J. Borak | Yale University School of Medicine (original) (raw)

Papers by J. Borak

Occupational Medicine, 2018

Background Bronchial hyper-responsiveness (BHR) is often regarded as a 'hallmark' of asthma, and ... more Background Bronchial hyper-responsiveness (BHR) is often regarded as a 'hallmark' of asthma, and bronchoprovocation testing is frequently performed to support a diagnosis of asthma. The European Respiratory Society (ERS) and American Thoracic Society (ATS) have recently updated their technical standards and guidelines for performing methacholine challenge testing (MCT), the most commonly performed clinical test of BHR. Aims To review the updated guidelines and discuss the various changes and their potential impact on clinicians. Methods We performed a systematic review of references identified using Medline and hand searches of identified articles. Results The new ERS and ATS guidelines recommend that MCT be performed using tidal breathing, not deep inspirations with breath holding, that results be reported as the PD20 (cumulative dose causing a 20% fall in forced expiratory volume in 1 s [FEV 1 ]), rather than PC20 (concentration causing a 20% fall in FEV 1), and that manufacturers of nebulizers and other delivery systems provide performance characteristics to allow calculation of PD20 values. Our preliminary survey found that the new guidelines are only slowly being adopted. Conclusions Clinicians should be aware that recommended BHR testing methods, particularly for MCT, have changed. As a result, they should anticipate that test outcomes will increasingly be reported in terms of PD20, which will facilitate longitudinal assessment of their patients. Compliance with the new guidelines will increase the sensitivity of MCT in mild and asymptomatic asthmatics.

Occupational health & safety (Waco, Tex.), 1985

This article stresses the importance of developing meaningful medical disaster plans for worksite... more This article stresses the importance of developing meaningful medical disaster plans for worksites as the probability for major industrial disasters increases. To be effective, these plans must be integrated into the surrounding communities utilizing the local emergency medical services (EMS). By taking this approach, industries can further their OWN well being and that of their workers, protect against extraordinary financial damages and provide a resource of great importance to their communities

The American Journal of Emergency Medicine, 1988

Cutaneous larva migrans is a distinctive dermatitis caused by the fiiariform ianrae of certain ne... more Cutaneous larva migrans is a distinctive dermatitis caused by the fiiariform ianrae of certain nematode parasites. Most often associated with tropical climates, it has increasingly been noted in nontropical settings. To familiarize northern clinicians with this condition, a case report is presented and its pathaphysioiogy, diagnosis, and treatment are reviewed. (Am J Emerg Med 1988;6:462-464. 0 1988 by W.8. Saunders Company.) Cutaneous larva migrans (CLM) is a characteristic cutaneous eruption caused by larva of various nematode parasites. It is generally associated with moist, humid, sandy environments. An important cause of morbidity throughout the world,' CLM is infrequently diagnosed in most parts of North America. However, as world travel and exotic vacation sites have become more popular and accessible, the likelihood of diagnosing CLM in travellers returning to northern climates has increased.' The following case report iilustrates some CLM-related diagnostic and therapeutic issues of which North American clinicians should be aware.

Clinical and investigative medicine. Médecine clinique et experimentale, 1979

ABSTRACT

Journal of Occupational and Environmental Medicine, 2002

Traditional methods for monitoring occupational creosote exposure have focused on inhalation. How... more Traditional methods for monitoring occupational creosote exposure have focused on inhalation. However, there is evidence that dermal exposure contributes importantly to total systemic dose, as measured by biological monitoring methods. This study was conducted to further characterize the relationships between inhalation and dermal exposures to creosote, and to compare traditional ambient exposure monitoring versus biological monitoring in 36 creosote-exposed wood treatment workers. Full-shift personal air samples were obtained, along with post-shift and next-day urine measurements for 1-hydroxypyrene. There was little or no correlation between airborne measures and urinary 1-hydroxypyrene (r 2 ϭ 0.05 to 0.35). More than 90% of 1-hydroxypyrene could be attributed to dermal exposure. These data indicate that traditional monitoring methods may be inappropriate for creosote workers, raising concerns about the adequacy of methods currently mandated by the Occupational Safety and Health Administration.

Annals of Emergency Medicine, 1992

Canadian Medical Association Journal, Sep 20, 1980

Journal of Occupational and Environmental Medicine, 1995

Occupational health & safety (Waco, Tex.), 1994

Emergency medical services, 1988

Emergency medical services, 1991

Federal laws and regulations require hazardous-materials-response training for EMS personnel and ... more Federal laws and regulations require hazardous-materials-response training for EMS personnel and other emergency responders. The requirements, however, aren't entirely clear about the amount of time and topics to be covered for EMS training. EMTs and paramedics should either be trained to the highest level at which they are likely to perform, or their performance levels should be restricted to the highest level to which they have been trained.

Occupational health & safety (Waco, Tex.), 1995

Clinics in Occupational and Environmental Medicine, 2002

Journal of Pediatric Endocrinology and Metabolism, 2000

... Jonathan Borak, MD, DABT Associate Clinical Professor of Medicine and Epidemiology, Yale Scho... more ... Jonathan Borak, MD, DABT Associate Clinical Professor of Medicine and Epidemiology, Yale School of Medicine, New Haven, CT, USA e-mail: <jborak@worldnet.att.net> or <jborak@jborak. com> ... JNutr 1939; 17: 545-555. 8. Wilgus HS Jr, Gassner FX, Patton AR, et al. ...

Journal of Occupational and Environmental Medicine, 2001

Phosgene (carbonyl chloride, CAS 75-44-5) is a highly reactive gas of historical interest and cur... more Phosgene (carbonyl chloride, CAS 75-44-5) is a highly reactive gas of historical interest and current industrial importance. Phosgene has also proved to be a useful model for the study of those biochemical mechanisms that lead to permeability-type pulmonary edema (adult respiratory distress syndrome). In turn, the study of phosgene-induced adult respiratory distress syndrome has provided insights leading to revised treatment strategies for exposure victims. We summarized recent findings on the mechanisms of phosgene-induced pulmonary edema and their implications for victim management. In light of that research, we also provide a comprehensive approach to the management and treatment of phosgene exposure victims.

Teratology, 1998

There is concern that environmental and dietary aluminum (Al) might cause developmental toxicity.... more There is concern that environmental and dietary aluminum (Al) might cause developmental toxicity. To better understand this concern, we reviewed published studies which administered Al compounds to pregnant animals and measured accumulation of Al in mother, fetus, or born offspring. A total of 7 studies were identified which administered Al during gestation and evaluated fetal accumulation. Another 7 studies administered Al at least until birth and then evaluated accumulation in mothers and/or pups. These 14 studies included 4 different Al compounds (hydroxide, chloride, lactate, and citrate) administered by 4 different routes (gavage, feed, intraperitoneal injection, and subcutaneous injection) with total doses ranging from 13.5 to 8,400 mg/kg. Fetal Al levels were not increased in 6 of 7 studies and pup Al levels were not increased in 4 of 5 studies in which they were measured. Maternal Al levels were increased in some studies, but there was no consistent pattern of organ-specific accumulation and several positive studies were contradicted by subsequent reports from the same laboratory. Placental levels were increased in 6 of 9 studies and were greater than corresponding fetal levels. The weight of evidence in these studies suggests that environmental and dietary Al exposures are unlikely to pose risks of Al accumulation to pregnant animals or their fetuses.

Occupational Medicine, 2011