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Still others act on substances crucial to blood-pressure control diabete 500 cause discount 150 mg irbesartan with mastercard, or serve as sentries to spot invading agents of infection diabetes mellitus type 2 complications discount 150 mg irbesartan amex. Oxygen—the fuel all the cells and organs of our body need to function—is ex tracted from the air we inhale managing diabetes then told of cancer generic 150 mg irbesartan visa, carried within the bloodstream and distributed to other organs and tissues diabetes type 2 insulin order irbesartan 300 mg amex. With each exhalation, we dispose of the carbon di oxide that is the by-product of our bodily functions. In our lungs, in the course of a single day, an astonishing 8,000 to 9,000 liters of breathed-in air meet 8,000 to 10,000 liters of blood pumped in by the heart through the pulmonary artery. The lungs relieve the blood of its burden of waste and return a refreshed, oxygen-rich stream of blood to the heart through the pulmonary vein. The lungs are internal organs; yet they are uniquely and constantly exposed to our external environment, a direct interface with the world outside. With each breath, a host of alien substances enters our bodies, leaving the lungs a ravaged battlefeld. There are many types of lung diseases including: ¦¦ Obstructive lung diseases such as asthma, chronic bronchitis and emphysema. These all affect a person’s airways and limit or block the fow of air in or out of the lungs. Bacteria or viruses cause these diseases that can also affect the membrane (or pleura) that surrounds the lungs. These conditions are caused by problems with the normal gas exchange and blood fow in the lungs. Just as there is no single cause for lung disease, there is no single symptom of lung disease. Some conditions may send disease-specifc signals, such as the characteristic wheezing sound made as the asthma sufferer attempts to exhale. Some lung disorders, such as emphysema, may be evidenced mainly by in creasing shortness of breath, eventually upon the slightest physical effort, as tired muscles fail to receive suffcient oxygen. Other forms of lung disease may be signaled by persistent cough, chest pain, shortness of breath, abnormal sputum production, bloody sputum or a combi nation of these symptoms. When an infectious agent causes a lung disease, there may also be fever and/or chills. Any suspicion that the lungs might not be functioning properly means that a person should seek medical attention. In the pages that follow, we have presented important facts and fgures about some of the most common lung diseases in the United States today. The American Lung Association strongly believes that if cigarette smoking, preventable premature childbirth, disregard for workers’ safety and violation of clean-air laws were to end today, we could expect a future largely free of the most lethal forms of lung disease. Below are a few important facts on lung diseases overall: ¦¦ Every year almost 400,000 Americans die from lung disease—an age-adjusted death rate of 135. The condition is characterized by rapid breathing, diffculty getting enough air 2 into the lungs and low blood oxygen levels. Research shows that men and blacks have higher mortality rates compared to women and other races. Please view the State of Lung Disease in Diverse Communities: 2007 report at. Acute respiratory distress syndrome incidence (2005) and rates (2003) are per 100,000 population. Hispanics are not mutually exclusive from Whites and Blacks * Comparisons should only be made between groups and diseases using rates, not number of cases, as these do not take into account differences which may exist in population size or demographics. Quality of life in these survivors is compromised with poor mental and physical health outcomes. The diagnosis is made when there is diffculty in pro viding adequate oxygenation and diffuse abnormalities on chest x-rays. Preliminary results from a study by the Na tional Heart, Lung and Blood Institute suggested that receiving small, rather than large, breaths of air from a mechanical ventilator reduced the number of deaths by 22 percent and increased the number of days without ventilator use. Abnormal levels of these proteins are independently associated with higher mortality and other clinical outcomes such as organ failure. One such study at the Uni versity of California, San Francisco is testing a method for improving fuid transport in the lungs, while another at Brigham and Women’s Hospital is researching whether altering certain immune system responses will affect infammation in the lungs. Want to learn more about how the American Lung Association supports leading research in lung disease Numerous studies have shown that air pollution can cause lung disease, including lung cancer, as well as cardiovascular disease, birth defects and even death. Sadly, millions of Americans live in areas where the pollution in the outdoor air all too often puts their health and even their lives at risk. Indoor air pollution can be as hazardous to an individual’s health as outdoor air pollution. These levels of indoor air pollutants are of particular concern because it is estimated that most people spend as much as 90 percent of their time indoors, meaning their exposure to indoor air pollutants may be 10 to 50 times more than outdoor exposures. The Clean Air Act, the landmark federal air pollution law, provides the prin cipal framework for outdoor air quality in the United States. It sets national air quality standards that safeguard the public against six pollutants: ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon dioxide and lead. It is the result of emissions of volatile organic compounds, including hydrocarbons, reacting with nitrogen oxides released in fuel combustion, in the presence of sunlight. Ozone is very harmful to breathe and attacks lung tissue by chemically reacting with it. Studies have provided strong evidence that exposure to levels of ozone currently considered safe increases the risk of premature death. In addition, ozone exposure3 can cause shortness of breath and coughing, trigger asthma attacks and reduce lung function, often leading to hospital admissions and emergency room visits. In the United States, it usually reaches the highest levels during the summer months. Wind can carry ozone hun dreds of miles, so people who do not live in areas with lots of industry or auto mobiles are not necessarily safe from high ozone levels. Ozone Air Quality, 1980–2006 (Based on Annual 4th Maximum 8–Hour Average) National Trend based on 275 Sites 0. Two studies published in 2005 explored ozone’s ability to reduce lung func tion, or the ability of the lung to work effciently. Each study looked at other wise healthy groups of people who were exposed to ozone for long periods: outdoor postal workers in Taiwan and college freshmen who were lifelong residents of Los Angeles or the San Francisco Bay area. Both studies found that long exposure to elevated ozone levels had decreased their lung function. One new study linked exposure to high ozone levels for as little as one hour to a particular type of 14 Particle pollution is especially high in urban industrial and heavily traffcked areas, as well as in some rural locales with unpaved roads and extensive wood burning. Those of special concern have a diameter of 10 microns or less, or less than one-seventh the diameter of a human hair. Particles this small easily penetrate the alveoli, the very smallest air sacs in the lung. Exposure to particle pollution increases the risk of premature death and can trigger asthma attacks, wheezing, coughing and lung irritation in people with sensitive airways. Hundreds of thousands of Americans suffer from asthma attacks, cardiac problems, and up per and lower respiratory problems associated with exposure to fne particles from power plants. Numerous studies have also shown a strong link between outdoor air particles and heart and lung-related problems and death. Its major sources are motor vehicle exhaust, coal-fred electric utilities and industrial boilers. Nitrogen oxides are also a key ingredi ent in the formation of ozone and fne particulate air pollution. Sulfur dioxide also is a key ingredient in the formation of fne particulate air pollution. For example, cleaning up coal-fred power plants to reduce the fne particulate matter they produce has required cleaning up the sulfur dioxide as well. Due to the phase-out of leaded gasoline between 1975 and 1986, outdoor lead levels have decreased by more than 90 percent. Although the pri mary impact of lead is not on the lungs, they are the major route for lead par ticles to enter the body.

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These items diabetes uk cheap irbesartan 150mg without a prescription, plus all those listed in Resources diabetes symptoms vitamin d safe irbesartan 150 mg,” were used as source material during the writing of this guide diabetes type 1 uptodate order irbesartan 150mg without a prescription. Understanding the nature of autism: A guide to autism spectrum disorders (2nd ed) diabetes mellitus y complicaciones order irbesartan 300 mg free shipping. Autism and Asperger Syndrome in seven year-old children: A total population study. Behavioral and emotional disturbance in high-functioning autism and Asperger Syndrome. This book provides guidelines for meeting the needs of the child with Asperger Syndrome in your class, from elementary to high school. Production and distribution of the Educator’s Guide to Asperger Syndrome was made possible thanks to the generous support of the American Legion Child Welfare Foundation. Rather, Autism Speaks provides general information about autism as a service to the community. The information provided in this kit is not a recommendation, referral or endorsement of any resource, therapeutic method, or service provider and does not replace the advice of medical, legal or educational professionals. This kit is not intended as a tool for verifying the credentials, qualifications, or abilities of any organization, product or professional. Autism Speaks has not validated and is not responsible for any information or services provided by third parties. You are urged to use independent judgment and request references when considering any resource associated with the provision of services related to autism ©2010 Autism Speaks Inc. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. About this Kit Autism Speaks would like to extend special thanks to the Advisory Committee for the time and effort that they put into reviewing the Asperger Syndrome and High Functioning Autism Tool Kit. Asperger Syndrome and High Functioning Autism Tool Kit Advisory Committee Ann Brendel Geraldine Dawson, Ph. Chief Science Officer, Autism Speaks Research Professor, University of North Carolina, Chapel Hill Peter F. D Assistant Professor of Education Adelphi University Family Services Committee Members Liz Bell Parent Sallie Bernard Parent, Executive Director, SafeMinds Michele Pierce Burns Parent Farah Chapes Chief Administrative Officer, the Marcus Autism Center ©2010 Autism Speaks Inc. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Strong Center for Developmental Disabilities Brian Kelly * ** Parent Artie Kempner* Parent Gary S. Mayerson* Founding Attorney, Mayerson & Associates Kevin Murray* Parent Linda Meyer, Ed. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Page 4 List of Strengths and Challenges Strengths and Challenges Chart………………………………………………………. Page 5 Executive Functioning and Theory of Mind Executive Functioning and Theory of Mind…………………………………………. Page 13 Telling Peers……………………………………………………………… ………Pages 13, 14 Join a Support Group…………………………………………………………………. Page 15 Parent Education and Training…………………………………………………………Page 16 Cognitive Behavior Therapy…………………………………………………………. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Page 20 Transition into Adulthood Transition to Adulthood Overview……………………………………………. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Your child has normal cognitive abilities and has experienced normal language development, but has been diagnosed with Asperger Syndrome or High Functioning Autism, and you have asked for help. For some families, this may be the point when, after a long search for answers, you now have a name for something you didn’t know what to call, but you knew existed. Many families report mixed feelings of sadness and relief when their child is diagnosed. You may also feel relieved to know that the concerns you had for your child are valid. It was created to help you make the best possible use of the next 100 days in the life of your child. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called Asperger” syndrome. Individuals who are diagnosed with autism or autism spectrum disorder who have normal cognitive abilities, and experienced no significant delay in acquiring language skills, are very similar to individuals with Asperger Syndrome. Children with Asperger Syndrome show typical language development and often an above average vocabulary. However, you may have noticed that when your child interacts with others, he or she might use language skills inappropriately or awkwardly. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. The following is a list of symptoms that may present themselves in children with Asperger Syndrome: • improper or very few social interactions • "robotic" or repetitive speech • average or below average nonverbal communication skills, yet average or above average verbal communication skills • tendency to discuss self rather than others • inability to understand issues or phrases that are considered common sense” • lack of eye contact or reciprocal conversation • obsession with specific unique topics • one-sided conversations • awkward movements and/or mannerisms A very obvious and distinct indicator of Asperger Syndrome is preoccupation with one particular issue, from simple things like refrigerators or weather, to complex topics like President Franklin D. They become so attentive to these topics that they strive to learn every possible fact and detail, and as a result become incredible experts. They may not like the idea of discussing anything else, or may be unable to listen to and understand the responses of others. Your child may not be aware that his or her audience may no longer be listening, or may not be in the topic of discussion. Another symptom of Asperger Syndrome is an inability to understand the actions, words or behaviors of other people. Because they are often incapable of understanding these nonverbal cutes, the social world can seem very confusing and overwhelming to these individuals. To compound the problem, people with Asperger Syndrome have difficulty seeing things from another person’s perspective. This inability leaves them unable to predict or understand other people’s actions. Individuals with Asperger Syndrome may have an awkward or peculiar way of speaking. They might speak extremely loudly, constantly in a monotone, or with a particular accent. These individuals lack understanding of social interactions, and as a result, are unaware that their topics of discussion or method of speaking might be inappropriate or awkward, particularly in specific situations. For example, children who speak very loudly might enter a church and not understand that they can no longer speak at the same volume. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. Another typical sign of Asperger Syndrome may be awkward movements, or a delay in motor skills. Though these individuals might be very intelligent and might display expert language skills, they may not be able to catch a ball or understand how to bounce on a trampoline, despite the many attempts of others to teach them. It is important to note that not all individuals with Asperger Syndrome display each of these symptoms, and that the presence and severity of each symptom is likely to vary between individuals with the same diagnosis. While displaying some or all of these symptoms, each child with autism also possesses many unique gifts. It is important to keep in mind that autism spectrum disorders are not one disorder with one cause. Rather, the term represents a group of related disorders with many different causes. A great deal of research is currently focused on identifying how both genetic and environmental risk factors contribute to autism.

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The repair Periosteal sleeve of this injured structure through an open surgical approach was widely described diabetic dog treats discount irbesartan 150mg on-line, and this technique became the standard treatment for traumatic shoulder instability1–4 diabetes mellitus glucose levels purchase irbesartan 300 mg on line, 7–9 diabetes prevention toolkit order 300 mg irbesartan mastercard, 12 diabetic ulcer stages 150mg irbesartan free shipping, 15, 19, 35–43. Different authors reported success rates ranging from 80% to 97%1–4, 7–9, 12, 15, 19, 35–43. The main problems resulting from this operation were limitations in the patients’ ability to engage in sports involving overhead arm movements and a significant limitation of external rotation41–46. This leads to an increased capsular volume and a small increase in anterior translation. Advocates of open surgery claim that it is easier to reduce the capsular volume with a plication or shift procedure than reattach the torn labrum to its anatomical site. We do not believe that arthroscopic techniques are inferior to open surgery in performing an adequate capsular shift or effecting an anatomical reattachment of the labrum to the glenoid rim. The key advantage of arthroscopy is that it allows precise inspection of the capsulolabral complex, making it possible to perform a true anatomical reconstruction in the form of an inferior capsular shift. Advantages include the more accurate assessment of capsuloligamentous lesions and the detection of any associated injuries caused by the original trauma. Arthroscopic repairs were initially performed with metal One problem with all the above techniques was that staples47–51. These implants have need for extra portals dampened initial expectations provided arthroscopic surgeons with the same treat of success. Additionally, reports showed that this ment options available in the open Bankart operation technique did not yield good results in patients under while greatly reducing the negative sequelae of the 25 years of age55, 56, 59–62. The success of the suture-anchor Absorbable tags for reattaching the labrum were the technique is based on the ability to secure the capsulo next step in the evolution of arthroscopic techniques43, labral complex in an anatomical position while also 44,56,63,64. The success rates ranged from 79% to 96%43,44, shifting the joint capsule and reducing the capsular 56,63,64 volume while avoiding excessive capsular plication28, 52,. This technique missed the opportunity for an arthroscopic repairs are the same as those after open inferior-to-superior capsular shift, that would reduce repairs (5–10%), but with significantly less morbidity the capsular volume. The Bankart easily sweep the arthroscope through the glenohumeral lesion is easily visualized with an arthroscope intro joint from above downward without meeting significant duced through a posterior portal. Injuries of this kind cannot always be detected anterior instability will eliminate the drive-through sign. Functional arthroscopy in particular can supply avulsion of the glenohumeral ligament, humeral precise information on the direction and degree of the detachment of the capsule); tears of the subscapularis, instability. For this purpose, the arm is released from its supraspinatus, and infraspinatus muscles; posterior holder, abducted and externally rotated, and passively labral lesions; and intra-articular loose bodies can be moved in the direction of the dislocation. Besides complete arthroscopic inspection and the necessary extent of ruptures, injuries to the rotator cuff often consist of the inferosuperior capsulolabral shift can be assessed. This type of injury frequently goes undetected extent of the Hill-Sachs lesion and evaluating its patho in open repairs. The labral complex should standard in the surgical treatment of shoulder instability. If the pathology cannot be fully evaluated through the Once an anterosuperior instrument portal has been posterior portal, an anteroinferior portal should be placed placed below and medial to the biceps anchor with at a lateral site close to the subscapularis tendon. Now the first hole is drilled at the glenoid rim with a drill bit introduced through the anteroinferior portal at an approximately 45° angle. A drill sleeve can be used to keep the spinning bit from the presence of the triangle sign confirms that the skidding. Another option is to introduce a switching suture has not slipped out of the anchor. Another helpful technique is while the suture is brought out with the crochet hook. If this is not the case, any interposed soft tissues can Next, a bioabsorbable bone anchor armed with a be cleared with a knot pusher. The anchor should be introduced in such a way that In the socalled shuttle technique preferred by the one suture limb is directed laterally and the other is authors, the next step is to insert a suture instrument directed medially. Alternating traction is placed on the suture ends to make sure that the limbs of the suture slide freely It should be noted that the suture instrument is inserted through the anchor eyelet. The next step is to catch the laterally directly suture limb with a crochet hook and bring it out through the anterosuperior portal (Fig. The capsule is pierced with the suture instrument lateral and inferior to the suture anchor, the pierced capsule is shifted upward, and finally the needle tip is brought out below the labrum, caudal to the bone anchor (Figs. Following optimum placement of the needle tip, the and several centimeters of the lateral suture limb of the shuttle suture (usually an absorbable monofilament anchor is pulled through the loop and tied. At this stage both suture limbs have been brought out Note, that the suture limb passing through the capsule through the anteroinferior portal. Otherwise a nonsliding knot the procedure is concluded by inserting additional is used. This phenomenon is also called the drive its practical convenience, the laser became a popular through sign. They described a capsular shift sports participation, which was not the case following operation that yielded satisfactory results in 31 of their suture treatment. Younger patients also had better patients based on a superior shift of the medial or results than elderly patients. Savoie and Field described a new technique in which In the literature only few reports are based on inter a unipolar probe was introduced arthroscopically to mediate or long-term studies. Arthroscopic to date have been satisfactory, with good or excellent rotator interval closure, as described by Treacy76, was results reported in 75% to 100% of cases20, 70–72. All of their patients (n = 10) had a satisfactory multiple sutures were used to reduce the intra-articular outcome. They reported an 80% rate of good or excellent procedure has not been widely implemented because results, noting that 3 of the 5 failures were in patients of its technical difficulty. Arthroscopic surgery is preferred over deltoid, pectoralis major and latissimus dorsi muscles is open surgery in these cases, as it allows a controlled deferred until a normal functional status of the scapula capsulorrhaphy to be performed under arthroscopic stabilizing muscles and rotator cuff has been restored. We personally prefer the capsular plication technique of Snyder27 over Changes in daily living activities and physical activity patterns are the primary goals of rehabilitation. These high failure rates may stem from a single significant lesion that is responsible for subsequent instability15, 78–86. Papendick and Savoie76 published their results Combinations of different techniques have yielded of posterior instability operations. They had a notably better results, although the good results of anterior high success rate, with 95% of their patients stating instability operations have not yet been achieved. Savoie and Improved arthroscopic instruments and techniques Field85 also reported their results in 61 patients. They have enabled experienced surgeons to reconstruct modified their technique according to the specific intra this problem area arthroscopically. All of their patients that posterior shoulder instability can have multiple were reexamined at 1 to 7 years, and 55 of the patients causes, the arthroscopic technique has obvious advan (90%) still had stable shoulders. The preope rative focus should definitely be on intensive physical therapy, however. Injuries to this structure may lead to pure the neutral position and to increased anterior translation anterior instability12, 15, 16, 30. The anterosuperior quadrant of pain and signs of minor instability persist despite inten the shoulder joint features an exceptionally high density sive physical therapy. It should be added, however, of ligaments, tendons, and muscles, whose mechanical that an anatomical reconstruction of anterosuperior effects are concentrated in a very small area. When quadrant lesions will not be technically possible in all anatomical variants of individual ligaments are added cases. Both the patient and the surgeon should be to this complex picture, we can understand that even aware of this limitation. J Bone Joint Surg [Am] 76A: (1985): Glenoid labrum tears related to the long 1819–1826 head of the biceps. Surg [Am] 74A:53–66 Instructional Course Lectures 45:65–70 50 Shoulder Arthroscopy 30. Op Tech Sports et al (1992): Arthroscopic staple capsulorhaphy Med 5:257–263 for anterior shoulder instability. J Bone Joint Surg[Am] 66:175–184 (1995): Effect of lesions of the superior portion of 50.

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At work or at home diabetes 81 order irbesartan 300 mg mastercard, have you ever been exposed to hazardous solvents diabetes treatment quiz 150mg irbesartan amex, hazardous airborne chemicals (e metabolic decompensation diabetes definition buy 150mg irbesartan. Yes/No If yes diabetes test india purchase 150mg irbesartan mastercard,” name the chemicals if you know them: 3. Have you ever worked with any of the materials, or under any of the conditions, listed below Any other hazardous exposures: Yes/No If yes,” describe these exposures: 4. List any second jobs or side businesses you have: 5. List your current and previous hobbies: 22 7. Yes/No If yes,” were you exposed to biological or chemical agents (either in training or combat): Yes/No 8. Other than medications for breathing and lung problems, heart trouble, blood pressure and seizures mentioned earlier in this questionnaire, are you taking any other medications for any reason (including over-the-counter medications): Yes/No If yes,” name the medications if you know them: 10. How often are you expected to use the respirator(s) (circle yes” or no” for all answers that apply to you) Light (less than 200 kcal per hour): Yes/No If yes,” how long does this period last during the average shift: hrs. Examples of a light work effort are sitting while writing, typing, drafting or performing light assembly work; or standing while operating a drill press (1-3 lbs. Moderate (200 to 350 kcal per hour): Yes/No If yes,” how long does this period last during the average shift: hrs. Heavy (above 350 kcal per hour): Yes/No If yes,” how long does this period last during the average shift: hrs. Will you be wearing protective clothing and/or equipment (other than the respirator) when you’re using your respirator Yes/No If yes,” describe this protective clothing and/or equipment: 14. Describe the work you’ll be doing while you’re using your respirator(s): 17. Describe any special or hazardous conditions you might encounter when you’re using your respirator(s) (for example, confined spaces, life-threatening gases): 18. Provide the following information, if you know it, for each toxic substance that you’ll be exposed to when you’re using your respirator(s): Name of the first toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: 24 Name of the second toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the third toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: the name of any other toxic substances that you’ll be exposed to while using your respirator: 19. Describe any special responsibilities you’ll have while using your respirator(s) that may affect the safety and well-being of others (e. Respirator Fit-Testing Before an employee is required to use any respirator with a tight-fitting facepiece, the employee will be fit-tested to ensure proper facepiece seal. In qualitative methods, a challenge agent is used to determine whether or not the seal leaks. If there is a leak in the seal, the challenge agent elicits a response in the wearer. Quantitative methods use instrumentation to determine the relative concentrations inside and outside the facepiece. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery or an obvious change in body weight. Fit-Tester Qualifications Fit testing may be conducted by any individual who has received training and has demonstrated competency in the methods to be used. Records Records of all fit tests will be retained for all respirator users until the next fit test is administered. Records must include the name of the employee; type of fit test; specific make, model, style and size of respirator tested; date of the test; and test results. Safe Use of Respirators the following guidelines should be followed to ensure that respirators are kept clean, sanitary and in good working order. Disassemble facepieces by removing speaking diaphragms, demand and pressure-demand valve assemblies, hoses or any components recommended by the manufacturer. Wash components in warm (110F maximum) water with a mild detergent or with a cleaner recommended by the manufacturer. Rinse components thoroughly in clean, warm (110F maximum), preferably running water. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for two minutes in hypochlorite solution (50 ppm of chlorine) made by adding approximately 1 milliliter of laundry bleach to 1 liter of water at 110F. Other commercially available cleansers of equivalent disinfectant quality may also be used as directed, if their use is recommended or approved by the respirator manufacturer. Rinse components thoroughly in clean, warm (110F maximum), preferably running water. In addition, some disinfectants may cause deterioration of rubber or corrosion of metal parts if not completely removed. Reassemble facepiece, replacing filters, cartridges and canisters where necessary. Emergency respirators must be kept accessible to the work area, stored covered and clearly marked as a respirator for emergency use. Inspection Respirators must be inspected as follows: • Prior to use and during cleaning. Inspections will include the following: • A check of respirator function, tightness of connections and the condition of the various parts including, but not limited to, the facepiece, head straps, valves, connecting tube, and cartridges, canisters or filters. Air and oxygen cylinders shall be maintained in a fully charged state and shall be recharged when the pressure falls to 90% of the manufacturer’s recommended pressure level. The employer shall determine that the regulator and warning devices function properly. For respirators maintained for emergency use, the employer shall: • Certify the respirator by documenting the date the inspection was performed, the name (or signature) of the person who made the inspection, the findings, required remedial action, and a serial number or other means of identifying the inspected respirator. This information shall be maintained until replaced following a subsequent certification. All repairs will be made according to the manufacturer’s recommendations and specifications for the type and extent of repairs to be performed. Reducing and admission valves, regulators and alarms shall be adjusted or repaired only by the manufacturer. All compressors used to supply breathing air to respirators are constructed and situated so that the air supply cannot become contaminated. They will be equipped with in-line air-purifying sorbent beds and filters to further ensure breathing-air quality. Sorbent beds and filters must be maintained and replaced or refurbished periodically following the manufacturer’s instructions. To protect breathing air from carbon monoxide, compressors that are not oil-lubricated must be monitored to ensure that carbon monoxide levels do not exceed 10 ppm. For oil lubricated compressors, a high-temperature or carbon monoxide alarm, or both, must be used to monitor carbon monoxide levels. If only high-temperature alarms are used, the air supply must be monitored at intervals sufficient to prevent carbon monoxide in the breathing air from exceeding 10 ppm. Breathing-air couplings must be incompatible with outlets for non-irrespirable air or other gas systems. Either the positive and negative pressure checks listed in this appendix or the respirator manufac turer’s recommended user seal check method shall be used. The face fit is considered satisfactory if a slight positive pressure can be built up inside the facepiece without any evidence of outward leakage of air at the seal. For most respirators this method of leak testing requires the wearer to first remove the exhalation valve cover before closing off the exhalation valve and then carefully replacing it after the test. Close off the inlet opening of the canister or cartridge(s) by covering with the palm of the hand(s) or by replacing the filter seal(s). Inhale gently so that the facepiece collapses slightly, and hold the breath for 10 seconds. The design of the inlet opening of some cartridges cannot be effectively covered with the palm of the hand. The test can be performed by covering the inlet opening of the cartridge with a thin latex or nitrile glove. If the facepiece remains in its slightly collapsed condition and no inward leakage of air is detected, the tightness of the respirator is considered satisfactory.

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