BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherapy; the cytotoxic solution is administered in the operating room with the abdomen open so that manual distribution results in uniform... more
BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherapy; the cytotoxic solution is administered in the operating room with the abdomen open so that manual distribution results in uniform treatment. The potential risk of this procedure to the operating room personnel has not been previously investigated.METHODS: Mitomycin C was perfused through the peritoneal cavity, which was partially covered by a plastic sheet. Large volumes of air were suctioned from 5 and 35 cm above the abdominal skin edge. Urine from the surgeon and from the perfusionist were assayed. Sterile gloves worn in the operating room for manipulating the viscera during treatment were assayed for their permeability to mitomycin C. All samples were analyzed by high-performance liquid chromatography.RESULTS: Analysis of samples of operating room air and urine from 10 procedures showed no detectable levels of mitomycin C. Six tests of three different types of gloves showed a 10-fold range of mitomycin C penetration. The least permeable gloves leaked a mean of 3.8 parts per million over 90 minutes.CONCLUSIONS: No detectable safety hazard to the surgeon or other operating room personnel was demonstrated.
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Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Eight-six workers... more
Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records. Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve co...
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This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining... more
This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
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ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged case by case in research on innovations, but there is no formal mechanism to explore the transfer of safety and health technologies in the... more
ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged case by case in research on innovations, but there is no formal mechanism to explore the transfer of safety and health technologies in the construction industry. Methods: We will present findings from a symposium sponsored by The Center for Construction Research and Training in May 2012. The meeting will identify drivers for and barriers to moving new, safer tools and equipment from research to practice in the construction industry. Participants will include academics, construction professionals, manufacturers, and trade association representatives. Results and discussion: The symposium will develop recommendations for building and sustaining a technology transfer function for the construction industry. Issues for discussion include: (1) Intellectual property/patents and the role of exclusive vs. non-exclusive licenses for inventions. (2) Cost factors that impact adoption, such as how to quantify the expenses related to implementing, operating, and/or maintaining new safety and health technologies; degree of worker training needed; impact of innovation on job performance and/or quality of work);. (3) Incentives for tech transfer, including the impact of existing regulations on adoption, whether other incentives are sufficient in absence of regulation, and the availability and access to financial incentives for research, manufacturing, and industry adoption (e.g., research funding, subsidized tool evaluation, tax breaks, insurance premium reductions). (4) How to apply diffusion of innovation theory, including the attributes of an innovation that affect diffusion (relative advantage, compatibility, complexity, trialability and observability) and the role of innovators and early adopters in the construction industry.
Causes of permanent work disability in the sheet metal industry are not well characterized. Pension records were used to compare causes of disability among sheet metal workers and the U.S. working population. Subgroup analysis examined... more
Causes of permanent work disability in the sheet metal industry are not well characterized. Pension records were used to compare causes of disability among sheet metal workers and the U.S. working population. Subgroup analysis examined the major causes of sheet metal worker disability. Musculoskeletal disorders (MSDs), circulatory disease, and injuries were leading causes of sheet metal worker disability (47.2%, 13.7%, 10.9% of awards, respectively). Award distribution differed from the U.S. working population (P < 0.0001); MSDs and injuries accounted for higher proportions of sheet metal worker awards, particularly at spine, shoulder, and knee. Higher proportions of awards caused by MSD or injury among sheet metal workers may reflect higher rates of work-related injuries and MSDs, a high likelihood of disability with construction work given the same impairment, or higher prevalence of other conditions in the general population. Prevention requires task-specific ergonomic innovations and proven participatory interventions. Am. J. Ind. Med. 59:186-195, 2016. © 2016 Wiley Periodicals, Inc.
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Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers. We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to... more
Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers. We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to score postures and physical loads, and to observe the use of recommended interventions to reduce physical exposures in sheet metal activities made by a NIOSH stakeholder meeting in 2002. Workers showed consistent use of material handling devices, but we observed few uses of recommended interventions to reduce exposures during overhead work. Workers spent large proportions of time in awkward shoulder elevation and low back rotation postures. In addition to the development of new technologies and system designs, increased adoption of existing tools and practices could reduce time spent in awkward postures and other risks for musculoskeletal disorders in sheet metal work.
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To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and... more
To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed. Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease. Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.
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Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain high. Participatory ergonomics (PE) is an approach to engage workers and employers in identifying and implementing injury prevention... more
Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain high. Participatory ergonomics (PE) is an approach to engage workers and employers in identifying and implementing injury prevention solutions. When evaluated by decreased symptoms or injuries, PE has shown mixed results. Better evaluation of PE efficacy requires measurement of short-term and intermediate impacts. In this presentation we will: 1) describe this PE study implemented in groups of construction workers; 2) present short-term (learning), intermediate (actions), and long-term results; and 3) discuss multi-level factors for improving the implementation and dissemination of PE based on our identified barriers to implementation in construction. Methods: We recruited 96 workers from seven contractors in three trades. We trained workers in ergonomic problem identification and implementation of task-specific solutions. We evaluated our program using mixed methods including data from...
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The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between... more
The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.
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This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with... more
This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
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... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first described by Miller and Wynn in 1908 few therapeutic advances occurred [3]. Systemic chemotherapy, palliative surgery and/or total abdominal... more
... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first described by Miller and Wynn in 1908 few therapeutic advances occurred [3]. Systemic chemotherapy, palliative surgery and/or total abdominal radiation therapy were used selectively, ...
Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims... more
Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder and distal arm, and evaluated differences in claim rates. Fifty-one per cent of floor layers (n=1475) experienced musculoskeletal claims compared with 39% of MarketScan members (p<0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR 2.10 and 2.07). The excess risk was greatest for the neck ...
Research Interests: Health insurance, Adolescent, Construction Industry, Humans, Knee, and 13 moreShoulder, United States, Male, Arm, Young Adult, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Neck, Occupational Diseases, Occupational and environmental medicine, and Lumbosacral Region
Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks. We analyzed 45 videos from 32... more
Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks. We analyzed 45 videos from 32 floor layers using Multimedia-Video Task Analysis software to determine the time in task, forces, postures, and repetitive hand movements for installation of four common flooring materials. We used the WISHA checklists to define exposure thresholds. Most workers (91%) met the caution threshold for one or more exposures. Workers showed high exposures in multiple body parts with variability in exposures across tasks and for different materials. Prolonged exposures were seen for kneeling, poor neck and low back postures, and intermittent but frequent hand grip forces. Floor layers experience prolonged awkward postures and high force physical exposures in multiple body parts, which probably contribute to their high rates of musculoskeletal disorders.
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... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-fledging age in order to evaluate Mb concentration in birds that had never performed the long, deep dives which occur in the wild. ...... more
... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-fledging age in order to evaluate Mb concentration in birds that had never performed the long, deep dives which occur in the wild. ... Individual birds gained 1.9–6.8 kg during captivity. ...
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To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established.... more
To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities.
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Construction is a dangerous industry, with high rates of both fatal and nonfatal injuries. To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work site-based investigations or... more
Construction is a dangerous industry, with high rates of both fatal and nonfatal injuries. To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work site-based investigations or prevention programs, we established an emergency department-based surveillance program in November 1990. This article describes circumstances of injury, diagnoses, and demographic characteristics of injured construction workers for 2,791 cases identified through mid-August, 1997. Lacerations and strains and sprains were the most frequent diagnoses; cutting and piercing objects were the leading causes of injury among all construction workers, followed by falls and overexertion. Because of the variety of work performed in this industry, more detailed injury descriptions, by trade, are most useful for thinking about injury prevention. To illustrate this, we profile injury patterns among workers from four specific trades: carpenters, electricians, plumbers, and ironworkers. Areas of concern highlighted by the trade-specific analyses include eye injuries among plumbers; falls from ladders among electricians and plumbers; slips, trips, and falls on the same level among ironworkers; electrical exposure among electricians; and, amputations among carpenters.
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Research Interests: Health Promotion, Poverty, Community-Based Mental Health Services, Public Health, Adolescent, and 15 moreWorkplace, Humans, Chronic Disease, United States, Female, Male, Young Adult, Social Environment, Aged, Middle Aged, Adult, Public health systems and services research, Occupational therapy services in mental health services, Occupational Diseases, and Community Based Mental Health Services
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A cross-sectional study of unionized construction workers not currently known to be performing lead work was conducted. Participants completed an interviewer-administered questionnaire obtaining information about demographics, work... more
A cross-sectional study of unionized construction workers not currently known to be performing lead work was conducted. Participants completed an interviewer-administered questionnaire obtaining information about demographics, work history, other possible sources of lead exposure and health status (including hypertension, noise-induced hearing loss and renal disease). Blood was then obtained via venipuncture for whole blood lead level, hematocrit and free erythrocyte protoporphyrin determination. Two hundred and sixty-four Maryland construction workers had median whole blood lead determinations of 7 micrograms/dl and mean values of 8.0 micrograms/dl, with a skewed distribution ranging from 2 to 30 micrograms/dl. None were currently engaged in known lead work. Blood lead levels were significantly higher for the 124 who had &#39;ever&#39; worked in demolition (8.8 micrograms/dl vs. 7.2 micrograms/dl, p = .004), and for the 79 who had ever burned paint and metal and welded on outdoor structures compared to the 48 who had done none of these activities (8.6 micrograms/dl vs. 6.8 micrograms/dl, p = .01). The 58 workers who had ever had workplace lead monitoring performed had higher lead levels (9.7 vs. 7.5 micrograms/dl, p = .003). Blood lead levels increased with age, and cigarette smoking. African Americans (N = 68) had higher lead levels (9.1 vs. 7.5 micrograms/dl, p = .01). There were only two women in the study, one with a lead level of 21 micrograms/dl and one, 7 micrograms/dl. Blood lead levels did not predict either systolic or diastolic blood pressure in this population. However, there was a significant interaction between race and lead as predictors of blood pressure, with blacks demonstrating a trend-significant correlation, and whites showing a nonsignificant but negative association. Demolition and hotwork on outdoor structures are known to cause acute episodes of lead poisoning. They also appear to cause slight but persistent increases in blood lead levels. Future workplace regulation should recognize and seek to maintain the low baseline now apparent even in urban, East Coast, construction workers.
Research Interests: Adolescent, Construction Industry, Humans, Hypertension, Smoking, and 21 moreBlood Pressure, Female, Male, Lead, Welding, Regression Analysis, American, Body Mass Index, Maryland, Aged, Middle Aged, Questionnaires, Adult, Public health systems and services research, Age Factors, European Continental Ancestry Group, Biological Monitoring, Cross sectional Study, Occupations, Rate, and Cross Sectional Studies
Semen analysis has proven useful in the clinical diagnosis of infertility and is the most widely used method of monitoring the effects of occupational exposure on male fertility. Collection and analysis of semen samples in a field... more
Semen analysis has proven useful in the clinical diagnosis of infertility and is the most widely used method of monitoring the effects of occupational exposure on male fertility. Collection and analysis of semen samples in a field setting, however, require a highly motivated ...
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Intervention studies in participatory ergonomics (PE) are often difficult to interpret due to limited descriptions of program planning and evaluation. In an ongoing PE program with floor layers, we developed a logic model to describe our... more
Intervention studies in participatory ergonomics (PE) are often difficult to interpret due to limited descriptions of program planning and evaluation. In an ongoing PE program with floor layers, we developed a logic model to describe our program plan, and process and summative evaluations designed to describe the efficacy of the program. The logic model was a useful tool for describing the program elements and subsequent modifications. The process evaluation measured how well the program was delivered as intended, and revealed the need for program modifications. The summative evaluation provided early measures of the efficacy of the program as delivered. Inadequate information on program delivery may lead to erroneous conclusions about intervention efficacy due to Type III error. A logic model guided the delivery and evaluation of our intervention and provides useful information to aid interpretation of results.
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Hemoglobin, hematocrit, red cell indices, total and differential white blood cell counts, and platelet count were measured in shipyard painters and control subjects as part of a cross-sectional, observational study of the effects of... more
Hemoglobin, hematocrit, red cell indices, total and differential white blood cell counts, and platelet count were measured in shipyard painters and control subjects as part of a cross-sectional, observational study of the effects of ethylene glycol ethers. Although the means of all variables were comparable between the groups, a significant proportion of painters were anemic (10%) and granulocytopenic (5%); none of the controls were affected. Review of company records documented that most of these abnormalities were acquired during employment; preexisting disease and other exposure could not explain the findings. These findings are consistent with prior animal studies and human case reports. Potential biases and confounding of the data are discussed.
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In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust to examine the health hazards of the sheet metal industry... more
In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust to examine the health hazards of the sheet metal industry in the United States and Canada. Between 1986 and 2004, 18,211 individuals were examined. The mean age of this cohort was 57.9 years, and the