"The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer

BACKGROUND

Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care.

PROCEDURE

This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy.

RESULTS

Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care.

CONCLUSIONS

AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.

Patient, Family, and Clinician Perspectives on Location of Death for Adolescents and Young Adults With Cancer

PURPOSE

Adolescents and young adults (AYAs) with cancer have high rates of hospital deaths. It is not clear if this reflects their preferences or barriers to dying at home.

METHODS

Between December 2018 and January 2021, we conducted in-depth interviews with AYAs (age 12-39 years) with stage IV or recurrent cancer, family caregivers including bereaved caregivers, and clinicians of AYAs with cancer. Patients were asked about their priorities for care including location of death, caregivers were asked what was most important in the care of their AYA family member, and clinicians were asked to reflect on priorities identified through caring for AYAs. Directed content analysis was applied to interview data, and themes regarding location of death were developed.

RESULTS

Eighty individuals (23 AYAs, 28 caregivers, and 29 clinicians) participated in interviews. Most AYAs and caregivers preferred a home death. However, some AYAs and caregivers opted for a hospital death to alleviate caregiver burden or protect siblings from the perceived trauma of witnessing a home death. Lack of adequate services to manage intractable symptoms at home and insufficient caregiver support led some AYAs/caregivers to opt for hospital death despite a preference for home death. Participants acknowledged the value of hospice while also pointing out its limitations in attaining a home death.

CONCLUSION

Although most AYAs prefer to die at home, this preference is not always achieved. Robust home-based services for effective symptom management and caregiver support are needed to close the gap between preferred and actual location of death for AYAs.

Corrigendum to "Persistent and Toxic Chemical Pollutants in Fish Consumed by Asians in Chicago, United States" [Sci. Total Environ. 811 (2022):152214/ DOI:10.1016/j.scitotenv.2021.152214]

Consumption of seafood brings health benefits but may increase the ingestion of contaminants. Compared with other ethnic groups in the U.S., Asians consume seafood more frequently. However, there is little information about how culturally specific fish consumption contributes to exposure to toxicants. In this work, we surveyed fish consumption among Chinese, Korean and Vietnamese communities and purchased 103 seafood samples from local markets in Chicago. Each sample was analyzed for mercury (Hg) and 92 organic chemicals including polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), and Dechlorane Plus and related compounds (DPs). The rank order of pollutant concentration in all samples was Hg » Σ₆₆PCBs > Σ₁₇OCPs > Σ₈PBDEs > Σ₈DPs. Positive correlations were noted among most contaminant groups. Bluefish, pike, tuna steak, and albacore tuna had the highest mean Hg (>300 ng/g). The mean Σ₆₆PCBs was highest in pike and bluefish (>100 ng/g) followed by pollock and mackerel (>40 ng/g). Overall, octopus, shrimp and tilapia were the least contaminated; while pike, bluefish, and pollock were the most contaminated. Omega-3 fatty acids were more strongly affiliated with the organic contaminants than mercury. A risk assessment identified seven types of fish that should have consumption limitations and six that should not be consumed. For these seafoods, consumption advice based on Hg levels would adequately protect health, except for mackerel. In the survey participants, 10.3% of seafood mass consumed is from types of fish that should be limited to 1 or 2 meals/week, while 1.3% of the seafood mass consumed comes from types that should not be consumed at all. This work adds additional contaminants to the profile of health risks resulting from fish consumption among Asian Americans, which can be used in interventions aimed at conserving consumption of healthy fish while avoiding contaminants.

Persistent and toxic chemical pollutants in fish consumed by Asians in Chicago, United States

Consumption of seafood brings health benefits but may increase the ingestion of contaminants. Compared with other ethnic groups in the U.S., Asians consume seafood more frequently. However, there is little information about how culturally specific fish consumption contributes to exposure to toxicants. In this work, we surveyed fish consumption among Chinese, Korean and Vietnamese communities and purchased 103 seafood samples from local markets in Chicago. Each sample was analyzed for mercury (Hg) and 92 organic chemicals including polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), and Dechlorane Plus and related compounds (DPs). The rank order of pollutant concentration in all samples was Hg ≫ Σ₆₆PCBs > Σ₁₇OCPs > Σ₈PBDEs > Σ₈DPs. Positive correlations were noted among most contaminant groups. Bluefish, pike and tuna steak had the highest mean Hg (>1 mg/kg). The mean Σ₆₆PCBs was highest in pike and bluefish (>100 ng/g) followed by pollock and mackerel (>40 ng/g). Overall, octopus, shrimp and tilapia were the least contaminated; while pike, bluefish, and pollock were the most contaminated. Omega-3 fatty acids were more strongly affiliated with the organic contaminants than mercury. A risk assessment identified seven types of fish that should have consumption limitations and six that should not be consumed. For these seafoods, consumption advice based on Hg levels would adequately protect health. In the survey participants, 17% of seafood mass consumed is from types of fish that should be limited to 1 or 2 meals/week, while 7% of the seafood mass consumed comes from types that should not be consumed at all. This work adds additional contaminants to the profile of health risks resulting from fish consumption among Asian Americans, which can be used in interventions aimed at conserving consumption of healthy fish while avoiding contaminants.

Patient, Family, and Clinician Perspectives on End-of-Life Care Quality Domains and Candidate Indicators for Adolescents and Young Adults With Cancer

IMPORTANCE

End-of-life care quality indicators specific to adolescents and young adults (AYAs) aged 12 to 39 years with cancer have not been developed.

OBJECTIVE

To identify priority domains for end-of-life care from the perspectives of AYAs, family caregivers, and clinicians, and to propose candidate quality indicators reflecting priorities.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study was conducted from December 6, 2018, to January 5, 2021, with no additional follow-up. In-depth interviews were conducted with patients, family caregivers, and clinicians and included a content analysis of resulting transcripts. A multidisciplinary advisory group translated priorities into proposed quality indicators. Interviews were conducted at the Dana-Farber Cancer Institute, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and an AYA cancer support community (lacunaloft.org). Participants included 23 AYAs, 28 caregivers, and 29 clinicians.

EXPOSURE

Stage IV or recurrent cancer.

MAIN OUTCOMES AND MEASURES

Care priorities.

RESULTS

Interviews were conducted with 23 patients (mean [SD] age, 29.3 [7.3] years; 12 men [52%]; 18 White participants [78%]), 28 family caregivers (23 women [82%]; 14 White participants [50%]), and 29 clinicians (20 women [69%]; 13 White participants [45%]). Caregivers included 22 parents (79%), 5 spouses or partners (18%), and 1 other family member (4%); the 29 clinicians included 15 physicians (52%), 6 nurses or nurse practitioners (21%), and 8 social workers or psychologists (28%). Interviews identified 7 end-of-life priority domains: attention to physical symptoms, attention to quality of life, psychosocial and spiritual care, communication and decision-making, relationships with clinicians, care and treatment, and independence. Themes were consistent across the AYA age range and participant type. Although some domains were represented in quality indicators developed for adults, unique domains were identified, as well as AYA-specific manifestations of existing domains. For example, quality of life included global quality of life; attainment of life goals, legacy, and meaning; support of personal relationships; and normalcy. Within communication and decision-making, domains included communication early in the disease course, addressing prognosis and what to expect at the end of life, and opportunity for AYAs to hold desired roles in decision-making. Care and treatment domains relevant to cancer therapy, use of life-prolonging measures, and location of death emphasized the need for preference sensitivity rather than a standard path. This finding differs from existing adult indicators that propose that late-life chemotherapy, intensive measures, and hospital death should be rare.

CONCLUSIONS AND RELEVANCE

The findings of this qualitative study suggest that AYAs with cancer have priorities for care at the end of life that are not fully encompassed in existing indicators for adults. Use of new indicators for this young population may better reflect patient- and family-centered experiences of quality care.

Levels of Ethylene Oxide Biomarker in an Exposed Residential Community

The purpose of this study was to examine whether there is a difference in ethylene oxide (EtO) biomarker levels based on residential proximity to facilities emitting EtO, a carcinogen. We recruited residents living near two EtO-emitting facilities and administered a questionnaire on items such as address and length of residency, smoking habits, occupational exposures to EtO, and demographics. We also collected venous blood samples to measure an EtO biomarker, hemoglobin adduct N-2-hydroxyethyl-valine (HbEO), and cotinine, a metabolite of nicotine. Questionnaires and blood samples were collected from 93 participants. The overall geometric HbEO adduct level was 35.0 pmol/gmHb and for nonsmokers it was 29.7 pmol/gmHb. Mean HbEO adduct levels were not significantly associated with sex, age, race, BMI, or education level. HbEO adduct levels for nonsmoking participants who lived in a neighborhood approximately 0.8 km from one of the facilities were significantly higher compared to persons living farther away (p < 0.001). These results suggest that facilities that emit EtO may put nearby communities at risk of cancer and other associated health outcomes.

Exposure characteristics for congeners, isomers, and enantiomers of perfluoroalkyl substances in mothers and infants

Per- and polyfluoroalkyl substances (PFASs) are ubiquitous in the environment, making it inevitable for humans to be exposed to these pollutants. The exposure begins while in utero and continues in infancy, during the potentially most sensitive early stages of life. This review summarizes the current knowledge on pre- and neo-natal exposures based on more than 200 articles published from 2000 to date. All relevant biological matrices used in the cited studies were included, such as maternal blood, umbilical cord blood, breast milk, placenta, amniotic fluid, fetal organs, newborns' dried blood spots, and infant serum. We show that such exposures are geographically global with significant discrepancies among countries and continents, and that while the levels of major legacy PFASs (PFOS and PFOA) have declined since 2000, those of others may have not. We also show that levels of PFOS and PFOA exceed those of some major environmental toxins, such as p,p'-DDE, BDE-47, PCB-153, PBB-153, and OH-PBDEs in maternal blood. Given that the behavior and potential effects have an origin in molecular structure, biomonitoring and research at the levels of isomers and enantiomers are critically important. Through critical analysis of these works, we summarize the major achievements, consensus, and the deficiencies of existing research. To our knowledge, this is the first review on the overall internal exposure status of mothers and infants to PFASs during pregnancy and lactation.

Geospatial epidemiology of Staphylococcus aureus in a tropical setting: an enabling digital surveillance platform

Delivery of information to clinicians on evolving antimicrobial susceptibility needs to be accurate for the local needs, up-to-date and readily available at point of care. In northern Australia, bacterial infection rates are high but resistance to first- and second-line antibiotics is poorly described and currently-available datasets exclude primary healthcare data. We aimed to develop an online geospatial and interactive platform for aggregating, analysing and disseminating data on regional bacterial pathogen susceptibility. We report the epidemiology of Staphylococcus aureus as an example of the power of digital platforms to tackle the growing spread of antimicrobial resistance in a high-burden, geographically-sparse region and beyond. We developed an online geospatial platform called HOTspots that visualises antimicrobial susceptibility patterns and temporal trends. Data on clinically-important bacteria and their antibiotic susceptibility profiles were sought from retrospectively identified clinical specimens submitted to three participating pathology providers (96 unique tertiary and primary healthcare centres, n = 1,006,238 tests) between January 2008 and December 2017. Here we present data on S. aureus only. Data were available on specimen type, date and location of collection. Regions from the Australian Bureau of Statistics were used to provide spatial localisation. The online platform provides an engaging visual representation of spatial heterogeneity, demonstrating striking geographical variation in S. aureus susceptibility across northern Australia. Methicillin resistance rates vary from 46% in the west to 26% in the east. Plots generated by the platform show temporal trends in proportions of S. aureus resistant to methicillin and other antimicrobials across the three jurisdictions of northern Australia. A quarter of all, and up to 35% of methicillin-resistant S. aureus (MRSA) blood isolates in parts of the northern Australia were resistant to inducible-clindamycin. Clindamycin resistance rates in MRSA are worryingly high in regions of northern Australia and are a local impediment to empirical use of this agent for community MRSA. Visualising routinely collected laboratory data with digital platforms, allows clinicians, public health physicians and guideline developers to monitor and respond to antimicrobial resistance in a timely manner. Deployment of this platform into clinical practice supports national and global efforts to innovate traditional disease surveillance systems with the use of digital technology and to provide practical solutions to reducing the threat of antimicrobial resistance.

Association of methylmercury intake from seafood consumption and blood mercury level among the Asian and Non-Asian populations in the United States

BACKGROUND

MeHg is a well-established neurotoxicant for fetal brain growth and development and has been shown to increase the risk of cardiovascular disease in aging populations. In the U.S., Asian populations are of particular concern because of their seafood consumption behaviors.

OBJECTIVES

Our objective was to calculate the average daily MeHg intake (ADMI) from seafood and to assess the relationship between ADMI with blood methylmercury (BMeHg) concentrations, specifically among women of reproductive age (WORA) and adults ≥ 50 years of age.

METHODS

We estimated ADMI from seafood using the 30-day fish consumption data from the NHANES 2011-2014 datasets. Using multivariable linear regression, we estimated the proportional change in mean BMeHg associated with a doubling of the ADMI. Further, correlations between ADMI and BMeHg were compared between Asians and other racial/ethnic groups.

RESULTS

Our analysis found both Asian WORA and Asian adults age ≥ 50 years old had significantly higher BMeHg levels and ADMI than their Non-Asian counterparts. Correlations between ADMI from seafood and blood Hg levels were stronger among Asian WORA than among Non-Asian WORA. Key fish species that influenced the dietary MeHg intake for Asians were mackerel, tuna, and "other known/unknown fish species".

CONCLUSION

We confirmed that Asian populations have higher MeHg intake than the Non-Asian population in the U.S. and seafood intake is a key predictor of blood Hg concentration, especially among Asian women of reproductive age. Future studies should incorporate information on other known and unknown fish species that are frequently consumed by Asian populations and different parts and fish organs eaten to better understand determinants of MeHg exposure.

Tyrosine Kinase Inhibitors for the Treatment of Chronic-Phase Chronic Myeloid Leukemia: Long-Term Patient Care and Management

Several tyrosine kinase inhibitors (TKIs) are now approved for the treatment of chronic myeloid leukemia in chronic phase. The efficacy of these drugs has been repeatedly demonstrated, as has their tolerability in most patients. However, late and chronic toxicities become an important issue for many patients facing long-term TKI exposure. For patients on long-term imatinib, gastrointestinal events, fluid retention, muscle cramps, fatigue, and hepatotoxicity are among the most common and most clinically relevant adverse events (AEs). A few of these have also emerged as important AEs with some of the newer TKIs. Distinct long-term toxicity concerns have emerged for dasatinib (pleural effusion, pulmonary hypertension, headache, and dyspnea) and nilotinib (rash, headache, myalgia, alopecia, and hyperglycemia), whereas due to the recent approval of bosutinib and ponatinib, their long-term toxicity profiles have not been fully characterized. Clinical experience with each of these drugs is accumulating, and ensuring proper adherence and monitoring for potential AEs is essential for effective treatment.

Methyl mercury exposure in populations at risk: Analysis of NHANES 2011-2012

BACKGROUND

Ingestion of fish contaminated with methyl mercury can lead to adverse health outcomes, particularly when exposure occurs in utero. NHANES 2011-2012 includes total blood mercury (TBHg) and methyl mercury (MeHg) measurements as well as a unique race/ethnicity category for Asians, allowing for improved analysis of determinants of risk.

OBJECTIVE

Our objective was to characterize the current burden of MeHg exposure in the US among subgroups who are at risk of health effects due to their physiologic vulnerability to MeHg's effects and/or due to frequent fish consumption, specifically women of childbearing age (WCBA) and adults ≥50 years of age.

METHODS

We calculated 90th and 95th percentile estimates as well as geometric means of MeHg for predictive variables. We used multivariable linear regression analyses to estimate the proportional change in mean MeHg associated with each category of all predictive variables. We calculated the validity of screening procedures using fish consumption questions and TBHg testing to predict elevated MeHg.

RESULTS

The geometric mean MeHg levels were highest among Asian WCBA (1.17 µg/L) and Asians ≥50 years old (2.49 µg/L). Over 23% of Asian WCBA had levels ≥3.5 µg/L and 25% of Asians ≥50 years old had levels ≥5.8 µg/L. Frequency of fish consumption explained 21-23% of the variation in MeHg. Twenty-five percent of women eating fish ≥ twice per week had MeHg ≥3.5 µg/L. TBHg showed high validity for MeHg ≥5.8 µg/L, and two-step screening using ≥2 fish meals/month followed by TBHg also showed high validity.

CONCLUSION

Asian WCBA continue to have increased MeHg exposure from fish consumption, putting their offspring at risk. Screening for MeHg among high-risk groups should be considered.

The role of BamA in the biogenesis of beta-barrel membrane proteins

Beta-barrel membrane proteins are essential for nutrient import, signaling, motility, and survival. In Gram-negative bacteria, the beta-barrel assembly machinery (BAM) complex is responsible for the biogenesis of beta-barrel outer membrane proteins (OMPs), with homologous complexes found in mitochondria and chloroplasts. Despite their essential roles, exactly how these OMPs are formed remains unknown. The BAM complex consists of a central and essential component called BamA (an OMP itself) and four lipoproteins called BamB-E. While the structure of the lipoproteins have been reported, the structure of full length BamA has been elusive. Recently though, we described the structure of BamA from two species of bacteria: Neisseria gonorrhoeae and Haemophilus ducreyi. BamA consists of a large periplasmic domain attached to a 16-strand transmembrane beta-barrel domain. Together, our crystal structures and molecule dynamics (MD) simulations revealed several structural features which gave clues to the mechanism by which BamA catalyzes beta-barrel assembly. The first is that the interior cavity is accessible in one BamA structure and conformationally closed in the other. Second, an exterior rim of the beta-barrel has a distinctly narrowed hydrophobic surface, locally destabilizing the outer membrane. Third, the beta-barrel can undergo lateral opening, suggesting a route from the interior cavity in BamA into the outer membrane. And fourth, a surface exposed exit pore positioned above the lateral opening site which may play a role in the biogenesis of extracellular loops. In this presentation, the crystal structures and MD simulations of BamA will be presented along with our work looking at the role of these four structural features in the role of BamA within the BAM complex.

Guide to interpreting disease responses in chronic myeloid leukemia

With the introduction of tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia, the course of the disease has been altered from an acute, rapidly progressive terminal disorder to a serious condition with high remission rates when patients are compliant with long-term treatment. The goal of therapy is to prevent transformation to the accelerated or blast crisis phases, which are associated with poor survival. Knowledge of the appropriate monitoring tests and treatment milestones, as well as the ability to interpret responses, allows advanced practitioners (APs) to effectively communicate key aspects of management to their patients. Monitoring patient responses to TKIs and identifying suboptimal responses early on offer APs the opportunity to reevaluate and adjust therapeutic treatment options. One of the causes of treatment failure is noncompliance; thus, educating patients on the importance of adhering to treatment and identifying reasons for noncompliance are of major importance. Because intolerance to TKIs may lead to discontinuation, frequent monitoring of side effects and response to treatment, open communication, patient education, and careful management are all essential in helping patients remain compliant with therapy. This review discusses the AP's role in helping patients achieve their best response to TKI therapy and optimize their long-term outcomes.

Environmental exposures: how to counsel preconception and prenatal patients in the clinical setting

A growing body of scientific evidence suggests that preconception and prenatal exposures can impact fetal development adversely and lead to potential long-lasting health effects. Reproductive health professionals have little training on these exposures and how to counsel patients effectively. We present short summaries of some of the most common environmental exposures and give providers practical tools with which to counsel patients in the clinical setting. These tools may enable practitioners to help prevent harmful environmental exposures and to reduce the risk of future adverse health impacts for the prenatal and preconception patient population.

Piloting a personal protection equipment distribution program among Chicago day laborers

BACKGROUND

Occupational injury rates among day laborers have been estimated to be as high as 31%, where lack of personal protective equipment (PPE) use is repeatedly noted as a contributor to occupational injuries.

METHODS

We distributed duffel bags containing nine pieces of PPE and provided training on their use to Chicago day laborers during six distribution sessions over two summers. Participants were contacted 4-8 weeks post-distribution and queried on PPE use.

RESULTS

Of 117 participants who received the equipment, 42 completed the follow-up survey. Workers performed construction, demolition, and painting type tasks and most often used gloves, safety glasses, and respirators. Hardhats, coveralls, and earplugs were the least used.

CONCLUSIONS

The PPE we provided was used during 94% of the jobs, and every one of the nine items was used. Hearing protection was underused. This project showed that providing PPE, along with training on its use, may increase PPE use among Chicago day laborers, likely preventing occupational injuries.

A combined ecological and epidemiologic investigation of metal exposures amongst Indigenous peoples near the Marlin Mine in Western Guatemala

In August 2009 a combined epidemiological and ecological pilot study was conducted to investigate allegations of human rights abuses in the form of exposures to toxic metals experienced by mine workers and Indigenous Mam Mayan near the Marlin Mine in Guatemala. In the human study there were no differences in blood and urine metals when comparing five mine workers with eighteen non-mine workers, and there were no discernible relationships between metal exposures and self-reported health measures in any study group. On the other hand, individuals residing closest to the mine had significantly higher levels of certain metals (urinary mercury, copper, arsenic, and zinc) when compared to those living further away. The levels of blood aluminum, manganese, and cobalt were elevated in comparison to established normal ranges in many individuals; however, there was no apparent relationship to proximity to the mine or occupation, and thus are of unclear significance. In the ecological study, several metals (aluminum, manganese, and cobalt) were found significantly elevated in the river water and sediment sites directly below the mine when compared to sites elsewhere. When the human and ecological results are combined, they suggest that exposures to certain metals may be elevated in sites near the mine but it is not clear if the current magnitude of these elevations poses a significant threat to health. The authors conclude that more robust studies are needed while parallel efforts to minimize the ecological and human impacts of mining proceed. This is critical particularly as the impact of the exposures found could be greatly magnified by expected increases in mining activity over time, synergistic toxicity between metals, and susceptibility for the young and those with pre-existing disease.

Alternatives to the mercury sphygmomanometer

The mercury sphygmomanometer was introduced over 100 years ago. Mercury, however, is a potent human neurotoxin. An international effort has developed to eliminate health-care sources of mercury--the thermometer and sphygmomanometer--and replace them with less toxic alternatives. There is concern regarding the accuracy of these alternative devices. We conducted a literature review of articles published between 1995 and 2009 evaluating the accuracy of mercury, aneroid, and oscillometric blood pressure devices. Mercury sphygmomanometers fared the best although they do not always perform as expected, failing calibration tests between 1 and 28 per cent of the time. Up to 61 per cent of aneroid sphygmomanometers failed. Recently calibrated aneroid devices performed well. Oscillometric devices were less studied and their performance was variable. All three devices showed variable performance. They should be validated before purchase and calibrated on a regular basis.

Occupational injury disparities in the US hotel industry

BACKGROUND

Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers.

METHOD

OSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern.

RESULTS

A total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk.

CONCLUSION

Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed.

Toxins in everyday life

This article reviews the sources of exposure and health effects of common toxicants encountered by patients in primary care practice. The recognition and management of exposure to indoor and outdoor pollutants, heavy metals, pesticides, electromagnetic fields, and endocrine-disrupting chemicals are listed. A sample environmental history form is included.

Mapping water table depth using geophysical and environmental variables

Despite its importance, accurate representation of the spatial distribution of water table depth remains one of the greatest deficiencies in many hydrological investigations. Historically, both inverse distance weighting (IDW) and ordinary kriging (OK) have been used to interpolate depths. These methods, however, have major limitations: namely they require large numbers of measurements to represent the spatial variability of water table depth and they do not represent the variation between measurement points. We address this issue by assessing the benefits of using stepwise multiple linear regression (MLR) with three different ancillary data sets to predict the water table depth at 100-m intervals. The ancillary data sets used are Electromagnetic (EM34 and EM38), gamma radiometric: potassium (K), uranium (eU), thorium (eTh), total count (TC), and morphometric data. Results show that MLR offers significant precision and accuracy benefits over OK and IDW. Inclusion of the morphometric data set yielded the greatest (16%) improvement in prediction accuracy compared with IDW, followed by the electromagnetic data set (5%). Use of the gamma radiometric data set showed no improvement. The greatest improvement, however, resulted when all data sets were combined (37% increase in prediction accuracy over IDW). Significantly, however, the use of MLR also allows for prediction in variations in water table depth between measurement points, which is crucial for land management.

Functional neuroimaging with MEG: normative language profiles

The reliability of language-specific brain activation profiles was assessed using Magnetoencephalography (MEG) in five experiments involving ninety-seven normal volunteers of both genders ranging in age from seven to eighty-four years. MEG data were analyzed with a fully automated method to eliminate subjective judgments in the process of deriving the activation profiles. Across all experiments, profiles were characterized by significant bilateral activity centered in the superior temporal gyrus, and in activity lateralized to the left middle temporal gyrus. These features were invariant across age, gender, variation in task characteristics, and mode of stimulus presentation. The absolute amount of activation, however, did decline with age in the auditory tasks. Moreover, contrary to the commonly held belief that left hemisphere dominance for language is greater in men than in women, our data revealed an opposite albeit a not consistently significant trend.

Use of a national reporting system for occupational injuries in Costa Rica

Occupational injury surveillance in developing countries may be hindered by the lack of health data infrastructure as well the large numbers of informal-sector workers. The goal of this study was to elucidate the scope of occupational injury in the Monteverde district of Costa Rica using data collected through the national workers social security system. A list of occupational injuries occurring in the district reported to the National Insurance Institute (INS) central office between 1998 and 2002 was taken to the regional INS office, and the original injury reports for the cases were pulled. Specific data on the injuries were collected. There were 184 injuries reported during the five year period. Occupations with the highest number of injuries included production, building and grounds maintenance, and agricultural/forestry/fishing. Descriptive data showed that prevention efforts in this rural region should target food manufacturing, hotels, and construction.

Day labor and occupational health: time to take a closer look

The term "day labor" refers to work performed by individuals who are hired on a temporary basis, often for one day at a time. This type of employment has increased in North America as informal work arrangements and immigration have increased. Research on the occupational health of day laborers is minimal. The objectives of this article are to review the current literature pertaining to occupational health in day laborers, and to characterize the issues that affect this population's access to occupational health services. Surveys of day laborers and other immigrant, low-wage workers show that they are at elevated risk for occupational injury and are often unable to access medical care when injured on the job. Reasons include workers' reluctance to complain about unsafe work conditions, inadequate safety training, and lack of incentive for employers to reduce workplace injuries. More research is needed to better characterize the occupational health of this population.

The psychosocial aspects of donating blood stem cells: the sibling donor perspective

The collection of peripheral blood progenitor cells (PBPC) by apheresis has become common in related allogeneic donors. However, the acceptability of the procedure to donors has not been documented. The purpose of this baseline case series study was to evaluate the psycho-social dimensions of apheresis from the perspective of healthy sibling donors and to explore issues surrounding fully informed consent including voluntary donation. At the first interview to discuss donation, 17 consecutive human leucocyte antigens (HLA) identical sibling donors who chose to donate PBPC were recruited to the study. They then completed both scales of the State-Trait Anxiety Inventory. The state scale was completed again immediately before first apheresis. At the end of the final apheresis, the donors were interviewed again by an independent researcher using a standardised questionnaire. All aspects of the procedure were well tolerated, including levels of anxiety and pain. Donors donated even if the relationship with their sibling was poor. However, some areas for improvement were highlighted. Eight (47%) donors were asked to donate by their sibling or another close relative, and this gave them no real volunteer status. Written information was judged important by 11 (65%) donors, but the material used was limited. The possibility of a poor outcome for the recipient was not well understood. The content of the written documentation and the management of confidentiality in terms of donor volunteer status needed to be addressed. A further study regarding the follow-up needs of donors, including those where the outcome is poor, is underway.

Comparative changes in plasma concentrations of progesterone, oestradiol and LH during the ovulatory cycle in a multiple ovulating male line and a single ovulating traditional line of turkeys

The aim of this study was to compare the profile of circulating concentrations of LH, progesterone and oestradiol in a multiple ovulating male line with that of a single ovulating line of traditional turkeys. Plasma samples from seven traditional and 12 male-line turkeys were obtained every 3 h for 36 h. Male-line and traditional turkeys had single peaks of LH and progesterone that were of similar duration in both lines. The mean height of the plasma peaks of LH and progesterone were similar in the two lines and there was no detectable peak plasma oestrogen concentration. Mean plasma concentrations of LH and oestrogen were higher in single compared with multiple ovulating turkeys, whereas there were no differences in mean plasma progesterone concentrations. The results indicate that the multiple ovulation state in genetically selected high-growth lines of turkey may be the result of a correlated response in the steroidogenic capacity of ovarian tissue associated with low plasma concentrations of oestrogen rather than of a disturbance in the hormone profile of the ovulatory cycle.

Comparative changes in plasma concentrations of progesterone, oestradiol and LH during the ovulatory cycle in a multiple ovulating male line and a single ovulating traditional line of turkeys

The aim of this study was to compare the profile of circulating concentrations of LH, progesterone and oestradiol in a multiple ovulating male line with that of a single ovulating line of traditional turkeys. Plasma samples from seven traditional and 12 male-line turkeys were obtained every 3 h for 36 h. Male-line and traditional turkeys had single peaks of LH and progesterone that were of similar duration in both lines. The mean height of the plasma peaks of LH and progesterone were similar in the two lines and there was no detectable peak plasma oestrogen concentration. Mean plasma concentrations of LH and oestrogen were higher in single compared with multiple ovulating turkeys, whereas there were no differences in mean plasma progesterone concentrations. The results indicate that the multiple ovulation state in genetically selected high-growth lines of turkey may be the result of a correlated response in the steroidogenic capacity of ovarian tissue associated with low plasma concentrations of oestrogen rather than of a disturbance in the hormone profile of the ovulatory cycle.

Sequestration and phosphorylation of the prostaglandin E2 EP4 receptor: dependence on the C-terminal tail

The prostaglandin E2 (PGE2) EP4 subtype is one of four prostanoid receptors that use PGE2 as the preferred ligand. We have investigated the agonist-mediated regulation of EP4 using a multifaceted approach. Short-term (30 min) agonist challenge of recombinant EP4 expressed in human embryonic kidney 293 cells (EP4-HEK293 cells) with PGE2 (1 microM) resulted in the desensitization of intracellular cyclic AMP (cAMP) accumulation and a reduction in cell surface [3H]PGE2 specific binding sites. These events correlated with sequestration of EP4, as visualized by immunofluorescence confocal microscopy and phosphorylation, as shown by [32P]orthophosphate labeling of the receptor. Stimulation of protein kinase A activity in EP4-HEK293 cells (10 microM forskolin or 1 mM 8-bromo-cAMP) did not induce EP4 desensitization, sequestration, or phosphorylation. In contrast, stimulation of protein kinase C activity (100 nM phorbol 12-myristate 13-acetate) attenuated PGE2-induced adenylyl cyclase activity and increased EP4 phosphorylation, but did not induce sequestration or a reduction in [3H]PGE2 specific binding sites. EP4 receptors containing a third intracellular loop deletion [EP4 (del. 215-263)] or a carboxyl-terminal tail truncation [EP4 (del. 355)] of EP4 were used to demonstrate that the C-terminal tail governs sequestration as well as phosphorylation of the receptor.

Prospective randomised concurrent comparison of the COBE spectra version 4.7, COBE spectra version 6 (Auto PBSCtrade mark), and haemonetics MCS+ cell separators for leucapheresis in patients with haematological and non haematological malignancies

A prospective study of three cell separators was undertaken to compare the mononuclear cell, CD34+ cell and CFU-GM yield. Twenty patients were entered in the study; all had received chemotherapy and daily G-CSF (5 microg/kg subcutaneously) up to and including the first day of leucapheresis. The first leucapheresis was performed on the first day the peripheral blood absolute CD34+ cell count was > or =20 cells/microl. All patients underwent two leucaphereses on consecutive days. The patients were randomised to undergo either the first or second leucapheresis using the COBE Spectra Version 4.7 and then randomised to either the COBE Spectra Version 6 or Haemonetics MCS+ for the other leucapheresis. The target durations of the procedure on the COBE Spectra Version 4.7 and Version 6 were 180 minutes or 2 total blood volumes (TBV), and for the Haemonetics MCS+ was 20 cycles with four recirculations. All machines were operated on the 1997 software supplied by the respective manufacturers. The time taken for the procedure was significantly longer with both the Haemonetics MCS+ and the COBE Spectra Version 6 than the COBE Spectra Version 4.7. Both COBE Spectra versions processed significantly larger volumes of blood than the Haemonetics MCS+. The absolute yield of mononuclear cells, CFU-GM and CD34+ cells were all significantly lower with the Haemonetics MCS+ compared with both COBE Spectra versions, as were the yields per unit volume of blood processed. The product volume was significantly higher with the COBE Spectra Version 4.7 compared to the other two machines. There was no significant difference in the reduction in the platelet count following leucapheresis with any of the machines. The COBE Spectra Version 6 is particularly useful for patients with potentially poor peripheral venous access because of its increased interface stability.

Ovarian steroid hormone production in a multiple ovulating male line and a single ovulating traditional line of turkeys

Ovarian production of oestradiol and progesterone was investigated in a single ovulating traditional line and a multiple ovulating male line of turkeys. The oestradiol output from small follicles in response to LH stimulation and the aromatase activity of the residual ovary were also compared. The multiple hierarchy of follicles in the male line was shown to consist of a series of follicles of a similar size and stage of physiological maturation. The follicles of the traditional line produced significantly greater quantities of oestradiol than those of the male line. Impaired oestradiol production may have resulted in the lower plasma oestradiol concentration observed in the male line. There was no difference in follicular progesterone output between the traditional-line and male-line turkeys. The oestradiol output of whole small white follicles in response to LH stimulation was similar in the two lines and the depressed steroidogenesis of the male line was not changed. The aromatase activity of the small follicles was also lower in the male line, and there was no evidence that the male line ovary produced oestradiol in quantities proportional to its size. The results demonstrated that the hierarchy of follicles in the male line consisted of groups of follicles of similar mass and hormone output and indicated that selection for increased meat yield may have resulted in reduced ovarian steroidogenesis in male-line turkeys, in comparison with traditional, unselected turkeys.

Ovarian steroid hormone production in a multiple ovulating male line and a single ovulating traditional line of turkeys

Ovarian production of oestradiol and progesterone was investigated in a single ovulating traditional line and a multiple ovulating male line of turkeys. The oestradiol output from small follicles in response to LH stimulation and the aromatase activity of the residual ovary were also compared. The multiple hierarchy of follicles in the male line was shown to consist of a series of follicles of a similar size and stage of physiological maturation. The follicles of the traditional line produced significantly greater quantities of oestradiol than those of the male line. Impaired oestradiol production may have resulted in the lower plasma oestradiol concentration observed in the male line. There was no difference in follicular progesterone output between the traditional-line and male-line turkeys. The oestradiol output of whole small white follicles in response to LH stimulation was similar in the two lines and the depressed steroidogenesis of the male line was not changed. The aromatase activity of the small follicles was also lower in the male line, and there was no evidence that the male line ovary produced oestradiol in quantities proportional to its size. The results demonstrated that the hierarchy of follicles in the male line consisted of groups of follicles of similar mass and hormone output and indicated that selection for increased meat yield may have resulted in reduced ovarian steroidogenesis in male-line turkeys, in comparison with traditional, unselected turkeys.