Sleep and Transportation Safety: Role of the Employer.

Human fatigue is an important factor in transportation safety and a major causal factor of accidents. Employers play a vital role in minimizing fatigue-related risk, and are legally liable for damages arising from failure to address the risk. By taking an active role as stakeholders in transportation safety, employers not only reduce their risk of adverse safety events and limit their legal liability but may also benefit from improvements in productivity, morale, and health care expenditures. Employers should focus on reducing fatigue-related risk, with ongoing support from sleep safety research.

Barriers and solutions to improving nutrition among fire academy recruits: a qualitative assessment.

The primary health concerns among US firefighters are cardiovascular disease, cancer, and depression and occur in an occupational setting where dietary habits are suboptimal. To understand if a diet or lifestyle modification works in a fire academy training setting, it is important to evaluate the cultural barriers and challenges that might be faced. A semi-structured telephone interview method followed by a focus group was used to gather common themes among fire service leaders. Twelve leaders participated in the telephonic interviews and a subset of five in the subsequent group session. Five main themes were identified. The study identified a need for staff and recruits to develop a cohesive culture that facilitates long-term change. Participants reported that incentives for good choices and the elimination of certain poor choices from the food environment would promote healthier choices. The study supports an intervention using education of fire recruits and modifications of the fire academy food environment.

Treatment of resectable intrathoracic sarcomas: a single institution experience over twenty years.

BACKGROUND: There are very few published data on the management of primary intrathoracic sarcoma, defined as sarcomas arising from the lung, pleura, and mediastinum, excluding the chest wall. Therefore, the aim of this study was to evaluate the outcome of patients with intrathoracic sarcoma treated at an academic referral center over a 21-year period. METHODS: A retrospective search was performed to identify patients with intrathoracic sarcomas treated with surgical resection from January 1990 to November 2011 at the University of Washington Medical Center. Local control and overall survival were analyzed in relation to the treatment received. RESULTS: Thirty-five patients were identified. Hazard ratios for local control, adjusted for tumor margin status, at 5 years were 0.74 (95 % CI [0.21, 2.58]) for the addition of chemotherapy (CT) to surgery, 0.57 (95 % CI [0.15, 2.23]) with the addition of (radiation therapy) RT, and 0.50 (95 % CI [0.06, 4.03]) with the addition of both CT and RT. At 7 years, the ratios for local control were 0.69 (95 % CI [0.20, 2.36]) for CT added to surgery, 0.58 (95 % CI [0.15, 2.27]) for RT, and 0.41 (95 % CI [0.05, 3.33]) with the addition of both CT and RT. Hazard ratios for overall survival, adjusted for sarcoma stage, at 5 years were 0.61 (95 % CI [0.16, 2.39]) for the addition of CT to surgery, 1.03 (95 % CI [0.26, 4.08]) for the addition of RT, and 0.54 (95 % CI [0.11, 2.69]) for the addition of both CT and RT. The 7-year hazard ratios for overall survival were 0.77 (95 % CI [0.23, 2.60]) for CT added to surgery, 0.99 (95 % CI [0.25, 3.84]) for the addition of RT, and 0.42 (95 % CI [0.09, 2.05]) for both CT and RT with surgery. At 10 years, hazard ratios for overall survival were 0.71 (95 % CI [0.21, 2.38]) for added CT, 0.81 (95 % CI [0.21, 3.08]) for added RT, and 0.33 (95 % CI [0.07, 1.65]) for the addition of both CT and RT to surgery. CONCLUSIONS: Our series is the largest published study of intrathoracic sarcoma which focuses on the survival benefit of adding RT, chemotherapy or both to surgery in resectable intrathoracic sarcoma. Our data suggest a potential benefit in local control and survival from adjuvant therapy, with the greatest benefit likely to come from combined CT and RT, though none of the results achieved statistical significance. As intrathoracic sarcomas are rare and histologically heterogeneous, larger collaborative studies are necessary to determine treatment efficacy and elucidate which histologic subtypes are likely to benefit most from adjuvant therapy.

Neutron radiotherapy for adenoid cystic carcinoma of the lacrimal gland.

PURPOSE: Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors that share histopathologic similarities with salivary gland malignancies. Neutron radiotherapy may be useful for treatment due to its high biological effectiveness for salivary malignancies. METHODS: The authors retrospectively reviewed the outcomes for 11 lacrimal gland adenoid cystic carcinoma patients treated with neutrons from 1988 to 2011. Most had undergone surgery prior to radiation therapy. However, gross residual disease was present in 8 patients. The most common American Joint Committee on Cancer stage was T4cN0M0. Four patients with skull base involvement received a radiosurgery boost and 1 received a proton therapy boost. RESULTS: Median follow up was 6.2 years. Median overall survival was 11.1 years and median disease-free survival was 6.3 years. Five-year local control was estimated by the Kaplan-Meier method as 80%. Three patients had a local recurrence; 4 developed distant metastases. Six patients died. Seven patients had intact vision in the affected eye before neutron radiation. Two required enucleation for a painful dry eye. Of the 5 who avoided an enucleation, 3 had either severe visual impairment (20/400) or only light perception and 2 were without known vision compromise or complications at the time of their death. One patient developed asymptomatic frontal lobe radionecrosis after 2 courses of radiation therapy. CONCLUSIONS: Neutron radiation therapy achieved excellent 5-year local control in this series of high-risk patients, with most cases having gross residual disease. Late recurrences and distant metastases remain a challenge. Meaningful ipsilateral vision preservation was not possible in most cases in the long term, although only 2 patients required an enucleation for treatment effects.

True photoallergy to sunscreens is rare despite popular belief.

BACKGROUND: Rising use of sunscreen products has led to increased reporting of adverse reactions to sunscreens. OBJECTIVE: To investigate possible photoallergic reactions in patients who identified themselves as "being allergic" to sunscreens. METHODS: Patients filled out questionnaires about types of sunscreens they used and timing of their "allergic" reactions. Next, they consented to be photopatch-tested with active sunscreen ingredients, including the new sunscreen Anthelios SX (containing Mexoryl SX) and the new ultraviolet filters Tinosorb M and Tinosorb S. Standard allergen patch testing was also done. RESULTS: Twenty-seven patients self-reported "sunscreen allergy." Photopatch testing is difficult for patients; hence, only 11 agreed to proceed with the testing. Eight patients had negative patch testing results. One patient reacted to benzophenone-2. Another had a prior reaction to titanium dioxide and titanium oxalate but did not react to the silicone-coated titanium in our study. Yet another patient had relevant photopatch reactions to benzophenone-3 and ethylhexyl dimethyl para-aminobenzoic acid (PABA). None reacted to the Tinosorbs or Anthelios SX. Few positive reactions to the standard allergens were not relevant. CONCLUSION: Although small, this study parallels prior studies in concluding that true delayed type IV hypersensitivity (allergic contact dermatitis and photoallergy) to sunscreens is more infrequent than patients tend to believe.

Fragrance mix reactions and lime allergic contact dermatitis.

Allergic contact dermatitis due to citrus fruits is rare, but has been reported in cooks and bartenders. We report an interesting case of a bartender with hand dermatitis who had an allergic contact sensitivity to lime peel, fragrance mix I, and fragrance mix II. Most reported cases of citrus peel allergy are due to d-limonene, which makes up the majority of the peel oil. However, our patient had an allergic reaction to geraniol, which is a minor component of the peel oil and is present in fragrance mix I. It is important to consider a contact sensitivity to citrus in patients who have positive reactions to fragrance mix I and II and who are occupationally exposed to citrus fruits. An initial positive reaction to fragrance mixes should prompt further testing to citrus in these individuals.