The Secret World of your Elbow

The crook of your elbow is not just a plain patch of skin. It is a piece of coveted real estate, a special ecosystem, a bountiful home to no fewer than six tribes of bacteria. Even after you have washed the skin, there are 1 million bacteria in every square centimeter.

These are not bad bacteria. They are what biologists call commensals, creatures that eat at the same table with people to everyone's mutual benefit. Though they were not invited to enjoy board and lodging in the skin of your inner elbow, they are giving something of value in return.
They are helping to moisturize the skin by processing the raw fats it produces, said Dr. Julia Segre, of the National Human Genome Research Institute.

Segre and colleagues reported their discovery of the six tribes in a paper published online Friday in Genome Research. The research is part of the human microbiome project, "microbiome" meaning the entourage of all microbes that live in people. The project is a government-financed endeavor to catalog the typical bacterial colonies that inhabit each niche in the human ecosystem.

The project, in its early stages, has established that the bacteria in the human microbiome collectively possess at least 100 times as many genes as the mere 20,000 or so in the human genome.

Since humans depend on their microbiome for various essential services, including digestion, a person should be considered a superorganism, microbiologists said, consisting of his or her own cells and those of all the commensal bacteria. The bacterial cells outnumber human cells by 10-1, meaning that if cells could vote, people would be a minority in their own body.

Segre reckons there are at least 20 different niches for bacteria, and maybe many more, on the skin, each with a characteristic set of favored commensals. The types of bacteria she found in the inner elbow are different from those that another researcher identified a few inches away, on the inner forearm. But each of the five people Segre sampled harbored much the same set of bacteria, suggesting this set is specialized for the precise conditions of nutrients and moisture that prevail in the human elbow.

Microbiologists think humans and their commensal bacteria are continually adapting to one another genetically. The precision of this mutual accommodation is indicated by the presence of particular species of bacteria in different niches on the human body, as Segre has found with denizens of the elbow.

Other researchers have found that most gut bacteria belong to just 2 of the 70 known tribes of bacteria. The gut bacteria perform vital services such as breaking down complex sugars in the diet and converting hydrogen, a byproduct of bacterial fermentation, to methane.

The nature of the gut tribes is heavily influenced by diet, according to a research team led by Dr. Ruth Ley and Dr. Jeffrey Gordon of the Washington University School of Medicine in St. Louis.
With the help of colleagues at the San Diego and St. Louis zoos, Ley and Gordon scanned the gut microbes in the feces of people and 59 other species of mammals, including meat eaters, plant eaters and omnivores. Each of these three groups has a distinctive set of bacteria, they reported in Friday's issue of Science, with the gut flora of people grouping with the other omnivores.
Despite the vast changes that people have made to their diet through cooking and agriculture, their gut bacteria "don't dramatically depart in composition from those of other omnivorous primates," Gordon said.

The lifetime of an individual bacterium in the human superorganism may be short, since millions are shed each day from the skin or gut. But the colonies may survive for a long time, cloning themselves briskly to replace members that are sacrificed. Where these colonies come from and how long they last is not known.

Dr. David Relman of Stanford University has tracked the gut flora of infants and found that their first colonists come from their mother. But after a few weeks the babies acquired distinctive individual sets of bacteria, all except a pair of twins who had the same set. Relman said he was trying to ascertain if the first colonists remain with an individual for many years.

Strong Link Between Crime and Lead Exposure

The first study to follow lead-exposed children from before birth into adulthood has shown that even relatively low levels of lead permanently damage the brain and are linked to higher numbers of arrests, particularly for violent crime.

Previous studies linking lead to such problems have used indirect measures of lead and criminality, and critics have argued that socioeconomic and other factors may be responsible for the observed effects.

But by measuring blood levels of lead before birth and during the first seven years of life and then correlating the levels with arrest records and brain size, Cincinnati researchers have produced the strongest evidence yet that lead plays a major role in crime.

The team also found that lead exposure is a continuing problem despite the efforts of the federal government and cities to minimize exposure.

The average lead levels in the study "unfortunately are still seen in many thousands of children throughout the United States," said Dr. Philip Landrigan, director of the Children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

The link between criminal behavior and lead exposure was found among even the least-contaminated children in the study, who were exposed to amounts of lead similar to what the average U.S. child is exposed to today, said Landrigan, who was not involved in the study.

"People will sometimes say, 'This is in the past. We are cleaning up lead. We don't have lead problems anymore,' " said criminologist Deborah Denno of Fordham University in New York, who was not involved in the study. "The Ohio study says this is still a big problem."
Nationwide, about 310,000 children between 1 and 5 have blood lead levels above the federal guideline of 10 micrograms per deciliter, and experts suspect that many times that number have lower levels that are nonetheless dangerous.

"It is a national disgrace that so many children continue to be exposed at levels known to be neurotoxic," said Dr. David Bellinger, of the Harvard Medical School, who wrote an editorial accompanying the research.

Although some urban soil is contaminated with lead from gasoline, 80 percent of lead exposure comes from houses built before 1978. Paint in such houses often contains up to 50 percent lead and, even though it has been covered by newer, lead-free paints, it flakes or rubs off.
About 38 million U.S. homes, 40 percent of the nation's housing, contain lead-based paint, according to the U.S. Department of Housing and Urban Development. The problem is particularly acute in urban areas, which typically have older housing that has not been renovated.

More recently, parents and authorities have become concerned about lead-based paint in toys imported from China.

Researchers have long known that lead exposure reduces IQ by damaging brain cells in children during their early years.

It is also known that lead increases children's distractibility, impulsiveness and restlessness and leaves them with a shortened attention span, all factors considered precursors of aggressive or violent behavior.

A landmark 1990 paper by Denno linked lead to increases in criminal behavior, but the children in the study were not tested for lead levels. The diagnosis was based on their physicians' evaluation, Denno said.

The Cincinnati Lead Study enrolled 376 pregnant women in Cincinnati between 1979 and 1984, measuring their blood lead levels during pregnancy and the children's levels during the their first seven years.

In the first of the new studies, environmental health research Kim Dietrich of the University of Cincinnati College of Medicine studied 250 of the original group, correlating their lead levels with adult criminal-arrest records from Hamilton County, Ohio.

Controlling for a variety of factors, including parental IQ, education, income and drug use, Dietrich and colleagues found that the more lead in a child's blood from birth through age 7, the more likely he or she was arrested as an adult. The tie between high lead and violent crime was particularly strong.

They found that 55 percent of the subjects (63 percent of males) had been arrested, and that the average was five arrests between the ages of 18 and 24.

The higher the blood-lead level at any time in childhood, the greater the likelihood of arrests. "The strongest association was with violent criminal activity: murder, rape domestic violence, assault, robbery and possession of weapons," Dietrich said.

Blood levels in the children ranged from 4 to 37 micrograms per deciliter.

The researchers found, for example, that every 5-microgram-per-deciliter increase in blood lead level at age 6 was accompanied by a 50 percent increase in violent crime later in life.
Confirming previous findings, the effect of lead was strongest in males, who had an arrest rate 4.5 times that of females.

"We need to be thinking about lead as a drug and a fairly strong one," Dietrich said.

In the second study, radiologist Kim Cecil and her colleagues examined a "representative sample" of 157 members of the same group using whole-brain MRI scans. They found that those with the highest blood levels of lead during childhood had the smallest brain volume.
For those with average lead level in the study, their brains were about 1.2 percent smaller. The most affected regions of the brain were those regulating decision making, impulse control and attention, among other areas.

"The most important message is that lead affects brain volume, independent of demographic and social factors that are often used to explain away poor outcomes" in life, Cecil said. "This is independent biological evidence showing that the brain is affected by lead."

Getting in Shape by Cycling

As the days get warmer and longer, more riders will hop on their bicycles for a spin. Just how fast and where you go will determine if your bike is a piece of fitness equipment or simply a comfortable, recreational way to save gas and enjoy the outdoors.

Ask Craig Undem about bicycling and fitness. He will give you a short but insightful answer.
"Go climb hills," said Undem, a local cycling coach who operates the Cycle U training company in Seattle and regularly serves as an instructor for the Cascade Bicycle Club.

Undem said too few cyclists choose hills for workouts, when doing so a couple times per week can transform your body composition (goodbye, fat) and dispel any doubts that cycling is a top calorie burner among physical activities.

"Hills give you more bang for the buck," Undem said. "You might choose to go on a slow, steady ride for 20 miles (about an hour's worth for experienced riders and more like two hours for novices). But if you do moderate hills for 30 minutes that will burn more calories."

Undem said moderate hills translates to "a grade of 4 to 6 percent, not too steep, especially if you're just getting back into shape." He said you want to work at an exertion rate of 70 to 90 revolutions per minute, or rpm. You can determine this level by purchasing a bicycle computer (about $50 retail) or comparing that pedaling rate of 70 to 90 rpm to how that registers on a indoor stationary bike.

"You want that cadence to be moderately intense," Undem said. "It keeps you in a safe zone and gives you a great workout."

Increasing your intensity levels in short bursts (enough to be out of breath but not gagging) elevates cycling to one of the best calorie-burners among all physical activities. In fact, statistics from the American Council on Exercise (the primary certification group for personal trainers) equates bicycle racing with a vigorous game of basketball and not far off running at a brisk clip that would leave most people gasping.

Adding hills to any bicycle ride is easy enough here in the Pacific Northwest. Undem said to do it most efficiently requires more expertise than you might think. For instance, Cycle U teaches a "boot camp" devoted strictly to going up and down hills. It runs for eight two-hour sessions.
"It's a lot like skiing once you get into it," explained Undem. "There is a lot of technique."
Some highlights: Sit more upright in the bike saddle when you're climbing a hill. Don't pull your arms back too hard or too much when navigating the upward slope. And breathe deeply as you work.

One more tip for climbers that applies to all cyclists as they roll back outside this spring. Undem said too many recreational riders forget to drink water during the ride and eat something if they are going more than a hour nonstop. Sports nutritionist will suggest a snack and water is good idea some time in the hour before your ride.

Cycle U and the Cascade Bicycle Club offers plenty of other courses for beginners as well as the most savvy riders. You can learn how to ride a bike -- "there are plenty of people who come to us that never learned as kids," Undem said -- or perhaps take a refresher course on how to shift gears. Cascade instructors might go to the bike shop with you to pick out just the right model.

Not surprisingly, the Cascade club, the country's largest with a membership base of 10,000, works with a significant percentage of injured athletes from other sports. Basketball, running and tennis lead the list, mostly due to balky knees that are treated less jarringly on a bike.
Lateral movement fells basketball and tennis players, Undem said. Runners tend to not rest their bodies enough and stride themselves right into overuse injuries.

"Cycling has a locked range of motion so those runners, tennis players and basketball players can exercise without doing any more harm to the knees," Undem said.

The key strategy is to add intensity to your bike workouts, whether you are rehabbing an injury, cross training or deciding to make your commute your daily workout. All cycling for fitness will turn up noticeable changes in your body composition and personal energy level if you add some hills and maybe incorporate a few all-out sprints for 30 seconds or less when it is safe to do.

"Cycling is a real tonic for the body," Undem said. "Work harder and it will charge you up. You will feel good even after you're off the bike."

Quality Critical to Health Care Reform

Expanding healthinsurance coverage is a critical step in health reform, but reforms willnot be successful if they fail to also address the quality and cost of care.

That is the conclusion of The Quality Crossroads Group, a broad groupof stakeholders drawn together to identify strategies to address thecomplex challenges confronting the U.S. health care system. The group laysout a five-point agenda in an article published today in Health Affairs that serves as a vision for quality in an election year when patient safety, the plight of the uninsured, and rising costs are making front-pagenews.

"Quality improvement is intricately connected with containing costs andexpanding coverage. Yet too often, quality is left out of the equation,"says co-author Margaret E. O'Kane, president of the National Committee forQuality Assurance. "Poor quality care is a major contributor to runaway health care costs.

Improving quality is a key part of making coverage affordable."

"The future of health care reform rests on the ability for diversegroups, at national, state, and community levels, to work to achieve consensus. We cannot achieve the important policy goals outlined in this paper without collaboration," says co-author Janet Corrigan, president and CEO of the National Quality Forum. "The thinking in this paper, by leadersin the quality movement across the country, represents a successful effort to collaborate in moving beyond rhetoric and sparking real change," sheadded.

If taken up by the new President, Congress and others, the five-point reform plan put forward by the 13 authors of the paper would mobilize true change in the nation's vast, complicated, and expensive health care system.

The reform plan calls for:

A national center to support effectiveness research. The U.S. invests too little in understanding what works and what does not for a whole array of technologies, drugs, and treatments. In order to ensure that our health care dollars are wisely spent, we need to systematically identify where critical gaps in evidence exist and fill them.

Models of accountable health care entities capable of providing integrated and coordinated care. The sickest patients often suffer the most from lack of care coordination across settings. They see multiple specialists, get an array of tests, and take multiple medications - usually without a "health care home" or central coordinator of care. Achieving high levels of coordination will require investments in organizational supports that go beyond information technology. IT is a critical enabler of management, but is not sufficient to produce high-quality, efficient, and patient-centered care.

Payment models that reward high-value care. There are nearly 10,000 codes for payment for medical procedures, but not one for outcomes or results. The Quality Crossroads Group believes that if quality is not tied to payment, providers' behavior will not appreciably change, and if it does not change, access to insurance and care will continue to decline.

We need to aggressively develop models of payment that reward clinically effective and efficient care and yield high patient satisfaction. Those might include innovative ideas like bundled chronic care episodes.

A national strategy for performance measurement, including standardized measures of patient and population health. We need a common vision of what quality care means. To get there, we need to agree on what we are measuring and how we are measuring it. Performance information is a public good and federal funding for the National Quality Forum, a private sector standard-setting organization, will facilitate development of a comprehensive portfolio of standardized measures that is continually assessed and updated.

A multistakeholder approach to improving population health. Obesity is a national crisis that demands solutions that lie mostly outside of health care. The public sector can do much to promote population health. For example, in Arkansas, nearly 38 percent of young people are overweight or at risk of becoming overweight. State officials implemented a strategy to target children in schools, focusing on what they eat and how often they exercise. We must make a concerted public- and private-sector effort -- similar to the one we mounted for tobacco control -- to achieve the outcomes we know are possible.

Executing the most popular Yoga position

HOW TO DO A DOWNWARD DOG

Place your feet hip-width apart on the floor, toes facing forward.

Place your hands shoulder-width apart on the floor, lightly spread the fingers.

Keep your tailbone lifted towards the sky and gently push down through the heels. If you're a beginner, you might not get your heels all the way to the floor at first -- that's OK.

Open your upper back by rotating the shoulder blades away from one another. Keep the shoulders away from the ears and press down firmly through all fingers and thumbs. Place more weight onto your feet than your hands.

Shifting the weight back to the hips is the key element in feeling the energizing effect of this posture. Pull your navel toward your spine and lift the pelvic floor muscles. Lift your kneecaps up and contract the quadriceps muscles.

Maintain this pose for 5 to 10 deep breaths.

Stress Relief From Yoga

Funny thing. When Jenny Hayo first started practicing yoga in 1996, she thought of it as "purely an exercise option." Within two years, she was teaching classes and digging deeper.

Her appreciation of yoga as a personal methodology changed with each new mentor. Hayo realized yoga is energizing in ways beyond the workout, and said she sees no reason why the rest of us can't tap into it for stress relief and everyday vigor.

"The interesting point of modern-day yoga is it is looked at as exercise by most people," says Hayo, who teaches at 8 Limbs Yoga Center in the Capitol Hill neighborhood, plus some classes at the downtown Zum health club. "Ninety-five percent of people get into yoga that way. But no one is complaining. It puts people on the yoga mat and that's great."

In fact, Seattle P-I venture capital columnist and blogger John Cook noted earlier this month in an item about the TeachStreet free online directory that there are no fewer than 984 yoga classes in the Seattle area.

That's a lot of yoga mats.

For her part, Hayo, 33, learned yoga is more than meets the physical plane and any form of the seemingly undoable lotus position.

"The name, '8 Limbs,' comes from the eight principles of yoga," Hayo said. "As you practice yoga, you can begin to feel the physical, emotional, mental and energetic benefits."

There are different interpretations, but fundamentally the "eight limbs" of yoga include body postures, breathing exercises or control of "prana," personal observances, control of the senses, concentration and inner awareness, devotion or meditation, universal morality and union with the divine.

Hayo acknowledged that most of us would recognize the body postures, breathing and meditation components. The remaining "limbs" are less familiar but powerful, even if you commit to just minutes of yoga daily or one session a week.

The ideal strategy for yoga novices is a one-on-one session with an instructor -- "it will cost about the same as an appointment with your massage therapist," Hayo said. But you can certainly get an energy boost from a beginner's class at your local yoga studio (look for a teacher who offers different versions of the same posture depending upon experience and fitness level).

Or you can begin with the "downward-facing dog" pose, which Hayo said is one of the "inversion" postures that can instantly energize the body.

Yoga brings balance, said Hayo, who works with numerous clients to match a customized set of postures to their needs. "The downward dog can help if you feel tired or anxious (or both)."
The downward dog is a more accessible version of the handstand or headstand, which likely most American adults have not done since, oh, fifth grade. Yet maybe there is more to those childhood handstands than just playing or showing off.

"I have teacher who calls headstands and handstand the 'yogi's coffee,' " Hayo said.

The downward dog pose looks, not surprisingly, a lot like a dog stretching its paws in front and its rear high in the air. For us humans, it starts with putting your hands in alignment with your shoulders and hips as you move to hands and feet on the floor. Novices often spread the hands too far apart and the feet too close together.

Next, as you come into all fours, place your knees under your hips and gently extend your spine. As you put your hands on the mats, spread the fingers a bit with the middle finger straight ahead.

Lift your pelvis toward the ceiling and pull the hips back. Your eyes look to the feet. The feet are even with the hips. Resist moving them closer to the hands just put the heels down. If your heels don't touch, they will if you do the downward dog regularly.

Hayo said a good practice is to hold the posture for five slow, purposeful breaths.
"Keep at it," she said. "You will get mental clarity while in the pose. I tell students to experience it until it feels right. You will know."

What keeps yoga regulars coming back is, to be sure, a combination of results. But one of the most satisfying is increased energy, not just after class but the rest of the day or week. You feel more clear-headed. You stand more upright. There is less tiredness midday. Who can resist that in today's hurly-burly?

Well, there is one problem. You might call it the Foot-and-Leg-Over-the-Head mental block.
To that end, 8 Limbs and other local yoga studios are eager to attract beginners with basics classes and special weekend workshops, such as the "Yoga for Men" class, 2:30 to 4:45 p.m. at the 8 Limbs center in West Seattle, on May 18. Instructor Greg Owen will be working to help reluctant men get past "what they feel is their lack of flexibility."

Owen plans to help men connect yoga movement and breathing with ways to ease the strain and pain of "sore lower backs, tight hamstrings and stiff shoulders."

A good deal for at least four limbs.

Stress in the Workplace

The longer he waited, the more David worried. For weeks he had been plagued by aching muscles, loss of appetite, restless sleep, and a complete sense of exhaustion. At first he tried to ignore these problems, but eventually he became so short-tempered and irritable that his wife insisted he get a checkup.

Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him. They had been good friends when she worked in the front office at the plant, but he hadn't seen her since she left three years ago to take a job as a customer service representative.

Her gentle poke in the ribs brought him around, and within minutes they were talking and gossiping as if she had never left.

"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three.

We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."

"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks.

All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval. Most of the time I'm caught between what the customer wants and company policy.

I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her.

No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.

The concept of job stress is often confused with challenge, but these concepts are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.

But for David and Theresa, the situation is different-the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.

Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.

According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

Solvents in the Workplace

A solvent is a liquid that can dissolve another material. In industry the term solvent is generally applied to the kinds of substances known as "organic solvents" that are widely used to dissolve organic chemicals such as oils and resins.

Examples of such solvents include kerosene, acetone, petroleum distillates and naphthas. Potential solvent uses are limitless and include degreasing, cleaning, stripping, thinning and finishing. Solvents are used extensively in many industries.

How Can Exposure To Solvents Affect Health?

Excessive solvent exposures can lead to health problems.

Solvents are ABSORBED (enter the body) by the following routes:

Inhalation

This is the most important route of exposure for most solvents. Once inhaled, the vapors which arise from solvents can directly irritate the upper respiratory tract (nose, throat and bronchial tubes) and the lungs. Solvent vapors can also be easily absorbed from the lungs into the bloodstream and travel to other parts of the body to produce additional harmful effects.

Skin Contact

Solvents can be absorbed through the skin and travel to other parts of the body. Solvents can also break down the natural protective oils and fats of the skin. This can cause the skin to become dry, cracked and inflamed.

Mouth Contact

Solvents can enter the body and bloodstream through the mouth and digestive system. Although not a common route of entry, mouth contact with contaminated hands, food and cigarettes can occur and be dangerous.

Health Effects Are Dependent On What Factors?

Toxicity of the solvent.
Route of exposure.
Amount of exposure.
Individual worker's susceptibility.
Combination with other chemical exposures.

All of these factors are important in determining whether a person will experience any damaging health effects from solvent exposures. For example, a worker who already has respiratory breathing problems, such as asthma, may experience breathing difficulties while working around solvent vapors that do not produce any health effects in a person without respiratory problems.

What Acute (Short-Term) Effects Can Occur?

Solvent health effects that are ACUTE follow a single or short-term chemical exposure and usually occur soon after the exposure. Acute effects generally last only minutes, hours or days and are reversible once the exposure is over. Since they occur shortly after exposure, they are more easily identified. Common acute effects from solvent exposure include:

Respiratory Irritation

Exposure to solvent vapors can irritate respiratory mucous membranes. This can produce a burning sensation of the nose, throat or chest and lead to coughing. Inhalation of very high concentrations of solvents may result in severe irritation of the lungs and a condition called pulmonary edema, or fluid in the lungs. Symptoms of pulmonary edema include coughing and difficulty in breathing and require prompt medical attention.

Eye Irritation

Exposure to high concentrations of solvent vapors may produce eye irritation. This can lead to burning, tearing, and painful eyes. Dermatitis. Acute contact with a solvent can cause a breakdown of protective fats and oils in the skin. Skin may become reddened, itchy, and blistered. Central Nervous System Depression. The central nervous system consists of the brain and spinal cord. Solvent exposure can affect the brain like alcohol and lead to a state similar to being drunk. Large exposures can produce central nervous system effects including euphoria, feeling "high," dizziness, lack of coordination, headaches, fatigue and nausea.

Heart Arrhythmia

Solvents, particularly chlorinated hydrocarbons (those with chlorine molecules attached to carbon), can increase the irritability of the heart muscle at high exposure levels. This can lead to irregular heartbeats called cardiac arrhythmia.

What Chronic (Long-Term) Effects Can Occur?

Solvent exposures can produce CHRONIC health effects, which occur after repeated exposures and are often long-lasting or irreversible. Symptoms may appear gradually, so they may be initially ignored. This can make it hard to identify the chronic health problems related to solvent exposure.

Chronic health effects include:

Respiratory Effects

Repeated irritation of the respiratory tract may result in bronchitis and produce symptoms of chronic cough and sputum production. Dermatitis. Long-term exposure can lead to chronic dermatitis. The skin can become dry, thickened, cracked, hardened and flaky.

Nervous System

Most organic solvents affect the central nervous system, primarily the brain. With increasing levels of exposure, these effects include feeling "high," irritability, nervousness, weakness, tiredness, dizziness, sleeplessness, disorientation, confusion and even unconsciousness.

Long-term exposure has been associated with effects such as difficulty in thinking and personality changes. A few solvents, such as n-hexane and methyl n-butyl ketone, can damage the peripheral nerves, which are nerves to sensory organs and muscles. Symptoms of nerve damage include pain, loss of sensation, and weakness, usually beginning in the toes, then the fingers and moving up the legs and arms.

Liver

Some solvents, particularly chlorinated types, can damage the liver, causing a type of hepatitis. There may be no symptoms. If there are symptoms, they may include: nausea, pain in the right side, yellow skin and eyes, dark urine and light-colored bowel movements. Hepatitis may be detected by blood tests of liver function.

Blood

A few solvents, such as glycol ethers, affect the blood, either by damaging blood cells that are circulating in the body or decreasing the production of new blood cells. There usually are no symptoms until blood counts are extremely low, resulting in tiredness or infections. Benzene is one solvent that is known to be particularly dangerous; it can cause anemia (low blood counts) and also leukemia (cancer of the white blood cells).

Reproductive Effects

Although chemicals may affect reproduction in females and males, there are no definitive studies that demonstrate the effects of solvents on human reproduction. Cancer. Benzene is the only commonly used solvent that has been associated with cancer in exposed workers. A number of other solvents, including carbon tetrachloride, chloroform, 1,4-dioxane and trichloroethylene have caused cancer in laboratory animals. Vinyl chloride has been known to cause angiosarcoma of the liver in humans.

What Should You Do If You Develop Symptoms That May Be Related To Solvent Exposure?

Inform your employer and consult a physician. Many health problems that can be related to solvent exposures can also be caused by other medical problems which may need immediate treatment. Special laboratory tests can be performed to assess solvent exposures.

How Can Exposure To Solvents Be Reduced or Prevented?

The best way to guard against the harmful health effects of solvents is to prevent or minimize exposure. As a first step, be aware of the hazards and safe handling procedures for materials on the job. This information must be available to you and usually is provided in Material Safety Data Sheets (MSDS), employer instructions and container warning labels.

Secondly, use the procedures and equipment that are available. Employers are responsible for providing safe work conditions.

The most important ways of preventing exposure are:

• Substitution of a solvent with a less hazardous substance.
• Enclosure of the process or containers where the solvent is being used (so it never enters the air you breathe).
• Exhaust ventilation systems that function effectively.
• Redesign of a process (to eliminate a step releasing vapors or requiring liquid contact).
• Personal protective equipment (should be used only when engineering controls such as enclosure of a process are not feasible).
• Respirators should be worn as a part of a comprehensive respiratory protection program. Other protective gear such as gloves, aprons, goggles and face shields should be used when appropriate.
• Good housekeeping practices (essential to ensure exposures are minimal).

What Other Hazards Are Posed By Solvents?

Solvents can be flammable or explosive, and exposing them to flame or hot surfaces can also form highly toxic decomposition products. Ignition sources such as welding torches, lit cigarettes and sparks should be kept away from solvent use and storage areas. I

n addition, some chemicals are incompatible with solvents and mixing will produce toxic gases, heat or fire. Oxidizers (e.g., sodium chlorate) and strong acids and bases (e.g. sulfuric acid, sodium hydroxide) should never come in contact with solvents. Refer to Material Safety Data Sheets or chemical suppliers' information for special hazards.

Protecting your ears

The safest way to protect your ears is to always wear hearing protectors anytime you are around loud noises. You can protect your ears by wearing special earplugs or special earmuffs. There are hundreds of kinds available. There are formable earplugs you can mold to your ears and premolded earplugs that come in several sizes. There are canal caps that are attached to headbands and are very convenient if you work in intermittent noise where you need to take your earplugs on and off throughout the day. Some earplugs have stems so you can insert them without touching the part that goes inside your ear. You can also get earplugs custom molded to fit your ear. Earmuffs come with large and small earcups, different types of headbands, and different types of ear cushions. There is something for everyone and for every environment.

Ventilation for Airborne Hazards.

A good ventilation system at your work site is an effective method of keeping both toxic and nuisance materials out of the air and out of your lungs. Some toxic materials capable of causing chronic lung disease, if inhaled in large enough quantities, include asbestos fibers, chlorine, silica dust (silicon dioxide) and arsenic fumes. Examples of nuisance materials (those that don't usually have a bad effect on the lungs when exposures are kept under reasonable control) include cellulose fibers, glycerin mist, limestone, plaster of paris and tin oxide.

The first step in keeping the air clean is to prevent materials from escaping from their containers by using covers and lids. Solvent vapors can be kept out of the air by keeping solvent tanks covered when not in use. Furthermore, airborne dust levels can be reduced by keeping operations which generate dust, such as sandblasting operations, separated from other work areas.

However, when it is not possible to keep toxic materials contained, it is important to remove dirty or contaminated air from the work area and replace it with clean air.

How Should Dirty Air Be Removed From The Workplace?

The best way to remove contaminated air from the work area is with the use of what is called "local exhaust ventilation." Typical window or cooling fans were not designed to remove contaminated air from individual work areas and are not recommended for this purpose.

What Is Local Exhaust Ventilation?

Local exhaust ventilation is an effective method for removing airborne toxic or nuisance materials at their point of origin, thereby preventing them from entering your lungs. Examples of processes that use local exhaust ventilation include welding and grinding operations. To be effective, a local exhaust ventilation system should include: 1) a collector or hood, 2) ducts to carry the air, 3) the right choice of fan, 4) a device to clean the air if required, and 5) exhaust system.

What Should You Do To Use A Local Exhaust Ventilation System Correctly?

Simple but important points in working with a local exhaust ventilation system include:

Try not to put yourself between the source and the opening of the air exhaust hood. If you do this, you will breathe contaminants as they are drawn into the hood.

• Do not block fresh air supply for the workroom.
• Do not block or obstruct hoods.
• Protect ventilation ducts from damage and holes.
• Keep operation close to the hood to improve capture of vapors and fumes.
• Be aware of special precautions required when ventilating potentially explosive or corrosive vapors.
• Prevent recirculation of exhaust air back into the workplace.
• Evaluate the ventilation system periodically to ensure it is operating as designed.
  

What If You Have Problems With The System?

Problems can occur with ventilation equipment, like any other tool used at work. Contact your employer if you experience problems with a ventilation system. Most often a routine maintenance program of cleaning out ducts, replacing fan blades and repairing leaks will restore a system to full operation.

Fight a Fire or Flee?

Workplace fires and explosions kill hundreds and injure thousands of workers each year. One way to limit the amount of damage due to such fires is to make portable fire extinguishers an important part of your fire prevention program. When used properly, fire extinguishers can save lives and property by putting out a small fire or controlling a fire until additional help arrives.

A fire is the most common type of emergency for which small businesses must plan. A critical decision when planning is whether or not employees should fight a small fire with a portable fire extinguisher or simply evacuate. Small fires can often be put out quickly by a well-trained employee with a portable fire extinguisher. However, to do this safely, the employee must understand the use and limitation of a portable fire extinguisher and the hazards associated with fighting fires. Evacuation plans that designate or require some or all of the employees to fight fires with portable fire extinguishers increase the level of complexity of the plan and the level of training that must be provided employees.

Battling Eye Strain

Your eyes hurt. Your head aches. And there you sit, peering at your computer monitor. If you're one of the many people who use computers every day — either for work or personal use — you may experience eyestrain as a result.

Eyestrain: Signs and symptoms

Common signs and symptoms include:

• Sore, tired, burning or itching eyes
• Watery eyes
• Dry eyes
• Blurred or double vision
• Headache and sore neck
• Difficulty shifting focus between monitor and paper documents in your work area
• Color fringes or afterimages when you look away from the monitor
• Increased sensitivity to light
• Eyestrain associated with computer use isn't thought to have serious or long-term consequences, but it's disruptive and unpleasant. Though you may not be able to change the nature of your job or all the factors that can cause eyestrain, you can take steps to reduce the strain.

New habits can help relieve eyestrain

A few simple adjustments in how you work or surf the Internet can give your eyes a much-needed rest.

Follow these simple tips to reduce eyestrain:

• Take eye breaks. Throughout the day, give your eyes a break by forcing them to focus on something other than on your screen.
• Try the following exercise: Hold a finger a few inches in front of your face; focus on the finger as you slowly move it away; focus on something far in the distance and then back to the finger; slowly bring the finger back toward your face. Next, shift your focus to something farther than eight feet away and hold your eyes there for a few seconds. Repeat this exercise three times, several times a day.
• Change the pace. Try to stand up and move around at least once every hour or so. If possible, lean back and close your eyes for a few moments. At the very least, try to give yourself a five-minute rest every hour. Do other work, such as phone calls or filing, during this time.
• Blink often to refresh your eyes. Because many people blink less than normal when working at a computer, dry eyes can result from prolonged computer use. Blinking produces tears that can help moisten and lubricate your eyes. Make a conscious effort to blink more often.
• Consider using artificial teardrops. Available over the counter, artificial tears can help relieve dry eyes that result from prolonged sessions at the computer.
• Practice relaxation. Ease muscle tension with this relaxation exercise: Place your elbows on your desk, palms facing up; let your weight fall forward and your head fall into your hands; position your head so that your eyebrows rest on the base of your palms, with your fingers extended toward your forehead; close your eyes and take a deep breath through your nose; hold it for four seconds, then exhale. Continue this deep breathing for 15 to 30 seconds. Perform this simple exercise several times a day.
• Get appropriate eyewear. If you wear glasses or contacts, make sure the correction is right for computer work. Most lenses are fitted for reading print and may not be optimal for computer work. Glasses or contact lenses designed specifically for computer work may be a worthwhile investment.

Put your workstation in order

• Take some of the strain off your eyes by making sure your desk space is set up in an appropriate and eye-friendly way.
• Adjust your monitor. Position your monitor directly in front of you about 20 to 28 inches from your eyes. Many people find that putting the screen at arm's length is about right. If you need to get too close to read small type, consider increasing the font size.
  Keep the top of your screen at eye level or below so that you look down slightly at your work. If it's too high or too low, it can lead to a sore neck. If you have your monitor on top of your central processing unit (CPU), consider placing the CPU to the side or on the floor. And if you wear bifocals or trifocals, keep in mind that you may have a tendency to tilt your head backwards so that you can see through the lower portion of your glasses. To adjust for this, consider lowering your monitor a few inches or buying glasses designed for computer work.
• Position your keyboard properly. Place your keyboard directly in front of your monitor. If you place it at an angle or to the side, your eyes have to focus at different distances from the screen, a tiring activity.
• Keep reference materials nearby. Place reading and reference material on a document holder beside your monitor and at the same level, angle and distance from your eyes as the monitor is from your eyes. This way your eyes aren't constantly readjusting.
• Check the lighting and reduce glare. Bright lighting and too much glare can make it difficult to see objects on your screen and strain your eyes. To check glare, sit at your computer with the monitor off. This allows you to see the reflected light and images. Note any intense glare. The worst problems are generally from sources above or behind you, including fluorescent lighting and sunlight.
• If possible, place your monitor so that the brightest light sources are off to the side, at a right angle to your monitor. Consider turning off some or all of the overhead lights. If you need light for writing or reading, use an adjustable desk lamp. Close blinds and shades and avoid placing your monitor directly in front of a window or white wall. Use a glare-reducing screen to minimize glare from overhead lighting. Finally, adjust the contrast and brightness on the monitor to a level that's comfortable for you, making sure the letters on the screen are easy to read.
• Also wipe the dust from your computer screen regularly. Dust on the screen cuts down on contrast and may contribute to glare and reflection problems.
  

If problems still persist, it could be a sign of a more serious problem

See your doctor if you have:

• Prolonged eye discomfort
• A noticeable change in vision
• Double vision
• But if you're like most people, making a few simple adjustments can help keep your eyes rested and ready.

We serve the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Ask NIOSH for help

Do you think a health hazard exists in your workplace? Do any of the following stories resemble situations at your workplace?

A factory worker was feeling numbness and tingling in her fingers. She learned that three coworkers had the same problem, and two had headaches while at work but not over the weekend. Some workers said the air at work smelled bad. Their supervisor noticed the smell but didn’t think it was anything to worry about.

A manager noticed that employees in one work area had more skin rashes in the past year than the year before. He wanted to know why, but didn’t know what to do.

A work crew was putting cement tiles on a roof. They were working outside, but the air seemed dusty. The saws used to cut the tiles were noisy. Someone told them that this work was dangerous and they should have it checked out.

At no cost to employers or employees, or their representatives, the NIOSH Health Hazard Evaluation (HHE) program may be able to help with problems like these. This site lets you know about the program and how to ask for NIOSH help. It also has links to reports from thousands of HHEs done by NIOSH.

Preventing Back Injuries at Work

Whether it's dull and annoying or screaming for attention, back pain can make it hard to concentrate on your job.

Many occupations — such as nursing, construction and factory work — may place significant demands on your back. Even routine office work can worsen back pain if you fall into risky habits.

But you often can avoid back pain and injuries by understanding what causes them and focusing on prevention.

What causes back injuries?

Doctors aren't sure about all of the causes of back pain. In fact, most back problems are probably the result of a combination of factors. Some factors, such as family history, aren't preventable. Other factors, such as weight, fitness and flexibility, can be controlled by changing your lifestyle.

Still other factors are work related, and you may or may not be able to modify these to prevent injury.

Four work-related factors are associated with increased risk of back pain and injury:

Force

Exerting too much force on your back may cause injury. If your job is physical in nature, you might face injury if you frequently lift or move heavy objects.

Repetition

Repetition refers to the number of times you perform a certain movement. Overly repetitious tasks can lead to muscle fatigue or injury, particularly if they involve stretching to the end of your range of motion or awkward body positioning.

Posture

Posture refers to your position when sitting, standing or performing a task. If, for instance, you spend most of your time in front of a computer, you may experience occasional aches and pains from sitting still for extended periods of time. On average, your body can tolerate being in one position for about 20 minutes before you feel the need to adjust.

Stress

Pressures at work or at home can increase your stress level and lead to muscle tension and tightness, which may in turn lead to back pain.

How to avoid injuries

Your best bet in preventing back pain and injury is to be as fit as you can be and take steps to make your work and your working environment as safe as possible.

Be fit

Even if you move around a lot on your job or your job requires physical exertion, you still need to exercise. Regular exercise is your best bet in maintaining a healthy back. First of all, you'll keep your weight in check, and carrying around a healthy weight for your body's frame minimizes stress on your back.

You can do specific strengthening and stretching exercises that target your back muscles. These exercises are called "core strengthening" because they work both your abdominal and back muscles. Strong and flexible muscles will help keep your back in shape.

Pay attention to posture

Poor posture stresses your back. When you slouch or stand with a swayback, you exaggerate your back's natural curves. Such posture can lead to muscle fatigue and injury. In contrast, good posture relaxes your muscles and requires minimal effort to balance your body.

Standing posture

If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level. Don't bend forward to do desk work or handwork.

Sitting posture

To promote comfort and good posture while sitting, choose a chair that supports your back. Adjust the chair so that your feet stay flat on the floor. If the chair doesn't support your lower back's curve, place a rolled towel or small pillow behind your lower back. Remove bulky objects, such as a wallet, from your back pockets when you sit because they can disrupt balance in your lower back.

Lift properly

There's a right way and a wrong way to lift and carry a load. Some key tips for lifting the right way include letting your legs do the work, keeping objects close to your body and recruiting help if a load is too heavy.

Adjust your work space

Look at the setup of your office or work area. Think about how you could modify repetitive job tasks to reduce physical demands. Remember that you're trying to decrease force and repetition and maintain healthy, safe postures. For instance, you might use lifting devices or adjustable equipment to help you lift loads. If you're on the phone most of the day, try a headset. Avoid cradling the phone between your shoulder and ear to free up your hands for yet another task. If you work at a computer, make sure that your monitor and chair are positioned properly.

Adopt healthy work habits

Pay attention to your surroundings and abilities on the job. Take these steps to prevent back pain:

Plan your moves

Reorganize your work to eliminate high-risk, repetitive movements. Avoid unnecessary bending, twisting and reaching. Limit the time you spend carrying heavy briefcases, purses and bags. If you're carrying something heavy, know exactly where you intend to put it and whether that space is free from clutter.

Listen to your body

If you must sit or stand for a prolonged period, change your position often. Take a 30-second timeout every 15 minutes or so to stretch, move or relax. Try standing up when you answer the phone, to stretch and change positions. If your back hurts, stop activities that aggravate it.

Minimize hazards

Falls can seriously injure your back. Think twice before wearing high heels. Low-heeled shoes with nonslip soles are a better bet. Remove anything from your work space that might cause you to trip.

Work on coordination and balance

Just walking regularly for exercise can help you maintain your coordination and balance. You can also perform balance exercises to keep you steady on your feet.

Reduce stress

Being under stress causes your muscles to tense, and this can make you more prone to injury. In addition, the more stress you feel, the lower your tolerance for pain. Try to minimize your sources of stress both on the job and at home. Develop coping mechanisms for times when you feel especially stressed. For instance, perform deep-breathing exercises, take a walk around the block or talk about your frustrations with a trusted friend.

Preventing Falls From a Ladder

1. Choose the right ladder for the job.First you need to make sure that a ladder is the best equipment for what you need to do. Would a scaffolding or a mechanical lift be better?

Many times, the ladder is the only physical support you have while you are working. If it fails, you can fall. That's why it is so important to find the right ladder when you do need to use one.

The three main types of ladders—step ladders, straight ladders, and extension ladders—are used in different situations for different tasks.

Before you start using a ladder, ask yourself two questions.

Is the ladder long enough? It should be long enough for you to set it at a stable angle and still extend at the top to give you something to hold on to when you get on the ladder to descend. Setting the ladder at the right angle helps you keep your balance on the ladder. It also helps keep the ladder from falling backwards.

Make sure the ladder extends 3 feet (3 rungs; 0.9 meters) above the surface you will be working on.

Make sure the ladder is placed at a stable angle. For every four feet (1.2 m) high the ladder is, the base should be 1 foot (.3 m) out from the wall

For example, if you will be working on a 10 foot-high roof (3 m), you need a ladder that is at least 14 feet (4.25 m) long. The base should be 2 ½ feet (.75 m) from the wall. Is the ladder in good working condition? It shouldn’t be missing pieces or be cracked or otherwise damaged. Check the duty rating on extension ladders – is it high enough for the weight you will be putting on it? Longer ladders don’t always have higher duty ratings, so be sure to check. In construction, the most common ratings are:

• Type 1 supports up to 250 pounds (113 kg).
• Type 1A supports up to 300 pounds (136 kg).
• Type 1AA supports up to 375 pounds (170 kg).

2. Tie the top and bottom of the ladder to fixed points.

Tie both sides of the top of the ladder to a fixed point on the roof or other high surface near where you are working. The bottom should be tied to a fixed point on the ground. Securing the ladder in this way prevents the ladder from sliding side-to-side or falling backwards and prevents the base from sliding.

Tying the ladder off at the beginning of the day and untying it at the end will only take you about 5 minutes. It can make all the difference for your safety. If you need to move the ladder around, allow extra time for this important step, or consider using something else, such as a scaffold.

3. Don't carry tools or other materials in-hand while climbing the ladder.

Take precautions when you are going up or down a ladder. Instead of carrying tools, boards, or other materials in your hands, use a tool belt, install a rope and pulley system, or tie a rope around your materials and pull them up once you have reached the work surface. Ask for help if you need to use more than one hand to pull them up.

Carrying tools or anything else in your hands as you climb the ladder can throw you off balance.

When you climb a ladder, you should always have 3 points of contact to keep you stable. That means that you either have both feet and one hand gripping the ladder, or both hands and one foot, at all times. If one of your hands is full, you can't maintain your 3 points of contact and aren't stable on the ladder.

Preventing Construction Falls

CDC/NIOSH works in partnership with The Center for Construction Research and Training (CPWR), Hollywood, Health and Society, and the Spanish-language network Telemundo to develop and evaluate this new approach to disseminating workplace safety and health information.

The storyline, part of Telemundo's hit show Pecados Ajenos (weeknights at 10 PM), is intended to raise awareness among Spanish-speaking construction workers, and their friends and families, about the safety risks they often face at work and how to prevent them.

The focus of the storyline was determined by a few basic facts:

• More than 2 million Latinos work in construction in the U.S.
• Every day, four construction workers die on the job, and one of them is Latino.
• Falls are the most common cause of fatal injuries to construction workers.
• The consequences of a fall affect not only the worker, but also his family and community.

Construction falls can be prevented. Contractors and foreman can do many things to organize the worksite to be safer for their employees. But workers themselves can also make some inexpensive, simple changes to the way they work that can save their lives.

Ladders are one of the most common pieces of equipment on a construction site. But that doesn't mean they are safe. There are construction workers who are injured or killed falling from a height every day. Using ladders more safely is one way to start preventing falls at your work site.

Your co-workers can learn a lot from you.

At first, you might be the only one who is concerned with safety at your worksite. But over time, other workers will see that the foreman will give you the time you need to be safe. They will see how many little things add up to big effects on safety. And they will see how they, too, can help to make your worksite safer.

So, set an example!

Don't worry about being the first—they'll thank you for it later.

Workers Memorial Day

Workers Memorial Day, April 28, was established to recognize workers who died or were injured on the job. On average, 16 workers in the United States die each day from injuries sustained at work , and 134 are estimated to die from work-related diseases .

Daily, an estimated 11,200 private-sector workers have a nonfatal work-related injury or illness, and as a result, more than half require a job transfer, work restrictions, or time away from their jobs .

An estimated 9,000 workers are treated in emergency departments each day because of occupational injuries, and approximately 200 of these workers are hospitalized . In 2005, workers' compensation costs for employers totaled an estimated $89 billion .

Workers Memorial Day 2008 also will commemorate the thirty-seventh anniversary of the creation of the National Institute for Occupational Safety and Health in the U.S. Department of Health and Human Services and the Occupational Safety and Health Administration in the U.S. Department of Labor.

While much progress has been made in preventing work-related injuries, illnesses, and deaths since NIOSH and OSHA were created in 1971, more remains to be done. The occasion of Workers Memorial Day encourages us to think of ways in which we all can help to achieve the goal of safer and healthier workplaces.

Firefighters at risk for Cancer

A new study suggests that firefighters face higher-than-average risks of several types of cancer, adding to evidence that the job carries hazards beyond the fires themselves.

A number of studies have found that firefighters have elevated cancer rates, though they have not always been consistent in the specific types of cancer.

In the current study, researchers found that professional firefighters had higher-than-expected rates of colon cancer and brain cancer. There was also evidence, albeit weaker, that they had elevated risks of bladder and kidney cancers, as well as Hodgkin's lymphoma.

Dr. Letitia Davis with the Massachusetts Department of Public Health in Boston, and colleagues report the findings in the American Journal of Industrial Medicine.

Firefighters are exposed to many potentially cancer-causing chemicals released from burning materials. At the scene of the fire, toxic substances such as benzene, lead, uranium and asbestos can be inhaled or absorbed through the skin.

Though firefighters wear a breathing apparatus and other protective equipment while battling blazes, they typically do not wear the gear when they're merely in the vicinity of the fire. There can also be health hazards at the firehouse, where idling trucks expose firefighters to diesel exhaust.

For their study, the researcher combed through nearly two decades' worth of data from the Massachusetts cancer registry. Between 1986 and 2003, the registry recorded 2,125 cancer diagnoses among professional male firefighters.

The researchers found that, compared with men in other occupations, firefighters had nearly twice the risk of brain cancer and a 36 percent higher risk of colon cancer. They also showed higher risks of bladder cancer, kidney cancer and Hodgkin's lymphoma, but the evidence was weaker due, in part, to the relatively small number of cases.

Other researchers have called for greater efforts to protect firefighters from the toxic substances that may be fueling these elevated cancer rates -- including less cumbersome protective equipment that firefighters can keep on when they are near a fire.

Experts also recommend that firefighters shower as soon as they return to the firehouse, in order to remove contaminated soot from their skin.

At the end of life, a turn to "slow medicine"

Edie Gieg, 85, strides ahead of people half her age and plays a fast-paced game of tennis. But when it comes to health care, she is a champion of "slow medicine," an approach that encourages less aggressive — and less costly — care at the end of life.

Slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency-room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.

Slow medicine, which shares with hospice care the goal of comfort rather than cure, is increasingly available in nursing homes, but for those living at home or in assisted living, a medical scare usually prompts a call to 911, with little opportunity to choose otherwise.

At the end of her husband's life, Gieg was spared these extreme options because she lives in Kendal at Hanover, a retirement community affiliated with Dartmouth Medical School that has become a laboratory for the slow-medicine movement. At Kendal, it is possible — even routine — for residents to say "No" to hospitalization, tests, surgery, medication or nutrition.

Charley Gieg, 86 at the time, was suffering from a heart condition, an intestinal disorder and the early stages of Alzheimer's disease when doctors suspected he also had throat cancer.

A specialist outlined what he was facing: biopsies, anesthesia, surgery, radiation or chemotherapy. Edie Gieg doubted he had the resilience to bounce back. She worried, instead, that such treatments would accelerate his downward trajectory, ushering in a prolonged period of decline and dependence. This is what the Giegs said they feared even more than dying, what some call "death by intensive care."

Many people in their 80s and 90s — and their boomer children — want to pull out all the stops to stay alive. The costliest patients — the elderly with multiple chronic illnesses — are the only group with universal health coverage under Medicare, leading to huge federal expenditures that experts agree are unsustainable as boomers age.

Dr. Tom Rosenthal, UCLA's chief medical officer, said aggressive treatment for the elderly at acute-care hospitals can be "inhumane," and that once a patient and family were drawn into that system, "it's really hard to pull back from it."

"The culture has a built-in bias that everything that can be done will be done," Rosenthal said, adding that the pace of a hospital also discourages "real heart-to-heart discussions."
Beginning that conversation earlier, he said, "sounds like fundamentally the right way to practice."

That means explaining that elderly people are rarely saved from cardiac arrest by CPR, or advising women with broken hips that they may never walk again, with or without surgery, unless they have the stamina for physical therapy.

"It's almost an accident when someone gets what they want," said Dr. Mark McClellan, a former administrator of Medicare.

The term slow medicine was coined by Dr. Dennis McCullough, a Dartmouth geriatrician and author of "My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved One."

Among the hard truths is that nine of 10 people who live past 80 will wind up unable to take care of themselves, either because of frailty or dementia.

"Everyone thinks they'll be the lucky one, but we can't go along with that myth," McCullough said.

Too much, too little sleep tied to ill health in CDC study

People who sleep fewer than six hours a night - or more than nine - are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies.

The study also linked light sleepers to higher smoking rates, less physical activity and more alcohol use.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don't get proper shuteye, said Dr. Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine.

"The data is all coming together that short sleepers and long sleepers don't do so well," Kramer said.

The study released Wednesday is based on door-to-door surveys of 87,000 U.S. adults from 2004 through 2006 conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Such surveys can't prove cause-effect relationships, so - for example - it's not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study's lead author.

It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 percent smoking.

The overall U.S. smoking rate is about 21 percent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 percent.

Results were similar, though a bit less dramatic, for obesity: About 33 percent of those who slept less than six hours were obese, and 26 percent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 percent.

For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.

Stress or psychological problems may explain what's going on with some of the lighter sleepers, experts said.

Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected Columbia University sleep researcher.

"We're getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity," said Gangwisch, who was not involved in the study.

Train Quarantined in Ontario

Authorities quarantined a train in Ontario Friday after a woman died and several others reported being ill. But a doctor later ruled out a serious infectious disease and said the train would likely soon resume its journey.

Dr. David Williams, Ontario's chief medical officer, said that an elderly woman who died on the train did not have an infectious disease and the illnesses were unrelated.

A passenger who was airlifted to a hospital and five others who reported being sick had unrelated minor illnesses, Williams said. He called it a confluence of three different events.
One person was hospitalized in stable condition, said Laurel Ostfield, a spokeswoman for Ontario's minister of health.

"The origin of the illness that caused the passenger death is unknown at this time," Williams said. "Lab tests have to date have eliminated a number of serious infectious illnesses."

Williams anticipated that the train will continue onto Toronto later Friday.

Officials were keeping passengers from leaving the train, said Steve Trinier, the director of ambulance services in the area.

The train, carrying 269 passengers and 30 crew members, was being held in the station in the town of Foleyet, 500 miles northwest of Toronto. The station was evacuated.

The cross country Via passenger train was headed from Vancouver to Toronto when emergency officials received a call Friday morning and met the train in Foleyet.

Health officials were on the alert for norovirus, which can cause stomach flu and can be caught through contact with infected people or by touching or ingesting contaminated items.

Who Gets Treated in a Pandemic?

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health-care disaster hits, said Dr. Asha Devereaux. She is a critical-care specialist in San Diego and lead writer of the task-force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task-force members said.
Their recommendations appear in a report appearing today in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

• People older than 85
• Those with severe trauma, which could include critical injuries from car crashes and shootings.
• Severely burned patients older than 60.
• Those with severe mental impairment, which could include advanced Alzheimer's disease.
• Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency-operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Georgetown University public-health-law expert Lawrence Gostin, who was not on the task force, called the report an important initiative but also "a political minefield and a legal minefield."

If strictly followed, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said.

Children of Smokers Less Healthy than they seem

Children with smoking parents may not be as healthy as they appear.

A study presented at the American Thoracic Society International Conference shows that although children of smokers may not exhibit respiratory problems, they may still be suffering from damage to their airways.

Some researchers claim that children of smokers are more likely to have respiratory problems such as puffing, wheezing, and cases of pneumonia.

However it is unclear if there is impairment in children who have no respiratory complaints or diagnosed problems.

The study consisted of 244 children ages 4 through 12 who had no history of lung or airway ailments. Based on the smoking patterns of parents, the children were separated into four groups:

(1) never smokers
(2) smoking after birth but not during pregnancy
(3) during pregnancy but not after birth
(4) before and after both. Children of smoking parents were found to have reductions in lung function similar to that in smokers.

Smoking after birth contributed more to lung impairment than smoking during pregnancy alone.

Researchers believe that, with the growing number of outdoor smoking bans, there may be an increasing trend for parents to smoke inside the home. While no ill effects of passive smoking have been demonstrated from outdoor smoke, if such a trend proves to be true, children exposed to indoor smoke could see diminished lung function over time.

It remains controversial whether personal smoking habits go beyond affecting the health of a single individual, and whether outdoor smoking bans make any sense from a scientific standpoint..

A look back to Workplace Injury Stats in 1992

Most Americans between the ages of 22 and 65 spend 40 to 50 percent of waking hours at work. Every year millions of Americans suffer injuries and thousands experience deaths in our workplaces. Yet little effort has been made to estimate either the extent of these injuries, deaths, and diseases or their cost to the economy. Thus, important questions about workplace safety and the economic resources expended due to workplace health problems remain unanswered.

In this study, we address these questions by presenting estimates of the incidence, prevalence, and costs of workplace-related injuries, illnesses, and deaths for the entire civilian workforce of the United States in 1992. We also consider controversies surrounding cost methodologies, estimate how these costs are distributed across occupations, consider who pays the costs, and address some policy issues.

Our major findings are as follows:

Roughly 6,371 job-related injury deaths, 13.3 million nonfatal injuries, 60,300 disease deaths, and 1,184,000 illnesses occurred in the U.S. workplace in 1992.

The total direct and indirect costs associated with these injuries and illnesses were estimated to be $155.5 billion, or nearly 3 percent of gross domestic product (GDP).

Direct costs included medical expenses for hospitals, physicians, and drugs, as well as health insurance administration costs, and were estimated to be $51.8 billion.

The indirect costs included loss of wages, costs of fringe benefits, and loss of home production (e.g., child care provided by parent and home repairs), as well as employer retraining and workplace disruption costs, and were estimated to be $103.7 billion.

Injuries generated roughly 85 percent whereas diseases generated 15 percent of all costs.
These costs are large when compared to those for other diseases. The costs are roughly five times the costs for AIDS, three times the costs for Alzheimer's disease, more than the costs of arthritis, nearly as great as the costs for cancer, and roughly 82 percent of the costs of all circulatory (heart and stroke) diseases.

Workers' compensation covered roughly 27 percent of all costs. Taxpayers paid approximately 18 percent of these costs through contributions to Medicare, Medicaid, and Social Security.

Costs were borne by injured workers and their families, by all other workers through lower wages, by firms through lower profits, and by consumers through higher prices.

Our study appears to be the first to use national data to produce estimates on costs for occupational injuries and illnesses. Prior studies have underestimated costs by ignoring nondisabling injuries, deaths, and workplace violence, by taking inadequate account of diseases, and, most importantly, by relying on only one or two sources of data.

The Annual Survey of the Bureau of Labor Statistics (BLS) provides the most reliable and comprehensive data on nonfatal injuries. However, it misses roughly 53 percent of job-related injuries. This omission, in part, is due to the exclusion of government employees and the self-employed and also, in part, due to illegal underreporting by private firms.

Contrary to the Annual Survey data, we find small firms have exceptionally high injury rates.
Occupations contributing the most to costs included truck drivers, laborers, janitors, nursing orderlies, assemblers, and carpenters. On a per capita basis, lumberjacks, laborers, millwrights, prison guards, and meatcutters contributed the most to costs.

Occupations at highest risk for carpal tunnel syndrome include dental hygienists, meatcutters, sewing machine operators, and assemblers. Among well-paid professions, dentists face the highest risks.

Any of the major sources of data, such as the Bureau of Labor Statistics, National Institute for Occupational Safety and Health, workers' compensation systems, or National Health Interview Survey, by themselves underestimate the numbers of injuries and illnesses.

Greater efforts need to be directed toward gathering data on job-related injuries and illnesses. The United States needs a comprehensive data bank for fatal and nonfatal injuries and all illnesses. Future researchers should not have to investigate the over 20 sources of primary data and 300 sources of secondary data that we investigated.

Asthma Worsened by Obesity

In asthma patients, dynamic hyperinflation, following a test measure airway hypersensitivity, is greater in obese individuals than in their nonobese counterparts, which helps explain why asthma is perceived to be more severe in patients with a higher body mass index (BMI), investigators in New Zealand report.

A BMI is the ratio between height and weight, and is used to classify people as underweight, overweight or normal weight.

"The greater dynamic hyperinflation means that obese individuals lose the ability to inhale as deeply or exhale as fully as normal weight individuals," Dr. D. Robin Taylor explains in an American Thoracic Society statement.

Taylor's team at the University of Otago in Dunedin studied the changes in airway expansion and lung volume that occur with acute constriction of the bronchial tubes in a group of 30 adult women with asthma. Ten women each were classified as normal weight, overweight, or obese, and lung volumes were measured.

The degree of bronchial constriction following the airway sensitivity test did not vary by group, the team reports in the American Journal of Respiratory and Critical Care Medicine. The only significant difference among the subjects was a decrease in vital capacity that significantly corresponded with increasing BMI.

Lung volume measurements also showed that the volume of air retained in the lung following exhalation was significantly higher as BMI increased, while the amount of air that could be inhaled was lower.

These variations "were significantly greater in relation to BMI" after taking into account the effects of "airway hyperresponsiveness, the severity of airflow obstruction, and lung volume measurements, indicating the effect of BMI was an independent one," the investigators note, meaning that BMI alone was associated with the severity of asthma.

This puts obese individuals at greater disadvantage due to enhanced gas trapping, they point out, a significant contributor to difficulty in breathing.

Taylor and his associates also noted that conventional lung function tests "may have limitations when used to evaluate symptoms in obese patients with asthma, with the potential for misinterpretation" in the absence of lung volume measurements.

Healthy Trust Occupational Health Clinic

Healthy Trust Occupational Health Clinic serves as your companies ‘team doctor ’

Challenging government regulations and rising workers’ compensation premiums may make navigating through a workplace injury daunting to an employer. Having a health care partner completely dedicated to the health and safety of your employees not only results in a productive work force, it is also vital to the bottom line.

Healthy Trust Immediate Medical Care, a locally owned and operated occupational medicine clinic, is comprised of trained and certified professionals striving to ensure worker health and safety in the Chicago North Shore suburbs.

Along with skilled treatment of job-related injuries, Healthy Trust Immediate Medical Care can provide your company with drug and alcohol testing, respirator mask fitting, audio testing, immunizations, diagnostic services, customized wellness plans, preventive screenings, and other health services. Many of these services can be provided at your worksite or office.

An occupational medicine physician is similar to a team doctor for a sports team. The ultimate goal is to get the employee (athlete) healthy and back into the workplace quickly. In the past, occupational medicine was thought to only be practical for the industrial corridor—construction and manufacturing companies, refineries and other industrial organizations.

Today, representatives from all businesses, industrial and professional, are recognizing the benefits of a strong working relationship with an occupational medicine provider.

Healthy Trust Immediate Medical Care serves as the company’s medical department, providing health care services to employees. With proper testing, Healthy Trust providers may spot pre-existing medical conditions that otherwise have gone unnoticed.

Healthy Trust Occupational Health Clinic can also assist in the development of a drug and alcohol testing program in an effort to monitor a safe work environment. “Employers can increase the productivity of their employees,” says Medical Director Dr. Boris Gurevich. “Whether it’s flu shots or wellness programs, there is a substantial return on each dollar spent.”

Time is a major factor in the workplace today. Many companies now operate outside of the traditional 9 to 5 workday and need a health care provider to accommodate the odd-hour schedules of their employees. Healthy Trust Occupational Health Clinic makes this easy.

Extended hours help to alleviate the stress of taking time out of the workday to receive necessary health care services.

The physicians and other clinical providers at Healthy Trust Immediate Care are trained in occupational health issues and are ready to provide reliable and professional services for all segments of business and industry.

Healthy Trust Occupational Health Clinic serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Walking While Working

On the heels of research finding that fat-burning enzymes shut down while sitting, Mayo Clinic researchers believe they may have the cure for inactive 9-to-5ers chained to their desks: walking workstations.

According to experts, the walkstations, which resemble treadmills with computers attached, represent a bold new step by the medical community in an effort to fight the rising obesity epidemic.

James Levine, an endocrinologist at the Mayo Clinic, came up with the walkstation idea about three years ago while talking to an ABC producer about new obesity research; it indicated that people with obesity fidget less and are more likely to sit than people who aren't obese.

During the conversation, Levine gave her four ideas to revolutionize offices. Six weeks later, he began putting them into action as part of his NEAT (non-exercise activity thermogenesis) initiative to transform offices into gyms.

"Support from the Mayo Clinic was unbelievable. People at Mayo said this is very important," Levine said. "They literally assigned 50 to 60 builders to do this, night and day. I would show up at 3 in the morning, people would be there painting walls, designing desks."

Fifteen years of research at the Mayo Clinic has shown that sitting all day long at the office is actually quite harmful to human health and that people who are obese tend to be seated two hours more than leaner people, according to Levine.

We're chair-based. People being seated all day is crucial to why obesity occurred," he said.
Levine first tested the newly designed office with his own research staff for six to 10 weeks. Then he approached Steelcase to collaborate and develop walkstations that can now be integrated into any office.

"They call it a walkstation, I call it a dream for my patients," he said. "One can write manuscripts, talk on the telephone while walking one mile per hour. Patients with weight problems are burning 100 to 150 calories more per hour, potentially 1,000 more per day. That number is profoundly important."

In offices with walkstations, employees can also hold conferences on the move. Levine's research team even developed "Meeting in Progress" stickers that indicate that a person is not to be interrupted as they're walking.

A month ago, Deb Bailey, director of corporate communications at Steelcase, began to use one of the walkstation units available at her office.

"I walked by a couple of times [and] saw other people using them," she said. "I was shocked at the way they were sending e-mails, checking e-mails while on the treadmill. Then I thought, why not be multitasking in a healthy way?"

Bailey now uses the walkstation daily.

"I jump on it for an hour. In the morning, I check e-mails; it's a nice period of time," she said. "I think I'm more productive [throughout the day as a result. It gets the adrenaline pumping."
She is quick to dismiss criticism of the new units.

"People will say it's a treadmill. It's not like I'm trying to talk and run. I keep it at a 1.3 miles per hour gait," she said. "It's very much regular activity. The only thing I do differently is bring a pair of walking shoes. It's not designed to be strenuous. It's the same thing you would be doing if you were on campus walking from building to building."

She also adds that the walkstation is an excellent remedy for the midafternoon post lunch sugar slump.

"We only look at a change in posture as a good way of adding energy. Why not stand up and do this? Or a 30-minute conference call, do it from a walkstation," Bailey said.

Growing Trend?

Four walkstations are currently in use at Wal-Mart's corporate offices in Bentonville, Ark., and at Salo, a financial outsourcing firm in Minneapolis, according to Bud Klipa, president of Details, a Steelcase company. Hundreds of walkstations have already been reserved for customers, including some Fortune 500 companies.

The walkstations are also extending into some schools. Traditional school desks are removed from classrooms; kids are then free to sit on the floor with their laptops, stand or move around as they're listening to their teachers.

Student behaviors in those schools improved substantially, according to Levine.
The response from the scientific community the walkstations has been largely positive.

"Often in science when you come up with ideas that are offbeat, the standard response of many scientists is very skeptical. Sometimes it's unhelpful because it makes people think scientists argue all the time," said George Brooks, a professor in the Department of Integrative Biology at the University of California at Berkeley. "When I sent an e-mail to NIH[National Institutes of Health] [about the whole project], no scientist was opposed to it. They said, "How can we be involved?' It's fantastic. It's been incredible, quite amazing."

Brooks believes that the walkstations are an important step in the fight against obesity.

"Physical activity is gone from our jobs, as a consequence people are overweight, diabetic, and it's even leading to some forms of cancer. We need to be active at least one hour a day," he said. "The walk stations are a revolutionary step in terms of putting physical activity in the workplace in a way people are still effective at their jobs."

Brooks insists that investing in workplace fitness has great benefits for employers, despite financial costs.

"If organizations try to implement it, we'll see if people will do it. I think people will resist it mightily," he said. "But people who will do it will be healthier, more effective, and happier."

Urgent Care In Tucson

A surgeon and a physician assistant who took care of injured troops in Iraq and Afghanistan are now using their emergency treatment skills at a new urgent care cetner they’ve opened in north central Tucson.

Dr. David Orringer, a surgeon, and Davidson Hall, a physician assistant, partnered to open Velo Med Urgent Care in a 6,400-square-foot building at 50 E. Croydon Park Road, off North Stone Avenue a block south of River Road. The urgent care business is using 4,400 square feet of space and Orringer and Hall plan to rent the remaining 2,000 square feet to a tenant.

Although trained as a surgeon, Dr. Orringer said he had never considered getting involved with an urgent care facility until after treating wounded military personnel.

"A lot of what you get in the field is bare bones operations," Dr. Orringer said. "You’re treating people with few resources and so you have to be prepared to see anything and everything — and you have so many guys depending on you. So urgent care is the same except in a little more of a controlled environment, with better equipment and better resources and a fully trained staff."

Orringer believes his military experience now serves him and Hall well as they see "pretty much anything and everything." He realized while in Iraq and Afghanistan that handling emergency treatment never gets boring and has a component of excitement about it that he thrives on.
The building was designed by Edward Marley, of Swaim Associates LTD Architects. Orringer said Marley, like himself, is a cycling enthusiast and the clinic’s reception area has been designed in the pattern of a bicycle.

An accomplished classical pianist and opera singer who once considered that as a career, Dr. Orringer achieved the rank of major and served as the medical director for the Air Force’s Combat Search and Rescue mission in Iraq and Afghanistan for four months each location before leaving the Air Force in 2007. Hall was a combat medic in Iraq during Desert Storm and also served with the 82nd Airborne and as a Special Forces Medic.

Orringer was awarded the Sikorsky Rescue Award, given to those involved in the rescue of someone in combat.

According to the Sikorsky website, the Winged-S Rescue Award Program was created in 1950 to honor all those who perform rescues flying a Sikorsky helicopter. "Through this award, we gratefully acknowledge the humanitarian efforts of all pilots and crewmembers who put themselves in harm’s way to save others and fulfill company founder Igor Sikorsky’s vision of the helicopter as a unique and powerful life-saving instrument," the website says.

Orringer and Hall met while practicing at another urgent care facility in Tucson and decided to open Velo Med Urgent Care facility.

The facility, which employees 16, including two other part-time physicians, has five exam rooms and a sixth which also is used for minor surgical procedures. There also is an X ray suite, a lab and a limited onsite pharmacy.

The clinic specializes in sports or work injuries, physical exams, lacerations, sprains, rashes, allergies, colds and coughs and sore throats and walk-ins are encouraged.

Originally from New England, where he studied classical piano at Dartmouth, Dr. Orringer said he "really fell in love with Tucson" and decided to stay here. Because there are not enough primary care physicians and emergency rooms are overcrowded here in Tucson, Dr. Orringer said he felt that his new clinic could offer a good intermediate solution for patients.

His sole disadvantage in Tucson is that he doesn’t get much opportunity to use his classical piano and opera training. "It’s mostly just singing in the car," he laughed.