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IOM affirms CDC guidance on N95 use in H1N1 setting

first_imgSep 3, 2009 (CIDRAP News) – The Institute of Medicine (IOM) today affirmed existing federal guidance that healthcare workers caring for H1N1 influenza patients should wear fit-tested N95 respirators, not just surgical masks, to protect them from the virus.At the same time, the IOM called for additional research on flu transmission and the effectiveness of various respiratory protection tools in clinical settings, along with efforts to develop new respiratory protection technologies to enhance safety and comfort.”Based on what we currently know about influenza, well-fitted N95 respirators offer health care workers the best protection against inhalation of viral particles,” said Kenneth Shine, chair of the committee that wrote the report, in an IOM news release.”But there is a lot we still don’t know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield,” added Shine, who is executive vice chancellor for health affairs in the University of Texas System, Austin, and former president of the IOM.. “Health care organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, hand washing, disinfection, gloves, vaccination, and antiviral drug use.”But the IOM report drew criticism today from a representative of the Association of Professionals in Infection Control and Hospital Epidemiology (APIC), who said the recommendation to wear N95s fails to recognize the many practical and logistical problems related to N95 use, including discomfort, costs, shortages, and the difficulty of fit testing.In the face of unclear science concerning flu virus transmission, the IOM prepared the report at the request of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA).The panel, which was given just 8 weeks to write the report, held a 4-day meeting, including a 1 1/2-day public workshop, in August. The panel’s assignment specifically excluded the economical and logistical considerations related to personal protective equipment (PPE).The report notes that the current CDC guidance on protection for health workers caring for H1N1 patients differs from guidance from the World Health Organization (WHO) and Canadian guidance. The CDC recommends use of N95s for all healthcare workers who enter the rooms of patients in isolation with confirmed or suspected H1N1 infection. The same advice goes for emergency medical personnel who come in close contact with such patients.In contrast, the WHO recommends “standard and droplet precautions (including a medical mask, gown, gloves, eye protection, hand hygiene) for those working in direct contact with patients and additional precautions for aerosol-generating procedures including wearing a facial particulate respirator,” the report says. The recommendation allows for “the need for sustainability” in different countries.Similarly, recently released Canadian guidelines call for using N95s only during aerosol-generating procedures and recommend using medical (surgical) masks in other situations, according to the report.On the murky question of the extent to which flu viruses spread through the air, the IOM committee concluded that studies show that “airborne (inhalation) transmission is one of the potential routes of transmission.”The panel said it found few studies comparing the effectiveness of N95 respirators and medical masks in clinical settings, although several studies are under way. Hence the group based its decisions on comparisons of the two kinds of protection in controlled experiments. Those studies show that medical masks are unlikely to be effective in preventing aerosol transmission, the report says.In view of that evidence, the panel recommends that health workers in close contact with patients who have novel H1N1 flu or flu-like illness should wear fit-tested N95 respirators or respirators that are “demonstrably more effective.” The report specifically endorses the current CDC guidance and says it should be followed until there is evidence that other forms of protection work as well or better.In addition, the report advises that employers should make sure that N95 respirators are used and fit-tested in accordance with OSHA regulations.The panel further found that the need for more research on flu transmission and PPE is “striking.” It urges federal agencies and private organizations to support and undertake research to:Answer questions about the relative contribution of different routes of flu transmissionExplore the effectiveness of different respiratory protection tools in clinical settings through randomized trialsDesign and develop new respiratory protection technologies “to enhance safety, comfort, and ability to perform work-related tasks”The IOM’s recommendation to use fit-tested N95s drew criticism on practicality grounds today from Ruth Carrico, an infection control expert at the University of Louisville School of Public Health and Information Sciences and a former APIC board member. Carrico was on a panel of experts who reviewed the IOM report in draft form.”I think the IOM has missed the mark,” Carrico told CIDRAP News.She acknowledged that the panel of authors was specifically charged with looking only at the science and not the logistical and economic issues. But she said it’s difficult to separate the scientific issues from the logistical matters, such as the ability of health workers to follow the guidance and its applicability in clinical settings.”As a human being, if you’re being told this is the best protection for your and you go to work and that protection is not available, how likely are you to go to work the next day?” she asked.Noting that the recommendation specifically calls for the use of fit-tested respirators, Carrico said there are “lots of gaps” in the information about fit testing. Given the cost and time requirements of fit testing, she said, “Does it really make sense and is it a valid point? We have to be concerned about that in our economic times.”More generally, she said, “Divorcing the recommendations from the practicality of implementation represents a serious problem for healthcare workers who are trying to figure out, ‘What do I do to provide care for my patients in a safe manner?'”Hospitals say they do fit testing as best they can, but “there’s no way to be fit tested for all the kinds of respirators used,” Carrico continued. For example, this past spring, some hospitals ran out of respirators and hence used respirators from the government’s Strategic National Stockpile. Those were a different type from what hospitals normally use, which created a need for additional fit testing, she said.Keeping respirators on hand is a continuing problem, she added. “There are back orders; there are constant calls about interruptions in supply. We simply do not have the supply line of these types of materials in order to apply these recommendations.” As a result, hospitals try to save their respirators for us in the highest-risk settings.The shortages and other problems lead to inconsistent and changing hospital policies, which confuse workers, she added. “We’re hearing about workers who will say ‘I refuse to care for this patient because I don’t feel safe,'” she said.Carrico also commented that most workers can wear N95s only a short time before they become hot and uncomfortable.”At some point you’ve got to peel the onion and say what’s really necessary, what’s really practical, and how are we going to enable our healthcare workers to do what needs to be done?” she said.She also expressed hope that the IOM’s appeal for new research will lead to some well-designed studies in clinical settings.At a press briefing today, CDC Director Dr. Thomas Frieden said the CDC has just received the IOM report and is looking at it.CDC spokesman Tom Skinner said the agency is considering the recommendations from the IOM and other expert groups on the issue of respiratory protection for health workers. “We hope to have a plan that further addresses this issue very soon,” he told CIDRAP News.See also:Sep 3 National Academy of Sciences news release about the reporthttp://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12748Table of contents page for full IOM report “Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A”http://www.nap.edu/catalog.php?record_id=12748Aug 13 CIDRAP News story “Experts air practical PPE considerations to IOM”Aug 12 CIDRAP News story “IOM hears diverse findings on PPE for flu”last_img read more

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Sterling praise for Peters

first_img “Maybe on the outside people had the impression I’ve always been really confident,” Sterling said. “But after a good start (to last season) I started looking for easy options rather than taking a chance myself, beating a man, taking a shot on myself. “I’d stopped being natural, (and doing) all the things that I’d done which got me into the first team in the first place. “You could look at the City goal as an example. I’m not trying to sound cheeky or over confident but three or four months ago I would have squared rather than take the responsibility all for myself. “My goal was always to play for Liverpool when I first came here and maybe for a while I thought that goal was achieved because I was one of the lucky ones to do it. “But you realise that is not enough. There always has to be the next challenge, to achieve things and win things – making your mark. “From December time I realised I had to start stamping my personality, running with the ball, running into the box, making goals, scoring goals. Not playing with that barrier, not to be worried about making mistakes.” “The way he (Peters) works is brilliant,” Sterling told the latest edition of the official Liverpool FC magazine. “At first I thought it wasn’t for me. On the outside you might think it’s complicated, but all the messages are very straightforward. “He understands the players and the emotional side of the game. What he says really helps you. “We use a motto ‘focus on the ball, focus on the team’. I had a meeting with him before the Manchester City game (on April 13, which Liverpool won 3-2 with Sterling scoring the opening goal). “I thought it was going to last 20-25 minutes. So I walked in, sat down and he just said: ‘focus on the ball, focus on the team’. “‘Is that it?’ I asked him. But it was really important.” Sterling has scored 10 goals in all competitions this season and the one he netted against City was particularly memorable, with the composure he showed to take his time before rifling past England colleague Joe Hart. The teenager says a “barrier” has been lifted in terms of him worrying about making mistakes. Press Association Liverpool winger Raheem Sterling has revealed advice from sports psychiatrist Dr Steve Peters has helped boost his performance this season. Sterling has been one of several key men in the Reds’ impressive campaign, delivering displays worthy of the sort of hype that surrounded him when he made his breakthrough into the first team in 2012. And the 19-year-old says meeting at Melwood with Peters – who he will be able to speak to this summer in the England camp at the World Cup if he makes Roy Hodgson’s squad as expected – has played an important part in that. last_img read more

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College football Week 12 primer: Heisman Watch, upset picks, predictions and more

first_imgThe Tigers have a future No. 1 pick at quarterback in Trevor Lawrence, an All-American tailback in Travis Etienne who averages 8.9 yards per carry, a receiver who averages 20.4 yards per catch in Tee Higgins and a defense led by the multi-talented Isaiah Simmons. Did we mention they have won 25 straight games?  Clemson might play in the ACC, but they aren’t like the other teams in the ACC. They also are a victim of a close 21-20 victory on Sept. 28 against North Carolina. One more time: The Tigers won the game.   The Tigers at +300 to win a national championship might be a steal. No. 23 Navy meets No. 16 Notre Dame (2:30 p.m., NBC) in the first of those matchups. No. 4 Georgia travels to No. 12 Auburn (3:30 p.m., CBS) in the afternoon slot along with a matchup between No. 8 Minnesota and No. 20 Iowa (4 p.m., FOX). The prime-time spotlight shines on the Big 12 with No. 10 Oklahoma at No. 13 Baylor (7:30 p.m., ABC).  WEEK 12 PICKS: Straight up | Against the spreadNo. 5 Georgia travels to No. 13 Auburn (3:30 p.m., CBS) in the biggest SEC game of the week, and No. 7 Minnesota is an underdog at No. 23 Iowa (4 p.m., FOX). No. 12 Baylor puts its unbeaten record on the line against No. 10 Oklahoma (7:30 p.m., ABC) in the primetime slot. Every week, Sporting News will survey the landscape looking for Heisman contenders, coaches on the spot, upset alerts and other trends. With that in mind, get ready for Week 12:  Heisman watch   LSU’s Joe Burrow took control of the Heisman Trophy race after hitting 31 of 39 passes for 393 yards and rushing for 64 more yards in a 46-41 victory against Alabama last Saturday. That effectively knocked Tua Tagovailoa and the rest of the field into a race for second. Ohio State’s Chase Young won’t be on the field in Week 12, so this is an opportunity for Oklahoma’s Jalen Hurts to firm up a spot as a finalist.  Hurts still leads all FBS quarterbacks with a 94.1 QBR, and he ranks second in the FBS in total offense at 401.2 yards per game. Burrow is third at 376.3. Hurts by no means will catch Burrow with a victory at Baylor, but it’s still a chance to stay in the Heisman vote and continue the never-ending debate with Tagovailoa.  Who is second on your ballot right now?  Coach on the spot  Penn State is coming off a 31-26 loss at Minnesota, and the Nittany Lions cannot afford to look ahead to next week’s noon showdown with No. 2 Ohio State.  Not with Indiana coming to Happy Valley. James Franklin can’t lose this game. The Nittany Lions are 5-6 against teams ranked in the AP Top 25 since 2017, and the Hoosiers are No. 24. Indiana is 0-10 at Beaver Stadium, however.  The Nittany Lions must win out to get to the College Football Playoff, but a loss here and next win in Columbus would be devastating for a program on the rise.Upset alert   We will give you three doors to choose from:  Can Auburn throw a wrench into the Playoff race by knocking off Georgia at Jordan-Hare Stadium? The Tigers won the last meeting 40-17 in 2017 and are 7-1 ATS as home underdogs under Gus Malzahn. That’s a tough spot for the Bulldogs.  Iowa beat No. 2 Michigan at Kinnick Stadium on Nov. 12, 2016, then beat No. 3 Ohio State in the same place on Nov. 4, 2017. Will Kirk Ferentz beat another top-10 team at home for the third time in four seasons with Minnesota coming to down?  Notre Dame coach Brian Kelly is 7-2 against Navy, but he has never lost to the Midshipmen in South Bend. Navy won at Notre Dame Stadium in 2007 and 2009, however, and they can slow the Irish’s so-so run defense down.  One of those is going to happen Saturday. We just don’t know which door to choose.  Over/under  Alabama suffered a November loss, but that will not be the defining reason as to why they would be left out of the CFP.  Of the 20 playoff participants since 2020, a total of five lost in November. That list includes Michigan State (Nov. 7, 2015), Clemson (Nov. 12, 2016), Washington (Nov. 12, 2016), Georgia (No. 11, 2017) and Alabama (Nov. 25, 2017). The Crimson Tide  There have been six undefeated teams, too, and among other nine playoff teams seven lost in October and two lost in September. That says it’s still better to lose early, but it really does not matter if you don’t lose twice.  Think about it …   Clemson averages more points this year than last year – a slim difference of 45.3 to 44.3 – and is giving up fewer points than last year – 11.5 to 13.1 – and yet they are considered a rung below LSU and Ohio State.   Week 12 of the college football season has arrived, and there are just three more weeks until the College Football Playoff pairings are revealed.  There are four matchups involving teams ranked in the College Football Playoff rankings.  last_img read more

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Costa Rica hopes to clinch World Cup berth against a carefree Mexico

first_imgThe Costa Rican Men’s National Team hopes to clinch its spot at the 2018 World Cup on Tuesday when it faces off against a Mexican side that’s missing a few key players, but will arrive carefree in San José. Why? Because Mexico nabbed its World Cup spot on Friday when it defeated Panama 1-0 at home at the Azteca Stadium.Costa Rica took a step toward classification that same night when it defeated the United States, 2-0, bringing it within one point of a trip to Russia.The final round of Concacaf qualifying, known as the Hexagonal, assigns three direct World Cup spots; the fourth-place team will battle an Asian side for a ticket to Russia.Mexican captain Andrés Guardado said that in some ways, the match against Costa Rica, scheduled for 8 p.m., feels like the first match of the World Cup for the Tricolor.“We have won in places where we haven’t won for a long time, and today we’re one step away from taking first place,” he said. “The World Cup starts today [for us]. We have to think about what we can do to arrive at the World Cup in the best possible way, and what would be better than taking first place in the Hexagonal?” Costa Rican coach Oscar “El Machillo” Ramírez said Costa Rica has quite a challenge ahead as it seeks to achieve its classification on the field with Mexico.“It’s a very competitive side and we’ll have to know how to manage it,” he said after his team’s victory against the United States.Possible lineups – Costa Rica: Keylor Navas – Cristian Gamboa, Johnny Acosta, Kendall Waston, Francisco Calvo, Bryan Oviedo – David Ramírez, Celso Borges, Bryan Ruiz, Cristian Bolaños – Marco Ureña. Coach: Óscar Ramírez.Mexico: Guillermo Ochoa – Jair Pereira, Hugo Ayala, Diego Reyes, Héctor Moreno – Andrés Guardado, Jesús Gallardo, Jürgen Damm – Carlos Vela, Jesús Corona and Javier Hernández. Coach: Juan Carlos Osorio. Facebook Comments However, the team will face Costa Rica with three key players missing: Héctor Herrera because of an injury, Jesús Dueñas because of a family matter, and Néstor Araujo because of a suspension for accumulated yellow cards.center_img Related posts:Costa Rica returns with full-strength lineup in last step toward World Cup qualifying The 5 greatest moments in Costa Rican soccer history Costa Rica humiliates the United States 4-0 in World Cup qualifier ‘La Sele’ draws Nicaragua, Haiti and Bermuda in Gold Cup grouplast_img read more