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Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care. • The NEL Framework can guide the design of nurse-led equitable training programs. • 10 programs used the framework to support >1000 trainees with $18.3 million in grants. • Framework for programs to grow, bolster & diversify nursing & public health workforce [ABSTRACT FROM AUTHOR]

Nursing faculty are challenged to integrate immunization content in prelicensure nursing curricula. Historically, most immunization content has been delivered in pediatrics courses, with less emphasis on other populations across the lifespan. Skills related to vaccine administration may be prioritized over the most current immunization science, such as pathophysiology, immunology, and epidemiology. As the most trusted profession rated by the public (Saad, 2020), nurses are ideally suited to address vaccine hesitancy and promote vaccination in the communities they serve. Nurses apply active listening, problem solving, and communication skills with patients and their families, contributing to a person's confidence in their decision to be vaccinated. The Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research collaborated to develop a framework for immunization content and teaching resources, Immunization Resources for Undergraduate Nursing (IRUN), for faculty to use in designing the nursing curricula. Content includes a curriculum framework, curriculum mapping tool, multiple teaching resources, and a dedicated website (IRUNursing.org). The framework provides guidance for faculty on integrating immunization content into a curriculum. Teaching resources include case studies, simulation scenarios, and PowerPoint slide decks. Although primarily focused on prelicensure nursing education, resources are also relevant to advanced professional nursing education. • Immunization content is critically needed in pre-licensure nursing curriculum. • Faculty have historically faced challenges integrating immunization content. • Immunization Resources for Undergraduate Nursing provides faculty resources. • Curriculum resources include a framework and mapping tool. • Teaching resources include case studies, simulation scenarios, and slides. [ABSTRACT FROM AUTHOR]

Background: Infants are often brought to an emergency department (ED) for medical evaluation upon surrender or abandonment. However, no specific guidelines exist for the care of surrendered or abandoned children. We describe the case of an abandoned infant who was brought to a pediatric quaternary care hospital as a model for evaluation and management.Case Report: A 3-day-old abandoned female was brought to a quaternary care pediatric hospital ED. Given limitations in history, upon physical examination and in consultation with specialists, our team completed an extensive laboratory workup to guide initial management and treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abandoned and surrendered infants frequently enter the medical system via the ED, and emergency physicians must be aware of best practices to evaluate and manage these patients. While each infant presentation is unique, commonalities exist. Our care may serve as a starting point by which others may base their own management. © 2022 Elsevier Inc. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) directly contribute to health inequities among populations and communities. These structural and social forces impact health and health outcomes. Nurses play a vital role in addressing the SDOH and closing gaps relative to disparate outcomes. Integration of SDOH in nursing curriculums has become highly prioritized in nursing education as marginalized communities continue to experience inequities in health, which have been highlighted during the COVID pandemic. Many schools of nursing have embedded SDOH in course content throughout curricula but lack a structured approach to appraise the effectiveness of incorporating these concepts. This paper describes a framework used to evaluate SDOH integration in pre-and post-licensure curriculum. • Social determinants of health are associated with profound differences in health and health outcomes. • Nurses play a vital role in addressing social determinants of health. • Integration of social determinants of health in nursing curriculum is essential. • Evaluating social determinants of health integration in curriculums will inform nursing education. [ABSTRACT FROM AUTHOR]

Dietary diversity is widely advocated in national and international recommendations although whether the beneficial effects on survival or longevity still apply in the final phase of the lifespan remains understudied. We aimed to prospectively examine the association of dietary diversity, food items with all-cause mortality among the oldest old (80+) and determine whether dietary diversity recommendations were appropriate for this population. The study included 28,790 participants aged 80+ (9957 octogenarians, 9925 nonagenarians, and 8908 centenarians). A baseline dietary diversity score (DDS) was constructed based on nine food items of a food frequency questionnaire. Cox models with penalized splines evaluated non-linear associations of DDS as continuous variable with mortality to identify cut-offs of DDS. We documented 23,503 deaths during 96,739 person-years of follow-up. Each one unit increase in DDS was associated with a 9% lower risk of mortality (adjusted hazard ratio (HR): 0.91; 95% confidential interval (CI): 0.90–0.92). Compared to participants whose DDS less than 2 scores, those with a DDS of 2, 3, 4, 5, and higher than 6 scores had a lower mortality risk, the HRs were 0.86 (0.82–0.89), 0.78 (0.75–0.81), 0.69 (0.66–0.72), 0.65 (0.62–0.68), and 0.56 (0.53–0.58) respectively, and a significant trend emerged (p < 0.001). Protein-rich food items were associated with prominent beneficial effects on mortality including meat (HR and 95% CI for high vs low frequency: 0.70 (0.68–0.72)), fish and sea food (HR, 0.74 (0.72–0.77)), egg (HR, 0.75 (0.73–0.77)), and bean (HR, 0.80 (0.78–0.82)). Even after the age of 80, the DDS tool may offer a simple and straightforward mean of identifying and screening individuals at high risk for mortality. Recommendation of dietary diversity, especially consumption of protein-rich food, may be advocated to reduce mortality risk and promote longevity in the oldest old. • In this prospective cohort, 23,503 deaths were documented during 96,739 person-years of follow-up, higher DDS was associated with significant lower mortality risk. • Protein-rich food items were associated with prominent beneficial effects on mortality. • Even after the age of 80, the DDS tool may offer a simple and straightforward mean of identifying and screening individuals at high risk for mortality. • Recommendation of dietary diversity, especially consumption of protein-rich food, may be advocated to reduce mortality risk and promote longevity in the oldest old. [ABSTRACT FROM AUTHOR]

Hedonic dysregulation is a core mechanism of addiction. There is a dearth of research on hedonic dysregulation in cannabis use disorder (CUD). The current study tested whether personalized scripted imagery may be an efficacious approach to remediate reward functioning in adults with CUD. Adults with CUD (n=10) and non-CUD controls (n=12) completed a single session personalized scripted imagery procedure. Non-drug (i.e. natural) reward and neutral scripts were transcribed and participants listened to the scripts in counterbalanced order. Primary outcomes included positive affect (PA), galvanic skin response (GSR), and cortisol and were assessed at four timepoints. Mixed effects models were used to compare between and within subject effects. Mixed effects models revealed a Condition (reward vs. neutral) X Group (CUD vs. control) interaction (p=0.01) on PA response, indicating blunted PA response to the neutral script relative to the reward script in CUD participants. Likewise, GSR response in CUD participants was decreased in response to the neutral script relative to the reward script (p=0.034; interaction n.s.). An interaction effect of Group X PA on cortisol response was found (p=.036) indicating that cortisol was positively correlated with PA in healthy control participants, but not CUD participants. Adults with CUD may demonstrate acute deficits in hedonic tone under neutral conditions relative to healthy controls. Personalized scripted imagery may be an efficacious tool to remediate hedonic dysregulation in CUD. Cortisol may play a role in healthy positive affect regulation warranting further investigation. • Natural reward processing in adults with cannabis use disorder (CUD) was investigated. • Adults with CUD showed blunted positive affect (PA) under neutral conditions. • Adults with CUD showed blunted galvanic skin response (GSR) under neutral conditions. • Cortisol and PA were positively correlated in healthy controls but not adults with CUD. [ABSTRACT FROM AUTHOR]

The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up. We retrospectively evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive and primary stroke centers in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of 90-day follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1, 2019- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across hospitals less than 1 mile, 10 miles, and 25 miles from the stroke clinic. Of 1096 ischemic stroke patients discharged home or to a rehab facility during the study period, 342 (31%) had follow-up in the Emory Stroke Clinic (comprehensive stroke center 46%, primary stroke center 10 miles away 18%, primary stroke center 25 miles away 14%). Overall, 90-day follow-up increased from 19% to 41% after telemedicine implementation (p<0.001) with telemedicine appointments amounting for up to 28% of all follow-up visits. In multivariable analysis, factors associated with teleneurology follow-up (vs no follow-up) included discharge from the comprehensive stroke center, thrombectomy treatment, private insurance, private transport to the hospital, NIHSS 0-5 and history of dyslipidemia. Despite telemedicine implementation at an academic healthcare network successfully increasing post-stroke discharge follow-up in a centralized subspecialty stroke clinic, the majority of patients did not complete 90-day follow-up during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Tumor cell invasion involves targeted localization of proteins required for interactions with the extracellular matrix and for proteolysis. The localization of many proteins during these cell-extracellular matrix interactions relies on membrane trafficking mediated in part by SNAREs. The SNARE protein syntaxin4 (Stx4) is involved in the formation of invasive structures called invadopodia; however, it is unclear how Stx4 function is regulated during tumor cell invasion. Munc18c is known to regulate Stx4 activity, and here we show that Munc18c is required for Stx4-mediated invadopodium formation and cell invasion. Biochemical and microscopic analyses revealed a physical association between Munc18c and Stx4, which was enhanced during invadopodium formation, and that a reduction in Munc18c expression decreases invadopodium formation. We also found that an N-terminal Stx4-derived peptide associates with Munc18c and inhibits endogenous interactions of Stx4 with synaptosome-associated protein 23 (SNAP23) and vesicle-associated membrane protein 2 (VAMP2). Furthermore, expression of the Stx4 N-terminal peptide decreased invadopodium formation and cell invasion in vitro. Of note, cells expressing the Stx4 N-terminal peptide exhibited impaired trafficking of membrane type 1 matrix metalloproteinase (MT1-MMP) and EGF receptor (EGFR) to the cell surface during invadopodium formation. Our findings implicate Munc18c as a regulator of Stx4-mediated trafficking of MT1-MMP and EGFR, advancing our understanding of the role of SNARE function in the localization of proteins that drive tumor cell invasion. [ABSTRACT FROM AUTHOR]

Background Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors. Material and methods The study consisted of a retrospective review of medical charts of patients less than 6 months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics. Results The study included 168 patients. Their postnatal age was 48 ± 48 days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise ( n = 19, 11.3%), multiple organ dysfunction syndrome (MODS, n = 8, 4.8%) and respiratory failure requiring ventilation ( n = 3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA < 40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration. Conclusion This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications. [ABSTRACT FROM AUTHOR]

Background Morphine is the most commonly used postoperative analgesic for moderate to severe pain in paediatric patients, but there is little research into predictive factors correlating with postoperative morphine consumption. Methods All patients undergoing surgery who received morphine postoperatively over eight months were prospectively enrolled. Data analysed included total morphine consumption to day 3, age, weight, type of surgery, ASA status, preoperative opioid administration, predicted postoperative pain intensity (according to French Society of Anaesthesiology and Intensive Care classification) and surgery duration. Two cohorts were constructed: the first over 6 months to construct a statistical model and the second over 2 months to validate the model. ANOVA univariate analyses and multivariate linear analysis were performed. Results One hundred and fifty-three patients were included in the construct cohort and 40 in the validation cohort. Multivariate analysis demonstrated that total morphine consumption through postoperative day 3 was independently increased by a decreased age, female gender, an increased duration of surgery and an increased morphine titration in PACU. Overall, the model explained 57% of morphine requirement variability. When the model was applied to the validation cohort, a significant correlation was demonstrated between observed and predicted values: r = 0.67, P < 0.0001. Conclusion Age, gender, duration of surgery and doses of titrated morphine in PACU proved to be strong predictors of postoperative morphine consumption by day 3 during paediatric surgery. Knowledge of such factors may help clinicians to better manage postoperative pain in children. [ABSTRACT FROM AUTHOR]

Objective: There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes.Materials and Methods: Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home.Results: There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, <1% of patients presenting to participating hospitals with MaRISS within the eligible time window received IV tPA.Conclusions: Baseline characteristics, presenting symptoms, and response to dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. [ABSTRACT FROM AUTHOR]

Summary Human platelets acutely increase mitochondrial energy generation following stimulation. Herein, a lipidomic circuit was uncovered whereby the substrates for this are exclusively provided by cPLA 2 , including multiple fatty acids and oxidized species that support energy generation via β-oxidation. This indicates that acute lipid membrane remodeling is required to support energetic demands during platelet activation. Phospholipase activity is linked to energy metabolism, revealing cPLA 2 as a central regulator of both lipidomics and energy flux. Using a lipidomic approach (LipidArrays), we also estimated the total number of lipids in resting, thrombin-activated, and aspirinized platelets. Significant diversity between genetically unrelated individuals and a wealth of species was revealed. Resting platelets demonstrated ∼5,600 unique species, with only ∼50% being putatively identified. Thrombin elevated ∼900 lipids >2-fold with 86% newly appearing and 45% inhibited by aspirin supplementation, indicating COX-1 is required for major activation-dependent lipidomic fluxes. Many lipids were structurally identified. With ∼50% of the lipids being absent from databases, a major opportunity for mining lipids relevant to human health and disease is presented. [ABSTRACT FROM AUTHOR]

Purpose Emerging evidence suggests that breasts may be a barrier to physical activity for adult females. With only 12% of the UK 14-year-old girls achieving exercise guidelines, to understand deterrents to exercise in this population, we should consider whether breasts may also influence sport and exercise participation in school girls. This survey-based study investigated the influence of the breast on sport and exercise participation and breast-specific concerns in the UK school girls. Methods A survey was developed to assess demographics, breast characteristics, breast-specific concerns in sports, breast knowledge, views on breast education, and sport participation. Chi-squared tests assessed associations between participation and breast size, sports bra use, and breast concerns. Results Two thousand eighty-nine school girls aged 11–18 years completed the survey, for 97 their breasts had begun developing and 96% reported wearing breast support. Forty-six percent of girls reported that their breasts had some effect on their participation in compulsory sports and exercise, which was more prevalent in girls aged 13–14 years (51%) and in larger-breasted girls (63%). More than 50% reported never wearing a sports bra during sports. Breast concerns were high with 73% reporting ≥1 breast-specific concern in sports; with breast bounce being most prevalent (38%). Conclusions As most of the breast concerns raised in this survey could be addressed via education and 87% of girls wanted to know more about breasts, this study demonstrates a need for breast education for school girls, which may reduce the influence of the breast on sport and exercise participation. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of a clinical trial involving participants with concussion randomized to treatments designed to address fear avoidance or endurance coping, which are risk factors for disability. A secondary objective was to evaluate whether each treatment could affect selective change on targeted coping outcomes. Randomized controlled trial. Outpatient concussion clinics. Adults (N=73, mean age=42.5y) who had persistent postconcussion symptoms and high avoidance or endurance behavior were enrolled at a mean of 12.9 weeks post injury. Ten participants did not complete treatment. Participants were randomized to an interdisciplinary rehabilitation program delivered via videoconferencing and tailored to avoidance coping (graded exposure therapy [GET]) or endurance coping (operant condition-based pacing strategies plus mindfulness training [Pacing+]). Feasibility outcomes included screening efficiency, accrual, credibility, treatment fidelity, adherence, and retention. Avoidance was measured with the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire and endurance behavior with the Behavioral Response to Illness Questionnaire. Screening efficiency, or the proportion of clinic patients who were assessed for eligibility, was 44.5% (275 of 618). A total of 65.8% (73 of 111) of eligible patients were randomized (37 to GET, 36 to Pacing+), meeting accrual targets; 91.7% (55 of 60) of participants perceived treatment as credible. Therapists covered a mean of 96.8% of essential prescribed elements, indicating excellent fidelity. The majority (71.2%; 47 of 66) of participants consistently attended treatment sessions and completed between-session homework. Retention was strong, with 65 of 73 (89%) randomized participants completing the outcome assessment. GET was associated with greater posttreatment reductions in avoidance behavior compared with Pacing+ (Cohen's d repeated measures , 0.81), whereas the treatment approach-specific effect of Pacing+ on endurance behavior was less pronounced (Cohen's d repeated measures , 0.39). These findings support a future efficacy-focused clinical trial. GET has the potential to selectively reduce fear avoidance behavior after concussion, and, via this mechanism, to prevent or reduce disability. [ABSTRACT FROM AUTHOR]

Background and Purpose: Screening scales are recommended to assist field-based triage of acute stroke patients to designated stroke centers. Cincinnati prehospital stroke scale (CPSS) is a commonly used prehospital stroke screening tool and has been validated to identify large vessel occlusion (LVO). This study addresses the impact of county-based CPSS implementation to triage suspected LVO patients to a comprehensive stroke center (CSC).Materials and Methods: Dekalb County in Atlanta, Georgia, implemented CPSS-based protocol with score of 3 and last seen normal time < 24 h mandating transfer to the nearest CSC if the added bypass time was <15 min. Frequency of stroke codes, LVO, IV-tPA use, and thrombectomy treatment were compared six months before and after protocol change (November 1, 2020).Results: During the study period, 907 stroke patients presented to the CSC by EMS, including 289 (32%) with CPSS score 3. There was an increase in monthly ischemic stroke volume (pre-16 ± 2 vs.19 ± 3 p = 0.03), LVO (pre-4.3 ± 1.7 vs. post-7.0 ± 2.4; p = 0.03), EVT (pre-15% vs. post-30%; p = 0.001), without significant increase in stroke mimic volume or delay in mean time from last seen normal to IV-tPA (pre-165 ± 66, post-158 ± 49 min; p = 0.35). CPSS score 3 was associated with increased likelihood of LVO diagnosis (OR 8.5, 95% CI 5.0-14.4; p = 0.001) and decreased the likelihood of stroke mimics (OR 0.66, 95% CI 0.50-0.88; p = 0.004).Conclusion: CPSS is a quick, easy to implement, and reliable prehospital severity scale for EMS to triage LVO to CSC without delaying IV-tPA treatment or significantly increasing stroke mimics. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity contributes to atherosclerotic processes, which manifest as increased arterial stiffness. Arterial stiffness is associated with myocardial demand and coronary perfusion and is a risk factor for stroke and other adverse cardiac outcomes. Poststroke mobility limitations often lead to physical inactivity and sedentary behaviors. This exploratory study aimed to identify functional correlates, reflective of daily physical activity levels, with arterial stiffness in community-dwelling individuals >1 year poststroke. Methods: Carotid–femoral pulse wave velocity (cfPWV) was measured in 35 participants (65% men; mean ± SD age 66.9 ± 6.9 years; median time poststroke 3.7 years). Multivariable regression analyses examined the relationships between cfPWV and factors associated with daily physical activity: aerobic capacity (VO2 peak), gait speed, and balance ability (Berg Balance Scale). Age and the use of antihypertensive medications, known to be associated with pulse wave velocity, were also included in the model. Results: Mean cfPWV was 11.2 ± 2.4 m/s. VO2 peak and age were correlated with cfPWV (r = −0.45 [P = .006] and r = 0.46 [P = .004], respectively). In the multivariable regression analyses, age and the use of antihypertensive medication accounted for 20.4% of the variance of cfPWV, and the addition of VO2 peak explained an additional 4.5% of the variance (R 2 = 0.249). Conclusions: We found that arterial stiffness is elevated in community-dwelling, ambulatory individuals with stroke relative to healthy people. Multivariable regression analysis suggests that aerobic capacity (VO2 peak) may contribute to the variance of cfPWV after accounting for the effects of age and medication use. Whether intense risk modification and augmented physical activity will improve arterial stiffness in this population remains to be determined. [Copyright &y& Elsevier]

Summary: The ubiquitin-modification status of proteins in cells is highly dynamic and maintained by specific ligation machineries (E3 ligases) that tag proteins with ubiquitin or by deubiquitinating enzymes (DUBs) that remove the ubiquitin tag. The development of tools that offset this balance is critical in characterizing signaling pathways that utilize such ubiquitination switches. Herein, we generated a DUB-resistant ubiquitin mutant that is recalcitrant to cleavage by various families of DUBs both in vitro and in mammalian cells. As a proof-of-principle experiment, ectopic expression of the uncleavable ubiquitin stabilized monoubiquitinated PCNA in the absence of DNA damage and also revealed a defect in the clearance of the DNA damage response at unprotected telomeres. Importantly, a proteomic survey using the uncleavable ubiquitin identified ubiquitinated substrates, validating the DUB-resistant ubiquitin expression system as a valuable tool for interrogating cell signaling pathways. [Copyright &y& Elsevier]

Abstract: Understanding why accidents occur in the work place has a long and convoluted history. This paper adds to this corpus of research by investigating the relationship between an individual''s level of cognitive failure, psychological stress, and work place accident occurrence. Retrospective analysis of accident-case individuals vs. control-match individuals on the General Health Questionnaire (GHQ) and Cognitive Failures Questionnaire (CFQ) was undertaken from amalgamated data of two Royal Navy databases. Individuals in the accident-case sub-sample had higher GHQ and CFQ scores when compared to matched-controls. Mediated regression analysis revealed high GHQ score predicted accidents but was transmitted through high CFQ scores. Individuals who are stressed are more likely to have an accident in the workplace because of a propensity for cognitive failures. A specific recommendation to reduce accident risk in the work-place is discussed. [Copyright &y& Elsevier]

Abstract: Purpose: To estimate the late morbidity of a novel, hypofractionated external beam radiotherapy schedule of 55Gy in 16 fractions (4 fractions/week, 3.4Gy per fraction) for localized prostate cancer. Methods and materials: A multi-center phase 2 study enrolled seventy-three patients between September 2004 and June 2006. After insertion of fiducial gold markers, they were treated with image-guidance (IGRT) using conformal techniques with intensity-modulation, if necessary, and then followed every 6months for toxicity rating and PSA. Patient reported outcomes were collected yearly. Median follow up was 4.6years. Results: At 4years post-radiotherapy, the cumulative incidence of combined urinary and bowel grade 3 toxicity was 7% (95% CI 3–16%) and grade 2+ was 33% (95% CI 24–46%). All except two patients recovered from their grade 3 events. Patient-reported reduction of function was most pronounced at year two for urinary function (mean −7, SD 16), and at year one for bowel function (mean −7, SD 21). The cumulative incidence of biochemical (PSA nadir+2) or biopsy-proven relapse at 4years was 9% (95% CI 4–18%). Conclusions: Hypofractionated radiotherapy is clinically feasible and more convenient than conventional schedules for patients with localized prostate cancer. Phase 3 multicenter studies are on-going (NCT00126165). [Copyright &y& Elsevier]

Abstract: Sixty one percent of respondents to a questionnaire survey of occupational stress (Phase I) returned follow-up questionnaires twelve months later (Phase II). The Phase I questionnaire measured psychological strain resulting from exposure to occupational stressors, and measured the presence of stress buffers and demographic, psychological and lifestyle-related confounding factors, including age, rank and gender, mood state and the occurrence of stressful life events outside of work. The prevalence of strain was 31% at Phase I and 33% at Phase II. Fifty percent of personnel had no strain on either occasion, 15% had strain on both occasions and the remainder had strain on one occasion. The main stressor associated with strain at Phase I was an inability to disengage from work and this stressor accounted for a greater proportion of the variance in strain in personnel serving on ships than those serving ashore. The twelve-month follow-up questionnaire (Phase II) re-assessed psychological strain. A multiple linear regression analysis was conducted to identify factors measured at Phase I that predicted strain at Phase II in previously strain-free individuals. A lack of autonomy and control and dissatisfaction with living conditions predicted strain twelve months later in those serving on ships. Of the living conditions assessed, lack of privacy was the most strongly associated with strain twelve months later in those serving on ships. These stressors were not associated with strain twelve months later in those serving ashore. The findings suggest that improvements to the design of the environment on ships may have benefits for the psychological health of personnel. [Copyright &y& Elsevier]

Abstract: Aim: The aim of the study was to evaluate the morbidity rate of stoma in children diagnosed with chronic intestinal pseudoobstruction (CIPO) and try to determine risk factors. Material and Methods: Twenty-two children (65%) of 34 referred to our center between 1988 and 2008 had a stoma. They were compared with 22 other children referred for another pathology necessitating a stoma. Results: The incidence of stomal prolapse in CIPO children was 45% vs 9% in non-CIPO children (P = .01). Prolapse occurred between the first postoperative day and the 10th postoperative month, with a median of 2 months. Surgical management was required in 60%, with an intestinal necrosis rate of 20% leading to intestinal resection. No mortality was noted. No risk factors favoring prolapse in CIPO children were identified. Conclusion: Children with CIPO have a high rate of stomal prolapse with an increased risk of intestinal necrosis. Careful management of the stoma is necessary to avoid the risk of intestinal resection, which may aggravate the underlying intestinal disorder. [Copyright &y& Elsevier]

Congenital heart disease (CHD) is the most common congenital defect. Infants with critical congenital heart disease (CCHD) require complex medical care, and their caregivers need extensive training before being discharged home to safely care for their child. The rooming-in process provides caregivers with an opportunity to learn, practice, and manage the skills required for discharge to home during hospitalization. Although the literature reflects positive implications for the use of the rooming-in process in other populations (e.g., neonatal abstinence syndrome), literature about the rooming-in process in a pediatric cardiac care setting is limited. There remains a gap in the literature pertaining to the viewpoints of nurses, specifically as it relates to implementing a rooming-in process. Therefore, a qualitative study design was chosen to explore the nurses' perceptions of the rooming-in process using focus groups. The purpose of this study was to gain insight from nurses as to strategies to enhance the rooming-in process for caregivers of infants with CCHD. Additionally, we explored potential education and interventions to improve outcomes for infants with CCHD preparing to be discharged home. [ABSTRACT FROM AUTHOR]

This study examined the small area variation in motor vehicle crash fatality rates in the province of Alberta, Canada. Motor vehicle crash fatality rates per 100,000 population (1995–1997, inclusive) were determined for five geographic areas in the province. The rates showed substantial, statistically significant variation across areas, with fatality rates lowest in the urban areas of Calgary and Edmonton, and highest in the rural areas (south, central, and northern Alberta). Examination of area-level predictors—population density, impaired driving citation rates, education level, unemployment levels, and ethnicity—showed that population density and impaired driving rates were associated with motor vehicle crash fatality rates. There was a five-fold difference in annual motor vehicle crash fatality rates between rural (22.9/100,000) and urban areas (4.4/100,000), whereas annual impaired driving rates were around 1.8% in rural areas, compared with 0.6% in urban areas. Because of multicollinearity problems, it was not possible to estimate a multivariable Poisson regression model. In conclusion, rural areas in the province of Alberta demonstrate a significantly higher motor vehicle crash fatality rate, compared with urban areas. [Copyright &y& Elsevier]

Currently the Chinese government has adopted World Health Organization interim target-1 values as the national ambient air quality standards values. However, the population-based evidence was insufficient, especially for the oldest old (aged 80+). We evaluated the association of fine particulate matters (PM 2.5) exposure and incidence of disability in activities of daily living (ADL) in 15 453 oldest old in 886 counties/cities in China from 2002 to 2014 using Cox model with penalized splines and competing risk models to evaluate the linear or non-linear association. After adjusting for potential confounders, a J-shaped association existed between PM 2.5 exposure with a threshold concentration of 33 μg/m3, and incident disability in ADL. Above this threshold, the risk magnitude significantly increased with increase of PM 2.5 concentrations; compared to 33 μg/m3, the hazard ratio ranged from 1.03 (1.00–1.06) at 40 μg/m3 to 2.25 (1.54–3.29) at 110 μg/m3. The risk magnitude was not significantly changed below this threshold. Each 10 μg/m3 increase in PM 2.5 exposure corresponded to a 7.7% increase in the risk of disability in ADL (hazard ratio 1.077, 95% CI 1.051–1.104). Men, smokers, and participants with cognitive impairment might be more vulnerable to PM 2.5 exposure. The study provided limited population-based evidence for the oldest old and detected a threshold of 33 μg/m3, and supported that reduction to current World Health Organization interim target-1value (35 μg/m3) and Chinese national ambient air quality standards (35 μg/m3) or lower may be associated with lower risk of disability in ADL. Image 1 • The dose-response relationship between long-term PM 2.5 exposure and ADL was J-shaped. • The identification of a threshold of 33 μg/m3 for PM 2.5 and ADL disability incidence. • The first cohort study to demonstrate effect of PM 2.5 on ADL for the oldest old. • Air pollution reduction may reduce the public health burden of disability in the elderly. A J-shaped association existed between long-term PM 2.5 exposure with a threshold concentration of 33 μg/m3 and incident disability in ADL. [ABSTRACT FROM AUTHOR]