Prenatal features of ductus arteriosus-related branch pulmonary stenosis in fetal pulmonary atresia.

OBJECTIVE: Ductus arteriosus (DA)-related branch pulmonary stenosis (PS), due to ductal tissue migration into the proximal pulmonary artery (PA) ipsilateral to the DA, is common in newborns with pulmonary atresia (PAtr) and contributes significantly to their mortality and morbidity. We sought to define fetal echocardiographic predictors of DA-PS in PAtr. METHODS: This was a study of all neonates diagnosed prenatally with PAtr and a DA-dependent pulmonary circulation, with a DA that joined the underbelly of the arch, who had undergone surgical or catheter intervention in our hospital between 2009 and 2018. The postnatal echocardiograms and clinical records were reviewed to confirm the presence or absence of DA-PS based on the need for angioplasty at initial intervention and/or development of proximal PA stenosis post intervention. Fetal echocardiograms were examined for the features of DA-PS. RESULTS: Of 53 fetuses with PAtr, 34 (64%) had analyzable images, including 20/34 (59%) with and 14/34 (41%) without DA-PS. An inability to visualize the branch PAs in the same plane, largely associated with abnormal DA insertion into the ipsilateral PA (85% of cases), had sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of 75%, 100%, 100% and 74%, respectively, for the prediction of postnatal DA-PS. The mean branch PA posterior bifurcation angle was more obtuse in cases with DA-PS compared to cases without DA-PS (117° ± 17° vs 79° ± 17°, P < 0.001), and an angle of > 100°, the preoperative cut-off observed previously in affected newborns, had a sensitivity, specificity, PPV and NPV of 88%, 79%, 82% and 85%, respectively. The receiver-operating-characteristics curve revealed an angle of ≥ 105° to have a sensitivity and specificity of 88% and 93%, respectively, for prenatal prediction of DA-PS. The presence of one or both features (inability to image in the same plane and the posterior bifurcation angle of ≥ 105°) had a sensitivity, specificity, PPV and NPV of 100%, 93%, 95% and 100%, respectively. CONCLUSION: An inability to visualize the branch PAs in the same plane, associated with abnormal insertion of the DA in most cases, and/or the presence of a posterior PA bifurcation angle of ≥ 105° are predictive features of postnatal DA-PS in fetuses with PAtr. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Ergonomics assessment of selected dust respirators: Their use in the tropics.

The suitability and effectiveness of four different types of British made respirators were studied with respect to comfort, convenience and fit on wearers in Sri Lanka (a developing country). Objective and subjective assessments were made to evaluate the degree of discomfort and interferences to the use of senses. The study revealed that factors such as breathing resistance, work-rate and activity period affected the physiological responses. The weight of the respirator and the skin temperature had no direct relationship with the cardiovascular stress. Positive-pressure respirators that gave lower face temperatures than negative-pressure masks gave this type of respirator an additional advantage in hot environments. Respirators that restricted jaw movement affected the speech intelligibility of the wearer. Orinasal masks restricted vision more than the other types. The problem of fit was found negligible though head and face dimensions significantly differed between the British and the Sri Lankans. Subjective assessment correlated well with objective tests.

A head-model reconstruction based upon photogrammetric data from Sri Lankan adult males relevant to the design of headgear.

Due to the large variability in heads and faces in one population, the standard anthropometric dimensions of the head, measured from anatomical landmarks alone, may not suffice for the design of fitting headgear, e.g., helmets. To provide adequate data of the shapes and contours of the head to the designer, appropriate head models sculptured using comprehensive head dimensions, must be developed. This paper describes (a) a procedure of collecting comprehensive anthropometric data of the head using a photogrammetric method and (b) a simple sculpturing technique to reconstruct a head model of the user population.

Adaptation to discomfort in personal protective devices: an example with safety helmets.

Discomfort in the use of personal protective devices (PPD) has been one of the chief causes of their non-use. A field trial using industrial helmets was carried out to ascertain whether by training and repeated wearing subjects could experience a significant adaptation to discomfort. Ten subjects took part in the trial in a tropical environment by wearing helmets repeatedly (6 h a day) for one month. Subjective evaluations of discomfort were made at the end of the 1st, 3rd, 5th, 14th and 30th day. It was revealed that complaints of discomfort, viz. hotness, heaviness, bad fit, etc., decreased markedly throughout the 30 day period. Though positive responses of adaptation to discomfort seem to reach an optimum towards 30 days, it is difficult to draw any conclusions on the optimum period of adaptation for each discomfort factor. In relation to inherent discomforts that are extremely difficult to overcome without compromising the protection efficiency of a PPD, the principle of adaptation seems to be a very important facet which has to be developed for an effective PPD programme.

Some design recommendations to improve comfort in helmets: a case study from China.

Unless the basic user needs are satisfied in safety helmets, it is difficult to get workers to wear them habitually and for long periods. Hotness, weight and fitting problems are major wearability issues that require improvements. The enormous need for an optimally designed helmet in China prompted a case study on comfort aspects in helmets. The subjective impressions of the wearers of test helmets provided useful information for design changes to improve comfort. The heat transfer measurements through helmets indicated the need for ventilation openings to be provided on the shell of plastic helmets. Due to the advantage of low weight and good ventilation, it is recommended that cane helmets be further developed to improve protection, wearability and durability, and subsequently be produced in large scale.

Human-centred approaches in slipperiness measurement.

A number of human-centred methodologies--subjective, objective, and combined--are used for slipperiness measurement. They comprise a variety of approaches from biomechanically-oriented experiments to psychophysical tests and subjective evaluations. The objective of this paper is to review some of the research done in the field, including such topics as awareness and perception of slipperiness, postural and balance control, rating scales for balance, adaptation to slippery conditions, measurement of unexpected movements, kinematics of slipping, and protective movements during falling. The role of human factors in slips and falls will be discussed. Strengths and weaknesses of human-centred approaches in relation to mechanical slip test methodologies are considered. Current friction-based criteria and thresholds for walking without slipping are reviewed for a number of work tasks. These include activities such as walking on a level or an inclined surface, running, stopping and jumping, as well as stair ascent and descent, manual exertion (pushing and pulling, load carrying, lifting) and particular concerns of the elderly and mobility disabled persons. Some future directions for slipperiness measurement and research in the field of slips and falls are outlined. Human-centred approaches for slipperiness measurement do have many applications. First, they are utilized to develop research hypotheses and models to predict workplace risks caused by slipping. Second, they are important alternatives to apparatus-based friction measurements and are used to validate such methodologies. Third, they are used as practical tools for evaluating and monitoring slip resistance properties of footwear, anti-skid devices and floor surfaces.