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PubMed2000

Flow limitation and dynamic hyperinflation during exercise in COPD patients after single lung transplantation.

STUDY OBJECTIVE: Using the negative expiratory pressure (NEP) method, we have previously shown that patients receiving single lung transplantation (SLT) for COPD do not exhibit expiratory flow limitation and have little dyspnea at rest. In the present study, we assessed whether SLT patients exhibit flow limitation, overall hyperinflation, and dyspnea during exercise. METHODS: Expiratory flow limitation assessed by the NEP method and inspiratory capacity maneuvers used to determine end-expiratory lung volume (EELV) and end-inspiratory lung volume (EILV) were performed at rest and during symptom-limited incremental cycle exercise in eight SLT patients. RESULTS: At the time of the study, the mean (+/- SD) FEV(1), FVC, functional residual capacity, and total lung capacity (TLC) amounted to 55 +/- 14%, 67 +/- 12%, 137 +/- 16%, and 110 +/- 11% of predicted, respectively. At rest, all patients did not experience expiratory flow limitation and were without dyspnea. At peak exercise, the maximal mechanical power output and maximal oxygen consumption amounted to 72 +/- 20% and 65 +/- 8% of predicted, respectively, with a maximal dyspnea Borg score of 6 +/- 3. All but one patient exhibited flow limitation and dynamic hyperinflation; the EELV and EILV amounted to 74 +/- 5% and 95 +/- 9% TLC, respectively. The patient who did not exhibit flow limitation during exercise had the lowest dyspnea score. CONCLUSION: Most SLT patients for COPD exhibit expiratory flow limitation and dynamic hyperinflation during exercise, whereas maximal dyspnea is variable.

Aged↗
PubMed1997

Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring.

OBJECTIVE: The purpose of our study was to determine if three-level thin-section CT depicts idiopathic pulmonary fibrosis (IPF) pathology as accurately as CT obtained at 10-mm increments throughout the entire lungs. SUBJECTS AND METHODS: Thin-section (1.0- to 1.5-mm) images at 10-mm increments were obtained and scored prospectively in 25 consecutive patients with newly diagnosed IPF who were participating in a Special Center of Research grant for interstitial lung disease. Each patient's lobe was scored by four thoracic radiologists on a scale of 0-5 for both ground-glass attenuation and fibrosis. The radiologists used three images (limited CT) and also used the entire data set (complete CT). CT scores were compared with pathology scores from 67 open and thoracoscopic biopsies. Limited and complete scores were compared with each other (Pearson correlation coefficient). Interobserver variation in the CT scoring system was assessed using kappa values. RESULTS: CT fibrosis scores strongly correlated with pathology fibrosis scores for complete (r = .53, p = .0001) and limited (r = .50, p = .0001) CT. CT ground-glass scores correlated with the histologic inflammatory scores for each lobe on complete (r = .27, p = .03) and limited (r = .26, p = .03) CT. The desquamative subcomponent of the pathology inflammatory score had the highest correlation with the CT ground-glass scores (complete: r = .29, p = .01; limited: r = .33, p = .007). Good interobserver agreement existed for both the alveolar and fibrosis components of the CT scoring system (kappa values ranging from .51 to .83) for each lobe of the lung on limited and complete CT. CONCLUSION: Limited thin-section CT reveals the pathologic changes associated with IPF as well as CT obtained at 10-mm increments. An added advantage of limited thin-section CT is that it exposes patients to less radiation.

Adult↗
PubMed2001

Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography.

OBJECTIVE: The purpose of this investigation is to determine the sensitivity, specificity, and accuracy of unenhanced limited CT of the abdomen in children with suspected appendicitis and compare these results with graded compression sonography. MATERIALS AND METHODS: Seventy-six children underwent unenhanced limited CT over a 11-month period for evaluation of suspected appendicitis. A historical cohort of 86 consecutive children who had undergone graded compression sonography was identified. Results were correlated with surgical, pathologic, chart, and clinical follow-up data. The sensitivity, specificity, accuracy, rate of alternate diagnosis, time to perform examinations, and charge at our institution were determined for unenhanced limited CT and sonography. RESULTS: Sensitivity, specificity, and accuracy for unenhanced limited CT were 97%, 100%, 99%, respectively, and were 100%, 88%, 91%, respectively, for sonography. Alternate diagnoses were suggested in 35% and 28% children without appendicitis who had unenhanced limited CT and sonography, respectively. Unenhanced limited CT required 5 min and sonography required 20-30 min to perform. The charge at our institution was $408 for unenhanced limited CT and $295 for sonography. CONCLUSIONS: CT can be performed rapidly in children without IV, oral, or rectal contrast medium. Unenhanced limited CT and sonography are highly sensitive, specific, and accurate in the evaluation of children with suspected appendicitis.

Abdomen↗
PubMed1998

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after October 1, 1997--HCFA. Notice with comment period.

This notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program for cost reporting periods beginning on or after October 1, 1997. These limits replace the per visit limits that were set forth in our July 1, 1996 notice with comment period (61 FR 34344) and supersede those set forth in our July 1, 1997 notice with comment period (61 FR 35608). This notice also provides, in accordance with the Balanced Budget Act of 1997, that there be no changes in the home health per visit limits for cost reporting periods beginning on or after July 1, 1997 and before October 1, 1997 (that is, the cost limits set forth in our July 1, 1996 notice will apply to cost reporting periods beginning during this time period); that the establishment of the cost per visit limitations for cost reporting periods beginning on or after October 1, 1997 be based on 105 percent of the median of the labor-related and nonlabor per visit costs for freestanding home health agencies; that there be no updates in the home health costs limits (including no adjustments for changes in the wage index or other updates) for cost reporting periods beginning on or after July 1, 1994 and before July 1, 1996; and the wage index value that is applied to the labor portion of the per visit limitations be based on the geographic area in which the home health service is furnished.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1982

Medicare program; schedule of limits on hospital inpatient operating costs for cost reporting periods beginning on or after October 1, 1982--HCFA. Interim final notice with comment period.

This notice sets forth a schedule of limits on the hospital inpatient operating costs that may be reimbursed under Medicare for cost reporting periods beginning on or after October 1, 1982. These limits are needed to implement changes in the Medicare law that were made by section 101(a) of Pub. L. 97-248, the Tax Equity and Fiscal Responsibility Act of 1982. The new limits differ from the current per diem limits on inpatient general routine operating costs in several major respects. First, they are not restricted to costs of inpatient general routine care, but cover total inpatient operating costs, including the costs of general routine service, special care, and ancillary services. The new limits will be applied on a cost per discharge rather than cost per diem basis. Finally, they are adjusted to reflect differences in the mix of Medicare cases treated by each hospital. The limits are similar to the current limits in that they do not apply to outpatient service cost, capital-related costs, malpractice insurance costs, or costs a hospital allocates to the interns and residents (in approved programs) or nursing school cost centers on its Medicare cost report. They also do not apply to children's hospitals, long-term care hospitals, or rural hospitals with fewer than 50 beds. The notice explains our methodology for deriving and applying the new limits.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Factors related to activity limitations in a group of Cuban Americans before and after hip fracture.

BACKGROUND AND PURPOSE: Cuban Americans over the age of 50 years, like people from a number of other cultures, have been exposed to distinctive social and psychological aspects of their culture that may affect their recovery from a major health event. The purpose of this study was to determine factors related to activity limitations in a group of Cuban Americans recovering from hip fractures. SUBJECTS: The subjects were 28 adults of Cuban-American origin with an average age of 79 years (SD=9, range=57-96) who were recovering from hip fracture. Subjects were followed for 2 months after discharge from a hospital-based inpatient rehabilitation facility. METHODS: Subjects were interviewed at the time of discharge from the rehabilitation facility and 2 months after discharge, and they completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and a social support interview. Functional Independence Measure scores and information regarding rehabilitative care were obtained from the rehabilitation facility. Multilinear regression analysis was used to determine the factors related to activity limitations before and after hip fracture. RESULTS: More premorbid activity limitations were related to poorer mental health status, older age, and male sex. More activity limitations at the time of discharge from the rehabilitation hospital were related to poorer mental health status prior to admission and partial or non-weight-bearing status after hip fracture. Older age and male sex were premorbid factors that appeared to relate to function after discharge. More activity limitations during the 2 months after discharge were related to the subjects reporting more social support in the form of physical assistance, less social support in the form of emotional assistance, less negative social support in the form of demand and criticism, status for weight bearing as tolerated at the time of discharge from the rehabilitation hospital, and older age. DISCUSSION AND CONCLUSION: In this group of Cuban Americans, mental health status was related to more activity limitations prior to admission to the rehabilitation facility and early in the recovery process, but not later in the recovery process. Conversely, social support was related to activity limitations later in the recovery process, but not prior to admission or early in the recovery process. Physical therapists should be aware of the psychosocial determinants of activity limitations during the process of recovery from disease or trauma.

Activities of Daily Living↗
PubMed2005

History of limited resection for non-small cell lung cancer.

A retrospective study of limited resection for lung cancer in a large number of patients was first reported in the 1970s. The reported outcome of segmentectomy was comparable to that of standard lobectomy. The North American Lung Cancer Study Group (LCSG) performed a randomized controlled clinical trial to compare limited resection (segment or wedge) with lobectomy for T1N0 (stage IA) non-small cell lung cancer (NSCLC) in the 1980s. The study revealed a significant excess of intrathoracic recurrence rate and a tendency to poorer survival in the limited resection group. Since then, limited resection has not been considered the standard operation for lung cancer. However, this situation is gradually changing, because the recent introduction of chest computed tomography (CT) to mass surveys has made peripherally located lung cancer detectable at the earliest stage. Several recent non-randomized studies of intentional limited resection from Japan demonstrated good outcomes comparable to those of lobectomy. Organ-sparing wedge resection without systematic dissection of lymph nodes may be suitable for some types of small lung cancers detected only by CT. Our meta-analysis of published data comparing survival rates after limited resection and lobectomy for stage I lung cancer revealed that limited resection was comparable to lobectomy. Further studies are necessary to define precise targets of intentional limited resection for lung cancer.

Carcinoma, Small Cell↗
PubMed2006

The limited protocol MRI in diagnosis of lumbar disc herniation.

OBJECTIVE: To assess agreement in detection of lumbar disc herniation (LDH) between limited and full protocol MRI. MATERIAL AND METHOD: 123 patients who requested lumbar MRI for diagnosis of disc herniation were assessed The full protocol MRI composed of sagittal T1-wi, sagittal T2-wi and axial T2-wi was performed on each patient. The sagittal T2-wi was selected as the limited protocol MRI. The limited and full protocols MRI of each patient were separately interpreted by three neuroradiologists to assess disc herniation and nerve root compression. The consensus results of limited and full protocol were compared. The diagnostic performance of each protocol was analyzed using surgery as the gold standard. RESULTS: There were 62 females and 61 males enrolled into the study between the age of 21-60 years old (means = 42.91 years). The duration of pain was 1-204 months (mean = 31.20 months). The degree of severity was mild in 23.58%, moderate 45.52% and severe 30.89% of cases. Thirty-three cases were operated on. For detection of LDH, the limited protocol gave the same interpretation results as the full protocol (0 = 1.04, 95%CI = 0.94, 1.14 with accepted range of 0.95-1.05). In nerve root compression, the limited protocol was not accurate as the full protocol (0 = 0.75, 95%CI = 0.87, 0.63). The sensitivity, specificity, accuracy, PPV, NPV, and LR+ in the surgical group of limited protocol in diagnosis of LDH were 82.61%, 80%, 81.82%, 90.48%, 60.67%, 4.13 and in nerve root compression were 54.84%, 100%, 57.58%, 100%, 12.5% respectively. The same statistics of full protocol MRI in diagnosis of LDH were 82.61%, 70.80%, 78.79%, 86.36%, 63.64%, 2.75 and of nerve root compression were 80.65%, 100%, 81.82%, 100%, 25% respectively. The sensitivity and specificity in diagnosis of LDH were not different in both protocols but the sensitivity of nerve root compression was statistically significant different (p < 0.013, 95%CI = -0.33, -0.25). CONCLUSION: The authors concluded that limited protocol MRI may replace full protocol MRI in diagnosis of LDH but not in nerve root compression.

Adult↗
PubMed2006

Limitations to practising holistically in the public sector in a rural sub-district in South Africa.

INTRODUCTION: The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term 'holism' was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts. Over the past two decades the term has entered into many academic disciplines as well as popular culture. Also within public healthcare services, despite predominantly biomedical approaches, there is the aspiration to offer a more holistic service. As part of a larger research study, the limitations to working holistically in the public sector in a rural sub-district in South Africa were explored. METHODOLOGY: The study used a participatory action research design that allowed participants a large degree of influence over the direction of the study. The research group consisted of four primary healthcare nurses and one medical doctor, all working in the public sector in a rural sub-district. The research group took part in the process of design and data gathering phases, as well as analysing and making meaning of the data generated. After a thematic analysis of the transcribed meetings, interviews and field notes, the themes were shared with the participants, who arranged them into a graphic representation showing the interrelationships of the themes. RESULTS: From analysis of the data it was clear that there were significant limitations to practicing holistically in the public sector of the rural sub-district in which the study took place. The limitations were grouped into those arising from within the public healthcare system and those outside the healthcare system. Within the healthcare system, the main factors limiting holistic care were: limited resources; poor training in and knowledge of holistic care; poor supervision; distance from the community; the referral system, intersectoral work and bureaucracy. Outside the healthcare sector the following factors challenged the provision of holistic care: poverty; poor nutrition; HIV/AIDS; and the cultural context. All the limitations were found to contribute to the danger of burnout among healthcare workers who wanted to work holistically. The limitations were also found to have a negative impact on the healthcare worker-patient relationship, thereby further challenging holistic care. CONCLUSION: A number of aspects of the healthcare provision system that contributed to limiting the provision of holistic care could be changed quite readily, if there was a will to do so. Many of the issues seemed to plague the healthcare system generally, not only in relation to the provision of holistic care (such as supervision or a response to poverty). The close relationship between difficulty in providing a holistic healthcare service and burnout was an important finding that deserves further exploration.

Burnout, Professional↗
PubMed1987

An assessment of the use of fixed limits to characterize intralaboratory performance by proficiency testing.

Currently, proficiency-testing (PT) programs are expanding the use of fixed limits to evaluate interlaboratory performance. These limits are an attempt to relate total allowable intralaboratory analytical error and performance in a PT program. Fixed limits are a means of counteracting the effects of overly stringent performance requirements derived from the interlaboratory group mean and standard deviations (SD) achieved by today's very precise analytical systems. Our previously described computer model of a PT program is used to delineate the quantitative relationship between the magnitude of intralaboratory coefficient of variation (CV) and bias that is compatible with fixed interlaboratory limits of 5, 10, 15, and 20% relative error. However, fixed limits alone do not fully characterize intralaboratory performance. The efficiency, or the percentage of times a laboratory's PT results are required to fall within the fixed limit, also must be considered when criteria for PT performance are being set. For example, a 10% fixed limit and a 80% efficiency will allow laboratories having CV-bias combinations from 8%-0%, 7%-4%, etc., to pass PT. The use of a 95% efficiency will allow CV-bias combinations from 4.8%-0%, 3.5%-4%, etc., to pass PT. We give a figure that depicts all possible combinations for four fixed limits and six efficiencies.

Computer Simulation↗
PubMed1981

[Self-limited idiopathic fever. A study of twenty cases (author's transl)].

Out of 23 cases with a final diagnosis of idiopathic fever, 20 had self-limited fever with complete resolution. Comparing the cases of self-limited fever with other groups of patients with fever of unknown origin, the following differences were apparent: compared with tumoral and collagen diseases, self-limited fever occurred more frequently below age 40, the difference being significant (p less than 0.01). Chills occurred more frequently in self-limited fever than in tumoral and collagen diseases, while the incidence was similar in infectious diseases. Infectious, tumoral and collagen diseases presented with significantly greater weight loss (p less than 0.01) than self-limited fever. A greater incidence of hepatosplenomegaly was noted in self-limited fever than in infectious diseases. Hemoglobin and erythrocyte sedimentation rate (ESR) were significantly higher in self-limited fever than in the other illnesses. The NBT test was positive, with a reduction superior to 30% in the six cases in whom it was performed. In nine cases various invasive procedures were utilized: radiology, biopsy, laparoscopy (two cases), and laparotomy (one case). The data on the present series of self-limited idiopathic fever support an infectious origin of the disease because of the following: absence of an age difference with the group with a demonstrated infectious cause; fever of less than two months duration in most cases; presence of chills and less incidence of weight loss, anemia, and elevated ESR in relation to the other groups of fever of unknown origin; a positive NBT test; and spontaneous evolution to complete resolution of the disease.

Adolescent↗
PubMed1993

Tolerance limits for short-term analytical bias and analytical imprecision derived from clinical assay specificity.

I propose a method for defining tolerance limits for assay bias and assay imprecision, based on the effects of these tolerance limits on the clinical specificity of the assay. An analytical "error budget" is defined as the squared sums of the imprecision and bias errors. The maximum limit for this error budget is set at a value corresponding to a 50% increase in the false-positive rate for classifying healthy subjects. For gaussian distributions with +/- 2 SD used as decision limits, this error budget equates to 0.45 SD of combined within-person and between-person biological variation (SDBiol). To provide reasonable power for bias detection in an assay, I recommend that the SD of the assay be kept at less than half the bias limit. Then, for the gaussian distribution, the maximum bias limit should be < 0.36 SDBiol and the SD of the assay should be < 0.18 SDBiol. Procedures are provided for using the same principles to define tolerance limits for decision limits other than +/- 2 SD and for nongaussian distributions.

Bias↗
PubMed1997

Lung hyperinflation and flow limitation in chronic airway obstruction.

We reasoned that if flow limitation plays an important role in lung hyperinflation, then bronchodilatation should be associated with a decrease of functional residual capacity (FRC) only in subjects breathing under conditions of flow limitation. This hypothesis was tested in 33 subjects with chronic airway narrowing due to asthma or chronic obstructive pulmonary disease (COPD). Flow limitation during tidal breathing was inferred from the impingement of the tidal flow-volume loop on the flow recorded during submaximally forced expiratory manoeuvres initiated from end-tidal inspiration. At baseline, flow limitation during tidal breathing was present in seven asthmatic (Group 1) and eight COPD subjects (Group 2), but absent in 11 asthmatic (Group 3) and seven COPD subjects (Group 4). FRC (mean+/-SEM) was similar in the four groups (range 117+/-7 to 134+/-6% of predicted). Inhalation of salbutamol (200 microg) caused significant increments of the forced expiratory volume in one second (FEVI) (range 6+/-1 to 21+/-8% of baseline) and forced expiratory flows at 30% of baseline forced vital capacity (V'30) (range 58+/-13 to 235+/-93% of baseline) in all groups. In groups with flow limitation during tidal breathing at baseline the FRC measured by plethysmography decreased significantly (12+/-2% in Group 1, and 9+/-2% in Group 2), and the inspiratory capacity (IC) measured by spirometry increased significantly (17+/-3% in Group 1 and 7+/-3% in Group 2). This was associated with flow limitation disappearing at the volume of baseline end-tidal expiration. In Groups 3 and 4 neither FRC nor IC changed significantly. The breathing pattern was not modified in any group after salbutamol. These findings suggest that flow limitation may contribute to generation of lung hyperinflation both in asthma and chronic obstructive pulmonary disease. We speculate that the increment of functional residual capacity could be triggered by dynamic airway compression downstream from the flow-limiting segment.

Adult↗
PubMed1998

Regression-based reference limits and their reliability: example on hemoglobin during the first year of life.

Calculation of reference limits by regression analysis makes it unnecessary to partition the reference data into subgroups, and age-dependent limits can be estimated within as narrow age intervals as necessary. However, the reliability of the regression-based reference limits has not been considered before. To get valid regression-based confidence intervals (CIs) for reference limits, one must evaluate the convolution of two distributions. In this study, age-dependent reference limits with corresponding CIs were produced for blood hemoglobin concentrations over the age interval from newborns to 12 months. We describe how the variance associated with the reference limits can be estimated, and present a Table from which appropriate values can be chosen for the calculation of regression-based reference limits and exact CIs. Also, an equation for the calculation of approximate CIs is given. The data were modeled by linear regression in several cumulative age groups to find the transition zone where the slope changed. After defining this cutoff point, piecewise linear regression was applied. Reference limits and their CIs calculated by conventional and piecewise linear regression methods were almost the same in older age groups but differed significantly during the period of most rapid age-dependent changes, i.e., during the 2 months after birth.

Age Factors↗
PubMed2006

Metalworking fluid mist occupational exposure limits: a discussion of alternative methods.

NIOSH published a recommended exposure limit (REL) for metalworking fluids (MWF) in 1998 that was designed to prevent respiratory disorders associated with these industrial lubricants. The REL of 0.4 mg/m(3) (as a time-weighted average for up to 10 hours) was for the fraction of aerosol corresponding to deposition in the thoracic region of the lungs. This nonregulatory occupational exposure limit (OEL) corresponded to approximately 0.5 mg/m(3) for total particulate mass. Although this REL was designed to prevent respiratory disorders from MWF exposures, NIOSH acknowledged that exposures below the REL may still result in occupational asthma and hypersensitivity pneumonitis--two of the most significant respiratory illnesses associated with MWF. In the 8 years since the publication of the NIOSH MWF REL, neither the Occupational Safety and Health Administration (OSHA) nor the American Conference of Governmental Industrial Hygienists (ACGIH) has recommended an exposure limit for water-soluble MWF specifically, other than their previous exposure limits for mineral oil. An informal effort to benchmark companies involved in the manufacture of automobiles and automotive parts in North America indicated that most companies are using the NIOSH MWF REL as a guide for the purchase of new equipment. Furthermore, most companies have adopted a goal to limit exposures to below 1.0 mg/m3. We failed to find any company that has strictly enforced an OEL of 1.0 mg/m(3) through the use of either administrative controls or personal protective equipment, when engineering controls failed to bring the exposures to below this limit. We also found that most companies have failed to implement specific medical surveillance programs for those employees exposed to MWF mist above 1.0 mg/m(3). Organization Resources Counselors (ORC) published in 1999 (on their website) a "best practices" manual for maintaining MWF systems and reducing the likelihood of MWF-related illnesses. The emphasis of this approach was on control techniques, and there was no assignment of a specific OEL for MWF due to the wide variety of fluids that exist. The ORC did suggest that maintaining exposure levels to below 2.0 mg/m(3) would assist in minimizing upper respiratory complaints associated with MWF. Although the ORC manual indicated that MWF vary in composition and no single OEL is likely to be appropriate for all such fluids, it adopted a very similar concept to control banding, placing all MWF operations into a single band using similar (if not identical) controls. OSHA, in lieu of adopting a 6B health standard for MWF, has also published a voluntary "best practices" manual on their website. Their document drew heavily from the work of ORC and also incorporated information from the 1998 NIOSH MWF criteria document. Industrial users of MWF need to have guidance, such as an OEL, to determine when either engineering, administrative controls, or personal protective equipment must be implemented to protect their employees. The purpose of this article is to explore various approaches that might be taken to result in a single or multiple limits for exposures to MWF and its components. Approaches such as control banding are discussed in terms of an alternative to the use of an OEL.

Aerosols↗
PubMedDate not supplied

Derivation of temporary emergency exposure limits (TEELs).

Short-term chemical concentration limits are used in a variety of applications, including emergency planning and response, hazard assessment and safety analysis. Development of emergency response planning guidelines (ERPGs) and acute exposure guidance levels (AEGLs) are predicated on this need. Unfortunately, the development of peer-reviewed community exposure limits for emergency planning cannot be done rapidly (relatively few ERPGs or AEGLs are published each year). To be protective of Department of Energy (DOE) workers, on-site personnel and the adjacent general public, the DOE Subcommittee on Consequence Assessment and Protective Actions (SCAPA) has developed a methodology for deriving temporary emergency exposure limits (TEELs) to serve as temporary guidance until ERPGs or AEGLs can be developed. These TEELs are approximations to ERPGs to be used until peer-reviewed toxicology-based ERPGs, AEGL or equivalents can be developed. Originally, the TEEL method used only hierarchies of published concentration limits (e.g. PEL- or TLV-TWAs, -STELs or -Cs, and IDLHs) to provide estimated values approximating ERPGs. Published toxicity data (e.g. lc(50), lc(LO), ld(50) and ld(LO) for TEEL-3, and tc(LO) and td(LO) for TEEL-2) are included in the expanded method for deriving TEELs presented in this paper. The addition here of published toxicity data (in addition to the exposure limit hierarchy) enables TEELs to be developed for a much wider range of chemicals than before. Hierarchy-based values take precedence over toxicity-based values, and human toxicity data are used in preference to animal toxicity data. Subsequently, default assumptions based on statistical correlations of ERPGs at different levels (e.g. ratios of ERPG-3s to ERPG-2s) are used to calculate TEELs where there are gaps in the data. Most required input data are available in the literature and on CD ROMs, so the required TEELs for a new chemical can be developed quickly. The new TEEL hierarchy/toxicity methodology has been used to develop community exposure limits for over 1200 chemicals to date. The new TEEL methodology enables emergency planners to develop useful approximations to peer-reviewed community exposure limits (such as the ERPGs) with a high degree of confidence. For definitions and acronyms, see Appendix.

Animals↗
PubMed2005

Activity limitation in rheumatoid arthritis correlates with reduced grip force regardless of sex: the Swedish TIRA project.

OBJECTIVE: To evaluate activity limitations 3 years after diagnosis of early rheumatoid arthritis (RA) in relation to grip force and sex. METHODS: A total of 217 patients, 153 women and 64 men, with recent-onset RA were included. Activity limitations were reported using the Health Assessment Questionnaire (HAQ) and the Evaluation of Daily Activities Questionnaire (EDAQ). The relationships between activity limitations versus grip force (measured by the Grippit), walking speed, functional impairment, grip ability, pain, plasma C-reactive protein, the 28-joint disease activity score and its components, the physician's global assessment of disease activity, and sex were analyzed by partial least squares (PLS). RESULTS: Women had significantly lower grip force and more activity limitations (HAQ and EDAQ) than men. The PLS analyses demonstrated that grip force was the strongest regressor of activity limitation, closely followed by walking speed. However, within subgroups based on grip force (group 1 = grip force <114 N, group 2 = 116-206 N, group 3 = 214-321 N, group 4 = grip force >328 N) and including sexes, women and men had corresponding degrees of activity limitation as reported by the HAQ and EDAQ. CONCLUSION: Our results indicate that the more pronounced activity limitations seen in women with RA, as compared with men, may be explained by lower grip force rather than sex.

Activities of Daily Living↗
PubMed2006

Health status, activity limitations, and disability in work and housework among Latinos and non-Latinos with arthritis: an analysis of national data.

OBJECTIVE: To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables. METHODS: We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I. RESULTS: The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking. CONCLUSION: Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

Activities of Daily Living↗