bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep Deprivation and Injuries in Part-Time Kentucky Farmers: Impact of Self Reported Sleep Habits and Sleep Problems on Injury Risk
Authors: Spengler Susan E. , Browning Steven R. , Reed Deborah B.
Published: March 2019

Part-time farmers who hold off-farm jobs may be at risk for injuries because of impaired performance resulting from inadequate sleep. For this study, 1,004 part-time male Kentucky farmers completed a telephone interview for the 1994 to 1995 National Institute for Occupational Safety and Health-funded Farm Family Health and Hazard Surveillance Project. Questions were included about demographics, sleep habits, and injury occurrence. Twelve percent of the farmers reported an injury requiring medical intervention in the previous year. Farmers reported sleeping an average of 7.6 hours daily. Approximately 6.7% of the sample had three symptoms of sleep apnea. Although hours of sleep were not related to injury incidence, sleep medication use (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.01 to 4.40) and presence of three sleep apnea symptoms (OR = 2.48, 95% CI = 1.13 to 5.41) were related to injury incidence. These data support the need for further research to examine sleep habits and promote strategies that reduce the risk for injuries caused by lack of sleep
Occupational Health Nursing in Brazil: Exploring the World through International Occupational Health Programs
Authors: Marziale Maria Helena , Hong Oisaeng
Published: March 2019

The next International Commission on Occupational Health (ICOH) Congress will be a celebration of its 100th anniversary, held in Milan, Italy from June 11 to 16, 2006. With significant improvements in the understanding of occupational health at the international level, it is hoped that all occupational health professionals throughout the world can celebrate 100 years of progress and accomplishments at this Congress. With this goal, the AAOHN Journal has been running a special series of articles focusing on “Exploring the World Through International Occupational Health Programs” organized by OiSaeng Hong, PhD, RN, Assistant Professor and Director, Occupational Health Nursing Program, Division of Health Promotion and Risk Reduction, School of Nursing, University of Michigan, Ann Arbor, Michigan. This is the fourth article of the series.
What are Some Challenges Related to Return to Work Policies, Procedures, and Processes?
Authors: Kalina Christine M. , Haag Annette B.
Published: March 2019

Case Management Update appears as part of Clinical Rounds in the Journal. The panel approach provides a forum for sharing ideas, viewpoints, and perspectives. Panel members come with expertise from a variety of case management arenas and have agreed to share their opinions and perspectives in response to specific questions or scenarios. Opinions and perspectives are those of the panel members, and do not necessarily represent the views of the AAOHN, the Editor, or the Publisher. We encourage readers to submit their questions or scenarios for the Panel. This month's Panel members include Christine M. Kalina and Annette B. Haag.
Employee Perceptions of Diabetes Education Needs: A Focus Group Study
Authors: Wood Felecia , Jacobson Sharol
Published: March 2019

The purpose of this descriptive non-experimental research was to assess employee perceptions of desired diabetes education through focus groups. Thirteen employees of a southern university in three focus groups identified many standard and some emerging educational topics of interest including healthier food choices when eating out, increasing activity, deciding whether highly advertised “special” products for diabetes were necessary, and recognizing the importance of obesity among children. The employees were willing to attend group meetings related to diabetes, but not to pay for them. The information will be used to plan an intervention to promote diabetes prevention and self-management in a worksite environment where diabetes costs are rising rapidly, and to support the need for a university wellness program. Occupational health nurses can address both employees' needs and employers' costs through such a program.
Influenza Vaccination: Incidence of Symptoms and Resulting Absenteeism in Hospital Employees
Authors: Speroni Karen Gabel , Dawson Elaine , Atherton Martin , Corriher Joy
Published: March 2019

A convenience sample of hospital workers, those receiving influenza vaccine and those not receiving vaccine, were asked to complete questionnaires delineating the occurrence of symptoms (e.g., fever, headache, extreme tiredness, dry cough, sore throat, runny nose, stuffy nose, muscle aches) and absenteeism in the 7-day period post-vaccination if vaccinated. Those unvaccinated completed the questionnaire in a self-selected 7 consecutive day period during the study conducted from November 2004 to February 2005. Those receiving either Fluzone® or FluMist™ reported significantly fewer symptoms and related absenteeism than the unvaccinated group (p < .05). Administration of influenza vaccine did not result in higher rates of post-vaccination symptoms as compared to an unvaccinated group. Further, vaccinated employees did not experience higher absenteeism rates as a result of receiving either influenza vaccine. However, for those reporting absenteeism as a result of symptoms, mean absenteeism days were highest in the FluMist group (4.5 days) compared to the unvaccinated group (2.1 days) and the Fluzone group (1.9 days).
Musculoskeletal Injuries among Ultrasound Sonographers in Rural Manitoba
Authors: Friesen Margaret N. , Friesen Rebecca , Quanbury Arthur , Arpin Suzanne
Published: March 2019

The purpose of this study was to compare the epidemiology of musculoskeletal injuries and workplace ergonomics among rural-based sonographers compared to urban-based sonographers. The authors also tested the use of a biomechanical software program to assess load on the spine and upper extremity joints. A mail-in survey was sent to all practicing sonographers in rural Manitoba, and on-site video-taped ergonomic and biomechanical evaluations were completed for four sites. Rural-based sonographers appear to have greater work stress related to waiting lists, use of outdated and non-adjustable equipment, and high client load. They also do not advocate for better working conditions because they are few in number and geographically distant from one another. Use of the biomechanical software proved minimally useful. Information related to industry standards and greater collaboration is needed to promote workplace health for sonographers.
Under What Circumstances Should a Case Manager Seek an Independent Medical Evaluation, and is There a Good Method of Selecting an Examiner for This Purpose?
Authors: Brown Norman D. , Tourigian Robin
Published: March 2019

Case Management Update appears as part of Clinical Rounds in the Journal. The panel approach provides a forum for sharing ideas, viewpoints, and perspectives. Panel members come with expertise from a variety of case management arenas and have agreed to share their opinions and perspectives in response to specific questions or scenarios. Opinions and perspectives are those of the panel members and do not necessarily represent the views of the AAOHN, the Editor, or the Publisher. We encourage readers to submit their questions or scenarios for the panel. This month's panel members include Norman Brown and Robin Tourigian.
Health and Safety Needs of Older Farmers
Authors: Lizer Shannon K. , Petrea Robert E.
Published: March 2019

A random sample ( N = 87) of older Illinois farmers was surveyed to assess their experiences with traumatic injuries and the relationship between injury rate and age, type of farm activities, amount of stress, and hours of work per week. Farmers' knowledge of safety was assessed. Findings revealed that the number of hours worked, age, and type of farm activities were not significantly related to the number of injuries reported. However, self-reported stress, when stratified by age, was found to be related to injury among farmers aged 55 to 59 years. Also, scores on a farm safety quiz were found to be higher (less knowledge) among farmers who reported more injuries. Items in the safety quiz frequently missed by farmers included falls as a source of injury (29.2%), children being commonly injured on farms (19%), the cause of farmers' lung disease (46.9%), and animals as a cause of injury on farms (12.9%).
Sharps Injuries and Bloodborne Pathogen Exposures in Home Health Care
Authors: Chalupka Stephanie M. , Markkanen Pia , Galligan Catherine , Quinn Margaret
Published: March 2019

Home health care is one of the fastest growing industries in the United States. Approximately 20,000 provider agencies deliver home health care services to 7.6 million individuals with acute illness, long-term health conditions, permanent disability, or terminal illness. The home health care setting poses many challenges that likely increase the risk of sharps injuries. Home health nurses face unique challenges in preventing and reporting sharps injuries in the home. This article examines the nature of and risk factors for sharps injuries in the home health care setting, the scope of the problem, the legislative and regulatory framework relevant to sharps injuries, and the role of occupational health nurses in promoting a culture of safety to prevent sharps injuries and bloodborne pathogen exposures.
A Measure of University Employees' Exposure to Risk Factors for Work-Related Musculoskeletal Disorders
Authors: Fisher Thomas , Gibson Troy
Published: March 2019

This study examined the computer workstations of 50 faculty and staff at a regional comprehensive university in the southeastern United States. Data were collected using a subjective questionnaire and the observational Computer Workstation Analysis tool. The researchers found no significant differences between participants' perceptions of their risk for work-related musculoskeletal disorders (WRMDs) and observations of workstations at the worksite. The researchers recommend developing an ergonomics program delivered by occupational health team members with knowledge and skill in WRMD prevention, identification, and treatment.
Venipuncture Syncope—One Occupational Health Clinic's Experience
Authors: Childre Frances , Barker Lori J.
Published: March 2019

Occupational health nurses must anticipate this complication of phlebotomy and recognize that, in certain situations, it is an OSHA-recordable event.
Metal Fume Fever
Authors: Chalupka Andrew N. , Chalupka Stephanie
Published: March 2019

Metal fume fever is an occupational hazard in metal-working industries.
Psychometric Properties of a Modified Version of a Worksite Harassment Tool—Preliminary Findings
Authors: Strasser Patricia B. , Al-Modallal Hanan , Hall Lynne , Anderson Debra
Published: March 2019

This study examined the psychometric properties of a modified version of a worksite harassment tool. Data were collected from 180 long-haul female drivers. Cronbach's alpha was used to assess internal consistency. Principal components analysis was used to investigate the tool's dimensionality, and correlation analysis was used to investigate construct validity. Cronbach's alpha for the tool was 0.88. Principal components analysis indicated the presence of two factors. Two items were eliminated due to low factor loadings. Cronbach's alpha for the short version (7 items) was 0.86. Higher abuse scores were associated with poorer health and greater levels of stress. The greater the level of abuse, the poorer the woman's ability to sleep. The 7-item version of the worksite harassment tool is valid and reliable, easy to understand, and written at a 7th grade reading level.
Acute Occupational Exposure to Hydrogen Sulfide
Authors: Chalupka Andrew N. , Chalupka Stephanie
Published: March 2019

Occupational exposures to hydrogen sulfide occur in a wide variety of sectors.
The Pregnant Health Care Worker—An Evidence-Based Approach to Job Assignment and Reassignment
Authors: Childre Frances , Hood Joyce
Published: March 2019

Women of childbearing age must carefully consider the risks and benefits of working in the field of health care prior to becoming pregnant.
Transition from the Afghanistan and Iraqi Battlefields to Home
Authors: Brown Norman D.
Published: March 2019

Occupational health nurses are encountering veterans in the workplace who have served one or more tours of duty in Afghanistan or Iraq. Soldiers making the transition from combat to civilian life may have physical and mental injuries from war. Occupational health nurses who recognize the unique nature of these injuries and are knowledgeable about resources for meeting veterans' needs will be instrumental in facilitating their return to civilian life.
Redesign of Occupational Health Service Operations—Strategic Planning and Evaluation
Authors: Strasser Patricia B. , Tobias Beverley , Burnes-Line Bernadette , Pellarin Margaret
Published: March 2019

This article describes the strategic planning process used by a major academic medical center to redesign the employee health service. The steps in the process are discussed and data demonstrating the success of the program redesign are presented.
Preventing Skin Cancer among a Farming Population
Authors: Gaetano Diana E. , Hodge Bernadette , Clark Arleen , Ackerman Susan , Burdick Patrick , Cook Mary Lou Wranesh
Published: March 2019

Agricultural workers are at risk for developing skin cancer due to exposures to ultraviolet radiation. Occupational health nurses implemented a skin cancer screening during an agricultural trade show to facilitate primary and secondary prevention of skin cancer through risk assessment, visual skin examination, counseling, and education. The purpose of this article is to present an evidence-based practice model that describes the demographics of a skin cancer screening population, self-reported risk factors, the occurrence of presumptive diagnoses, and compliance with health-related recommendations. Eighty-eight individuals were screened. Thirty-nine (44%) of all screened participants were referred for further evaluation. Of the 39 referrals, 16 (41%) were recommended for biopsy. One month after the screening, 21 (54%) of the participants had completed or arranged follow-up. Status of the identified lesion was also explored. General comments yielded statements that demonstrated appreciation for the screening, teaching, reminders, and encouragement.
High Blood Pressure—When Should Employees Be Sent Home from Work?
Authors: Childre Frances , Foster Donna
Published: March 2019

This article explores guidelines for hypertension and why individuals do not control their hypertension.
Improving Workplace Safety Training Using a Self-Directed CPR-AED Learning Program
Authors: Mancini Mary E. , Cazzell Mary , Kardong-Edgren Suzan , Cason Carolyn L. , Berryman Phyllis , Lukes Eileen
Published: March 2019

RESEARCH ABSTRACT Adequate training in cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) is an important component of a workplace safety training program. Barriers to traditional in-classroom CPR-AED training programs include time away from work to complete training, logistics, learner discomfort over being in a classroom setting, and instructors who include information irrelevant to CPR. This study evaluated differences in CPR skills performance between employees who learned CPR using a self-directed learning (SDL) kit and employees who attended a traditional instructor-led course. The results suggest that the SDL kit yields learning outcomes comparable to those obtained with traditional instructor-led courses and is a more time-efficient tool for CPR-AED training. Furthermore, the SDL kit overcomes many of the barriers that keep individuals from learning CPR and appears to contribute to bystanders' confidently attempting resuscitation.
Psychosocial Factors Contributing to Occupational Injuries among Direct Care Workers
Authors: Zontek Tracy L. , Isernhagen Jody C. , Ogle Burton R. , Strasser Patricia B.
Published: March 2019

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (χ2 = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.
Nurses' and Therapists' Experiences with Occupational Musculoskeletal Injuries
Authors: Gropelli Theresa M. , Corle Kim
Published: March 2019

Occupational musculoskeletal injuries are costly to the health care industry. It is estimated that 12% of nurses leave the profession annually because of back injuries. With the use of grounded theory methodology, 15 nursing personnel and physical therapists were interviewed about their perceptions of occupational musculoskeletal injuries. Analysis of the data identified major themes, including feelings of fear and frustration; chronic issue and part of the job; love of the profession and concerns about continuing in the profession; increased risk of injury; compliant with treatment; negative impact on quality of life; negative feelings about the occupational health department; and educational needs. A theory began to emerge in which health care workers accepted occupational injuries as part of the job and took no action or initiated only minor interventions to prevent work-related injuries. The study indicates a need for education and better communication.
You're a Published Author!
Authors: Wachs Joy E. , Williamson Geraldine , Moore Pamela V. , Roy Deborah , Childre Frances
Published: March 2019

Once a nurse author writes a quality manuscript, the article is submitted to an appropriate journal, reviewed by the editor, and sent to review panel members with expertise consistent with the topic of the article or the methodology of research articles. After review, panel members recommend the article be published, accepted for publication after revision, revised without promise of publication, or rejected. Nurse authors have options as to how they handle the recommendation. To successfully publish in a peer-reviewed journal, nurse authors should communicate with the editor and realize that the editor and author have the same goals.
A Clinical Ladder for Occupational Health Nurses
Authors: Lang Yolanda C.
Published: March 2019

Occupational health nurses must have a growing, expanding knowledge base to remain current in practice. The American Board for Occupational Health Nurses, Inc. encourages advancement with the availability of certification examinations. Health care centers support clinical advancement programs for bedside nurses. Nurses who continue their education either through a degree program or via continuing education or certification advance up the clinical ladder, receiving a higher salary, recognition from their peers, and perhaps even financial assistance to continue climbing, yet occupational health nurses do not have their own clinical advancement ladder. This article examines the steps necessary to develop a clinical ladder and presents a clinical ladder specific to occupational health nursing developed by the author.
Professionalism among Occupational Health Nurses
Authors: Primm Robin D.
Published: March 2019

Occupational health nurses can use the Wheel of Professionalism to assess their own behaviors and then set goals to improve professionalism in practice.
Tailored E-Mails in the Workplace
Authors: Yap Tracey L. , James Diane M. Busch
Published: March 2019

Employee wellness programs can potentially contribute to a stronger and healthier work force, with increased dexterity and positive mental health. Programs that keep the work force physically active can reduce heart disease, type 2 diabetes, hypertension, hyperlipidemia, cerebrovascular accident, and workplace injury. The occupational health nurse provides information to motivate employees to take the first step toward an active lifestyle. The purpose of this article is to present the qualitative evaluation results of an intervention study that tested the effectiveness of tailored e-mail communications designed to increase intentional physical activity in a group of manufacturing workers. The increase in overall physical activity demonstrates the effectiveness of the workplace interventions. Research will now strengthen theoretical concepts, refine messages, and increase both the dose and the power of the interventions.
Registered Nurses and Influenza Vaccination
Authors: Toronto Coleen E. , Mullaney Susan M.
Published: March 2019

Influenza is a serious infectious disease, causing 226,000 hospitalizations and 36,000 deaths in the United States each year. Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers receive influenza vaccination annually. Current CDC reports indicate that only 40% of health care workers receive influenza vaccination. Vaccination rates are lower among registered nurses than other health care workers. This integrative review encompasses international research published between 2003 and 2009, and explores factors that influence nurses' decision to receive or decline influenza vaccination. Findings indicated that concerns about the vaccine's safety and efficacy continue to be major barriers for registered nurses. Future efforts to improve vaccination rates should include rigorous education on vaccine efficacy and safety specific to nursing personnel.
Mortality among Members of a Truck Driver Trade Association
Authors: Birdsey Jan , Alterman Toni , Li Jia , Petersen Martin R. , Sestito John
Published: March 2019

Previous studies report that truck drivers are at increased risk for illness and on-the-job mortality. It is unknown whether owner-operator truck drivers face the same risks as employee drivers, yet few studies have targeted owner-operators as a study population. This study examined the overall and cause-specific mortality ratios for a cohort with owner-operator truck drivers constituting 69% of the study population. Of the 26 major disease classifications and 92 specific causes of death examined, only mortality due to transportation accidents was significantly elevated (standardized mortality ratio = 1.52, 95% confidence interval = 1.36–1.70). Leading causes of death were ischemic heart disease and lung cancer, although risk was below that of the general population. Transportation accidents pose a particular hazard for members of the trade association. The absence of excess disease mortality deserves careful interpretation, and may be due to both a strong healthy worker effect and a short monitoring period.
Integrating Primary Care with Occupational Health Services
Authors: Griffith Karen , Strasser Patricia B.
Published: March 2019

This article describes the process used by a large U.S. manufacturing company to successfully integrate full-service primary care centers at two locations. The company believed that by providing employees with health promotion and disease prevention services, including screening, early diagnosis, and uncomplicated illness treatment, its health care costs could be significantly reduced while saving employees money. To accurately demonstrate the cost-effectiveness of adding primary care to existing occupational health services, a thorough financial analysis projected the return on investment (ROI) of the program. Decisions were made about center size, the scope of services, and staffing. A critical part of the ROI analysis involved evaluating employee health claim data to identify the actual cost of health care services for each center and the projected costs if the services were provided on-site. The pilot initiative included constructing two on-site health center facilities staffed with primary care physicians, nurse practitioners, physical therapists, and other health care professionals. Key outcome metrics from the pilot clinics exceeded goals in three of four categories. In addition, clinic use after 12 months far exceeded benchmarks for similar clinics. Most importantly, the pilot clinics were operating with a positive cash flow within the first year and demonstrated an increasingly positive ROI.
The Occupational Vision Assessment
Authors: Tompkins Olga S.
Published: March 2019

The occupational vision assessment identifies visual ability that is below the standard for a safe and effective level of productivity. Early identification and prevention of further vision loss enhances workplace productivity and job performance quality.
Early Detection of Colon Cancer Following Incidental Finding of Clostridium septicum Bacteremia
Authors: Sidhu Jasdeep Singh , Mandal Amrendra , Virk Jeevanjot , Gayam Vijay
Published: March 2019

Clostridium septicum is a Gram-positive, anaerobic, spore-forming bacillus found in the intestine. It is linked to colon cancer and immunosuppression. Infection with C septicum may vary in manifestation and is associated with more than 60% mortality rate. In this article, we present a case of incidental isolation of C septicum in a patient who presented with fever and later on colonoscopy was found to have colon carcinoma. Bacteremia may be the unexpected initial presentation of undiagnosed colon carcinoma.
Constructing Matched Groups in Dental Observational Health Disparity Studies for Causal Effects
Authors: Cheng J. , Gregorich S.E. , Gansky S.A. , Fisher-Owens S.A. , Kottek A.M. , White J.M. , Mertz E.A.
Published: March 2019

Introduction:

Electronic health record (EHR) systems provide investigators with rich data from which to examine actual impacts of care delivery in real-world settings. However, confounding is a major concern when comparison groups are not randomized.

Objectives:

This article introduced a step-by-step strategy to construct comparable matched groups in a dental study based on the EHR of the Willamette Dental Group. This strategy was employed in preparation for a longitudinal study evaluating the impact of a standardized risk-based caries prevention and management program across patients with public versus private dental insurance in Oregon.

Methods:

This study constructed comparable dental patient groups through a process of 1) evaluating the need for and feasibility of matching, 2) considering different matching methods, and 3) evaluating matching quality. The matched groups were then compared for their average ratio in the number of decayed, missing, and filled tooth surfaces (DMFS + dmfs) at baseline.

Results:

This systematic process resulted in comparably matched groups in baseline covariates but with a clear baseline disparity in caries experience between them. The weighted average ratio in our study showed that, at baseline, publicly insured patients had 1.21-times (95% CI: 1.08 to 1.32) and 1.21-times (95% CI: 1.08 to 1.37) greater number of DMFS + dmfs and number of decayed tooth surfaces (DS + ds) than privately insured patients, respectively.

Conclusion:

Matching is a useful tool to create comparable groups with EHR data to resemble randomized studies, as demonstrated by our study where even with similar demographics, neighborhood and clinic characteristics, publicly insured pediatric patients had greater numbers of DMFS + dmfs and DS + ds than privately insured pediatric patients.

Knowledge Transfer Statement:

This article provides a systematic, step-by-step strategy for investigators to follow when matching groups in a study—in this case, a study based on electronic health record data. The results from this study will provide patients, clinicians, and policy makers with information to better understand the disparities in oral health between comparable publicly and privately insured pediatric patients who have similar values in individual, clinic, and community covariates. Such understanding will help clinicians and policy makers modify oral health care and relevant policies to improve oral health and reduce disparities between publicly and privately insured patients.
Expanding Pharmacist and Student Pharmacist Access to Genetics/Genomics/Pharmacogenomics Competency Education
Authors: Kisor David F , Farrell Christopher L
Published: March 2019

Background:

As pharmacogenomics (PGx), a component of genetics/genomics and precision medicine, gains traction in the clinical setting, education of health care providers and health professions students must be made broadly available to improve accessibility of such services to patients. As medication experts with education in pharmacology, pharmacokinetics, and pharmacodynamics, pharmacists must further their education to include pharmacogenomics. Currently, few opportunities exist to gain this type of education, and therefore, these services are not yet broadly available to the public.

Objective:

The specific goal of this study was to evaluate pharmacists’ and student pharmacists’ self-assessed perception of competence related to genetics, genomics, and pharmacogenomics as presented via an online “pharmacogenomics certification program” (PGx program).

Design:

The PGx program was delivered online with the content consisting of 3 background lessons and 8 specific drug-gene lessons presented in the context of pharmacist competency statements. In addition, 11 “video modules” with competency-related PGx content were included to provide a comprehensive program. A pre- and post-course survey instrument was used to evaluate the participants’ self-assessed perception of competence related to each of 16 statements.

Results:

One hundred thirty-seven (137) individuals enrolled in and completed the pharmacogenomics certification program. Overall, participants reported self-perceived improved competency as evidenced by the pre-course survey as compared with the post-course survey for each of the 16 competency statements related to genetics/genomics, including pharmacogenomics. Similar results were observed for the subgroups of student pharmacists (n = 63) and pharmacists (n = 74).

Future direction:

This study showed that dissemination of genetics/genomics/pharmacogenomics competency statements education can be accomplished via online delivery. This delivery approach can expand genetics/genomics/pharmacogenomics content dissemination. The intent is to reach a broader population of pharmacy students, pharmacists, and other health care providers and health professions students to potentially advance the availability of such services, which can improve the safety and efficacy of medication use for patients.
Historical view on the attempts to understand the function of sleep in the school of Ivan Pavlov and his Russian forerunners and followers
Authors: Pigarev Ivan N , Pigareva Marina L
Published: March 2019

We reviewed the ideas of Ivan Pavlov and his Russian forerunners (Ivan Tarkhanov and Maria Manaseina) and followers (Nikolai Rozjanskiy and Konstantin Bykov) on the functional role of sleep. This analysis led to the conclusion that the state of sleep is connected with functional operations that have not been considered in the past and are also not being investigated in present neuroscience. Thus, a real understanding of the function of sleep may only come with a new neurophysiological paradigm.
Phase 1b study of venetoclax-obinutuzumab in previously untreated and relapsed/refractory chronic lymphocytic leukemia
Authors: Flinn Ian W. , Gribben John G. , Dyer Martin J. S. , Wierda William , Maris Michael B. , Furman Richard R. , Hillmen Peter , Rogers Kerry A. , Iyer Swaminathan Padmanabhan , Quillet-Mary Anne , Ysebaert Loic , Walter Harriet S. , Verdugo Maria , Klein Christian , Huang Huang , Jiang Yanwen , Lozanski Gerard , Pignataro Daniela Soriano , Humphrey Kathryn , Mobasher Mehrdad , Kipps Thomas J.
Published: March 2019

This single-arm, open-label, phase 1b study evaluated the maximum tolerated dose (MTD) of venetoclax when given with obinutuzumab and its safety and tolerability in patients with relapsed/refractory (R/R) or previously untreated (first line [1L]) chronic lymphocytic leukemia (CLL). Venetoclax dose initially was escalated (100-400 mg) in a 3 + 3 design to define MTD combined with standard-dose obinutuzumab. Patients received venetoclax (schedule A) or obinutuzumab (schedule B) first to compare safety and determine dose/schedule for expansion. Venetoclax-obinutuzumab was administered for 6 cycles, followed by venetoclax monotherapy until disease progression (R/R) or fixed duration 1-year treatment (1L). Fifty R/R and 32 1L patients were enrolled. No dose-limiting toxicities were observed. Safety, including incidence of tumor lysis syndrome (TLS), did not differ between schedules (2 laboratory TLSs per schedule). Schedule B and a 400-mg dose of venetoclax were chosen for expansion. The most common grade 3-4 adverse event was neutropenia (R/R, 58% of patients; 1L, 53%). Rates of grade 3-4 infections were 29% (R/R) and 13% (1L); no fatal infections occurred in 1L. All infusion-related reactions were grade 1-2, except for 2 grade 3 events. No clinical TLS was observed. Overall best response rate was 95% in R/R (complete response [CR]/CR with incomplete marrow recovery [CRi], 37%) and 100% in 1L (CR/CRi, 78%) patients. Rate of undetectable (<10−4) minimal residual disease (uMRD) in peripheral blood for R/R and 1L patients, respectively, was 64% and 91% ≥3 months after last obinutuzumab dose. Venetoclax and obinutuzumab therapy had an acceptable safety profile and elicited durable responses and high rates of uMRD. This trial was registered at www.clinicaltrials.gov as #NCT01685892.
RECIST 1.1 for Response Evaluation Apply Not Only to Chemotherapy-Treated Patients But Also to Targeted Cancer Agents: A Pooled Database Analysis
Authors: Litière Saskia , Isaac Gaëlle , De Vries Elisabeth G.E. , Bogaerts Jan , Chen Alice , Dancey Janet , Ford Robert , Gwyther Stephen , Hoekstra Otto , Huang Erich , Lin Nancy , Liu Yan , Mandrekar Sumithra , Schwartz Lawrence H. , Shankar Lalitha , Therasse Patrick , Seymour Lesley ,   on behalf of the RECIST Working Group
Published: March 2019

PURPOSE

The mode of action of targeted cancer agents (TCAs) differs from classic chemotherapy, which leads to concerns about the role of RECIST in evaluating tumor response in trials with TCAs. We investigated the performance of RECIST using a pooled database from 50 clinical trials with at least one TCA.

METHODS

We examined the impact of the number of target lesions (TLs) on within-patient variability of tumor response. The prognostic effect of TL response (at 12 weeks or on study on the basis of a maximum five TLs) on survival was studied through landmark and time-dependent Cox models adjusted for baseline tumor load, occurrence of new lesions, or unequivocal progression of nontarget disease.

RESULTS

Data were obtained from 23,259 patients with cancer (36% lung, 28% colorectal, 11% breast, and 25% other); 15,620 received TCAs, predominantly transduction or angiogenesis inhibitors, as a single agent (37%), combined with other TCAs (7%), or as chemotherapy (56%); 28% received chemotherapy only; and 5% received best supportive care or placebo. A total of 17,222 patients contributed to the analyses. Within-patient variability decreased with increasing number of TLs, similarly for TCAs (with/without chemotherapy) and chemotherapy only. Mixed responses occurred proportionally in all treatment classes. Landmark analyses showed an ordinal relationship between percentage change from baseline to 12 weeks and overall survival, and demonstrated a clear distinction between tumor shrinkage and progressive disease according to RECIST. Time-dependent analysis showed no marked improvement in the ability to predict survival on the basis of TL tumor growth compared with nontarget progression or new lesion occurrence, regardless of treatment. Similar results were seen for major tumor types and different classes of TCAs.

CONCLUSION

This work reinforces that RECIST version 1.1 perform well for response assessment of TCAs.
Clinicopathological Features of Young Versus Older Patients With Breast Cancer at a Single Pakistani Institution and a Comparison With a National US Database
Authors: Zeeshan Sana , Ali Basim , Ahmad Khabir , Chagpar Anees B. , Sattar Abida K.
Published: March 2019

PURPOSE

The age at which women present with breast cancer varies widely among nations, and breast cancer may behave differently in younger women. Differences in clinicopathological characteristics based on age have not been well characterized in Pakistani patients with breast cancer.

METHODS

We conducted a retrospective review of patients with symptoms of breast cancer presenting to Aga Khan University Hospital (AKUH), a large tertiary care center in Pakistan, between 2001 and 2010; we compared young (≤ 40 years) versus older (> 40 years) patients in terms of their clinicopathological characteristics. We also compared this Pakistani cohort with the US population using data from the National Cancer Database (NCDB).

RESULTS

A total of 1,334 patients with breast cancer presented to our center over the 10-year review period. The median age at diagnosis was 50 years, compared with 60 years for patients in the NCDB. In the AKUH cohort, younger patients were significantly more likely than their older counterparts to present with metastatic disease (13.1% v 10.8%; P < .01). They also were more likely to present with higher-grade tumors (grade 3: 40.1% v 28.3%; P < .001), have triple hormone receptor–negative phenotype (25.4% v 14.1%, P < .001), and have positive axillary lymph node involvement (70.9% v 57.5%; P < .001) compared with older women. Younger and older patients in the AKUH cohort tended to present with higher-stage disease ( P < .001) and were more likely to have triple hormone receptor–negative disease ( P < .001), compared with all patients in the NCDB and with those of Indo-Pakistani origin.

CONCLUSION

Young Pakistani women, similar to their Western counterparts, present with more advanced disease and more aggressive tumor biology than their older counterparts.
Pediatric Cancer Outcomes in an Intensive Care Unit in Pakistan
Authors: Khan Sial Gull Zareen , Khan Saadiya Javed
Published: March 2019

PURPOSE

Although cancer is uncommon, it is a significant cause of pediatric morbidity and mortality in the developing world. The need for intensive care in pediatric oncology has increased with more intense chemotherapeutic interventions. It is important to identify patients who will benefit from management in the intensive care unit (ICU), given the resource limitation in developing countries. In this review, we examine our institutional experience with pediatric patients with cancer needing ICU care.

METHODS

A retrospective chart review from December 2015 to June 2017 was performed with institutional review board approval for all pediatric oncology patients admitted to the ICU. Data collection included age, diagnosis, disease stage, Pediatric Risk of Mortality (PRISM III) score, and therapeutic interventions.

RESULTS

We reviewed 59 pediatric oncology ICU medical records. There were 36 boys (61%) and 23 girls (39%). The median age was 4 years. Average stay in the ICU was 4.6 days. Three significant reasons for ICU referral were respiratory distress, sepsis, and circulatory collapse. There were 34 ICU survivors (57.6%). Among those who survived the ICU, 20 patients (58.8%) later died of therapy-related complications. Factors related to increased ICU mortality included the need for mechanical ventilation, the need for inotropic support, the number of failing organs, and a high PRISM III score.

CONCLUSION

The mortality rate for pediatric oncology patients admitted to the ICU in developing countries is higher than in developed countries. Mortality was significantly related to the need for mechanical ventilation. PRISM III scoring can help identify patients who can benefit from ICU treatment, which is expensive in resource-limited low- and middle-income countries such as Pakistan.
Biguanides Exert Antitumoral Actions in Pituitary Tumor Cells Through AMPK-Dependent and -Independent Mechanisms
Authors: Vázquez-Borrego Mari C , Fuentes-Fayos Antonio C , Herrera-Martínez Aura D , L-López Fernando , Ibáñez-Costa Alejandro , Moreno-Moreno Paloma , Alhambra-Expósito María R , Barrera-Martín Ana , Blanco-Acevedo Cristóbal , Dios Elena , Venegas-Moreno Eva , Solivera Juan , Gahete Manuel D , Soto-Moreno Alfonso , Gálvez-Moreno María A , Castaño Justo P , Luque Raúl M
Published: March 2019

Context

Pituitary neuroendocrine tumors (PitNETs) are a commonly underestimated pathology in terms of incidence and associated morbimortality. Currently, an appreciable subset of patients are resistant or poorly responsive to the main current medical treatments [i.e., synthetic somatostatin analogs (SSAs) and dopamine agonists]. Thus, development and optimization of novel and available medical therapies is necessary. Biguanides (metformin, buformin, and phenformin) are antidiabetic drugs that exert antitumoral actions in several tumor types, but their pharmacological effects on PitNETs are poorly known.

Objective

We aimed to explore the direct effects of biguanides on key functions (cell viability, hormone release, apoptosis, and signaling pathways) in primary cell cultures from human PitNETs and cell lines. Additionally, we evaluated the effect of combined metformin with SSAs on cell viability and hormone secretion.

Design

A total of 13 corticotropinomas, 13 somatotropinomas, 13 nonfunctioning PitNETs, 3 prolactinomas, and 2 tumoral pituitary cell lines (AtT-20 and GH3) were used to evaluate the direct effects of biguanides on cell viability, hormone release, apoptosis, and signaling pathways.

Results

Biguanides reduced cell viability in all PitNETs and cell lines (with phenformin being the most effective biguanide) and increased apoptosis in somatotropinomas. Moreover, buformin and phenformin, but not metformin, reduced hormone secretion in a cell type–specific manner. Combination metformin/SSA therapy did not increase SSA monotherapy effectiveness. Effects of biguanides on PitNETs could involve the modulation of AMP-activated protein kinase–dependent ([Ca2+]i, PI3K/Akt) and independent (MAPK) mechanisms.

Conclusion

Altogether, our data unveil clear antitumoral effects of biguanides on PitNET cells, opening avenues to explore their potential as drugs to treat these pathologies.
Optimized Reaction Pair of the CysHis Tag and Ni(II)-NTA Probe for Highly Selective Chemical Labeling of Membrane Proteins
Authors: Zenmyo Naoki , Tokumaru Hiroki , Uchinomiya Shohei , Fuchida Hirokazu , Tabata Shigekazu , Hamachi Itaru , Shigemoto Ryuichi , Ojida Akio
Published: March 2019

Chemical labeling of proteins with synthetic molecular probes offers the possibility to probe the functions of proteins of interest in living cells. However, the methods for covalently labeling targeted proteins using complementary peptide tag-probe pairs are still limited, irrespective of the versatility of such pairs in biological research. Herein, we report the new CysHis tag-Ni(II) probe pair for the specific covalent labeling of proteins. A broad-range evaluation of the reactivity profiles of the probe and the CysHis peptide tag afforded a tag-probe pair with an optimized and high labeling selectivity and reactivity. In particular, the labeling specificity of this pair was notably improved compared to the previously reported one. This pair was successfully utilized for the fluorescence imaging of membrane proteins on the surfaces of living cells, demonstrating its potential utility in biological research.
A liberdade acadêmica no direito brasileiro: fundamentos e abrangência
Authors: Rodrigues Horácio Wanderlei , Oliveira Amanda Muniz
Published: March 2019

O objeto deste trabalho é o princípio da liberdade acadêmica, analisado no âmbito constitucional e infraconstitucional, indicando as suas possibilidades e limites frente ao direito fundamental à educação e à exigência de preservação do pluralismo de ideias, em especial aqueles decorrentes da interação entre as liberdades que a compõe (de ensinar, denominada indevidamente de liberdade de cátedra, de aprender, de pesquisar e de divulgar o conhecimento). Considerando essas questões o artigo caminha no sentido de propor a adoção do termo liberdade acadêmica como o mais adequado e representativo quando se faz referência às diversas liberdades envolvidas nos processos educativos e de produção do conhecimento. Também conclui que a Constituição Federal contém a liberdade acadêmica no âmbito do direito fundamental à educação e como instrumento de garantia do pluralismo de ideias, não como liberdade em si mesma.
Avaliação dos impactos da política pública de cotas na Índia
Authors: Lima José Wilson Ferreira , Machado Bruno Amaral
Published: March 2019

O artigo tem por objetivo avaliar peculiaridades inerentes à adoção do sistema de cotas em contextos sociais, políticos e culturais distintos da sociedade brasileira. Pretende verifi car o impacto que a adoção desse sistema proporcionou em termos de mudanças na ordem social da Índia. Diante dos estudos fundamentados, entende-se que a experiência adquirida em torno dos modelos de cotas que outros países adotaram fornece subsídios esclarecedores e signifi cativos sobre como esses modelos podem operar transformações de acordo com as características de cada sítio de análise, cujas diferenças de organização social, política, econômica, jurídica e religiosa refl etem os aspectos peculiares de cada modelo e, por essemotivo, como podem ser determinantes quanto ao seu sucesso ou ao seu fracasso. Assim, a avaliação dos impactos das políticas públicas instituídas no ambiente internacional pode ser providência útil para o Brasil, visando ao enfrentamento de futuras consequências decorrentes do emprego dessa modalidade de ação afirmativa.
Do Electronic Health Records Affect Quality of Care? Evidence from the HITECH Act
Authors: Lin Yu-Kai , Lin Mingfeng , Chen Hsinchun
Published: March 2019

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act is landmark legislation that places electronic health record (EHR) technologies at the center of health system reform in the United States. This study leverages the meaningful use (MU) provisions of the HITECH Act to quantify different degrees of EHR use in a large and heterogeneous set of hospitals and investigates the impact of EHR use on quality of care. The results provide evidence of EHRs’ positive quality effects and reconcile earlier mixed findings in the EHR evaluation literature by showing that their benefits vary according to different levels of use and hospital characteristics. The effect sizes were larger in disadvantaged (i.e., small and rural) hospitals, suggesting the potential of EHRs in mitigating the disparities in the quality of healthcare.
Online child sexual exploitation, grooming and the law
Authors: Bullock Fiona
Published: March 2019

Online sexual exploitation is an important safeguarding concern and cases are likely to be under-reported. Fiona Bullock discusses the law and the role school nurses can play in prevention and early intervention.
Mindfulness and yoga used to teach pupils coping mechanisms
Authors: Lepkowska Dorothy
Published: March 2019

Mindfulness and yoga are being taught at school to children at risk of exclusion and/or with special needs to help provide them with coping strategies. Dorothy Lepkowska explains
Talking to students about puberty: New resources
Authors: Bates Adele
Published: March 2019

Public Health England has published a range of PSHE resources focused on puberty. Drawing on these and signposting other support, Adele Bates looks at how this sensitive topic can be tackled with students.