Pneumopericardium after peritoneopericardial diaphragmatic hernia repair in a dog

A one-year-old neutered Goldendoodle presented for evaluation. One week prior to presentation, surgical closure of a peritoneopericardial diaphragmatic hernia (PPDH) was performed via ventral midline celiotomy. Since the procedure, the dog had been lethargic and anorexic at home. Thoracic radiographs revealed a pneumopericardium. Pericardiocentesis was performed which evacuated approximately 100 mL of air from the pericardial sac. The dog recovered well and began eating in the hospital and resumed normal activity. This is the first reported case of a pneumopericardium post-PPDH repair requiring pericardiocentesis. Clinicians should be aware of this rare complication in postoperative PPDH patients.

Characterizing the Health and Safety Concerns of U.S. Rideshare Drivers: A Qualitative Pilot Study

BACKGROUND

Despite the growth and popularity of gig work, limited information exists about the occupational health and safety concerns faced by individuals who are employed through ridesharing online applications. In this qualitative study, we characterized the perceived health and safety concerns of drivers employed by rideshare companies.

METHODS

During September-October 2019, we requested car rides, using digital rideshare platforms. During the ride, drivers responded verbally to a brief closed-end sociodemographic and work characteristics survey. A semi-structured interview script was used to collect rideshare driver perceptions on health and safety risks.

FINDINGS

A total of 35 rideshare drivers of group mean age of 43.1 ± 11.2 years were interviewed, of whom 77.1% were male and 82.9% identified as Latino. Sixty percent of participants reported rideshare as their primary job, working an average of 47.9 ± 19.6 hours weekly (minimum = 6 hours, maximum = 84 hours). Drivers enjoyed job autonomy yet faced stressors such as passenger risky behavior, car accidents, and lack of policies that protect the driver. Rideshare drivers also raised concerns about their current health status, economic pressures, and worker safety.

CONCLUSION/APPLICATION TO PRACTICE

Drivers are forced to extend work hours to support themselves financially, exacerbating their current health concerns and safety risks as it means more time spent working in their sedentary job, compromising their mental and physical health as well as their safety. Occupational health and safety programs geared toward workers in the gig economy are needed.

Evaluation of owner medication adherence for canine cardiovascular disease in the referral setting

OBJECTIVE

To evaluate owners' medication adherence for management of cardiovascular disease in the small animal specialty setting.

ANIMALS, MATERIALS, AND METHODS

A questionnaire-based study of owners at a single, multispecialty, small animal referral center was conducted. Owners completed a written survey evaluating demographics, degree of medication adherence, and difficulties encountered for medication adherence. Owners were free to decline participation in the study.

RESULTS

Ninety-six questionnaires were completed during the study period. Fifty-four respondents (56.3%) reported treating their pet for over one year for cardiovascular disease, and myxomatous mitral valve disease was the most common diagnosis (76.0%). Twenty-nine (30.2%) respondents felt they could consistently administer a maximum of three medications daily, and 46 (47.9%) respondents reported twice-daily dosing was the highest frequency of administration that could be consistently achieved. Twenty-two respondents (22.9%) reported that their pet required daily medications for at least one other chronic condition besides cardiac disease. Seventeen respondents (17.7%) reported at least occasionally missing medications, although only one (1.0%) reported it was more than 20% of medications per week.

CONCLUSIONS

Medication adherence was high in this study population. Almost one-half of owners surveyed reported being unable to consistently administer more than three medications daily, and approximately one-quarter of patients were treated for at least one additional chronic condition requiring daily medications, in addition to cardiac disease. Clinicians should be aware of these factors when determining optimal treatment protocols for the management of cardiovascular disease in dogs.

Assessment of organizational readiness for participatory occupational safety, health and well-being programs

BACKGROUND

Organizational readiness for change measures were reviewed to develop an assessment tool for guiding implementation of an occupational safety and health program based on Total Worker Health (TWH) principles. Considerable conceptual ambiguity in the theoretical and empirical peer-reviewed literature was revealed.

OBJECTIVE

Develop and validate an assessment tool that organizations can use to prepare for implementation of a participatory TWH program.

METHODS

Inclusion criteria identified 29 relevant publications. Analysis revealed eight key organizational characteristics and predictors of successful organizational change. A conceptual framework was created that subject matter experts used to generate prospective survey items. Items were revised after pretesting with 10 cognitive interviews with upper-level management and pilot-tested in five healthcare organizations. Reliability of the domain subscales were tested based on Cronbach's α.

RESULTS

The Organizational Readiness Tool (ORT) showed adequate psychometric properties and specificity in these eight domains: 1) Current safety/health/well-being programs; 2) Current organizational approaches to safety/health/well-being; 3) Resources available for safety/health/well-being; 4) Resources and readiness for change initiatives to improve safety/health/well-being; 5) Resources and readiness for use of teams in programmatic initiatives; 6) Teamwork; 7) Resources and readiness for employee participation; and 8) Management communication about safety/health/well-being. Acceptable ranges of internal consistency statistics for the domain subscales were observed.

CONCLUSIONS

A conceptual model of organizational readiness for change guided development of the Organizational Readiness Tool (ORT), a survey instrument designed to provide actionable guidance for implementing a participatory TWH program. Initial internal consistency was demonstrated following administration at multiple organizations prior to implementation of a participatory Total Worker Health® program.

Evaluation of owners' attitudes towards veterinary insurance in a specialty hospital

OBJECTIVES

The purpose of this study was to investigate the frequency and perception of veterinary insurance among owners' at a small animal specialty hospital around a large urban city.

MATERIALS AND METHODS

A questionnaire evaluated the prevalence and perception of insurance among owners at a small animal specialty hospital over a 2 month period. Respondents provided demographic information including age, sex, educational level and household income. Respondents without insurance were asked reasons for not having insurance, approximate cost of insurance per month desired and percentage of coverage of medical expenses they would want insurance to provide. Respondents with insurance were asked how they chose their current plan, how it affects their medical decisions for their pet and their overall satisfaction.

RESULTS

Sixty-seven (28.5%) owners reporting having insurance for at least one pet. Owners most commonly selected their current insurance plan based on online research (27, 40.3%). Fifty-two respondents (77.6%) reported being satisfied with their insurance plan and 49 (73.2%) stated that would recommend their current insurance plan to a friend.

CLINICAL SIGNIFICANCE

Insurance had a relatively high prevalence in this study group with most owners being satisfied with their current plan and would be likely to recommend it to a friend. The role of insurance in how it affects owner's medical decisions, care for their pet and interactions with veterinarians in companion animal medicine requires further evaluation.

Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida

Purpose: Epidemiologic studies of cancer among U.S. firefighters suggest a disproportionate burden of select cancer types including respiratory, gastrointestinal, skin, and kidney when compared to the general population. Although routine colorectal and whole-body skin cancer screening is widely recommended, screening rates among firefighters remain low. The National Fire Protection Association estimates a 1.1 million firefighter workforce, most of whom are Caucasian male, however, sub-groups of women, Hispanic, sexual minority, and Black firefighters are growing. In the present study we describe facilitators and barriers to cancer screening among Black firefighters. Method: A semi-structured interview script was used to conduct five focus group sessions of 45 to 60-minute duration with a total of 22 Black firefighters in South Florida between December 2019 and June 2020. A 20-item demographic survey was administered prior to the start of the interview. Data analysis was conducted using a grounded theory approach and NVIVO 12 software. Qualitative data was analyzed for themes and patterns. Results: Among participating Black firefighters, 90.9% were male, 4.6% Hispanic, 77.3% married, 68.1% with college/master’s educational attainment, 72.7% with private health insurance, 72.7% had a personal doctor, and a group mean age was 44 years (SD ± 8.7 years). Across all focus group sessions, the following three major themes emerged as facilitators and barriers to cancer screening: 1) societal culture of machismo and familial culture; 2) cancer education and cancer awareness; and 3) individual faith. Black firefighters describe culture as influencing health decisions and behaviors throughout their lives, including food choices, receiving a health screening, or visiting a doctor. A second prevalent theme focused on education and cancer awareness; specifically, Black firefighters did not feel comfortable with doctors, particularly because they were Black and firefighters.

Many felt that their doctors are not as aware of racial health differences as they should be, and they had to bring information to their doctors about firefighters’ unique job exposures. Lastly, a third theme describing individual faith influencing cancer screening practices frequently emerged. Many participants reported faith as being very important to them, however, they would not let religious beliefs prevent them from seeking medical interventions when needed. Conclusion: Black societal culture of machismo, cancer education and awareness, and individual faith were identified as facilitators and barriers of cancer screening among Black firefighters in South Florida. Strategies to improve cancer screening and prevention for Black firefighters should consider these factors in the design of workplace cancer interventions for this unique minority occupational subgroup.

Citation Format: Kemi Ogunsina, Natasha Solle, Lauren A. Murphy, Debi Brannan, Keith Bell, William McAlister, Erin Kobetz, Alberto Caban- Martinez. Examining facilitators and barriers to cancer screening among Black firefighters in South Florida [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-251.

Comparison of pregnancy outcomes following preimplantation genetic testing for aneuploidy using a matched propensity score design

STUDY QUESTION

Does preimplantation genetic testing for aneuploidy (PGT-A) increase the likelihood of live birth among women undergoing autologous IVF who have fertilized embryos?

SUMMARY ANSWER

PGT-A is associated with a greater probability of live birth among women 35 years old and older who are undergoing IVF.

WHAT IS KNOWN ALREADY

Previous studies evaluating the association between PGT-A and the incidence of live birth may be prone to confounding by indication, as women whose embryos undergo PGT-A may have a lower probability of live birth due to other factors associated with their increased risk of aneuploidy (e.g. advancing age, history of miscarriage). Propensity score matching can reduce bias where strong confounding by indication is expected.

STUDY DESIGN, SIZE, DURATION

We conducted a retrospective cohort study utilizing data from women who underwent autologous IVF treatment, had their first oocyte retrieval at our institution from 1 January 2011 through 31 October 2017 and had fertilized embryos from this retrieval. If a woman elected to use PGT-A, all good quality embryos (defined as an embryo between Stages 3 and 6 with Grade A or B inner or outer cell mass) were tested. We only evaluated cycles associated with the first oocyte retrieval in this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Our analytic cohort included 8227 women. We used multivariable logistic regression to calculate a propensity score for PGT-A based on relevant demographic and clinical factors available to the IVF provider at the time of PGT-A or embryo transfer. We used the propensity score to match women who did and did not utilize PGT-A in a 1:1 ratio. We then used log-binomial regression to compare the cumulative incidence of embryo transfer, clinical pregnancy, miscarriage and live birth between women who did and did not utilize PGT-A. Because the risk of aneuploidy increases with age, we repeated these analyses among women <35, 35–37 and ≥38 years old based on the Society for Assisted Reproductive Technology’s standards.

MAIN RESULTS AND THE ROLE OF CHANCE

Overall, women with fertilized embryos who used PGT-A were significantly less likely to have an embryo transfer (risk ratios (RR): 0.78; 95% CI: 0.73, 0.82) but were more likely to have a cycle that resulted in a clinical pregnancy (RR: 1.15; 95% CI: 1.04, 1.28) and live birth (RR: 1.21; 95% CI: 1.08, 1.35) than women who did not use PGT-A. Among women aged ≥38 years, those who used PGT-A were 67% (RR: 1.67; 95% CI: 1.31, 2.13) more likely to have a live birth than women who did not use PGT-A. Among women aged 35–37 years, those who used PGT-A were also more likely to have a live birth (RR: 1.27; 95% CI: 1.05, 1.54) than women who did not use PGT-A. In contrast, women <35 years old who used PGT-A were as likely to have a live birth (RR: 0.91; 95% CI: 0.78, 1.06) as women <35 years old who did not use PGT-A.

LIMITATIONS, REASONS FOR CAUTION

We were unable to abstract several potential confounding variables from patients’ records (e.g. anti-Mullerian hormone levels and prior IVF treatment), which may have resulted in residual confounding. Additionally, by restricting our analyses to cycles associated with the first oocyte retrieval, we were unable to estimate the cumulative incidence of live birth over multiple oocyte retrieval cycles.

WIDER IMPLICATIONS OF THE FINDINGS

Women aged 35 years or older are likely to benefit from PGT-A. Larger studies might identify additional subgroups of women who might benefit from PGT-A.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was received for this study. D.S. reports that he is a member of the Cooper Surgical Advisory Board. The other authors report no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Double trouble? Clinic-specific risk factors for monozygotic twinning

OBJECTIVE

To investigate clinic-specific risk factors for monozygotic twinning (MZT) using a large, electronic database.

DESIGN

Retrospective case-control study.

SETTING

Infertility clinics.

PATIENT(S)

Using an electronic medical record system, viable clinical pregnancy (confirmation of a gestational sac(s) and presence of at least one fetal pole with a heartbeat on first trimester ultrasound), data were obtained from homologous in vitro fertilization (IVF) cycles after single ET from June 1, 2004, to December 31, 2016. Monozygotic twinning was defined as a pregnancy with two fetal heartbeats on ultrasound with sex concordance at birth.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Risk factors for MZT including cycle type, method of insemination, and method of cryopreservation.

RESULT(S)

Of the 28,265 IVF cycles that met inclusion criteria over the study period, 8,749 (31.0%) resulted in a viable intrauterine clinical pregnancy. There were 102 (2.7%) MZT in the fresh cycle cohort and 133 (2.7%) in the frozen cycle cohort. Neither cryopreservation nor the method of cryopreservation was a significant risk factor for MZT. However, the use of sequential media was an independent risk factor for MZT in fresh, but not frozen, ETs (odds ratio = 1.72, 95% confidence interval, 1.10-2.68). Significant differences were seen in the incidence of MZT between clinics, and this difference persisted after controlling for known risk factors (clinic 0, reference; clinic 2, odds ratio = 2.22; 95% confidence interval, 1.48-3.32; clinic 3, odds ratio = 1.93; 95% confidence interval, 1.30-2.87).

CONCLUSION(S)

Differences in MZT rates exist between individual IVF clinics, suggesting that variations in practice patterns may contribute to this event. The present study noted the use of sequential media was an independent risk factor for fresh but not frozen cycles.

The effect of atorvastatin on haemostatic parameters in apparently healthy dogs

OBJECTIVE

To determine the effect of atorvastatin on haemostatic parameters as measured by prothrombin time, activated partial thromboplastin time and thromboelastography in apparently healthy dogs administered 2 mg/kg orally once daily for 1 week.

MATERIALS AND METHODS

Prospective study of 20 apparently healthy client-owned dogs at a small animal specialty hospital. Dogs had a baseline complete blood count, serum chemistry profile, fibrinogen, platelet count, prothrombin time, activated partial thromboplastin time and thromboelastography performed. Each dog was then administered approximately 2 mg/kg of atorvastatin orally once daily for 1 week, and the laboratory tests were repeated. Adverse effects attributed to atorvastatin were recorded.

RESULTS

All 20 enrolled dogs completed the study. Dogs received a median dose of 2.06 mg/kg (range 1.94 to 2.44 mg/kg) atorvastatin once daily, which was associated with a significant increase in pulse rate, mean corpuscular haemoglobin concentration, albumin and a significant decrease in mean corpuscular volume, cholesterol and lipase values compared with baseline. On thromboelastography, there was a significant increase in maximum amplitude, G, coagulation index, amplitude at 30 minutes, amplitude at 60 minutes and significant decrease in percentage of clot lysed at 30 minutes and percentage of clot lysed at 60 minutes values compared with baseline. Six dogs had a noticeable increase in appetite.

CLINICAL SIGNIFICANCE

The results of this study suggest that atorvastatin may produce a procoagulant effect in dogs, although the clinical significance is unclear. Polyphagia was the most commonly reported adverse effect.

The Gap Between Tools and Best Practice: An Analysis of Safety Prequalification Surveys in the Construction Industry

This study characterizes safety prequalification surveys currently in use in the construction industry to identify approaches that include leading indicators of worker safety performance. We collected prequalification surveys available in the public domain from internet searches, construction company websites, published literature, and construction industry partners. We utilized a conceptual framework, based on safety theory and best practices, to categorize survey questions. Fifty-two prequalification surveys were identified containing 112 unique questions. Most included questions related to lagging indicators (83 percent), safety management leadership (75 percent), and worker training (60 percent). Safety management system elements such as hazard prevention and control, program evaluation and improvement, and coordination and communication were notably absent in 90 percent of the surveys. There was little consistency in the surveys available concerning leading indicators of safety. Only a small number of surveys currently in use incorporate all the elements of best practices associated with robust safety management systems.

Effect of client complaints on small animal veterinary internists

OBJECTIVES

To investigate the effect of client complaints on small animal veterinary internists' welfare, job satisfaction and medical practices.

MATERIALS AND METHODS

Cross-sectional anonymous survey study. Between February 1 and March 31, 2017, a web-based questionnaire was made available through the American College Veterinary Internal Medicine sub-specialty Small Animal Internal Medicine E-mail List Serve.

RESULTS

A total of 92 completed surveys were available for review. Fifty-nine (64∙1%) respondents received a client complaint during the previous 6 months with cost of care the most common reason (53∙3%). Eighty-nine (96∙7%) respondents worry about client complaints being made against them with 33 (35∙8%) stating they worry "most of the time" or "all of the time." Thirty-two (34∙8%) reported being verbally assaulted by a client in the previous 6 months and 27 (29∙4%) reported being threatened with litigation during the previous 6 months. Sixty-six (71∙7%) have reported changing the way they practice medicine to avoid a client complaint and 40 (43∙5%) have considered changing their career because of complaints made against them.

CLINICAL RELEVANCE

Client complaints are a frequent problem among small animal veterinary internists that have detrimental effects on job satisfaction, psychological distress and medical practices.

Does talking the talk matter? Effects of supervisor safety communication and safety climate on long-haul truckers' safety performance

This study examines the distinct contribution of supervisory safety communication and its interaction with safety climate in the prediction of safety performance and objective safety outcomes. Supervisory safety communication is defined as subordinates' perceptions of the extent to which their supervisor provides them with relevant safety information about their job (i.e., top-down communication) and the extent to which they feel comfortable discussing safety issues with their supervisor (i.e., bottom-up communication). Survey data were collected from 5162 truck drivers from a U.S. trucking company with a 62.1% response rate. Individual employees' survey responses were matched to their safety outcomes (i.e., lost-time injuries) six months after the survey data collection. Results showed that the quality of supervisor communication about safety uniquely contributes to safety outcomes, above and beyond measures of both group-level and organization-level safety climate. The construct validity of a newly-adapted safety communication scale was demonstrated, particularly focusing on its distinctiveness from safety climate and testing a model showing that communication had both main and moderating effects on safety behavior that ultimately predicted truck drivers' injury rates. Our findings support the need for continued attention to supervisory safety communication as an important factor by itself, as well as a contingency factor influencing how safety climate relates to safety outcomes.

Musculoskeletal Pain and Interest in Meditation and Yoga in Home Health Aides: Evidence From the Home Health Occupations Musculoskeletal Examinations (HHOME) Study

Home healthcare aides (HHAs) are a growing U.S. workforce highly susceptible to workplace stressors and musculoskeletal pain. In the present study we: 1) examine the association of musculoskeletal pain to life satisfaction and emotional exhaustion; and 2) characterize interest in meditation and yoga in a sample of HHAs. A nonprobabilistic sample of HHAs employed at home healthcare agencies in Florida, Massachusetts, and Oregon (n = 285 total) completed a self-administered questionnaire with standard survey measures on musculoskeletal pain location, duration, and severity; life satisfaction; emotional exhaustion; and interest in meditation techniques and yoga. Among HHAs responding, 48.4% reported pain in the last 7 days and 46.6% reported pain in the last 3 months. Home healthcare aides who reported current pain and chronic pain had a significant (P < .05) decrease in satisfaction with life score and a significant increase in emotional exhaustion score. The majority of HHAs reported an interest in learning about the benefits (65.6%) and practice (66.4%) of meditation and a willingness to participate in a yoga class (59.2%) or stress management meeting (59.1%). The HHAs reported both acute and chronic musculoskeletal pain that was correlated with lower life satisfaction and greater emotional exhaustion. More efforts are needed to reduce the sources of injury and emotional exhaustion.

A sociotechnical systems approach to enhance safety climate in the trucking industry: Development of a methodology

The systems approach is increasingly used as a framework within which to examine safety climate. Utilizing a macroergonomics approach to design work systems can help identify aspects of human-technology-organization interfaces that impact workers' perceptions of safety, both positively and negatively. Such an approach also supplements traditional uses of safety climate as a leading indicator of safety and helps expand research toward an approach that can determine problems impacting safety. The purpose of this study was to develop a methodology that extends safety climate beyond just an overall score by using the framework of macroergonomics to examine the entire system in a more comprehensive manner. The proposed methodology can be used as a way to identify gaps in the specific work system, and this information can be used to design interventions to change the safety climate, and ultimately the culture, of an organization in order to reduce negative safety outcomes.

A sociotechnical systems approach to enhance safety climate in the trucking industry: Results of an in-depth investigation

The purpose of this study was to develop a methodology that extends safety climate beyond an overall score by using the framework of macroergonomics to examine the entire system in a more comprehensive manner. The study is discussed in two papers: one paper describes the study methodology in detail (Murphy, Robertson, Huang, Jeffries, & Dainoff, in press), and the current paper describes the results of the study. Multiple methods were combined to create a systems approach, and those methods include the critical incident technique, contextual inquiries with functional role diagrams, and affinity mapping. Key informants in the trucking industry identified 19 themes that affect safety. The themes ranged from balancing work and family/personal time, the company's policy vs. practice, respecting the job of the driver, and active listening and meaningful feedback. The most prominent themes were related to the workers and their activities; the internal environment, including psychosocial job design elements; and organizational design. Such information can be used to design interventions to change the safety climate of an organization in order to reduce negative safety outcomes.

Association between positive and negative affect and musculoskeletal pain among US home health aides

As the US population ages, there is an expected increase in demand for home health aides (HHAs); therefore, it is important to ensure their occupational well-being. Previous studies have demonstrated associations between negative emotions and musculoskeletal pain. Using survey data collected from 285 HHAs, we characterize the association between affect and musculoskeletal pain. Affect was measured using the Positive and Negative Affect Schedule, while musculoskeletal pain was measured using the Brief Pain Inventory. We found that as positive affect composite score increased, musculoskeletal pain decreased [β = -0.57, t(124) = -7.01, p < .001]. There was no significant association between the negative affect composite score and musculoskeletal pain. However, several individual moods were associated with decreased or increased pain. These data suggest that some moods may buffer against musculoskeletal pain, while others may predispose HHAs to musculoskeletal pain.

Beyond safety outcomes: An investigation of the impact of safety climate on job satisfaction, employee engagement and turnover using social exchange theory as the theoretical framework

Safety climate, a measure of the degree to which safety is perceived by employees to be a priority in their company, is often implicated as a key factor in the promotion of injury-reducing behavior and safe work environments. Using social exchange theory as a theoretical basis, this study hypothesized that safety climate would be related to employees' job satisfaction, engagement, and turnover rate, highlighting the beneficial effects of safety climate beyond typical safety outcomes. Survey data were collected from 6207 truck drivers from two U.S. trucking companies. The objective turnover rate was collected one year after the survey data collection. Results showed that employees' safety climate perceptions were linked to employees' level of job satisfaction, engagement, and objective turnover rate, thus supporting the application of social exchange theory. Job satisfaction was also a significant mediator between safety climate and the two human resource outcomes (i.e., employee engagement and turnover rate). This study is among the first to assess the impact of safety climate beyond safety outcomes among lone workers (using truck drivers as an exemplar).

Surgical correction of gastro-oesophageal intussusception with bilateral incisional gastropexy in three dogs

Three dogs presented for evaluation of acute onset tachypnoea and dyspnoea following episodes of vomiting and/or regurgitation. Thoracic radiographs were suggestive of a gastro-oesophageal intussusception in all three dogs; one dog also showed evidence of aspiration pneumonia. All three dogs underwent surgical correction with a bilateral incisional gastropexy. All dogs recovered from anaesthesia uneventfully and were discharged from the hospital 3 days after presentation. Persistent megaoesophagus was evident in all three dogs, and they are being chronically managed with a strict feeding regime and pro-motility agents.

Influence of fatigue on construction workers' physical and cognitive function

BACKGROUND

Despite scientific evidence linking workers' fatigue to occupational safety (due to impaired physical or cognitive function), little is known about this relationship in construction workers.

AIMS

To assess the association between construction workers' reported fatigue and their perceived difficulties with physical and cognitive functions.

METHODS

Using data from a convenience sample of US construction workers participating in the 2010-11 National Health Interview Survey two multivariate weighted logistic regression models were built to predict difficulty with physical and with cognitive functions associated with workers' reported fatigue, while controlling for age, smoking status, alcohol consumption status, sleep hygiene, psychological distress and arthritis status.

RESULTS

Of 606 construction workers surveyed, 49% reported being 'tired some days' in the past 3 months and 10% reported 'tired most days or every day'. Compared with those feeling 'never tired', workers who felt 'tired some days' were significantly more likely to report difficulty with physical function (adjusted odds ratio [AOR] = 2.03; 95% confidence interval [CI] 1.17-3.51) and cognitive function (AOR = 2.27; 95% CI 1.06-4.88) after controlling for potential confounders.

CONCLUSIONS

Our results suggest an association between reported fatigue and experiencing difficulties with physical and cognitive functions in construction workers.

Development and validation of a fatigue assessment scale for U.S. construction workers

OBJECTIVE

To develop a fatigue assessment scale and test its reliability and validity for commercial construction workers.

METHODS

Using a two-phased approach, we first identified items (first phase) for the development of a Fatigue Assessment Scale for Construction Workers (FASCW) through review of existing scales in the scientific literature, key informant interviews (n = 11) and focus groups (three groups with six workers each) with construction workers. The second phase included assessment for the reliability, validity, and sensitivity of the new scale using a repeated-measures study design with a convenience sample of construction workers (n = 144).

RESULTS

Phase one resulted in a 16-item preliminary scale that after factor analysis yielded a final 10-item scale with two sub-scales ("Lethargy" and "Bodily Ailment"). During phase two, the FASCW and its subscales demonstrated satisfactory internal consistency (alpha coefficients were FASCW [0.91], Lethargy [0.86] and Bodily Ailment [0.84]) and acceptable test-retest reliability (Pearson Correlations Coefficients: 0.59-0.68; Intraclass Correlation Coefficients: 0.74-0.80). Correlation analysis substantiated concurrent and convergent validity. A discriminant analysis demonstrated that the FASCW differentiated between groups with arthritis status and different work hours.

CONCLUSIONS

The 10-item FASCW with good reliability and validity is an effective tool for assessing the severity of fatigue among construction workers.

The next generation of macroergonomics: integrating safety climate

To date little research has examined safety climate in relation to macroergonomics and how the two distinct sub-disciplines can be integrated to affect safety outcomes. The purpose of macroergonomics is to design a fully "harmonized" work system that improves numerous aspects of organizational performance and effectiveness, and this is accomplished by incorporating the foundational theoretical framework of sociotechnical systems theory (STS). Two broad subsystems within such a system are the personnel subsystem, the ways individuals perform tasks, and the technological subsystem, the tasks to be performed. Management is an important aspect of the personnel subsystem, and there is a growing body of research regarding supervisors' influence over employee safety. One such area of research is safety climate, which is based on the perception of workers regarding safety and organizational practices. Two major factors of safety climate are management commitment to safety and communication pertaining to safety as a true priority from both top management and direct supervisors. This article describes the conceptual overlaps of macroergonomics and safety climate in order to present a conceptual model that integrates these domains using the framework of mesoergonomics. In conclusion, we discuss how this model can serve as a framework to guide the analysis and design of work systems and subsequent organizational interventions.

External validity of a generic safety climate scale for lone workers across different industries and companies

PURPOSE

The goal of this study was to examine the external validity of a 12-item generic safety climate scale for lone workers in order to evaluate the appropriateness of generalized use of the scale in the measurement of safety climate across various lone work settings. External validity evidence was established by investigating the measurement equivalence (ME) across different industries and companies.

METHOD

Confirmatory factor analysis (CFA)-based and item response theory (IRT)-based perspectives were adopted to examine the ME of the generic safety climate scale for lone workers across 11 companies from the trucking, electrical utility, and cable television industries.

RESULTS

Fairly strong evidence of ME was observed for both organization- and group-level generic safety climate sub-scales. Although significant invariance was observed in the item intercepts across the different lone work settings, absolute model fit indices remained satisfactory in the most robust step of CFA-based ME testing. IRT-based ME testing identified only one differentially functioning item from the organization-level generic safety climate sub-scale, but its impact was minimal and strong ME was supported.

IMPLICATIONS

The generic safety climate scale for lone workers reported good external validity and supported the presence of a common feature of safety climate among lone workers. The scale can be used as an effective safety evaluation tool in various lone work situations.

Correlation between safety climate and contractor safety assessment programs in construction

BACKGROUND

Contractor safety assessment programs (CSAPs) measure safety performance by integrating multiple data sources together; however, the relationship between these measures of safety performance and safety climate within the construction industry is unknown.

METHODS

Four hundred and one construction workers employed by 68 companies on 26 sites and 11 safety managers employed by 11 companies completed brief surveys containing a nine-item safety climate scale developed for the construction industry. CSAP scores from ConstructSecure, Inc., an online CSAP database, classified these 68 companies as high or low scorers, with the median score of the sample population as the threshold. Spearman rank correlations evaluated the association between the CSAP score and the safety climate score at the individual level, as well as with various grouping methodologies. In addition, Spearman correlations evaluated the comparison between manager-assessed safety climate and worker-assessed safety climate.

RESULTS

There were no statistically significant differences between safety climate scores reported by workers in the high and low CSAP groups. There were, at best, weak correlations between workers' safety climate scores and the company CSAP scores, with marginal statistical significance with two groupings of the data. There were also no significant differences between the manager-assessed safety climate and the worker-assessed safety climate scores.

CONCLUSIONS

A CSAP safety performance score does not appear to capture safety climate, as measured in this study. The nature of safety climate in construction is complex, which may be reflective of the challenges in measuring safety climate within this industry. Am. J. Ind. Med. 56:1463-1472, 2013. © 2013 Wiley Periodicals, Inc.

Development and validation of safety climate scales for mobile remote workers using utility/electrical workers as exemplar

PURPOSE

The objective of this study was to develop and test the reliability and validity of a new scale designed for measuring safety climate among mobile remote workers, using utility/electrical workers as exemplar. The new scale employs perceived safety priority as the metric of safety climate and a multi-level framework, separating the measurement of organization- and group-level safety climate items into two sub-scales. The question of the emergence of shared perceptions among remote workers was also examined.

METHOD

For the initial survey development, several items were adopted from a generic safety climate scale and new industry-specific items were generated based on an extensive literature review, expert judgment, 15-day field observations, and 38 in-depth individual interviews with subject matter experts (i.e., utility industry electrical workers, trainers and supervisors of electrical workers). The items were revised after 45 cognitive interviews and a pre-test with 139 additional utility/electrical workers. The revised scale was subsequently implemented with a total of 2421 workers at two large US electric utility companies (1560 participants for the pilot company and 861 for the second company). Both exploratory (EFA) and confirmatory factor analyses (CFA) were adopted to finalize the items and to ensure construct validity. Reliability of the scale was tested based on Cronbach's α. Homogeneity tests examined whether utility/electrical workers' safety climate perceptions were shared within the same supervisor group. This was followed by an analysis of the criterion-related validity, which linked the safety climate scores to self-reports of safety behavior and injury outcomes (i.e., recordable incidents, missing days due to work-related injuries, vehicle accidents, and near misses).

RESULTS

Six dimensions (Safety pro-activity, General training, Trucks and equipment, Field orientation, Financial Investment, and Schedule flexibility) with 29 items were extracted from the EFA to measure the organization-level safety climate. Three dimensions (Supervisory care, Participation encouragement, and Safety straight talk) with 19 items were extracted to measure the group-level safety climate. Acceptable ranges of internal consistency statistics for the sub-scales were observed. Whether or not to aggregate these multi-dimensions of safety climate into a single higher-order construct (overall safety climate) was discussed. CFAs confirmed the construct validity of the developed safety climate scale for utility/electrical workers. Homogeneity tests showed that utility/electrical workers' safety climate perceptions were shared within the same supervisor group. Both the organization- and group-level safety climate scores showed a statistically significant relationship with workers' self-reported safety behaviors and injury outcomes.

IMPLICATIONS

A valid and reliable instrument to measure the essential elements of safety climate for utility/electrical workers in the remote working situation has been introduced. The scale can provide an in-depth understanding of safety climate based on its key dimensions and show where improvements can be made at both group and organization levels. As such, it may also offer a valuable starting point for future safety interventions.

The impact of background television on parent-child interaction

This study investigated the hypothesis that background television affects interactions between parents and very young children. Fifty-one 12-, 24-, and 36-month-old children, each accompanied by 1 parent, were observed for 1 hr of free play in a laboratory space resembling a family room. For half of the hour, an adult-directed television program played in the background on a monaural television set. During the other half hour, the television was not on. Both the quantity and quality of parent-child interaction decreased in the presence of background television. These findings suggest one way in which early, chronic exposure to television may have a negative impact on development.

Is hypoallergenic a credible term?

Hypoallergenic is a term that is frequently applied to cosmetics and is intended to imply a very low likelihood of developing or potentiating allergic cutaneous reactions. However there are neither industry standards nor legal requirements which must be fulfilled in order to make this claim. We describe a 25-year-old woman referred with worsening eczema which she related to the use of two skincare products. Both had been promoted as hypoallergenic and 'preservative free'; chemical analysis using HPLC confirmed the presence of methyldibromoglutaronitrile and formaldehyde, both at robust concentrations. We consider it unlikely that these were present as contaminants and suggest that the term hypoallergenic must be interpreted with caution.

Structural analysis of an offset-keel design glenoid component compared with a center-keel design

Many different designs of glenoid prostheses have been developed in an attempt to reduce the loosening rates and improve the prognosis of total shoulder arthroplasty. This study investigated a design in which the keel is positioned anterior to the central plane of the component, an offset-keel design. The primary purpose of anterior location of the keel is to avoid contact between the keel and the cortical bone surface. However, anterior placement of the keel also situates it more directly under the line of action of the contact force in abduction; this has the possible advantage of reducing the bending stress on the cement mantle. Our purpose was to establish whether an offset-keel design reduces the cement stresses below those obtained with conventional central-keel designs. A computed tomography-based finite element model of the glenoid region is used and dynamic loading for 0 degrees to 180 degrees in both flexion and abduction is simulated with the use of data from van der Helm (J Biomech 1994;27:527-50). Finite element analyses are carried out for both the normal and the rheumatoid arthritic case. For the rheumatoid arthritic joint, a Larsen grade IV type destruction is reproduced and proximal subluxed loads are applied, associated with a deficient rotator cuff for 0 degrees to 180 degrees in flexion and abduction. Results predict that the cement mantle in the offset-keel design is much less stressed compared with that in the center-keel design for the maximum glenohumeral joint load in abduction for both the normal and the rheumatoid arthritis case. In flexion the offset-keel design still has lower cement stresses even though the load is acting on the opposite side of the glenoid cup from the keel; one explanation for this is that insertion of the offset keel involves removal of the lower stiffness cancellous bone, leaving the glenoid component flanges to be supported by the stronger bone remaining in the glenoid cavity. From a biomechanical point of view, the advantages of an offset-keel design would appear to be considerable.

Scabies management in the community

BACKGROUND

Unidentified and undertreated cases of scabies are the source of continued spread.

AIMS

To evaluate management of scabies in the community.

METHODS

Eighty-six outpatient and ward referrals were reviewed. Fifty-six had previously applied scabicidal treatments (Group 1), whilst in 30 patients the diagnosis was made de novo (Group 2). Treatment failure was identified by a detailed questionnaire. In both groups, patients were reviewed at four to six weeks.

RESULTS

Sixty-four per cent of Group 1 was initially correctly diagnosed. Seventy per cent of Group 1 patients had received verbal and written instruction as part of previous unsuccessful treatments. The clearance rate in the combined group treated according to protocol was 96%; 100% clearance was ultimately achieved.

CONCLUSION

Inconsistency in diagnosis and treatment of patients is common. A treatment protocol should be made available to family practitioners.

Three-dimensional finite element analysis of glenoid replacement prostheses: a comparison of keeled and pegged anchorage systems

Glenoid component loosening is the dominant cause of failure in total shoulder arthroplasty. It is presumed that loosening in the glenoid is caused by high stresses in the cement layer. Several anchorage systems have been designed with the aim of reducing the loosening rate, the two major categories being "keeled" fixation and "pegged" fixation. However, no three-dimensional finite element analysis has been performed to quantify the stresses in the cement or to compare the different glenoid prosthesis anchorage systems. The objective of this study was to determine the stresses in the cement layer and surrounding bone for glenoid replacement components. A three-dimensional model of the scapula was generated using CT data for geometry and material property definition. Keeled and pegged designs were inserted into the glenoid, surrounded by a 1-mm layer of bone cement. A 90 deg arm abduction load with a full muscle and joint load was applied, following van der Helm (1994). Deformations of the prosthesis, stresses in the cement, and stresses in the bone were calculated. Stresses were also calculated for a simulated case of rheumatoid arthritis (RA) in which bone properties were modified to reflect that condition. A maximum principal stress-based failure model was used to predict what quantity of the cement is at risk of failure at the levels of stress computed. The prediction is that 94 percent (pegged prosthesis) and 68 percent (keeled prosthesis) of the cement has a greater than 95 percent probability of survival in normal bone. In RA bone, however, the situation is reversed where 86 percent (pegged prosthesis) and 99 percent (keeled prosthesis) of the cement has a greater than 95 percent probability of survival. Bone stresses are shown to be not much affected by the prosthesis design, except at the tip of the central peg or keel. It is concluded that a "pegged" anchorage system is superior for normal bone, whereas a "keeled" anchorage system is superior for RA bone.

Gianotti-Crosti syndrome in an infant following immunization

Gianotti-Crosti syndrome (GCS) is a distinctive, self-limiting acropapular or papulovesicular eruption. Typical clinical presentation is that of a monomorphic, nonpruritic eruption most commonly involving the face, neck, buttocks, and extremities. It tends to occur in childhood, though infrequently it has been reported in adults. We report GCS occurring in an infant following immunization.

Hyperthermia induces resistance to ultraviolet light B in primary and immortalized epidermal keratinocytes

Environmental exposure to UVB (290-320 nm) wavelengths of the solar spectrum causes major damage, including carcinogenesis, in the skin. Therefore, cellular responses that protect against UVB damage are of particular interest in cutaneous epithelial cells. In cultured keratinocytes, mild hyperthermia generates a classical stress response with acquired thermotolerance and elevated stress protein synthesis (E. V. Maytin, J. Biol. Chem., 267: 23189-23196, 1992). To test the ability of this stress response to protect against UVB damage, monolayers of primary murine keratinocytes or BALB/MK keratinocytes were heated at 42 degrees C for 1 h and then exposed to UVB at 6 h (typical dose, 40 mJ/cm2). Survival was assessed by fluorescein diacetate/ethidium bromide vital dye uptake and video microscopy. With heat-conditioning prior to UVB, a significant increase in both the percentage viability (2- to 3-fold) and in the absolute number of living (fluorescein diacetate-positive) cells was measurable at 24-48 h. Steady-state incorporation into [3H]DNA and 35S-protein, while suppressed immediately after UVB, showed greater recovery in heat-conditioned cultures compared to sham-conditioned cultures at 48 h. Increased metabolic activity was accompanied by increased proliferative potential since colonies of BALB/MK cells observed at 72 h were larger, more numerous, and more active in the uptake of 5-bromo-2'-deoxyuridine in heat-conditioned cultures. A time course for the development of UVB resistance showed maximal protection when heat and UVB were spaced approximately 6 h apart. Hyperthermic conditioning could induce UVB protection in nonproliferating cells, indicating that cell cycle arrest was not primarily responsible for the UVB-protective effect. In summary, hyperthermia induces a mechanism in epithelial cells which can ameliorate damage from UVB.

In vitro evidence that bone formation may be coupled to resorption by release of mitogen(s) from resorbing bone

Bone-derived proteins have been shown to stimulate the proliferation of bone-forming cells and to increase the rate of embryonic bone formation in vitro. The current studies were intended to determine the tissue distribution of bone cell-active mitogen(s) in the embryonic chick, to determine the cellular origin and the target cell specificity of the bone cell-active mitogen(s) in embryonic chick bone, to determine whether the release of mitogenic activity from embryonic chick tibiae was proportional to bone resorption, and to compare mitogenic activities prepared from different skeletal sources, with respect to Mr, chemical stability, and mitogen activity kinetics. A bone cell-active mitogen(s) was identified in extracts of bone and cartilage but not in extracts of muscle, liver, intestine, or brain. (Mitogenic activity was determined as increased incorporation of 3[H]-thymidine into DNA in serum-free, calvarial cell cultures.) Together, the following three observations indicate an osteoblastic origin for the bone cell-active mitogen(s) in chick bone. First, the mitogen content of embryonic chick tibiae increased 4.5-fold, during eight days of serum-free in vitro growth (P less than .005). Second, conditioned medium (CM) from serum-free monolayer cultures of calvarial cells contained bone cell-active mitogen(s), but CM from parallel cultures of skin, liver, and intestinal cells did not. And, finally, the amount of bone cell-active mitogen(s) in calvarial cell CM was correlated with the amount of alkaline phosphatase (ALP) activity per cell, ie, an index of osteoblastic differentiation (r = .92, P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydrate binding studies on the Bandeiraea simplicifolia I isolectins. Lectins which are mono-, di-, tri-, and tetravalent for N-acetyl-D-galactosamine

Association constants for the binding of methyl alpha-D-galactopyranoside (methyl alpha-D-Galp) and methyl 2-acetamido-2-deoxy-alpha-D-galactopyranoside (methyl alpha-D-GalNAcp) to three Bandeiraea simplicifolia isolectins (A4, A2B2, B4) were determined by equilibrium dialysis and fluorescence enhancement measurements. The a and B subunits appear to have approximately the same Kassoc for methyl alpha-D-Galp: 1.45 X 10(4), 1.98 X 10(4), and 2.06 X 10(4) M-1 for A4, A2B2, and B4, respectively, as determined by equilibrium dialysis. Fluorescence enhancement measurements on B4 gave an association constant of 2.07 X 10(4) M-1 for methyl alpha-D-Galp and 1.87 X 10(3) M-1 for methyl beta-D-galp. By equilibrium dialysis, we were able to detect 3.3 (theory, 4.0) methyl alpha-D-GalNAcp binding sites for A4 (Kassoc = 1.87 X 10(5) M-1), 1.9 for A2B2 (Kassoc = 1.19 X 10(5) M-1), and were unable to detect any methyl alpha-D-GalNAcp binding sites for B4. However, four very weak methyl alpha-D-GalNAc binding sites for B4 were detected by fluorescence enhancement measurement (Kassoc = 1.26 X 10(2) M-1). Thus, the A subunit has an affinity for methyl alpha-D-GalNAc 3 orders of magnitude greater than the B subunit. Precipitation and hapten inhibition data are in accord with these binding measurements. Toward guaran and type B blood group substance, all isolectins precipitated the same amount of biopolymer. However, AB3, A2B2, and A3B, which are mono-, di-, and trivalent for alpha-D-GalNAcp, were differentially precipitated by type A blood group substance which contains alpha-D-GalNAcp-end groups. A3B precipitated the most, A2B2 less, and AB3 no type A substance. These isolectins should prove useful in studies evaluating the effect of valence on lectin-cell interaction.

Physical-chemical characterization and carbohydrate-binding activity of the A and B subunits of the Bandeiraea simplificolia I isolectins

Bandeiraea simplicifolia I plant seed isolectins comprise a family of tetrameric alpha-D-galactopyranosyl-binding glycoproteins composed of various combinations of teo different kinds of subunits designated A and B. Subtypes of the A (Aa, Ab, Ac, Ad, and Ae) and B (Ba, Bb, Bc, Bd, and Be) subunits were demotypes varies from seed to seed (e.g., some seeds contain only B subunits, others only A subunits), subtypes Ac and Bc predominate in a natural mixture of the isolectins. Two-dimensional agar gel diffusion studies indicate that, in addition to common structural features, each subunit contains its own distinct antigenic determinants. Although the A and B subunits have closely similar amino acid compositions, they differ markedly in one respect: the B subunit has one methionine residue whereas the A subunit contains no methionine. The neutral carbohydrate content of both subunits is identical. The ability of biopolymers and synthetic glycoproteins to precipitate A4 and B4, as well as the capacity of sugars and oligosaccharides to inhibit precipitate formation, was examined. On the basis of these studies, it is suggested that hydrogen bonding occurs between the hydrogen atoms of the C-3 and C-4 hydroxyl groups of alpha-D-GalNAcp and alpha-D-galp units and the A and B subunits, respectively.

Abnormal lymphocyte responses in residents of a town with a cluster of Hodgkin's disease

A time-space aggregate of Hodgkin's disease was observed in a small town. A large elevator for the storage of navy beans was located in the residential area of the town. Lymphocytes of town residents compared to those of non-residents showed increased levels of transformations when challenged with extracts of navy beans. A phytohaemagglutinin from navy beans with the ability to stimulate lymphocytes was isolated and characterized. A hypothesis concerning a connection between this cluster of Hodgkin's disease and the abnormal lymphocyte responses to navy-bean phytohaemagglutinin is discussed.

An anti-B reagent prepared from the alpha-D-galactopyranosyl-binding isolectins from Bandeiraea simplicifolia seeds

A method for the large scale preparation of the alpha-D-galactosyl binding isolectins from Bandeiraea simplicifolia seeds using an absorbent prepared by linking D-galactosamine to CH-Sepharose is described. The addition of N-acetyl-D-galactosamine (GalNAc) to these isolectins produced an anti-B reagent (BS I + GalNAc anti-B). Although BS I + GalNAc anti-B readily agglutinated red blood cells from the majority of group B and AB donor and patient blood samples tested, it reacted weakly with group B and AB cord red blood cells and failed to agglutinate five of 100 group AB donor blood samples when tested by an automated technique. The reagent did not agglutinate the red blood cells from seven acquired-B red blood cell samples and was strongly reactive with Tn-polyagglutinable red blood cells. These findings indicate that this lectin anti-B preparation may be of more value in investigative immunohematology, rather than as an alternative to human group A serum as a source of anti-B for blood-typing purposes. The results of tests on Tn-polyagglutinable red blood cells with BS I + GalNAc anti-B and the purified isolectins BS I(A4) and BS I(B4) are also presented, and discussed in relation to current concepts on the structure of the Tn receptor.

Five alpha-D-galactopyranosyl-binding isolectins from Bandeiraea simplicifolia seeds

The alpha-D-galactopyranosyl-binding lectin previously purified from Bandeiraea simplicifolia seeds (Hayes, C.H., and Goldstein, I.J. (1974) J. Biol. Chem. 249, 1904) is shown to consist of five isolectins separable on polyacrylamide gel electrophoresis at pH 9.5. The isolectins are tetrameric structures composed of various combinations of two different glycoprotein subunits designated A and B. The A and B subunits appear to be immunochemically indistinguishable against rabbit antisera prepared from the isolectin mixture. The A subunit contains no methionine, whereas the B subunit contains 1 residue. The subunits migrate differently on polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate and, although each subunit contains 1 residue of cysteine, they react differently toward 5,5'-dithiobis(2-nitrobenzoic acid). The carbohydrate binding specificity of the two subunits differs significantly: the A subunit exhibits a primary specificity for alpha-D-GalNAcp but also reacts with alpha-D-Galp units, whereas the B subunit shows a sharp specificity toward alpha-D-Galp residues. The differences in carbohydrate binding specificity were exploited in separating the isolectins. B. simplicifolia I isolectins (A4) and (A3B) were purified on a Bio-Gel melibionate column, and (A2B2), (AB3), and (B4) were separated on a column of insolubilized blood group A substance.