile range 27) were diagnosed with primary cutaneous melanoma. The location of melanoma was head and neck (470 cases), trunk (745 cases), upper limbs (239 cases), and lower limbs (483 cases). From July 2006 through 2017 we detected an increase in the incidence of head and neck melanomas (19.9% vs 28.6%, p <0.001). A drop in the incidence of melanomas located in the lower extremities was also seen in women (39.8% vs 30.4%, p <0.001), and in the trunk men (57.5% vs 47.3%, p=0.003). In the multivariate analyses, only the decrease in melanomas located in lower extremities in women remained significant. CONCLUSION: The increased incidence of head and neck melanomas in both sexes and the decrease in trunk melanomas in men can be attributed to the aging of our population. The reduction in the incidence of melanomas in the lower extremities in women could be associated with changes in photoexposure patterns. Analyzing the factors possibly associated with these changes would contribute to better understanding the pathogenesis of cutaneous melanoma for prevention purposes.

[Translated article] Changes in the Location of Cutaneous Melanoma Over the Past 30 Years. A Retrospective Observational Study.

BACKGROUND: The location of cutaneous melanoma is associated with photoexposure. OBJECTIVES: To retrospectively analyze changes in the location of cutaneous melanoma over the past 30 years. PATIENTS AND METHODS: All patients treated at our hospital for cutaneous melanoma from 1988 through 2017 were prospectively collected. Data obtained in cases diagnosed from 1988 through June 2006 were compared to those diagnosed from July 2006 through 2017. RESULTS: A total of 1,937 patients (876 men and 1061 women; median age, 57 years; interquartile range 27) were diagnosed with primary cutaneous melanoma. The location of melanoma was head and neck (470 cases), trunk (745 cases), upper limbs (239 cases), and lower limbs (483 cases). From July 2006 through 2017 we detected an increase in the incidence of head and neck melanomas (19.9% vs 28.6%, p <0.001). A drop in the incidence of melanomas located in the lower extremities was also seen in women (39.8% vs 30.4%, p <0.001), and in the trunk men (57.5% vs 47.3%, p=0.003). In the multivariate analyses, only the decrease in melanomas located in lower extremities in women remained significant. CONCLUSION: The increased incidence of head and neck melanomas in both sexes and the decrease in trunk melanomas in men can be attributed to the aging of our population. The reduction in the incidence of melanomas in the lower extremities in women could be associated with changes in photoexposure patterns. Analyzing the factors possibly associated with these changes would contribute to better understanding the pathogenesis of cutaneous melanoma for prevention purposes.

Effects of liquid cooling garment on physiological and psychological strain of firefighter in hot and warm environments.

This study aimed to explore the effects of a liquid cooling garment on the physiological and psychological strains of firefighters. Twelve participants wearing firefighting protective equipment with the liquid cooling garment (LCG group) and without the liquid cooling garment (CON group) were recruited to conduct human trials in a climate chamber. During the trials, physiological parameters (mean skin temperature (Tsk), core temperature (Tc), and heart rate (HR)) and psychological parameters (thermal sensation vote (TSV), thermal comfort vote (TCV), and rating of perceived exertion (RPE)) were measured continuously. The heat storage, sweating loss, physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the liquid cooling garment decreased the mean skin temperature (maximum value of 0.62 °C), scapula skin temperature (maximum value of 1.90 °C), sweating loss (26%), and PSI (0.95 scales) with a significant difference (p < 0.05) at some time points when compared with the CON group. Moreover, the liquid cooling garment had little influence (p > 0.05) on core temperature, heart rate, TSV, TCV, RPE, and PeSI. The association analysis indicated that psychological strain had the potential to predict physiological heat strain with an R2 value of 0.86 between the PeSI and PSI. This study offers insights into the evaluation of cooling system performance, the design of next-generation cooling systems, and the improvement of firefighters' benefits.

Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method.

The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.

Research on the influence of indoor thermal environment and activity levels on thermal comfort in protective clothing.

With the outbreak of infectious diseases such as Corona Virus Disease 2019, medical staff work intensively in isolated plots, medical disposable protective clothing (MDPC) has poor air condition and humidity permeability, which seriously reduces the thermal comfort of medical staff. In this paper, the effect of indoor thermal environment and activity levels on thermal comfort inside MDPC was studied by experiment. Five parts of the body were measured inside MDPC and the appropriate movements were chosen to simulate different levels of labor intensity. Meanwhile, physiological parameters and subjective thermal sensation were statistically analyzed. The results showed the influence range of different indoor temperatures on the temperature and humidity inside MDPC was about 1 °C and 10 %, respectively; it indicated that the environment inside MDPC could be improved by reducing indoor temperature, that is, a cross intelligent adjustment mode was proposed. The effect of labor intensity on the temperature inside MDPC was significantly less than that of humidity. Within 20 min, the humidity changes under moderate and heavy labor intensity were even more than 10 %, and the subjective discomfort threshold of the subjects increased by nearly 50 %. Furthermore, the maximum benefit could be obtained by concentrating cooling on back, forehead, chest and upper arm. Theoretical models of working time, labor intensity, and temperature and humidity inside MDPC under different indoor temperatures and different parts were given. In addition, acceptable regions inside MDPC which were approximately parallelogram in the enthalpy-humidity chart. These conclusions could be a reference for future thermal comfort inside MDPC research.

Coronavirus disease 2019 and radiation oncology-survey on the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on health care professionals in radiation oncology.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed the lives of most humans worldwide. The aim of this study was to evaluate the impact of the SARS-CoV­2 pandemic on health care professionals (HCPs) in radiation oncology facilities. METHODS: We distributed an online survey to HCPs in radiation oncology (physicians, medical physics experts, radiology assistants/radiation therapists, nurses, and administrative personnel). The survey was completed by 334 participants between May 23 and June 9, 2020. RESULTS: In 66.2% of the cases, HCPs reported a shortage of protective clothing. The protective measures were regarded as very reasonable by 47.4%, while 0.8% regarded them as not reasonable (rather reasonable: 44.0%; less reasonable 7.8%). 29.0% of the participants had children who needed care. The most frequently used care options were public emergency childcare (36.1%) and private childcare (e.g. relatives/friends). HCPs reported about additional work burden (fully agreed: 27.2%, rather agreed: 34.4%, less agreed: 28.2%, not agreed: 10.2%), and reduced work satisfaction (fully agreed: 11.7%, rather agreed: 29.6%, less agreed: 39.8%, not agreed: 18.9%). 12.9% and 29.0% of the participants were fully or rather mentally strained (less mentally strained: 44.0%, not mentally strained: 14.1%). CONCLUSION: We must learn from this pandemic how to prepare for further outbreaks and similar conditions. This includes the vast availability of protective clothing and efficient tracing of infection chains among the HCPs, but also secured childcare programs and experienced mental health support are crucial. Further, work satisfaction and appreciation by employers is essential.

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic.

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19.

BACKGROUND: The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19). METHODS: An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated. RESULTS: The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score. CONCLUSION: Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Monitoring heat strain: the effect of sensor type and location on single-site and mean skin temperature during work in the heat.

PURPOSE: Elevations in skin temperature and heat strain reduce tolerance to work in the heat. This study assessed agreement between mean (eight sites) and single-site skin temperature, measured by a conductive or infrared sensor, during exercise in the heat. METHODS: Twelve males (age: 24.2 ± 3.7 years; height: 180 ± 6.5 cm; body mass: 82.9 ± 9.5 kg; body fat: 16.0 ± 6.5%) volunteered to participate in two trials. Thirty minutes of seated rest was followed by 60 min of treadmill walking (4.5 km·h-1, 1%) inside an environmental chamber (35.5 ± 0.2 °C dry bulb, 50.7 ± 2.5% relative humidity) wearing either an athletic (ATH: t-shirt, shorts, shoes) or a chemical protective ensemble (CPE: ATH plus coverall and respirator). Skin temperature was measured on the axilla with a conductive sensor (Tsk-C) and an infrared sensor (Tsk-I) and compared to mean skin temperature ([Formula: see text] 8-site conductive sensors). Rectal temperature and heart rate were measured and used to calculate the adaptive physiological strain index (aPSI). RESULTS: Skin temperature on the chest, scapula, and thigh showed acceptable agreement with [Formula: see text] (mean difference < 0.5 °C and limits of agreement ± 1.0 °C) in both ATH and CPE. Skin temperature on the axilla overestimated [Formula: see text] in ATH (Tsk-C: 1.5 ± 0.8 °C; Tsk-I: 2.2 ± 1.2 °C) and CPE (Tsk-C: 1.1 ± 0.9 °C; Tsk-I: 1.8 ± 1.1 °C). Significant differences (p < 0.001) were observed in aPSI using Tsk-I (ATH: 5.7 ± 1.0, CPE: 8.3 ± 1.1) and Tsk-C (ATH: 5.4 ± 1.0, CPE 7.8 ± 1.0) compared to [Formula: see text] (ATH: 5.2 ± 1.0, CPE: 7.4 ± 1.0). CONCLUSION: The overestimate of mean skin temperature had a significant influence on the aPSI, which has important implications for real-time monitoring and risk management of personnel working in hot environments.

Industrial workwear for hot workplace environments: thermal management attributes.

Personal protective clothing (PPC) is critical for worker safety and wellbeing from both protection and thermal management perspectives, particularly as PPC typically covers more than 90% of the body. Research of PPC in low-risk categories such as mining, oil, gas, and construction and their thermal management attributes is limited, although these industries represent a significant proportion of the industrial workforce, work across a broad range of major industries, and frequently work in hot and/or humid thermal environments. This study evaluated and characterized the thermal management attributes of a selection of commercial low-level risk PPC ensembles currently used around the world as well as a civilian/corporate wear ensemble, using a sweating thermal manikin. The results demonstrate that there are substantially poorer thermal attributes for the PPC ensembles. Predicted Heat Strain Index (PHS) results for hot conditions reveal significantly lower duration limited exposure (DLE) and considerably greater body water loss for the wearers of PPC. Opportunities to substantially reduce PPC material mass and improve construction for these low-level risk categories in order to enhance thermal management performance are identified. Relationships between the thermal attributes of PPC and civilian clothing, and their garment construction, fit, and material characteristics are identified, providing new and important knowledge for current performance and direction for development of new improved PPC. This study provides researchers, developers, and garment designers with valuable insights for future improvement of PPC to create improved PPC for industrial workwear worn in hot environments.

Physiological interactions with personal-protective clothing, physically demanding work and global warming: An Asia-Pacific perspective.

The Asia-Pacific contains over half of the world's population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.

A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit.

Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.

Use of effective dose to assess x-ray protective clothing.

This review article provides an overview on the results of studies conducted by the authors to improve the current personal protection concept in the clinical application of x-rays. With the aid of personal dose equivalent measurements during radiologically guided clinical interventions, laboratory tests using the Alderson-Rando phantom as well as Monte Carlo simulations various x-ray application scenarios were investigated. The organ doses and the effective doses of staff persons standing near the patient were determined. The 3D-attenuation properties of protective clothing under the scattered radiation emitted by the patient play a special role here. With regard to the minimisation of the quantity 'effective dose' the protection of the lower body from the gonads to the chest is of particular importance, since 80% of the effective dose is contributed by this region of the body. In contrast, protection of the back plays a subordinate role. Protective aprons optimised in terms of effective dose can be significantly lighter than conventional aprons, providing equal protection. The assessment of the attenuation properties of protective clothing should be based on the risk-related dose quantity, effective dose, rather than lead equivalent. In the future, the evaluation of radiation protective clothing could be based on the calculation of the effective dose assuming standardised irradiation conditions.

Thermal and humid environment improvement of the protective clothing for medical use with a portable cooling device: Analysis of air supply parameters.

COVID-19 has caused a huge impact on people's daily life and has made great damage on national economy. All the epidemic situation not only require the improvement of medical science, but also the corresponding auxiliary research field, e.g. the improve of protective clothing for medical use (MUPC). Developing a new kind of MUPC with portable cooling devices to improve medical workers' thermal comfort and protection performance of MUPC is imminent. In this paper, an integrated MUPC with a portable vortex tube cooling device was studied with experimental method. In a phytotron, a manikin wearing the MUPC was experimentally studied in terms of the influence of environment temperature and cool air supply conditions. On the basis of experiments, the MUPC inside air temperature and relative humidity, skin temperature of human body was studied with simulation method. Overall thermal sensation vote (TSV) and local TSV of human body were calculated, based on simulation results, to evaluate human thermal sensation. The results showed that, first, 50 L/min cool air flowrate with 18-20 °C supply temperature can create a good MUPC inside thermal sensation environment, for both head supply and body supply conditions. Both body supply condition and head supply condition cannot create a uniform MUPC inside thermal sensation environment. Second, MUPC inside air relative humidity is around or lower than 60% for most body parts, except for air supply position and body parts that air is difficult to reach. Thirdly, with cool air supplied into MUPC, a micro-positive pressure environment can be obtained, and the protection performance of MUPC can be improved.

Chemical permeation of similar disposable nitrile gloves exposed to volatile organic compounds with different polarities Part 2. Predictive polymer properties.

A follow-up study evaluated the chemical and physical parameters of 10 disposable nitrile glove products in association with the observed variability in chemical permeation performance. The aim was to determine which polymer properties explained or were predictive of the observed wide variation in breakthrough time and steady state permeation rate. The physical and mechanical properties evaluated were thickness, area density, volume fraction and modulus 50-100%. The chemical composition properties evaluated were relative acrylonitrile content, relative carboxylation content, oily plasticizers, inorganic fillers and organic polymer content. A combination of correlation and multiple regression analyses were performed to evaluate the predictive nature of these parameters. For the regression analyses, stepwise, forward selection and backward elimination methods were used to determine an optimal regression fit. Both thickness and area density were strongly correlated with the breakthrough time. With the addition of volume fraction, these factors accounted for about 88-89% of the variation in breakthrough times. The correlation results for the steady-state permeation rate were largely inconclusive and only a moderate correlation with thickness was observed with one solvent. However, regression analyses revealed a moderate to strong association (R2 = 0.742; p < 0.001) between the permeation rate and thickness and volume fraction. With the inclusion of volume fraction in all regression models, the microstructure of the polymer played a critical role in chemical permeation, which requires further investigation. Based on these results, selection based on the availability of chemical permeation data for the product should always be preferred, especially when skin protection is critical. When chemical resistance ratings are based on general performance data, additional factors such as thickness and area density should be taken into consideration. In general, increases in thickness and area density are associated with increases in breakthrough time and decreases in the steady-state permeation rate. However, evidence in the literature and this study support the need for inclusion of additional factors associated with the microstructure of the polymer.

Chemical permeation of similar disposable nitrile gloves exposed to volatile organic compounds with different polarities: Part 1: Product variation.

Many glove manufacturers of chemical protective clothing produce chemical resistance guides to aid in selection of an appropriate product. Some manufacturers provide permeation data, but others provide a general rating system without reporting testing their own products. A critical issue is that considerable variation in chemical resistance, both with breakthrough times and steady-state permeation rates, have been observed with disposable nitrile gloves. The main purpose of this study was to determine whether significant variation in chemical resistance was present between products from a single brand that provided a generalized chemical resistant guide. The objective was to determine if the ratings noted on the chemical resistance guide were sufficient for protection against chemical permeation. The chemical permeation of ten disposable nitrile gloves against three organic solvents of varying polarity (cyclohexane, tert-butanol, and cyclohexanol) was performed in triplicate. Despite the similar chemical resistant ratings for the products, significant variation in both breakthrough times and steady-state permeation rates were observed among the ten nitrile gloves. The largest variation in breakthrough time was about 8-fold. The largest variation in steady-state permeation rate was about 177-fold. A proposed chemical resistance rating system was used to further evaluate the variation in performance, as it would relate to similar rating systems used by glove manufacturers or brands. Polarity played a role in the observed performance, with the nitrile gloves providing increased protection with an increase in solvent polarity, more notably with the dielectric constant. Using a proposed rating system, the percentages of products rating as excellent to good were 20% (cyclohexane), 60% (tert-butanol), and 90% (cyclohexanol). Ultimately, the ratings noted on the general chemical resistance guide were not sufficient for worker protection against chemical permeation. It is not valid to assume that little variation should exist among the different glove products under a same brand or based on the use of generic chemical resistant data. When critical, occupational health and safety professionals should base glove selection on product-specific chemical permeation data.

Lightweight Lead Aprons: The Emperor's New Clothes in the Angiography Suite?

OBJECTIVE: The aim was to determine whether lead containing and lead free composite garments in current use provide the level of radiation protection stated by manufacturers. METHODS: Fifteen garments, produced by five different manufacturers using eight different composites, were randomly selected for testing from four hospitals in South Australia. Labelling, material composition, design, and condition of the garments were assessed by direct garment examination, garment label, and product information. Garment attenuation was tested in a simulated angiography suite using a Siemens Ysio Max digital Xray machine. The front and back panels of each garment were tested under direct beam at 100 kVp. A Perspex phantom was used to simulate the density and scatter properties of the human abdomen. The front panels of each garment were tested under scattered radiation at Xray tube voltages of 50 and 70 kVp. RESULTS: Forty-seven per cent of front panels and 90% of back panels provided lower lead equivalence than claimed by the manufacturer. Twenty per cent of front panels and 62% of back panels tested did not meet the minimum International Electrotechnical Commission requirements for angiographic use. There was a 38 fold difference in front panel performance of garments to scatter radiation, which were all labelled 0.5 mm lead equivalence. 56% of garments had differences in scatter transmission of at least 49% when tested at 50 and 70 kVp. CONCLUSION: The results show that lead containing and lead free composite garments probably provide less radiation protection than manufacturer stated lead equivalence. The demonstrated wide variations in attenuation of scatter radiation are greater than previously reported. It was found that most garments failed to comply with labelling standards. The study highlights challenges in radiation shielding and the need to identify composites that consistently provide better attenuation per unit weight than lead.

Filtering performances of 20 protective fabrics against solid aerosols.

Workers can be exposed to solid airborne particles in some occupational environments, and they might be required to wear chemical protective clothing to prevent skin exposure. Dedicated standards exist to certify the protective value of such clothing, but they are not informative enough to identify the main pathways of entry for solid particles nor to compare performances between different chemical protective clothing. In this work, 20 non-woven fabrics used to make chemical protective clothing for solid particle protection were selected to be examined for both filtration and comfort performances. Nine were microporous fabrics (MP), 10 were multilayered nonwoven fibrous media (SMS) and one was a flash spun material (FS). To assess their filtration performances, fabrics were challenged in a benchtop wind tunnel with a 20-3,000 nm diameter sodium chloride aerosol at three low fabric face velocities (0.05, 0.15, 0.3 cm/sec). Airflow resistance and water vapor transmission rate were also measured to provide indications of comfort for the wearer. The penetration results led to the classification of the 20 fabrics into distinct groups of filtration efficiency. The data were analysed based on the porous media characteristics (thickness, fiber diameter, porosity, etc.). MPs were the most efficient fabrics, and SMSs showed a wide range of performances, mostly due to variations in the thickness of the filtering layer as well as to the fabric treatment. Measurements of airflow resistance and water vapor transmission rates revealed major differences between MPs and FSs and SMSs. This highlights the potential of some SMS fabrics to meet a compromise between protection and comfort.