James Blando

Secondary organic aerosol formation in cloud and fog droplets: a literature evaluation of plausibility

This paper investigates the hypothesis that cloud and fog processes produce fine organic particulate matter in the atmosphere. The evidence provided suggests that cloud and fog processes could be important contributors to secondary organic aerosol formation, and the contribution of this formation pathway should be further investigated. This conclusion is based on the following observations: (1) many organic vapors present in the atmosphere are sorbed by suspended droplets and have been measured in cloud and fog water, (2) organics participate in aqueous-phase reactions, and (3) organic particulate matter is sometimes found in the size mode attributed to cloud processing (i.e. the droplet mode). Specific compounds identified as potential precursors include aldehydes (e.g. formaldehyde, acetaldehyde, and propionaldehyde), acetone, alcohols (e.g. methanol, ethanol, 2-propanol, and phenol), monocarboxylic acids, and organic peroxides. Carboxylic acids (e.g. diacids and oxo-acids), glyoxal, esters, organosulfur compounds, polyols, amines and amino acids are potential products of cloud and fog processing.

Workplace violence prevention programs in hospital emergency departments

Objective: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. Methods: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. Results: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. Conclusions: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.

Workplace Violence Prevention Programs in Psychiatric Units and Facilities

Psychiatric health care providers have high rates of workplace violence victimization, yet little is known about the strategies used by facilities to reduce violence. This study compared workplace violence prevention (WVP) programs in psychiatric units and facilities in California and New Jersey. Information was collected through interviews, a facility walk-through, and a review of written policies and training material. A similar proportion of hospitals in both states had WVP training programs. A higher proportion of hospitals in California had written WVP policies, and a higher proportion of New Jersey hospitals had implemented environmental and security modifications to reduce violence. Legislation is one of many potential approaches to increase workplace violence prevention programs in health care settings.

Hospital Employee Assault Rates Before and After Enactment of the California Hospital Safety and Security Act

PURPOSE This study examines changes in violent event rates to hospital employees before and after enactment of the California Hospital Safety and Security Act in 1995. METHODS We compared pre- and post-initiative employee assault rates in California (n = 116) emergency departments and psychiatric units with those in New Jersey (n = 50), where statewide workplace violence initiatives do not exist. Poisson regression with generalized estimating equations was used to compare assault rates between a 3-year pre-enactment period (1993-1995) and a 6-year post-enactment period (1996-2001) using New Jersey hospitals as a temporal control. RESULTS Assault rates among emergency department employees decreased 48% in California post-enactment, compared with emergency department employee assault rates in New Jersey (rate ratio [RR] = 0.52, 95% confidence interval [CI]: 0.31, 0.90). Emergency department employee assault rates decreased in smaller facilities (RR = 0.46, 95% CI: 0.21, 0.96) and for-profit-controlled hospitals (RR = 0.39, 95% CI: 0.19, 0.79) post-enactment. Among psychiatric units, for-profit-controlled hospitals (RR = 0.41, 95% CI: 0.19, 0.85) and hospitals located in smaller communities (RR = 0.44, 95% CI: 0.21, 0.92) experienced decreased assault rates post-enactment. CONCLUSION Policy may be an effective method to increase safety to health care workers.

Emergency Department Security Programs, Community Crime, and Employee Assaults

BACKGROUND Violence against health care workers is a serious occupational health hazard, especially for emergency department (ED) employees. A significant degree of variability in security programs among hospital EDs is present in part due to the absence of federal legislation requiring baseline security features. Nationally, only voluntary guidelines from the Occupational Safety and Health Administration (OSHA) for the protection of health care workers exist. OBJECTIVES The purpose of this study was to examine ED security programs and employee assault rates among EDs with different financial resources, size, and background community crime rates. METHODS This cross-sectional survey was conducted among large and small hospitals located in communities with low or high rates of community crime. Hospital financial data were collected through the state health department, and employee assault data were abstracted from hospital OSHA logs. Comparisons were made using a chi-squared or Wilcoxon test. RESULTS Small hospitals located in towns with low community crime rates implemented the fewest security program features despite having the second highest rate of assault-related OSHA-recordable injuries among ED employees (0.66 per 100,000 staff hours). CONCLUSION Due to the highly stressful workplace characteristics of EDs, the risk of employee assault is universal among all hospital sizes in all types of communities.

Preliminary Study of Propyl Bromide Exposure among New Jersey Dry Cleaners as a Result of a Pending Ban on Perchloroethylene

Abstract Many states are considering, and some states have actively pursued, banning the use of perchloroethylene (PERC) in dry cleaning establishments. Proposed legislation has led many dry cleaners to consider the use of products that contain greater than 90% n-propyl bromide (n-PB; also called 1-bromopropane or 1-BP). Very little information is known about toxicity and exposure to n-PB. Some n-PB-containing products are marketed as nonhazardous and “green” or “organic.” This has resulted in some users perceiving the solvent as nontoxic and has resulted in at least one significant poisoning incident in New Jersey. In addition, many dry cleaning operators may not realize that the machine components and settings must be changed when converting from PERC to n-PB containing products. Not performing these modifications may result in overheating and significant leaks in the dry cleaning equipment. A preliminary investigation was conducted of the potential exposures to n-PB and isopropyl bromide (iso-PB; also called 2-bromopropane or 2-BP) among dry cleaners in New Jersey who have converted their machines from PERC to these new solvent products. Personal breathing zone and area samples were collected using the National Institute for Occupational Safety and Health Sampling and Analytical Method 1025, with a slight modification to gas chromatography conditions to facilitate better separation of n-PB from iso-PB. During the preliminary investigation, exposures to n-PB among some workers in two of three shops were measured that were greater than the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) for n-PB. The highest exposure measured among a dry cleaning machine operator was 54 parts per million (ppm) as an 8-hr time-weighted average, which is more than 5 times the ACGIH TLV of 10 ppm. The preliminary investigation also found that the work tasks most likely to result in the highest short-term exposures included the introduction of solvent to the machine, maintenance of the machine, unloading and handling of recently cleaned clothes, and interrupting the wash cycle of the machine. In addition, this assessment suggested that leaks may have contributed to exposure and may have resulted from normal machine wear over time, ineffective maintenance, and from the incompatibility of n-PB with gasket materials.

Assessment of potassium iodide (KI) distribution program among communities within the emergency planning zones (EPZ) of two nuclear power plants.

The primary objective of this study was to evaluate a joint state and local government-sponsored potassium iodide (KI) distribution program in New Jersey. This program is part of a radiological emergency response system for residents living within the Emergency Planning Zones (EPZs) of nuclear power facilities. KI pills and an informational fact sheet were distributed locally at six different public clinics in the summer of 2002. In this study, a mailed survey was developed, pilot tested, and sent to the general public to assess knowledge about KI use. The survey consisted of two groups of people, those who attended a KI distribution clinic and those that did not attend a clinic. There was a statistically significant difference in knowledge among the two groups of survey respondents regarding KI prophylaxis, with a mean of 46% of survey questions answered correctly by those who attended a clinic vs. 15% by those who did not attend. Certain questions were problematic for the public to answer correctly and included potential low compliance with government instructions for taking KI, confusion regarding where the public can obtain KI pills during an emergency, and the lack of awareness on the proper use of KI for children, pregnant women, and persons over the age of 40 y. Additional outreach in these specific areas is warranted. This study also found that there was a highly variable geographic pattern of homes that have a supply of KI pills, with some areas having 60% of the households supplied with pills from the clinic while other areas had as low as 1% of the homes supplied with KI pills.

Evaluation of potassium iodide prophylaxis knowledge and nuclear emergency preparedness: New Jersey 2005.

The Nuclear Regulatory Commission requires states to consider including potassium iodide as a protective measure in the unlikely event of a major release of radioactivity from a nuclear power plant. We evaluated emergency preparedness knowledge, including proper potassium iodide use, among the general public and emergency responders located around New Jerseys nuclear power plants. We found that knowledge about responder chain of command, evacuation routes, and some aspects of potassium iodide usage was incomplete among the general public and emergency responders.

Communicating Information in an Emergency Preparedness Pill Distribution Campaign

OBJECTIVES Public health agencies are often tasked with the development and execution of interventions, but the communication strategy and its impact on the effectiveness of an intervention is often not evaluated or incorporated by local and state health agencies. The primary objective of this study was to determine the impact of information from various sources on knowledge about an emergency preparedness public health intervention involving the mass distribution of medicine. METHODS The study used validated written mail surveys containing 12 simple knowledge-based questions. One-way ANOVA, the Studentized Newman-Keuls (SNK) test, logistic regression, and multiple regression were used to evaluate the data. RESULTS Reading an educational fact sheet or receiving job training were the highest predictive variables for correct responses on the survey among all groups. Commercial media were found to potentially diminish comprehension among survey respondents. There was significant variability in knowledge among different groups surveyed, ranging from an average of 15% to 74% correct responses on the survey. CONCLUSIONS This study found that job training and fact sheets that are delivered directly to the intended recipients are very effective at enhancing knowledge among the general public and emergency responders. Conversely, we found that commercial media, such as television, may be detrimental to educating the public about important public health interventions. The internet was not widely used by the survey respondents to obtain information; this raises questions regarding the usefulness of websites for emergency preparedness education.

Exposure and Health Risk from Swimming in Outdoor Pools Contaminated by Trichloroethylene

ABSTRACT A method was developed that evaluated the exposure and health risk to children from swimming in outdoor pools filled with contaminated water. It was found that dermal absorption of trichloroethylene (TCE) was significantly larger than the inhalation component of the exposures. It was estimated that the inhalation route accounted for only 1% of the total exposure, whereas accidental ingestion was 7% of the childs total intake and the dermal absorbed dose was 92% of the total exposure. The relative percentage of the total exposure estimated for each exposure route indicated that the dermal exposure route and accidental ingestion of pool water should not be ignored for volatile compounds when evaluating exposure. The method utilized was simple enough to use computer spreadsheets for the calculations and can be easily adapted to various swimming scenarios and age groups. This method also included an assessment of the uncertainty in the exposure and risk estimates. The range of estimated exposures was 40 μ g to 442 μ g of TCE per swimming season. All values in this range were below the health benchmark for both non-carcinogenic and carcinogenic endpoints.