Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults.

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1.

BACKGROUND: Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period. OBJECTIVE: As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers. METHODS: Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures. RESULTS: Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common. CONCLUSION: Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

Prevalence of workplace violence against young workers in the United States.

BACKGROUND: Workers under the age of 25 may be at particular risk for workplace violence, given their predominant employment in the high-risk retail and service industries. Little research exists, however, that estimates the scope of the problem within this population. To fill this gap, we conducted the first national study of workplace violence against young people in the United States. METHODS: We analyzed survey data collected via telephone interview from a national sample of 1031 young workers ages 14 through 24 who held a formal job in the last 12 months. Weighted frequencies were calculated and χ2 tests of significance were used to detect differences between groups. RESULTS: Many youth experience workplace violence (60%). Verbal abuse of the sort that made victims feel scared and unsafe (53%) and sexual harassment (24%) were the most commonly reported forms of violence. Females were more likely than males to experience workplace violence overall (p < 0.001) and sexual harassment (p < 0.001) in particular. Males were more likely to experience verbal abuse (p < 0.001). Workplace violence was most prevalent among workers in healthcare settings and eating and drinking places. The occupation with the highest prevalence of workplace violence was customer service. CONCLUSIONS: Workplace violence is common among young workers in the United States and more widespread than prior estimates have suggested. This study is the first to provide a true national prevalence estimate of the problem of workplace violence among young workers ages 14 to 24 in the United States. These findings should be used to locate areas of concern and target resources where they are needed most to address this significant problem.

If Smoking Were Eliminated, Which US Counties Would Still Have High Rates of Smoking-Related Cancers?

OBJECTIVE: to characterize the county variability of the impact of smoking elimination on rates of smoking-related cancers and explore whether common environmental indices predicted which metropolitan counties would experience high rates of smoking-related cancers even after smoking was eliminated. METHODS: Surveillance, Epidemiology, and End Results Program (SEER) and Environmental Protection Agency (EPA) data were obtained. County level cancer rates for 257 metropolitan SEER counties, including the observed rates and those predicted after eliminating smoking, were derived via multilevel regression modeling and age standardized to the 2016 SEER population. Associations between the EPA's Environmental Quality Index (EQI) scores and "Low Benefit" counties (counties that remain above the top 20th percentile of post-smoking elimination incidence rates) were explored via logistic regression. RESULTS: Reductions in smoking-related cancer incidence ranged from 58.4 to 3.2%. The overall EQI (OR = 1.96, 95% CI [1.34, 2.86]) and the air quality index (OR = 5.99, 95% CI [3.20, 11.22]) scores predicted higher odds of being a "Low Benefit" county. CONCLUSIONS: Substantial inequities in the post-smoking elimination cancer rates were observed; air pollution appears to be a primary explanation for this. Cancer prevention in metropolitan counties with high levels of air pollution should prioritize pollution control at least as much as tobacco control.

Left Ventricular Thrombus of Unknown Etiology in a Patient With COVID-19 Disease With No Significant Medical History.

The incidence of left ventricular thrombus is relatively low. Ventricular thrombi typically manifest in patients with reduced ejection fraction and post myocardial infarction [1]. The impact of COVID-19's hypercoagulability state is presented here. A 44 year old male who contracted COVID-19, progressed to moderate disease requiring inpatient treatment with supplemental oxygen. During the course of the hospital stay, while receiving National Institutes of Health guideline directed thromboembolism prophylaxis for COVID-19 infected patients [2], the patient developed a left ventricular thrombus which consequently embolized and occluded the left anterior descending and left circumflex coronary arteries requiring rheolytic thrombectomy.

A comparison of owner/operator and worker perspectives on workplace safety in the West Virginia logging industry.

BACKGROUND: The logging industry is known to have one of the highest rates of fatal and nonfatal occupational injuries in the United States. Perspectives on why this study is so hazardous may differ between logging company owners/operators and workers. In this study, we explored and compared the safety perspectives of logging company owners/operators and workers in West Virginia. METHODS: Using a mixed-methods approach, we analyzed survey (n = 245) and interview (n = 14) data collected in 2015 from logging company owners/operators and workers in West Virginia. Survey data were analyzed via logistic regression; interview data were analyzed using thematic analysis. Response patterns were contrasted by occupational status (owners/operators vs. workers) in both analyses. RESULTS: Owners/operators and workers agreed on several aspects of workplace safety including the importance of personal protective equipment and the benefits of mechanization when timber harvesting. Key differences observed between owners/operators and workers included why injuries are underreported and the effects of production pressures on safety. CONCLUSION: While there was much agreement, owners/operators and workers in the West Virginia logging industry reported differences in key domains of workplace safety. These differences should be taken into account when designing and implementing safety programs in the logging industry.

Exploring differences in the workplace violence experiences of young workers in middle and late adolescence in the United States.

PROBLEM: Young workers, typically characterized as 15-24 years of age, are commonly employed in jobs where the risk of workplace violence is high. It is unknown how these young workers, at varying stages of development, might understand and respond to workplace violence differently. We set out to explore whether the experiences and understandings of young workers varied between those in middle (ages 15-17) and late (ages 18-24) adolescence. METHOD: Separate focus groups were conducted with working students (n = 31), ages 15-17 and ages 18-24, who had either experienced or witnessed workplace violence. A focus group guide was used to facilitate the sessions which were recorded, transcribed, and content analyzed for themes. RESULTS: Those in the older group experienced more severe episodes of sexual harassment and physical assault, reported using formal mechanisms for reporting, and noticed an employer focus on customer satisfaction over employee safety, while the younger participants tended to report to their parents. Both groups reported negative effects of experiencing workplace violence including depression, anxiety, feelings of worthlessness, and spill over into personal life. DISCUSSION: Findings suggest that young workers at different developmental stages may experience and respond to workplace violence differently. Further research is needed to see if these results are generalizable. SUMMARY: It is imperative that we understand the distinct differences between these subsets of young workers and how they experience and respond to workplace violence in order to improve research, policy development, and prevention/intervention mechanisms. Practical Applications: Understanding that differences exist among young workers based on age due to developmental stage, lack of experience, education, and social awareness can enable employers, companies, policy makers, and researchers the opportunity to better address the issue of workplace violence in this population.

Cancer rates not explained by smoking: a county-level analysis.

BACKGROUND: Debates over the importance of "lifestyle" versus "environment" contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates. METHODS: Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006-2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates. RESULTS: Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = - 0.8, 95% CI = - 1.0 to - 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = - 0.1, 95% CI = - 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties. CONCLUSIONS: Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens.

Work-related deaths among youth: Understanding the contribution of US child labor violations.

BACKGROUND: Evidence shows that violations of the United States (US) child labor regulations are common. The main purpose of this study was to investigate the magnitude and nature of work-related deaths among youth involving violations of US child labor regulations. METHODS: We analyzed Census of Fatal Occupational Injury data from 2001 to 2012 using descriptive statistics and Chi-square tests. RESULTS: Between 2001 and 2012, 406 workers under age 18 were recorded in the CFOI as having suffered a fatal work-related injury. Among these cases, 233 were covered by the US child labor regulations. Forty-three percent of these cases involved at least one violation. The majority of cases that were not covered by the regulations involved decedents working on their family's farms (N = 139). CONCLUSIONS: Violations of federal child labor regulations are a significant contributor to work-related deaths among youth in the United States. Increased investment in enforcement is needed to prevent further young worker deaths involving child labor violations. Am. J. Ind. Med. 59:959-968, 2016. © 2016 Wiley Periodicals, Inc.

Occupational fatalities among young workers in the United States: 2001-2012.

BACKGROUND: While adolescent workers in the United States (US) are protected by child labor laws, they continue to suffer fatal occupational injuries. This study was designed to provide a comprehensive profile of occupational fatalities among this sub-population of US workers. METHODS: Using Census of Fatal Occupational Injuries data between 2001 and 2012, we calculated descriptive statistics and rates to examine the magnitude and nature of fatalities among workers under age 18. RESULTS: During the study period, there were 406 fatalities among young workers which translated into 24,790 years of potential life lost; 12,241 of which were in agriculture alone. Rates declined since 2001 yet Hispanics, foreign-born workers, males, and those working in agriculture continued to suffer a disproportionate fatality burden. CONCLUSIONS: Efforts to reduce young worker fatalities should focus on male Hispanics, particularly those who are foreign-born, as well as agricultural workers as these groups have the greatest fatality risks. Am. J. Ind. Med. 59:445-452, 2016. © 2016 Wiley Periodicals, Inc.

Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures.

OBJECTIVE: To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures. DESIGN: A 10-year retrospective cohort study. SETTING: A single large academic teaching hospital. PARTICIPANTS: Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010 and 2,113 reported percutaneous BBFE were analyzed. METHODS: A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices. RESULTS The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture needles (0.96 [0.88-1.04]). CONCLUSIONS: Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

Quantification of Dihydroxyacetone Phosphate (DHAP) in Human Red Blood Cells by HPLC-TripleTOF 5600™ Mass Spectrometer.

Triosephosphate isomerase (TPI) is a glycolytic enzyme which catalyzes the interconversion between glyceraldehyde-3-phosphate (G3P) and dihydroxyacetone phosphate (DHAP). TPI deficiency results in accumulation of DHAP in human red blood cells and other tissues. The disease is characterized by congenital hemolytic anemia, and progressive neuromuscular dysfunction. The laboratory diagnosis is generally made by measurement of TPI activity in RBCs. Measurement of DHAP can be useful in further confirmation and follow-up of the disease. We developed HPLC/TOF-MS method for quantitation of DHAP in RBCs. The method involves simple protein precipitation, reverse phase C8 column chromatography, ion pairing with tributylamine, and long run time of 50 min to separate the two isomers (G3P and DHAP).

Factors affecting high school teacher adoption, sustainability, and fidelity to the "Youth@Work: Talking Safety" curriculum.

BACKGROUND: Our objective was to identify individual- and organizational-level factors that affect high school teacher adoption, sustainability, and fidelity to the occupational safety and health curriculum, "Youth@Work: Talking Safety." METHODS: We analyzed survey data collected from 104 high school teachers across the US who were trained in the curriculum since 2004. Linear and Cox regression were used to examine bivariate associations between individual and organizational-level factors and the outcomes of interest. RESULTS: Except for perceived complexity, all individual-level factors (acceptance, enthusiasm, teaching methods fit, and self-efficacy) were associated with one or more outcomes of interest (P-values ranged from <0.001 to 0.031). Priority for non-academic courses (P = 0.035) and supportive organizational climate (P = 0.037) were the organizational-level factors associated with sustainability and number of lessons delivered, respectively. CONCLUSIONS: Consistent with the literature, individual-level factors influenced teacher adoption and, to a lesser extent, sustainability, and fidelity to the Youth@Work: Talking Safety curriculum and should be considered in attempts to promote the curriculum's use in high schools.

Early transduction produces highly functional chimeric antigen receptor-modified virus-specific T-cells with central memory markers: a Production Assistant for Cell Therapy (PACT) translational application.

BACKGROUND: Virus-specific T-cells (VSTs) proliferate exponentially after adoptive transfer into hematopoietic stem cell transplant (HSCT) recipients, eliminate virus infections, then persist and provide long-term protection from viral disease. If VSTs behaved similarly when modified with tumor-specific chimeric antigen receptors (CARs), they should have potent anti-tumor activity. This theory was evaluated by Cruz et al. in a previous clinical trial with CD19.CAR-modified VSTs, but there was little apparent expansion of these cells in patients. In that study, VSTs were gene-modified on day 19 of culture and we hypothesized that by this time, sufficient T-cell differentiation may have occurred to limit the subsequent proliferative capacity of the transduced T-cells. To facilitate the clinical testing of this hypothesis in a project supported by the NHLBI-PACT mechanism, we developed and optimized a good manufacturing practices (GMP) compliant method for the early transduction of VSTs directed to Epstein-Barr virus (EBV), Adenovirus (AdV) and cytomegalovirus (CMV) using a CAR directed to the tumor-associated antigen disialoganglioside (GD2). RESULTS: Ad-CMVpp65-transduced EBV-LCLs effectively stimulated VSTs directed to all three viruses (triVSTs). Transduction efficiency on day three was increased in the presence of cytokines and high-speed centrifugation of retroviral supernatant onto retronectin-coated plates, so that under optimal conditions up to 88% of tetramer-positive VSTs expressed the GD2.CAR. The average transduction efficiency of early-and late transduced VSTs was 55 ± 4% and 22 ± 5% respectively, and early-transduced VSTs maintained higher frequencies of T cells with central memory or intermediate memory phenotypes. Early-transduced VSTs also had higher proliferative capacity and produced higher levels of TH1 cytokines IL-2, TNF-α, IFN-γ, MIP-1α, MIP-1ß and other cytokines in vitro. CONCLUSIONS: We developed a rapid and GMP compliant method for the early transduction of multivirus-specific T-cells that allowed stable expression of high levels of a tumor directed CAR. Since a proportion of early-transduced CAR-VSTs had a central memory phenotype, they should expand and persist in vivo, simultaneously protecting against infection and targeting residual malignancy. This manufacturing strategy is currently under clinical investigation in patients receiving allogeneic HSCT for relapsed neuroblastoma and B-cell malignancies (NCT01460901 using a GD2.CAR and NCT00840853 using a CD19.CAR).

Setting culture apart: distinguishing culture from behavior and social structure in safety and injury research.

The concept of culture is now widely used by those who conduct research on safety and work-related injury outcomes. We argue that as the term has been applied by an increasingly diverse set of disciplines, its scope has broadened beyond how it was defined and intended for use by sociologists and anthropologists. As a result, this more inclusive concept has lost some of its precision and analytic power. We suggest that the utility of this "new" understanding of culture could be improved if researchers more clearly delineated the ideological - the socially constructed abstract systems of meaning, norms, beliefs and values (which we refer to as culture) - from concrete behaviors, social relations and other properties of workplaces (e.g., organizational structures) and of society itself. This may help researchers investigate how culture and social structures can affect safety and injury outcomes with increased analytic rigor. In addition, maintaining an analytical distinction between culture and other social factors can help intervention efforts better understand the target of the intervention and therefore may improve chances of both scientific and instrumental success.

Occupational health literacy and work-related injury among U.S. adolescents.

Building on the concept of 'health literacy' used in the U.S., we developed an analogous measure specific to safety in the workplace labeled 'occupational health literacy' (OHL) and investigated whether OHL is a protective factor against work-related injury (WRI) among adolescents. Using cross-sectional survey data from 2262 14 to 18-year olds in five high schools across the US, we found that OHL (level of occupational safety and health (OSH) information and training received combined with knowledge and awareness of OSH information and concepts) is positively associated with WRI prevalence. This association appears to be largely driven by the OHL subscale on respondents' receipt of safety training, which likely represents job hazardousness and may be overwhelming any protective effect of OHL on work injury. This exploratory study has shown that more precise measurement of OHL and confounding variables (job hazardousness) will be crucial in further studies exploring a OHL-WRI relationship.