Evaluating the impact of the live healthy, work healthy program on organizational outcomes: A randomized field experiment

The prevalence of chronic health conditions is increasing, with over half the current workforce attempting to manage one or more chronic conditions. The Live Healthy, Work Healthy (LHWH) program is a version of the Chronic Disease Self-Management Program translated to the workplace, with the goal of improving and sustaining the health, well-being, and productivity of employees living with chronic health conditions. Using organizational support theory as a theoretical framework and a clustered randomized controlled trial design, this article demonstrates how the LHWH program positively impacts work-related quality of life, orientations toward the organization, and organizational cognitions and behaviors. Participants in the program experienced increases in perceived organizational support (POS), with a large intervention effect. Direct intervention effects were also found for burnout, work engagement, work ability, affective organizational commitment, and organizational citizenship behaviors. Within-person changes in POS during the intervention was a key mechanism through which participants of the program experienced changes in organizationally relevant outcomes. Finally, offering the program on work time strengthened these effects indirectly through greater changes in POS during the intervention period. This article provides evidence to researchers and organizational decision-makers that offering the LHWH program not only improves the health and well-being of employees but also improves important organizational outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations Between Occupational and Leisure-Time Physical Activity With Employee Stress, Burnout and Well-Being Among Healthcare Industry Workers

PURPOSE

Examine the associations of occupational and leisure-time physical activity with job stress, burnout, and well-being among healthcare industry workers.

DESIGN

Quantitative; cross-sectional.

SETTING

Healthcare Industry.

SAMPLE

US Amazon Mechanical Turk participants (n = 550) employed in the healthcare industry, worked 35 hours or more per week, had ≥ 1 supervisor and ≥ 1 co-worker, and were ≥ 18 years old.

MEASURES

Self-reported measures of occupational physical activity (OPA) and leisure-time physical activity (LTPA), employee well-being, job stress, and burnout operationalized as exhaustion and disengagement.

ANALYSIS

Associations between OPA and LTPA with employee well-being, job stress, exhaustion and disengagement were assessed with separate multiple linear regression models.

RESULTS

OPA had positive significant associations with job stress (β = 0.10, P value = .003) and exhaustion (β = 0.21, P value < .0001). No significant associations were found between OPA with other psychological outcomes. A significant inverse association was found between LTPA and exhaustion (β = -0.04, P value = .007).

CONCLUSION

In a sample of U.S. health care workers, and consistent with prior epidemiological studies, greater LTPA was associated with lower feelings of exhaustion. In contrast, health care workers with greater OPA reported higher perceptions of job stress and exhaustion. The findings underscore the need for more research aimed at understanding relationships between OPA and psychological health among healthcare workers.

Differences in Work and Non-Work Support Associations With Job Stress, Burnout, and Well-Being Between Types of Healthcare Workers

OBJECTIVE

To determine associations between work and non-work supports with employee well-being, job stress, and burnout among direct and non-direct care healthcare workers.

METHODS

Cross-sectional data were collected from 550 full-time (≥ 35 h/wk), US Amazon Mechanical Turk workers (≥ 18 years of age) in the healthcare industry, had at least one supervisor, and at least one coworker. Canonical correlational analysis assessed the shared variance of organizational, supervisor, coworker, and family/friend support on employee outcomes.

RESULTS

Non-direct care support workers indicated a significantly stronger association between work supports and employee outcomes than family/friend supports. Direct care support workers had significant support from both work and non-work sources of support.

CONCLUSION

Workplace supports are important resources for healthcare workers responsible for ensuring patient care and safety. Workplace interventions may tailor interventions to encourage types of support for subgroups within the healthcare industry.

Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program

PURPOSE

Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP).

DESIGN

14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group.

SETTING

The diverse set of work organizations centered around a rural community in SE US.

SUBJECTS

411 participants completed baseline data with 359 being included in the final analyses.

INTERVENTION

LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders.

MEASURES

The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.).

ANALYSIS

Analyses were conducted using latent change score models in a structural equation modeling framework.

RESULTS

79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = -1.45, p < .05), stress (uΔ = -0.98, p < .01) and mentally unhealthy days (uΔ = -3.47, p < .001).

CONCLUSIONS

The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

The workplace health group: A case study of 20 years of multidisciplinary research

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of a workplace holiday weight gain prevention program

BACKGROUND

The average worker gains 2-3 lb (0.9-1.4 kg) a year, about half of which is gained during the fall holiday season (Halloween through New Year's).

AIM

The aim of the study was to conduct a pilot test of a weight gain prevention program that was implemented in a workplace setting during the fall holiday season.

METHODS

239 state government employees participated in a weight gain prevention program offered during the fall holiday season. The program was a 10-week, team-based program that consisted of self-monitoring, regular weigh-ins, a team challenge, and organizational support. Weight was measured at baseline, every two weeks during the program, and post-program.

RESULTS

Participants lost a significant amount of weight (from 196.7 lb/89.2 kg to 192.3 lb/87.2 kg) during the program. Positive changes were observed in physical activity and eating behaviors.

CONCLUSIONS

This study demonstrated that a weight gain prevention program during a high risk period (fall holiday season) can be effective.

Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life

OBJECTIVE

Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination.

METHODS

Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs).

RESULTS

The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated).

CONCLUSIONS

Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson’s Patients

Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.

Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients

BACKGROUND

A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients.

AIM

To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices.

DESIGN

A cross-sectional survey study of neurologists.

SETTING/PARTICIPANTS

A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database.

RESULTS

Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral.

CONCLUSION

Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Evaluation of a Digital Behavioral Counseling Program for Reducing Risk Factors for Chronic Disease in a Workforce

OBJECTIVE

To evaluate a digitally delivered, intensive behavioral counseling program for a workforce at risk for obesity-related chronic disease.

METHODS

Employees were offered a digital health program modeled after the diabetes prevention program (DPP). Annual workforce health assessments were used to examine changes in chronic disease risk factors between participants (n = 634) relative to a matched comparison group (n = 1268).

RESULTS

Overall, employees were gaining an average of 3.5 pounds annually before program inception. Program engagement was positive; 83% completed the majority of the curriculum and 31% lost at least 5% of their starting weight. Compared with non-participating peers, participants demonstrated reduced weight, improved fasting blood glucose, and improved nutritional intake after a year.

CONCLUSIONS

The digital health program was effective for engaging employees in health behavior change. Digital options facilitate widespread implementation.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Does Organizational and Coworker Support Moderate Diabetes Risk and Job Stress Among Employees?

PURPOSE

Examine the moderating role of perceived organizational and coworker support on the relationship between job stress and type 2 diabetes risk among employees.

DESIGN

A cross-sectional survey was administered to employees at the workplace.

SETTING

One national retail organization.

PARTICIPANTS

Baseline data were obtained from 1595 employees in 21 retail stores.

MEASURES

Self-reported organizational and coworker support to encourage and fulfill job responsibilities and job stress. Diabetes risk was calculated using age, gender, race/ethnicity, blood pressure, physical activity, weight status, and self-reported diagnosed type 2 diabetes.

ANALYSIS

Multilevel multiple regression was conducted to test the interaction effect of support on the association between job stress and diabetes risk.

RESULTS

Mean age was 37.95 years (±12.03) and body mass index was 26.72 (±4.95). Three percent of participants reported diagnosed diabetes. Organizational support was positively associated with coworker support. Both were negatively associated with job stress. Organizational support, but not coworker support, moderated the relationship of job stress with diabetes risk. Participants with greater perceived organizational support had lower diabetes risk scores compared to those with lower perceived organizational support.

CONCLUSION

Organizational support may be a key factor for workplaces to reduce stress and diabetes risk. Further testing of organizations' supportive role on employee health may be helpful in developing future workplace programs.

A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP

OBJECTIVE

An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination.

METHODS

A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives.

RESULTS

The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1).

CONCLUSIONS

This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.

Exploring Changes in Two Types of Self-Efficacy Following Participation in a Chronic Disease Self-Management Program

Chronic conditions and falls are related issues faced by many aging adults. Stanford’s Chronic Disease Self-Management Program (CDSMP) added brief fall-related content to the standardized 6-week workshop; however, no research had examined changes in Fall-related self-efficacy (SE) in response to CDSMP participation. This study explored relationships and changes in SE using the SE to manage chronic disease scale (SEMCD Scale) and the Fall Efficacy Scale (FallE Scale) in participants who successfully completed CDSMP workshops within a Southern state over a 10-month period. SE scale data were compared at baseline and post-intervention for 36 adults (mean age = 74.5, SD = ±9.64). Principal component analysis (PCA), using oblimin rotation was completed at baseline and post-intervention for the individual scales and then for analysis combining both scales as a single scale. Each scale loaded under a single component for the PCA at both baseline and post-intervention. When both scales were entered as single meta-scale, the meta-scale split along two factors with no double loading. SEMCD and FallE Scale scores were significantly correlated at baseline and post-intervention, at least p < 0.05. A significant proportion of participants improved their scores on the FallE Scale post-intervention (p = 0.038). The magnitude of the change was also significant only for the FallE Scale (p = 0.043). The SEMCD Scale scores did not change significantly. Study findings from the exploratory PCA and significant correlations indicated that the SEMCD Scale and the FallE Scale measured two distinct but related types of SE. Though the scale scores were correlated at baseline and post-intervention, only the FallE Scale scores significantly differed post-intervention. Given this relationship and CDSMP’s recent addition of a 10-min fall prevention segment, further exploration of CDSMP’s possible influence on Fall-related SE would provide useful understanding for health promotion in aging adults.

FUEL Your Life: A Translation of the Diabetes Prevention Program to Worksites

Purpose.

To evaluate the effectiveness of FUEL Your Life, a translation of the Diabetes Prevention Program for worksites.

Design.

A randomized control group design was conducted in five worksites of a large transportation company. Measures were collected pretest, posttest (6 months), and follow-up (12 months).

Setting.

Railroad maintenance facilities of Union Pacific Railroad.

Subjects.

Participants consisted of 362 workers (227 treatment, 135 control).

Intervention.

FUEL Your Life was translated from the Diabetes Prevention Program to better fit within the context of the worksite. The primary difference was the use of peer health coaches to provide social support and reinforcement and an occupational nurse to provide lesson content (six sessions of 10 minutes) to participants instead of the lifestyle coaches employed by the Diabetes Prevention Program, resulting in a less structured meeting schedule.

Measures.

The primary outcomes were weight and body mass index (BMI), with secondary outcomes including eating behaviors, physical activity, and social support.

Analysis.

Latent growth modeling was used to measure changes in the outcomes over time.

Results.

Participants in the intervention group maintained weight/BMI (–.1 pounds/–.1 BMI), whereas the control participants gained weight/BMI (+2.6 pounds/+.3 BMI), resulting in a statistically significant difference between groups. Fifty-five percent of intervention participants lost some weight, whereas only 35% of the control group lost weight.

Conclusions.

FUEL Your Life, a low intensity intervention, was not effective for promoting weight loss, but was effective for helping workers maintain weight over a 12-month period.

Associations between supportive leadership and employees self-rated health in an occupational sample

BACKGROUND

Protecting the health of the work force has become an important issue in public health research.

PURPOSE

This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees.

METHOD

We drew on cross-sectional data from a cohort of industrial workers (n = 3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort-reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations.

RESULTS

Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95-2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26-2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups.

CONCLUSION

SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.

Chronic disease self-management program in the workplace: opportunities for health improvement

Disease management is becoming increasingly important in workplace health promotion given the aging workforce, rising chronic disease prevalence, and needs to maintain a productive and competitive American workforce. Despite the widespread availability of the Chronic Disease Self-Management Program (CDSMP), and its known health-related benefits, program adoption remains low in workplace settings. The primary purpose of this study is to compare personal and delivery characteristics of adults who attended CDSMP in the workplace relative to other settings (e.g., senior centers, healthcare organizations, residential facilities). This study also contrasts characteristics of CDSMP workplace participants to those of the greater United States workforce and provides recommendations for translating CDSMP for use in workplace settings. Data were analyzed from 25,664 adults collected during a national dissemination of CDSMP. Only states and territories that conducted workshops in workplace settings were included in analyses (n = 13 states and Puerto Rico). Chi-squared tests and t-tests were used to compare CDSMP participant characteristics by delivery site type. CDSMP workplace participant characteristics were then compared to reports from the United States Bureau of Labor Statistics. Of the 25,664 CDSMP participants in this study, 1.7% (n = 435) participated in workshops hosted in worksite settings. Compared to CDSMP participants in non-workplace settings, workplace setting participants were significantly younger and had fewer chronic conditions. Differences were also observed based on chronic disease types. On average, CDSMP workshops in workplace settings had smaller class sizes and workplace setting participants attended more workshop sessions. CDSMP participants in workplace settings were substantially older and a larger proportion were female than the general United States workforce. Findings indicate opportunities to translate CDSMP for use in the workplace to reach new target audiences.

National workplace health promotion surveys: the Affordable Care Act and future surveys

This commentary reviews findings from the four previous national surveys of workplace health promotion activities (1985, 1992, 1999, and 2004, respectively) and offers recommendations for future surveys mandated under the Affordable Care Act of 2010. Future surveys should place greater emphasis on assessing program quality, reach, and effectiveness. Both employer and employee input should be sought. In addition, sampling plans should differentiate worksites from employers, and results should include public as well as private sector organizations. Ideas are offered for addressing these limitations and for creating a sustainable survey process and multifunctional database of results.

Factors related to rural young adolescents' participation in outdoor, noncompetitive physical activity

PURPOSE

Young adolescents who have little interest in participating in competitive team sports are at an increased risk for physical inactivity. Noncompetitive outdoor physical activity can provide young adolescents with increased opportunities to participate in physical activities that appeal to them and have positive health effects. The purpose of this study was to examine factors related to rural young adolescents' participation in noncompetitive outdoor physical activity to inform intervention design.

METHOD

Young adolescents aged 10 to 14 years old (N = 1,032) from 1 rural county completed a self-administered questionnaire assessing constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) related to noncompetitive outdoor physical activity. Structural equation modeling was used to examine an integrated conceptual model of hypothesized relationships among constructs.

RESULTS

The hypothesized conceptual model provided a good fit to the data with greater perceptions of autonomy support and self-determined motivation having statistically significant positive indirect effects on participation in noncompetitive outdoor physical activity mediated by the constructs of the TPB. All direct paths in the model were statistically significant; however, the direct effect of attitudes on intention was weak (.08) and self-determined motivation had no indirect effect on intention through attitudes (.03).

CONCLUSIONS

Constructs of SDT and TPB should be accounted for by interventions targeting noncompetitive outdoor physical activity among young adolescents. More research is needed to determine young adolescents' preferences for noncompetitive and competitive physical activity and the potential influence that noncompetitive outdoor physical activity may have on total daily physical activity.

Applying RE-AIM to the Evaluation of FUEL Your Life

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce.

The safety and effectiveness of a long-acting transdermal fentanyl solution compared with oxymorphone for the control of postoperative pain in dogs: a randomized, multicentered clinical study

A prospective, double-blinded, positive-controlled, multicenter, noninferiority study was conducted to evaluate the safety and effectiveness of transdermal fentanyl solution (TFS) compared with oxymorphone for the control of postoperative pain in dogs. Five hundred and two (502) client-owned dogs were assigned to a single dose of TFS (2.7 mg/kg) applied 2–4 h prior to surgery or oxymorphone hydrochloride (0.22 mg/kg) administered subcutaneously 2–4 h prior to surgery and q6h through 90 h. Pain was evaluated over 4 days by blinded observers using a modified Glasgow composite pain scale, and the a priori criteria for treatment failure was a pain score ≥8 or adverse event necessitating withdrawal. Four TFS- and eight oxymorphone-treated dogs were withdrawn due to lack of pain control. Eighteen oxymorphone-treated, but no TFS-treated dogs were withdrawn due to severe adverse events. The one-sided upper 95% confidence interval of the difference between TFS and oxymorphone treatment failure rates was −5.3%. Adverse events associated with oxymorphone were greater in number and severity compared with TFS. It was concluded that a single administration of TFS was safe and noninferior to repeated injections of oxymorphone for the control of postoperative pain over 4 days at the dose rates of both formulations used in this study.

Observation of associated near-side and away-side long-range correlations in sqrt[s(NN)]=5.02 TeV proton-lead collisions with the ATLAS detector

Two-particle correlations in relative azimuthal angle (Δø) and pseudorapidity (Δη) are measured in sqrt[s(NN)] = 5.02 TeV p+Pb collisions using the ATLAS detector at the LHC. The measurements are performed using approximately 1 μb(-1) of data as a function of transverse momentum (p(T)) and the transverse energy (ΣE(T)(Pb)) summed over 3.1 < η < 4.9 in the direction of the Pb beam. The correlation function, constructed from charged particles, exhibits a long-range (2 < |Δ η | < 5) "near-side" (Δø ~ 0) correlation that grows rapidly with increasing ΣE(T)(Pb). A long-range "away-side" (Δø ~ π) correlation, obtained by subtracting the expected contributions from recoiling dijets and other sources estimated using events with small ΣE(T)(Pb), is found to match the near-side correlation in magnitude, shape (in Δη and Δø) and ΣE(T)(Pb) dependence. The resultant Δø correlation is approximately symmetric about π/2, and is consistent with a dominant cos2Δø modulation for all ΣE(T)(Pb) ranges and particle p(T).

Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum

Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥ 2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.

Differentiating athlete's heart from inherited cardiac pathology: the challenge of repolarisation abnormalities presenting during anaesthesia

This case report describes an asymptomatic healthy male professional athlete who underwent general anaesthesia for a routine orthopaedic operation. Peri-procedure, pronounced ST elevation suggestive of myocardial ischaemia manifested on the electrocardiogram lasting for four hours post-procedure, upon which the athlete developed deep and diffuse inferolateral T-wave inversion. These changes resolved spontaneously and the patient remained clinically stable throughout. This case demonstrates the clinical conundrum facing anaesthetists attempting to differentiate between repolarisation anomalies that are commonly observed in high-level athletes and those of inherited cardiac pathology, namely hypertrophic cardiomyopathy, which is the leading cause of sudden cardiac death in young athletes.

Measurement of Z boson production in Pb-Pb collisions at sqrt[s(NN)]=2.76 TeV with the ATLAS detector

The ATLAS experiment has observed 1995 Z boson candidates in data corresponding to 0.15  nb(-1) of integrated luminosity obtained in the 2011 LHC Pb+Pb run at sqrt[s(NN)]=2.76  TeV. The Z bosons are reconstructed via dielectron and dimuon decay channels, with a background contamination of less than 3%. Results from the two channels are consistent and are combined. Within the statistical and systematic uncertainties, the per-event Z boson yield is proportional to the number of binary collisions estimated by the Glauber model. The elliptic anisotropy of the azimuthal distribution of the Z boson with respect to the event plane is found to be consistent with zero.

Search for dark matter candidates and large extra dimensions in events with a photon and missing transverse momentum in pp collision data at sqrt[s]=7 TeV with the ATLAS detector

Results of a search for new phenomena in events with an energetic photon and large missing transverse momentum in proton-proton collisions at sqrt[s] = 7 TeV are reported. Data collected by the ATLAS experiment at the LHC corresponding to an integrated luminosity of 4.6 fb(-1) are used. Good agreement is observed between the data and the standard model predictions. The results are translated into exclusion limits on models with large extra spatial dimensions and on pair production of weakly interacting dark matter candidates.

Search for magnetic monopoles in sqrt[s]=7 TeV pp collisions with the ATLAS detector

This Letter presents a search for magnetic monopoles with the ATLAS detector at the CERN Large Hadron Collider using an integrated luminosity of 2.0  fb(-1) of pp collisions recorded at a center-of-mass energy of sqrt[s]=7  TeV. No event is found in the signal region, leading to an upper limit on the production cross section at 95% confidence level of 1.6/ϵ  fb for Dirac magnetic monopoles with the minimum unit magnetic charge and with mass between 200 GeV and 1500 GeV, where ϵ is the monopole reconstruction efficiency. The efficiency ϵ is high and uniform in the fiducial region given by pseudorapidity |η|<1.37 and transverse kinetic energy 600-700<E(kin)sinθ<1400  GeV. The minimum value of 700 GeV is for monopoles of mass 200 GeV, whereas the minimum value of 600 GeV is applicable for higher mass monopoles. Therefore, the upper limit on the production cross section at 95% confidence level is 2 fb in this fiducial region. Assuming the kinematic distributions from Drell-Yan pair production of spin-1/2 Dirac magnetic monopoles, the efficiency is in the range 1%-10%, leading to an upper limit on the cross section at 95% confidence level that varies from 145 fb to 16 fb for monopoles with mass between 200 GeV and 1200 GeV. This limit is weaker than the fiducial limit because most of these monopoles lie outside the fiducial region.

Search for direct top squark pair production in final states with one isolated lepton, jets, and missing transverse momentum in sqrt[s] = 7 TeV pp collisions using 4.7 fb(-10 of ATLAS data

A search is presented for direct top squark pair production in final states with one isolated electron or muon, jets, and missing transverse momentum in proton-proton collisions at sqrt[s] = 7 TeV. The measurement is based on 4.7 fb(-1) of data collected with the ATLAS detector at the LHC. Each top squark is assumed to decay to a top quark and the lightest supersymmetric particle (LSP). The data are found to be consistent with standard model expectations. Top squark masses between 230 GeV and 440 GeV are excluded with 95% confidence for massless LSPs, and top squark masses around 400 GeV are excluded for LSP masses up to 125 GeV.

Search for a supersymmetric partner to the top quark in final states with jets and missing transverse momentum at sqrt[s] = 7 TeV with the ATLAS detector

A search for direct pair production of supersymmetric top squarks (t(1)) is presented, assuming the t(1) decays into a top quark and the lightest supersymmetric particle, χ(1)(0), and that both top quarks decay to purely hadronic final states. A total of 16 (4) events are observed compared to a predicted standard model background of 13.5(-3.6)(+3.7)(4.4(-1.3)(+1.7)) events in two signal regions based on ∫Ldt = 4.7 fb(-1) of pp collision data taken at sqrt[s] = 7 TeV with the ATLAS detector at the LHC. An exclusion region in the t(1) versus χ(1)(0) mass plane is evaluated: 370<m(t)(1)}<465 GeV is excluded for m(χ)(1)(0) ~ 0 GeV while m(t)(1) = 445 GeV is excluded for m(χ)(1)(0) ≤ 50 GeV.

The effectiveness of a long-acting transdermal fentanyl solution compared to buprenorphine for the control of postoperative pain in dogs in a randomized, multicentered clinical study

A prospective, double-blinded, positive-controlled, multicenter, noninferiority clinical study was conducted to evaluate the safety and effectiveness of a long-acting transdermal fentanyl solution (TFS) for the control of postoperative pain. Four hundred forty-five client-owned dogs of various breeds were randomly assigned to receive a single dose of TFS (2.6 mg/kg [∼50 μL/kg]) (N = 223) applied 2-4 h prior to surgery or buprenorphine (20 μg/kg) (N = 222) administered intramuscularly 2-4 h prior to surgery and every 6 h through 90 h. There were 159 (35.7%) males and 286 (64.3%) females ranging from 0.5 to 16 years of age and 3 to 98.5 kg enrolled. Pain was scored using the modified Glasgow Composite Pain Scale with an a priori dropout criteria of ≥ 8 (20 maximum score). The one-sided upper 95% confidence interval of the mean difference between fentanyl and buprenorphine treatment failures was 5.6%, which was not greater than the a priori selected margin difference of 15%. Adverse events attributed to either treatment were minimal in impact and were approximately equal between groups. Sustained plasma fentanyl concentrations provided by a single pre-emptive dose of TFS are safe and effective and are noninferior to repeated injections of buprenorphine in controlling postoperative pain over 4 days. This long-acting fentanyl formulation provides veterinarians with a novel, registered option for the control of postoperative pain in dogs that improves dosing compliance and potentially mitigates the disadvantages of oral, parenteral, and patch delivered opioids.

Worksite translation of the Diabetes Prevention Program: formative research and pilot study results from FUEL Your Life

This article summarizes formative research and pilot study findings from a workplace translation of the Diabetes Prevention Program (DPP). The overarching goal was to devise a relatively straightforward weight management intervention suitable for use in a wide array of work settings. This project was conducted in conjunction with Union Pacific Railroad at one of their locomotive maintenance facilities. Participating employees were predominately male and middle-aged. Formative data were collected through stakeholder interviews, focus groups, and direct observation of the work environment. These results were used to adapt the DPP into a largely self-directed intervention augmented by peer health coaches and the on-site nurse. A small pilot test of the adapted program (n = 67) produced modest but statistically significant weight reductions at both 6 (core intervention period) and 12 months (maintenance period). These results are discussed in terms of the original DPP and other DPP translation studies.

Baseline Predictors of Success When Comparing Two Treatments

Since few medications are equally effective in all patients, physicians can maximize the risk/benefit ratio of therapy for their patients by limiting exposure based on baseline predictors of success. Traditional procedures typically evaluate the response of patients receiving the same treatment regimen without evaluating a comparator. However, when treatments are compared, such as in clinical trials, traditional procedures of identifying predictors must be modified to analyze the treatment effect on the primary outcome variable. We focus on clinical and statistical considerations that arise when developing baseline predictors through models which consider treatment differences. To illustrate an application of this method, we used data from 1,026 patients completing at least 6 months of double-blind therapy in clinical trials comparing fluoxetine (N=522) with placebo (N=504) for weight loss. Stepwise regression procedures were used to identify baseline variables which were predictive of a beneficial fluoxetine treatment effect on last-visit-carried-forward (LVCF) weight change. In this example, age, smoking activity, and uric acid concentration were the best baseline predictors of long-term treatment effect relative to LVCF weight change. Patients were more likely to achieve long-term benefit with fluoxetine if they were older, and/or were nonsmokers, and/or had high concentrations of uric acid at baseline. These predictors, developed through models keying on treatment effect, can be used to identify patients who are more likely to accrue benefits with active therapy beyond those expected with placebo therapy, thus enriching the treatment population so that a higher proportion of treated patients are successful.

Process evaluation results from an environmentally focused worksite weight management study

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.

Search for supersymmetry in events with three leptons and missing transverse momentum in √[s]=7 TeV pp collisions with the ATLAS detector

A search for the weak production of charginos and neutralinos decaying to a final state with three leptons (electrons or muons) and missing transverse momentum is presented. The analysis uses 2.06 fb(-1) of √[s]=7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with standard model expectations in two signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric and simplified models. For the simplified models, degenerate lightest chargino and next-to-lightest neutralino masses up to 300 GeV are excluded for mass differences from the lightest neutralino up to 300 GeV.

Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector

A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.

Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes

Objectives

To evaluate the electrocardiographic (ECG) characteristics of West-Asian, black and Caucasian male athletes competing in Qatar using the 2010 recommendations for 12-lead ECG interpretation by the European Society of Cardiology (ESC).

Design

Cardiovascular screening with resting 12-lead ECG analysis of 1220 national level athletes (800 West-Asian, 300 black and 120 Caucasian) and 135 West-Asian controls was performed.

Results

Ten per cent of athletes presented with ‘uncommon’ ECG findings. Black African descent was an independent predictor of ‘uncommon’ ECG changes when compared with West-Asian and Caucasian athletes (p<0.001). Black athletes also demonstrated a significantly greater prevalence of lateral T-wave inversions than both West-Asian and Caucasian athletes (6.1% vs 1.6% and 0%, p<0.05). The rate of ‘uncommon’ ECG changes between West-Asian and Caucasian athletes was comparable (7.9% vs 5.8%, p>0.05). Seven athletes (0.6%) were identified with a disease associated with sudden death; this prevalence was two times higher in black athletes than in West-Asian athletes (1% vs 0.5%), and no cases were reported in Caucasian athletes and West-Asian controls. Eighteen West-Asian and black athletes were identified with repolarisation abnormalities suggestive of a cardiomyopathy, but ultimately, none were diagnosed with a cardiac disease.

Conclusion

West-Asian and Caucasian athletes demonstrate comparable rates of ECG findings. Black African ethnicity is positively associated with increased frequencies of ‘uncommon’ ECG traits. Future work should examine the genetic mechanisms behind ECG and myocardial adaptations in athletes of diverse ethnicity, aiding in the clinical differentiation between physiological remodelling and potential cardiomyopathy or ion channel disorders.

Management support of workplace health promotion: field test of the leading by example tool

PURPOSE

This study tested a repeated-measures application of the Leading by Example (LBE) questionnaire, a self-report instrument measuring organizational leadership support for health promotion.

DESIGN

The efficacy of the LBE was tested in a quasi-experimental health promotion intervention trial. Twelve worksites were assigned to three intervention conditions (i.e., control, moderate, high intensity).

SETTING

The worksites were selected from a large U.S.-based chemical company.

SUBJECTS

Baseline data were collected from employees in various job roles in 2005 (N  =  125). Follow-up data were collected in 2006 (N  =  114) and 2007 (N  =  106). Response rates ranged from 54% to nearly three-fourths of potential respondents.

INTERVENTION

Worksites assigned to both treatment conditions received changes in the built environment via supports for weight management. Worksites assigned to the intense condition received additional elements designed to impact leadership's support for a positive health promotion climate.

MEASURES

Four LBE factors measuring management support for health were assessed over time.

ANALYSIS

The Kruskal-Wallis H-test and analyses of variance/covariance were used to compare LBE scores.

RESULTS

Significant changes from baseline to 2006 were identified for the four factors (p  =  .000) of the LBE. No significant changes were found from 2006 to 2007.

CONCLUSIONS

The LBE effectively captured perceptions of management support for health. Researchers and practitioners alike should consider using the LBE to track and evaluate perceptions of management support for health promotion.

Dose relations between goal setting, theory-based correlates of goal setting and increases in physical activity during a workplace trial

The effectiveness of an intervention depends on its dose and on moderators of dose, which usually are not studied. The purpose of the study is to determine whether goal setting and theory-based moderators of goal setting had dose relations with increases in goal-related physical activity during a successful workplace intervention. A group-randomized 12-week intervention that included personal goal setting was implemented in fall 2005, with a multiracial/ethnic sample of employees at 16 geographically diverse worksites. Here, we examined dose-related variables in the cohort of participants (N = 664) from the 8 worksites randomized to the intervention. Participants in the intervention exceeded 9000 daily pedometer steps and 300 weekly minutes of moderate-to-vigorous physical activity (MVPA) during the last 6 weeks of the study, which approximated or exceeded current public health guidelines. Linear growth modeling indicated that participants who set higher goals and sustained higher levels of self-efficacy, commitment and intention about attaining their goals had greater increases in pedometer steps and MVPA. The relation between change in participants' satisfaction with current physical activity and increases in physical activity was mediated by increases in self-set goals. The results show a dose relation of increased physical activity with changes in goal setting, satisfaction, self-efficacy, commitment and intention, consistent with goal-setting theory.

Do intervention fidelity and dose influence outcomes? Results from the move to improve worksite physical activity program

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

Making work safer: testing a model of social exchange and safety management

INTRODUCTION

This study tests a conceptual model that focuses on social exchange in the context of safety management. The model hypothesizes that supportive safety policies and programs should impact both safety climate and organizational commitment. Further, perceived organizational support is predicted to partially mediate both of these relationships.

METHODS

Study outcomes included traditional outcomes for both organizational commitment (e.g., withdrawal behaviors) as well as safety climate (e.g., self-reported work accidents). Questionnaire responses were obtained from 1,723 employees of a large national retailer.

RESULTS

Using structural equation modeling (SEM) techniques, all of the model's hypothesized relationships were statistically significant and in the expected directions. The results are discussed in terms of social exchange in organizations and research on safety climate.

IMPACT ON INDUSTRY

Maximizing safety is a social-technical enterprise. Expectations related to social exchange and reciprocity figure prominently in creating a positive climate for safety within the organization.

Search for new bottomlike quark pair decays QQ-->(tW(+)(-))(tW(+)(-)in same-charge dilepton events

We report the most restrictive direct limits on masses of fourth-generation down-type quarks b{'}, and quarklike composite fermions (B or T{5/3}), decaying promptly to tW{-/+}. We search for a significant excess of events with two same-charge leptons (e, mu), several hadronic jets, and missing transverse energy. An analysis of data from pp collisions with an integrated luminosity of 2.7 fb{-1} collected with the CDF II detector at Fermilab yields no evidence for such a signal, setting mass limits m{b{'}}, m{B}>338 GeV/c{2} and m{T{5/3}}>365 GeV/c{2} at 95% confidence level.

Measurement of D{0}-D[-over]{0} mixing from a time-dependent amplitude analysis of D{0}-->K+pi{-}pi{0} decays

We present evidence of D{0}-D[-over ]{0} mixing using a time-dependent amplitude analysis of the decay D{0}-->K+pi{-}pi;{0} in a data sample of 384 fb{-1} collected with the BABAR detector at the PEP-II e+e{-} collider at the Stanford Linear Accelerator Center. Assuming CP conservation, we measure the mixing parameters x{Kpipi{0}}{'}=[2.61{-0.68}{+0.57}(stat)+/-0.39(syst)]%, y{Kpipi;{0}}{'}=[-0.06{-0.64}{+0.55}(stat)+/-0.34(syst)]%. This result is inconsistent with the no-mixing hypothesis with a significance of 3.2 standard deviations. We find no evidence of CP violation in mixing.

Exploring relationships among anger, perceived organizational support, and workplace outcomes

The present study examines anger within a perceived organizational support (POS) theory framework. Using structural equation modeling, the authors explored relationships among POS, anger, and workplace outcomes in a sample of 1,136 employees in 21 stores of a U.S. retail organization. At both individual and store levels, low POS was directly associated with greater anger. At the individual level, anger partially mediated relationships among low POS and turnover intentions, absences, and accidents on the job. Anger had direct and indirect effects on alcohol consumption and health-related risk taking. At the store level, anger had direct negative effects on inventory loss and turnover. The authors interpret these findings in light of social exchange theory and emotion regulation theory.