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NK cells utilize a large array of receptors to screen their surroundings for aberrant or virus-infected cells. Given the vast diversity of receptors expressed on NK cells we seek to identify receptors involved in the recognition of HIV-1-infected cells. By combining an unbiased large-scale screening approach with a functional assay, we identify TRAIL to be associated with NK cell degranulation against HIV-1-infected target cells. Further investigating the underlying mechanisms, we demonstrate that TRAIL is able to elicit multiple effector functions in human NK cells independent of receptor-mediated induction of apoptosis. Direct engagement of TRAIL not only results in degranulation but also IFNγ production. Moreover, TRAIL-mediated NK cell activation is not limited to its cognate death receptors but also decoy receptor I, adding a new perspective to the perceived regulatory role of decoy receptors in TRAIL-mediated cytotoxicity. Based on these findings, we propose that TRAIL not only contributes to the anti-HIV-1 activity of NK cells but also possesses a multifunctional role beyond receptor-mediated induction of apoptosis, acting as a regulator for the induction of different effector functions.
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Citotoxicidade Imunológica , HIV-1 , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Humanos , Interferon gama/metabolismo , Células Matadoras Naturais , Ativação LinfocitáriaRESUMO
Introduction. Immigrant nail salon owners and employees face multiple barriers to accessing occupational health training and services. We formed an academic-community-based organization-business owner partnership-unique in that all partners were culturally congruent-to develop a pilot intervention program for the nail salon community. Methods. Eighteen individuals (nine salon owners and nine employees) from the Greater Philadelphia region received the training in their native language and provided feedback through in-depth qualitative interviews. Interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Themes of perceived benefits and barriers were identified and aligned with relevant CFIR constructs to gain better understanding of the implementation challenges. Results. Reported benefits of program were improved knowledge of the workplace hazards and safety practices, and the potential to attract more customers and retain employees. Perceived barriers to implementing recommended practices were limited availability of safer products and high cost, challenges communicating with customers, lack of engagement from some owners, organizational management practices affecting employees' motivation, and limited partnership with local government to assist small immigrant-owned businesses. Conclusions. Our study revealed multiple factors that pit long-term health protection of nail salon workers against the economic viability of the businesses that employ them. Our research highlights the need to (1) advocate for federal policies making safer products to be more accessible to the masses, (2) establish local policy and culturally appropriate technical support programs that engage community-based organizations, and (3) develop economic opportunities and mentorship for immigrant entrepreneurs to operate profitable healthy salons.
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Emigrantes e Imigrantes , Exposição Ocupacional , Saúde Ocupacional , Humanos , Exposição Ocupacional/prevenção & controle , Philadelphia , UnhasRESUMO
BACKGROUND: During the 2010 Deepwater Horizon (DWH) disaster, in-situ burning and flaring were conducted to remove oil from the water. Workers near combustion sites were potentially exposed to burning-related fine particulate matter (PM2.5). Exposure to PM2.5 has been linked to increased risk of coronary heart disease (CHD), but no study has examined the relationship among oil spill workers. OBJECTIVES: To investigate the association between estimated PM2.5 from burning/flaring of oil/gas and CHD risk among the DWH oil spill workers. METHODS: We included workers who participated in response and cleanup activities on the water during the DWH disaster (N = 9091). PM2.5 exposures were estimated using a job-exposure matrix that linked modelled PM2.5 concentrations to detailed DWH spill work histories provided by participants. We ascertained CHD events as the first self-reported physician-diagnosed CHD or a fatal CHD event that occurred after each worker's last day of burning exposure. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) for the associations between categories of average or cumulative daily maximum PM2.5 exposure (versus a referent category of water workers not near controlled burning) and subsequent CHD. We assessed exposure-response trends by examining continuous exposure parameters in models. RESULTS: We observed increased CHD hazard among workers with higher levels of average daily maximum exposure (low vs. referent: HR = 1.26, 95% CI: 0.93, 1.70; high vs. referent: HR = 2.11, 95% CI: 1.08, 4.12; per 10 µg/m3 increase: HR = 1.10, 95% CI: 1.02, 1.19). We also observed suggestively elevated HRs among workers with higher cumulative daily maximum exposure (low vs. referent: HR = 1.19, 95% CI: 0.68, 2.08; medium vs. referent: HR = 1.38, 95% CI: 0.88, 2.16; high vs. referent: HR = 1.44, 95% CI: 0.96, 2.14; per 100 µg/m3-d increase: HR = 1.03, 95% CI: 1.00, 1.05). CONCLUSIONS: Among oil spill workers, exposure to PM2.5 from flaring/burning of oil/gas was associated with increased risk of CHD.
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Doença das Coronárias , Desastres , Poluição por Petróleo , Humanos , Poluição por Petróleo/efeitos adversos , Material Particulado/análise , Seguimentos , Doença das Coronárias/induzido quimicamente , Doença das Coronárias/epidemiologia , Exposição AmbientalRESUMO
BACKGROUND: During the 2010 Deepwater Horizon (DWH) disaster, oil spill response and cleanup (OSRC) workers were exposed to toxic volatile components of crude oil. Few studies have examined exposure to individual volatile hydrocarbon chemicals below occupational exposure limits in relation to neurologic function among OSRC workers. OBJECTIVES: To investigate the association of several spill-related chemicals (benzene, toluene, ethylbenzene, xylene, n-hexane, i.e., BTEX-H) and total petroleum hydrocarbons (THC) with neurologic function among DWH spill workers enrolled in the Gulf Long-term Follow-up Study. METHODS: Cumulative exposure to THC and BTEX-H across the oil spill cleanup period were estimated using a job-exposure matrix that linked air measurement data to detailed self-reported DWH OSRC work histories. We ascertained quantitative neurologic function data via a comprehensive test battery at a clinical examination that occurred 4-6 years after the DWH disaster. We used multivariable linear regression and modified Poisson regression to evaluate relationships of exposures (quartiles (Q)) with 4 neurologic function measures. We examined modification of the associations by age at enrollment (<50 vs. ≥50 years). RESULTS: We did not find evidence of adverse neurologic effects from crude oil exposures among the overall study population. However, among workers ≥50 years of age, several individual chemical exposures were associated with poorer vibrotactile acuity of the great toe, with statistically significant effects observed in Q3 or Q4 of exposures (range of log mean difference in Q4 across exposures: 0.13-0.26 µm). We also observed suggestive adverse associations among those ≥ age 50 years for tests of postural stability and single-leg stance, although most effect estimates did not reach thresholds of statistical significance (p < 0.05). CONCLUSIONS: Higher exposures to volatile components of crude oil were associated with modest deficits in neurologic function among OSRC workers who were age 50 years or older at study enrollment.
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Desastres , Poluição por Petróleo , Petróleo , Humanos , Pessoa de Meia-Idade , Poluição por Petróleo/efeitos adversos , Seguimentos , Hidrocarbonetos/toxicidade , Petróleo/toxicidadeRESUMO
Since 2010, New South Wales (NSW) Health has assisted local water utilities to develop and implement risk-based drinking water management systems based on the Australian Drinking Water Guidelines Framework for Management of Drinking Water Quality. This support has benefited regional communities, and especially smaller utilities, by helping to identify and control risks. NSW Health's support projects have resulted in statistically significant improvements across many elements of drinking water management system implementation. Through this program of support, NSW Health has identified possible infrastructure and operational needs and assessed implementation of drinking water management systems. In parallel, NSW Health has worked to assess the risk from Cryptosporidium in drinking water supplies and to develop a formal audit program. Findings from the NSW Health support program informed the development of two NSW Government programs and the commitment of more than $1 billion to help local water utilities address public health and other critical needs. The introduction of risk-based drinking water management systems has driven incremental improvement in drinking water quality management across the state of NSW.
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Criptosporidiose , Cryptosporidium , Água Potável , Humanos , New South Wales , Austrália , Abastecimento de ÁguaRESUMO
BACKGROUND: The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. METHODS: We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population-based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two-digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre-1975 vs. post-1975), and region. RESULTS: Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. CONCLUSIONS: Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work-related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers.
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Acidente Vascular Cerebral , Adulto , Masculino , Humanos , Pessoa de Meia-Idade , Estudos de Coortes , Acidente Vascular Cerebral/epidemiologia , Fatores de Risco , Ocupações , EmpregoRESUMO
Asian and Asian Americans (A/AA) are a group overlooked in general health outcomes but especially occupational safety and health outcomes. In the United States, the beauty service microbusiness industry (e.g., nail salons) predominantly employs immigrant Asian women who regularly encounter a plethora of occupational hazards (e.g., harmful chemical exposures -toluene, formaldehyde, bloodborne pathogens, fungi. However, due to the precariousness of beauty service jobs, cultural and linguistic barriers, and social determinants of health, A/AA beauty service workers face complex occupational safety and health challenges that require interdisciplinary collaboration and cultural competency to address. This commentary will discuss a multi-level approach including specific outreach partners that will offer the required diverse skillsets necessary for improving the occupational safety and health for this worker population in this microbusiness industry. Implications and suggestions for interventions and policy changes are also recommended utilizing the National Institute on Minority Health and Health Disparities' Research Framework.
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Exposição Ocupacional , Saúde Ocupacional , Humanos , Feminino , Estados Unidos , Asiático , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/análise , Indústria da Beleza , Tolueno/análiseRESUMO
BACKGROUND: An important goal in animal breeding is to improve longitudinal traits. The objective of this study was to explore for longitudinal residual feed intake (RFI) data, which estimated breeding value (EBV), or combination of EBV, to use in a breeding program. Linear combinations of EBV (summarized breeding values, SBV) or phenotypes (summarized phenotypes) derived from the eigenvectors of the genetic covariance matrix over time were considered, and the linear regression method (LR method) was used to facilitate the evaluation of their prediction accuracy. RESULTS: Weekly feed intake, average daily gain, metabolic body weight, and backfat thickness measured on 2435 growing French Large White pigs over a 10-week period were analysed using a random regression model. In this population, the 544 dams of the phenotyped animals were genotyped. These dams did not have own phenotypes. The quality of the predictions of SBV and breeding values from summarized phenotypes of these females was evaluated. On average, predictions of SBV at the time of selection were unbiased, slightly over-dispersed and less accurate than those obtained with additional phenotypic information. The use of genomic information did not improve the quality of predictions. The use of summarized instead of longitudinal phenotypes resulted in predictions of breeding values of similar quality. CONCLUSIONS: For practical selection on longitudinal data, the results obtained with this specific design suggest that the use of summarized phenotypes could facilitate routine genetic evaluation of longitudinal traits.
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Ingestão de Alimentos , Genoma , Ração Animal/análise , Animais , Peso Corporal/genética , Ingestão de Alimentos/genética , Feminino , Genômica , Fenótipo , Suínos/genéticaRESUMO
OBJECTIVES: Given mixed evidence for carcinogenicity of current-use herbicides, we studied the relationship between occupational herbicide use and risk of non-Hodgkin's lymphoma (NHL) in a large, pooled study. METHODS: We pooled data from 10 case-control studies participating in the International Lymphoma Epidemiology Consortium, including 9229 cases and 9626 controls from North America, the European Union and Australia. Herbicide use was coded from self-report or by expert assessment in the individual studies, for herbicide groups (eg, phenoxy herbicides) and active ingredients (eg, 2,4-dichlorophenoxyacetic acid (2,4-D), glyphosate). The association between each herbicide and NHL risk was estimated using logistic regression to produce ORs and 95% CIs, with adjustment for sociodemographic factors, farming and other pesticides. RESULTS: We found no substantial association of all NHL risk with ever-use of any herbicide (OR=1.10, 95% CI: 0.94 to 1.29), nor with herbicide groups or active ingredients. Elevations in risk were observed for NHL subtypes with longer duration of phenoxy herbicide use, such as for any phenoxy herbicide with multiple myeloma (>25.5 years, OR=1.78, 95% CI: 0.74 to 4.27), 2,4-D with diffuse large B-cell lymphoma (>25.5 years, OR=1.47, 95% CI: 0.67 to 3.21) and other (non-2,4-D) phenoxy herbicides with T-cell lymphoma (>6 years, lagged 10 years, OR=3.24, 95% CI: 1.03 to 10.2). An association between glyphosate and follicular lymphoma (lagged 10 years: OR=1.48, 95% CI: 0.98 to 2.25) was fairly consistent across analyses. CONCLUSIONS: Most of the herbicides examined were not associated with NHL risk. However, associations of phenoxy herbicides and glyphosate with particular NHL subtypes underscore the importance of estimating subtype-specific risks.
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Herbicidas , Linfoma não Hodgkin , Exposição Ocupacional , Praguicidas , Humanos , Herbicidas/efeitos adversos , Exposição Ocupacional/efeitos adversos , Linfoma não Hodgkin/induzido quimicamente , Linfoma não Hodgkin/epidemiologia , Agricultura , Estudos de Casos e Controles , Fatores de RiscoRESUMO
Augmented and virtual reality devices are being actively investigated and implemented for a wide range of medical uses. However, significant gaps in the evaluation of these medical devices and applications hinder their regulatory evaluation. Addressing these gaps is critical to demonstrating the devices' safety and effectiveness. We outline the key technical and clinical evaluation challenges discussed during the US Food and Drug Administration's public workshop, "Medical Extended Reality: Toward Best Evaluation Practices for Virtual and Augmented Reality in Medicine" and future directions for evaluation method development. Evaluation challenges were categorized into several key technical and clinical areas. Finally, we highlight current efforts in the standards communities and illustrate connections between the evaluation challenges and the intended uses of the medical extended reality (MXR) devices. Participants concluded that additional research is needed to assess the safety and effectiveness of MXR devices across the use cases.
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Realidade Aumentada , Medicina , Realidade Virtual , Estados Unidos , HumanosRESUMO
INTRODUCTION: Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant-reported outcomes of research capacity building toolkit implementation in an occupational therapy department. METHODS: An observational pre-post-cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author-designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi-structured interviews were used to elicit reflections regarding participant experience. RESULTS: All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow-up. Eighty-five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'. CONCLUSION: The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual-related factors and processes to the building of research capacity is required.
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Fortalecimento Institucional , Terapia Ocupacional , Austrália , Estudos de Coortes , Humanos , Serviço Hospitalar de Terapia OcupacionalRESUMO
Evidence for the human health effects of pesticides is needed to inform risk assessment. We studied the relationship between occupational insecticide use and risk of non-Hodgkin lymphoma (NHL) by pooling data from nine case-control studies participating in the InterLymph Consortium, including 7909 cases and 8644 controls from North America, the European Union and Australia. Insecticide use was coded using self-report or expert assessment, for insecticide groups (eg, organophosphates, pyrethroids) and active ingredients (eg, malathion, permethrin). Associations with insecticides were estimated using logistic regression to produce odds ratios (ORs) and 95% confidence intervals (CI) for all NHL and NHL subtypes, with adjustment for study site, demographic factors and use of other pesticides. Occupational insecticide use, overall, was not associated with risk of NHL. Use of organophosphate insecticides was associated with increased risk of all NHL and the subtype follicular lymphoma, and an association was found with diazinon, in particular (ever use: OR = 2.05, 95%CI: 1.24-3.37). The carbamate insecticide, carbaryl, was associated with risk of all NHL, and the strongest associations were found with T-cell NHL for ever-use (OR = 2.44, 95%CI: 1.13-5.28) and longer duration (>8 years vs never: OR = 2.90, 95%CI: 1.02-8.25). There was no association of NHL with other broad groups of insecticides, including organochlorines and pyrethroids, and some inverse associations were estimated in relation to historical DDT use. Our findings contribute to the totality of evidence available to help inform risk decisions by public health and regulatory agencies of importance given continued, widespread use of organophosphate and carbamate insecticides.
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Inseticidas/intoxicação , Linfoma não Hodgkin/diagnóstico , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional/estatística & dados numéricos , Adulto , Idoso , Austrália , Estudos de Casos e Controles , União Europeia , Feminino , Humanos , Linfoma não Hodgkin/etiologia , Linfoma não Hodgkin/prevenção & controle , Masculino , Pessoa de Meia-Idade , América do Norte , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/análise , Razão de Chances , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de RiscoRESUMO
BACKGROUND: Residual feed intake (RFI) is one measure of feed efficiency, which is usually obtained by multiple regression of feed intake (FI) on measures of production, body weight gain and tissue composition. If phenotypic regression is used, the resulting RFI is generally not genetically independent of production traits, whereas if RFI is computed using genetic regression coefficients, RFI and production traits are independent at the genetic level. The corresponding regression coefficients can be easily derived from the result of a multiple trait model that includes FI and production traits. However, this approach is difficult to apply in the case of multiple repeated measurements of FI and production traits. To overcome this difficulty, we used a structured antedependence approach to account for the longitudinality of the data with a phenotypic regression model or with different genetic and environmental regression coefficients [multi- structured antedependence model (SAD) regression model]. RESULTS: After demonstrating the properties of RFI obtained by the multi-SAD regression model, we applied the two models to FI and production traits that were recorded for 2435 French Large White pigs over a 10-week period. Heritability estimates were moderate with both models. With the multi-SAD regression model, heritability estimates were quite stable over time, ranging from 0.14 ± 0.04 to 0.16 ± 0.05, while heritability estimates showed a U-shaped profile with the phenotypic regression model (ranging from 0.19 ± 0.06 to 0.28 ± 0.06). Estimates of genetic correlations between RFI at different time points followed the same pattern for the two models but higher estimates were obtained with the phenotypic regression model. Estimates of breeding values that can be used for selection were obtained by eigen-decomposition of the genetic covariance matrix. Correlations between these estimated breeding values obtained with the two models ranged from 0.66 to 0.83. CONCLUSIONS: The multi-SAD model is preferred for the genetic analysis of longitudinal RFI because, compared to the phenotypic regression model, it provides RFI that are genetically independent of production traits at all time points. Furthermore, it can be applied even when production records are missing at certain time points.
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Fenômenos Fisiológicos da Nutrição Animal/genética , Modelos Genéticos , Aumento de Peso/genética , Animais , Interação Gene-Ambiente , Estudo de Associação Genômica Ampla/métodos , Gado/genética , Gado/fisiologia , Polimorfismo de Nucleotídeo Único , Aves Domésticas/genética , Aves Domésticas/fisiologia , Característica Quantitativa Herdável , Fatores de TempoRESUMO
In the United States (U.S.), up to 2.2 million individuals have been chronically infected with hepatitis B virus (HBV). Many nail salon workers are at risk for HBV as they are coming from high-risk and traditionally underserved communities. To understand barriers and knowledge associated with HBV in the Vietnamese nail salon community, the Health Belief Model (HBM) was used to qualitatively assess the health needs for the prevention of HBV among Vietnamese nail salon workers in Philadelphia through focus groups and interviews (N = 19). Results revealed several themes that highlight barriers within the Vietnamese nail community. Major themes were the lack of knowledge related to hepatitis B, including significant misconceptions related to symptoms, and how hepatitis B is transmitted and prevented. There were also several barriers to health care access within the Vietnamese nail community including the cost of health care, long work hours, lack of insurance and lack of understanding of current community resources. Additionally, discrimination and stigma related to those infected with hepatitis B emerged as a theme from this data. Those interviewed also noted that the nail training and licensing they received did not highlight hepatitis B and other infectious diseases that can be spread within the nail salon.
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Hepatite B , Exposição Ocupacional , Povo Asiático , Indústria da Beleza , Humanos , PhiladelphiaRESUMO
OBJECTIVE: This qualitative study explored factors that influence health and safety practices among Vietnamese nail salon technicians and owners. METHODS: We conducted semi-structured focus group discussions and individual interviews with a sample of 17 Vietnamese nail salon technicians and owners in the Philadelphia metropolitan area, Pennsylvania. RESULTS: Analysis of transcripts revealed perceived health benefits/concerns, knowledge about work-related hazards, salon's management and policies attributed to owners, client influence, external policies/regulations, and protective equipment-specific challenges were among factors affecting workplace health promotion practices at the salons. CONCLUSIONS: The study highlighted a complex interplay among the various stakeholders including nail technicians, owners, clients, policy makers, and enforcers. Interventions addressing barriers at the personal and organizational levels, as well as public policy change and enforcement are needed to create sustainable behavioral and organizational change in nail salons.
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Indústria da Beleza , Conhecimentos, Atitudes e Prática em Saúde , Unhas , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Adulto , Indústria da Beleza/legislação & jurisprudência , Feminino , Grupos Focais , Luvas Protetoras , Humanos , Entrevistas como Assunto , Masculino , Máscaras , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/prevenção & controle , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional/legislação & jurisprudência , Política Organizacional , Pennsylvania , Política Pública , Pesquisa Qualitativa , Participação dos Interessados , Vietnã/etnologia , Adulto JovemRESUMO
We numerically and experimentally investigate a broadband, polarization-independent and wide-incident-angle metamaterial perfect absorber (MPA) based on conductive polymer. By optimizing the electrical conductivity of the polymer, a 16.7 GHz broadband MPA is observed with the absorptivity greater than 80% for both transverse magnetic and electric polarization. The measurement results performed in the range 8-18 GHz show a diametrical concatenation with simulation results and theoretical analysis. The absorption mechanism is explained by demonstrating the influence of polymer conductivity on the dissipated power, the equivalent impedance, and the induced electric field. Our work may contribute to further studies on broadband MPA using for various applications.
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Background: USP <797> regulatory requirements have mandated that pharmacies improve aseptic techniques and cleanliness of the medication preparation areas. In addition, the Institute for Safe Medication Practices (ISMP) recommends that technology and automation be used as much as possible for preparing and verifying compounded sterile products. Objective: To determine the benefits associated with the implementation of the workflow management system, such as reducing medication preparation and delivery errors, reducing quantity and frequency of medication errors, avoiding costs, and enhancing the organization's decision to move toward positive patient identification (PPID). Methods: At Texas Children's Hospital, data were collected and analyzed from January 2014 through August 2014 in the pharmacy areas in which the workflow management system would be implemented. Data were excluded for September 2014 during the workflow management system oral liquid implementation phase. Data were collected and analyzed from October 2014 through June 2015 to determine whether the implementation of the workflow management system reduced the quantity and frequency of reported medication errors. Data collected and analyzed during the study period included the quantity of doses prepared, number of incorrect medication scans, number of doses discontinued from the workflow management system queue, and the number of doses rejected. Data were collected and analyzed to identify patterns of incorrect medication scans, to determine reasons for rejected medication doses, and to determine the reduction in wasted medications. Results: During the 17-month study period, the pharmacy department dispensed 1,506,220 oral liquid and injectable medication doses. From October 2014 through June 2015, the pharmacy department dispensed 826,220 medication doses that were prepared and checked via the workflow management system. Of those 826,220 medication doses, there were 16 reported incorrect volume errors. The error rate after the implementation of the workflow management system averaged 8.4%, which was a 1.6% reduction. After the implementation of the workflow management system, the average number of reported oral liquid medication and injectable medication errors decreased to 0.4 and 0.2 times per week, respectively. Conclusion: The organization was able to achieve its purpose and goal of improving the provision of quality pharmacy care through optimal medication use and safety by reducing medication preparation errors. Error rates decreased and the workflow processes were streamlined, which has led to seamless operations within the pharmacy department. There has been significant cost avoidance and waste reduction and enhanced interdepartmental satisfaction due to the reduction of reported medication errors.
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Classical statistical methods for analyzing exposure data with values below the detection limits are well described in the occupational hygiene literature, but an evaluation of a Bayesian approach for handling such data is currently lacking. Here, we first describe a Bayesian framework for analyzing censored data. We then present the results of a simulation study conducted to compare the ß-substitution method with a Bayesian method for exposure datasets drawn from lognormal distributions and mixed lognormal distributions with varying sample sizes, geometric standard deviations (GSDs), and censoring for single and multiple limits of detection. For each set of factors, estimates for the arithmetic mean (AM), geometric mean, GSD, and the 95th percentile (X0.95) of the exposure distribution were obtained. We evaluated the performance of each method using relative bias, the root mean squared error (rMSE), and coverage (the proportion of the computed 95% uncertainty intervals containing the true value). The Bayesian method using non-informative priors and the ß-substitution method were generally comparable in bias and rMSE when estimating the AM and GM. For the GSD and the 95th percentile, the Bayesian method with non-informative priors was more biased and had a higher rMSE than the ß-substitution method, but use of more informative priors generally improved the Bayesian method's performance, making both the bias and the rMSE more comparable to the ß-substitution method. An advantage of the Bayesian method is that it provided estimates of uncertainty for these parameters of interest and good coverage, whereas the ß-substitution method only provided estimates of uncertainty for the AM, and coverage was not as consistent. Selection of one or the other method depends on the needs of the practitioner, the availability of prior information, and the distribution characteristics of the measurement data. We suggest the use of Bayesian methods if the practitioner has the computational resources and prior information, as the method would generally provide accurate estimates and also provides the distributions of all of the parameters, which could be useful for making decisions in some applications.
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Teorema de Bayes , Limite de Detecção , Modelos Estatísticos , Exposição Ocupacional/estatística & dados numéricos , Saúde Ocupacional , Simulação por Computador , Humanos , Exposição Ocupacional/análise , Medição de Risco/métodos , Tamanho da AmostraRESUMO
The National Institute for Environmental Health Sciences (NIEHS) is conducting an epidemiologic study (GuLF STUDY) to investigate the health of the workers and volunteers who participated from April to December of 2010 in the response and cleanup of the oil release after the Deepwater Horizon explosion in the Gulf of Mexico. The exposure assessment component of the study involves analyzing thousands of personal monitoring measurements that were collected during this effort. A substantial portion of these data has values reported by the analytic laboratories to be below the limits of detection (LOD). A simulation study was conducted to evaluate three established methods for analyzing data with censored observations to estimate the arithmetic mean (AM), geometric mean (GM), geometric standard deviation (GSD), and the 95th percentile (X0.95) of the exposure distribution: the maximum likelihood (ML) estimation, the ß-substitution, and the Kaplan-Meier (K-M) methods. Each method was challenged with computer-generated exposure datasets drawn from lognormal and mixed lognormal distributions with sample sizes (N) varying from 5 to 100, GSDs ranging from 2 to 5, and censoring levels ranging from 10 to 90%, with single and multiple LODs. Using relative bias and relative root mean squared error (rMSE) as the evaluation metrics, the ß-substitution method generally performed as well or better than the ML and K-M methods in most simulated lognormal and mixed lognormal distribution conditions. The ML method was suitable for large sample sizes (N ≥ 30) up to 80% censoring for lognormal distributions with small variability (GSD = 2-3). The K-M method generally provided accurate estimates of the AM when the censoring was <50% for lognormal and mixed distributions. The accuracy and precision of all methods decreased under high variability (GSD = 4 and 5) and small to moderate sample sizes (N < 20) but the ß-substitution was still the best of the three methods. When using the ML method, practitioners are cautioned to be aware of different ways of estimating the AM as they could lead to biased interpretation. A limitation of the ß-substitution method is the absence of a confidence interval for the estimate. More research is needed to develop methods that could improve the estimation accuracy for small sample sizes and high percent censored data and also provide uncertainty intervals.
Assuntos
Viés , Interpretação Estatística de Dados , Modelos Estatísticos , Exposição Ocupacional/análise , Simulação por Computador , Humanos , Limite de Detecção , Medição de Risco/métodos , Tamanho da AmostraRESUMO
The health sector has prioritized the physical health of vulnerable Generation X individuals at high Coronavirus risk. Despite vaccination efforts, both infected and healthy people continue facing health threats. Unlike other industries devastated by COVID-19, wearable fitness technology equipment (WFTE) is essential for health-focused individuals. This research examined customers' intention to use WFTE using an adapted Technology Acceptance Model (TAM) framework. A key contribution is the inclusion of perceived health risk and its impact on WFTE value perceptions and usage attitudes post-pandemic. The study gathered qualitative data from coronavirus patients and survey data from 513 participants. Structural equation modeling analysis supported the theoretical model. While the standard TAM evaluated intent to use WFTE, this study uniquely examined how WFTE's functional, hedonic, and symbolic value shapes its perceived value. Perceived health risk was found to significantly impact perceived WFTE value and usage attitudes after the pandemic recovery. Findings offer managerial implications to boost WFTE adoption among the vulnerable Generation X demographic.