Thesis (Ph. D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6368. Adviser: Kenneth S. Suslick. Includes bibliographical references. Available on microfilm from Pro Quest Information and Learning.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

As nanotecnologias são um conjunto multidisciplinar de técnicas que manipulam a matéria em escala nanométrica, mais precisamente partículas abaixo de 100 nanômetros, cujas características por conta do tamanho diminuto são essencialmente diferentes daquelas encontradas no material em sua forma macro. Em função destas novas propriedades dos materiais, existem lacunas de conhecimento relativas aos efeitos destas partículas sobre o organismo humano e sobre o meio ambiente. Embora ainda sejam consideradas tecnologias emergentes, seu crescimento é cada vez mais acelerado e o número de produtos que fazem uso de nanotecnologia em alguma fase de sua produção continua crescendo, bem como o número de pesquisadores envolvidos com o tema. Considerando este cenário e a literatura pertinente, este trabalho objetivou desenvolver uma sistemática de ações de segurança e saúde no trabalho (SST) para laboratórios de pesquisa com atividades de nanotecnologia. Esta sistemática é fundamentada na estrutura das diretrizes para um sistema de gestão de segurança e saúde no trabalho proposto pela Organização Internacional do Trabalho (OIT). A esta base foram agregadas diversas recomendações nanoespecíficas, sendo desta maneira consolidada a Sistemática de SST para Laboratórios com Nanotecnologia (S-SST/LabNano). Além da comparação desta sistemática com outras apresentadas por outros autores, uma pesquisa survey foi realizada, com o propósito de obter um retrato da SST em laboratórios com atividades de nanotecnologia no Brasil. De forma complementar, objetivando a adequação prática, a S-SST/LabNano foi avaliada em relação a realidade de SST encontrada em laboratório. O resultado final da tese, além da sistemática em si (S-SST/LabNano), almeja oferecer elementos de reflexão que possam auxiliar a gestão e o controle de riscos ocupacionais associados às nanotecnologias. / Nanotechnology is a multidisciplinary set of techniques that manipulates material at nanoscale, precisely particles below 100 nanometers whose characteristics, due to the small size, are essentially different from those found in material while in macro format. In the light of these new properties of materials, there are knowledge gaps regarding the effects of these particles on the human body and the environment. Although still considered emerging technologies, their growth is increasingly accelerated and the number of products that use nanotechnology in some stage of its production continues to grow, as well as the number of researchers involved with the topic. Given this scenario and its relevant literature, this study aimed to develop a proposed methodology of actions in occupational safety and health (OSH) to research laboratories with nanotechnology activities. This methodology is based on the structure of the International Labour Organization (ILO) guidelines for a management system in safety and health at work. Several specific recommendations were added, named Participatory Nano Safety Lab (PNSL). Besides the confrontation of this proposal with other authors, a research survey was conducted with the purpose to obtain a general picture of the OSH in laboratories with nanotechnology activities in Brazil. In a complementary way, aiming a practical suitability, the PNSL was confronted with the reality of OSH found in laboratory. The final result of this thesis, besides the methodology itself (PNSL), aims to provide elements of reflection that may assist management and occupational risk control associated to nanotechnology.

The original purpose or motive of the sacrifice, rooted in ceremonious or religious acts, was as a gift to a centralized power that ensured a common good or prosperity. In modern capitalist society, sacrifice is about “a willingness to sacrifice short-term gains for long-term gains” (Keenan 2005: 11) of freedom and fortune. What is concealed in this propaganda is that true freedom and prosperity is mostly restricted to a few exceedingly privileged and powerful individuals – and every year, these ‘short-term’ sacrifices include the millions of lives of the disciplined and altruistic workers that the system supposedly admires. Within this context, in recent years a growing recognition of the social and economic harms that corporations are capable of causing, specifically against workers and members of the public, led to the development of laws in several countries aimed at corporate manslaughter and corporate criminal liability. However, despite these legal advancements, the law continues to fail at protecting the victims of corporate harm and wrongdoing, and to adequately hold corporations and their actors accountable for their crimes. This research asks the following question: what role does corporate manslaughter law play in the reproduction of sacrifice and, in the process, violence and capitalist hegemony? This is done by interrogating the introduction and enforcement of corporate manslaughter law in the United Kingdom and the struggle for corporate criminal accountability from the socio-historical perspective of advanced neoliberal capitalism. Employing a theoretical lens that draws together literatures on sacrifice, law, and violence, this research shows that the law (re)produces particular understandings of sacrifice and violence that benefit the powerful, therein normalizing death and dying at work as the natural and largely unavoidable costs of modern employment relations. The research concludes that, to better address the systemic violence faced by workers, we must consider a restructuring of the legal enterprise and the ‘common sense’ understandings of sacrifice, violence, and harm that accompany it.

As nanotecnologias são um conjunto multidisciplinar de técnicas que manipulam a matéria em escala nanométrica, mais precisamente partículas abaixo de 100 nanômetros, cujas características por conta do tamanho diminuto são essencialmente diferentes daquelas encontradas no material em sua forma macro. Em função destas novas propriedades dos materiais, existem lacunas de conhecimento relativas aos efeitos destas partículas sobre o organismo humano e sobre o meio ambiente. Embora ainda sejam consideradas tecnologias emergentes, seu crescimento é cada vez mais acelerado e o número de produtos que fazem uso de nanotecnologia em alguma fase de sua produção continua crescendo, bem como o número de pesquisadores envolvidos com o tema. Considerando este cenário e a literatura pertinente, este trabalho objetivou desenvolver uma sistemática de ações de segurança e saúde no trabalho (SST) para laboratórios de pesquisa com atividades de nanotecnologia. Esta sistemática é fundamentada na estrutura das diretrizes para um sistema de gestão de segurança e saúde no trabalho proposto pela Organização Internacional do Trabalho (OIT). A esta base foram agregadas diversas recomendações nanoespecíficas, sendo desta maneira consolidada a Sistemática de SST para Laboratórios com Nanotecnologia (S-SST/LabNano). Além da comparação desta sistemática com outras apresentadas por outros autores, uma pesquisa survey foi realizada, com o propósito de obter um retrato da SST em laboratórios com atividades de nanotecnologia no Brasil. De forma complementar, objetivando a adequação prática, a S-SST/LabNano foi avaliada em relação a realidade de SST encontrada em laboratório. O resultado final da tese, além da sistemática em si (S-SST/LabNano), almeja oferecer elementos de reflexão que possam auxiliar a gestão e o controle de riscos ocupacionais associados às nanotecnologias. / Nanotechnology is a multidisciplinary set of techniques that manipulates material at nanoscale, precisely particles below 100 nanometers whose characteristics, due to the small size, are essentially different from those found in material while in macro format. In the light of these new properties of materials, there are knowledge gaps regarding the effects of these particles on the human body and the environment. Although still considered emerging technologies, their growth is increasingly accelerated and the number of products that use nanotechnology in some stage of its production continues to grow, as well as the number of researchers involved with the topic. Given this scenario and its relevant literature, this study aimed to develop a proposed methodology of actions in occupational safety and health (OSH) to research laboratories with nanotechnology activities. This methodology is based on the structure of the International Labour Organization (ILO) guidelines for a management system in safety and health at work. Several specific recommendations were added, named Participatory Nano Safety Lab (PNSL). Besides the confrontation of this proposal with other authors, a research survey was conducted with the purpose to obtain a general picture of the OSH in laboratories with nanotechnology activities in Brazil. In a complementary way, aiming a practical suitability, the PNSL was confronted with the reality of OSH found in laboratory. The final result of this thesis, besides the methodology itself (PNSL), aims to provide elements of reflection that may assist management and occupational risk control associated to nanotechnology.

This study focuses on computer workers with repetitive strain injury (RSI) that lead to chronic pain, interference with daily activities (work and leisure), getting a night's sleep, and pain-related mental health issues (e.g., anxiety and depression). People take their hands for granted, and when they suddenly lose the use of them and are unable to perform basic daily activities (bathing, dressing, feeding ourselves), may develop anxiety and depression. This research examines how physical pain caused by RSI affects computer workers as a whole, and how workers use exercise/physical activity participation and health professionals use exercise/physical activity prescription to alleviate the accompanying pain, anxiety and depression, interviews were conducted with eight RSI-injured computer workers from the public service and eight health professionals who treat this type of injury. The results show that regular exercise/physical activity is seen to be a weapon in combating pain and pain-related mental health issues in RSI-injured computer workers. An improved understanding of the benefits of exercise/physical activity for RSI-injured computer workers living with chronic pain and pain-related mental health issues will provide them with more effective coping strategies, ameliorate their emotional/psychological recovery, facilitate their active return to the workforce, and enhance their overall quality of life.

Background: Heart Rate Variability (HRV) as a research outcome has the potential for misclassification due to its inability to account for changes in the heart rate. HRV can be parsed into Acceleration Capacity (AC) and Deceleration Capacity (DC) which address these limitations. Objectives: To investigate the associations between AC and DC with short-term and long-term metal PM2.5 exposures; and examine if these associations are mediated by inflammation. Methods: A panel of 45-50 male welders, mean age 39-40 years, had continuous PM2.5 exposure during typical welding work shifts for 4-6 hours repeated 2-5 times over sampling periods in 2010-2012. We also obtained continuous recordings of digital electrocardiograms (ECG) over their work shift using Holter monitors during the same time; and analyzed blood samples before and after each welding shift for potential mediators of inflammation. In our first analysis, we used linear mixed models to assess the association between hourly PM2.5 exposure and each of simultaneously measured hourly AC and DC, controlling for covariates. Then, mediation analysis was done using linear mixed models to assess the associations between shift PM2.5 exposure, potential mediator levels, and AC and DC, controlling for relevant covariates in order to deduce the direct and indirect effects (via the mediator) of PM2.5 on AC and DC. In our final analysis, we used linear regression to assess the association between CEI PM2.5 exposure and each of current AC and DC, controlling for confounders. Results: Negative exposure-response associations were found for AC and DC with increased PM2.5 both in the short-term and long-term exposure after adjusting for covariates. In our mediation models, the proportion of the total effect of PM2.5 on AC or DC (indirect effect) mediated through IL-6 on AC was at best 4%. Conclusions: There are sustained acute and chronic effects of metal particulates on AC and DC even after exposure has ceased. These findings suggest that there may be more pathways that sustain response following exposure other than a direct effect of metal particulates on AC and DC. Furthermore, there may be complex mediating pathways involving interleukin 6. / Environmental Health

Statement of Problem: Despite significant advancements in occupational health and safety in recent decades, injury rates in commercial construction remain high. New programs that address the complexity of the construction work environment are needed to keep workers healthy and safe. Methods: The first step of this dissertation was to explore associations between organizational programs and policies, as measured by a Contractor Safety Assessment Program (CSAP) score, and worker safety climate scores. Next, a safety communication and recognition program was developed and piloted. It was evaluated through a mixed methods approach in a randomized controlled trial. Primary outcome measures included safety climate, awareness, communication, and teambuilding. Additionally, the dynamic nature of the construction site was quantified through an analysis of the determinants of length of stay of construction workers on the worksite. Results: Correlations between CSAP scores and safety climate scores were weak at best, thus highlighting a gap in communication between management and workers. The B-SAFE program, a safety communication and recognition program was developed to meet this gap. It used data from safety inspection scores to provide feedback to workers on hazards and controls, and provided a reward when the site met a pre-determined safety inspection threshold (a measure that was fair, consistent, attainable and fair). In the final program design, the whole site was treated as the unit of analysis. B-SAFE led to many positive changes, including a statistically significant increase in safety climate scores of 2.29 points (p-value=0.012), when adjusting for time-varying parameters and worker characteristics. Workers at the B-SAFE sites noted increased levels of safety awareness, communication, and teamwork, when compared to control sites. The composition of workers on-site at any given month changed by approximately 50%, and the length of stay on-site was associated with race/ethnicity, union status, title, trade, and musculoskeletal pain (p-values<0.05). Conclusions: The construction work environment is dynamic, with over half of the population on-site changing each month. This makes applying and evaluating traditional worksite based interventions challenging. Interventions like B-SAFE that are developed to address the complexities can have a positive impact on site safety measures. / Environmental Health

Background: welders are often exposed to various types of metals from the welding fumes and they also have high risks of cardiac autonomic dysfunction. Knowing the hazardous components within metals mixture as well as understanding the potential underlying mechanisms is essential for environmental and occupational regulations. Objective: to identify metal components which are associated with cardiac autonomic responses, as measured by two novel markers -acceleration capacity (AC) and deceleration capacity (DC); to examine whether inflammation mediates effects of metals exposure on AC/DC changes; to identify epigenetic variants which are associated with AC/DC changes. Methods: we collected urine, blood and electrocardiogram (ECG) samples from 75 welders over six sampling occasions between June 2003 and June 2012. Urinary concentrations of 16 types of metals were determined. Blood serum samples were analyzed for inflammatory cytokines levels including CRP, IL-2, IL4, IL6 and IL8. AC and DC values were quantified from ECG recordings. Firstly, we used linear mixed-effects models with Lasso to identify hazardous metals that were significantly associated with AC or DC changes. We fitted the co-pollutants model with “selected” metals in the linear mixed model to estimate the exposure-response relationship. Then, we conducted a mediation analysis to examine whether inflammatory cytokines mediated the effects of metals exposure on AC or DC changes. We report both direct and indirect effects in single pollutant model as well as co-pollutants models. Finally, we conducted the epigenome-wide association study (EWAS) to identify epigenetic variants that were associated with AC or DC changes. Results: we observed negative associations between urinary mercury and chromium concentrations with both DC and AC changes. Indirect effects of metals exposure on AC or DC through inflammation pathway were not significant. We identified GPR133 gene at which methylation level changes were associated with DC values. Conclusion: metals exposures are associated with impaired cardiac autonomic functions. Our study did not provide evidence that these effects were mediated through inflammation pathway. However, DNA methylation of specific genes may be a potential pathway linking environmental and occupational pollutants exposure and alterations in cardiac autonomic responses.

Noise is a major aggressor in the workplace. It is widely acknowledged that noise may be hazardous to health and may interfere with speech communication. Researchers have found that noise and noise-induced hearing loss can also compromise the audibility of warning signals. A computerized tool called "Detectsound" has been developed for predicting the capability of workers to detect auditory warning signals in noise and for providing an optimal adjustment of signal levels according to the functional limits of the target worker(s). This work represents a comprehensive revision and improvement over an earlier version of the "Detectsound" model [Laroche et al. (1991), Applied Acoustics, 32, 193--214]. The main enhanced features are: (1) taking into account the hearing status for individuals, (2) incorporating the normative data describing the effect of noise exposure and age on hearing thresholds (ISO 1999, ISO 7029), (3) integrating more recent and accurate data on frequency selectivity, and (4) improving the user interface for the implemented software program. (Abstract shortened by UMI.)