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OBJECTIVE:: Coronary heart disease (CHD) is the primary cause of death among US firefighters during fire suppression. In other populations, exposure to respirable particles, including ultrafine particles, has been widely implicated as a risk factor for CHD. This study is the first to report detailed characterization of respirable particles released by combustion of an automobile and model residential structures under firefighter exposure conditions. METHODS:: Characterization was performed when feasible during knockdown and routinely during overhaul. RESULTS:: Ultrafines accounted for >70% of particles in all fire suppression stages, occurring in concentrations exceeding background by factors between 2 (automobile) and 400 (bedroom), consistent among all structures. CONCLUSIONS:: Exposure to ultrafine particles during fire suppression should be considered a potential contributing factor for CHD in firefighters. Of major significance is their predominance during overhaul, where firefighters frequently remove respiratory protection. [ABSTRACT FROM AUTHOR]

This report updates U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens have been changed. This report emphasizes adherence to HIV PEP when it is indicated for an exposure, expert consultation in management of exposures, follow-up of exposed workers to improve adherence to PEP, and monitoring for adverse events, including seroconversion. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns. [ABSTRACT FROM AUTHOR]

To examine the effect of lowest core body temperature on adverse outcomes associated with coronary artery bypass graft (CABG) surgery, data were collected on 7134 isolated CABG procedures carried out in New England from 1997 to 2000. Excluded from the analysis were patients with pump times < 60 and > 120 min and those operated upon using continuous warm cardioplegia. Data for lowest core temperature were divided into quartiles for analysis ( < 31.4 degrees C, 31.5-33.1 degrees C, 33.2-34.3 degrees C, and 2 34.4 degrees C). Patients with lower core body temperature on cardiopulmonary bypass (CPB) had higher in-hospital mortality rates. Crude mortality rates were 2.9% in the < or = 31.4 degrees C group, 2.1% in the 31.5-33.1 degrees C group, 1.3% in the 33.2-34.3 degrees C group and 1.2% in the > or = 34.4 degrees C group. The trend toward higher mortality as core temperature decreased was statistically significant (P(trend) < 0.001). Adjustment for differences in patient and disease characteristics did not significantly change the results and the test of trend remained significant (p < 0.001). Rates of perioperative stroke were somewhat lower in the colder groups. Rates in the two colder groups were 0.9% compared with 1.6% and 1.4% in the warmer groups (P(trend) = 0.082). This remained a marginal but significant trend after adjustment for possible confounding factors (p = 0.044). Low core body temperatures on CPB are associated with higher rates of in-hospital mortality among isolated CABG patients. Rates of intra- or postoperative use of an intra-aortic balloon pump are also higher with lower core temperatures. We concluded that temperature management strategy during CABG surgery has an important effect on patient outcomes. [ABSTRACT FROM AUTHOR]