Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 33 Records) |
Query Trace: Coffey C[original query] |
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Update on the ASTM International Standard Test Method for Respirator Fit Capability
Coffey C , Miller C , Szalajda J . Synergist (Akron) 2021 32 (6) In observance of the 100th anniversary of the publication of the U.S. Bureau of Mines first respirator approval schedule, NIOSH published, “The Respirator Fit Capability Test: Enhancing the Efficacy of Filtering Facepeice Respirators”, in the digital supplement to the September 2019 issue of the Synergist. In the article, we described the development of a new voluntary ASTM International standard designed to help ensure negative-pressure half-facepiece particulate respirators fit a percentage of wearers.1 The purpose of this article is to provide an update on the status of this standard. | | As stated in the September article, the draft standard was first balloted in April 2019 by the ASTM F23.65 subcommittee on Respriatory.1 There were three negative votes. Based on the input received during the June 2019 subcommittee meeting, the draft standard was revised and all comments were addressed. A second ballot occurred in April 2020 resulting in two negative and three affirmative with comment balllots. The negative comments were in regards to the passing rate being too low, the test chamber variables, the in-facepeice probe placement, the ability of other types of personal protective equipment (e.g., safety glasses) to affect the fit of the respirator, what needs to be said during the talking exercise, posting of the passing fit factor, and using the NIOSH Bivariate Panel. The comments received with the affirmative ballots were about formatting, providing examples of probed elastomeric facepieces, and providing specific makes and models as examples of the equipment needed to conduct the testing. |
COVID-19 SeroHub, an online repository of SARS-CoV-2 seroprevalence studies in the United States.
Freedman ND , Brown L , Newman LM , Jones JM , Benoit TJ , Averhoff F , Bu X , Bayrak K , Lu A , Coffey B , Jackson L , Chanock SJ , Kerlavage AR . Sci Data 2022 9 (1) 727 Seroprevalence studies provide useful information about the proportion of the population either vaccinated against SARS-CoV-2, previously infected with the virus, or both. Numerous studies have been conducted in the United States, but differ substantially by dates of enrollment, target population, geographic location, age distribution, and assays used. This can make it challenging to identify and synthesize available seroprevalence data by geographic region or to compare infection-induced versus combined infection- and vaccination-induced seroprevalence. To facilitate public access and understanding, the National Institutes of Health and the Centers for Disease Control and Prevention developed the COVID-19 Seroprevalence Studies Hub (COVID-19 SeroHub, https://covid19serohub.nih.gov/ ), a data repository in which seroprevalence studies are systematically identified, extracted using a standard format, and summarized through an interactive interface. Within COVID-19 SeroHub, users can explore and download data from 178 studies as of September 1, 2022. Tools allow users to filter results and visualize trends over time, geography, population, age, and antigen target. Because COVID-19 remains an ongoing pandemic, we will continue to identify and include future studies. |
The history of the evaluation of particulate respirator fitting characteristics in the U.S. approval requirements
Coffey CC , Miller C , Szalajda J . J Occup Environ Hyg 2021 18 1-10 To be effective, a negative-pressure, air-purifying, particulate-removing, half-facepiece respirator (particulate respirator) must form a good seal against the wearer’s face. This fact has long been recognized by those in the respiratory protection n community. As one historical example, in 1911, German investigators conducted studies on fit (Brown 1937). However, the current National Institute for Occupational Health and Safety (NIOSH) respirator approval program does not evaluate particulate respirator fit characteristics. Therefore, it is difficult to predict which particulate respirator model will be the best fit in a particular population. Having particulate respirators with good fit characteristics is extremely important today. With the resurgence of tuberculosis (TB) in the United States in the 1990s, the use of particulate respirators in healthcare has increased due to surgical masks only providing barrier protection against droplets that include large respiratory particles. Most surgical masks lack an adequate face seal and do not effectively filter small particles from the air or aerosols, allowing for leakage around the mask and subsequent exposure (Umer et al. 2020). Therefore, surgical masks do not provide adequate protection against infectious respiratory diseases since they are transmitted via droplets and aerosols. With this increased use of particulate respirators in healthcare, supplies of particulate respirators, including N95 filtering facepiece respirators (FFRs), can become depleted during a pandemic or widespread outbreak of infectious respiratory illnesses (Institute of Medicine 2006). However, previous shortages pale in comparison to those caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. The resulting respirator shortage left doctors, nurses, and other frontline workers dangerously ill-equipped to care for COVID-19 patients while protecting themselves from being infected with SARS-CoV-2. The shortages were so severe that even with the availability of hundreds of NIOSH-approved particulate respirator models, under an emergency use authorization, the U.S. Food and Drug Administration (FDA) allowed certain non-NIOSH approved particulate respirators to be used in healthcare for protection against COVID-19 (FDA 2020). Many employers had to buy whatever respirators they could find, resulting in healthcare workers having to wear particulate respirators with which they were unfamiliar. With the need to wear these respirators immediately to care for COVID-19 patients, some healthcare workers may have increased their risk of exposure and infection by wearing respirators with poor fit characteristics. In addition to healthcare workers, particulate respirator wearers in other industries may be at risk from overexposure to various contaminants. A 2001 survey of over 40,000 establishments designed to represent all private-sector establishments revealed that only about 57% of those requiring the use of tight-fitting facepiece respirators performed fit testing (BLS/ NIOSH 2003). Having particulate respirators that meet a standard such as the new ASTM F3407-20 Standard Test Method for Respirator Fit Capability (RFC) for Negative-Pressure Half-Facepiece Particulate Respirators would reduce the number of employees who may be overexposed due to wearing a particulate respirator with poor fit characteristics. |
Occupational Histoplasmosis: Epidemiology and Prevention Measures
de Perio MA , Benedict K , Williams SL , Niemeier-Walsh C , Green BJ , Coffey C , Di Giuseppe M , Toda M , Park JH , Bailey RL , Nett RJ . J Fungi (Basel) 2021 7 (7) In areas where Histoplasma is endemic in the environment, occupations involving activities exposing workers to soil that contains bird or bat droppings may pose a risk for histoplasmosis. Occupational exposures are frequently implicated in histoplasmosis outbreaks. In this paper, we review the literature on occupationally acquired histoplasmosis. We describe the epidemiology, occupational risk factors, and prevention measures according to the hierarchy of controls. |
Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2.
Payne AB , Gilani Z , Godfred-Cato S , Belay ED , Feldstein LR , Patel MM , Randolph AG , Newhams M , Thomas D , Magleby R , Hsu K , Burns M , Dufort E , Maxted A , Pietrowski M , Longenberger A , Bidol S , Henderson J , Sosa L , Edmundson A , Tobin-D'Angelo M , Edison L , Heidemann S , Singh AR , Giuliano JSJr , Kleinman LC , Tarquinio KM , Walsh RF , Fitzgerald JC , Clouser KN , Gertz SJ , Carroll RW , Carroll CL , Hoots BE , Reed C , Dahlgren FS , Oster ME , Pierce TJ , Curns AT , Langley GE , Campbell AP , Balachandran N , Murray TS , Burkholder C , Brancard T , Lifshitz J , Leach D , Charpie I , Tice C , Coffin SE , Perella D , Jones K , Marohn KL , Yager PH , Fernandes ND , Flori HR , Koncicki ML , Walker KS , Di Pentima MC , Li S , Horwitz SM , Gaur S , Coffey DC , Harwayne-Gidansky I , Hymes SR , Thomas NJ , Ackerman KG , Cholette JM . JAMA Netw Open 2021 4 (6) e2116420 IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. OBJECTIVE: To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1 000 000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. EXPOSURES: Race/ethnicity, sex, and age group (ie, ≤5, 6-10, 11-15, and 16-20 years). MAIN OUTCOMES AND MEASURES: Overall and stratum-specific adjusted estimated MIS-C incidence per 1 000 000 person-months and per 1 000 000 SARS-CoV-2 infections. RESULTS: In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1 000 000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1 000 000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1 000 000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1 000 000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1 000 000 person-months). CONCLUSIONS AND RELEVANCE: In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group. |
Evaluation of total inward leakage for NIOSH-approved elastomeric half-facepiece, full-facepiece, and powered air-purifying respirators using sodium chloride and corn oil aerosols
Rengasamy S , Zhuang Z , Lawrence RB , Boutin B , Yorio P , Horvatin M , McClain C , Harris JR , Coffey C . J Occup Environ Hyg 2021 18 (7) 1-9 Recently, total inward leakage (TIL) for filtering facepiece and elastomeric half-mask respirators (EHRs) was measured according to the International Organization for Standardization (ISO) test method standard 16900-1:2014 that showed larger TIL for corn oil aerosol than for NaCl aerosol. Comparison of TIL measured for different aerosols for higher protection level respirators is lacking. The objective of this study was to determine TIL for EHRs, full-facepiece respirators, and loose-fitting and tight-fitting powered air-purifying respirators (PAPRs) using NaCl and corn oil aerosols to compare. TIL was measured for two models each of EHRs, full-facepiece respirators, and loose-fitting and tight-fitting PAPRs. After fit testing with a PortaCount (TSI, St. Paul, MN) using the Occupational Safety and Health Administration (OSHA) protocol, eight subjects were tested in the NaCl aerosol chamber first and then in the corn oil aerosol chamber, while another eight subjects tested in the reverse order. Subjects were randomly assigned to one of the two groups. TIL was measured as a ratio of mass-based aerosol concentrations inside the mask to the test chamber while the subjects performed ISO 16900-1-defined exercises using continuous sampling methods. The concentration of corn oil aerosol was measured with one light scattering photometer, alternately, and NaCl aerosol was measured using two flame photometers. Results showed the geometric mean TIL for EHR was significantly (p < 0.05) larger for corn oil aerosol than for NaCl aerosol. EHR models equipped with P100 filters showed relatively smaller TIL values than the same models with N95 filters showing that TIL was inversely related to filter efficiency. Interestingly, TIL was significantly (p < 0.05) larger for NaCl aerosol than for corn oil aerosol for PAPRs, but not for full-facepiece respirators. TIL was inversely related to fit factors of respirator types. Overall, filter efficiency and faceseal leakage determine TIL. The relative trends in TIL for the two aerosols' test methods differ between respirator types indicating that generalization of TIL for respirator types may not be appropriate when using different test agents. |
Respiratory Protection in a Time of Crisis: NIOSH Testing of International Respiratory Protective Devices for Emergency Use.
Andrews AS , Powers JR Jr , Cichowicz JK , Coffey CC , Fries ML , Yorio PL , D'Alessandro MM . Health Secur 2021 19 (4) 379-385 National Institute for Occupational Safety and Health (NIOSH)-approved respirators are required by the Occupational Safety and Health Administration (OSHA) when personal respiratory protection is used in US occupational settings. During the COVID-19 pandemic, the demand for NIOSH-approved N95 filtering facepiece respirators overwhelmed the available supply. To supplement the national inventory of N95 respirators, contingency and crisis capacity strategies were implemented and incorporated a component that endorsed the use of non-NIOSH-approved respiratory protective devices that conformed to select international standards. The development and execution of this strategy required the collaborative effort of numerous agencies. The Food and Drug Administration temporarily authorized non-NIOSH-approved international respiratory protective devices through an emergency use authorization, OSHA relaxed their enforcement guidance concerning their use in US workplaces, and NIOSH initiated a supplemental performance assessment process to verify the quality of international devices. NIOSH testing revealed that many of the non-NIOSH-approved respiratory protective devices had filtration efficiencies below 95% and substantial inconsistencies in filtration performance. This article reports the results of the NIOSH testing to date and discusses how it has contributed to continuous improvement of the crisis strategy of temporarily permitting the use of non-NIOSH-approved respirators in US occupational settings during the COVID-19 pandemic. |
Movement of St. Louis encephalitis virus in the Western United States, 2014- 2018.
Swetnam DM , Stuart JB , Young K , Maharaj PD , Fang Y , Garcia S , Barker CM , Smith K , Godsey MS , Savage HM , Barton V , Bolling BG , Duggal N , Brault AC , Coffey LL . PLoS Negl Trop Dis 2020 14 (6) e0008343 St. Louis encephalitis virus (SLEV) is a flavivirus that circulates in an enzootic cycle between birds and mosquitoes and can also infect humans to cause febrile disease and sometimes encephalitis. Although SLEV is endemic to the United States, no activity was detected in California during the years 2004 through 2014, despite continuous surveillance in mosquitoes and sentinel chickens. In 2015, SLEV-positive mosquito pools were detected in Maricopa County, Arizona, concurrent with an outbreak of human SLEV disease. SLEV-positive mosquito pools were also detected in southeastern California and Nevada in summer 2015. From 2016 to 2018, SLEV was detected in mosquito pools throughout southern and central California, Oregon, Idaho, and Texas. To understand genetic relatedness and geographic dispersal of SLEV in the western United States since 2015, we sequenced four historical genomes (3 from California and 1 from Louisiana) and 26 contemporary SLEV genomes from mosquito pools from locations across the western US. Bayesian phylogeographic approaches were then applied to map the recent spread of SLEV. Three routes of SLEV dispersal in the western United States were identified: Arizona to southern California, Arizona to Central California, and Arizona to all locations east of the Sierra Nevada mountains. Given the topography of the Western United States, these routes may have been limited by mountain ranges that influence the movement of avian reservoirs and mosquito vectors, which probably represents the primary mechanism of SLEV dispersal. Our analysis detected repeated SLEV introductions from Arizona into southern California and limited evidence of year-to-year persistence of genomes of the same ancestry. By contrast, genetic tracing suggests that all SLEV activity since 2015 in central California is the result of a single persistent SLEV introduction. The identification of natural barriers that influence SLEV dispersal enhances our understanding of arbovirus ecology in the western United States and may also support regional public health agencies in implementing more targeted vector mitigation efforts to protect their communities more effectively. |
The respirator fit capability test: Enhancing the efficacy of filtering facepiece respirators
Coffey C , Miller C . Synergist 2019 2019 (9) When NIOSH promulgated its Respiratory Protective Devices rule in 1995 (Title 42 code of Federal Regulations, Part 84), which specified approval standards for respirators, no test for evaluating the fitting characteristics of filtering facepiece respirators was included. The consequences of the lack of a fit test in 42 CFR 84 included the approval of devices that did not fit the general respirator-wearing population very well, higher costs for conducting the OSHA-required fit test, and the potential for wearing to pass a fit test in error. Today, the need still exists for a fit test for use by manufacturers of filtering facepiece respirators and conformity assessment organizations. |
Evolving epidemiology of reported giardiasis cases in the United States, 1995-2016
Coffey CM , Collier SA , Gleason ME , Yoder JS , Kirk MD , Richardson AM , Fullerton KE , Benedict KM . Clin Infect Dis 2020 72 (5) 764-770 BACKGROUND: Giardiasis is the most common intestinal parasitic disease of humans identified in the United States and an important waterborne disease. In the United States, giardiasis has been variably reportable since 1992 and was made a nationally notifiable disease in 2002. Our objective was to describe the epidemiology of US giardiasis cases from 1995-2016 using National Notifiable Disease Surveillance System data. METHODS: Negative binomial regression models were used to compare incidence rates by age groups (0-4, 5-9, 10-19, 20-29, 30-39, 40-49, 50-64 and >/=65 years) during three time periods (1995-2001, 2002-2010 and 2011-2016). RESULTS: From 1995-2016, the average number of reported cases were 19 781 per year (range 14 623-27 778 cases). The annual incidence of reported giardiasis in the US decreased across all age groups. This decrease differs by age group and sex and may reflect either changes in surveillance methods (for example changes to case definitions or reporting practices) or changes in exposure. Incidence rates in males and older age groups did not decrease to the same extent as rates in females and children. CONCLUSIONS: Trends suggest that differences in exposures by sex and age group are important to the epidemiology of giardiasis. Further investigation into the risk factors of populations with higher rates of giardiasis will support prevention and control efforts. |
Rural-urban trends in opioid overdose discharges in Missouri emergency departments, 2012-2016
Coffey W , Hunter A , Mobley E , Vivolo-Kantor A . J Rural Health 2019 36 (2) 177-186 PURPOSE: Opioid overdose death rates rose 36% from 2015 to 2016 in Missouri, indicating a worsening of the opioid overdose epidemic. To better understand urban and rural differences in nonfatal opioid overdoses treated in Missouri emergency departments, this paper analyzed hospital billing data from emergency departments due to opioid overdose from 2012 to 2016. METHODS: Emergency department records meeting the opioid overdose case definition were aggregated into 6 progressively rural groups using the National Center for Health Statistics (NCHS) urban-rural county classification from 2013. These data were analyzed to determine significant trends amongst and between the geographic groups. FINDINGS: Generally, the magnitude of opioid overdose morbidity decreased as levels of rurality increased, using annual percentage change as the metric of change. Over the study period, Missouri's most urban counties had significantly higher rates of opioid overdose and saw larger percentage increases in rates compared to more rural areas. Statewide, all rural-urban classifications experienced increases in heroin overdose morbidity; however, there was extreme variation in the trajectory of those increases. Heroin overdose rates were much higher in urban areas than rural areas. Conversely, rural and urban areas saw relatively similar patterns for non-heroin opioid overdoses, though overall magnitude of these increases was more modest across all geographic groups. CONCLUSIONS: The results from this analysis can help inform prioritization of strategies and resources to implement activities addressing the opioid overdose epidemic. Using a rich hospital discharge database could allow for further analysis of subpopulations to enhance personalization and customization of care. |
A comparison of total inward leakage measured using sodium chloride (NaCl) and corn oil aerosol methods for air-purifying respirators
Rengasamy S , Zhuang Z , Niezgoda G , Walbert G , Lawrence R , Boutin B , Hudnall J , Monaghan WP , Bergman M , Miller C , Harris J , Coffey C . J Occup Environ Hyg 2018 15 (8) 1-34 The International Organization for Standardization (ISO) standard 16900-1:2014 specifies the use of sodium chloride (NaCl) and corn oil aerosols, and sulfur hexafluoride gas for measuring total inward leakage (TIL). However, a comparison of TIL between different agents is lacking. The objective of this study was to measure and compare TIL for respirators using corn oil and NaCl aerosols. TIL was measured with 10 subjects donning two models of filtering facepiece respirators (FFRs) including FFP1, N95, P100, and elastomeric half-mask respirators (ERs) in NaCl and corn oil aerosol test chambers, using continuous sampling methods. After fit testing with a PortaCount (TSI, St. Paul, MN) using the Occupational Safety and Health Administration (OSHA) protocol, five subjects were tested in the NaCl chamber first and then in the corn oil chamber, while other subjects tested in the reverse order. TIL was measured as a ratio of mass-based aerosol concentrations in-mask to the test chamber, while the subjects performed ISO 16900-1-defined exercises. The concentration of NaCl aerosol was measured using two flame photometers, and corn oil aerosol was measured with one light scattering photometer. The same instruments were used to measure filter penetration in both chambers using a Plexiglas(R) setup. The size distribution of aerosols was determined using a scanning mobility particle sizer and charge was measured with an electrometer. Filter efficiency was measured using an 8130 Automated Filter Tester (TSI). Results showed the geometric mean TIL for corn oil aerosol for one model each of all respirator categories, except P100, were significantly (p<0.05) greater than for NaCl aerosol. Filter penetration in the two test chambers showed a trend similar to TIL. The count median diameter was approximately 82 nm for NaCl and approximately 200 nm for corn oil aerosols. The net positive charge for NaCl aerosol was relatively larger. Both fit factor and filter efficiency influence TIL measurement. Overall, TIL determination with aerosols of different size distributions and charges using different methodologies may produce dissimilar results. |
ICTV virus taxonomy profile: Togaviridae
Chen R , Mukhopadhyay S , Merits A , Bolling B , Nasar F , Coffey LL , Powers A , Weaver SC , Ictv Report Consortium . J Gen Virol 2018 99 (6) 761-762 The Togaviridae is a family of small, enveloped viruses with single-stranded, positive-sense RNA genomes of 10-12 kb. Within the family, the genus Alphavirus includes a large number of diverse species, while the genus Rubivirus includes the single species Rubella virus. Most alphaviruses are mosquito-borne and are pathogenic in their vertebrate hosts. Many are important human and veterinary pathogens (e.g. chikungunya virus and eastern equine encephalitis virus). Rubella virus is transmitted by respiratory routes among humans. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the taxonomy of the Togaviridae, which is available at www.ictv.global/report/togaviridae. |
Racial disparities in sepsis-related in-hospital mortality: Using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013
Jones JM , Fingar KR , Miller MA , Coffey R , Barrett M , Flottemesch T , Heslin KC , Gray DT , Moy E . Crit Care Med 2017 45 (12) e1209-e1217 OBJECTIVES: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths. DESIGN: Retrospective, repeated cross-sectional study. SETTING: Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting. PATIENTS: Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock. MEASUREMENTS AND MAIN RESULTS: In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5-7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and "other" (104.7; p < 0.001) racial/ethnic patients. CONCLUSIONS: Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations. |
Age-related disparities in trauma center access for severe head injuries following the release of the updated field triage guidelines
Flottemesch TJ , Raetzman S , Heslin KC , Fingar K , Coffey R , Barrett M , Moy E . Acad Emerg Med 2017 24 (4) 447-457 Objective: In 2006, the American College of Surgeons' Committee on Trauma and the Centers for Disease Control and Prevention released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. Methods: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases with multivariable logistic regressions considered changes in 1) the trauma designation of the emergency department where treatment was initiated and 2) transfer to a TC following initial treatment at a non-TC. Results: Compared with adults aged 18 to 44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45 to 64 years (odds ratio [OR] = 0.76 in 2009 and 0.74 in 2012), aged 65 to 84 years (OR = 0.61 and 0.59), and aged 85+ years (OR = 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = 0.02) from the increase among adults aged 18 to 44 years (OR = 1.12). The analysis of transfers yielded similar results. Conclusions: Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted. |
Relative analytical sensitivity of donor nucleic acid amplification technology screening and diagnostic real-time polymerase chain reaction assays for detection of Zika virus RNA.
Stone M , Lanteri MC , Bakkour S , Deng X , Galel SA , Linnen JM , Munoz-Jordan JL , Lanciotti RS , Rios M , Gallian P , Musso D , Levi JE , Sabino EC , Coffey LL , Busch MP . Transfusion 2017 57 734-747 BACKGROUND: Zika virus (ZIKV) has spread rapidly in the Pacific and throughout the Americas and is associated with severe congenital and adult neurologic outcomes. Nucleic acid amplification technology (NAT) assays were developed for diagnostic applications and for blood donor screening on high-throughput NAT systems. We distributed blinded panels to compare the analytical performance of blood screening relative to diagnostic NAT assays. STUDY DESIGN AND METHODS: A 25-member, coded panel (11 half-log dilutions of a 2013 French Polynesia ZIKV isolate and 2015 Brazilian donor plasma implicated in transfusion transmission, and 3 negative controls) was sent to 11 laboratories that performed 17 assays with 2 to 12 replicates per panel member. Results were analyzed for the percentage reactivity at each dilution and by probit analysis to estimate the 50% and 95% limits of detection (LOD50 and LOD95 , respectively). RESULTS: Donor-screening NAT assays that process approximately 500 microL of plasma into amplification reactions were comparable in sensitivity (LOD50 and LOD95 , 2.5 and 15-18 copies/mL) and were approximately 10-fold to 100-fold more sensitive than research laboratory-developed and diagnostic reverse transcriptase-polymerase chain reaction tests that process from 10 to 30 microL of plasma per amplification. Increasing sample input volume assayed with the Centers for Disease Control and Prevention reverse transcriptase-polymerase chain reaction assays increased the LODs by 10-fold to 30-fold. CONCLUSIONS: Blood donor-screening ZIKV NAT assays demonstrate similar excellent sensitivities to assays currently used for screening for transfusion-transmitted viruses and are substantially more sensitive than most other laboratory-developed and diagnostic ZIKV reverse transcriptase-polymerase chain reaction assays. Enhancing sensitivities of laboratory-developed and diagnostic assays may be achievable by increasing sample input. |
Admissions after discharge from an emergency department for chest symptoms
Moore BJ , Coffey RM , Heslin KC , Moy E . Diagnosis (Berl) 2016 3 (3) 103-113 Often patients who present to the emergency department (ED) with chest symptoms return to the hospital within 30 days with the same or closely related symptoms and are admitted, raising questions about quality of care, timeliness of diagnosis, and patient safety. This study examined the frequency of and patient characteristics associated with subsequent inpatient admissions for related symptoms after discharge from an ED for chest symptoms. We used data from the 2012 and 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) from eight states to identify over 1.8 million ED discharges for chest symptoms. Approximately 3% of ED discharges experienced potentially related subsequent admissions within 30 days - 0.2% for acute myocardial infarction (AMI), 1.7% for other cardiovascular conditions, 0.5% for respiratory conditions, and 0.6% for mental disorders. Logistic regression results showed higher odds of subsequent admission for older patients and those residing in low-income areas, and lower odds for females and non White racial/ethnic groups. Privately insured patients had lower odds of subsequent admission than did those who were uninsured or covered by other programs. Because we included multiple diagnostic categories of subsequent admissions, our results show a more complete picture of patients presenting to the ED with chest symptoms compared with previous studies. In particular, we show a lower rate of subsequent admission for AMI versus other diagnoses. ED physicians and administrators can use the results to identify characteristics associated with increased odds of subsequent admission to target at-risk populations. |
The US Culture Collection Network lays the foundation for progress in preservation of valuable microbial resources.
McCluskey K , Alvarez A , Bennett AR , Bokati D , Boundy-Mills K , Brown D , Bull CT , Coffey M , Dreaden T , Duke C , Dye G , Ehmke E , Eversole K , Fenstermacher K , Geiser DM , Glaeser J , Greene S , Gribble L , Griffith MP , Hanser K , Humber R , Johnson BW , Kermode A , Krichevsky M , Lauden M , Leach J , Leslie JF , May M , Melcher U , Nobles DR , Risso Fonseca N , Robinson S , Ryan M , Scott J , Silflow C , Vidaver A , Webb K , Wertz J , Yentsch S , Zehr S . Phytopathology 2016 106 (6) 532-40 The United States Culture Collection Network was formed in 2012 by a group of culture collection scientists and stakeholders in order to continue the progress established previously through efforts of an ad hoc group. The network is supported by a Research Coordination Network grant from the US National Science Foundation (NSF) and has the goals of promoting interaction among collections, encouraging the adoption of best practices, and protecting endangered or orphaned collections. After prior meetings to discuss best practices, shared data, and synergy with genome programs, the network held a meeting at the US Department of Agriculture (USDA) Agricultural Research Service (ARS) National Center for Genetic Resources Preservation (NCGRP) in Fort Collins, Colorado in October 2015 specifically to discuss collections that are vulnerable because of changes in funding programs, or are at risk of loss because of retirement or lack of funding. The meeting allowed collection curators who had already backed up their resources at the USDA NCGRP to visit the site, and brought collection owners, managers, and stakeholders together. Eight formal collections have established off-site backups with the USDA-ARS, ensuring that key material will be preserved for future research. All of the collections with backup at the NCGRP are public distributing collections including US NSF-supported genetic stock centers, USDA ARS collections, and university supported collections. Facing the retirement of several pioneering researchers, the community discussed the value of preserving personal research collections and agreed that a mechanism to preserve these valuable collections was essential to any future national culture collection system. Additional input from curators of plant and animal collections emphasized that collections of every kind face similar challenges in developing long-range plans for sustainability. |
Inward leakage variability between respirator fit test panels - part II. probabilistic approach
Liu Y , Zhuang Z , Coffey CC , Rengasamy S , Niezgoda G . J Occup Environ Hyg 2016 13 (8) 0 This study aimed to quantify the variability between different anthropometric panels in determining the inward leakage (IL) of N95 filtering facepiece respirators (FFRs), and elastomeric half-mask respirators (EHRs). We enrolled 144 experienced and non-experienced users as subjects in this study. Each subject was assigned five randomly selected FFRs and five EHRs, and performed quantitative fit tests to measure IL. Based on the NIOSH bivariate fit test panel, we randomly sampled 10,000 pairs of anthropometric 35 and 25 member panels without replacement from the 144 study subjects. For each pair of the sampled panels, a Chi-Square test was used to test the hypothesis that the passing rates for the two panels were not different. The probability of passing the IL test for each respirator was also determined from the 20,000 panels and by using binomial calculation. We also randomly sampled 500,000 panels with replacement to estimate the coefficient of variation (CV) for inter-panel variability. For both 35 and 25 member panels, the probability that passing rates were not significantly different between two randomly sampled pairs of panels was higher than 95% for all respirators. All efficient (passing rate ≥80%) and inefficient (passing rate ≤60%) respirators yielded consistent results (probability >90%) for two randomly sampled panels. Somewhat efficient respirators (passing rate between 60% and 80%) yielded inconsistent results. The passing probabilities and error rates were found to be significantly different between the simulation and binomial calculation. The CV for the 35 member panel was 16.7%, which was slightly lower than that for the 25 member panel (19.8%). Our results suggested that IL inter-panel variability exists, but is relatively small. The variability may be affected by passing level and passing rate. Facial dimension based fit test panel stratification was also found to have significant impact on inter-panel variability, i.e., it can reduce alpha and beta errors, and inter-panel variability. |
Multidrug-resistant Salmonella Heidelberg associated with mechanically separated chicken at a correctional facility
Taylor AL , Murphree R , Ingram LA , Garman K , Solomon D , Coffey E , Walker D , Rogers M , Marder E , Bottomley M , Woron A , Thomas L , Roberts S , Hardin H , Arjmandi P , Green A , Simmons L , Cornell A , Dunn J . Foodborne Pathog Dis 2015 12 (12) 950-2 We describe multidrug-resistant (MDR) Salmonella Heidelberg infections associated with mechanically separated chicken (MSC) served at a county correctional facility. Twenty-three inmates met the case definition. All reported diarrhea, 19 (83%) reported fever, 16 (70%) reported vomiting, 4 (17%) had fever ≥103 degrees F, and 3 (13%) were hospitalized. A case-control study found no single food item significantly associated with illness. Salmonella Heidelberg with an indistinguishable pulsed-field gel electrophoresis pattern was isolated from nine stool specimens; two isolates displayed resistance to a total of five drug classes, including the third-generation cephalosporin, ceftriaxone. MDR Salmonella Heidelberg might have contributed to the severity of illness. Salmonella Heidelberg indistinguishable from the outbreak subtype was isolated from unopened MSC. The environmental health assessment identified cross-contamination through poor food-handling practices as a possible contributing factor. Proper hand-washing techniques and safe food-handling practices were reviewed with the kitchen supervisor. |
Inward leakage variability between respirator fit test panels - part I. deterministic approach
Zhuang Z , Liu Y , Coffey CC , Miller C , Szalajda J . J Occup Environ Hyg 2015 12 (11) 0 Inter-panel variability has never been investigated. The objective of this study was to determine the variability between different anthropometric panels used to determine the inward leakage (IL) of N95 filtering facepiece respirators (FFRs) and elastomeric half-mask respirators (EHRs). A total of 144 subjects, who were both experienced and non-experienced N95 FFR users, were recruited. Five N95 FFRs and five N95 EHRs were randomly selected from among those models tested previously in our laboratory. The PortaCount--> Pro+ (without N95-Companion) was used to measure IL of the ambient particles with a detectable size range of 0.02 to 1 microm. The Occupational Safety and Health Administration (OSHA) standard fit test exercises were used for this study. IL test were performed for each subject using each of the 10 respirators. Each respirator/subject combination was tested in duplicate, resulting in a total 20 IL tests for each subject. Three 35-member panels were randomly selected without replacement from the 144 study subjects stratified by the National Institute for Occupational Safety and Health (NIOSH) bivariate panel cell for conducting statistical analyses. The geometric mean (GM) IL values for all 10 studied respirators were not significantly different among the three randomly selected 35-member panels. Passing rate was not significantly different among the three panels for all respirators combined or by each model. This was true for all IL pass/fail levels of 1%, 2% and 5%. Using 26 or more subjects to pass the IL test, all three panels had consistent passing/failing results for pass/fail levels of 1% and 5%. Some disagreement was observed for the 2% pass/fail level. Inter-panel variability exists, but it is small relative to the other sources of variation in fit testing data. The concern about inter-panel variability and other types of variability can be alleviated by properly selecting: pass/fail level (IL 1% to 5%); panel size (e.g., 25 or 35); and minimum number of subjects required to pass (e.g., 26 of 35 or 23 of 35). |
Effect of interferents on the performance of direct-reading organic vapor monitors
LeBouf RF , Coffey CC . J Air Waste Manag Assoc 2015 65 (3) 261 Direct-reading organic vapor monitors are often used to measure volatile organic compound concentrations in complex chemical gas mixtures. However, there is a paucity of data on the impact of multiple gases on monitor performance, even though it is known that monitor sensitivity may vary by chemical. This study investigated the effects of interferents on the performance of the MIRAN SapphIRe Portable Ambient Air Analyzer (SAP) and Century Portable Toxic Vapor Analyzer (TVA-1000) when sampling a specific agent of interest (cyclohexane). The TVA-1000 contained a dual detector: a photoionization detector (PID) and a flame ionization detector (FID). Three devices of each monitor were challenged with different combinations of cyclohexane and potential interferent vapors (hexane, methyl ethyl ketone, trichloroethylene, and toluene) at 21°C and 90% relative humidity (RH), an extreme environmental condition. Five replicates at four target concentrations were tested: 30, 150, 300, and 475 ppm. Multiple proportions of cyclohexane to interferent enabled the determination of the interferent effect on monitor performance. The monitor concentrations were compared to reference concentrations measured using NIOSH Method 1500. Three scenarios were investigated: no response factor, cyclohexane response factor, and weighted-mixed response factor applied. False negatives occurred more frequently for PID (21.1%), followed by FID (4.8%) and SAP (0.2%). Measurements from all monitors generally had a positive bias compared to the reference measurements. Some monitor measurements exceeded twice the reference concentrations: PID (36.8%), SAP (19.8%), and FID (6.3%). Evaluation of the 95% confidence intervals indicated that performance of all monitors varied by concentration. In addition, the performance of the PID and SAP varied by presence of an interfering compound, especially toluene and hexane for the PID and trichloroethylene for the SAP. Variability and bias associated with all these monitors preclude supplanting traditional sorbent-based tube methods for measuring volatile organic compounds (VOCs), especially for compliance monitoring. Industrial hygienists need to use care when using any of the three monitor detection types to measure the concentration of unknown chemical mixtures. Monitor performance is affected by the presence of interferents. Application of manufacturer recommended response factors may not adequately scale measurements to minimize monitor bias when compared to standard reference methods. Users should calibrate their monitors to a known reference method prior to use, if possible. Each of the monitors has its own limitations, which should be considered to ensure quality measurements are reported. |
Protection factor for N95 filtering facepiece respirators exposed to laboratory aerosols containing different concentrations of nanoparticles
Rengasamy S , Walbert G , Newcomb W , Coffey C , Wassell JT , Szalajda J . Ann Occup Hyg 2014 59 (3) 373-81 A previous study used a PortaCount Plus to measure the ratio of particle concentrations outside (C out) to inside (C in) of filtering facepiece respirators (FFRs) worn by test subjects and calculated the total inward leakage (TIL) (C in/C out) to evaluate the reproducibility of the TIL test method between two different National Institute for Occupational Safety and Health laboratories (Laboratories 1 and 2) at the Pittsburgh Campus. The purpose of this study is to utilize the originally obtained PortaCount C out/C in ratio as a measure of protection factor (PF) and evaluate the influence of particle distribution and filter efficiency. PFs were obtained for five N95 model FFRs worn by 35 subjects for three donnings (5 models x 35 subjects x 3 donnings) for a total of 525 tests in each laboratory. The geometric mean of PFs, geometric standard deviation (GSD), and the 5th percentile values for the five N95 FFR models were calculated for the two laboratories. Filter efficiency was obtained by measuring the penetration for four models (A, B, C, and D) against Laboratory 2 aerosol using two condensation particle counters. Particle size distribution, measured using a Scanning Mobility Particle Sizer, showed a mean count median diameter (CMD) of 82nm in Laboratory 1 and 131nm in Laboratory 2. The smaller CMD showed relatively higher concentration of nanoparticles in Laboratory 1 than in Laboratory 2. Results showed that the PFs and 5th percentile values for two models (B and E) were larger than other three models (A, C, and D) in both laboratories. The PFs and 5th percentile values of models B and E in Laboratory 1 with a count median diameter (CMD) of 82nm were smaller than in Laboratory 2 with a CMD of 131nm, indicating an association between particle size distribution and PF. The three lower efficiency models (A, C, and D) showed lower PF values than the higher efficiency model B showing the influence of filter efficiency on PF value. Overall, the data show that particle size distribution and filter efficiency influence the PFs and 5th percentile values. The PFs and 5th percentile values decreased with increasing nanoparticle concentration (from CMD of 131 to 82nm) indicating lower PFs for aerosol distribution within nanoparticle size range (<100nm). Further studies on the relationship between particle size distribution and PF are needed to better understand the respiratory protection against nanoparticles. |
Effect of calibration environment on the performance of direct-reading organic vapor monitors
LeBouf RF , Slaven JE , Coffey CC . J Air Waste Manag Assoc 2013 63 (5) 528-533 The performance of two direct-reading organic vapor monitors (monitors) when calibrated at different environmental conditions was compared with charcoal tube results. Three MIRAN SapphIRe portable ambient air analyzers (SAP) and three Century portable toxic vapor analyzers (TVAs) were evaluated. Prior to sampling, the monitors were calibrated per the manufacturer's instructions using methane for the TVA flame ionization detector (FID) and isobutylene for the photoionization detector (PID), whereas the SapphIRe instruments were zeroed and the instrument's manufacturer-supplied library was used. For the first series of tests (Part 1Same condition), the monitors were calibrated under the same environmental conditions as those present during sampling. They were then challenged with four cyclohexane concentrations (30, 150, 300, and 475 ppm) under two extreme environmental conditions: 5 degrees C and 30% relative humidity (RH) (same/cold) and 38 degrees C and 90% RH (same/hot). For the second series of tests (Part 2Different condition), the monitors were calibrated at approximately normal indoor environmental conditions (21 degrees C and 50% RH) and sampled at extreme environmental conditions (different/cold and different/hot). The monitor readings from the two methods were compared with the actual cyclohexane concentration determined from charcoal tubes using ratios and root mean square errors. A number of monitor failures, both below detection limit values in the presence of a known challenge concentration and erroneously high measurements, occurred in each part: same condition 20.7% (149/720) and different condition 42.4% (305/720), with a majority of the failures (>78%) during the hot and humid conditions. All monitors performed best at the same/cold, followed by the same/hot, in terms of closeness to the reference standard method and low within-monitor variability. The ranked choice of monitors for same/cold is PID > SAP > FID; for different/cold FID > PID > SAP; for same/hot SAP > PID > FID; and for different/hot PID > SAP (FID not included due to 100% failure rate). Implications: Direct-reading organic vapor monitors are used for assessing the concentrations of volatile organic compounds in the air at varying environmental conditions. Typical calibration is performed at laboratory temperature and pressure. The monitors may be used in atmospheres that differ from that during calibration. An understanding of the effect of calibration environment on monitor performance may provide valuable information on the reliability and appropriateness of certain monitor types for industrial hygienists, emergency responders, and exposure assessment practitioners. Results of the study indicate monitor calibration should be performed at the same environmental conditions as sampling. |
Ecology of potential West Nile virus vectors in southeastern Louisiana: enzootic transmission in the relative absence of Culex quinquefasciatus
Godsey MS Jr , King RJ , Burkhalter K , Delorey M , Colton L , Charnetzky D , Sutherland G , Ezenwa VO , Wilson LA , Coffey M , Milheim LE , Taylor VG , Palmisano C , Wesson DM , Guptill SC . Am J Trop Med Hyg 2013 88 (5) 986-96 A study of West Nile virus (WNV) ecology was conducted in St. Tammany Parish, Louisiana, from 2002 to 2004. Mosquitoes were collected weekly throughout the year using Centers for Disease Control and Prevention (CDC) light traps placed at 1.5 and 6 m above the ground and gravid traps. A total of 379,466 mosquitoes was collected. WNV was identified in 33 pools of mosquitoes comprising five species; 23 positive pools were from Culex nigripalpus collected during 2003. Significantly more positive pools were obtained from Cx. nigripalpus collected in traps placed at 6 m than 1.5 m that year, but abundance did not differ by trap height. In contrast, Cx. nigripalpus abundance was significantly greater in traps placed at 6 m in 2002 and 2004. Annual temporal variation in Cx. nigripalpus peak seasonal abundance has significant implications for WNV transmission in Louisiana. Two WNV-positive pools, one each from Anopheles crucians s.l. and Cx. erraticus, were collected during the winter of 2004, showing year-round transmission. The potential roles of additional mosquito species in WNV transmission in southeastern Louisiana are discussed. |
Effect of calibration and environmental condition on the performance of direct-reading organic vapor monitors
Coffey C , Lebouf R , Lee L , Slaven J , Martin S . J Occup Environ Hyg 2012 9 (11) 670-80 The performance of three MIRAN SapphIRe Portable Infrared Ambient Air Analyzers and three Century Portable Toxic Vapor Analyzers equipped with photoionization (PID) and flame ionization (FID) detectors was compared with charcoal tube sampling. Relationships were investigated using two different calibration methods at four cyclohexane concentrations, three temperatures, and four relative humidities. For the first method, the TVA monitors were calibrated with a single concentration of methane for the FID, and isobutylene for the PID. The SapphIRe monitors were zeroed and the monitor's manufacturer-supplied library was used. For the second method, a five-point cyclohexane calibration curve was created for each monitor. Comparison of the monitor results of each calibration method (pooled data) indicated a significant difference between methods (t-test, p < 0.001), The SapphIRe group had results closer to the charcoal tubes with the second calibration method, while the PID and FID monitor groups performed better using the first calibration method. The PID monitor group's performance was affected only at the 90% relative humidity (RH) condition. Using the first method, the monitor readings were compared with the charcoal tube average using mixed linear model analyses of variance (ANOVAs) and regression. The ANOVA results showed there was a statistically significant difference among readings from all monitor types (p <0.0001). The regression results demonstrated that the SapphIRe (r(2) = 0.97) and FID (r(2) = 0.92) monitor groups correlated well with the charcoal tubes. The PID monitor group had a similar correlation when 90% RH was excluded (r(2) = 0.94) but had a weaker correlation when it was included (r(2) = 0.58). The operator should take care when using these monitors at high concentrations and the PID monitors at high humidities, consider the variability between units of the same monitor, and conduct performance verification of the monitor being used. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a program listing, schematic diagrams, and other design details for the test automation system.]. |
Quantity and size distribution of cough-generated aerosol particles produced by influenza patients during and after illness
Lindsley WG , Pearce TA , Hudnall JB , Davis KA , Davis SM , Fisher MA , Khakoo R , Palmer JE , Clark KE , Celik I , Coffey CC , Blachere FM , Beezhold DH . J Occup Environ Hyg 2012 9 (7) 443-9 The question of whether influenza is transmitted to a significant degree by aerosols remains controversial, in part, because little is known about the quantity and size of potentially infectious airborne particles produced by people with influenza. In this study, the size and amount of aerosol particles produced by nine subjects during coughing were measured while they had influenza and after they had recovered, using a laser aerosol particle spectrometer with a size range of 0.35 to 10 mcm. Individuals with influenza produce a significantly greater volume of aerosol when ill compared with afterward (p = 0.0143). When the patients had influenza, their average cough aerosol volume was 38.3 picoliters (pL) of particles per cough (SD 43.7); after patients recovered, the average volume was 26.4 pL per cough (SD 45.6). The number of particles produced per cough was also higher when subjects had influenza (average 75,400 particles/cough, SD 97,300) compared with afterward (average 52,200, SD 98,600), although the difference did not reach statistical significance (p = 0.1042). The average number of particles expelled per cough varied widely from patient to patient, ranging from 900 to 302,200 particles/cough while subjects had influenza and 1100 to 308,600 particles/cough after recovery. When the subjects had influenza, an average of 63% of each subject's cough aerosol particle volume in the detection range was in the respirable size fraction (SD 22%), indicating that these particles could reach the alveolar region of the lungs if inhaled by another person. This enhancement in aerosol generation during illness may play an important role in influenza transmission and suggests that a better understanding of this phenomenon is needed to predict the production and dissemination of influenza-laden aerosols by people infected with this virus. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a PDF file of demographic information, influenza test results, and volume and peak flow rate during each cough and a PDF file containing number and size of aerosol particles produced.] |
A review of the effectiveness and acceptability of the female condom for dual protection
Gallo MF , Kilbourne-Brook M , Coffey PS . Sex Health 2012 9 (1) 18-26 The female condom remains the sole female-initiated method of dual protection against unintended pregnancy and sexually transmissible infections (STIs), including HIV. We reviewed published data on the effectiveness and acceptability of the female condom for protection against pregnancy and infection. Overall, use of the female condom is low and several barriers hinder the wider adoption of the use of the method. Research on effectiveness has focussed on pregnancy, STIs and biological markers of semen exposure. Although the data available suggest that female condoms (or a mixture of female and male condoms) may provide similar degrees of protection against pregnancy and STIs as do latex male condoms alone, this conclusion has not been demonstrated and thus comparative research is urgently needed. |
Validation of an evacuated canister method for measuring part-per-billion levels of chemical warfare agent simulants
Coffey CC , LeBouf RF , Calvert CA , Slaven JE . J Air Waste Manag Assoc 2011 61 (8) 826-833 The National Institute for Occupational Safety and Health (NIOSH) research on direct-reading instruments (DRIs) needed an instantaneous sampling method to provide independent confirmation of the concentrations of chemical warfare agent (CWA) simulants. It was determined that evacuated canisters would be the method of choice. There is no method specifically validated for volatile organic compounds (VOCs) in the NIOSH Manual of Analytical Methods. The purpose of this study was to validate an evacuated canister method for sampling seven specific VOCs that can be used as a simulant for CWA agents (cyclohexane) or influence the DRI measurement of CWA agents (acetone, chloroform, methylene chloride, methyl ethyl ketone, hexane, and carbon tetrachloride [CCl(4)]). The method used 6-L evacuated stainless-steel fused silica-lined canisters to sample the atmosphere containing VOCs. The contents of the canisters were then introduced into an autosampler/preconcentrator using a microscale purge and trap (MPT) method. The MPT method trapped and concentrated the VOCs in the air sample and removed most of the carbon dioxide and water vapor. After preconcentration, the samples were analyzed using a gas chromatograph with a mass selective detector. The method was tested, evaluated, and validated using the NIOSH recommended guidelines. The evaluation consisted of determining the optimum concentration range for the method; the sample stability over 30 days; and the accuracy, precision, and bias of the method. This method meets the NIOSH guidelines for six of the seven compounds (excluding acetone) tested in the range of 2.3-50 parts per billion (ppb), making it suitable for sampling of these VOCs at the ppb level. |
Integrating direct-reading exposure assessment methods into industrial hygiene practice
Pearce T , Coffey C . J Occup Environ Hyg 2011 8 (5) 31-6 Real-time and near real-time methods for assessing workplace exposures are becoming increasingly available. While many conventional exposure assessment methods require collecting the agent of interest on some type of sampling media and subsequently sending it to a commercial laboratory for analysis, some workplace hazards are already routinely monitored in real time. Noise is the primary example of a workplace hazard that is monitored by direct-reading instruments, with the regulation governing the allowable exposure also specifying the operating characteristics for the monitors | Advancements in the technology for monitoring the range of workplace hazards have led to increased usage of real-time monitoring either as a supplement to or a replacement for conventional workplace sampling. Direct-reading methods are also being used in innovative ways, such as for identifying workplace factors that influence exposure (determinants of exposure). Such characterization is possible because these methods have unique capabilities for measuring peak concentrations and for differentiating exposures across different work tasks or manufacturing processes; such determinations are not usually possible with conventional time-weighted average (TWA) exposure assessment methods. |
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