Air evacuation under high-level biosafety containment: the aeromedical isolation team.
Military contingency operations in tropical environments and potential use of biological weapons by adversaries may place troops at risk for potentially lethal contagious infections (e.g., viral hemorrhagic fevers, plague, and zoonotic poxvirus infections). Diagnosis and treatment of such infections would be expedited by evacuating a limited number of patients to a facility with containment laboratories. To safely evacuate such patients by military aircraft and minimize the risk for transmission to air crews, caregivers, and civilians, the U.S. Army Medical Research Institute of Infectious Diseases maintains an aeromedical isolation team. This rapid response team, which has worldwide airlift capability designed to evacuate and manage patients under high-level containment, also offers a portable containment laboratory, limited environmental decontamination, and specialized consultative expertise. This article also examines technical aspects of the team's equipment, training, capabilities, and deployments. (+info)
Two cases of Chromobacterium violaceum infection after injury in a subtropical region.
Chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum. Two 24-year-old Korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South Korea, on 9 August 1997, 3 days after an airplane accident in Guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics. (+info)
Pulmonary function and respiratory symptoms in a population of airport workers.
OBJECTIVES: To assess the prevalence of respiratory symptoms and to measure spirometry in a sample of employees of Birmingham International Airport, United Kingdom, to examine whether occupational exposure to aircraft fuel or jet stream exhaust might be associated with respiratory symptoms or abnormalities of lung function. METHODS: Cross sectional survey by questionnaire and on site measurement of lung function, skin prick tests, and exhaled carbon monoxide concentrations. Occupational exposure was assigned by job title, between group comparison were made by logistic regression analysis. RESULTS: 222/680 full time employees were studied (mean age 38.6 y, 63% male, 28% current smokers, 6% self reported asthma, 19% self reported hay fever). Upper and lower respiratory tract symptoms were common and 51% had one or more positive skin tests. There were no significant differences in lung function tests between exposure groups. Between group comparisons of respiratory symptoms were restricted to male members of the medium and high exposure groups. The adjusted odds ratio (OR) for cough with phlegm and runny nose were found to be significantly associated with high exposure (OR 3.5, 95% confidence interval (95% CI) 1.23 to 9.74 and 2.9, 1.32 to 6.40 respectively) when the measured confounding effects of age and smoking, and in the case of runny nose, self reported hay fever had been taken into account. There was no obvious association between high exposure and the presence of shortness of breath or wheeze, or for the symptoms of watering eyes or stuffy nose. CONCLUSIONS: These findings support an association in male airport workers, between high occupational exposures to aviation fuel or jet stream exhaust and excess upper and lower respiratory tract symptoms, in keeping with a respiratory irritant. It is more likely that these effects reflect exposure to exhaust rather than fuel, although the effects of an unmeasured agent cannot be discounted. (+info)
Medical advice for commercial air travelers.
Family physicians are often asked to advise patients who are preparing to travel. The Air Carrier Access Act of 1986 has enabled more passengers with medical disabilities to choose air travel. All domestic U.S. airlines are required to carry basic (but often limited) medical equipment, although several physiologic stresses associated with flight may predispose travelers with underlying medical conditions to require emergency care. Recommendations for passengers with respiratory, cardiac or postsurgical conditions must be individualized and should be based on objective testing measures. Specific advice for patients with diabetes, postsurgical or otolaryngologic conditions may make air travel less hazardous for these persons. Air travel should be delayed after scuba diving to minimize the chance of developing decompression sickness. Although no quick cure for jet lag exists, several simple suggestions may make travel across time zones more comfortable. (+info)
Reactions of migrating birds to lights and aircraft.
Midair collsions between birds and aircraft pose a hazard for both. While observing migrating birds with a tracking radar, we find that birds often react, by taking evasive maneuvers, at distances of 200-300 m to both searchlight beams and the approach of a small airplane with its landing lights on. Appropriately arranged lights on aircraft should decrease the hazard of collisions with birds. (+info)
Estimates of stratospheric pollution by an analytic model.
With suitable choices of the height profile of eddy diffusion coefficient, the vertical flow of an inert tracer is given by an analytic solution. Odd nitrogen, or NOX, from aircraft exhausts can be regarded as such a tracer, and the amount in the stratosphere resulting from a source of a given strength can be immediately calculated. The resulting destruction of ozone is then estimated with the help of a formula obtained from earlier work. (+info)
Mortality among aircraft manufacturing workers.
OBJECTIVES: To evaluate the risk of cancer and other diseases among workers engaged in aircraft manufacturing and potentially exposed to compounds containing chromate, trichloroethylene (TCE), perchloroethylene (PCE), and mixed solvents. METHODS: A retrospective cohort mortality study was conducted of workers employed for at least 1 year at a large aircraft manufacturing facility in California on or after 1 January 1960. The mortality experience of these workers was determined by examination of national, state, and company records to the end of 1996. Standardised mortality ratios (SMRs) were evaluated comparing the observed numbers of deaths among workers with those expected in the general population adjusting for age, sex, race, and calendar year. The SMRs for 40 cause of death categories were computed for the total cohort and for subgroups defined by sex, race, position in the factory, work duration, year of first employment, latency, and broad occupational groups. Factory job titles were classified as to likely use of chemicals, and internal Poisson regression analyses were used to compute mortality risk ratios for categories of years of exposure to chromate, TCE, PCE, and mixed solvents, with unexposed factory workers serving as referents. RESULTS: The study cohort comprised 77,965 workers who accrued nearly 1.9 million person-years of follow up (mean 24.2 years). Mortality follow up, estimated as 99% complete, showed that 20,236 workers had died by 31 December 1996, with cause of death obtained for 98%. Workers experienced low overall mortality (all causes of death SMR 0.83) and low cancer mortality (SMR 0.90). No significant increases in risk were found for any of the 40 specific cause of death categories, whereas for several causes the numbers of deaths were significantly below expectation. Analyses by occupational group and specific job titles showed no remarkable mortality patterns. Factory workers estimated to have been routinely exposed to chromate were not at increased risk of total cancer (SMR 0.93) or of lung cancer (SMR 1.02). Workers routinely exposed to TCE, PCE, or a mixture of solvents also were not at increased risk of total cancer (SMRs 0.86, 1.07, and 0.89, respectively), and the numbers of deaths for specific cancer sites were close to expected values. Slight to moderately increased rates of non-Hodgkin's lymphoma were found among workers exposed to TCE or PCE, but none was significant. A significant increase in testicular cancer was found among those with exposure to mixed solvents, but the excess was based on only six deaths and could not be linked to any particular solvent or job activity. Internal cohort analyses showed no significant trends of increased risk for any cancer with increasing years of exposure to chromate or solvents. CONCLUSIONS: The results from this large scale cohort study of workers followed up for over 3 decades provide no clear evidence that occupational exposures at the aircraft manufacturing factory resulted in increases in the risk of death from cancer or other diseases. Our findings support previous studies of aircraft workers in which cancer risks were generally at or below expected levels. (+info)
Kinematic synergy adaptation to microgravity during forward trunk movement.
The aim of the present investigation was to see whether the kinematic synergy responsible for equilibrium control during upper trunk movement was preserved in absence of gravity constraints. In this context, forward trunk movements were studied during both straight-and-level flights (earth-normal gravity condition: normogravity) and periods of weightlessness in parabolic flights (microgravity). Five standing adult subjects had their feet attached to a platform, their eyes were open, and their hands were clasped behind their back. They were instructed to bend the trunk (the head and the trunk together) forward by approximately 35 degrees with respect to the vertical in the sagittal plane as fast as possible in response to a tone, and then to hold the final position for 3 s. The initial and final anteroposterior center of mass (CM) positions (i.e., 200 ms before the onset of the movement and 400 ms after the offset of the movement, respectively), the time course of the anteroposterior CM shift during the movement, and the electromyographic (EMG) pattern of the main muscles involved in the movement were studied under both normo- and microgravity. The kinematic synergy was quantified by performing a principal components analysis on the hip, knee, and ankle angle changes occurring during the movement. The results indicate that 1) the anteroposterior position of the CM remains minimized during performance of forward trunk movement in microgravity, in spite of the absence of equilibrium constraints; 2) the strong joint coupling between hip, knee, and ankle, which characterizes the kinematic synergy in normogravity and which is responsible for the minimization of the CM shift during movement, is preserved in microgravity. It represents an invariant parameter controlled by the CNS. 3) The EMG pattern underlying the kinematic synergy is deeply reorganized. This is in contrast with the invariance of the kinematic synergy. It is concluded that during short-term microgravity episodes, the kinematic synergy that minimizes the anteroposterior CM shift is surprisingly preserved due to fast adaptation of the muscle forces to the new constraint. (+info)