Technical Note: Comparison of Alinity c Hemoglobin A1c Immunoassay with Premier Hb9210 Automated HPLC Assay: A Preliminary Report

OBJECTIVE

We utilized Premier Hb9210 analyzer (HPLC method; Trinity Biotech, Jamestown, NY) for measuring HBA1c in whole blood. As our laboratory is transitioning to Abbott system, we compared HbA1c values obtained by Alinity c and Premier Hb9210.

METHODS

The Premier Hb9210 analyzer is based on boronate affinity high performance liquid chromatography with analytical measurement range of 3.8 to 18.5%. The Alinity c Hemoglobin A1c assay measured both total hemoglobin and HbA1c (enzymatic assay) in whole blood and then calculated %HbA1c. The analytical measurement range of this assay is 4 to 14% of HbA1c. We evaluated the analytical performance of Alinity c HbA1c by evaluating precision and also comparing 77 clinical samples with our reference HPLC method.

RESULTS

Both Alinity c HbA1c and Premier HB9210 have excellent total precision. Plotting HbA1c results obtained by the Premier Hb9210 analyzer in the x-axis (currently used reference method) and the corresponding values obtained by the Alinity c assay, we observed the following regression equation: y=0.9473x+0.1548 ( n=77, r=0.99).

DISCUSSION

Our result indicates that HbA1c enzymatic assay on the Alinity c analyzer showed values comparable to HPLC method. However, at the decision points (2.8% average negative bias at >6.4% and 3.3% average negative bias at 7%), HbA1c values obtained by the Alinity c analyzer were lower than the reference method.

CONCLUSIONS

We conclude that HbA1c assay on the Alinity c analyzer is a viable alternative to HPLC for measuring HbA1c in clinical laboratories but values at the decision points must be interpreted with caution and if necessary should be repeated by a reference HPLC method.

589. Oral Tablet Vaccination Induces Heightened Cross-Reactive CD8 T Cell Responses to SARS-COV-2 in Humans

Background

Covid-19 has accelerated global demand for easily distributed vaccines. Furthermore, as variant SARS-CoV-2 strains that circumvent antibody responses emerge, cross-protective vaccines provide substantial public health benefits. Vaxart is developing a shelf stable oral tablet vaccine that incorporates both the spike (S) and the more conserved nucleocapsid (N) proteins. Vaxart’s vaccine platform uses a non-replicating adenovirus and a TLR3 agonist as an adjuvant.

Methods

In an open-label phase 1 clinical study, 35 healthy subjects received either a single low (1x10¹⁰ IU; n=15) or high (5x10¹⁰ IU; n=15) dose of the vaccine candidate VXA-CoV2-1 with a small cohort receiving 2 low doses. PBMCs were taken at pre- and 7 days post-vaccination and restimulated with S and N peptides from SARS-CoV-2 or the 4 human endemic coronaviruses (HCoV). Cells were stained for CD4/CD8/CD107a (surface) and IFNγ/TNFα (intracellular). Subjects that received an intramuscular (i.m.) mRNA vaccine had PBMCs taken at the same timepoints and were compared in the same assay.

Results

The study’s results indicate that the VXA-CoV2-1 tablet was well tolerated. The majority of subjects had an increase in S-specific anti-viral CD8⁺ T cell responses. 19/26 (73%) subjects had a measurable CD8⁺ T cell response on day 8 above baseline, on average 1.5-4.6%. In a comparator experiment with the 2 SARS-CoV-2 i.m. mRNA vaccines, VXA-CoV2-1 outperformed other vaccine candidates with a >3.5-fold increase in S specific antiviral CD8 T cell responses. T cell responses specific to the 4 endemic HCoV were increased by 0.6% in subjects given VXA-CoV2-1.

Conclusion

Here we describe a room temperature stable tablet that induces SARS-CoV-2 S specific CD8 T cells of high magnitude after one dose in humans. Overall, the level of antiviral SARS-CoV-2 specific T cells, particularly IFNg-producing CD8s, induced following oral immunization with VXA-CoV2-1 are of higher magnitude than the mRNA vaccines currently in use against COVID-19. T cell responses against 4 endemic HCoV were also induced. Because T cells may be important in protecting against death and severe infection, these results suggest that VXA-CoV2-1 could be cross-protective against a wide array of emerging pandemic coronaviruses.

Disclosures

Susan Johnson, PhD, Vaxart (Employee) Clarissa Martinez, MPH, Vaxart (Employee) Mario Cortese, PhD, Vaxart (Employee) Josefina Martinez, n/a, Vaxart (Employee) Shaily Garg, BS, Vaxart (Employee) Nadine Peinovich, MPH, Vaxart (Employee) Emery Dora, n/a, Vaxart (Employee) Sean Tucker, PhD, Vaxart (Employee)

258 Are Electronic Algorithmic Referral Systems the Future of Triage? Evaluating the Use of The Oxford Acute Referrals System (OARS) For Plastic Surgery

Introduction

A traditional referral involves transfer of information over a telephone call and is typically documented in an unstructured format on paper notes, producing poor continuity of referrals between shifts, increasing the risk of error, and compromising patient safety. The Oxford Acute Referrals System (OARS) is an electronic platform that keeps a complete record of referrals, whilst providing the referring clinician with step-by-step specialist advice according to inbuilt BSSH guidelines. This audit demonstrates our experience of its’ use in a tertiary centre Plastics department.

Method

One week of referrals in 2019, prior to the implementation of OARS, were compared with the equivalent week in 2020 once OARS was established. Data was collected retrospectively using electronic patient records.

Results

In one week in 2019, 120 cases were reviewed in the emergency clinic compared with 155 OARS referrals for the equivalent week in 2020. Following OARS implementation, 69% of referred cases did not footfall in the emergency clinic. 46% were managed locally with specialist advice from Plastic Surgery. 10% were brought directly into a theatre list, of which 7% were subsequently treated conservatively. A Plastic surgery consultant reviewing OARS referrals taken by juniors, changed the decision of how or where to manage the patient in 6% of cases.

Conclusions

OARS is an effective triage system that has considerably reduced footfall in the emergency clinic, whilst simultaneously expediting patient care down the correct treatment pathway. Its use led to safe management of patients remotely, which has important implications during a pandemic.

1597 Navigating the Morality of Postponing Urgent Cancer Surgery in The Covid-19 Pandemic

Introduction

The Covid-19 pandemic presents challenges of unparalleled magnitude to healthcare resource allocation. Many cancer operations have been postponed due to reduced staff, bed and ICU availability, potentially allowing incurable disease progression. The five-year survival rate for stage 1 bowel cancer is 91%; stage 2, 84%1, yet some studies suggest the mortality rate of ventilated Covid-19 patients is 50-88%2,3,4,5. Many ethical documents attempt to guide just resource allocation for ICU, however, Covid-19 presents a greater conundrum. If resource allocation occurs on the basis of acute medical need it is preferential to Covid-19 care, and at what cost is this to those with potentially curable cancer? How can we navigate pandemic pressures to be as just as we can?

Method

Literature review and application of ethical theories including utilitarianism, deontology and a Rawlsian approach.

Results

Utilitarianism argues that allocating scarce resources to those likely to gain minimal benefit, whilst removing benefit from those with a higher likelihood of survival would not be for the greater good. Doctors, however, tend to practise in a more deontological way; that is in the best interests of the patient in front of them. Rawl’s thought experiment allows us to wear a ‘veil of ignorance’ to consider the fairest decision for any undefined individual.

Conclusions

Covid-19 has forced unprecedented moral dilemmas; these do not just extend to patients requiring ventilators, but those in need of curative surgery. An understanding of ethical principles and a multidisciplinary approach to decision-making should encompass the consideration of outcomes of oncological surgical intervention.

Parents' work injuries and children's mental health: The moderating role of children's work centrality

INTRODUCTION

The purpose of this study is to explore the relationship between parents' work-related injuries and their children's mental health, and whether children's work centrality - the extent to which a child believes work will play an important part in their life - exacerbates or buffers this relationship.

METHOD

We argue that high work centrality can exacerbate the relationship between parental work injuries and children's mental health, with parental work injuries acting as identity-threatening stressors; in contrast, high work centrality may buffer this relationship, with parental work injuries acting as identity-confirming stressors. We test this relationship with a sample of Canadian children (N = 4,884, 46.2% female, M age = 13.67 years).

RESULTS

Children whose parents had experienced more frequent lost-time work-related injuries reported worse mental health with high work centrality buffering this negative relationship.

CONCLUSIONS

Our study highlights the vicarious effects of work injuries on salient others, specifically parental work injuries on children's mental health, as well as the role of work centrality in shaping children's sense-making and expectations about the consequences of work.

Restarting plastic surgery: Drawing on the experience of the initial COVID-19 pandemic to inform the safe resumption of services

Coronavirus disease-2019 (COVID-19) has caused an unprecedented demand on healthcare resources globally. In the light of the arrival of a novel contagious and life-threatening virus, the NHS has responded by making difficult decisions to maintain care for patients and protect staff. The response has been frequently amended following updates in the UK Government policy as scientific understanding of the virus has improved. Our Plastic Surgery practice has adapted to mitigate risk to patients by reducing face-to-face contact, downgrading emergency procedures and deferring elective surgery where possible. This has inevitably resulted in a backlog in elective surgery and outpatient appointments. An assessment of the long-term health, social and economic impact of NHS wide service reconfiguration upon patient outcomes is yet to be seen. In this paper, we review the demonstrable early effects of service changes upon our unit and compare those to national and internationally published data. We also outline some of the considerations being made as we consider strategies to resume services in the light of the ongoing COVID-19 pandemic.

A plastic surgery service response to COVID-19 in one of the largest teaching hospitals in Europe

COVID-19 is presenting a colossal challenge to frontline NHS staff. This paper highlights how plastic surgery teams can use their diverse skills and resources in times of crisis. Through effective strategy and leadership we present how we are adapting as a department to serve our plastic surgery patients, other hospital teams and the Trust.

Revisiting vulnerability: Comparing young and adult workers' safety voice intentions under different supervisory conditions

In this study, we test the widely held belief that young workers (aged 15-24) are less likely than adults (aged 25 and over) to speak up about safety concerns. Counter to this belief, and in line with age-related resource selectivity theory, we hypothesized that older workers would actually be less likely than younger workers to speak up about workplace safety concerns ("safety voice intentions") when their supervisors are unclear about their own commitment to safety. To test this, we created two realistic scenarios in which we manipulated clarity of supervisor commitment to safety: (1) it is clear the supervisor clearly cares about/is open to hearing suggestions about safety (the "clear commitment" condition) and (2) it is unclear whether the supervisor cares about/is open to hearing suggestions about safety (the "unclear commitment" condition). We randomly assigned participants (N = 80; 58 % women; 40 % over the age of 24) to one of the two scenarios and measured their safety voice intentions. In the face of clear supervisor commitment to safety, younger and adult workers did not differ on their safety voice intentions. However, compared to younger workers, adult workers were less likely to speak up about safety in the face of unclear signals about the supervisor's commitment to safety. These findings have implications for our understanding of young and adult worker safety voice, and the importance of how supervisors signal commitment to safety.

78. Oral Norovirus Vaccination in Humans Induces Plasmablast B-Cell Expansion and Follicular T-Cell Activation Comparable to Natural Infection

Background

Norovirus (NoV) is a common cause of acute gastroenteritis, but no vaccines are currently licensed. Vaxart is developing an oral tableted NoV vaccine that induces both systemic and mucosal immune responses.

Methods

Two separate clinical studies were conducted to evaluate the safety and immunogenicity of an oral NoV vaccine and NoV infection. The first study investigated an oral tablet vaccine based on a recombinant adenovirus vector expressing NoV VP1 (rAd-VP1). In the second study, a controlled NoV infection (Norwalk virus) was performed using a strain isolated and purified from an infected subject. Serum and PBMCs were collected pre- and post-immunization/infection. Serum immune responses were assessed using IgG/IgA ELISAs and blocking titer (BT50) assays. Cellular immune responses were evaluated using antibody-secreting cell (ASC) assays to quantitate norovirus-specific B cells. Flow cytometry was used to analyze the phenotype of circulating B and T cells.

Results

The rAd-VP1 vaccine was well tolerated whereas most subjects (56%) in the controlled infection study had significant gastroenteritis 2–4 days post-inoculation. Subjects in cohorts vaccinated 28 days apart with 1 × 1010 or 1 × 1011 IUs showed the highest rises in serum IgG and IgA titers compared with those immunized 2 or 7 days apart with a 1 × 1010 IU vaccine dose. Subjects in the 1 × 1011 IU vaccine dose cohort had a 6-fold rise in serum IgA and 4-fold rise in BT50 titers, with mean IgA and IgG ASC values of 698 and 389 counts, respectively. In comparison, NoV-challenged subjects showed an average of 2,072 IgA and 886 IgG ASC counts. Remarkably, flow cytometry analysis revealed that activated B- and T-cell responses were similar post-vaccination and post-infection, with significant expansion of T follicular cells, plasmablasts, mucosal homing B cells, and preferential activation of IgA B cells.

Conclusion

The phenotype of activated B and T cells induced post-immunization was similar to that induced post-infection, suggesting that an oral vaccine can induce comparable adaptive immune responses without the substantial adverse clinical events that occur from natural infection. Future work in dose ranging will aide in the development of a safe and efficacious oral NoV vaccine.

Disclosures

All Authors: No reported Disclosures.

Supporting Arthritis and Employment Across the Life Course: A Qualitative Study

OBJECTIVE

To examine the need for and availability and use of formal and informal workplace resources and to uncover differences across the life course in adults with arthritis.

METHODS

Focus groups and interviews were conducted with young (aged 18-34 years; n = 7), middle-aged (35-54 years; n = 13), and older adults (≥55 years; n = 25) with a diagnosis of inflammatory arthritis, osteoarthritis, or other rheumatic disease. Participants were asked about their employment experiences, formal and informal workplace resource needs, and availability and use of workplace resources. Differences based on chronological, functional, psychosocial, organizational, and lifespan dimensions of age were examined. A modified grounded theory approach was used to inductively analyze the data.

RESULTS

Young, middle-aged, and older adult participants required similar workplace resources. Across all participants, scheduling modifications tended to be the most needed workplace resource. In contrast, the perceived availability and use of formal workplace resources differed among participants. Young adult participants and those who were newer to their jobs reported that workplace resources were less available and utilized. Middle-aged and older adults reported greater availability of workplace resources. Scheduling accommodations and at-work modifications were the workplace resources that were used most by middle-aged and older adults, respectively.

CONCLUSION

Similar workplace resources could meet the employment needs of individuals with arthritis across the life course. Attention should be paid to young adults and those who are new to their jobs, because they may perceive more barriers to accessing formal workplace resources and be susceptible to work disability.

1947. Influenza Vaccination via Oral Tablet is Protective and Induces a Unique Mucosal Immune Response

Background

Oral vaccines delivered as tablets offer several advantages over traditional injection-based vaccines including ease of distribution and administration as well as temperature-stable formulation options. Oral vaccination is also advantageous because it directly induces a strong mucosal response, which is thought to be critical for preventing future infections. Here we present results from a phase II clinical challenge study comparing efficacy of an oral recombinant adenovirus-based vaccine expressing hemagluttinin (HA) from A/California 04/09 to that of a commercial injectable quadrivalent (QIV) influenza vaccine.

Methods

In this 2016–2017 clinical trial (NCT02918006), subjects were immunized with either oral vaccine, QIV, or placebo and then challenged 90 days post-immunization with wildtype influenza A H1 virus to measure vaccine efficacy and durability. Protection was assessed by measuring changes in HAI titres, microneutralization, and IgA/IgG ASC assays. Additionally, exploratory flow cytometry evaluated quantitative and qualitative aspects of immunogenicity including markers of activation and mucosal homing on B cells. Analysis was performed on days 0 and 7 post-immunization and 0 and 6 days post-viral challenge. Plasmablasts sorted from PBMCs were then isolated for genomic DNA and sequenced for heavy chain receptor sequencing using NGS analysis.

Results

Of the subjects immunized with Vaxart’s oral tablet vaccine, 48% were protected. QIV, by comparison, protected 38% of immunized individuals. Only 37% of Vaxart subjects developed influenza infection compared with 44% of QIV subjects and 71% of placebo subjects. While both vaccines induced a humoral immune response, FACS analysis and NGS revealed that Vaxart subjects had more activated plasmablasts expressing surface mucosal homing markers and a more diverse B cell population than QIV subjects.

Conclusion

Vaxart’s oral influenza tablet vaccine protected against influenza infection as well or better than injectable QIV. However, the mechanism of protection appears to be unique to the route of immunization; oral immunization allows for specific homing of influenza specific B cells to sites of infection and produces a more diverse antibody repertoire.

Disclosures

N. Kolhatkar, Vaxart, Inc.: Employee, Salary. K. Gottlieb, Vaxart, Inc.: Employee, Salary. K. Kasparek, Vaxart, Inc.: Employee, Salary. K. Hodgson, Vaxart, Inc.: Employee, Salary. S. Tucker, Vaxart, Inc: Employee, Salary. D. Liebowitz, Vaxart, Inc.: Employee and Investigator, Salary.

Combating transnational organized crime by linking multiple large ivory seizures to the same dealer

Rapid growth in world trade has enabled transnational criminal networks to conceal their contraband among the 1 billion containers shipped worldwide annually. Forensic methods are needed to identify the major cartels moving the contraband into transit. We combine DNA-based sample matching and geographic assignment of tusks to show that the two tusks from the same elephant are often shipped by the same trafficker in separate large consignments of ivory. The paired shipments occur close in time from the same initial place of export and have high overlap in the geographic origins of their tusks. Collectively, these paired shipments form a linked chain that reflects the sizes, interconnectedness, and places of operation of Africa's largest ivory smuggling cartels.

Transitions that matter: life course differences in the employment of adults with arthritis

PURPOSE

To understand the similarities and differences in the employment participation of people living with arthritis across the life course.

METHOD

Focus groups and interviews were conducted with young (ages 18-34 years, n = 7), middle-aged (ages 35-54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data.

RESULTS

Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market.

CONCLUSION

Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client's age, life phase and work history as a strategy to enhance the delivery of interventions that promote work participation.

Injunctive safety norms, young worker risk-taking behaviors, and workplace injuries

Injunctive safety norms (ISNs) refer to perceptions of others' expectations of one's safety-related conduct. Drawing on a sample of Canadian young workers (n=11,986;M age=17.90years; 55% males), we study the relationships among four sources of non-work-related (i.e., parents, siblings, friends, teachers), two sources of work-related (i.e., supervisors, co-workers) ISNs, young workers' self-reported work-related risk-taking behaviors, and workplace injuries. Structural equation modeling suggests that ISNs from parents, supervisors, and co-workers were related to less frequent work-related risk-taking behaviors, and with fewer workplace injuries via less frequent work-related risk-taking behaviors. In addition, ISNs from supervisors were directly associated with fewer workplace injuries. In contrast, ISNs from teachers and siblings were not associated with work-related risk-taking behaviors, but ISNs from siblings were associated with fewer work injuries. Finally, ISNs from friends were associated with more frequent work-related risk-taking and more frequent work injuries via more frequent work-related risk-taking. This study draws attention to the relative roles of non-work sources of social influence and provides some evidence of how ISNs might be related to young workers' work-related risk-taking behaviors and their workplace injuries. It also contributes to practice by suggesting specific interventions that parents, supervisors, and co-workers could undertake to reduce young workers' work-related risk-taking and workplace injuries, namely encouraging youth to be safe at work.

Observation of Quasichanneling Oscillations

We report on the first experimental observations of quasichanneling oscillations, recently seen in simulations and described theoretically. Although above-barrier particles penetrating a single crystal are generally seen as behaving almost as in an amorphous substance, distinct oscillation peaks nevertheless appear for particles in that category. The quasichanneling oscillations were observed at SLAC National Accelerator Laboratory by aiming 20.35 GeV positrons and electrons at a thin silicon crystal bent to a radius of R=0.15  m, exploiting the quasimosaic effect. For electrons, two relatively faint quasichanneling peaks were observed, while for positrons, seven quasichanneling peaks were clearly identified.

The Use of Darbepoetin to Stimulate Erythropoiesis in the Treatment of Anemia of Chronic Kidney Disease in Dogs

Background

Darbepoetin alfa (darbepoetin) is an erythropoiesis‐stimulating agent used for the treatment of anemia secondary to chronic kidney disease (CKD) in dogs, but reports describing response are lacking.

Hypothesis/Objectives

To evaluate the effectiveness of darbepoetin in dogs with anemia secondary to CKD, dosing protocols, and adverse events.

Animals

Thirty‐three client‐owned dogs with naturally occurring CKD, including 26 with comorbidities.

Methods

Multi‐institutional retrospective study.

Results

The median starting dosage and highest dosage of darbepoetin administered were 0.5 and 0.8 μg/kg SC once weekly, respectively. Response to treatment was defined as achieving a packed cell volume (PCV) ≥30% or an increase in PCV ≥10%. Twenty‐eight of 33 dogs (85%) achieved a PCV ≥30% and 22 of 33 (67%) dogs achieved an increase in PCV ≥10%. Median time to achieve a PCV ≥30% was 29 days. A higher starting dosage was associated with achieving an increase in PCV ≥10% (P = .01). No dog sustained a response at a dosing interval >q21d. Potential adverse events included increased blood pressure requiring treatment (n = 12), seizures (n = 5), vomiting (n = 3), diarrhea (n = 3), and possible pure red cell aplasia (PRCA) (n = 2).

Conclusions and Clinical Importance

Darbepoetin, when combined with treatment of comorbidities, is an effective treatment for anemia secondary to CKD in dogs. A dosing interval >q21d was ineffective at maintaining a response to treatment. PRCA was a possible adverse event in 2 of 33 dogs (6%).

Improving the mix of institutional and community care for older people with dementia: an application of the balance of care approach in eight European countries

OBJECTIVES

To examine whether the mix of community and institutional long-term care (ILTC) for people with dementia (PwD) in Europe could be improved; assess the economic consequences of providing alternative services for particular groups of ILTC entrants and explore the transnational application of the 'Balance of Care' (BoC) approach.

METHOD

A BoC study was undertaken in Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK as part of the RightTimePlaceCare project. Drawing on information about 2014 PwD on the margins of ILTC admission, this strategic planning framework identified people whose needs could be met in more than one setting, and compared the relative costs of the possible alternatives.

RESULTS

The findings suggest a noteworthy minority of ILTC entrants could be more appropriately supported in the community if enhanced services were available. This would not necessarily require innovative services, but more standard care (including personal and day care), assuming quality was ensured. Potential cost savings were identified in all countries, but community care was not always cheaper than ILTC and the ability to release resources varied between nations.

CONCLUSIONS

This is believed to be the first transnational application of the BoC approach, and demonstrates its potential to provide a consistent approach to planning across different health and social care systems. Better comparative information is needed on the number of ILTC entrants with dementia, unit costs and outcomes. Nevertheless, the findings offer important evidence on the appropriateness of current provision, and the opportunity to learn from different countries' experience.

Safety in the c-suite: How chief executive officers influence organizational safety climate and employee injuries

According to social learning theory, powerful and high status individuals can significantly influence the behaviors of others. In this paper, we propose that chief executive officers (CEOs) indirectly impact frontline injuries through the collective social learning experiences and effort of different groups of organizational actors-including members of the top management team (TMT), organizational supervisors, and frontline employees. We found support for our collective social learning model using data from 2,714 frontline employees, 1,398 supervisors, and 229 members of TMTs in 54 organizations. TMT members' experiences within a CEO-driven TMT safety climate was positively related to organizational supervisors' reports of the broader organizational safety climate and their subsequent collective support for safety (reported by frontline employees). In turn, supervisory support for safety was associated with fewer employee injuries at the individual level. We discuss the theoretical and practical implications of these findings for workplace safety research and practice. (PsycINFO Database Record

Prevalence of texting while driving and other risky driving behaviors among young people in Ontario, Canada: Evidence from 2012 and 2014

This paper reports on the prevalence of texting while driving and other risky driving behaviors by age and gender in two large samples of youth aged 16-19 years in Ontario, Canada. In Study 1 (N=6133), we found that males reported more frequent texting while driving and speeding than females and, in terms of age, sixteen year olds reported frequent texting while driving than older participants. In Study 2 (N=4450), which was conducted two years later, males again reported more frequent texting while driving, however there was no difference in the rate of talking on the phone while driving among males and females. Participants also reported on experiences that led to a significant reduction in their texting while driving. The most common reasons were the perceived danger of texting while driving, laws and fines against texting while driving, and observing close-calls and accidents experienced by other people. The results of both studies suggest that driving-related risk-taking behaviors co-occur and that young passengers in vehicles, including 14 and 15 year olds, are bystanders to texting while driving. Finally, there was a substantial decline in the prevalence of texting while driving across the studies. In Study 1, 27% of participants reported "sometimes" to "almost always" texting while driving compared to 6% of participants in Study 2. Limitations and implications for public campaigns targeted youth distracted driving are discussed.

Validation of daily increments and a marine-entry check in the otoliths of sockeye salmon Oncorhynchus nerka post-smolts

Juvenile sockeye salmon Oncorhynchus nerka that were reared and smolted in laboratory conditions were found to produce otolith daily increments, as well as a consistently visible marine-entry check formed during their transition to salt water. Field-collected O. nerka post-smolts of an equivalent age also displayed visible checks; however, microchemistry estimates of marine-entry date using Sr:Ca ratios differed from visual estimates by c. 9 days suggesting that microstructural and microchemical processes occur on different time scales.

Prevalence and demographic differences in microaccidents and safety behaviors among young workers in Canada

INTRODUCTION

The present study examines the self-reported frequency of non-lost work time workplace injuries ("microaccidents") and the frequency of three types of work-related safety behaviors (i.e., safety voice, safety compliance, and safety neglect) recalled over a four-week period.

METHOD

We analyzed data on microaccidents and safety behaviors from 19,547 young workers (aged 15-25years, Mdn=18years; 55% male) from multiple Canadian provinces.

RESULTS

Approximately one-third of all young workers recalled experiencing at least one microaccident at work in the last four weeks. Comparisons across three age groups revealed that younger workers, particularly between the ages of 15-18, reported more frequent microaccidents, less safety voice, less safety compliance, and more safety neglect than workers aged 19-22. This pattern of results also held for comparisons between workers in 19-22 and 23-25 age groups, except for safety voice which did not differ between these two older age groups. In terms of gender, males and females reported the same frequency of microaccidents, but males reported more safety voice, more safety compliance, and more safety neglect than females did. The results and limitations of the present study are discussed.

CONCLUSION

Frequency of microaccidents and safety behavior vary among young worker age sub-groups.

Work-related injury underreporting among young workers: prevalence, gender differences, and explanations for underreporting

INTRODUCTION

Although notifying an employer of a lost-time work-related injury is a legal requirement in many jurisdictions, employees frequently do not report such injuries.

METHOD

Based on data from 21,345 young part-time Canadian workers (55% male), we found that 21% of respondents had experienced at least one lost-time injury, with about half reporting the injury to an employer and a doctor.

RESULTS

Respondents provided 10 reasons for avoiding reporting lost-time injuries, with perceived low severity of the injury, negative reactions of others, and ambiguity about whether work caused the injury as the most common ones. Additional analysis of these categories revealed that young males cited concern about their self-identity as a reason for not reporting an injury more often than young females did. We discuss the findings in terms of implications for management practice (i.e., educating young workers about accurate injury reporting) and public policy.

PRACTICAL APPLICATIONS

Targeted campaigns should be developed for young workers, especially young male workers, who are less likely to report injuries than young female workers, to understand the importance of and to encourage injury reporting.

Favourable outcomes of coccygectomy for refractory coccygodynia

INTRODUCTION

Coccygodynia is a condition associated with severe discomfort in the region of the coccyx. While traditional procedures had poor outcomes and high complication rates, recent literature suggests better outcomes and lower complication rates with coccygectomy.

METHODS

Data were collected retrospectively from clinical notes. A questionnaire was used to evaluate the outcomes. The outcome measures included pain analogue score (PAS) in sitting and during daily activities as well as patients' overall pain relief. Overall improvement in pain and complications were documented.

RESULTS

Between 2000 and 2010, 14 patients underwent total coccygectomy for refractory coccygodynia. All patients were available for follow-up appointments and the follow-up duration ranged from 24 to 132 months (mean: 80 months). The aetiology was traumatic in eight patients and non-traumatic in six. The PAS improved from a median of 9 to 4 for sitting and from 7.5 to 2.5 for daily activities. One patient had mild discharge for more than two weeks. No patients required further surgery. Twelve patients (85.7%) had excellent or good pain relief. Only one patient was unsatisfied. A Wilcoxon signed-rank test revealed significant improvement in pain when sitting (p<0.05) and during activities of daily living (p<0.05) at the final follow-up visit. A Mann-Whitney U test did not show a significant difference in improvement in PAS between the traumatic and non-traumatic groups (p=0.282 and 0.755).

CONCLUSIONS

In our series, total coccygectomy offered satisfactory relief of pain in the majority of patients with a low wound complication rate.

Waiting for safety: responses by young Canadian workers to unsafe work

INTRODUCTION

This study examines young workers' responses to unsafe work through the lens of the exit, voice, patience, and neglect typology (Leck & Saunders, 1992).

METHOD

In Canada, social marketing campaigns and high school curriculum concerning workplace safety for young workers promote the benefits of "speaking out" against dangerous work. We conducted focus group interviews with teenagers in two Canadian cities to understand the types of work-related hazards experienced by this group, how they respond to hazards, and barriers to injury prevention.

RESULTS

Instead of speaking up about hazards, the vast majority of young workers in our sample take a "wait-and-see" approach when they have safety concerns. Their reluctance to raise issues by voicing concerns was related to fear of being fired, status as newcomers, supervisor indifference, and feelings of powerlessness.

CONCLUSIONS

Despite the emphasis on "speaking out" against unsafe work, young workers' beliefs about the perils of voicing persist.

Carbon-14 transfer into potato plants following a short exposure to an atmospheric 14CO2 emission: observations and model predictions

To improve the understanding of the environmental (14)C behaviour, the International Atomic Energy Agency (IAEA) coordinated a Tritium and C-14 Working Group (T&C WG) in its EMRAS (Environmental Modelling for Radiation Safety) programme. One of the scenarios developed in the frame of T&C WG involved the prediction of time dependent (14)C concentrations in potato plants. The experimental data used in the scenario were obtained from a study in which potatoes (Solanum tuberosum cv. Romano) were exposed to atmospheric (14)CO(2) in a wind tunnel. The observations were used to test models that predict temporal changes in (14)C concentrations in leaves at each sampling time for each experiment and (14)C concentrations in tubers at the final harvest of each experiment. The experimental data on (14)C dynamics in leaves are poorly reproduced by most of the models, but the predicted concentrations in tubers are in good agreement with the observations.

Prevalence of risk factors for foot ulceration in patients with end-stage renal disease on haemodialysis

BACKGROUND

End-stage renal disease (ESRD) has been associated with foot ulceration and lower extremity amputation (LEA). However, the underlying risk factors for foot ulceration have received limited attention in this population.

AIM

The aim of this study was to investigate the prevalence and type of risk factors for foot ulceration present in patients with ESRD on haemodialysis without the coexistence of diabetes mellitus (DM).

METHODS

One hundred and ninety participants with ESRD and/or DM were recruited over a 6-week period. Participants were allocated into one of three groups: (i) ESRD without DM; (ii) DM without ESRD; and (iii) coexisting ESRD and DM. Participants were screened for the risk factors for foot ulceration. Statistical comparisons were made between the three groups for both the prevalence and type of risk factors using a Fisher's exact test.

RESULTS

Risk factors for foot ulceration were found to be highly prevalent in the ESRD population. Participants with both ESRD and DM exhibited statistically significant differences in risk factor presentation for peripheral neuropathy (P= 0.033), vascular insufficiency (P= 0.001) and footwear (P= 0.037) in comparison with participants with DM alone.

CONCLUSION

There are high prevalence rates of risk factors for foot ulceration in the ESRD population on haemodialysis and are comparable with those with DM. Individuals with coexisting ESRD and DM have an even greater risk for foot ulceration and LEA. This highlights the importance that regular foot screening, preventative education and treatment are necessary for patients with ESRD potentially to reduce the risk of foot ulcerations and LEAs.

Variations in structures, processes and outcomes of community mental health teams for older people: a systematic review of the literature

OBJECTIVES

In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness.

METHOD

Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element.

RESULTS

Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature.

CONCLUSIONS

The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided.

SU-F-BRCD-05: Mean Regional Dose to the Esophagus Predicts Acute Toxicity Rate for Lung Cancer Patients

PURPOSE

The relationship between spatial aspects of the dose distribution and incidence of acute radiation esophagitis for non-small-cell lung cancer (NSCLC) patients is not well understood. Specifically, the location of dose along the superior-inferior (SI) axis of the esophagus has not been previously considered. We introduce the concept of mean regional dose (MRD) calculated for esophageal subvolumes, and test for significance for prediction of acute esophagitis (AE).

METHODS

The 3D dose distribution within the esophagus was extracted for 541 NSCLC patients treated with definitive photon therapy. The esophagus contour was divided into equal geometric halves, thirds, and fourths along the SI direction of the structure. MRD in each subvolume was calculated. Univariate logistic regression was performed to determine the correlation between MRD and CTCAE3.0 AE grade = 2 (medical intervention). The MRD was incorporated into an existing NTCP model (based on mean dose for the total esophageal volume) as a separate additive factor.

RESULTS

Univariate analysis indicated a significant correlation between AE grade = 2 and MRD in each of the esophageal subvolumes except for the inferior third and inferior-most quarter. There was a statistically significant improvement when including the additive MRD factor for the superior/inferior halves, superior/inferior thirds, and superior-most/inferior-most quarters into the NTCP model.

CONCLUSIONS

This study investigates previously unexplored regional differences in delivered dose to the esophagus of patients treated for NSCLC. There is evidence to suggest that dose to the superior portions of the esophagus is more important as it relates to the potential for acute toxicity. The 541 patient cohort is the largest database used to investigate AE in patients treated for NSCLC, strengthening the power of the statistical results. Additional methods to incorporate dose in individual esophagus voxels (along the SI axis) into the NTCP model are also being explored.