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This brief reports outlines a 9-month feasibility study aimed at introducing and evaluating a third-sector mental health recovery programme to support patients on an acute mental health ward transitioning to community discharge. The study outcome data indicates that the recovery programme improved self-reported well-being (p = 0.01) and self-reported recovery progress (p = 0.01). The sample size for this study is small, and the results should be interpreted with caution. Recommendations are made as to ways in which third sector recovery programmes can be further developed in inpatient mental health services. The study was a collaborative endeavour between NHS mental health services and a third sector mental health charity. The provision findings indicates that collaborative working between healthcare and third sector at the time of discharge from acute mental health care can improve service users’ well-being.

The mode of toxic action (MOA) is recognized as a key determinant of chemical toxicity and as an alternative to chemical class-based predictive toxicity modeling. However, MOA classification has never been standardized in ecotoxicology, and a comprehensive comparison of classification tools and approaches has never been reported. Here we critically evaluate three MOA classification methodologies using an aquatic toxicity data set of 3448 chemicals, compare the approaches, and assess utility and limitations in screening and early tier assessments. The comparisons focused on three commonly used tools: Verhaar prediction of toxicity MOA, the U.S. Environmental Protection Agency (EPA) ASsessment Tool for Evaluating Risk (ASTER) QSAR (quantitative structure activity relationship) application, and the EPA Mode of Action and Toxicity (MOAtox) database. Of the 3448 MOAs predicted using the Verhaar scheme, 1165 were classified by ASTER, and 802 were available in MOAtox. Of the subset of 432 chemicals with MOA assignments for each of the three schemes, 42% had complete concordance in MOA classification, and there was no agreement for 7% of the chemicals. The research shows the potential for large differences in MOA classification between the five broad groups of the Verhaar scheme and the more mechanism-based assignments of ASTER and MOAtox. Harmonization of classification schemes is needed to use MOA classification in chemical hazard and risk assessment more broadly.

In general, reliable studies are well designed and well performed, and enough details on study design and performance are reported to assess the study. For hazard and risk assessment in various legal frameworks, many different types of ecotoxicity studies need to be evaluated for reliability. These studies vary in study design, methodology, quality, and level of detail reported (e.g., reviews, peer-reviewed research papers, or industry-sponsored studies documented under Good Laboratory Practice [GLP] guidelines). Regulators have the responsibility to make sound and verifiable decisions and should evaluate each study for reliability in accordance with scientific principles regardless of whether they were conducted in accordance with GLP and/or standardized methods. Thus, a systematic and transparent approach is needed to evaluate studies for reliability. In this paper, 8 different methods for reliability assessment were compared using a number of attributes: categorical versus numerical scoring methods, use of exclusion and critical criteria, weighting of criteria, whether methods are tested with case studies, domain of applicability, bias toward GLP studies, incorporation of standard guidelines in the evaluation method, number of criteria used, type of criteria considered, and availability of guidance material. Finally, some considerations are given on how to choose a suitable method for assessing reliability of ecotoxicity studies. Integr Environ Assess Manag 2017;13:640-651. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Up to 70% of hospice patients are reported to experience dyspnea at end of life. Despite the high prevalence of this burdensome symptom, there is little in the literature to guide effective treatment. Assessment of subjective symptoms and objective signs as well as physical, psychospiritual, sociocultural, or environmental barriers is critical to an effective plan of care. The purpose of the article is to review the current literature on assessment and management of dyspnea in hospice patients and provide implications for hospice clinicians.

At a machining center used to produce transmission parts, aerosol instrumentation was used to quantitatively study mist generation and to evaluate the performance of an air cleaner for controlling the mist. This machining center drilled and tapped holes at rotational speeds of 1000 to 3000 rpm. During most machining operations, the metal-working fluid (MWF) was flooded over the part. To facilitate metal chip removal during some operations, MWF was pumped through the orifices in some tools at a pressure of 800 psi. These machining operations were performed in a nearly complete enclosure that was exhausted to an air cleaner at a flow rate of 1.1 m3/sec (2400 ft3/m). Although the use of high-pressure MWF increased the mist concentration by about 200%, it did not affect the mist size distribution. The observed penetration through the air cleaner appeared to be mostly consistent with the manufacturer's specifications on the air cleaner's filters. During the testing, MWF was observed to accumulate in the bottom of the filter housing and may have been reentrained due to air motion or mechanical vibration.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) applied Hazard and Operability (HAZOP) analysis to examine hazards during the use of anhydrous ammonia by farmers. This analysis evaluated the storage, transfer, and application of anhydrous ammonia, identifying credible hazard scenarios, practical solutions, and research needs. Ninety-five findings were developed that are of use to farmers, distributors of ammonia and application equipment, and manufacturers of application equipment. The findings generally involve training, equipment design changes, preventive maintenance, and material compatibilities. The HAZOP team found that additional safety features need to be developed or implemented. The study also pointed out where correct operator procedure and preventive maintenance can prevent inadvertent releases. Other inadvertent releases are caused by incompatible materials, or by using equipment in ways other than intended. Several examples of the findings are given to emphasize the HAZOP technique and the high-risk scenarios. Strategies for dissemination to the agricultural community are presented.

Process hazards review (PHR) techniques have generally been applied by large, sophisticated companies in the nuclear, aerospace, and chemical process industries. There remains, however, a large population of smaller distributors and consumers of hazardous materials which could benefit equally from the application of PHR. These consumers unfortunately are generally less sophisticated and individually lack the necessary resources required to apply such state-of-the-art safety techniques. Where common processes can be identified, it is possible to conduct a more generic PHR that will provide a sound technical basis for recognizing and preventing the development of hazards wherever these processes are used. Some facility-specific issues will always need to be considered, but the existence of the generic PHR should make the conduct of a PHR by each facility considerably easier and less costly. Researchers from the National Institute for Occupational Safety and Health (NIOSH) contracted with DNV Technica Inc. to lead a hazard and operability study (HAZOP) of agricultural handling of anhydrous ammonia, from the receipt of ammonia at the retail distribution centre to the application of the ammonia by farmers to the fields. The multidisciplinary HAZOP team consisted of representatives from NIOSH, an agricultural chemical trade association, an ammonia producer, state ammonia facility inspectors, a retail distributor, and an equipment manufacturer. Several participants were part-time farmers with ammonia application experience. Some specific aspects of applying the HAZOP technique in the context of this study, the findings obtained, and the plans to disseminate the important safety information developed during the course of the PHR are discussed. Finally, it is suggested that this approach could prove to be a useful addition to the product stewardship activities of chemical producers.

•RECENT EVENTS around the world have emphasized the need for health care facilities to prepare to deal with biological threats, including smallpox. •AT WALTER REED Army Medical Center, Washington, DC, administrators recognized the need for a policy on handling patients with smallpox in the OR and asked a group of students to create a template policy for care of patients with smallpox in need of surgery. •THIS ARTICLE provides a brief history of smallpox, concerns surrounding smallpox today, and smallpox characteristics with which perioperative personnel should be familiar, as well as a guideline for treating patients in the OR who have smallpox. AORN J 80 (October 2004) 681–689

Methylene chloride, a potential occupational carcinogen, is one of the principal solvents used for furniture stripping. Methylene chloride exposures among workers in furniture stripping operations have been found to be high. This article describes a furniture stripping operation at a sheltered workshop before and after the ventilation system was modified. Previous to ventilation system modifications, workers who were stripping furniture had exposures to methylene chloride ranging from 600 to 1150 ppm. These high exposures and an evaluation of the ventilation system prompted the design and installation of a modified ventilation system. Primary modifications included installing a local ventilation hood, decreasing the velocity of makeup air entering the stripping area, removing a contaminated charcoal adsorption bed and improving work practices. The modified system was arranged into three configurations that included a slot hood, a downdraft hood, and a combination slot and downdraft hood. The three configurations were evaluated over a three-day period, and it was found that they controlled the worker's personal exposures to methylene chloride while stripping to 28 ppm for the combination configuration, 30 ppm for the downdraft configuration, and 34 ppm for the slot configuration. Although the exposures are above the proposed Occupational Safety and Health Administration permissible exposure level of 25 ppm, these results show a substantial improvement over the existing ventilation system. The ventilation system described is applicable to other furniture stripping facilities if rinse area local ventilation is improved.

Background : Uncontrolled hemorrhage is one of the leading causes of death in both combat and civilian trauma. This study was designed to compare the arterial blood pressures at which rebleeding occurred when a hemostatic agent, ExcelArrest™, was used compared with a standard pressure dressing. Materials and Methods : This study was a prospective, experimental, and mixed research design. Swine were assigned to one of two groups: ExcelArrest™ (n=5) or a control consisting of standard pressure dressings (n=5). Investigators generated a complex groin injury. The femoral artery and vein were transected and allowed to bleed for 60 s in each pig. After 60 s, ExcelArrest™ was poured into the wound. The control group underwent the same procedures, but without treatment with the hemostatic agent. After 5 min of direct pressure, a standard pressure dressing was applied. After 30 min, dressings were removed and the systolic blood pressure (SBP) was increased incrementally using intravenous phenylephrine until rebleeding occurred. Statistical Analysis : A multivariate ANOVA and a least significant difference were used to analyze the data. Results : ExcelArrest™ was more effective in preventing rebleeding compared to a standard pressure dressing (P