Earthquake in Turkey: The Triangle of Life and Disaster Kits Saves Lives

OBJECTIVE

Precautions taken before an earthquake are of vital importance. When buildings collapse, the weight of the ceiling crushes objects such as furniture, leaving a space or void within the rubble. This area is called the "triangle of life." The larger and stronger the object, the more it will maintain its volume; the more the object maintains its volume, the larger the void will be, and the less likely it is that the person who uses this void will be injured.

METHODS

Durable, solid furniture such as beds and tables that can be tipped over during an earthquake in appropriate areas in the building can form a living triangle. Creating and using the triangle of life is the method of protection in an earthquake that produces the highest probability of survival.

RESULTS

Two earthquakes with magnitudes of 7.8 and 7.5 occurred in Kahramanmaraş, Turkey, on February 6, 2023. This report presents the case of a 43-y-old female victim of these earthquakes who used the triangle of life to survive; she was removed from the rubble 164 h after the earthquake.

CONCLUSIONS

The case provides evidence that predetermining areas in which the triangle of life can be formed and storing supplies necessary for survival can decrease morbidity and mortality in an earthquake.

Production planning of a furniture manufacturing company with random demand and production capacity using stochastic programming

In this article two multi-stage stochastic linear programming models are developed, one applying the stochastic programming solver integrated by Lingo 17.0 optimization software that utilizes an approximation using an identical conditional sampling and Latin-hyper-square techniques to reduce the sample variance, associating the probability distributions to normal distributions with defined mean and standard deviation; and a second proposed model with a discrete distribution with 3 values and their respective probabilities of occurrence. In both cases, a scenario tree is generated. The models developed are applied to an aggregate production plan (APP) for a furniture manufacturing company located in the state of Hidalgo, Mexico, which has important clients throughout the country. Production capacity and demand are defined as random variables of the model. The main purpose of this research is to determine a feasible solution to the aggregate production plan in a reasonable computational time. The developed models were compared and analyzed. Moreover, this work was complemented with a sensitivity analysis; varying the percentage of service level, also, varying the stochastic parameters (mean and standard deviation) to test how these variations impact in the solution and decision variables.

The risk factors for occupational contact dermatitis among workers in a medium density fiberboard furniture factory in Eastern Thailand

The aim of this study was to determine the occupational exposure to formaldehyde on the medium-density fiberboard (MDF) dust and allergic contact dermatitis among the workers at a furniture factory. Data were collected from 439 subjects using questionnaires and patch testing to evaluate allergic contact dermatitis resulting from formaldehyde on wood dust exposure in the workplace. The geometric mean concentration of formaldehyde on MDF dust that the workers in the production department were exposed to was 2.07 ppm (GSD 4.54). Patch test results revealed that some subjects developed allergy to various substances, including epoxy resin (16.7%) and formaldehyde (5.6%). The odds ratios (95% CI) for contact dermatitis were 3.6 (1.7-7.3) among those with a history of metal allergy, 1.8 (0.6-5.2) whose family members having a history of allergic contact dermatitis. Exposure to MDF dust in the workplace should be reduced, as the current levels of exposure exceed the permissible OSHA standard.

Fungal contamination of ward furnishings and medical equipment used in the treatment and nursing of newborns

INTRODUCTION AND OBJECTIVE

Newborn babies staying on hospital wards are likely to be colonized by microorganisms, including potentially pathogenic fungi. The aim of the study was to assess the mycological purity of hospital wards and medical equipment utilized in the treatment and nursing of newborns.

MATERIAL AND METHODS

The study was conducted in Neonatal High Dependency Units (NHDU) and Neonatal Intensive Care Units (NICU). 539 samples were collected from 24 different sources, 130 from ward furnishings and 289 from medical equipment. The study was carried out following the microbiology research methods for sample collection. Subsequently, the samples (swabs, water from incubators, washings from respirator tubes and nasal cannulas (nCPAP)) were cultivated on Sabouraud agar plates. The stamps were collected with the application of Count-Tact method. The samples were incubated at the temperature of 25+/-2 o C and the number of fungi assessed (cfu/cm -2 of the surface area). The species were identified based on their morphological and biochemical features.

RESULTS

Fungal growth was observed on 60% of samples collected from ward furnishings and 7% of samples collected from medical equipment. The average number of cfu/cm -2 ranged between 0-8.84 in the case of ward furnishings and between 0-1.22 cfu/cm -2 in the case of medical equipment. In 180 samples collected from the material which had direct contact with newborns no fungal growth was observed.

CONCLUSIONS

The furnishings of the wards on which newborns were treated and nursed were contaminated with fungi to an extent which did not pose a threat to the life and health of the newborns. Medical equipment (respirators, incubators, nCPAP cannulas and masks) which came into direct contact with newborns was free from fungi.

Computer-based Prompt's impact on postural variability and sit-stand desk usage behavior; a cluster randomized control trial

Sit-to-stand workstations have been deployed in office environments to reduce sedentary behavior and improve worker's health. However, efforts to initiate and sustain long-term usage of sit-stand workstations has been a challenge, with primarily anecdotal evidence suggesting many employees cease using their sit-stand workstations once the newness diminishes. To objectively determine sit-stand workstation usage and what impact computer-based prompts would have on sit-stand desk use and sustainability, 200 office workers (118 control and 82 treatment) in two different geographic locations were continuously monitored over a 4 ½ month period, which consisted of a 6-week baseline and a 3-month experimental period. During the 3-month experimental period, computer-based prompts elicited a 229% increase in daily standing transitions which was sustained over the entire 3 months with 40% of the participants adhering to a pre-determined sit to stand schedule. These findings indicate that the use of computer-based prompts can be used to motivate employees to change their behavior regarding the use of sit-to-stand workstations.

Functional Workspace Optimization via Learning Personal Preferences from Virtual Experiences

The functionality of a workspace is one of the most important considerations in both virtual world design and interior design. To offer appropriate functionality to the user, designers usually take some general rules into account, e.g., general workflow and average stature of users, which are summarized from the population statistics. Yet, such general rules cannot reflect the personal preferences of a single individual, which vary from person to person. In this paper, we intend to optimize a functional workspace according to the personal preferences of the specific individual who will use it. We come up with an approach to learn the individual's personal preferences from his activities while using a virtual version of the workspace via virtual reality devices. Then, we construct a cost function, which incorporates personal preferences, spatial constraints, pose assessments, and visual field. At last, the cost function is optimized to achieve an optimal layout. To evaluate the approach, we experimented with different settings. The results of the user study show that the workspaces updated in this way better fit the users.

Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls

OBJECTIVE

The relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed to pilot the Home Falls and Accidents Screening Tool (HOME FAST) to identify hazards in Malaysian homes, to evaluate the feasibility of using the HOME FAST in the Malaysian Elders Longitudinal Research (MELoR) study and to gather preliminary data about the experience of falls among a small sample of Malaysian older people.

DESIGN

A cross-sectional pilot study was conducted.

SETTING

An urban setting in Kuala Lumpur.

PARTICIPANTS

26 older people aged 60 and over were recruited from the control group of a related research project in Malaysia, in addition to older people known to the researchers.

PRIMARY OUTCOME MEASURE

The HOME FAST was applied with the baseline survey for the MELoR study via a face-to-face interview and observation of the home by research staff.

RESULTS

The majority of the participants were female, of Malay or Chinese ethnicity and living with others in a double-storeyed house. Falls were reported in the previous year by 19% and 80% of falls occurred at home. Gender and fear of falling had the strongest associations with home hazards. Most hazards were detected in the bathroom area. A small number of errors were detected in the HOME FAST ratings by researchers.

CONCLUSIONS

The HOME FAST is feasible as a research and clinical tool for the Malaysian context and is appropriate for use in the MELoR study. Home hazards were prevalent in the homes of older people and further research with the larger MELoR sample is needed to confirm the validity of using the HOME FAST in Malaysia. Training in the use of the HOME FAST is needed to ensure accurate use by researchers.

Domestic bioethanol-fireplaces--a new source of severe burn accidents

BACKGROUND

Bioethanol-fueled fireplaces are popular interior home decoration accessories. Although their safety is promoted frequently, actual presentations of severe burn injuries in our burn intensive care unit (ICU) have focused the authors on safety problems with these devices. In this article we want to explore the mechanisms for these accidents and state our experiences with this increasingly relevant risk for severe burn injuries.

MATERIALS AND METHODS

The computerized medical records of all burn intensive care patients in our burn unit between 2000 and 2014 were studied. Since 2010, 12 patients with bioethanol associated burn injuries were identified. Their data was compared to the values of all patients, except the ones injured by bioethanol fireplaces that presented themselves to our burn ICU between the years 2010 and 2014.

RESULTS

At time of admission the bioethanol patients had a mean ABSI-score of 4.8 (+/- 2.2 standard deviation (SD)). A mean of 17 percent (+/- 9.1 SD) body surface area was burned. Involvement of face and hands was very common. An operative treatment was needed in 8 cases. A median of 20 days of hospitalization (range 3-121) and a median of 4.5 days on the ICU (range 1-64) were necessary. No patient died. In most cases the injuries happened while refilling or while starting the fire, even though safety instructions were followed. In the control group, consisting of 748 patients, the mean ABSI-score was 5.6 (+/- 2.7 SD). A mean of 16.5 percent (+/- 10.1 SD) body surface area was burned. Treatment required a median of 3 days on the burn ICU (range 1-120). Regarding these parameters, the burden of disease was comparable in both groups.

CONCLUSION

Bioethanol-fueled fireplaces for interior home decoration are a potential source for severe burn accidents even by intended use.

The anthropometric match between high school learners of the Cape Metropole area, Western Cape, South Africa and their computer workstation at school

STUDY DESIGN

Descriptive study.

OBJECTIVE

The objective of this study was to present anthropometric data from high school students in Cape Metropole area, Western Cape, South Africa that are relevant for chair design and whether the dimensions of computer laboratory chairs currently used in high schools match linear anthropometrics of high-school students. Summary of Background Data. Learner-chair mismatch is proposed as a cause of poor postural alignment and spinal pain in adolescents. A learner-chair mismatch is defined as the incompatibility between the dimensions of a chair and the anthropometric dimensions of the learner. Currently, there is no published research to ascertain whether the furniture dimensions in school computer laboratories match the anthropometrics of the students. This may contribute to the high prevalence of adolescent spinal pain.

METHODS

The sample consisted of 689 learners, 13-18 years old. The following body dimensions were measured: stature, popliteal height, buttock-to-popliteal length and hip width. These measurements were matched with the corresponding chair seat dimensions: height, depth and width. Popliteal and seat height mismatch was defined when the seat height is either >95% or <88% of the popliteal height. Buttock-popliteal length and seat depth mismatch was defined when the seat depth is either >95% or <80% of the buttock-popliteal length. Seat width mismatch is defined where the seat width should be at least 10% and at the most 30% larger than hip width.

RESULTS

An 89% of learners did not match the seat. Five percent of learners matched the chair depth, the majority was found to be too big. In contrast, 65% of the learners matched the chair width dimension.

CONCLUSIONS

A substantial mismatch was found. The school chairs failed standard ergonomics recommendations for the design of furniture to fit the user. This study supports the conclusion that there is no one-size-fits-all solution. There is an urgent need for chairs that are of different sizes or that are adjustable.

Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness

OBJECTIVES

To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals.

DESIGN

Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011.

SETTING

U.S. acute care hospitals.

PARTICIPANTS

Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies).

INTERVENTION

Fall prevention interventions.

MEASUREMENTS

Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details.

RESULTS

Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52-1.12, P = .17; eight studies; I(2) : 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR.

CONCLUSION

Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.

Prevalence of dry methods in granite countertop fabrication in Oklahoma

Granite countertop fabricators are at risk of exposure to respirable crystalline silica, which may cause silicosis and other lung conditions. The purpose of this study was to estimate the prevalence of exposure control methods, especially wet methods, in granite countertop fabrication in Oklahoma to assess how many workers might be at risk of overexposure to crystalline silica in this industry. Granite fabrication shops in the three largest metropolitan areas in Oklahoma were enumerated, and 47 of the 52 shops participated in a survey on fabrication methods. Countertop shops were small businesses with average work forces of fewer than 10 employees. Ten shops (21%) reported using exclusively wet methods during all fabrication steps. Thirty-five shops (74%) employing a total of about 200 workers reported using dry methods all or most of the time in at least one fabrication step. The tasks most often performed dry were edge profiling (17% of shops), cutting of grooves for reinforcing rods (62% of shops), and cutting of sink openings (45% of shops). All shops reported providing either half-face or full-face respirators for use during fabrication, but none reported doing respirator fit testing. Few shops reported using any kind of dust collection system. These findings suggest that current consumer demand for granite countertops is giving rise to a new wave of workers at risk of silicosis due to potential overexposure to granite dust.

Musculoskeletal disorders amongst practising South African oral hygienists

OBJECTIVES

The study sought to determine the level of musculoskeletal disorders among working oral hygienists in South Africa and potential determinants that are associated with these disorders.

METHODS

Oral hygienists registered with the HPCSA were requested to complete an anonymous questionnaire. Apart from demographic information they were asked to report on any musculoskeletal symptoms experienced in the hands, neck, shoulders and lower back as well as details of workload, types of scaling procedures, size of instruments, the mobility of the operator's chair and the adjustability of patient chairs.

RESULTS

Of the 362 respondents, 61.3%, 66.5%, 56.6% and 59.6%, experienced hand, neck, shoulder and lower back symptoms respectively. Twenty-eight percent of the respondents performed hand-scaling for more than four hours per day. Twenty-six percent reported immobile operator chairs, while 12.6% reported patient chairs that were difficult to adjust. Employing multivariate analysis, excessive hand scaling was associated with hand and shoulder symptoms, while immobile operator's chairs and poorly adjustable patient chairs were respectively associated with neck and lower back problems.

CONCLUSIONS

The prevalence of work-related musculoskeletal disorders in practising oral hygienists in South Africa appears to be similar to that in developed countries. Significant determinants of musculoskeletal disorders may be immobile operator stools, poorly adjustable patient chairs and excessive hand-scaling daily.

Nonverbal communication in doctor-elderly patient transactions (NDEPT): development of a tool

OBJECTIVE

There are several measurement tools to assess verbal dimensions in clinical encounters; in contrast, there is no established tool to evaluate physical nonverbal dimensions in geriatric encounters. The present paper describes the development of a tool to assess the physical context of exam rooms in doctor-older patient visits.

METHOD

Salient features of the tool were derived from the medical literature and systematic observations of videotapes and refined during current research.

RESULTS

The tool consists of two main dimensions of exam rooms: (1) physical dimensions comprising static and dynamic attributes that become operational through the spatial configuration and can influence the manifestation of (2) kinesic attributes.

CONCLUSION

Details of the coding form and inter-rater reliability are presented. The usefulness of the tool is demonstrated through an analysis of 50 National Institute of Aging videotapes. Physicians in exam rooms with no desk in the interaction, no height difference and optimal interaction distance were observed to have greater eye contact and touch than physicians' in exam rooms with a desk, similar height difference and interaction distance.

PRACTICE IMPLICATIONS

The tool can enable physicians to assess the spatial configuration of exam rooms (through Parts A and B) and thus facilitate the structuring of kinesic attributes (Part C).

Bedroom design and decoration: gender differences in preference and activity

This investigation examined gender differences in niche-building preference and activity among 238 8th and 9th grade boys and girls. A questionnaire was developed to measure both the actual and preferred bedroom content, bedroom design activity, and the level of perceived influence by the immediate and extended family, friends, and social institutions. Gender differences were identified for preference, activity, and influence in bedroom design and decoration. Girls and boys differed in the type of items contained in their bedrooms. Girls' rooms contained stuffed animals and pictures of people, including themselves, more frequently than the boys' rooms. In contrast, boys' rooms contained sports-related items, and things for building or that they had built themselves. Although bedroom design activity for both boys and girls was influenced by older teens, friends, media, and popular culture, boys (but not girls) were also influenced by their mothers, fathers, girlfriends, and activities such as sports, Boy or Girl Scouts, and music lessons.

A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples

This article reports a study of the physical design characteristics of a set of adult intensive care units (ICUs), built between 1993 and 2003. These ICUs were recognized as the best-practice examples by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects. This study is based on a systematic analysis of the materials found on these ICUs in the booklet and videos jointly published by the above organizations in 2005. The study finds that most of these examples of best-practice adult ICUs have the following negative characteristics: (1) they are built as renovation projects with more health and safety hazards during construction; (2) most of them are mixed-service units with more safety and staffing problems; (3) the overall layout and the layout of staff work areas in these ICUs do not have any common design solutions for improved patient and staff outcomes; and (4) in these ICUs, family space is often located outside the unit, and family access to the patient room is restricted, even though family presence at the bedside may be important for improved patient outcomes. Some of these negative characteristics are offset by the following positive characteristics in most ICUs: (1) they have only private patient rooms for improved patient care, safety, privacy, and comfort; (2) most patient beds are freestanding for easy access to patients from all sides; (3) they have handwashing sinks and waste disposal facilities in the patient room for improved safety; and (4) most patient rooms have natural light to help patients with circadian rhythms. The article discusses, in detail, the implications of its findings, and the role of the ICU design community in a very complicated design context.

Childhood injuries caused by falling televisions

OBJECTIVES

To obtain a detailed description of the injury scene in an attempt to identify methods for prevention and to describe the morbidity and mortality of children who present to an urban pediatric emergency department (ED) with an injury caused by a falling television.

METHODS

A retrospective descriptive study from a prospectively created database was conducted over one year. All adults accompanying a child younger than 13 years of age who was injured by a falling television were directly interviewed, and the patient medical charts were reviewed.

RESULTS

Twenty-eight children were eligible, and 26 children were analyzed. The median age was 40 months (25th and 75th quartiles: 31, 51 months). None of the televisions, or the furniture that they were placed on, were secured. Most parents (85%) reported that they were unaware that injuries could occur by this mechanism. Fourteen children suffered head injuries, and nine children injured an extremity. Nine children were hospitalized, including two patients admitted to the intensive care unit (ICU).

CONCLUSIONS

Children may present to the ED with injuries caused by falling televisions. These injuries are usually not severe; however, the potential for severe injury exists, and some children may require ICU monitoring. Our data indicate a lack of parental awareness and an absence of primary prevention as a root cause for this problem. Thus, more aggressive education to warn parents about the risk of injury must be implemented so that more families will take the time to place their televisions safely.

Determining the space needed to operate a mobile and an overhead patient hoist

Inadequate bed space affects manual handling techniques and the ability to carry out nursing care tasks. Many nurses will join a trust on the basis of the workspace design of the wards. This paper looks at the space required to operate two types of hoist and argues for the recommended bed space dimensions to be increased.

Asthma, wheezing, and allergies in Russian schoolchildren in relation to new surface materials in the home

In a cross-sectional study of 5951 Russian 8-12-year-old schoolchildren, risks of current asthma, wheezing, and allergy were related to recent renovation and the installation of materials with potential chemical emissions. New linoleum flooring, synthetic carpeting, particleboard, wall coverings, and furniture and recent painting were determinants of 1 or several of these 3 health outcomes. These findings warrant further attention to the type of materials used in interior design.

Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations

OBJECTIVES

To ascertain whether the number of sudden infant deaths as a result of suffocation in cribs, in adult beds, on sofas or chairs, and on other sleep surfaces was increasing whether attributable to increased reporting, diagnostic shift, or an actual increase in suffocation deaths and to compare the risk of reported accidental suffocation for infants on sleep surfaces designed for infants with the risk on adult beds.

METHODS

We reviewed all accidental suffocation deaths among infants < or =11 months of age reported to the United States Consumer Product Safety Commission from 1980 through 1983 and 1995 through 1998. We compared infants' ages and other demographic data, the sleep location and surface used, and the reported mechanism or pattern of death. For 1995-1998, we used data on sleep location from an annual survey of randomly selected households of living infants younger than 8 months, collected as part of the National Infant Sleep Position Study at the National Institute of Child Health and Human Development, to calculate risk for death as a result of suffocation in cribs, in adult beds, and on sofas or chairs.

METHODS

The number of reported suffocation deaths by location were compared between the 1980s and 1990s using logistic regression modeling to calculate odds ratios (OR), 95% confidence intervals (CI), and P values. Comparative risks for suffocation deaths on a given sleep surface for infants in the 1990s were examined by calculating rates of death per 100 000 exposed infants and comparing the 95% CI for overlap.

RESULTS

From the 1980s, 513 cases of infant suffocation were considered; from the 1990s, 883 cases. The number of reported suffocation deaths in cribs fell from 192 to 107, the number of reported deaths in adult beds increased from 152 to 391, and the number of reported deaths on sofas or chairs increased from 33 to 110. Using cribs as the reference group and adjusting for potential confounders, the multivariate ORs showed that infant deaths in adult beds were 8.1 times more likely to be reported in the 1990s than in the 1980s (95% CI: 3.2-20.3), and infant deaths on sofas and chairs were 17.2 times more likely to be reported in the 1990s than in the 1980s (95% CI: 5.0-59.3). The sleep location of a subset of cases from the 1990s, 348 infants younger than 8 months at death, was compared with the sleep location of 4220 living infants younger than 8 months. The risk of suffocation was approximately 40 times higher for infants in adult beds compared with those in cribs. The increase in risk remained high even when overlying deaths were discounted (32 times higher) or the estimate of rates of bedsharing among living infants doubled (20 times higher).

CONCLUSIONS

Reported deaths of infants who suffocated on sleep surfaces other than those designed for infants are increasing. The most conservative estimate showed that the risk of suffocation increased by 20-fold when infants were placed to sleep in adult beds rather than in cribs. The public should be clearly informed of the attendant risks.

Emergency department crowding: a point in time

STUDY OBJECTIVE

This is a pilot study designed to assess the feasibility of a point prevalence study to assess the degree of crowding in hospital emergency departments (EDs). In addition, we sought to measure the degree of physical crowding and personnel shortage in our sample.

METHODS

A mail survey was sent to a random sample of 250 EDs chosen from a database compiled by the American College of Emergency Physicians of 5,064 EDs in the United States. In addition to demographic information, respondents were asked to count the patients and staff in their EDs at 7 PM local time on Monday, March 12, 2001 (index time).

RESULTS

The response rate was 36%. At the index time, there was an average of 1.1 patients per treatment space, and 52% of EDs reported more than 1 patient per treatment space. There was also evidence of personnel shortage, with a mean of 4.2 patients per registered nurse and 49% of EDs having each registered nurse caring for more than 4 patients. There was a mean of 9.7 patients per physician. Sixty-eight percent of EDs had each physician caring for more than 6 patients. There was crowding present in all geographic areas and all hospital types (teaching-nonteaching status of the hospital). Consistent with the crowded conditions, 11% of institutions were on ambulance diversion and not accepting new acute patients. Delays in transfer of admitted patients out of the ED contributed to the physical crowding. Twenty-two percent of patients in the ED were already admitted and were awaiting transfer to an inpatient bed; 73% of EDs were boarding 2 or more inpatients. The amount of crowding quantified by this point prevalence study was confirmed by the amount of crowding reported for the previous week: 48% of EDs were boarding inpatients during the previous week for a mean of 8.9 hours, 4.2 days per week; 31% had been on diversion; 59% had been routinely using their halls for patients; 38% had been doubling their rooms; and 47% had been using nonclinical space for patient care.

CONCLUSION

Our low response rate limits this pilot study. Nonetheless, this study, as well as others, demonstrates that EDs throughout the United States are severely crowded. Such crowding raises concerns about the ability of EDs to respond to mass casualty or volume surges.

Injuries when children reportedly fall from a bed or couch

One-hundred-fifteen patients with orthopaedic injuries resulting from a reported fall from a piece of furniture at home were studied to define the relationship of suspected child abuse associated with this mechanism of injury. One hundred-thirteen patients sustained fractures or dislocations and two patients were impaled with a pencil and a needle. Each patient was evaluated by a primary care physician or an emergency room physician and by an orthopaedic surgeon. In six of 115 patients (5%), a treating physician filed a child abuse report. In 109 patients (95%) the purported mechanism of injury was considered sufficient to produce the resulting injury. Two of four children younger than 1 year (50%), four of 83 children 1 to 5 years (5%), and none of the 28 children older than 5 years were investigated for potential child abuse. Orthopaedic injuries reportedly attributable to a child falling from a bed or couch at home usually are accidental unless the child is younger than 1 year.

The timed 'Up & Go' is dependent on chair type

INTRODUCTION

The timed 'Up & Go' (TUG) is a performance test identifying problems in functional mobility. More knowledge on how the type of chair used influences test results is needed.

OBJECTIVE

To investigate inter-rater agreement on the time score and to assess if chair type used influenced the performance of the test.

SETTING

(1) Inter-rater agreement investigation on the time score was carried out with elderly individuals living in a retirement home (n = 31). (2) Four types of chairs were tested on elderly individuals in three different health care centres (n = 100).

RESULTS

The two observers were close in timing (mean difference = 0.04 s). From a reference chair the median time for TUG was 15.7 s compared with 16.9 s from a chair with a low seat (p < 0.001). It was significantly more difficult to stand up from a chair without armrests (p < 0.001), and from the lowest chair (p < 0.001), which was also the only chair difficult to sit down on (p = 0.02).

CONCLUSION

The inter-rater agreement of the time scoring of the TUG has been confirmed. Test performance is dependent on chair type; chairs with armrests and a seating height of 44-47 cm should be used. Clinicians must follow standard procedures and equipment when using the test or else risk invalidating test findings.

A health and demographic profile of noninstitutionalized older Americans residing in environments with home modifications

OBJECTIVES

In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications.

METHODS

Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications.

RESULTS

Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications. Low income, Hispanic, and African American elderly appear underrepresented among those with modifications.

DISCUSSION

The authors conclude that specialized housing alternatives will be an increasingly important issue in the future as individuals aim to achieve and maintain the delicate balance between their functional ability and their living environment.

Computer users' postures and associations with workstation characteristics

This investigation tested the hypotheses that (1) physical workstation dimensions are important determinants of operator posture, (2) specific workstation characteristics systematically affect worker posture, and (3) computer operators assume "neutral" upper limb postures while keying. Operator head, neck, and upper extremity posture and selected workstation dimensions and characteristics were measured among 379 computer users. Operator postures were measured with manual goniometers, workstation characteristics were evaluated by observation, and workstation dimensions by direct measurement. Considerably greater variability in all postures was observed than was expected from application of basic geometric principles to measured workstation dimensions. Few strong correlations were observed between worker posture and workstation physical dimensions; findings suggest that preference is given to keyboard placement with respect to the eyes (r = 0.60 for association between keyboard height and seated elbow height) compared with monitor placement with respect to the eyes (r = 0.18 for association between monitor height and seated eye height). Wrist extension was weakly correlated with keyboard height (r = -0.24) and virtually not at all with keyboard thickness (r = 0.07). Use of a wrist rest was associated with decreased wrist flexion (21.9 versus 25.1 degrees, p < 0.01). Participants who had easily adjustable chairs had essentially the same neck and upper limb postures as did those with nonadjustable chairs. Sixty-one percent of computer operators were observed in nonneutral shoulder postures and 41% in nonneutral wrist postures. Findings suggest that (1) workstation dimensions are not strong determinants of at least several neck and upper extremity postures among computer operators, (2) only some workstation characteristics affect posture, and (3) contrary to common recommendations, a large proportion of computer users do not work in so-called neutral postures.

[The physiological hygiene bases for the requirements for illumination and color decor of the quarters for the station masters]

The values 100 to 200 lux are the most favourable levels of illumination for differentiation of red and green luminous objects. The 500-1000-lux illumination causes a considerable reduction in the visual range of red and green objects. Comparative assessment of the colour of materials used for a control desk has indicated that the colours in the mid-wave range are the best in differentiating red and green objects.

Interior design. Mastering the master plan

Reflecting on the results of the survey, this proposed interior design master planning process addresses the concerns and issues of both CEOs and facility managers in ways that focus on problem-solving strategies and methods. Use of the interior design master plan process further promotes the goals and outcomes expressed in the survey by both groups. These include enhanced facility image, the efficient selection of finishes and furnishings, continuity despite staff changes, and overall savings in both costs and time. The interior design master plan allows administrators and facility managers to anticipate changes resulting from the restructuring of health care delivery. The administrators and facility managers are then able to respond in ways that manage those changes in the flexible and cost-effective manner they are striving for. This framework permits staff members to concentrate their time and energy on the care of their patients--which is, after all, what it's all about.

Environmental modifications in the homes of elderly Canadians with disabilities

This study was performed to (1) determine if the use of architectural modifications in the homes of the disabled elderly can reduce the level of disability; (2) determine the predictors of the use of architectural modifications; and (3) estimate the degree of need for environmental modifications. The degree of need was estimated using data from 8895 respondents (55 years and older) from the Canadian Health and Disability Survey (1983-84). A subgroup of 1520 respondents who needed architectural modifications was selected to predict: (1) the ability to perform instrumental activities of daily living (IADL) and (2) the use of architectural modifications. These data were analysed using multiple linear regression. Approximately 37.9% of the disabled elderly required at least one modification to their home. About 40% did not have the architectural modification that was needed. Income was found to be a predictor of the use of architectural modifications (p = 0.0273). Users of architectural modifications were more independent in IADL than non-users (p < 0.0312). In conclusion, there is a substantial need for environmental modifications in the homes of the disabled elderly. Furthermore, architectural modifications should be available at a low cost.

A new instrument for the measurement of forces on beds and seats

Knowledge of the interaction of forces between persons and the bed in which they lie or the seat on which they are sitting, provides an insight into the loading of their muscles, bones and soft tissue. To determine the total forces on the body-supporting surfaces (backrest, seat pan, foot rest) resolved in components perpendicular and parallel to these surfaces a new instrument has been developed, with which the forces perpendicular and parallel to three different freely adjustable body-supporting surfaces can be registered. During the first measurements the forces on a bed were measured when a person sits in a bed with the backrest at an angle of 45 degrees to the horizontal and the mattress horizontal. The measurements on a healthy population (mean mass = 77 kg, SD = 11 kg) showed an accuracy of +/- 10N. In this position the mean shear force on the seat pan was 97 N.

Criteria for the ergonomic evaluation of work chairs

On the basis of a critical overview of specialised ergonomics literature and of national and international standards on the subjects, this paper outlines the main ergonomic requirements and characteristics for work chairs. The main ergonomic requirements for work chairs are the following:

SAFETY

the chair should not be the source or cause of accidents. Adaptability: the chair's dimensions and control features should be such that they meet the anthropometric characteristics of at least 90% of the potential users. Comfort: the chair should be physiologically comfortable for the user. To this end, the following are all important features: seat-plane and backrest contours, backrest height and inclination adjustability, padding and covering materials that allow the body to breath. Practicality: the chair, and in particular the control features, should be practical and easy to control use. Durability: the chair should offer good wear and durability of its components and controls. Suitability for the job: the chair should be appropriately designed for the intended type of job and working environment. For each of these requirements single parameters are considered and for each parameter specific qualitative and/or quantitative data are given in order to class each single item as: "not acceptable", "acceptable" or "good", as regards standards and regulations, anthropometric parameters and intended uses. Criteria are given for a concise assessment of each of the six main requirements and for a comprehensive assessment of the "ergonomic quality" of the work chair.

When older adults face the chair-rise challenge. A study of chair height availability and height-modified chair-rise performance in the elderly

OBJECTIVE

Define the range of community seating heights available for use by older adults; test whether raising chair height by small increments facilitates chair-rise performance; and heighten physician and furniture industry awareness of discrepancies that may exist between actual and acceptable chair heights for older adults.

DESIGN

Phase 1: Survey of commercially available chair heights. Phase 2: Cross-sectional descriptive study of chair-rise ability.

SETTING

Phase 1: Local furniture stores, physician offices, hospital waiting areas, and nursing homes. Phase 2: Postural Control Lab.

PARTICIPANTS

Twenty-two volunteers (nursing home residents and community dwellers).

EXCLUSION CRITERIA

inability to stand independently and inability to bear full weight on the lower extremities in the standing position.

MEASUREMENTS

Chair rise success at six heights (17-22 inches), self-reported difficulty (visual analogue scale), change in minimum hip angle and maximum shoulder angle during rise, using motion analysis.

RESULTS

Phase 1: Community chair heights ranged from 12 to 18 inches, with a mean of 16.3 in physician offices, 16.6 in nursing homes, 16.4 in hospitals, 17.3 in "kitchens" and 15 in "living rooms." Phase 2: As chair height increased from 17 to 22 inches, chair rise effort decreased, as shown by near doubling of percent successful rises, decline in mean self-reported difficulty score, increase in mean minimum hip angle, and decrease in mean maximum shoulder angle.

CONCLUSIONS

Seating height may need to be more closely scrutinized in areas frequented by frail elders. Augmentation of seat height by small increments facilitates chair rise performance.