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Parentalatrial brillation asa risk factorforatrial brillation and inhibits predisposition to atrial brillation. The continuum of personalized cardiovascular medicine: a ling in persistent valvular atrial brillation. Kirchhof P, Breithardt G, Aliot E, Al Khatib S, Apostolakis S, Auricchio A, tients with chronic atrial brillation. Cellular and molecular mechanisms of atrial arrhythmogenesis in pa Rasmussen L, Ravens U, Reiffel J, Richard-Lordereau I, Schafer H, Schotten U, tients with paroxysmal atrial brillation. Anne W, Willems R, Roskams T, Sergeant P, Herijgers P, Holemans P, Ector H, structural and electrical development and remodeling of the heart. Histological substrate of human atrial lated atrial microvascular dysfunction in patients with lone recurrent atrial bril brillation. Venteclef N, Guglielmi V, Balse E, Gaborit B, Cotillard A, Atassi F, Amour J, 105. Human epicardial adipose tissue system in atrial brillation: pathophysiology and therapy. Atrialamyloidosis:anarrhythmogenicsubstrateforpersistentatrial b vanish in human chronic atrial brillation. Electropathological substrate of long-standing persistent atrial brilla Mouroux A, Le Metayer P, Clementy J. Spontaneous initiation of atrial brillation tion in patients with structural heart disease: longitudinal dissociation. Dynamic nature of atrial bril tachycardia-pause early afterdepolarizations and triggered arrhythmia in canine lation substrate during development and reversal of heart failure in dogs. Atienza F, Almendral J, Moreno J, Vaidyanathan R, Talkachou A, Kalifa J, Arenal A, 88. Effect tivation of inward recti er potassium channels accelerates atrial brillation in hu of atrial brillation on atrial thrombogenesis in humans: impact of rate and mans: evidence for a reentrant mechanism. Biomarkers in atrial b as a mechanism of atrial brillation in the isolated sheep heart.

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One structural collapse took the lives of three career frefghters, and two motor vehicle crashes killed, respectively, two wildland frefghters each. Multiple frefghter fatality incidents Year Number of incidents Total number of deaths 2016 3 7 2015 3 7 2014 2 4 2013 4 34 2012 4 10 2011 3 6 2010 4 8 2009 6 13 2008 5 18 2007 7 21 2016 Findings 9 Wildland frefghting deaths In 2016, 15 frefghters were killed during activities involving brush, grass or wildland firefighting. This total includes part-time and seasonal wildland firefighters, full-time wildland frefghters, and municipal or volunteer frefghters whose deaths are related to a wildland fre (Figure 4. Firefghter fatalities related to wildland frefghting (2006 to 2016) 40 35 30 31 25 26 20 15 17 16 15 10 12 12 11 11 10 5 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year Table 2. Firefghter deaths associated with wildland frefghting Number of Total number Number of frefghters killed Year of deaths fatal incidents in multiple-death incidents 2016 15 13 4 2015 12 9 5 2014 11 11 0 2013 31 13 19 2012 16 12 6 2011 10 9 2 2010 12 12 0 2009 17 14 5 2008 26 15 14 2007 11 11 0 10 Firefghter Fatalities in the United States in 2016 Table 3. Wildland frefghting aircraft deaths An excellent online Total number Number of Year of deaths fatal incidents mapping tool to 2016 0 0 geographically search 2015 2 1 and contextualize 2014 2 2 U. This by type of duty (2016) includes all firefighters who died responding to an emergency or at an emergency scene, returning from an emergency incident, and during other emergency related activities. Nonemergency duties include training, Emergency administrative activities, performing other functions 40% that are not related to an emergency incident, and Nonemergency (36) post-incident fatalities where the frefghter does not 60% experience the illness or injury during the emergency. Emergency duty frefghter deaths Percentage of all deaths Year Percentage of all deaths excluding Hometown Heroes 2016 40 54 2015 49 59 2014 46 63 2013 73 77 2012 56 65 2011 54 70 2010 55 67 2009 63 82 2008 64 70 2007 64 72 the number of deaths by type of duty being performed is shown in Table 5 and presented graphically in Figure 6 for 2016. Fireground duties were again the most common type of duty for frefghters killed while on duty. Firefghter deaths by type of duty (2016) Type of duty Number of deaths Returning 3 Training 9 Responding 10 On-scene nonfre 13 Other on-duty 16 On-scene fre 17 After 21 Total 89 Type of Duty 13 Figure 6. Firefghter deaths by type of duty (2016) Returning 3 Training 9 Responding 10 On-scene non re 13 Other on-duty 16 On-scene re 17 After 21 0 10 20 30 40 Number of deaths Fireground operations Seventeen frefghters experienced fatal injuries during freground operations in 2016. Of these fatalities, eight were at the scene of a structure fre, three were at the scene of a vehicle fre, and six others were at the scene of a wildland or outside fre. The average age of the frefghters killed during freground operations was 48, with the youngest being 20 years old and the oldest being 78 years old. Eight of those killed were volunteer, six were career and three were wildland frefghters. The nature of fatal injury while engaged in freground operations for seven of the frefghter deaths was heart attack (41 percent. The nature of fatal injury for the other 10 deaths include: asphyxiation (three), trauma (fve), burns (one), and pulmonary embolism (one. Type of freground activity Table 6 shows the types of freground activities in which frefghters were engaged when they sustained their fatal injuries or illnesses. This total includes all frefghting duties on the freground, such as wildland frefghting and structural frefghting. Type of activity (2016) Water supply 1 Support 1 Search and rescue 1 Scene safety 1 Pump operations 2 Other 2 Incident command 2 Unknown 3 Advance hoselines 4 14 Firefghter Fatalities in the United States in 2016 Fixed property use for structural frefghting deaths There were eight fatalities in 2016 where frefghters became ill or injured while on the scene of a structure fre.

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When delivering direct patient care: wear a disposable plastic apron if there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions or wear a long-sleeved fluid-repellent gown if there is a risk of extensive splashing of blood, body fluids, secretions or Recommendations excretions, onto skin or clothing. Trade off between clinical Wearing disposable aprons and gowns should protect healthcare workers from benefits and harms becoming contaminated whilst providing care and is also in line with health and safety legislation. Economic considerations the cost of disposable aprons, cost of uniforms, cost of laundering uniforms, and consequences of infection were taken into consideration. The cost associated with fluid-repellent gown use should be considered relative to the risk of contamination associated with each episode of direct patient care. Where the risk of soiling or infection is high, the increased cost of a fluid-repellent gown is likely to be justified. However, they did not feel it was necessary to make a recommendation in this area as this is covered in recommendation 5. The level of protection (disposable apron or full gown) should depend on the extent of potential contamination. Full gowns are generally only available in exceptional circumstances, such as high risk transfers and/or previously known risks or scenarios, which are rare. The recommendation from the previous guideline explicitly stated that aprons or gowns should be used to protect against body fluid contamination with the exception of sweat. When using disposable plastic aprons or gowns: use them as single-use items, for one procedure or one episode of direct patient care and Recommendations ensure they are disposed of correctly (see chapter 9. This benefit is negated if bad practice is adopted such as wearing aprons or gowns between patients or wearing the same apron for different procedures on the same patient. Quality of evidence the recommendation developed is in line with the available evidence which investigated the use of single-use items which were discarded after each patient use. It is unclear from consideration of the evidence reviewed whether the available gowns were disposable items. Our previous systematic review failed to reveal any robust experimental studies that suggested any clinical benefit from wearing surgical masks to protect patients during routine ward procedures such as wound dressing or invasive medical procedures. In these instances, surgical masks are not effective protection and specialised respiratory protective equipment should be worn,. Face masks and eye protection mustgg be worn where there is a risk of blood, body fluids, secretions or excretions splashing into the face and eyes. Respiratory protective equipment, for example a particulate filter mask, mustgg be used when clinically indicated. The choice of safety cannulae and needles were prioritised for update to determine whether newer safety devices available since the publication of the previous guideline are effective at reducing needle stick injury and associated infection. Sections not updated in this chapter are the safe handling of sharps (relating to the recommendation on sharps not being passed directly from hand to hand, and handling being kept to a minimum.

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