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The Lance Creek Formation (Late Cretaceous) is significant in the study of late dinosaurs and is a diverse formation containing both terrestrial and aquatic macrofossils. To study this important ecosystem, all of the fossils present must be uncovered and examined from Lance Creek sedimentary rocks, which exhibit variable degrees of lithification. In order to liberate the fossils, a dissolution methodology was designed to determine which solution was most effective at uncovering specimens and dissolving/disaggregating sediment. Different solutions were tested including water, a 50% Calgon© solution, and a 5% acetic acid solution. The control was a sedimentary rock sample not subjected to any solutions prior to rinsing and sieving. A small-scale dissolution (10 g of loose sediment) was performed using each solution and examined for fossils. Acetic acid was deemed the most effective solution for the dissolution of dense sandstones, and indurated sediment from the Lance Creek Formation. Large-scale disaggregation (800 g of consolidated sedimentary rock) yielded abundant terrestrial, fluvial, and marine macrofossils. Macrofossil disaggregation using these methods has the potential to yield a more diverse assemblage of contemporaneous fossils than macrofossils alone, and can therefore provide substantial insight into ecological reconstructions. • A small-scale study was done to determine which solution was the most efficient at dissolution of sediment. Acetic acid was deemed the most effective. • A large-scale experiment was done on dense sandstones using 5% acetic acid and a shaking incubator. • A large-scale experiment of indurated sediment was performed using 5% acetic acid.

ABSTRACT Objective To assess whether revascularisation that is considered to be clinically appropriate is also cost effective. Design Prospective observational study comparing cost effectiveness of coronary artery bypass grafting, percutaneous coronary intervention, or medical management within groups of patients rated as appropriate for revascularisation. Setting Three tertiary care centres in London. Participants Consecutive, unselected patients rated as clinically appropriate (using a nine member Delphi panel) to receive coronary artery bypass grafting only (n=815); percutaneous coronary intervention only (n=385); or both revascularisation procedures (n=520). Main outcome measure Cost per quality adjusted life year gained over six year follow-up, calculated with a National Health Service cost perspective and discounted at 3.5%/year. Results Coronary artery bypass grafting cost £22 000 (¿33 000; $43 000) per quality adjusted life year gained compared with percutaneous coronary intervention among patients appropriate for coronary artery bypass grafting only (59% probability of being cost effective at a cost effectiveness threshold of £30 000 per quality adjusted life year) and £19 000 per quality adjusted life year gained compared with medical management among those appropriate for both types of revascularisation (probability of being cost effective 63%). In none of the three appropriateness groups was percutaneous coronary intervention cost effective at a Threshold of £30 000 per quality adjusted life year. Among patients rated appropriate for percutaneous coronary intervention only, the cost per quality adjusted life year gained for percutaneous coronary intervention compared with medical management was £47 000, exceeding usual cost effectiveness thresholds; in these patients, medical management was most likely to be cost effective (probability 54%). Conclusions Among patients judged clinically appropriate for coronary revascularisation, coronary artery bypass gr [ABSTRACT FROM AUTHOR]

Fall injuries often occur on extension ladders. The extendable fly section of an extension ladder is typically closer to the user than the base section, though this design is minimally justified. This study investigates the effects of reversing the fly on foot placement, frictional requirements, adverse stepping events (repositioning the foot or kicking the rung), and user preferences. Participant foot placement was farther posterior (rung contacted nearer to toes) in the traditional ladder compared to the reversed fly condition during descent, with farther anterior foot placements during ascent. The reversed configuration had similar friction requirements during early/mid stance and significantly lower frictional requirements during late stance. Increased friction requirements during late stance were associated with farther anterior foot placement and further plantar flexed foot orientation. The reversed fly had 5 adverse stepping events versus 22 that occurred in the traditional configuration. Users typically preferred the reversed fly. These results suggest that a reversed extension ladder configuration offers potential benefits in reducing fall-related injuries that should motivate future research and development work., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Obstructive sleep apnea (OSA) among veterans is frequently underdiagnosed and undertreated. The present study sought to: 1) characterize the prevalence and rate of treatment of OSA among VA users and non-users and 2) examine the associations between diagnosed or probable OSA and key physical and mental health outcomes., Methods: Gulf-War I-era Veterans were recruited as part of a national survey assessing mental and physical health concerns, healthcare needs, and healthcare utilization. OSA diagnoses were self-reported while sleep apnea risk was assessed via the STOP-Bang. Veterans also completed questionnaires assessing overall health, pain, depression, PTSD, and psychosocial functioning., Results: 1,153 veterans were included in the present analyses (Mean age = 58.81; 21.84% female). Compared to non-VA healthcare users, veterans receiving care at the VA were more likely to have been diagnosed with OSA ( p  < .001) and report receiving treatment for OSA ( p  = .005). Compared to veterans at low risk for OSA, veterans at elevated risk reported higher levels of pain ( p  = .001), depression ( p  = .02), and poorer psychosocial functioning ( p  < .001)., Conclusions: OSA diagnoses appear to be more common among VA healthcare users. Findings suggest that OSA remains underdiagnosed and associated with important physical and mental health consequences. Additional screening for OSA, especially among non-VA clinics, is warranted.

Objectives: A seminal study on loneliness and depression suggested that loneliness influences depression more than the reverse. However, the study's analytic method has since been criticized for failing to account for the trait-like nature of variables. This study aimed to examine the longitudinal relationship between loneliness and depressive symptoms while accounting for the trait-like nature of both variables., Methods: Data (n = 16,478) came from the Health and Retirement Study (2006-2016). Measures included the Hughes Loneliness Scale and a modified Center for Epidemiologic Studies Depression scale (loneliness item omitted). Analyses consisted of random intercepts cross-lagged panel models (three time-points evenly spaced across eight years)., Results: There was evidence that loneliness and depressive symptoms are trait-like and these trait-like components are strongly associated. There was not evidence of cross-lagged effects between loneliness and depressive symptoms., Conclusions: A tendency toward loneliness corresponded with a tendency toward depressive symptoms. However, deviations in one's typical level of loneliness did not predict deviations in one's typical level of depressive symptoms or vice-versa. These findings do not support past assertions that loneliness shapes subsequent depression more than the reverse., Clinical Implications: By middle to late adulthood, loneliness and depressive symptoms are trait-like phenomena that are strongly associated.

Severe and fatal falls involving ladders commonly occur during transitions across the ladder and another support surface. Slipping is a common initiating event in ladder falls. This study characterized the friction requirements and body kinematics of descending roof-to-ladder transitions with and without a walk-through extension. Healthy adults who regularly climb ladders (n = 17) completed descending roof-to-ladder transitions, while foot-rung kinetics and body kinematics were recorded. The peak required coefficient of friction (RCOF) with respect to the plane of the shoe sole was calculated. The RCOF and body angle were calculated using their resultant values and projections in the frontal and sagittal planes. Foot angle was calculated in the sagittal plane. Repeated-measures ANOVA determined that compared to a walk-through ladder, a traditional ladder was associated with a higher RCOF in the medial-lateral (ML) direction (F 1,1 6  = 190.07, p < 0.001) and a lower RCOF in the anterior-posterior (AP) direction (F 1,16  = 11.02, p = 0.004), but had no significant relationship with the resultant RCOF (F 1,16  = 0.098, p = 0.76). Spearman's rho tests performed across all testing configurations identified significant associations between foot angle and overall RCOF (r s  = -0.724, p < 0.001), foot angle and AP RCOF (r s  = -0.871, p < 0.001), and frontal plane body angle and ML RCOF (r s  = 0.782, p < 0.001). Clustering in the data suggests that ladder attachments reduced frontal plane kinematics, which altered the direction of RCOF by reducing the medial-lateral component. These results have implications for designing rungs with good friction in multiple directions and the potential for body position monitoring in ladder tasks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Tobacco cessation is reduced in U.S. military veterans experiencing homelessness. Mobile contingency management (mCM) is a promising treatment for tobacco use among populations experiencing homelessness, but past CM studies have largely been small, have relied on in-person follow-up, and/or lacked long-term biochemically verified abstinence measures. Veterans who smoked and were experiencing homelessness (N = 127) were randomly assigned to mCM treatment (4 weeks of mCM, 5 weeks of telehealth counseling, and the option of 12 weeks of pharmacotherapy) or VA standard care (3 biweekly group sessions and clinically appropriate pharmacotherapy), and all participants were randomly assigned to a $100 longer-term financial incentive for abstinence at 3-month follow-up. Participants were followed at 3-, 6-, and 12-months post-randomization, with the a priori main outcome designated as biochemically verified prolonged abstinence (with lapses) at 6-month follow-up. At 6-months, participants in the mCM group were significantly more likely to meet criteria for prolonged abstinence ( OR  = 3.1). Across time points, veterans in the mCM group had twice the odds of prolonged abstinence as those in the standard care group. However, by the 12-month follow-up, there was no statistically significant group difference in abstinence. Cost-effectiveness analysis indicated a modest increase in cost ($1,133) associated with an increase of one quality-adjusted life year saved for the intervention compared to standard care. mCM is a cost-effective approach to smoking cessation among veterans experiencing homelessness. Considering waning potency of this and other tobacco cessation interventions at 12-month follow-up, it is crucial to implement strategies to sustain abstinence for individuals experiencing homelessness., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Measuring shoe-floor friction is critical for assessing the safety of footwear products. Portable devices for measuring coefficient of friction (COF) are needed. This study introduces such a device and evaluates its ability to predict human slip events across shoe designs. A portable device (18 kg) was utilized to measure 66 unique shoe-floor-fluid coefficients of friction (COF). Consistent with the shoes, flooring, and fluid contaminants from the COF tests, participants (n = 66) were unexpectedly exposed to the fluid while walking. Slip predictions were made based on a separate training data set. Slip predictions were made prospectively and using logistic regression analyses. The slip predictions were valid (p < 0.001), 91% sensitive, and 64% specific. The logistic regression fit also revealed that the COF values predicted slip outcomes (p = 0.006). This device is expected to expand the capacity of researchers, product developers, forensic engineers, and safety professionals to prevent slips and enhance human safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Cannabis use has been indicated as a risk factor for suicide in veterans. This study of Gulf War veterans tested the relationship between self-report past year cannabis use and (a) past year suicidal ideation and (b) risk for suicidal behavior. Data were from a national sample ( N  = 1126) of Gulf War veterans. Logistic regression models indicated cannabis use was associated with past year suicidal ideation and elevated risk for suicidal behavior, independent of key covariates. In corroboration with research on other military populations, this study indicates a potentially concerning association between cannabis use and suicide risk in Gulf War veterans.

Background: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder., Methods: This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey., Results: Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD., Limitations: This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts., Conclusions: Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population., (Published by Elsevier B.V.)

Overuse of videoconferencing for work may contribute to what has been called "Zoom fatigue": feeling anxious, socially isolated, or emotionally exhausted due to lack of social connection. Given implications for employee well-being, this study investigated Zoom fatigue at work and its potential link to mental health symptoms. A national survey of mental health symptoms was conducted in the United States during the COVID-19 pandemic in August 2020. Adults ( n  = 902) endorsing a shift at work to videoconferencing completed an online survey; survey criteria included an age minimum of 22 years and reported annual gross income of < $75,000. Statistical raking was employed to weight the sample using U.S. census data on geographic region, age, gender, race, and ethnicity. A three-item Zoom Fatigue Scale measuring perceived stress, isolation, and depression associated with videoconferencing at work showed good internal consistency (α = 0.85). Higher scores on this scale were related to being married, nonwhite race, post-high school education, severe mental illness, greater loneliness, lower social support, lacking money for food, and more weekly videoconference calls. Depressive symptoms demonstrated a significant association with Zoom fatigue, even when adjusting for demographic, psychosocial, and clinical covariates. The study findings indicated that employers and employees should consider a complex array of individual-level and environment-level factors when assessing how videoconferencing at work may engender stress, social isolation, and emotional exhaustion. This impact could adversely impact mental health, work productivity, and quality of life, even after the COVID-19 pandemic.

Construction activities in healthcare settings potentially expose building occupants to waterborne pathogens including Legionella and have been associated with morbidity and mortality. A Water Management for Construction-Infection Control Risk Assessment (WMC-ICRA) tool was developed addressing gaps in building water management programs. This enables healthcare organizations to meet the requirements of ANSI/ASHRAE Standard 188 referenced in numerous guidelines and regulations. A WMC-ICRA was modeled after the ICRA required for prevention and control of airborne pathogens to reduce the risk of healthcare associated infections. The tool allows users to evaluate risk from waterborne pathogen exposure by analyzing construction activities by project category and building occupant risk group. The users then select an appropriate level of risk mitigation measures. Technical aspects (e.g., water age/stagnation, flushing, filtration, disinfection, validation testing), are presented to assist with implementation. An exemplar WMC-ICRA tool is presented as ready for implementation by infection prevention and allied professionals, addressing current gaps in water management, morbidity/mortality risk, and regulatory compliance. To reduce exposure to waterborne pathogens in healthcare settings and improve regulatory compliance, organizations should examine the WMC-ICRA tool, customize it for organization-specific needs, while formulating an organizational policy to implement during all construction activities.

Objective: Depression and chronic pain are major problems in American veterans, yet there is limited long-term research examining how they relate to one another in this population. This study examined the relationship between depressive symptoms and pain in U.S. veterans 50 years of age or older., Methods: This study used data on veterans from the 2002-2016 waves of the Health and Retirement Study (n = 4,302), a large-scale observational study of Americans 50 years of age or older. Measures included a short form of the Center for Epidemiologic Studies Depression scale and two items assessing the presence and degree of pain. Analyses included random-intercept cross-lagged panel models (RI-CLPM)., Results: In the RI-CLPM, there were roughly equivalent cross-lagged effects between depressive symptoms and pain. There was also evidence that depressive symptoms and pain have a trait-like component and that these trait-like characteristics are associated., Conclusions: These findings indicate that depressive symptoms and pain in veterans are stable characteristics in American veterans 50 years of age or older. There appear to be reciprocal effects between the two, whereby deviations in one's typical depressive symptoms predict subsequent deviations in one's pain level and vice versa; however, the size of these effects is very small. These findings suggest that clinicians should treat both depressive symptoms and pain, rather than assume that treatment benefits in one domain will lead to major benefits in another., (Published by Oxford University Press on behalf of the American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.)

OCCUPATIONAL APPLICATIONSWe investigated the association between shoe wear rate and several metrics describing an individual's spatiotemporal gait characteristics (cadence, step length, and preferred walking speed). No associations were found, indicating that alternative metrics should be investigated to predict the individualized rate at which workers wear down shoe tread.

Suicidality is a major public health concern, particularly for low-income, trauma-exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety-net primary care samples. Patients (N = 207) in a safety-net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low-income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety-net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low-income primary care patients, emphasize the importance of trauma-informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality., (© 2021 International Society for Traumatic Stress Studies.)

Loneliness is a risk factor for coronary heart disease, stroke, and hospital readmission, yet there are no studies to our knowledge examining loneliness in left ventricular assistance device (LVAD) patients. This study used a cross-sectional survey design on a convenience sample of LVAD patients ( n  = 73). Logistic regression was used to identify demographic correlates of loneliness; linear regression was used to examine the relationship between loneliness and both stress and depression. Loneliness was measured via the loneliness item from the Center for Epidemiologic Studies Depression (CESD), depression via the CESD (excluding the loneliness item), and stress via the Perceived Stress Scale. In bivariate analyses, older age (OR per year = 0.958, 95%CI = 0.919-0.998) and being partnered (OR = 0.245, 95%CI = 0.083-0.724) were associated with less loneliness. In the multivariate model, there was an interaction effect between age and partnership ( p  = 0.0212), where older age was protective against loneliness for non-partnered, but not partnered, patients. Higher loneliness was associated with higher stress (β = 0.484, B  = 5.687, 95%CI = 3.195-8.178) and depression (β = 0.618, B  = 7.544, 95%CI = 5.241-9.848). Patients who are not partnered and younger may be at increased risk of loneliness after LVAD. Loneliness in turn is associated with higher stress and depression. Longitudinal research is necessary to speak to direction of effects.

Objective: To examine the relationship between sleep disturbance and pain over a 14-year period., Methods: This study used data from the 2002-2016 waves of the Health and Retirement Study (HRS), an observational study of U.S. adults over age 50 (n = 17,756). Sleep disturbance was measured via four items (assessing difficulty falling asleep, staying asleep, and waking up too early as well as restedness) and pain via two items assessing the presence and degree of pain. Analyses consisted of path analysis; more specifically, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine how pain and sleep disturbance predict one another over two-year intervals after accounting for the trait-like nature of both factors., Results: There was evidence of reciprocal effects between sleep disturbance and pain across some, but not all, intervals. Moreover, the latent variables representing the trait-like nature of sleep disturbance and pain both showed significant variance (p < 0.001), indicating stable differences between persons in sleep and pain. These trait-like characteristics were strongly associated (β = 0.51, p < 0.001). The findings remained after adjusting the model for baseline age, self-reported health, partner status, depression, years of education, and sex., Conclusion: Sleep disturbance and pain are stable experiences. Moreover, there was some evidence that sleep disturbance and pain are bidirectionally linked across time among adults over 50, whereby across some intervals deviations in one's typical level of sleep disturbance predicted corresponding deviations in one's typical level of pain and vice versa. Clinically, this comorbidity and potential longitudinal bidirectionality underscore the importance of evidence-based interventions that target both sleep and pain among older individuals. Further studies should replicate these findings by collecting validated and/or objective sleep and pain measures on a more frequent basis., (Published by Elsevier B.V.)

Objectives: The population of Americans with limb loss is on the rise, with a different profile than in previous generations (e.g., greater incidence of amputation due to diabetes). This study aimed to identify the key characteristics of phantom limb sensation (PLS) and pain (PLP) in a current sample of Americans with limb loss., Methods: This cross-sectional study is the first large-scale (n=649) study on PLP in the current population of Americans with limb loss. A convenience sample of military and civilian persons missing one or more major limbs was surveyed regarding their health history and experience with phantom limb phenomena., Results: Of the participants surveyed, 87% experienced PLS and 82% experienced PLP. PLS and PLP typically first occurred immediately after amputation (47% of cases), but for a small percentage (3-4%) onset did not occur until over a year after amputation. Recent PLP severity decreased over time (β=0.028, 95% CI: -0.05-0.11), but most participants reported PLP even 10 years after amputation. Higher levels of recent PLP were associated with telescoping (β=0.123, 95% CI: 0.04-0.21) and higher levels of pre-amputation pain (β=0.104, 95% CI: 0.03-0.18). Those with congenitally missing limbs experienced lower levels of recent PLP (t (37.93)=3.93, p<0.01) but there were no consistent differences in PLP between other amputation etiologies., Conclusions: Phantom limb phenomena are common and enduring. Telescoping and pre-amputation pain are associated with higher PLP. Persons with congenitally missing limbs experience lower levels of PLP than those with amputation(s), yet PLP is common even in this subpopulation., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Firefighters have increased cancer incidence and mortality rates compared to the general population, and are exposed to multiple products of combustion including known and suspected carcinogens., Objective: The study objective was to quantify fire response exposures by role and self-reported exposure risks., Methods: Urinary hydroxylated metabolites of polycyclic aromatic hydrocarbons (PAH-OHs) were measured at baseline and 2-4 h after structural fires and post-fire surveys were collected., Results: Baseline urine samples were collected from 242 firefighters. Of these, 141 responded to at least one of 15 structural fires and provided a post-fire urine. Compared with baseline measurements, the mean fold change of post-fire urinary PAH-OHs increased similarly across roles, including captains (2.05 (95% CI 1.59-2.65)), engineers (2.10 (95% CI 1.47-3.05)), firefighters (2.83 (95% CI 2.14-3.71)), and paramedics (1.84 (95% CI 1.33-2.60)). Interior responses, smoke odor on skin, and lack of recent laundering or changing of hoods were significantly associated with increased post-fire urinary PAH-OHs., Significance: Ambient smoke from the fire represents an exposure hazard for all individuals on the fireground; engineers and paramedics in particular may not be aware of the extent of their exposure. Post-fire surveys identified specific risks associated with increased exposure., (© 2021. The Author(s).)

Overhaul is the phase of firefighting after flames have been extinguished but when products of combustion are still being released. While positive pressure self-contained breathing apparatus (SCBA) provide the highest level of respiratory protection during overhaul, use of air-purifying respirators (APRs) with suitable filters could potentially provide a lower weight, longer duration option for first responders. The objective of this study was to assess whether an APR with a chemical, biological, radiological, and nuclear (CBRN) canister could be recommended as substitution for SCBA during overhaul. A total of 15 simulated standard overhaul environments were created by burning household materials. Sampling was conducted using mannequin heads fitted with full facepiece respirators with either a CBRN canister or SCBA. In-mask and personal samples were collected for aldehydes, polynuclear aromatic hydrocarbons, inorganic acids, aromatic hydrocarbons, nitrogen dioxide, and particulate matter. An additional six simulated high-exposure overhaul environments were created in a flashover chamber by continuously adding household materials to a smoldering fire. The sampling train was the same for both the standard and high-exposure environments; however, the facepiece was sealed to the mannequin head in the high-exposure environments. In the standard overhaul environment, the CBRN canister effectively reduced the level of exposure for most contaminants, while in the high-exposure overhaul exposure setting in-mask acetaldehyde and formaldehyde were detected. In both exposure settings, the SCBA prevented almost all exposure, and therefore remains the recommended respiratory protection during overhaul., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Abstract: Wardenaar, FC, Ortega-Santos, CP, Vento, K, Beaumont, JS, Griffin, SC, Johnston, C, and Kavouras, SA. A 5-day heat acclimation program improves heat stress indicators while maintaining exercise capacity. J Strength Cond Res 35(5): 1279-1286, 2021-This study aimed to evaluate whether a daily 60 minutes isothermic biking protocol during a 5-day period could improve physiological heat acclimation and exercise performance capacity in partially acclimated subjects. A quasi-experimental study consisted of an intervention (INT, n = 7) and control (CON, n = 7) group completing 2 12 minutes Cooper tests (pre-CT on day 1 and post-CT on day 7) and a heat stress test (HST, on day 9). INT performed additional intensive exercise 1 hour per day on days 1-5, whereas CON did not. During CTs and HST, core temperature (Tc, telemetric capsule), skin temperature (Tsk, sensors at neck, right shoulder, left hand, and right shin), and heart rate (HR, chest strap) were continuously monitored and baseline, average, peak, and increment were calculated. During the HST, the INT group showed a smaller baseline-peak Tc increment (INT 0.88 ± 0.27 vs. CON 1.64 ± 0.90° C, p = 0.02), a lower HR peak (150.2 ± 12.6 vs. 173.0 ± 16.8 b·min-1, p = 0.02), and lower Tsk peak (36.47 ± 0.62 vs. 36.54 ± 0.46° C, p = 0.04). There was a nonsignificant, but practical difference based on a moderate effect size for change in pre-CT to post-CT performance of nearly +2.7 ± 12.3% in INT and -3.0 ± 8.5% in CON (p = 0.32 and d = 0.51), and HST distance covered resulting in a nonsignificant difference of 464 ± 849 m between INT and CON (p = 0.38 and d = 0.44). In conclusion a short-term 5-day heat acclimation program including 300 minutes of extra exercise resulted in positive physiological adaptions to heat stress, as indicated by lower core temperature and HR in comparison with a control group., (Copyright © 2021 National Strength and Conditioning Association.)

Occupational disease and injuries are the 8th leading cause of death in the United States. Low-wage and minority workers are more likely to work in hazardous industries and are thus at greater risk. Within the small business sector, in particular, the health of low-wage and minority workers is threatened by a multitude of complex and interrelated factors that increase their risk for injuries, death, and even chronic disease. The COVID-19 pandemic has amplified these concerns, as many low-wage and minority workers are essential workers, and many small businesses are reopening with little to no guidance. The article describes work-related health risks and reviews current research on occupational and social ecological approaches to improving the health of minority and low-wage workers primarily employed by small businesses. We propose a conceptual framework that integrates the social ecological model with the hierarchy of controls to address work-related health among low-wage and minority workers specifically in the small business sector. Community-based strategies are recommended to engage small business owners and workers in efforts to address their immediate needs, while building towards sustainable policy change over time. These strategies are of particular importance as small businesses reopen in the ongoing pandemic.

Background: As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health., Method: Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span., Results: Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression., Conclusion: Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.

Objectives: To model the relationship between loneliness and sleep disturbance over time. Method : Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age ≥ 65 years; n = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. Results : Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. Discussion : Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness.

Despite the mounting evidence linking loneliness with health, the mechanisms underlying this relationship remain obscure. This systematic review and meta-analysis on the association between loneliness and one potential mechanism-sleep-identified 27 relevant articles. Loneliness correlated with self-reported sleep disturbance ( r  = .28, 95% confidence interval (.24, .33)) but not duration, across a diverse set of samples and measures. There was no evidence supporting age or gender as moderators or suggesting publication bias. The longitudinal relationship between loneliness and sleep remains unclear. Loneliness is related to sleep disturbance, but research is necessary to determine directionality, examine the influence of other factors, and speak to causality., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Objective: Evaluate the effectiveness of firefighter exposure reduction interventions., Methods: Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station. Urinary polycyclic aromatic hydrocarbon metabolites (PAH-OHs) were measured after structural fire responses before and after intervention implementation. Separately, infrared sauna use following live-fire training was compared to standard postfire care in a randomized trial., Results: The fireground interventions significantly reduced mean total urinary postfire PAH-OHs in engineers (-40.4%, 95%CI -63.9%, -2.3%) and firefighters (-36.2%, 95%CI -56.7%, -6.0%) but not captains (-11.3% 95%CI -39.4%, 29.9%). Sauna treatment non-significantly reduced total mean PAH-OHs by -43.5% (95%CI -68.8%, 2.2%)., Conclusions: The selected fireground interventions reduced urinary PAH-OHs in engineers and firefighters. Further evaluation of infrared sauna treatment is needed.

Expanding agribusiness in Northern Mexico has increased demand for workers from Southern Mexico, with hundreds of thousands migrating for work annually. Extreme temperatures, physical labor, and low fluid consumption place workers at risk for heat strain and dehydration, commonly underreported hazards in the agricultural industry. The objectives of this pilot study were to assess heat exposure and hydration status of a population of migratory agricultural workers in Northern Mexico throughout the grape harvest season. In addition to demographic information, environmental conditions, hydration status, and core body temperatures were collected. The majority listed Chiapas as their home state, nearly half spoke an Indigenous language, and none had completed high school. The wet-bulb globe temperature was significantly higher during the harvest and post-harvest seasons compared to the pre-harvest season. Across the different seasons, the majority were dehydrated post-shift, and mean core body temperature of workers was not significantly different. This project highlights the need for targeted interventions to improve hydration and prevent heat stress in this region. As the number of warm days is expected to rise each year worldwide, it will be increasingly important to engage in practices to protect vulnerable populations, such as migratory agriculture workers.

Background : College students are at increased risk for sleep disorders, including insomnia disorder and obtaining less than 6.5 hr of sleep per night by choice, or behaviorally induced insufficient sleep syndrome (BIISS). These disorders can have deleterious daytime consequences, including depression. This study aims to establish the prevalence of insomnia and BIISS disorders and examine associations of insomnia and BIISS with other sleep characteristics and depression. Methods : A subset of data from Spit for Science, a college risk behaviors and health study ( n = 989) was used. Insomnia and BIISS were defined as mutually exclusive disorders, based on diagnostic criteria. Results : A majority (68%) of students were categorized as normal sleepers, followed by insomnia (22%), and BIISS (10%). Sleep duration was comparable between BIISS and insomnia, while daytime sleepiness was significantly higher in BIISS, and sleep latency was longer in insomnia ( m = 44 vs. m = 13 min). Insomnia was associated with the highest depression symptoms, followed by BIISS, and normal sleep, controlling for demographics. Insomnia was associated with twice the risk of moderate or higher depression compared to normal sleep (CI: 1.60, 2.70, p < .001). Conclusion : These findings highlight the sleep difficulties endemic to college populations. Further, this study provides the first prevalence estimation of BIISS in college students and the first comparison of insomnia and BIISS on sleep characteristics and depressive symptoms. This study underscores the importance of targeted screening and intervention to improve both sleep and depression in this vulnerable population.

Objective: To jointly examine isolation, loneliness, and cynical hostility as risk factors for cognitive decline in older adults. Method: Data came from the 2006 to 2012 waves of the Health and Retirement Study (HRS), a longitudinal study of U.S. older adults (age ⩾ 65 years, n = 6,654). Measures included frequency of contact with social network (objective isolation), the Hughes Loneliness Scale (loneliness), a modified version of the Cook-Medley Hostility Inventory (cynical hostility), and a modified version of the Telephone Interview for Cognitive Status (cognitive function). Multilevel modeling (random slope + intercept) was used to examine the association between these factors and trajectories of cognitive function. Results and Discussion: After controlling for demographic characteristics, self-reported health, and functional limitations, loneliness (β = -.34, 95% confidence interval [CI] = [-0.56, -0.11), and cynical hostility (β = -.14, 95% CI = [-0.24, -0.04) correlated with lower cognitive function, but none predicted change in cognitive function. Objective social isolation was associated with lower cognitive function (β = -.27, 95% CI = [-0.41, -0.12]) and steeper decline in cognitive function (β = -.09, 95% CI = [-0.16, -0.01]).

Introduction: Emergency service vehicle crashes (ESVCs), including rollovers and collisions with other vehicles and fixed objects, are a leading cause of death among U.S. firefighters. Risk management (RM) is a proactive intervention to identifying and mitigating occupational risks and hazards. The goal of this study was to assess the effect of RM in reducing ESVCs., Methods: Three fire departments (A, B and C), representing urban and suburban geographies, and serving medium to large populations, participated in facilitated RM programs to reduce their ESVCs. Interventions were chosen by each department to address their department-specific circumstances and highest risks. Monthly crash rates per 10,000 calls were calculated for each department an average of 28 months before and 23 months after the start of the RM programs. Interrupted time series analysis was used to assess the effect of the RM programs on monthly crash rates. Poisson regression was used to estimate the number of crashes avoided. Economic data from Department A were analyzed to estimate cost savings., Results: Department A had a 15.4% (P = 0.30) reduction in the overall monthly crash rate immediately post-RM and a 1% (P = 0.18) decline per month thereafter. The estimated two-year average cost savings due to 167 crashes avoided was $253,100 (95%CI= $192,355 - $313,885). Department B had a 9.7% (P = 0.70) increase in the overall monthly crash rate immediately post-RM and showed no significant changes in their monthly crash rate. Department C had a 28.4% (P = 0.001) reduction in overall monthly crash rate immediately post-RM and a 1.2% (P = 0.09) increase per month thereafter, with an estimated 122 crashes avoided., Conclusions: RM programs have the potential to reduce ESVCs in the fire service and their associated costs; results may vary based on the interventions chosen and how they are implemented. Practical applications: Risk management may be an effective and broadly implemented intervention to reduce ESVCs in the US fire service., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Firefighters are exposed to carcinogens and have elevated cancer rates. We hypothesized that occupational exposures in firefighters would lead to DNA methylation changes associated with activation of cancer pathways and increased cancer risk. To address this hypothesis, we collected peripheral blood samples from 45 incumbent and 41 new recruit non-smoking male firefighters and analyzed the samples for DNA methylation using an Illumina Methylation EPIC 850k chip. Adjusting for age and ethnicity, we performed: 1) genome-wide differential methylation analysis; 2) genome-wide prediction for firefighter status (incumbent or new recruit) and years of service; and 3) Ingenuity Pathway Analysis (IPA). Four CpGs, including three in the YIPF6, MPST, and PCED1B genes, demonstrated above 1.5-fold statistically significant differential methylation after Bonferroni correction. Genome-wide methylation predicted with high accuracy incumbent and new recruit status as well as years of service among incumbent firefighters. Using IPA, the top pathways with more than 5 gene members annotated from differentially methylated probes included Sirtuin signaling pathway, p53 signaling, and 5' AMP-activated protein kinase (AMPK) signaling. These DNA methylation findings suggest potential cellular mechanisms associated with increased cancer risk in firefighters., Competing Interests: The authors have declared that no competing interests exist.

Purpose of Review: Late-life insomnia is a serious medical condition associated with many untoward consequences. The high prevalence of late-life insomnia, along with the concomitant risks inherent in the use of hypnotic medications in older adults necessitates non-pharmacological (i.e., psychological) treatment options. We aim to summarize and evaluate the state-of-the-science of psychological treatment options for late-life insomnia., Recent Findings: Cumulative scientific evidence suggests the efficacy of psychological treatment of late-life insomnia. During the previous decade, trials of psychological treatments for insomnia have begun to test various modifications to treatments that have the potential to improve access for older adults, along with expanding their focus to include individuals with comorbid conditions that are common to older adults. While these modifications represent positive advances in the science of treatment for late-life insomnia, the evidence is still largely explanatory/efficacious in nature., Summary: Psychological strategies represent the best approaches for the treatment of late-life insomnia. Future investigations would be wise to progressively move towards increasingly pragmatic/effectiveness investigations, adding to the literature base regarding the treatment of late-life insomnia under usual/real-world conditions as opposed to ideal/artificial conditions., Competing Interests: Conflict of Interest Sarah C Griffin, Scott Ravyts, Bruce Rybarczyk declare no conflicts of interest.

Objectives: Firefighters have elevated cancer incidence and mortality rates. MicroRNAs play prominent roles in carcinogenesis, but have not been previously evaluated in firefighters., Methods: Blood from 52 incumbent and 45 new recruit nonsmoking firefighters was analyzed for microRNA expression, and the results adjusted for age, obesity, ethnicity, and multiple comparisons., Results: Nine microRNAs were identified with at least a 1.5-fold significant difference between groups. All six microRNAs with decreased expression in incumbent firefighters have been reported to have tumor suppressor activity or are associated with cancer survival, and two of the three microRNAs with increased expression in incumbent firefighters have activities consistent with cancer promotion, with the remaining microRNA associated with neurological disease., Conclusion: Incumbent firefighters showed differential microRNA expression compared with new recruits, providing potential mechanisms for increased cancer risk in firefighters.

Objective: Risk management (RM) is a cyclical process of identifying and ranking risks, implementing controls, and evaluating their effectiveness. This study aims to identify effective RM interventions in the U.S. mining industry., Methods: RM interventions were identified in four companies representing metal, aggregate, and coal mining sectors. Injury rates were determined using Mine Safety and Health Administration (MSHA) data and changes in injury rates identified through change point analysis. Program implementation costs and associated changes in injury costs were evaluated for select interventions., Results: Six of 20 RM interventions were associated with a decline in all injuries and one with a reduction in lost-time injuries, all with a positive return on investment., Conclusion: Reductions in injuries and associated costs were observed following implementation of a limited number of specific RM interventions.

Objective: Emergency service vehicle incidents are a leading cause of firefighter fatalities and are also hazardous to civilian road users. Modifiable driving behaviors may be associated with emergency service vehicle incidents. The goal of this study was to use telematics to identify driving behaviors associated with crashes in the fire service., Methods: Forty-three emergency service vehicles in 2 fire departments were equipped with telematics devices (12 in Department A and 31 in Department B). The devices collected vehicle coordinates, speed, and g forces, which were monitored for exceptions to driving rules established by the fire departments regarding speeding, harsh braking, and hard cornering. Fire department administrative reports were used to identify vehicles involved in crashes and merged with daily telematics data. Penalized logistic regression was used to identify driving rules associated with crashes. Least absolute shrinkage and selection operator (LASSO) regression was used to generate a telematics-based risk index for emergency service vehicle incidents., Results: Nearly 1.1 million km of driving data and 44 crashes were recorded among the 2 departments during the study. Harsh braking was associated with increased odds of crash in Department A (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.09-4.51) and Department B (OR = 1.55; 95% CI, 1.12-2.15). For every kilometer of nonemergency speeding, the odds of crash increased by 35% in Department A (OR = 1.35; 95% CI, 1.03-1.77) and by over 2-fold in Department B (OR = 2.09; 95% CI, 1.19-3.66). In Department B, hard cornering (OR = 1.14; 95% CI, 1.03-1.26) and emergency speeding (OR = 1.65; 95% CI, 1.06-2.57) were also associated with increased odds of crash. The final LASSO risk index model had a sensitivity of 73% and specificity of 57%., Conclusions: Harsh braking and excessive speeding were driving behaviors most associated with crash in the fire service. Telematics may be a useful tool for monitoring driver safety in the fire service.

Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV) is frequently used in HIV clinical trials; however, scores generated from the MOS-HIV are not suited for cost-effectiveness analyses as they do not assign utility values to health states. Our objective was to estimate and externally validate several mapping algorithms to predict Health Utilities Index Mark 3 (HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We developed and validated mapping algorithms using data from two HIV clinical trials. Data from the first trial (n = 367) formed the estimation data set for the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping algorithms; data from the second trial (n = 168) formed the HUI3 (1,135 observations) and EQ-5D-3L (1,152 observations) external validation data set. We compared ordinary least squares (OLS) models of increasing complexity with the more flexible two-part, beta regression, and finite mixture models. We assessed model performance using mean absolute error (MAE) and mean squared error (MSE). Results: The OLS model that used MOS-HIV dimension scores along with squared terms gave the best HUI3 predictions (mean observed 0.84; mean predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L score ranges (<0.40). Conclusions: The proposed mapping algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the MOS-HIV, although greater error may pose a problem in samples where a substantial proportion of patients are in poor health. These algorithms may be useful for estimating utility values from the MOS-HIV for cost-effectiveness studies when HUI3 or EQ-5D-3L data are not available.

Background and Purpose: Research indicates that mirror therapy reduces phantom limb pain (PLP). Objectives were to determine when mirror therapy works in those who respond to treatment, the relevance of baseline PLP to when pain relief occurs, and what pain symptoms respond to mirror therapy., Methods: Data from two independent cohorts with unilateral lower limb amputation were analyzed for this study (n=33). Mirror therapy consisted of 15-min sessions in which amputees performed synchronous movements of the phantom and intact legs/feet. PLP was measured using a visual analogue scale and the Short-Form McGill Pain Questionnaire., Results: The severity of PLP at the beginning of treatment predicted when pain relief occurred. Those with low baseline PLP experienced a reduction (p<0.05) in PLP by session 7 of treatment, those with medium baseline PLP experienced pain relief by session 14 of treatment, and those with high baseline PLP experienced pain relief by session 21 of treatment. Mirror therapy reduced throbbing, shooting, stabbing, sharp, cramping, aching, tender, splitting, tiring/exhausting, and punishing-cruel pain symptoms., Conclusion: The degree of PLP at baseline predicts when mirror therapy relieves pain., Implications: This article indicates that the degree of baseline PLP affects when mirror therapy relieves pain: relief occurs by session 7 in patients with low PLP but by session 21 in patients with high PLP. Clinicians should anticipate slower pain relief in patients who begin treatment with high levels of pain. ClinicalTrials.gov numbers:NCT00623818 and NCT00662415., (Copyright © 2017 Scandinavian Association for the Study of Pain. All rights reserved.)

Background: Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year., Methods: Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers' compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes., Results: The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%., Conclusions: We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Minimally invasive aortic valve replacement tends to be performed in specialist centers. Little data exists with regard to long-term outcomes of the upper hemi-sternotomy technique. We sought to evaluate the short- and long-term outcomes of this procedure in our institution., Methods: Data were collected from our cardiac surgical database. We compared the outcomes of all patients who underwent minimally invasive aortic valve replacement with all who underwent conventional aortic valve replacement between July 1999 and December 2013. Propensity-matching analysis was performed to evaluate hospital outcomes., Results: There were 125 patients who underwent minimally invasive aortic valve replacement and 1446 who had conventional surgery. After propensity score matching, there were no differences in postoperative mortality or complications between the 2 groups. The only significant differences were longer bypass (62.69 ± 10.12 vs. 68.94 ± 14.79 min, p = 0.002) and crossclamp times (45.48 ± 8.08 vs. 52.30 ± 16.29 min, p < 0.001) in conventional surgery. Long-term survival after minimally invasive aortic valve replacement at 2, 6, and 10 years was 88% ± 3.0%, 79% ± 4.0%, and 66% ± 6.0%, respectively. Predictors of long-term survival were age, peripheral vascular disease, and low ejection fraction (p < 0.005)., Conclusion: Minimally invasive aortic valve replacement has similar hospital outcomes compared to conventional aortic valve replacement. The operation is quicker and does not confer any significant increase in complications or length of hospital stay. The long-term outcomes are favorable and justify its continued use by specialist surgeons in the United Kingdom., (© The Author(s) 2015.)