Mild traumatic brain injury caused by workplace violence in a US workers' compensation system.

OBJECTIVES: Approximately 81% of traumatic brain injury cases are considered to be mild (mTBI), but few studies have reviewed mTBI caused by workplace violence (WPV). This study aimed to (1) determine the incidence of mTBI secondary to WPV in a statewide workers' compensation system using International Classification of Disease codes and (2) analyse and compare factors associated with return-to-work outcomes between WPV mTBI cases versus other mechanisms. METHODS: Using a retrospective cohort of claims data from the California Workers' Compensation Information System during 2015-2019, cases with a return-to-work date were classified as WPV if the injury description contained keywords such as assault, gunpoint, harassed, intimidated, punch, threat, robbery, violent or verbal abuse. RESULTS: Of the 14 089 mTBI claims analysed in this study, 11.2% were caused by WPV. When comparing WPV to non-WPV claims, the variables with statistically significant (p≤0.001) differences were age, income, industry and job class. There were no significant differences between groups for leave duration. In a linear mixed model, the variable of interest (WPV) was not associated with recovery duration after adjusting for other factors. CONCLUSION: To our knowledge, this is the first study to examine WPV mTBI claims in the USA. The findings suggest that the public administration, education and healthcare and social services industries are at higher risk for WPV mTBI. WPV and job class were the only modifiable factors in the model and therefore should be the focus of additional research.

Impacts of age, diabetes, and hypertension on serum endothelial monocyte-activating polypeptide-II after prolonged work in the heat.

BACKGROUND: With rising temperature extremes, older workers are becoming increasingly vulnerable to heat-related injuries because of age- and disease-associated decrements in thermoregulatory function. Endothelial monocyte-activating polypeptide-II (EMAP-II) is a proinflammatory cytokine that has not yet been well-characterized during heat stress, and which may mediate the inflammatory response to high levels of physiological strain. METHODS: We evaluated serum EMAP-II concentrations before and after 180 min of moderate-intensity work (200 W/m2 ) in temperate (wet-bulb globe temperature [WBGT] 16°C) and hot (WBGT 32°C) environments in heat-unacclimatized, healthy young (n = 13; mean [SD]; 22 [3] years) and older men (n = 12; 59 [4] years), and unacclimatized older men with hypertension (HTN) (n = 10; 60 [4] years) or type 2 diabetes (T2D) (n = 9; 60 [5] years). Core temperature and heart rate were measured continuously. RESULTS: In the hot environment, work tolerance time was lower in older men with HTN and T2D compared to healthy older men (both p < 0.049). While core temperature and heart rate reserve increased significantly (p < 0.001), they did not differ across groups. End-exercise serum EMAP-II concentrations were higher in young men relative to their older counterparts due to higher baseline levels (both p ≤ 0.02). Elevations in serum EMAP-II concentrations were similar between healthy older men and older men with HTN, while serum EMAP-II concentrations did not change in older men with T2D following prolonged work in the heat. CONCLUSION: Serum EMAP-II concentrations increased following prolonged moderate-intensity work in the heat and this response is influenced by age and the presence of HTN or T2D.

Occupational handling of nickel nanoparticles: a case report.

A 26-year-old female chemist formulated polymers and coatings usually using silver ink particles. When she later began working with nickel nanoparticle powder weighed out and handled on a lab bench with no protective measures, she developed throat irritation, nasal congestion, "post nasal drip," facial flushing, and new skin reactions to her earrings and belt buckle which were temporally related to working with the nanoparticles. Subsequently she was found to have a positive reaction to nickel on the T.R.U.E. patch test, and a normal range FEV1 that increased by 16% post bronchodilator. It was difficult returning her to work even in other parts of the building due to recurrence of symptoms. This incident triggered the company to make plans for better control measures for working with nickel nanoparticles. In conclusion, a worker developed nickel sensitization when working with nanoparticle nickel powder in a setting without any special respiratory protection or control measures.

Indoor overheating: A review of vulnerabilities, causes, and strategies to prevent adverse human health outcomes during extreme heat events.

The likelihood of exposure to overheated indoor environments is increasing as climate change is exacerbating the frequency and severity of hot weather and extreme heat events (EHE). Consequently, vulnerable populations will face serious health risks from indoor overheating. While the relationship between EHE and human health has been assessed in relation to outdoor temperature, indoor temperature patterns can vary markedly from those measured outside. This is because the built environment and building characteristics can act as an important modifier of indoor temperatures. In this narrative review, we examine the physiological and behavioral determinants that influence a person's susceptibility to indoor overheating. Further, we explore how the built environment, neighborhood-level factors, and building characteristics can impact exposure to excess heat and we overview how strategies to mitigate building overheating can help reduce heat-related mortality in heat-vulnerable occupants. Finally, we discuss the effectiveness of commonly recommended personal cooling strategies that aim to mitigate dangerous increases in physiological strain during exposure to high indoor temperatures during hot weather or an EHE. As global temperatures continue to rise, the need for a research agenda specifically directed at reducing the likelihood and impact of indoor overheating on human health is paramount. This includes conducting EHE simulation studies to support the development of consensus-based heat mitigation solutions and public health messaging that provides equitable protection to heat-vulnerable people exposed to high indoor temperatures.

Comorbidity and functional outcomes after hip fracture: an umbrella review protocol.

OBJECTIVE: The objective of the review is to examine the association between comorbidity and functional outcomes after hip fracture. INTRODUCTION: Patients who have suffered a hip fracture are at risk of poor functional recovery, which may be influenced by factors such as age, functional status at baseline, and comorbid conditions. Patients recovering from a hip fracture seldom present without other comorbid conditions. This proposed review will lead to a better understanding of the association between comorbidity and functional recovery after hip fracture and will assist in the medical support of patients recovering from these injuries. INCLUSION CRITERIA: Systematic reviews that include cohort studies reporting on comorbidity and functional outcomes after hip fracture in adults (≥ 18 years old) published at any time will be included. Study protocols, papers that are not systematic reviews, papers not reporting on comorbidities or functional outcomes, and papers published in languages other than English will be excluded from the review. METHODS: The JBI methodology for umbrella reviews will be followed. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews will be searched. Two reviewers will screen the titles and abstracts against the eligibility criteria. Data extraction will be performed by 2 independent reviewers on the reviews selected for inclusion. Extracted study characteristics will include the author, year published, databases searched, number of studies/patients included, comorbidity measures, functional outcomes, presence of meta-analysis, and bias appraisal results. The quality of included studies will be reported using the JBI critical appraisal checklist for systematic reviews and research syntheses. A summary of the extracted data will be presented in tabular format and a narrative synthesis will be performed on the collected systematic reviews that meet the inclusion criteria. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021272502.

Characteristics and outcomes of COVID-19-Positive Individuals Admitted for Inpatient Rehabilitation in Toronto, Canada.

OBJECTIVE: To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation at three rehabilitation hospitals in Toronto, Canada. DESIGN: Retrospective chart review of patients admitted to three COVID-19 rehabilitation units between 20 April 2020 and 3 June 2020. Sociodemographic factors, impairments, length of stay, and Functional Independence Measure data were reported. RESULTS: A total of 41 patients were included in this study, including 22 males and 19 females. The median age was 75 years. Thirty-six percent of patients were admitted to the intensive care unit during their acute stay. The most commonly affected body functions were: neuromusculoskeletal (73.2%); combined cardiovascular, haematological, immunological, and respiratory (65.9%); and mental functions (29.3%). Median total Functional Independence Measure score was 85 at admission and 108.5 at discharge. CONCLUSION: This study represents some of the first data on the characteristics and outcomes of COVID-19-positive individuals admitted to inpatient rehabilitation in Toronto, Canada early in the COVID-19 pandemic.

Identifying priorities and developing strategies for building capacity in amputation research in Canada.

BACKGROUND: Compared to other patient population groups, the field of amputation research in Canada lacks cohesion largely due to limited funding sources, lack of connection among research scientists, and loose ties among geographically dispersed healthcare centres, research institutes and advocacy groups. As a result, advances in clinical care are hampered and ultimately negatively influence outcomes of persons living with limb loss. OBJECTIVE: To stimulate a national strategy on advancing amputation research in Canada, a consensus-workshop was organized with an expert panel of stakeholders to identify key research priorities and potential strategies to build researcher and funding capacity in the field. METHODS: A modified Delphi approach was used to gain consensus on identifying and selecting an initial set of priorities for building research capacity in the field of amputation. This included an anonymous pre-meeting survey (N = 31 respondents) followed by an in-person consensus-workshop meeting that hosted 38 stakeholders (researchers, physiatrists, surgeons, prosthetists, occupational and physical therapists, community advocates, and people with limb loss). RESULTS: The top three identified research priorities were: (1) developing a national dataset; (2) obtaining health economic data to illustrate the burden of amputation to the healthcare system and to patients; and (3) improving strategies related to outcome measurement in patients with limb loss (e.g. identifying, validating, and/or developing outcome measures). Strategies for moving these priorities into action were also developed. CONCLUSIONS: The consensus-workshop provided an initial roadmap for limb loss research in Canada, and the event served as an important catalyst for stakeholders to initiate collaborations for moving identified priorities into action. Given the increasing number of people undergoing an amputation, there needs to be a stronger Canadian collaborative approach to generate the necessary research to enhance evidence-based clinical care and policy decision-making.IMPLICATIONS FOR REHABILITATIONLimb loss is a growing concern across North America, with lower-extremity amputations occurring due to complications arising from diabetes being a major cause.To advance knowledge about limb loss and to improve clinical care for this population, stronger connections are needed across the continuum of care (acute, rehabilitation, community) and across sectors (clinical, advocacy, industry and research).There are new surgical techniques, technologies, and rehabilitation approaches being explored to improve the health, mobility and community participation of people with limb loss, but further research evidence is needed to demonstrate efficacy and to better integrate them into standard clinical care.

Influence of nonthermal baroreceptor modulation of heat loss responses during uncompensable heat stress.

We evaluated the hypothesis that with increasing levels of hyperthermia, thermal influences would predominate over nonthermal baroreceptor control of cutaneous vascular conductance (CVC) and local sweat rate (LSR). On separate days, eight male participants were positioned in either an upright seated posture (URS) or a 15 degrees head-down tilt (HDT) posture in a thermoneutral condition and during passive heating, until mean body temperature (T(body)) increased by 1.5 degrees C. Hemodynamic [heart rate (HR), cardiac output, mean arterial pressure (MAP)] and thermal responses [T(re), CVC, LSR] were measured continuously. MAP showed a gradual decrease in the early- to mid-stages of heating for both HDT and URS. At a T(body) > 0.6 degrees C, MAP achieved a stable, albeit reduced level from baseline resting for the duration of the heating, whereas MAP decreased significantly throughout the heating period in the URS position (p < 0.001). CVC increased rapidly in the early stages of heating and achieved a stable elevated level in both HDT and URS at the mid-stage of heating (T(body) increase

Cardiovascular and thermal responses to repeated head-up tilts following exercise-induced heat stress.

BACKGROUND: We evaluated the acute cardiovascular and thermoregulatory responses to repeated 70 degrees head-up tilts (HUT) performed following exercise-induced hyperthermia. METHODS: Eight male subjects underwent intermittent episodes of 70 degrees HUT in either a non-exercise/ non-heat stress state (NH) or an exercise-induced hyperthermic state (EIH). Subjects remained supine for 30 min in a thermoneutral environment (22 degrees C) and were subsequently exposed to three successive 6-min 70 degrees head-up tilts (HUT1, HUT2, HUT3), each separated by 10 min of supine resting. During EIH, subjects were rendered hyperthermic by exercise in the heat (core temperature of approximately 40.0 degrees C) and were then transferred to an ambient temperature of 22 degrees C. We evaluated the relative change in hemodynamic and thermal responses from the last minute in the supine position preceding the HUT to the final minute in HUT. RESULTS: While we measured a difference in the relative change in heart rate between conditions for all HUTs, no differences were observed in mean arterial pressure (MAP), total peripheral resistance, or cardiac output. A reduced change in baroreceptor sensitivity was measured in EIH for HUT1 only (-2 +/- 1 ms x mmHg(-1) following EIH compared to -13 +/- 3 ms x mmHg(-1) during NH). A significant transient reduction in cutaneous vascular conductance (CVC) occurred during HUT1 and HUT2 following EIH (-20 +/- 5% CVCmax and -9 +/- 3 %CVCmax, respectively), despite significant elevations in core temperature above resting levels (i.e., 1.4 degrees C and 0.9 degrees C for HUT1 and HUT2). CONCLUSION: We conclude that the maintenance of MAP following exercise in the heat is mitigated by reductions in skin perfusion despite significant elevations in core temperature.

A systematic review of the impact of obesity on stroke inpatient rehabilitation functional outcomes.

BACKGROUND: Obesity is a known risk factor for stroke, but its impact on functional recovery is less clear. Understanding the effect of obesity on functional recovery during inpatient rehabilitation will aid clinicians in patient counselling and help administrators with program planning. OBJECTIVE: To determine if obesity affects the functional outcomes of adults undergoing inpatient stroke rehabilitation. METHODS: MEDLINE, Embase, CINAHL, and Cochrane databases were searched using the subject headings and text word terms for stroke, rehabilitation, and obesity. Two independent reviewers screened the articles against pre-defined eligibility criteria and extracted the data. Outcomes of interest included FIM, mRS, Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, and Barthel Index. RESULTS: Seven studies from five countries with a total of 3070 participants were included. There was significant heterogeneity among the studies in the BMI cut-off points and functional outcome measures used. Two studies found a positive association between obesity and functional outcome, two studies found no association, and three studies reported a negative relationship. CONCLUSIONS: No conclusions could be drawn regarding whether the functional outcome of adults undergoing inpatient stroke rehabilitation differ between individuals with and without obesity.

Macrophage inflammatory response to self-assembling rosette nanotubes.

Rosette nanotubes (RNTs) are a new class of nanomaterials with significant therapeutic potential. However, societal concerns related to the potential adverse health effects of engineered nanomaterials drew attention towards the investigation of their interaction with the human U937 macrophage cell line. The cells are treated with medium only (control), lysine (50 microg mL(-1)), lysine-functionalized RNTs (RNT-K; 1, 5, and 50 microg mL(-1)), Min-U-Sil quartz microparticles (80 microg mL(-1)), or lipopolysaccharide (1 microg mL(-1)). The supernatant and cells are assayed for cell viability, cytokine protein, and mRNA expression at 1, 6, and 24 h post-treatment. The results indicate that RNT-K activate transcription of proinflammatory genes (interleukin-8 and tumor necrosis factor-alpha (TNF-alpha)) within 1 h, but this effect is not accompanied by protein secretion into the supernatant. The effect of the length of RNTs on human U937 macrophage viability is also investigated. Although both short and long RNT-K exhibit time-dependent effects on TNF-alpha transcription, only the short RNT-K (5 microg mL(-1)) increase TNF-alpha concentration at 6 h relative to the long RNT-K. Moreover, RNT-K (1 and 5 microg mL(-1)) have no effect on cell viability by 24 h. These data indicate that RNT-K do not induce a robust inflammatory response or cytotoxicity in the U937 human macrophage cell line, and therefore could be used for biomedical applications.

Joint and soft-tissue injections in rehabilitation inpatients taking direct oral anticoagulants.

The risk for complications associated with joint and soft-tissue injections in patients taking direct oral anticoagulants (DOACs) is not fully understood. In this retrospective evaluation of 445 inpatients in a rehabilitation hospital who received corticosteroid injections, complications were compared in patients on DOACs with those who were not. After a review of all injections, no adverse events of significant bleeding (intra-articular or extra-articular) were observed. These findings suggest no substantial increase in adverse events associated with the use of DOACs when performing joint and soft-tissue injection procedures in inpatient rehabilitation setting.

Low inflammatory activation by self-assembling Rosette nanotubes in human Calu-3 pulmonary epithelial cells.

Rosette nanotubes (RNT) are a new class of metal-free organic nanotubes synthesized through self-assembly. Because of the wide range of potential biomedical applications associated with these materials, it is necessary to evaluate their potential in vitro toxicity. Here the cytotoxicity of a lysine-functionalized nanotube (RNT-K) in a human Calu-3 pulmonary epithelial cell line is investigated. The cells were treated with media only (control), lysine (50 mg mL(-1)), RNT-K (1, 5, and 50 microg mL(-1)), Min-U-Sil quartz microparticles (QM; 80 microg mL(-1)), and lipopolysaccharide (LPS; 1 microg mL(-1)). The supernatants were analyzed at 1, 6, and 24 h after treatment for the expression of three proinflammatory mediators: IL-8, TNF-alpha and EMAP-II. Cellular viability determined with the Trypan blue assay is significantly reduced in the QM and high-dose RNT-treated groups. TNF-alpha and EMAP-II are undetectable by enzyme-linked-immunosorbent assay (ELISA) in the supernatant of all groups. Although IL-8 concentrations do not differ between treatments, its concentrations increase with time within each of the groups. Quantitative reverse-transcriptase polymerase chain reaction (qRTPCR) of IL-8 mRNA shows increased expression in the high-dose RNT-treated groups at both 1 and 6 h, while an adhesion molecule, ICAM-1 mRNA, shows the greatest increase at 6 h in the QM-treated group. In summary, RNT-K neither reduces cell viability at moderate doses nor does it induce a time-dependent inflammatory response in pulmonary epithelial cells in vitro.

Menstrual cycle and oral contraceptive use do not modify postexercise heat loss responses.

It is unknown whether menstrual cycle or oral contraceptive (OC) use influences nonthermal control of postexercise heat loss responses. We evaluated the effect of menstrual cycle and OC use on the activation of heat loss responses during a passive heating protocol performed pre- and postexercise. Women without OC (n = 8) underwent pre- and postexercise passive heating during the early follicular phase (FP) and midluteal phase (LP). Women with OC (n = 8) underwent testing during the active pill consumption (high exogenous hormone phase, HH) and placebo (low exogenous hormone phase, LH) weeks. After a 60-min habituation at 26 degrees C, subjects donned a liquid conditioned suit. Mean skin temperature was clamped at approximately 32.5 degrees C for approximately 15 min and then gradually increased, and the absolute esophageal temperature at which the onset of forearm vasodilation (Th(vd)) and upper back sweating (Th(sw)) were noted. Subjects then cycled for 30 min at 75% Vo(2 peak) followed by a 15-min seated recovery. A second passive heating was then performed to establish postexercise values for Th(vd) and Th(sw). Between 2 and 15 min postexercise, mean arterial pressure (MAP) remained significantly below baseline (P < 0.05) by 10 +/- 1 and 11 +/- 1 mmHg for the FP/LH and LP/HH, respectively. MAP was not different between cycle phases. During LP/HH, Th(vd) was 0.16 +/- 0.24 degrees C greater than FP/LH preexercise (P = 0.020) and 0.15 +/- 0.23 degrees C greater than FP/LH postexercise (P = 0.017). During LP/HH, Th(sw) was 0.17 +/- 0.23 degrees C greater than FP/LH preexercise (P = 0.016) and 0.18 +/- 0.16 degrees C greater than FP/LH postexercise (P = 0.001). Postexercise thresholds were significantly greater (P < or = 0.001) than preexercise during both FP/LH (Th(vd), 0.22 +/- 0.03 degrees C; Th(sw), 0.13 +/- 0.03 degrees C) and LP/HH (Th(vd), 0.21 +/- 0.03 degrees C; Th(sw), 0.14 +/- 0.03 degrees C); however, the effect of exercise was similar between LP/HH and FP/LH. No effect of OC use was observed. We conclude that neither menstrual cycle nor OC use modifies the magnitude of the postexercise elevation in Th(vd) and Th(sw).

Hyperthermia modifies the nonthermal contribution to postexercise heat loss responses.

PURPOSE: This study investigated the nonthermoregulatory control of cutaneous vascular conductance (CVC) and sweating during recovery from exercise-induced hyperthermia as well as possible sex-related differences in these responses. Two hypotheses were tested in this study: 1) active and passive recovery would be more effective in attenuating the fall in mean arterial pressure (MAP) than inactive recovery, but CVC and sweat rate responses would be similar between all recovery modes; and 2) the magnitude of the change in postexercise heat loss and hemodynamic responses between recovery modes would be similar between sexes. METHODS: Nine males and nine females were rendered hyperthermic (esophageal temperature = 39.5 degrees C) by exercise, followed by 60 min of 1) active, 2) inactive, and 3) passive recovery. CVC, sweat rate, and MAP were recorded at baseline, after 2, 5, 12, and 20 min, and at every 10 min until the end of recovery. RESULTS: MAP was elevated above inactive recovery by 6 +/- 2 and 4 +/- 1 mm Hg for active and passive recovery, respectively (P < 0.001). No differences were observed between modes during the initial 10 min of recovery for CVC and 50 min of recovery for sweat rate. However, relative to inactive recovery CVC and sweat rate were subsequently greater by 16.2 +/- 5.8% of CVCpeak and 0.28 +/- 0.04 mg.min.cm, respectively, during active recovery, and by 11.6 +/- 2.9% of CVCpeak and 0.23 +/- 0.03 mg.min.cm, respectively, during passive recovery. CONCLUSION: We conclude that in the presence of a greater thermal drive associated with hyperthermia, the influence of nonthermal input on postexercise heat loss responses is still observed. However, thermal control predominates over nonthermal factors in the first 10 min of recovery for CVC and for up to 50 min postexercise for sweating. Sex did not influence the effect of recovery mode on any variable.

Postexercise heat loss and hemodynamic responses during head-down tilt are similar between genders.

PURPOSE: We evaluated the hypothesis that during recovery from dynamic exercise in the 15 degrees head-down tilt (HDT) position, the attenuation of the fall in mean arterial pressure (MAP), cutaneous vascular conductance (CVC), and sweat rate, and the augmentation of the rate of esophageal temperature (T(es)) decay relative to the upright seated (URS) posture, would be different between males and females. METHODS: Fourteen subjects (seven males, seven females) performed two experimental protocols: 1) 15 min of cycle ergometry at 75% VO2peak and then 60 min of recovery in the URS posture; or 2) 15 min of cycle ergometry at 75% VO2peak and then 60 min of recovery in the 15 degrees HDT position. Mean skin temperature, Tes, CVC, sweat rate, cardiac output (CO), stroke volume (SV), heart rate (HR), total peripheral resistance (TPR), and MAP were recorded at baseline; end of exercise; 2 min, 5 min, 8 min, 12 min, 15 min, and 20 min after exercise; and every 5 min until the end of recovery (60 min). RESULTS: During recovery from exercise, we observed significantly greater values for MAP, CVC, and sweat rate with HDT in comparison with the URS recovery posture (P