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Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence. We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations. Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers. Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving. Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies. • A retrospective video review found factors influencing PPE nonadherence correction. • Many providers did not adhere to PPE policies during aerosol-generating procedures. • Only 10% of nonadherence PPE instances were corrected by providers. • Correction time varied by PPE type and nonadherence level (incomplete vs absent). [ABSTRACT FROM AUTHOR]

Changes in atmosphere and temperature are affecting multiple environmental indicators from extreme heat events to global air quality. Workers will be uniquely affected by climate change, and the occupational impacts of major shifts in atmospheric and weather conditions need greater attention. Climate change-related exposures most likely to differentially affect workers in the USA and globally include heat, ozone, polycyclic aromatic hydrocarbons, other chemicals, pathogenic microorganisms, vector-borne diseases, violence, and wildfires. Epidemiologic evidence documents a U-, J-, or V-shaped relationship between temperature and mortality. Whereas heat-related morbidity and mortality risks are most evident in agriculture, many other outdoor occupational sectors are also at risk, including construction, transportation, landscaping, firefighting, and other emergency response operations. The toxicity of chemicals change under hyperthermic conditions, particularly for pesticides and ozone. Combined with climate-related changes in chemical transport and distribution, these interactions represent unique health risks specifically to workers. Links between heat and interpersonal conflict including violence require attention because they pose threats to the safety of emergency medicine, peacekeeping and humanitarian relief, and public safety professionals. Recommendations for anticipating how US workers will be most susceptible to climate change include formal monitoring systems for agricultural workers; modeling scenarios focusing on occupational impacts of extreme climate events including floods, wildfires, and chemical spills; and national research agenda setting focusing on control and mitigation of occupational susceptibility to climate change.

This research investigated the influence of exercise activities, situational factors, and personality on a submaximal cycle ergometry test (SCET). Data were collected via a questionnaire administered to 193 active duty Air Force members during their required annual SCET. Multiple regression and ANOVA were used to find the relative influence of each factor on the estimated maximal rate of oxygen uptake (VO2max) determined by the SCET. For the group as a whole, self-reported test anxiety explained 24% of the variance in SCET results, while self-reported aerobic caloric expenditure explained only 10%. For runners, test anxiety explained 26%, and calories expended running explained only 5%. For cyclists, calories expended cycling explained 53%of the variance, while test anxiety had no influence on SCET results. The results indicate that for non-cyclists, high test anxiety results in an underestimation of VO2max as determined by the SCET. The exercise that has the greatest influence on increasing SCET scores is cycling. Increased time or intensity spent running does not significantly enhance SCET performance. [ABSTRACT FROM AUTHOR]

The portable high-efficiency air filtration (PHEAF) device is used to control particulate matter (PM) generated from construction-type activities occurring within the built environment. Examples of activities where PHEAF devices are mobilized include building renovation, asbestos abatement, remediation of microbial contamination, and lead-based paint projects. Designed for use on short-term, temporary projects the PHEAF device captures airborne PM using a high-efficiency particulate air (HEPA) filter. This study sought to evaluate the capture efficiency of the PHEAF device in a field setting. An aerosol generator and photometer were used to measure particle penetration through 85 PHEAF devices. Average overall capture efficiency ranged from 41.78% to ≥99.97% with more than 88% of the tests failing to achieve 99.97% capture efficiency. Approximately 73% of the PHEAF device sample population failed to demonstrate HEPA performance criteria during any test round. A higher occurrence of PM concentrations measured around the perimeter of the filter suggested the presence of bypass leakage. While PHEAF devices were effective in capturing a significant quantity of aerosol test agent, these findings suggest that routine testing of the PHEAF device should be conducted to validate performance.

Background: Life cycle assessment (LCA) is a systems-based method used to determine potential impacts to the environment associated with a product throughout its life cycle. Conclusions from LCA studies can be applied to support decisions regarding product design or public policy, therefore, all relevant inputs (e.g., raw materials, energy) and outputs (e.g., emissions, waste) to the product system should be evaluated to estimate impacts. Currently, work-related impacts are not routinely considered in LCA. The objectives of this paper are: 1) introduce the work environment disability-adjusted life year (WE-DALY), one portion of a characterization factor used to express the magnitude of impacts to human health attributable to work-related exposures to workplace hazards; 2) outline the methods for calculating the WE-DALY; 3) demonstrate the calculation; and 4) highlight strengths and weaknesses of the methodological approach., Methods: The concept of the WE-DALY and the methodological approach to its calculation is grounded in the World Health Organization's disability-adjusted life year (DALY). Like the DALY, the WE-DALY equation considers the years of life lost due to premature mortality and the years of life lived with disability outcomes to estimate the total number of years of healthy life lost in a population. The equation requires input in the form of the number of fatal and nonfatal injuries and illnesses that occur in the industries relevant to the product system evaluated in the LCA study, the age of the worker at the time of the fatal or nonfatal injury or illness, the severity of the injury or illness, and the duration of time lived with the outcomes of the injury or illness., Results: The methodological approach for the WE-DALY requires data from various sources, multi-step instructions to determine each variable used in the WE-DALY equation, and assumptions based on professional opinion., Conclusions: Results support the use of the WE-DALY in a characterization factor in LCA. Integrating occupational health into LCA studies will provide opportunities to prevent shifting of impacts between the work environment and the environment external to the workplace and co-optimize human health, to include worker health, and environmental health.

Recent Clean Air Act regulations designed to reduce volatile organic compound (VOC) emissions have placed new restrictions on painting operations. Treating large volumes of air which contain dilute quantities of VOCs can be expensive. Recirculating some fraction of the air allows an operator to comply with environmental regulations at reduced cost. However, there is a potential impact on employee safety because indoor pollutants will inevitably increase when air is recirculated. A computer model was developed, written in Microsoft Excel 97, to predict compliance costs and indoor air concentration changes with respect to changes in the level of recirculation for a given facility. The model predicts indoor air concentrations based on product usage and mass balance equations. This article validates the recirculation model using data collected from a C-130 aircraft painting facility at Hill Air Force Base, Utah. Air sampling data and air control cost quotes from vendors were collected for the Hill AFB painting facility and compared to the model's predictions. The model's predictions for strontium chromate and isocyanate air concentrations were generally between the maximum and minimum air sampling points with a tendency to predict near the maximum sampling points. The model's capital cost predictions for a thermal VOC control device ranged from a 14 percent underestimate to a 50 percent overestimate of the average cost quotes. A sensitivity analysis of the variables is also included. The model is demonstrated to be a good evaluation tool in understanding the impact of recirculation.

The 1990 Clean Air Act Amendments resulted in new environmental regulations for hazardous air pollutants. Industries such as painting facilities may have to treat large volumes of air, which increases the cost of an air control system. Recirculating a portion of the air back into the facility is an option to reduce the amount of air to be treated. The authors of this study developed a computer model written in Microsoft Excel 97 to analyze the impact of recirculation on worker safety and compliance costs. The model has a chemical database with over 1300 chemicals. The model will predict indoor air concentrations using mass balance calculations and results are compared to occupational exposure limits. A case study is performed on a C-130 aircraft painting facility at Hill Air Force Base, Utah. The model predicts strontium chromate concentrations found in primer paints will reach 1000 times the exposure limit. Strontium chromate and other solid particulates are nearly unaffected by recirculation because the air is filtered during recirculation. The next highest chemical, hexamethylene diisocyanate, increases from 2.6 to 10.5 times the exposure limit at 0 percent and 75 percent recirculation, respectively. Due to the level of respiratory protection required for the strontium chromate, workers are well protected from the modest increases in concentrations caused by recirculating 75 percent of the air. The initial cost of an air control system is $4.5 million with no recirculation and $1.8 million at 75 percent recirculation. The model is an excellent tool to evaluate air control options with a focus on worker safety. In the case study, the model highlights strontium chromate primers as good candidates for substitution. The model shows that recirculating 75 percent of the air at the Hill painting facility has a negligible impact on safety and could save $2.7 million on the initial expenses of a thermal treatment system.