Exhalation time characterizing exhaustion while wearing respiratory protective masks.
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Biomedical subjects
Publications and source records attributed to A T Johnson.
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Over the past few decades new procedures and technologies have been introduced into clinical practice for the evaluation and management of breast disease. Ultrasound is rapidly becoming a valued tool in the armamentarium of the breast surgeon. The use of ultrasound by radiologists and breast surgeons to evaluate nonpalpalable detected breast lesions has increased dramatically. With its easy portability and improvements in the technology, the use of ultrasound has now expanded into the operating room. In this work we review the value of intraoperative ultrasound and other techniques in obtaining and assessing margin status.
In the premature infant, exposure of the incompletely vascularized retina to increased oxygen tension can result in the development of a blinding disease, retinopathy of prematurity (ROP). Despite the judicious curtailment of oxygen, the incidence of ROP is on the increase due to the technological advances that have improved the survival of the very young preterm infant. Six clinical trials have documented the efficacy of vitamin E supplementation in suppressing the development of severe ROP, but the mechanism of this protection has remained unknown. This report proposes that spindle cells, mesenchymal precursors of the inner retinal capillaries, are the primary inducers of the neovascularization associated with ROP. Exposure of spindle cells to elevated oxygen tension increases their gap junction area. This early morphologic event immediately halts the normal vasoformative process and eventually triggers the neovascularization that is observed clinically 8-12 weeks later. Vitamin E supplementation above the deficient plasma levels of these infants suppresses gap junction formation and clinically reduces the severity without altering the total incidence of ROP.
Respirator inspiratory resistance can affect performance times, especially when the experiment is optimized to elicit respiratory stress. Twelve subjects performed on a treadmill at constant speeds and grades chosen to result in performance times of 5-15 min. Six levels of inspiratory resistance were used, ranging from 0.78 to 7.64 cm H2O.sec/L. The results showed that performance times decrease linearly with resistance level, and no threshold resistance value is apparent. Inspiratory resistance also induces hypoventilation, with lower minute volumes and lower oxygen consumption values at higher resistances. These trends are also linear. From these results, there is no value for inspiratory resistance that can be given as a design goal. Other parameters such as weight and space may dictate filter resistance values, and these, in turn, will lead to determined performance degradations.
Respirators have been found to degrade communication effectiveness when wearers speak face-to-face. However, little is known about communication effectiveness when using the telephone and wearing a respirator. Eleven pairs of subjects were asked to pronounce and identify words chosen from Modified Rhyme Test lists. Each word appeared on a computer screen in one room and the speaker said the word into the telephone. The listener in another room identified the word and typed it into a computer linked with the first. Subjects wore U.S. Army M40 full-facepiece air-purifying respirators with hoods. Three different speech diaphragm arrangements and two hood materials were tested. Results show that accuracy suffered by about 10% when respirators and hoods were worn compared with the control condition. Word identification speed was one-third to one-half of the control (no respirator or hood) condition depending on specific equipment worn.
Respirator dead volume accumulates exhaled carbon dioxide and returns it to the respiratory system during subsequent inhalations. Because inhaled carbon dioxide is known to be a powerful respiratory stimulant and psychoactive gas, respirator dead volume would be expected to influence performance times while respirators are worn during work. This experiment was performed at intense levels of treadmill walking (80-85% VO2max) to demonstrate maximum sensitivity to respiratory stress. Six dead volume conditions (representing a range of 280 to 1,160 mL) were imposed on the subjects. Results show linear decreases in performance times and breathing apparatus comfort with increasing dead volumes. For each 350 mL of external dead volume, a 19% decrease of performance time and an 18% decrease in breathing apparatus comfort can be expected.
This study evaluated performance of individuals exercising at a fixed workload and wearing full-facepiece respirators modified to provide expiratory resistances of 0.27, 0.47, 1.81, 4.43, and 12.27 cmH20 x s x L(-1). On five separate occasions, 15 volunteers exercised to voluntary endpoint on a treadmill at fixed speeds and grades chosen to elicit 85% of maximal aerobic capacity for an unencumbered condition. Exercise performance time was recorded at the cessation of each test. Results showed that performance time decreased linearly (R2 = 0.79; p<0.001) with increased resistances, and no threshold value below which expiratory resistance has no impact on performance was found. Average oxygen consumption rates and minute ventilation also decreased linearly with increased expiratory resistances, indicating that increases in expiratory resistance result in a considerable level of hypoventilation. From the perspective of respirator design, the results of this study suggest that the only practical expiratory resistance level limitation is the reduction in performance that will be acceptable to the end users.
Previous work showed that telephone communications while wearing military respirators degraded both word comprehension and recognition speed. In addition, electronic amplification of the speech diaphragm signal had shown no advantage to the extra hardware. This experiment was performed to test effects of different configurations of commercially available respirators on telephone communications accuracy and speed. Twelve pairs of subjects were separated into different rooms and communicated by telephone. Modified rhyme-test words were presented by computer to the speaker, who transmitted the word by telephone to the listener. During the first replication, subjects were given no instruction about telephone communications procedure. During the second replication subjects followed a communications protocol that instructed them when to move the telephone handset from their ears to their mouths. Results showed that the protocol uniformly improved communications accuracy without incurring any extra time penalty. Word comprehension was still twice as fast without a respirator as with a respirator. Accuracy with the protocol nearly equaled the no respirator control value for most respirators tested.
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