Asbestos fiber length and width comparison between manual and semi-automated measurements.

The objective of the present study is to find a fast and accurate procedure to measure the length and width of asbestos fibers using images acquired by a scanning electron microscope (SEM), a phase-contrast microscope (PCM), and a polarized light microscope (PLM). The accuracy of the procedure was evaluated by comparing fiber length and width measurements to manual measurements. Four different types of images were used in the evaluation: (1) backscattered electron SEM images of fibrous tremolite, (2) secondary electron SEM images of fibrous grunerite, (3) PCM images of fibrous grunerite, and (4) PLM images of fibrous grunerite. Fiber length and width were measured with ImageJ (manual measurement) and Image-Pro software and were compared on an individual fiber basis and over the number-length and number-width distribution of each sample. The results of the comparison showed that the individual length and width measurements with ImageJ and Image-Pro software had a nearly 1:1 relationship except for the width measurement in PLM images (8% of the variance in ImageJ width measurements was not explained by Image-Pro width measurements). Similarly, the number-length distributions were not significantly different (p > 0.05) between ImageJ and Image-Pro, but the number-width distributions were significantly different (p < 0.05) for PLM and secondary electron SEM images. Although the image analysis procedure for measuring fiber length and width with Image-Pro is not a fully automated procedure and still requires some manual intervention, it can be a more efficient and equally accurate alternative to time-consuming manual fiber length and width measurements for well dispersed fibers with high aspect ratios.

LED Area Lighting to Reduce Glare for Roof Bolter Operators.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) developed a light-emitting diode (LED) area luminaire called the Saturn and conducted a laboratory study using a Fletcher High Dual-boom Mast Feed (HDDR) roof bolting machine. The Saturn luminaire was designed to (1) enhance floor illumination to enable better detection of trip hazards in the interior spaces of a roof bolter and (2) reduce glare that has typically been an issue of concern on roof bolters. This paper reports on the results of achieving the second objective. The existing roof bolter lighting was the baseline and was compared with three versions of the Saturn luminaire relative to light intensity (100%, 75%, and 50%). Discomfort and disability glare data were obtained from 30 participants that comprised three age groups. Discomfort glare perceptions were obtained using the De Boer rating scale, and disability glare was quantified by using Mars Letter Contrast Sensitivity tests. Discomfort glare was reduced at least 3 levels with all Saturn versions. Also, a predictive model was used to estimate discomfort glare, and the results were similar. Disability glare was the least for the Saturn's 50% intensity, and all Saturn versions had significantly less disability glare than with the baseline lighting. Veiling luminance was calculated and used as another indicator of disability glare. Veiling luminance was 28 to 42 times greater with the baseline lighting as compared with that of the Saturn lighting. Lastly, visibility levels were calculated. The Saturn versions were 4 to 6.5 times better in terms of visibility level.

Performance Comparison of Four Portable FTIR Instruments for Direct-on-Filter Measurement of Respirable Crystalline Silica.

Exposure to dusts containing respirable crystalline silica is a recognized hazard affecting various occupational groups such as miners. Inhalation of respirable crystalline silica can lead to silicosis, which is a potentially fatal lung disease. Currently, miners' exposure to respirable crystalline silica is assessed by collecting filter samples that are sent for laboratory analysis. A more timely field-based silica monitoring method using direct-on-filter (DoF) analysis is being developed by researchers at the National Institute for Occupational Safety and Health (NIOSH) to provide mine operators with the option to evaluate miners' exposure at the mine. This field-based silica monitoring technique involves the use of portable Fourier transform infrared (FTIR) instruments. As a step in the development of this new analytical technique, four commercially available portable FTIR instruments were evaluated for their ability to provide reproducible measurements from filter samples containing respirable crystalline silica. Reported testing indicates that measurements varied within ±4.1% between instruments for filter samples that contained high-purity respirable crystalline silica. Measurements varied within ±3.0% between instruments for filter samples that contained varying mineral composition. Filter samples were repeatedly analyzed by the same instrument over short and extended periods of time, and mean coefficients of variation did not exceed ±1.6 and ±2.4%, respectively. Mixed model analysis revealed that there was no statistically significant (P < 0.05) change in average measurements made over an extended period of time for all instruments. Results suggest that each of the four FTIR instruments evaluated in this study were able to generate precise and reproducible DoF analysis results of respirable dust samples.

Performance Comparison of Real-Time Light Scattering Dust Monitors Across Dust Types and Humidity Levels.

Video techniques for monitoring exposure, such as NIOSH's "Helmet-CAM," employ both real-time dust monitors and mobile video cameras to assess workers' respirable dust exposures. Many real-time personally worn dust monitors utilize light scattering sensing elements, which are subject to measurement biases as a function of dust type (size, composition, shape factor) and environmental conditions such as relative humidity. These biased and inaccurate dust measurements impair the monitor's ability to properly represent actual respirable dust concentrations. In the testing described, instrument mass concentration data was collected using three different types of commonly used commercial off-the-shelf personal dust monitors and compared to a reference standard. This testing was performed in a calm air (Marple) dust chamber in which three units of each make and model (for a total of nine monitors) were used for each test. Equivalency factors (EF, a multiplier to match the Thermo TEOM 1400a reference instrument) ranged between 0.746 and 1.879 across all dusts and environmental conditions tested, and between 0.821 and 1.519 on the ISO test dust.

Testing a revised inlet for the personal dust monitor.

A person-wearable dust monitor that provides nearly real-time, mass-based readings of respirable dust was developed for use in underground coal mines. This personal dust monitor (PDM) combined dust sampling instrumentation with a cap lamp (and battery) into one belt-wearable unit, with the air inlet mounted on the cap lamp. However, obsolescence of belt-carried cap lamp and batteries in coal mining ensued and led end users to request that the cap lamp and battery be removed from the PDM. Removal of these components necessitated the design of a new air inlet to be worn on the miner's lapel. The revised inlet was tested for dust collection equivalency against the original cap-mounted inlet design. Using calculated inlet respirable fractions and measured dust mass collection, the performance of the two inlets is shown to be similar. The new inlet requires a 1.02 factor for converting dust masses obtained from it to equivalent masses collected from the original inlet.

Evaluating Energy Expenditure Estimated by Wearable Technology During Variable Intensity Activity on Female Collegiate Athletes.

Monitoring an athlete's energy intake and energy expenditure (EE) is an important consideration of nutritional planning for sport conditioning and peak performance. In order to provide appropriate recommendations regarding nutritional requirements and caloric needs, an accurate determination of energy requirements is necessary. By knowing an individual's EE, a coach, athletic performance staff or trainer can effectively determine training loads and volumes necessary for periodization and seasonal planning for a particular sport. The purpose of this study is to examine the accuracy of the BodyMedia Mini armband while measuring EE in female basketball players during various-intensity game-like conditions. This investigation required three testing sessions: an orientation session, and two randomized experimental trials. Trials included a maximal multistage 20-m shuttle run (Trial I) and 30-minute basketball skills session (Trial II). The independent variable for this investigation was EE estimated by the Mini armband. The dependent variable was EE determined by the Cosmed K4b2 indirect calorimetry (IC) method. EE assessed with the Mini and EE measured with the IC method was significantly correlated for both Trial I (r= 0.839) and Trial II (r= 0.833). EE calculated by the Mini was significantly underestimated in both Trial I (9.41 ± 26.1 total kcals) and Trial II (56.71 ± 14.1 total kcals). During Trial I the underestimation of EE increased with a rise in test level and intensity (p<.05). Due to the underestimation of EE by the Mini, the development of exercise specific algorithms to improve the estimation of EE during intermittent exercise in basketball players is warranted.

Examining the Feasibility, Tolerability, and Preliminary Efficacy of Repetitive Task-Specific Practice for People With Unilateral Spatial Neglect.

OBJECTIVE: We examined the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect (USN). METHOD: People with USN ≥6 mo poststroke participated in a single-group, repeated-measures study. Attendance, total repetitions, and satisfaction indicated feasibility and pain indicated tolerability. Paired t tests and effect sizes were used to estimate changes in upper-extremity use (Motor Activity Log), function (Action Research Arm Test), and attention (Catherine Bergego Scale). RESULTS: Twenty participants attended 99.4% of sessions and completed a high number of repetitions. Participants reported high satisfaction and low pain, and they demonstrated small, significant improvements in upper-extremity use (before Bonferroni corrections; t = -2.1, p = .04, d = .30), function (t = -3.0, p < .01, d = .20), and attention (t = -3.4, p < .01, d = -.44). CONCLUSION: Repetitive task-specific practice is feasible and tolerable for people with USN. Improvements in upper-extremity use, function, and attention may be attainable.

Physiologic Effects from Using Tight- and Loose-Fitting Powered Air-Purifying Respirators on Inhaled Gases, Peak Pressures, and Inhalation Temperatures During Rest and Exercise.

The goal of this investigation was to evaluate the physiologic stresses of powered air-purifying respirators (PAPRs) used by workers in many industries (e.g., health care, automobile repair, public safety, building trades, etc.) during rest and three levels of energy expenditure. Twelve men and twelve women wore one tight-fitting and three loose-fitting PAPRs at rest (REST) and while walking for four minutes at oxygen consumption (V̇O2) rates of 1.0 l·min-1(LOW), 2.0 l·min-1 (MODERATE), and 3.0 l·min-1 or maximum (HIGH). Minimum inhaled carbon dioxide concentration (FICO2), maximum inhaled oxygen concentration (FIO2), peak inhalation pressure, and end inhalation temperature were measured continuously breath-by-breath. Repeated measures analysis of variance found that neither the main effect of gender, nor any interactions involving gender were significant. The highest minimum FICO2 among PAPRs occurred for MODERATE and HIGH energy expenditures while wearing the loose-fitting PAPR with the largest dead space. The lowest maximum FIO2 was observed during HIGH intensity energy expenditure also for the loose-fitting PAPR with the largest dead space. Among all PAPR models, peak inhalation pressures were negative at V̇O2 > LOW, suggesting that peak inhalation flow was greater than blower flow. Results using the variables reported here suggest that PAPRs used at various levels of energy expenditure may be tolerated among healthy workers. Further research is needed to determine the source of supplemented air when inhalation flow exceeds blower flow.

A study of leakage rates through mine seals in underground coal mines.

The National Institute for Occupational Safety and Health conducted a study on leakage rates through underground coal mine seals. Leakage rates of coal bed gas into active workings have not been well established. New seal construction standards have exacerbated the knowledge gap in our understanding of how well these seals isolate active workings near a seal line. At a western US underground coal mine, we determined seal leakage rates ranged from about 0 to 0.036 m3/s for seven 340 kPa seals. The seal leakage rate varied in essentially a linear manner with variations in head pressure at the mine seals.

Clear anterior rhinorrhea in the population.

BACKGROUND: Clear anterior rhinorrhea is commonly observed in older adults and is widely known as "senile rhinorrhea." Although appreciated in the literature, no studies support that clear rhinorrhea increases with age. Our goal was to determine the prevalence of clear rhinorrhea in adults and the variation between young and old. Additionally, we sought to determine if clear rhinorrhea was bothersome enough for patients to seek treatment. METHODS: A questionnaire was randomly distributed to 158 adults, 76 young adults on the University of Pittsburgh Undergraduate campus, and 82 older adults at Longwood Retirement Community in 2011. RESULTS: Older subjects reported more drip and an increase in rhinorrhea over time regardless of gender (p < 0.05). Participants wanting to seek treatment reported drip occurred more often, that they used more tissues, and were more bothered by drip compared to those not wanting treatment (p < 0.05). CONCLUSION: Clear, anterior rhinorrhea affects older adults regardless of gender significantly more often and more severely than young adults (p < 0.05). The more frequent and bothersome the nasal drip, the more likely individuals would elect treatment.

The relationship between elemental carbon and diesel particulate matter in underground metal/nonmetal mines in the United States and coal mines in Australia.

In the United States, total carbon (TC) is used as a surrogate for determining diesel particulate matter (DPM) compliance exposures in underground metal/nonmetal mines. Since TC can be affected by interferences and elemental carbon (EC) is not, one method used to estimate the TC concentration is to multiply the EC concentration from the personal sample by a conversion factor to avoid the influence of potential interferences. Since there is no accepted single conversion factor for all metal/nonmetal mines, one is determined every time an exposure sample is taken by collecting an area sample that represents the TC/EC ratio in the miner's breathing zone and is away from potential interferences. As an alternative to this procedure, this article investigates the relationship between TC and EC from DPM samples to determine if a single conversion factor can be used for all metal/nonmetal mines. In addition, this article also investigates how well EC represents DPM concentrations in Australian coal mines since the recommended exposure limit for DPM in Australia is an EC value. When TC was predicted from EC values using a single conversion factor of 1.27 in 14 US metal/nonmetal mines, 95% of the predicted values were within 18% of the measured value, even at the permissible exposure limit (PEL) concentration of 160 µg/m(3) TC. A strong correlation between TC and EC was also found in nine underground coal mines in Australia.

Evaluation of inpatient clinical documentation readiness for ICD-10-CM.

This research study examined the gaps in documentation that occur when coding in ICD-10-CM. More than 4,000 diagnoses from all chapters were coded from 656 electronic documents obtained from a large integrated healthcare facility at the time the study was conducted (2012). After the documents were coded, areas for documentation improvement were identified for chapters that resulted in deficiencies in documentation, and a quick reference guide was developed. The overall absent documentation percentage was 15.4 percent. The 10 chapters with the highest percentage of absent documentation were chapter 7 (Diseases of Eye and Adnexa), with 67.65 percent (p < .001); chapter 8 (Diseases of Ear and Mastoid Process), with 63.64 percent (p < .001); chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue), with 46.05 percent (p < .001); chapter 14 (Diseases of the Genitourinary System), with 40.29 percent (p < .001); chapter 10 (Diseases of Respiratory System), with 35.52 percent (p < .001); chapter 1 (Infectious and Parasitic Diseases), with 32.88 percent (p < .001); chapter 12 (Diseases of the Skin and Subcutaneous Tissue), with 32.35 percent (p < .001); chapter 2 (Neoplasms), with 25.45 percent (p < .001); chapter 4 (Endocrine, Nutritional and Metabolic Diseases), with 14.58 percent (p < .001); and chapter 17 (Congenital Malformations, Deformations, and Chromosomal Abnormalities), with 12.50 percent. We addressed the deficient areas in the quick reference guide developed for clinicians and technology vendors. Having complete and accurate documentation would benefit both the clinician and the patient in providing the highest quality of care.

Aerodynamic profiles of women with muscle tension dysphonia/aphonia.

PURPOSE: In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-Psub) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine whether results suggest new understanding of pathogenesis in MTD/A. METHOD: Retrospective review of aerodynamic data collected from 90 women at the time of primary MTD/A diagnosis. RESULTS: Aerodynamic profiles were significantly different for women with MTD/A as compared with healthy speakers. Five distinct profiles were identified: (a) normal flow, normal est-Psub; (b) high flow, high est-Psub; (c) low flow, normal est-Psub; (d) normal flow, high est-Psub; and (e) high flow, normal est-Psub. CONCLUSIONS: This study is the first to identify distinct subgroups of aerodynamic profiles in women with MTD/A and to quantitatively identify a clinical phenomenon sometimes described in association with it-"breath holding"-that is shown by low airflow with normal est-Psub. Results were consistent with clinical claims that diverse respiratory and laryngeal functions may underlie phonatory patterns associated with MTD/A. One potential mechanism, based in psychobiological theory, is introduced to explain some of the variability in aerodynamic profiles of women with MTD/A.

Problems and accommodation strategies reported by computer users with rheumatoid arthritis or fibromyalgia.

INTRODUCTION: Little is known about the problems experienced by and the accommodation strategies used by computer users with rheumatoid arthritis (RA) or fibromyalgia (FM). This study (1) describes specific problems and accommodation strategies used by people with RA and FM during computer use; and (2) examines if there were significant differences in the problems and accommodation strategies between the different equipment items for each diagnosis. METHODS: Subjects were recruited from the Arthritis Network Disease Registry. Respondents completed a self-report survey, the Computer Problems Survey. Data were analyzed descriptively (percentages; 95% confidence intervals). Differences in the number of problems and accommodation strategies were calculated using nonparametric tests (Friedman's test and Wilcoxon Signed Rank Test). RESULTS: Eighty-four percent of respondents reported at least one problem with at least one equipment item (RA = 81.5%; FM = 88.9%), with most respondents reporting problems with their chair. Respondents most commonly used timing accommodation strategies to cope with mouse and keyboard problems, personal accommodation strategies to cope with chair problems and environmental accommodation strategies to cope with monitor problems. CONCLUSIONS: The number of problems during computer use was substantial in our sample, and our respondents with RA and FM may not implement the most effective strategies to deal with their chair, keyboard, or mouse problems. This study suggests that workers with RA and FM might potentially benefit from education and interventions to assist with the development of accommodation strategies to reduce problems related to computer use.

The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome.

OBJECTIVE: To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on carpal tunnel symptoms and function. DESIGN: Randomized Clinical Trial. SETTING: Outpatient hand therapy clinics. PARTICIPANTS: Volunteers (N=124) with mild to moderate carpal tunnel syndrome. INTERVENTIONS: A 4-week home regimen of nocturnal splints (lumbrical splints or cock-up splints) combined with stretches (lumbrical intensive or general) performed 6 times daily. MAIN OUTCOME MEASURES: The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Questionnaire (CTQ) and Disabilities of the Arm, Shoulder, and Hand (DASH). We also evaluated whether subjects obtained surgery at 24 weeks. RESULTS: There were significant main effects over time for all outcome measures at 4, 12, and 24 weeks. There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks. Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups. At 24 weeks, a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinically important improvement on the CTQ-Function. By 24 weeks, only 25.5% of subjects had elected to undergo surgery. CONCLUSIONS: A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment.

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults.

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.

Cognitive and physical performance in patients with asymptomatic carotid artery disease.

The purpose of this study was to determine if patients with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in cognitive and physical performance. The relationship between cognitive measures and performance of instrumental activities of daily living was examined. Seventy-nine patients with asymptomatic carotid artery stenosis of moderate and severe degrees or occlusion were tested. Cognition was assessed via the repeatable battery for the assessment of neuropsychological status (RBANS) and the executive interview (EXIT). Physical performance was assessed via the physical performance test (PPT) and the Lawton instrumental activities of daily living (IADL). Deficits in the RBANS visuospatial/constructional, attention, language and delayed memory domains were found for patients with occlusion. Deficits in all RBANS domains were found for the moderate stenosis subgroup, and deficits in all domains except language were found in the severe subgroup. No deficit was found in executive function in any group. Additionally, deficits were related to sidedness of involvement with visuospatial/constructional deficits related to right sided disease, and deficits in all cognitive domains except language were found in left sided and bilateral disease. Decreased performance on the PPT was identified in all three subgroups with the lowest scores in the moderate stenosis subgroup and the highest scores in the severe stenosis subgroup. The Lawton IADL did not identify any decrease in performance. Deficits in cognitive and physical function were found in this observational study of patients with asymptomatic carotid artery stenosis and occlusion, indicating that asymptomatic patients may not be truly asymptomatic. These areas of function and the potential change in their status need to be considered when patients are being evaluated for interventions to manage their carotid artery disease.

Predicted and actual exercise discomfort in middle school children.

PURPOSE: The purpose of this study was to use a match-mismatch paradigm to examine children's exercise discomfort during an aerobic shuttle run. METHODS: Thirty-four middle school females (n = 18) and males (n = 16) aged 11-14 yr participated. An Exercise Discomfort Index (EDI) was calculated as a rating of perceived exertion for the overall body (Children's OMNI Scale) x a rating of perceived muscle hurt (Children's OMNI Muscle Hurt Scale). Measurements were obtained immediately before (i.e., predicted) and after (i.e., actual) performance of the nationally standardized Progressive Aerobic Cardiovascular Endurance Run (PACER) shuttle test of aerobic fitness. Self-report physical activity and sport participation history were obtained before PACER performance. RESULTS: Two-way ANOVA (gender x assessment time point) showed a significant main effect for assessment time point: predicted EDI (means +/- SD = 25.9 +/- 20.1) was greater than actual EDI (means +/- SD = 19.4 +/- 17.8) for the total group (P = 0.021). However, neither the main effect of gender nor the gender x assessment time point interaction was significant. Idiographic analysis showed that overpredictors of discomfort reported less time (5.25 median h x wk(-1)) and engaged in less recreational activity than underpredictors (11.14 median h x wk(-1)). However, no significant relation (P = 0.508) was observed between PACER laps completed and exercise discomfort. CONCLUSIONS: The sample of middle school children in this study predicted greater exercise discomfort than actually experienced when performing a PACER test. It is possible that a discomfort construct plays an important role in the initiation and maintenance of children's aerobic exercise, providing a basis for physical activity interventions.

Problems experienced by people with arthritis when using a computer.

OBJECTIVE: To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). METHODS: Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. RESULTS: A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. CONCLUSION: Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.