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PubMed1981

Evolution of modern concepts of hemostasis. A backward glance at the discoveries that made modern practice possible.

Most of our current knowledge about the roles of blood vessels, platelets, and plasma factors in hemostasis has been gained in the last three decades. However, prior to this period a relatively limited but critical framework of ideas about hemostasis had slowly but steadily evolved, beginning in 1666 when Malpighi discovered fibrin in blood clots. By the turn of the 20th century aggregation of platelets at the site of blood vessel injury was recognized and four enduring coagulation factors emerged: fibrinogen, prothrombin, tissue extracts (thromboplastin), and calcium. Them progress exploded after World War II, leading us into a search for the molecular basis of hemostasis where we are today. Through it all, observations made at the bedside by astute clinicians have been a driving force in the advancement of basic knowledge.

Hematology↗
PubMedDate not supplied

Modern critical care unit design. Nursing implications in modern critical care unit design: bed area ergonomics.

Management of the bed area in the critical care unit is important in terms of patient management and occupational safety of healthcare staff. There are many fundamental considerations concerning the design, layout and aesthetics of the bed area. The aesthetics should be an amalgamation of the expectations of patients, relatives and healthcare staff. Most of the activity is centered in the patient care area, and facilities should be designed according to ergonomic considerations.

Ergonomics↗
PubMed1995

Modernity and obesity in coastal and Highland Papua New Guinea.

OBJECTIVE: To investigate the association between individual degree of modernization and obesity in Papua New Guineans using a score of relative 'modernity'. DESIGN: Cross-sectional survey in six populations with varying degrees of modernity. Independent effects of modernity score, components of modernity score, age and physical activity were assessed in relation to general obesity (body mass index (BMI)) and body fat distribution (waist-hip ratio (WHR)). A sub-study of the relationship between diet and modernity was also performed. SETTING: Population-based samples of subjects in three Highland and three coastal locations in the developing country of Papua New Guinea (PNG). SUBJECTS: 1877 subjects > or = 25 years of age attended the survey. MEASUREMENTS: Age, physical activity, BMI, WHR, 2-h oral glucose tolerance test, and modernity score, based on area of origin, father's employment, type and duration of individual's employment, education, years in an urban centre, housing type and spouse score. RESULTS: More modern subjects had higher mean BMI and lower levels of physical activity, and mean WHR also varied with modernity in men but not women. In linear regression analysis, total modernity score was significantly associated with both BMI and WHR in men and women, independently of age and physical activity. When components of the modernity score were examined, younger age, more sophisticated housing and increasing number of years in an urban centre were independently associated with BMI in men and women, while education level and reduced physical activity were also significant predictors in men. Associations with WHR were weaker. Results of the dietary sub-study suggested that the lowest energy and nutrient intakes occurred in the least modern men and women. CONCLUSION: Aspects of modernity, such as more sophisticated housing and greater number of years spent in an urban centre, may be markers of higher income and increasing adoption of Western ways, which in turn are associated with physical inactivity and increased availability of energy-dense Western food, thus promoting obesity in this rapidly developing Pacific nation.

Adult↗
PubMed2000

Impact of a design modification in modern firefighting uniforms on burn prevention outcomes in New York City firefighters.

Our aim was to determine the impact of three different firefighting uniforms (traditional, modern, and modified modern) on the incidence and severity of thermal burn injuries, the major occupational injury affecting firefighters. Injury data were collected prospectively for the entire New York City Fire Department (FDNY) firefighting force wearing FDNY's traditional uniform (protective over-coat) from May 1, 1993 to August 31, 1993; FDNY's modern uniform (protective over-coat and over-pant) from May 1, 1995 to August 31, 1995; and FDNY's modified modern uniform (short sleeved shirt and short pants, rather than long-sleeved shirt and long pants, worn under firefighter's protective over-clothes) from May 1, 1998 to August 31, 1998. Outcome measures were burn incidence and severity. Adverse outcomes were heat exhaustion and cardiac events. During this 12-month study, 29,094 structural fires occurred. The incidence rate for upper extremity burns was 2341 per 100,000 fires and for lower extremity burns, 2076 per 100,000 fires. With the change from the traditional to modern uniform, the distribution of burns per fire decreased significantly (P = 0.001) for upper extremity burns (86%) and lower extremity burns (93%). With the change from traditional to modern uniform, days lost to medical leave for upper or lower extremity burns decreased by 89%. The majority of burns occurred at the lower arm and mid-leg, and the change to the modern uniform decreased such burns by 87% and 92%. Burn incidence and severity were not significantly affected by the change to the modified modern uniform. The distribution of heat exhaustion or cardiac events per fire was not significantly affected by the change from the traditional to modern uniform, and heat exhaustion was decreased (P < 0.001) by the change to the modified modern uniform. In conclusion, the modern uniform dramatically reduced burn incidence and severity without adverse impact. The modified modern uniform significantly reduced heat exhaustion without significantly affecting thermal protection.

Adult↗