Holistic understanding of ventilation rate in occupational health risk control.

Throughout the history of occupational health risk control, ventilation has been implemented widely as a tried-and-true method to reduce exposure intensity to airborne contaminants. Proper determination of the ventilation rate merits careful consideration when addressing concerns directed toward occupational health and indoor air quality in commercial buildings, albeit this does not translate well among the current engineering and scientific community. This article aims to facilitate a better understanding and proper determination of ventilation rates as a countermeasure for occupational health risk control. To that end, guidance is provided to select the appropriate ventilation rate for nonpandemic versus pandemic scenarios in terms of pertinent regulatory/professional codes and mathematical modeling tools. Limitations and assumptions of the models are summarized to facilitate proper application. Furthermore, the emerging DNA-based aerosol tracing technology, which helps to verify ventilation efficacy, is discussed.

Uncovering eco-friendly design in the ancient bronze goose-and-fish lamp: an unnoticeable gap boosts ventilation.

The bronze goose-and-fish lamp exhibited in the national museum of China is a 2,000-y-old artifact once used for indoor lighting by nobility in the Western Han dynasty (206 BCE TO 25 CE). The beauty of this national treasure arises from its elegant shape vividly showing a goose catching fish with beautiful colors painted over the whole body. Beyond the artistic and historical value, what enchants people most is the eco-design concept of this oil-burning lamp. It is widely believed that the smoke generated by burning animal oil can flow into the goose belly through its long neck, then be absorbed by prefilled water in the belly, hence mitigating indoor air pollution. Although different mechanistic hypotheses such as natural convection and even the siphon effect have been proposed to qualitatively rationalize the above-claimed pollution mitigation function, due to the absence of a true scientific analysis, the definitive mechanism remains a mystery. By rigorous modeling of the nonisothermal fluid flow coupled with convection-diffusion of pollutant within and out of the lamp, we discover that it is the unnoticeable gap between goose body and lamp tray (i.e., an intrinsic feature of the multicompartmental design) that can offer definitive ventilation in the lamp. The ventilation is facilitated by natural convection due to oil burning. Adequate ventilation plays a key role in enabling pollution mitigation, as it allows pollutant to reach the goose belly, travel over and be absorbed by the water.

Ultraviolet C Supported Novel Phototherapy Units at the Crossroads of the COVID-19 Pandemic.

The numerous dermatology clinics have decreased or stopped phototherapy sessions due to the increased risk of getting COVID-19 during the current pandemic. In this context, poorly ventilated phototherapy units (PUs) should be redesigned in order to continue UV-based therapies and to protect our patients from getting COVID-19. Recently, it has been reported that ultraviolet C (UVC)-related dose and virus concentration may play a decisive role in the virucidal activity. Considering air changes per hour and viral inactivation time, 30 min of 30-W UVC radiation is able to inactivate poorly ventilated PUs of 3-4 m length, 5.5-7 m width, and 2.7-3 m height. Upper-air UVC radiation for 30 min between sessions would allow us to have more treatment options for numerous dermatological diseases in novel PUs during the COVID-19 pandemic and possible future pandemics.

Determination of optimal ventilation rates in educational environment in terms of radon dosimetry.

INTRODUCTION: New and renovated energy efficient buildings with minimised ventilation rates together with increased building airtightness are often associated with higher indoor radon concentrations compared to the concentrations in existing buildings. The purpose of our study is to analyse the problem associated with the increased radon concentration and ventilation requirements and recommendations in schools. The radon concentration was critically assessed by varying the design ventilation rates (DVRs) within fifteen cases according to legislative requirements and recommendations. The case study is a branch primary school in western part of Slovenia situated in a radon prone area. METHODS: Radon (222Rn) concentrations were simulated in the classroom, using CONTAM 3.2. PROGRAM: For validation, measurements were performed on 8 measuring days in September and 6 measuring days in March. The simulated and measured 222Rn concentrations are well correlated for all measurement days, with the simulated/measured ratio of 0.85-1.39. In order to define optimal DVRs in terms of dosimetry, the effective dose and its ratio to the worldwide average effective dose at workplace, received by radon progeny in 950 h (expected effective dose, 0.13 mSv/y), were calculated for each case. RESULTS: Simulations showed that the highest radon concentrations were observed in case 1 with a DVR of 79.6 m3/h (621 Bq/m3) and case 4 with a DVR of 69.4 m3/h (711 Bq/m3), both defined by national regulations. The calculated values in both cases exceeded the national reference value for radon (300 Bq/m3) by 2.1 times and 2.4 times, and the WHO guideline value (100 Bq/m3) by 6.2 times and 7.1 times, respectively. The simulations are in line with the results of radon dosimetry. Both DVRs correspond to the highest effective doses, 1.88 mSv/y (about 14-fold higher than expected effective dose) for case 1 and 2.15 mSv/y (about 17-fold higher than expected effective dose) for case 4. Case 11_Cat I with a DVR of 1999.7 m3/h defined by EN 15251: 2007 resulted in minimal Rn concentration (35 Bq/m3) and corresponds to the lowest effective dose 0.11 mSv/y and its ratio to the expected effective dose 0.8. CONCLUSIONS: Ventilation is an immediate measure to reduce radon concentration in a classroom and it must be performed in line with other holistic measures to prevent and control radon as a health risk factor.

Possible role of Unani Pharmacology in COVID-19 - a narrative review.

According to the World Health Organization (WHO), viral diseases continue to rise, and pose a significant public health problem. Novel coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. The pathogenesis and clinical manifestations of COVID-19 is close to Amraz-e-Wabai (epidemic diseases) which was described by Hippocrates, Galen, Aristotle, Razes, Haly Abbas, Avicenna, Jurjani etc. Presently, there is no specific or challenging treatment available for COVID-19. Renowned Unani Scholars recommended during epidemic situation to stay at home, and fumigate the shelters with aromatics herbs like Ood kham (Aquilaria agallocha Roxb.), Kundur (Boswellia serrata Roxb), Kafoor (Cinnamomum camphora L.), Sandal (Santalum album L), Hing (Ferula foetida L.) etc. Use of specific Unani formulations are claimed effective for the management of such epidemic or pandemic situation like antidotes (Tiryaqe Wabai, Tiryaqe Arba, Tiryaqe Azam, Gile Armani), Herbal Decoction (Joshandah), along with Sharbate Khaksi, Habbe Bukhar, Sharbate Zanjabeel, Khamira Marwareed, Jawarish Jalinus, and Sirka (vinegar). Such drugs are claimed for use as antioxidant, immunomodulatory, cardiotonic, and general tonic actions. The study enumerates the literature regarding management of epidemics in Unani medicine and attempts to look the same in the perspective of COVID-19 prevention and management.

Design and Implementation of a Regional Inpatient Psychiatry Unit for Patients who are Positive for Asymptomatic SARS-CoV-2.

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.

Spatial distributions of ozonolysis products from human surfaces in ventilated rooms.

Ozone has adverse effects on human health. Skin oil on the human surface acts as an ozone sink indoors, producing oxidation products that can cause skin and respiratory irritations. Concentrations of ozone and oxidation products near human surfaces, including the breathing zone, can be modulated by indoor ventilation modes and human surface conditions. The objective of this study is to examine concentrations and spatial heterogeneity of ozone and ozonolysis products under representative ranges of indoor ventilation, clothing, and breathing conditions. Using computational fluid dynamics (CFD) simulation in conjunction with a chemical kinetic model, details of ozone reactions with the human surface and subsequent chemical reactions are examined. The results show that primary ozonolysis products are concentrated near the soiled clothing, while the secondary products are relatively well distributed throughout the room. Increasing indoor air mixing enhances the ozone deposition to the human surface, thereby resulting in higher emission rates of oxidation products in the room. Soiled clothing consumes more ozone than clean clothing and accordingly produces ~ 65% more primary products and ~15% more secondary products. The results also reveal that unsaturated hydrocarbons from the human breath, such as isoprene, contribute to only ~0.5% of ozone removal compared to ozone deposition to the human surface.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce.

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Household energy efficiency and health: Area-level analysis of hospital admissions in England.

INTRODUCTION: Fuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study. METHODS: In this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions. RESULTS: In the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature. DISCUSSION: Despite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of "whole house approaches" when retrofitting the existing housing stock. CONCLUSION: To be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative 'greener' and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health. STUDY IMPLICATIONS: This study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes.

Biological variation of resting measures of ventilation and gas exchange in a large healthy cohort.

PURPOSE: Resting measures of ventilation and gas exchange are impacted by a variety of physiological stressors, such as those resulting from a research intervention or an extreme environment. However, the biological variation of these parameters, an important statistical consideration for identifying a meaningful physiological change, has not been quantified. METHODS: We performed a retrospective analysis of 21 studies completed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) from 1985 to present, totaling 411 healthy volunteers. First, we determined the intraindividual, interindividual, and analytic coefficients of variation (CVI, CVG, and CVA, respectively) and subsequently the index of individuality and heterogeneity (II and IH, respectively). Second, when deemed appropriate via these outcomes, we defined the accompanying static and dynamic thresholds, beyond which a significant deviation from normal is indicated. RESULTS: End-tidal partial pressure of oxygen (PETO2) and the respiratory exchange ratio (RER) approached the II threshold required to be considered useful in the static assessment of physiological deviations from normal. PETO2 and peripheral oxygen saturation (SpO2) approached the IH threshold required to be considered useful in the dynamic assessment of physiological deviations from normal. CONCLUSIONS: This analysis identifies RER and PETO2 as parameters that might be most useful when aiming to identify a meaningful ventilatory change following a research intervention or stressor. Alternatively, other parameters of ventilation and gas exchange, such as PETCO2 and VE, may be less useful for observing an anticipated physiological change.

Estimation of radon release rate for an underground uranium mine ventilation shaft in China and radon distribution characteristics.

Radon, known to be a human carcinogen, is one of the most concerned radionuclides in uranium mining which need to be monitored and controlled. A large amount of radon is discharged to the atmosphere mainly through underground ventilation shafts for underground uranium mining. There are many studies on radon release of uranium mine, but the differences of the measured radon results are very big. In this paper, a typical underground uranium mine in China is chosen as a case study. This study finds that distribution of radon concentration and airflow speed inside the ventilation shaft are extremely uneven, but the distributions are respectively stable and regular for a fixed cross-section at the wellhead depth of 0-1 m. There is also a stable numerical relationship between the radon release rate and the product of radon concentration and airflow speed at the center for any cross-section in the shaft. Based on this regulation, a multipoint interpolation-integration method and a one-point method for calculating radon release from underground ventilation shaft are proposed in this paper. The results show that the difference between these two methods is 2-10%, the one-point method is more suitable and convenient to be applied for the long-term monitoring radon release rate from uranium mine ventilation. The research results in this paper can be applied in the estimation of radon release rate for other underground uranium ventilation shafts.

Effects of Two Music Therapy Methods on Agitation and Anxiety among Patients Weaning off Mechanical Ventilation: A Pilot Study / 기본간호학회지

PURPOSE: The feasibility and differential effects of two music therapy methods (interventions with preferred music vs. classical relaxation music) were done to examine the effects on agitation and anxiety in patients weaning off mechanical ventilation. METHODS: This pilot study was conducted using a crossover design. Six patients listened to preferred music choices and classical relaxation music. Anxiety scores were measured using the Richmond Agitation Sedation Scale (RASS), State-Trait Anxiety Inventory (STAI), and visual analog scale (VAS). RESULTS: Patients showed a significant decrease in agitation and anxiety after both the preferred and classical relaxation music interventions. The difference in the effects of preferred music and that of classical relaxation music was not significant. As for feasibility, patients exhibited a change in agitated behaviors after the music interventions by not trying to take off medical devices and quietly listening to the music, and by smiling and moving lips along with the lyrics while listening. CONCLUSION: Music interventions which centered on either patients' preferences or classical relaxation music to enhance relaxation, helped reduce agitation and anxiety during the mechanical ventilation weaning process.

Effects of Early Phosphorus Intake on Respiratory Distress in Extremely Low-Birth-Weight Infants

PURPOSE: This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. METHODS: We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children's Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. RESULTS: Hypophosphatemia (phosphorus level <4 mg/dL) was observed in 72.0% of the subjects. The rates of invasive ventilation (P=0.001) and moderate-to-severe BPD (P=0.005) were significantly lower in the high phosphorus intake group (≥0.7 mM/kg/day) than in the low phosphorus intake group (<0.7 mM/kg/day). Phosphorus intake during the first week was a significant factor affecting invasive ventilation at 2 weeks of age (adjusted odds ratio [OR], 8.212; 95% confidence interval [CI], 2.256 to 28.896; P=0.001) and moderate-to-severe BPD (adjusted OR, 3.402; 95% CI, 1.274 to 9.084; P=0.015). CONCLUSION: Early insufficient phosphorus intake confers a significantly higher risk with invasive ventilation at 2 weeks of age and moderate-to-severe BPD. Therefore, early sufficient phosphorus supply may improve respiratory outcomes in ELBWIs.

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

NMR-Based Metabolomics Approach To Study the Influence of Different Conditions of Water Irrigation and Greenhouse Ventilation on Zucchini Crops.

This study describes the approach of 1H NMR metabolomic profiling for the differentiation of zucchini produced under different conditions of water irrigation (desalinated seawater -0.397 dS/m, 0.52 €/m3 vs groundwater -2.36 dS/m, 0.29 €/m3) and ventilation (surface area of the vent openings/greenhouse area was 15.0% for one sector and 9.8% for the other). Overall, 72 extracts of zucchini ( Cucubirta pepo L. cv Victoria) under four different conditions were regularly analyzed during the spring-summer cycle from April to July 2017. We have found that zucchini plants irrigated with desalinated seawater increased the zucchini production yield, presented fruits with higher concentration of glucose, fructose, and vitamin B3, and displayed an increased antioxidant activity. On the contrary, plant groundwater irrigation produced the increment of sucrose level that could rise the sweetness perception of the fruits. Finally, the ventilation variable produced a higher concentration of trigonelline, histidine, and phenylalanine but only on those zucchinis irrigated with groundwater.

Modeling the resiliency of energy-efficient retrofits in low-income multifamily housing.

Residential energy efficiency and ventilation retrofits (eg, building weatherization, local exhaust ventilation, HVAC filtration) can influence indoor air quality (IAQ) and occupant health, but these measures' impact varies by occupant activity. In this study, we used the multizone airflow and IAQ analysis program CONTAM to simulate the impacts of energy retrofits on indoor concentrations of PM2.5 and NO2 in a low-income multifamily housing complex in Boston, Massachusetts (USA). We evaluated the differential impact of residential activities, such as low- and high-emission cooking, cigarette smoking, and window opening, on IAQ across two seasons. We found that a comprehensive package of energy and ventilation retrofits was resilient to a range of occupant activities, while less holistic approaches without ventilation improvements led to increases in indoor PM2.5 or NO2 for some populations. In general, homes with simulated concentration increases included those with heavy cooking and no local exhaust ventilation, and smoking homes without HVAC filtration. Our analytical framework can be used to identify energy-efficient home interventions with indoor retrofit resiliency (ie, those that provide IAQ benefits regardless of occupant activity), as well as less resilient retrofits that can be coupled with behavioral interventions (eg, smoking cessation) to provide cost-effective, widespread benefits.

Factors associated with failed weaning from mechanical ventilation in adults on ventilatory support during 48 hours or more / Factores asociados a destete fallido de la ventilación mecánica en adultos con soporte ventilatorio igual y mayor a 48 horas

Abstract Introduction: Failed weaning from mechanical ventilation (MV) has been reported in a proportion ranging from 10% to 20% of patients requiring ventilation support; this population has a longer duration of MV and risk of mortality. Objective: To evaluate factors associated with failed weaning from MV. Methodology: Descriptive study of a cohort of 139 patients, who participated in the clinical trial. Efficacy of respiratory muscle training (RMT) for weaning from MV in patients on MV during 48 hours or more. Clinical and sociodemographic exposure variables were measured. The outcome variable evaluated was failed weaning from MV. A descriptive analysis was carried out, and relative risks (RRs) were estimated using the Poisson regression. Single and multiple models were built. Results: The incidence of failed weaning was 24.09%, 95% confidence interval (CI) 16.83 to 31.33. Independent associated factors were the respiratory system as the main compromised system upon admission to the intensive care unit (RR: 3.89; 95% CI 1.33-11.37; P = 0.01) and the Apache score (RR 0.96; 95% CI 0.920.98; P = 0.02). Modifiable factors such as pulmonary rehabilitation interventions, physical rehabilitation, RMT, and specific ventilatory strategies showed no association (P >0.05). Conclusion: There are non-modifiable factors related to failed weaning from MV in adults. Patients admitted to the intensive care unit with the respiratory system as the main system compromised have a higher risk of failed weaning; modifiable factors were not found to be associated with failed weaning in the population studied.

Resumen Introducción: El destete fallido de la ventilación mecánica se ha reportado en una proporción que va del 10 al 20% de los pacientes que requieren soporte ventilatorio; esta población presenta mayor duración de la ventilación mecánica y riesgo de mortalidad. Objetivo: Evaluar factores asociados a destete fallido de la ventilación mecánica en pacientes adultos con soporte ventila-torio igual y mayor a 48 horas Metodología: Estudio observacional de una cohorte de 139 pacientes, quienes participaron en el ensayo clínico. Eficacia del entrenamiento muscular respiratorio en el destete de la ventilación mecánica en pacientes con ventilación mecánica por 48 horas o más; variables de exposición clínicas y sociodemográficas fueron medidas. La variable resultado evaluada fue destete fallido de la ventilación mecánica. Se realizó análisis descriptivo, y se estimaron riesgos relativos a través de la regresión Poisson. Se construyeron modelos simples y un modelo múltiple. Resultados: La incidencia de destete fallido fue 24.09% [C95%:16.83-31.33.Los factores independientemente asociados fueron sistema respiratorio como principal comprometido al ingreso a UCI (RR:3.89 IC95%:1.33-11.37 p = 0.01) y apache (RR:0.96 IC95%:0.92-0.98 p = 0.02).Factores modificables como intervenciones de rehabilitación pulmonar, rehabilitación física, entrenamiento muscular respiratorio, y estrategias ventilatorias especificas no mostraron asociación (p>0.05). Conclusiones: Factores no modificables están relacionados con el destete fallido de la ventilación mecánica en la población estudiada. El sistema respiratorio como principal comprometido al ingreso a la unidad de cuidado intensivo fue el factor de riesgo asociado a falla en el destete de la ventilación mecánica, los factores no modificables no se encontraron asociados con el evento estudiado.

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate.

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities.

Indoor birch pollen concentrations differ with ventilation scheme, room location, and meteorological factors.

Indoor pollen concentrations are an underestimated human health issue. In this study, we measured hourly indoor birch pollen concentrations on 8 days in April 2015 with portable pollen traps in five rooms of a university building at Freising, Germany. These data were compared to the respective outdoor values right in front of the rooms and to background pollen data. The rooms were characterized by different aspects and window ventilation schemes. Meteorological data were equally measured directly in front of the windows. Outdoor concentration could be partly explained with phenological data of 56 birches in the surrounding showing concurrent high numbers of trees attaining flowering stages. Indoor pollen concentrations were lower than outdoor concentrations: mean indoor/outdoor (I/O) ratio was highest in a room with fully opened window and additional mechanical ventilation (.75), followed by rooms with fully opened windows (.35, .12) and lowest in neighboring rooms with tilted window (.19) or windows only opened for short ventilation (.07). Hourly I/O ratios depended on meteorology and increased with outside temperature and wind speed oriented perpendicular to the window opening. Indoor concentrations additionally depended on the previously measured concentrations, indicating accumulation of pollen inside the rooms even after the full flowering period.

Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test / 대한마취과학회지

BACKGROUND: The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures. METHODS: The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation. RESULTS: Overall, 27 (14–52), 19 (5–41), and 14 (6–33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP. CONCLUSIONS: A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.