Title Best current evidence on chest physiotherapy in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis: a systematic review. Purpose To determine the current scientific evidence for using three chest physiotherapy modalities namely percussion, postural drainage and suctioning in paediatric patients (0 to 24 months). Relevance The field of cardiopulmonary physiotherapy seems to be a neglected area in physiotherapy, with a subsequently limited evidence base. The author observed that in various clinical settings physiotherapists tend to administer routine chest physiotherapy to paediatric patients with bronchiolitis. Findings from this study may assist physiotherapists in their choice of effective treatment options. Sources The following databases were searched for evidence: African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP E-theses/dissertations, PEDro, Medline Ovid, Sabinet, Science Direct, Up To Date. Methodology This was a systematic review. The databases were reviewed by making use of a specified search strategy customised for each database. Keywords were: physiotherapy/physical therapy, bronchiolitis and paediatric/pediatric in combination with percussion, postural drainage and suction. The search yielded 10,016 study titles. Studies were chosen from the population of studies using pre-set inclusion and exclusion criteria. These criteria were applied to the titles, abstracts and full-text articles as appropriate. Five full text-articles were appraised and based on the scores from the appraisal three were included in the final sample. Data analysis Appraisal instruments from the National Health System Critical Appraisal Skills Programme (NHS CASP) and the PEDro scale (for randomised controlled trials) were used to evaluate and score the sample. Scoring was done independently by two researchers, and agreement reached through negotiation. The evidence was synthesised and graded according to the Sackett hierarchy of evidence. Results Owing to the heterogeneity of the sample, and the nature of results reported, a meta-analysis was not possible. Results from this study reveal that there is no evidence to support routine chest physiotherapy in uncomplicated viral bronchiolitis amongst the paediatric population. Chest physiotherapy does not decrease length of hospital stay, oxygen requirements or clinical scores indicating distress/morbidity. However, with secondary bacterial respiratory infections, chest physiotherapy may be indicated, depending on the assessment of each individual patient. Conclusion Percussion, postural drainage and suctioning are not effective in the management of bronchiolitis in children, newborn to 24 months old, except in individually assessed cases with secondary bacterial infection. In this subset, physiotherapy must be customised to the patient. Therefore routine physiotherapy is not indicated. Implications Chest physiotherapy should be based on a complete evaluation and on clinical merit, as well as on evidence and patient preference. Education of physiotherapy students at universities as well as doctors regarding the current evidence for chest physiotherapy in paediatric bronchiolitis is essential. Doctors and clinicians need to be made aware that routine chest physiotherapy for paediatric patients with bronchiolitis should not be prescribed. AFRIKAANS : Titel Die beste huidige bewyse aangaande longfistioterapie vir non geventileerde pediatriese pasiënte (0 tot 24 maande) met brongiolitis: 'n sistematiese oorsig. Doel Om huidige wetenskaplike bewyse vir die gebruik van drie long fisioterapietegnieke naamlik beklopping, posturale dreinasie en suiging in pediatriese pasiënte (0 tot 24 maande) te bepaal. Toepaslikheid Die veld van pediatriese fisioterapie blyk 'n verwaarloosde area van navorsing te wees, met gevolglik beperkte bewysbasis. Die navorser het ondervind dat fisioterapeute dikwels in kliniese praktyk roetine longfisioterapie in pediatriese pasiënte met brongiolitis toepas. Bewyslewering vanuit hierdie studie kan fisioterapeute help met die keuse van effektiewe behandelingsprosedures. Bronne Die volgende databasisse is deursoek vir bewyse: African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP e-theses and dissertations, PEDro, Medline, Sabinet, Science Direct en Up To Date. Die soektog het 10,016 titels gelewer. Metode 'n Sistematiese oorsig van die data is uitgevoer deur 'n gespesifiseerde soekstrategie, aangepas vir elke databasis, te volg. Sleutelwoorde was: “physiotherapy/physical therapy”, “bronchiolitis” and “paediatric/pediatric” in kombinasie met “percussion”, “postural drainage” and “suction”. Voorafbepaalde insluitings- en uitsluitingskriteria is toegepas op titels, abstrakte en artikels soos toepaslik. Data analise Evalueringsinstrumente van die “National Health System Critical Appraisal Skills programme” (NHS CASP) asook die PEDro skaal (ewekansige gekontroleerde eksperiment) is gebruik vir evaluasie van en puntetoedeling vir die verkose studies. Die puntetoekenning is onafhanklik deur twee navorsers gedoen en konsensus is bereik deur onderhandeling. Die inligting verkry is gesintetiseer en gegradeer aan die hand van die Sackett hiërargie van bewyse. As gevolg van die heterogeniteit van die ingeslote studies en die aard van die resultate was 'n meta-analise nie moontlik nie. Resultate Die studie het bevind dat daar geen bewyse is vir roetine borskasfisioterapie van ongekompliseerde akute virale pediatriese brongiolitis nie. Borskasfisioterapie verminder nie die duur van hospitaalverblyf, suurstofbehoeftes of die kliniese respiratoriese aanduiding van stres in die pasiënte nie. In die geval van sekondêre bakteriële respiratoriese infeksies mag borskasfisoterapie egter geindikeerd wees, afhangend van die evaluasie van elke individuele pasiënt. Gevolgtrekking Beklopping, posturale dreinasie, en suiging as roetine behandeling is nie effektief in die behandeling van brongiolitis in pasgebore tot 24 maand oue pasiënte nie, behalwe individuele gevalle met sekondêre bakteriële infeksies. In hierdie spesifieke subgroep moet borskasfisioterapie aangepas word vir pasiënt. Roetine fisioterapie is dus nie aangedui nie. Implikasies Borskasfisioterapie moet gebasseer wees op 'n volledige evaluasie en kliniese meriete, asook bewyslewering en die pasiënt se voorkeure. Opleiding van fisioterapie studente by universiteite, asook dokters aangaande die huidige bewyslewering vir borskasfisioterapie in pediatriese brongiolitis is belangrik. Dokters en klinici moet bewus gemaak word dat roetine borskasfisioterapie vir pediatriese brongiolitis pasiënte nie voorgeskryf moet word nie. Additional information available on a CD stored at the Merensky Library. / Dissertation (MPhysT)--University of Pretoria, 2011. / Physiotherapy / unrestricted

Ammonium Nitrate-Fuel Oil (ANFO) is the explosive generally used in the mining industry to blast ore from the rock face. The use and detonation of ANFO explosives in an underground mine is an intrinsically hazardous process. The by-products formed during blasting have been well studied over the years and modern mining techniques and methods have evolved to mitigate the inherent blasting and gas emission risks. However, there is insufficient research and quantitative data on mine workers’ respiratory exposure to blasting gasses under realistic underground conditions. Aim: The objective of this study was to determine whether blasting gasses such as nitric oxide (NO), nitrogen dioxide (NO2) and ammonia (NH3) pose an inhalation health risk to underground mine workers cleaning at the blasting panels approximately three hours after the detonation of ANFO explosives. Scraper Winch Operators’ (SWOs) respiratory exposure to selected blasting gasses was simultaneously sampled by means of active and passive sampling methodologies. Method: Personal exposures to NO, NO2 and NH3 were measured and analysed in accordance with NIOSH methods 6014 and 6015. Along with the active air samplers, respiratory exposure to NO2 and NH3 were measured by means of radial symmetry diffusive samplers (Aquaria® RING). Measurements were taken over an 8-hour period, where this was not applicable; results were time weighed to an average 8-hour exposure concentration in order to compare the Scraper Winch Operators’ (SWOs) respiratory exposure to the Occupational Exposure Limits (OELs) contained in the Regulations of the Mine Health and Safety Act (No. 29 of 1996). Results: The active air sampling results indicated that the SWOs’ respiratory exposure to NO, NO2 and NH3 complied with their respective OELs contained in the Regulations of the Mine Health and Safety Act (No. 29 of 1996). However, one of the SWOs had an exposure which exceeded the action level (50% of OEL) at which level the implementation of control measures are recommended to reduce the SWO’s exposure. Based on the results of the Wilcoxon matched pairs test, statistical significant differences were observed between the exposure results of the two sampling methodologies for NO2 (p = 0.00078) and NH3 (p = 0.044), with the passive diffusive sampling technique under sampling when compared to the active sampling method. This was also confirmed by a Spearman rank order correlation which indicated a poor relationship between the two sampling methods for NO2 (r = -0.323) and NH3 (r = 0.090). Environmental conditions (i.e. temperature and humidity), as presented in an underground mine, may have been a major factor for the variation between the two sampling methods, mostly affecting the passive samplers. Conclusion: It was established that engineering and administrative control measures implemented at the underground mine were effective to control SWOs’ respiratory exposure to NO, NO2 and NH3 below their respective OELs. An acute health risk pertaining the inhalation of blasting gasses was, therefore, not presented to mine workers cleaning at the blasting panels approximately three hours after the detonation of ANFO explosives. However, long-term exposure to blasting gasses at low concentrations may present SWOs with a health risk if such exposures are not adequately controlled or mitigated. The dilution and production of blasting gasses also varied from one blasting level to another. Geological formation, explosive charge-up and loading practices, the amount of water vapour inside the stopes and ventilation parameters are among the factors that may have affected the amount of blasting gasses produced underground. In addition, a drop in the carbon monoxide levels as indicated by the mine’s central gas monitoring system would not necessarily mean a lowering in other blasting gas concentrations (i.e. elevated ammonia gas concentrations as identified in the present study). The personal exposure levels between the active and passive sampling measurements also differed considerably. This may be ascribed to the impact underground mining conditions and processes had on the sampling media as well the complexities involved when sampling blasting gasses in general. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014

Ammonium Nitrate-Fuel Oil (ANFO) is the explosive generally used in the mining industry to blast ore from the rock face. The use and detonation of ANFO explosives in an underground mine is an intrinsically hazardous process. The by-products formed during blasting have been well studied over the years and modern mining techniques and methods have evolved to mitigate the inherent blasting and gas emission risks. However, there is insufficient research and quantitative data on mine workers’ respiratory exposure to blasting gasses under realistic underground conditions. Aim: The objective of this study was to determine whether blasting gasses such as nitric oxide (NO), nitrogen dioxide (NO2) and ammonia (NH3) pose an inhalation health risk to underground mine workers cleaning at the blasting panels approximately three hours after the detonation of ANFO explosives. Scraper Winch Operators’ (SWOs) respiratory exposure to selected blasting gasses was simultaneously sampled by means of active and passive sampling methodologies. Method: Personal exposures to NO, NO2 and NH3 were measured and analysed in accordance with NIOSH methods 6014 and 6015. Along with the active air samplers, respiratory exposure to NO2 and NH3 were measured by means of radial symmetry diffusive samplers (Aquaria® RING). Measurements were taken over an 8-hour period, where this was not applicable; results were time weighed to an average 8-hour exposure concentration in order to compare the Scraper Winch Operators’ (SWOs) respiratory exposure to the Occupational Exposure Limits (OELs) contained in the Regulations of the Mine Health and Safety Act (No. 29 of 1996). Results: The active air sampling results indicated that the SWOs’ respiratory exposure to NO, NO2 and NH3 complied with their respective OELs contained in the Regulations of the Mine Health and Safety Act (No. 29 of 1996). However, one of the SWOs had an exposure which exceeded the action level (50% of OEL) at which level the implementation of control measures are recommended to reduce the SWO’s exposure. Based on the results of the Wilcoxon matched pairs test, statistical significant differences were observed between the exposure results of the two sampling methodologies for NO2 (p = 0.00078) and NH3 (p = 0.044), with the passive diffusive sampling technique under sampling when compared to the active sampling method. This was also confirmed by a Spearman rank order correlation which indicated a poor relationship between the two sampling methods for NO2 (r = -0.323) and NH3 (r = 0.090). Environmental conditions (i.e. temperature and humidity), as presented in an underground mine, may have been a major factor for the variation between the two sampling methods, mostly affecting the passive samplers. Conclusion: It was established that engineering and administrative control measures implemented at the underground mine were effective to control SWOs’ respiratory exposure to NO, NO2 and NH3 below their respective OELs. An acute health risk pertaining the inhalation of blasting gasses was, therefore, not presented to mine workers cleaning at the blasting panels approximately three hours after the detonation of ANFO explosives. However, long-term exposure to blasting gasses at low concentrations may present SWOs with a health risk if such exposures are not adequately controlled or mitigated. The dilution and production of blasting gasses also varied from one blasting level to another. Geological formation, explosive charge-up and loading practices, the amount of water vapour inside the stopes and ventilation parameters are among the factors that may have affected the amount of blasting gasses produced underground. In addition, a drop in the carbon monoxide levels as indicated by the mine’s central gas monitoring system would not necessarily mean a lowering in other blasting gas concentrations (i.e. elevated ammonia gas concentrations as identified in the present study). The personal exposure levels between the active and passive sampling measurements also differed considerably. This may be ascribed to the impact underground mining conditions and processes had on the sampling media as well the complexities involved when sampling blasting gasses in general. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014

Nickel is one of the most commonly known sensitisers and has been classified by the International Agency for Research on Cancer (IARC) as a possible carcinogen to humans (group 2B). Workers at a South African base metal refinery packaging area are potentially exposed to many hazardous chemicals that include nickel. Aims and Objectives: The aim and objectives of this study were to assess dermal and respiratory exposure of workers exposed to nickel in a packaging section at a South African base metal refinery and to assess the change in skin barrier function during a work shift by measuring percentage change in trans epidermal water loss (TEWL), skin hydration and skin surface pH. Skin health was established with a skin questionnaire. Surfaces that workers may come into contact with were also assessed. Method: Respiratory and dermal exposure assessment was done concurrently. Respiratory exposure was assessed and analysed by using the National Institute for Occupational Safety and Health (NIOSH) method 7300. The Institute of Occupational Medicine (IOM) inhalable aerosol sampler was used for personal air sampling. The TEWL index, skin hydration and skin surface pH of the index finger, palm, forearm and forehead were measured before and at the end of the shift with a Derma Measurement Unit, EDS 12 and Skin-pH-Meter® pH 905. These measurements were reported as percentage change in skin barrier function during the shift. Dermal exposure samples were collected with Ghostwipes™ from the index finger and palm of the dominant hand before, during and at the end of the shift, while samples from the forearm and forehead were only collected before and after the shift. Surface sampling was collected and all wipes were analysed for nickel according the NIOSH method 9102, using inductively coupled plasma-atomic emission spectrometry. Results: Respiratory exposure for the whole group of workers in a packaging section was well below the eight hour Time Weighted Average (TWA) respiratory Occupational Exposure Limit (OEL) of 0.5 mg m-3 for nickel. Dermal nickel loading was detected for all the job categories on all the anatomical areas even before the shift had commenced. During the shift more nickel was detected on the index finger and palm of the hand. Levels on the forearm and forehead were much lower in comparison with the index finger and the palm of the hand. Workplace surfaces, which workers may come into contact with on a daily basis, were also contaminated with nickel. Forklift drivers showed high exposure on the index finger and palm of their hands, and this can be attributed to them not wearing any gloves for hand protection. An increase in percentage change for TEWL was seen for most of the job categories on all anatomical areas measured during the shift. Percentage change in skin surface pH and skin hydration varied among job categories. Conclusion: The research addressed the problem statement, with the stated objectives. It was hypothesised that workers at a packaging section of a base metal refinery are exposed to quantifiable levels of nickel through the dermal exposure route. The hypothesis was accepted and control measures together with future studies were recommended. The results confirmed that all workers at a base metal refinery are exposed to quantifiable levels of nickel through the dermal exposure route. Dermal exposure was evident on all anatomical areas for all job categories before the shift had commenced. Personal protective equipment was provided to all employees, but forklift drivers did not wear gloves when operating the forklift. Respirable exposure to nickel was below the OEL. Changes in TEWL and to a lesser extent skin hydration, suggest a deterioration in skin barrier function during the shift. Forklift drivers as well as plate washers may be the highest risk job categories in developing allergic contact dermatitis. Several measures to lower respiratory and dermal exposure to nickel are also recommended. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014

Nickel is one of the most commonly known sensitisers and has been classified by the International Agency for Research on Cancer (IARC) as a possible carcinogen to humans (group 2B). Workers at a South African base metal refinery packaging area are potentially exposed to many hazardous chemicals that include nickel. Aims and Objectives: The aim and objectives of this study were to assess dermal and respiratory exposure of workers exposed to nickel in a packaging section at a South African base metal refinery and to assess the change in skin barrier function during a work shift by measuring percentage change in trans epidermal water loss (TEWL), skin hydration and skin surface pH. Skin health was established with a skin questionnaire. Surfaces that workers may come into contact with were also assessed. Method: Respiratory and dermal exposure assessment was done concurrently. Respiratory exposure was assessed and analysed by using the National Institute for Occupational Safety and Health (NIOSH) method 7300. The Institute of Occupational Medicine (IOM) inhalable aerosol sampler was used for personal air sampling. The TEWL index, skin hydration and skin surface pH of the index finger, palm, forearm and forehead were measured before and at the end of the shift with a Derma Measurement Unit, EDS 12 and Skin-pH-Meter® pH 905. These measurements were reported as percentage change in skin barrier function during the shift. Dermal exposure samples were collected with Ghostwipes™ from the index finger and palm of the dominant hand before, during and at the end of the shift, while samples from the forearm and forehead were only collected before and after the shift. Surface sampling was collected and all wipes were analysed for nickel according the NIOSH method 9102, using inductively coupled plasma-atomic emission spectrometry. Results: Respiratory exposure for the whole group of workers in a packaging section was well below the eight hour Time Weighted Average (TWA) respiratory Occupational Exposure Limit (OEL) of 0.5 mg m-3 for nickel. Dermal nickel loading was detected for all the job categories on all the anatomical areas even before the shift had commenced. During the shift more nickel was detected on the index finger and palm of the hand. Levels on the forearm and forehead were much lower in comparison with the index finger and the palm of the hand. Workplace surfaces, which workers may come into contact with on a daily basis, were also contaminated with nickel. Forklift drivers showed high exposure on the index finger and palm of their hands, and this can be attributed to them not wearing any gloves for hand protection. An increase in percentage change for TEWL was seen for most of the job categories on all anatomical areas measured during the shift. Percentage change in skin surface pH and skin hydration varied among job categories. Conclusion: The research addressed the problem statement, with the stated objectives. It was hypothesised that workers at a packaging section of a base metal refinery are exposed to quantifiable levels of nickel through the dermal exposure route. The hypothesis was accepted and control measures together with future studies were recommended. The results confirmed that all workers at a base metal refinery are exposed to quantifiable levels of nickel through the dermal exposure route. Dermal exposure was evident on all anatomical areas for all job categories before the shift had commenced. Personal protective equipment was provided to all employees, but forklift drivers did not wear gloves when operating the forklift. Respirable exposure to nickel was below the OEL. Changes in TEWL and to a lesser extent skin hydration, suggest a deterioration in skin barrier function during the shift. Forklift drivers as well as plate washers may be the highest risk job categories in developing allergic contact dermatitis. Several measures to lower respiratory and dermal exposure to nickel are also recommended. / MSc (Occupational Hygiene), North-West University, Potchefstroom Campus, 2014