Evaluation of direct workers' compensation costs for musculoskeletal injuries surrounding interventions to reduce patient lifting.

OBJECTIVES: We evaluated costs for workers' compensation (WC) injuries of a musculoskeletal (MS) nature in a large tertiary care hospital and an affiliated community hospital in the 13 years surrounding an institution-wide shift to a 'minimal manual patient-lifting environment' supported with inpatient mechanical lift equipment. METHODS: Negative binomial regression was used to model adjusted and discounted payment rates based on full-time equivalents (FTEs), and payment ratios. The risk of higher cost was assessed based on type of injury (patient-handling vs non-patient-handling), hospital, job, age, gender, institutional tenure and time since the implementation of lift equipment. Lagging was used to evaluate the latency of the intervention effect. RESULTS: Patient-handling injuries (n=1543) were responsible for 72% of MS injuries and 53% of compensation costs among patient care staff. Mean costs per claim were 5 times higher for those over age 45 than those <25 years of age. Physical and occupational therapy aides had the highest cost rates ($578/FTE) followed by nursing aides ($347/FTE) and patient transporters ($185/FTE). There was an immediate, marked decline in mean costs per claim and costs per FTE following the policy change and delivery of lift equipment. CONCLUSIONS: The observed patterns of changes in cost likely reflect the effects of activities other than use of lift equipment, including targeted efforts to close WC claims and an almost simultaneous policy that shifted cost responsibility to the budgets of managers on individual units. Inference was facilitated through the use of longitudinal data on the workgroups and an internal injury comparison.

Occupational injuries among aides and nurses in acute care.

BACKGROUND: Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses. METHODS: A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI). RESULTS: Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1-1.3) and lost work time (RR = 2.8, 95% CI: 2.1-3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care. CONCLUSIONS: Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth.

Otolith chemistry of prey fish consumed by a fish predator: does digestion hinder Russian doll techniques?

The effect of digestion by a predatory fish (largemouth bass Micropterus salmoides) on stable isotopic (delta(13)C and delta(18)O) and trace elemental (Sr:Ca and Ba:Ca) compositions of prey fish (bluegill Lepomis macrochirus) otoliths was investigated in a laboratory experiment. Trace element and stable-isotopic signatures of L. macrochirus otoliths were not significantly altered for up to 16 h after L. macrochirus were consumed by M. salmoides. Prey fish otoliths recovered from predator digesta can retain environmental stable isotopic and trace elemental signatures, suggesting that determination of environmental history for prey fishes by stable-isotope and trace-element analysis of otoliths recovered from stomachs of piscivorous fishes will be feasible.

Systematic reviews of workplace injury interventions: what are we missing?

BACKGROUND: There are pitfalls associated with applying a biomedical model with its emphasis on experimental designs to the evaluation of workplace injury interventions. OBJECTIVES: Evaluation over enough time is essential in occupational safety when interventions are expected to have a latent effect as well as to assess sustained effects. Controlled trials are not well-suited to this task and are not even possible in circumstances where a policy change, such as legislative action, affects a population of workers simultaneously. Social context influences occupational injury interventions, their evaluation and the wider generalization of findings but is lost in the pooling of data for meta-analyses. Some of these issues can be addressed through recognition of the contribution of diverse observational methodologies in intervention evaluation, improvement and maintenance of robust surveillance systems, and inclusion of qualitative methodologies not typically embraced by epidemiologists or medical researchers. METHODS: Through consideration of an evaluation of a legislative effort to prevent falls from height in construction, we demonstrate lack of flexibility in current methods used for evaluating time series analyses in systematic reviews of occupational injury intervention effectiveness. DISCUSSION AND CONCLUSIONS: These include the manner in which downward change in slope is assessed and the call to demonstrate a significant initial downward change in level. We illustrate essential contextual detail regarding this intervention that is lost in the pooling of data from multiple studies into a combined measure of effect. This reduction of occupational injury intervention evaluation to one of pure statistical significance is ill-conceived, irresponsible, and should be stopped.

Cloning, chromosomal location, and characterization of mouse E2F1.

E2F has been implicated in growth control because of its association with the retinoblastoma protein and the presence of E2F binding sites in the promoters of several growth-regulated genes. Proteins that bind to an E2F site have been cloned from human and mouse cells. However, these two proteins (human E2F1 and mouse DP-1) are quite different in sequence. We have now cloned a mouse cDNA encoding a protein 86% identical to the human E2F1 protein. The mouse E2F1 cDNA encodes a 430-amino-acid protein with a predicted molecular weight of 46,322 and detects mRNAs of 2.7 and 2.2 kb. Using primers complementary to sequences in the mouse E2F1 3' untranslated region, we mapped the mouse E2F1 gene to chromosome 2, near the Agouti and c-src loci. To understand the role of the different E2F family members in the growth of mouse NIH 3T3 cells, we examined the levels of E2F1 and DP-1 mRNAs in different stages of the cell cycle. Since the levels of E2F1 but not DP-1 mRNA correlated with changes in transcription from the dhfr promoter, we examined whether E2F1 could activate various growth-regulated promoters. We found that E2F1 could activate some (dhfr, thymidine kinase, and DNA polymerase alpha) but not all (thymidylate synthase, cad, and c-myc) of these promoters. On the basis of changes in levels of E2F1 and its ability to transactivate growth-regulated promoters, we propose that E2F1 may mediate growth factor-initiated signal transduction.

Interaction of microbial DNA with cultured mammalian cells. Binding of the donor DNA to the cell surface.

Cultured fibroblasts grown in monolayer were incubated for a short time with radioactively labeled microbial DNA and diethylaminoethyl-dextran (DEAE-dextran), poly-L-lysine, or calcium phosphate, agents previously demonstrated by others to markedly enhance transfection. Immediately after such treatment of 1 by 10(-6)-1.5 by 10(6) cells with DNA, approx. 0.05-0.15 mug of donor DNA representing 10-30% of the input DNA became cell associated. In contrast, when the cells are similarly treated with only a DNA solution approx. 0.5-5% of the donor DNA was retained by the cells. More than 95% of the cell-associated donor DNA was shown to be bound to the surface of cells treated with polycation. It was also shown that in the absence of polycation treatment, most of the cell-associated donor DNA was bound to the cell surface.

Allogeneic peripheral blood stem cell transplant for myelodysplasia after chemotherapy for post-transplant lymphoma in a cardiac transplant recipient at 10 years.

A 32-year-old male received an allogeneic peripheral blood stem cell transplant (alloPBSCT) for myelodysplasia from his one HLA-A antigen mismatched brother. He is alive with trilineage engraftment and without active GVHD 200 days after transplant. In July 1986 he underwent orthotopic cardiac transplantation for viral cardiomyopathy and has received continuous immunosuppressive therapy. A post-transplant lymphoproliferative disorder with Hodgkin-like histopathology was diagnosed in August 1993 and was successfully treated with four cycles of MOPP chemotherapy. Due to persistent pancytopenia he underwent a bone marrow aspiration and biopsy in May 1996 which revealed monosomy 7 and morphologic changes compatible with myelodysplasia. This is the first report of a cardiac transplant recipient receiving an allogeneic hematopoietic stem cell transplant.

Reversible cyclosporine-induced cortical blindness in allogeneic bone marrow transplant recipients.

We report the occurrence of reversible cyclosporine-induced cortical blindness in three allogeneic bone marrow transplant recipients. Possible mechanisms involved in this rare complication, as well as the associated radiographic and pathologic findings, are discussed.

Pneumocystis carinii infection presenting as necrotizing thyroiditis and hypothyroidism.

Extrapulmonary Pneumocystis infection has been increasingly reported in patients with acquired immune deficiency syndrome (AIDS), in particular, recently in association with the increasing use of aerosolized pentamidine. This report describes the unusual presentation of extrapulmonary Pneumocystis infection as a thyroid neck mass and clinical hypothyroidism in a 37-year-old man with hemophilia and AIDS. This case differs from the previously reported single case of isolated thyroid pneumocystosis in the presence of a rapidly enlarging neck mass, lack of previous Pneumocystis, and prior prophylaxis with aerosolized pentamidine. The pathologic and electron microscopic description of the peculiar flocculent necrotic thyroid material is contrasted with typical pulmonary alveolar findings in Pneumocystis pneumonia (PCP), the differential diagnoses of a rapidly expanding neck mass, and diagnostic difficulties of hypothyroidism in patients with AIDS are discussed. Finally, it is emphasized that use of aerosolized pentamidine, although successful for prevention of pulmonary PCP, may be insufficient to prevent extrapulmonary infection.

A comparison between glutaraldehyde and diepoxide-fixed stentless porcine aortic valves: biochemical and mechanical characterization and resistance to mineralization.

As previously reported, we found that the fixation rate and thermal denaturation (shrink) temperature of the diepoxide-fixed tissue could be controlled by varying the concentration of the fixative as well as by adding alcohol and/or sodium chloride to the solution. In contrast to prior experience, however, we now found that the epoxide-fixed leaflets exhibited significantly higher resistance to mineralization compared to controls, but only when the tissue had not been exposed to phosphate ion.

Development and evaluation of an enzyme-linked immunosorbent assay for the detection of antibodies to avian pneumovirus.

The development and evaluation of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to avian pneumovirus (APV) in chicken or turkey sera is described. The assay was capable of detecting serological responses as early as 11 days after chickens had been experimentally exposed to APV. The assay was evaluated by testing 4989 chicken or turkey sera from Canada (a known APV-negative country) and by testing 1190 chicken or turkey sera assumed positive from evidence of other laboratory results or clinical signs. This evaluation indicated that the ELISA was 98.7% sensitive and 99.5% specific. Evaluation of the agreement between the results of this ELISA and that of another laboratory was done by testing a panel of 218 chicken or turkey sera. The Kappa statistic for agreement was 0.92, indicating an excellent level of agreement between the two laboratories.

Inactivation of bovine herpesvirus-1 and bovine viral diarrhea virus in association with preimplantation bovine embryos using photosensitive agents.

Hematoporphyrin (HP), hematoporphyrin derivative (HPD), and thiopyronine (TP) are photosensitive agents (PSA) that have a germicidal effect when they are activated by light: helium neon laser (He/Ne) light (HP, HPD), white light (HP, HPD), and yellow-green light (TP). Experiments were conducted with appropriate controls to determine the effect of photosensitive agents a) for inactivating bovine herpesvirus-1 (BHV-1; titre 10(6) TCID50/ml) and bovine viral diarrhea virus (BVDV; titre 10(6) TCID50/ml); b) for disinfecting Day-7, zona pellucida-intact (ZP-I) bovine embryos that had been exposed to BHV-1 (titre 10(6) TCID50/ml) or BVDV (titre 10(6) TCID50/ml); and c) on the in vitro development of embryos. Exposure to HP, HPD and TP followed by light irradiation inactivated BHV-1 and BVDV. Embryos exposed to BHV-I were disinfected by HP or HPD (5 microg/ml) in combination with He Ne light, or by HP or HPD (10 microg/ml) in combination with white light. Embryos exposed to BVDV were disinfected by HPD (5 and 10 microg/ml) followed by He Ne or white light irradiation. Exposure of embryos to light alone or to light and HP or HPD had no detrimental effect on their in vitro development; however, exposure of embryos to TP (5 microg/ml) followed by irradiation caused embryonic degeneration. Exposure of embryos to 5 microg of HPD followed by He Ne light, or 10 microg/ml of HP or HPD, followed by white light, is simple methods of disinfecting them of BHV-I and BVDV.

Attempts to establish congenital bluetongue virus infections in calves.

Three bovine fetuses were inoculated in utero with approximately 10(3) plaque forming units of type 11 bluetongue virus. The gestational ages of the fetuses at the time of inoculation were 106, 113 and 122 days. They were spontaneously aborted 104, 65 and 109 days later, respectively, and the first and third of these fetuses were recovered. There was no grossly normal cerebral tissue, the meninges formed fluid filled sacs, and the cerebellums were reduced in size. Bluetongue virus was not isolated from the fetuses but the older one had neutralizing antibody. The three dams developed neutralizing antibody to bluetongue virus. The present work supports the observation by others that early fetal infections with bluetongue virus normally result in severe central nervous system damage and not in clinically normal, persistently infected calves.

Experimental peste des petits ruminants (goat plague) in goats and sheep.

In order to study the pathomorphology and immunohistochemistry of peste des petits ruminants, four goats and two sheep were inoculated intranasally with the Malig-Yemen strain of peste des petits ruminants virus. The animals developed fever, nasal discharge, oral erosions, cough and diarrhea. One goat and one sheep died and one moribund goat was killed. Three animals survived the infection. At necropsy, erosive stomatitis, pneumonia and gastroenteritis were found. Histopathologically the pneumonocytes and epithelial cells of the ileum had eosinophilic cytoplasmic and nuclear inclusions. By an indirect immunoperoxidase method, the nuclei and cytoplasm of the ileal epithelial cells of one goat contained positively (brown) stained antigen, which corresponded to viral nucleocapsids by electron microscopy. Virus appeared to be released through the microvilli of the epithelial cells. We also confirmed the formation of giant cells due to peste des petits ruminants virus.

A survey of cattle for antibodies against bluetongue and epizootic hemorrhagic disease of deer viruses in British Columbia and southwestern Alberta in 1987.

In 1987 a serological survey of cattle for antibodies (Ab) to bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) was undertaken in British Columbia and southwestern Alberta after infection with the viruses was diagnosed in wild and domestic ruminants in the Okanagan Valley. Of 4610 cattle tested, five had Ab only to BTV, 125 had antibodies only to EHDV and 16 had Ab to both viruses. The Ab were identified as specific for BTV type 11 (BT-11) or EHDV type 2 (EHDV-2). All but one of the seropositive cattle originated in the Okanagan Valley of British Columbia. The remaining one seropositive animal which had Ab to EHDV-2 was pastured with a bull purchased from the Okanagan Valley.

Specificity of the indirect enzyme-linked immunosorbent assay for detection of pseudorabies virus antibodies in pigs exposed to bovine herpesvirus-1.

Six 5-week-old pigs were inoculated intranasally (IN) with 10(7.6) TCID50 of bovine herpesvirus-1 (BHV-1). Three of the pigs also were inoculated IV with a similar dose of BHV-1. Clinical responses were not observed in these 6 pigs before oronasal challenge exposure with 10(7.8) TCID50 of virulent pseudorabies virus (PRV) at postinoculation day 42. Two pigs inoculated IN with BHV-1 and challenge exposed with PRV remained healthy, whereas the remaining 4 pigs developed severe clinical signs of pseudorabies and were moribund at postinoculation day 50 (8 days after challenge exposure). Anti-BHV-1 antibodies were demonstrable by ELISA in all 6 pigs and by serum neutralization (SN) in 5 pigs before challenge exposure with PRV. Anti-PRV antibody was not detected by ELISA or SN before challenge exposure to PRV. After challenge exposure to PRV, pigs with humoral antibody to BHV-1 responded anamnestically, and anti-PRV antibody activity was demonstrable by ELISA and SN in the 2 surviving pigs.

Application of a competitive ELISA for the detection of bluetongue virus antibodies in llamas and wild ruminants.

A competitive enzyme-linked immunosorbent assay (C-ELISA), using a group-specific monoclonal antibody against bluetongue virus (BTV), was applied to detect anti-BTV antibodies in serum samples from two llamas (Llama glama) experimentally infected with BTV serotype 10. Antibodies were detected in both llamas by 1 wk or 2 wk post-infection. Antibodies to BTV increased exponentially during the first 4 wk in both llamas and stabilized at an elevated level during the remaining 5-wk-period of the experiment. We evaluated the C-ELISA for 1,442 field sera from bluetongue-free areas, collected from 398 llamas in New Zealand as well as 451 elk (Cervus elaphus canadensis), 323 bison (Bison bison) and 270 reindeer (Rangifer tarandus tarandus) in Canada. Based on the frequency distribution of the C-ELISA values, we propose that the current negative cut-off value of 50% inhibition established for bovine field sera also can be applied to the sera from these wild ruminants. The C-ELISA values for other wild ruminant field sera collected in bluetongue-free areas of Canada from 98 native caribou (Rangifer tarandus caribou), 32 white-tailed deer (Odocoileus virginianus), 14 moose (Alces alces), and nine musk-oxen (Ovibos maschatus) and 15 yak (Bos grunniens) also were less than 50%, with the exception of three caribou samples. Based on our results, we propose that the C-ELISA be used as a rapid and specific test for serodiagnosis of BTV infection in llamas and possibly other wild ruminants.

Sheep pox: experimental studies with a west african isolate.

Under conditions of a maximum security laboratory, four cross-bred sheep were inoculated intradermally only or intradermally and intratracheally with a West African isolate of sheep pox virus. All sheep had increased temperature and depression by the fourth or fifth day after infection. Nasal and lacrimal discharge and coughing occurred in all sheep but were more severe in sheep receiving the virus via the tracheal route. From the fifth day after infection, numerous papular erythematous skin lesions developed at the inoculation sites. These were 3-7 mm in diameter and gradually became nodular. Some of these lesions healed and others coalesced to form tumorlike masses. In one sheep, euthanized 14 days after intradermal and intratracheal inoculation, nodular lesions were found in the skin around the eyes, nostrils, oral and perianal regions, the mucosa of the rumen and throughout the lungs. Histologically, skin nodules were characterized by ischemic necrosis, vasculitis, microvesicualtion, eosinophilic cytoplasmic inclusions in the dermal epithelial cells and vacuolar nuclear degeneration. The pulmonary lesion was that of proliferative alveolitis with occasional cytoplasmic inclusions in the alveolar cells and macrophages. Ultrastructurally, large cuboidal virus particles were found both in the skin lesion and inoculated tissue cultures. The sheep pox virus structure was easily distinguished from contagious ecthyma virus, a parapoxvirus which causes sporadic disease in Canada. Serum neutralizing antibodies developed in all the sheep by 14 days postinfection.The clinical and pathological characteristics of experimental sheep pox produced with this West African isolate were similar to those caused by Neethling virus of lumpy skin disease in cattle.

Newcastle disease in wild water birds in western Canada, 1990.

This report describes the investigation of mortality of double-crested cormorants (Phalacrocorax auritus), white pelicans (Pelecanus erythrorhynchos), and gulls (Larus spp.) in Alberta, Saskatchewan, and Manitoba during late summer 1990. Techniques used varied among areas, but virological and histopathological examination of birds was done in each area. The major clinical sign in cormorants was inability to fly, often with unilateral wing or leg paralysis. Focal nonsuppurative inflammation was present in the brain and spinal cord of cormorants and pelicans. Newcastle disease virus (NDV) was isolated from cormorants, a pelican, and a ring-billed gull (Larus delawarensls) from Saskatchewan. Cormorants from Alberta were positive for NDV in an immunofluorescent test. Most of the viruses were classed as velogenic and all had a similar monoclonal antibody profile to viruses from the 1970 to 1974 panzootic. Approximately half of cormorant, pelican, and gull eggs collected from affected colonies in the spring of 1991 had antibody to NDV. Antibody was also present in cormorant eggs from the Great Lakes. No unusual mortality was detected at any colony in 1991. Fledgling cormorants and gulls from colonies where mortality occurred in 1990 did not have antibody to NDV in June-July 1991. The overall extent of mortality among water birds and the source of the virus were not determined.

Consistency of dosing with a thermal aerosol generation system: in vitro and in vivo correlation.

Dosing consistency and reproducibility are presented for a novel pharmaceutical inhaler technology based on a thermal condensation process. Two different device platforms producing thermally generated aerosols have been created and used in clinical studies with a number of different drug compounds. Because this approach does not rely on energy from the user to disperse the aerosol particles, aerosol production is reliable, reproducible and virtually user independent following actuation. Pharmacokinetic data from multiple clinical studies show rapid absorption, dose proportionality, and concentration levels and variability similar to intravenous injection. In addition, products used in clinical trials show excellent subject consistency with the vast majority of devices delivering greater than 90% of the loaded dose and little drug exhaled.