Program Evaluation of Fit to Pass®, a Remotely Accessible Health Promotion Program for Commercial Motor Vehicle Truck Drivers.

BACKGROUND: Chronic health conditions are highly prevalent among truck drivers due to many unique occupational and environmental stressors. Health promotion programs are shown to be effective in improving truck driver health outcomes; however, there is no research on whether such programs can increase the length of a driver's Department of Transportation (DOT) medical certificate. The purpose of this quality improvement project was to evaluate Fit to Pass (FTP), a remotely accessible health promotion program available for truck drivers on improved health outcomes and increased DOT medical certificate length. METHOD: Program evaluation included an evaluation of the FTP coaching guide against evidence-based practice guidelines. An analysis of a limited dataset of 22 truck driver records examined the effectiveness of the program in achieving improved health outcomes and increased medical certification length. FINDINGS: A review of the literature revealed three major themes: (a) motivational interviewing to increase driver intention and self-efficacy; (b) mobile health care technology to connect hard-to-reach truck drivers; and (c) effectiveness of structured multicomponent health promotion programs. After participation in FTP, truck drivers experienced a mean decrease in weight and body mass index (BMI) of 4.6 lbs and 1.3 kg/m2, respectively. The lengths of initial DOT medical certificates were compared with DOT medical certificates received at the time of recertification (post-FTP). Only eight participants had the potential for improvement in certificate length. Of those, three truck drivers achieved an increased DOT medical certificate length at the time of recertification. CONCLUSION/APPLICATIONS TO PRACTICE: FTP offers tailored and comprehensive health coaching for truck drivers using current evidence-based practice guidelines to educate and reinforce healthy lifestyle habits. Analysis of a limited dataset revealed a mean decrease in BMI and a trend of increased DOT medical certification lengths after participation in FTP; however, further research with larger sample sizes is recommended.

Identifying and Decreasing Sharps Injuries Through Root Cause Analysis in a Large Urban Hospital System.

BACKGROUND: Despite safety mandates and interventions, sharps injuries remain an occupational risk for registered nurses (RNs). Sharps and needlestick injuries increase the risk of exposure to blood-borne pathogens. Post-exposure direct and indirect costs of these percutaneous injuries have been estimated at about US$700 per incident. The goal of this quality improvement project was to identify root causes of sharps injuries for RNs at a large urban hospital system. METHODS: A retrospective evaluation of sharps injuries sustained by RNs, identification epsication of themes or root causes, and the development of a fishbone diagram to sort the causes into categories to identify workable solutions were conducted. Fisher's exact tests were performed to identify association between variables and root causes. FINDINGS: A total of 47 sharps injuries were reported from January 2020 through June 2020. Among sharps injuries sustained by nurses, 68.1% were among nurses 19 to 25 years of age and 57.4% reported job tenure of 1 to 2 years. There was a statistically significant association between root causes and tenure range, gender, and procedure type (p < .05) with moderate effect size (Cramer's V = 0.35-0.60). Technique also was a primary cause of sharps injuries for blood draw (77%), discontinuing line (75%), injection (46%), intravenous (IV) start (100%), and suturing (50%). CONCLUSIONS/APPLICATIONS TO PRACTICE: Technique and patient behavior were primary root causes of sharps injuries in this study. More sharps injuries caused by technique occurred among nurses with job tenure of 1 to 10 years, female, blood draw, discontinuing line, injection, IV start, and suturing procedures. The root cause analysis identified tenure, technique, and behavior as potential root causes of sharps injuries specifically occurring most during blood draw and injections at a large urban hospital system. These findings will inform nurses, especially new nurses in the proper use of safety devices and behaviors to prevent injury.

Nurse Anesthesia Diversion Prevention: A Knowledge and Needs Gap Analysis.

BACKGROUND: Substance misuse is an occupational health problem for anesthesia providers (APs). More than 10% of nurse anesthetists misuse and divert medications. No standard exists for addressing AP drug diversion. The purpose of this quality improvement project was to evaluate the use of a knowledge and needs assessment to inform the development of a successful drug diversion prevention program for certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). METHODS: A 28-item questionnaire, using the health belief model (HBM) and the risk perception attitude (RPA) framework, was developed to assess knowledge, beliefs, and practices of substance misuse and diversion. RPA groups were determined by level of belief in self-risk and perceived efficacy of prevention strategies. The survey was emailed to 100 CRNAs and over 100 SRNAs. Survey results were organized using the RPA framework. FINDINGS: One hundred twelve surveys were completed. The RPA avoidant category (high-risk belief and low perceived efficacy of preventive interventions) comprised 52.5% of CRNAs; SRNAs were divided primarily among the RPA responsive category with high perceived risk and high-efficacy beliefs (38.9%) and the indifferent category of low-risk beliefs and low perceived efficacy (31.9%). CONCLUSIONS/APPLICATIONS TO PRACTICE: Anesthesia providers have varying beliefs regarding drug misuse and diversion risks and perceptions of their ability to be successful with preventive strategies. Failure to address nurse anesthesia needs-based diversion prevention may result in missed opportunities to educate this group. Implementation of RPA-tailored interventions by health care organizations may produce effective, long-term outcomes for drug diversion within the profession.

Returning to Work After an Orthopaedic Injury.

Workers' compensation and orthopaedic nursing are often intertwined for the treatment of an injured worker and returning them to work. The workers' compensation system can be complex, and knowing the regulations can be beneficial in the treatment of an injured worker and returning them to work safely. Orthopaedic nurses often play an integral role in the evaluation, treatment, and discharge of an injured worker, so understanding workers' compensation, workers' job, and expectations is important for the safe return of a worker back to duty. Orthopaedic nurses are in key positions to assist with the planning, treatment, and return of a worker back to their job.

Improving Hearing Protection Device Noise Attenuation Through Fit-Testing in an Occupational Health Clinic.

BACKGROUND: Occupational noise-induced hearing loss (NIHL) is the second most common medical disability for military veterans and accounts for 24% of all hearing loss in the United States. Hearing loss negatively affects health and billions of dollars are spent annually for direct and indirect medical costs and lost work productivity. Proper hearing protection device (HPD) fit can prevent NIHL. Quantitative fit-testing systems to determine personal attenuation rates (PARs) are available, but not widely utilized. Without quantitative testing, validating appropriate fit and attenuation to a permissible exposure level to prevent NIHL is difficult. METHODS: A quality improvement project measured 100 employees enrolled in a hearing conservation program (HCP) to determine if they obtained a target PAR after inserting the HPDs in their "usual" fashion. Those who did not obtain target PAR (n = 27) received an evidence-based intervention that demonstrated proper HPD fit by a skilled trainer followed by a repeat attempt by the participant to replicate the feel of the demonstrated HPD placement. PAR was subsequently measured to assess for appropriate noise attenuation. FINDINGS: Seventy-one percent achieved target PAR (≥ 20 decibels) at baseline testing. After the intervention, 91 of 100 participants had achieved target PAR, a 20% improvement. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Findings suggest this evidence-based intervention was an effective strategy for improving HPD fit for employees enrolled in HCPs. This intervention may prevent occupational hearing loss and decrease the health and socioeconomic impacts of NIHL.

Eye Health, COVID-19, and the Occupational Health Professional: Round Table.

BACKGROUND: Eye health has garnered increased attention since the COVID-19 pandemic. This Round Table explored the impact mask wearing, delays in eye examinations, and increased screen time have on vision and ultimately the worker. METHODS: Leading experts in the areas of occupational health, risk management, eye health, and communication were identified and invited to participate in a Round Table discussion. Questions posed to experts were based on literature that addressed eye health, such as mask wearing, communication and managing expectations when accessing professional eye health appointments, and increased screen time. FINDINGS: Experts agreed that eye health considerations must be in place. These considerations should address not only clinical care of the patient but ways to protect workers from occupational injury associated with the eye. CONCLUSION/APPLICATION TO PRACTICE: The occupational health professional is a key resource for assessment and training that pertains to eye health.

Hepatitis A.

Hepatitis A is a vaccine preventable liver infection caused by the hepatitis A virus. The occupational health nurse should be aware of the signs and symptoms of the virus, educate workers about the infection, and recommend immunization for workers traveling or working in high-risk areas for hepatitis A.

E-Cigarettes and Vaping.

Once considered a harmless alternative to smoking tobacco, e-cigarettes are now a public health threat. Occupational health nurses should recommend workers avoid using e-cigarettes and vaping unless suggested by their doctor for smoking cessation purposes.

Visual Performance and Occupational Safety Among Aging Workers.

With the rapid growth of the aging workforce, age-related conditions may negatively influence overall workplace safety and health among these workers and their employers. In this summary, we have outlined details about visual acuity, glare sensitivity, and contrast sensitivity, which are common age-related vision changes that can potentially affect their occupational safety. The occupational health nurse is well positioned to address these concerns by instructing aging workers about potential development of vision change and ensuring they receive the appropriate vision screening. By assisting employers to modify work environments to accommodate this population, the occupational health nurse can reduce the risk of injury, as well as positively impact the health of their aging workforce.

Carbon Monoxide Poisoning.

Carbon monoxide poisoning is a serious and life-threatening event. Educating workers and communities on exposure sources, symptoms, and prevention is an important role for occupational health nurses.

Clostridium difficile Infection.

Preventing Clostridium difficile, the most common cause of health care-associated infections in hospitals and infectious disease death in the United States, is a national priority. Increased rates of infection among low-risk individuals in the community call for community-based prevention efforts to halt the increasing spread of this highly contagious opportunistic infection.

Evaluation and treatment of the acutely injured worker.

The primary care NP has a significant opportunity to meet the special healthcare needs of the occupational community. While NPs routinely diagnose and treat workers, writing return-to-work restrictions can pose a challenge.

Hypersensitivity Pneumonitis.

Chronic exposure to a broad array of antigens after workers inhale aerosolized organic dust particles from mold, animal dander, bird droppings, and chemicals, especially pesticides or herbicides, increases risk for hypersensitivity pneumonitis. Several demographic characteristics of immigrant workers in farming, poultry processing, construction, and landscaping increase this worker population's risk.

Chinese hamster genome database: an online resource for the CHO community at www.CHOgenome.org.

The Chinese hamster genome database (http://www.chogenome.org/) is an online resource for the Chinese hamster (Cricetulus griseus) and Chinese hamster ovary (CHO) cell communities. CHO cells are important for biomedical research and are widely used in industry for the production of biopharmaceuticals. The genome of the CHO-K1 cell line was recently sequenced and the CHO community has developed an online resource to facilitate accessibility of the genomic data and the development of genomic tools.

RNA interference of cofilin in Chinese hamster ovary cells improves recombinant protein productivity.

RNA interference (RNAi) has been recently applied to improve the yield and quality of recombinant proteins produced in Chinese hamster ovary (CHO) cells, the most commonly used mammalian cell line for production of complex biopharmaceuticals. Proteomic profiling of CHO cells undergoing gene amplification identified cofilin, a key regulatory protein of actin cytoskeletal dynamics, as a cellular target for genetic engineering studies. Transient reduction of cofilin by small interfering RNA (siRNA) enhanced specific productivity in recombinant CHO cells by up to 80%. CHO cell lines expressing cofilin-specific short hairpin RNA (shRNA) vectors showed up to a 65% increase in specific productivity. These results suggest that modulation of cofilin, and its regulatory pathways, may be a new approach to enhance recombinant protein productivity in CHO cells.

Profiling conserved microRNA expression in recombinant CHO cell lines using Illumina sequencing.

MicroRNAs (miRNAs) are small, non-coding RNAs that regulate multiple aspects of cell physiology. The differential expression of conserved miRNAs in two Chinese hamster ovary (CHO) cell lines producing recombinant proteins was examined relative to the CHO-K1 cell line. A total of 190 conserved CHO miRNAs were identified through homology with known human and rodent miRNAs. More than 80% of these miRNAs showed differential expression in recombinant CHO cell lines. The small RNA sequencing data were analyzed in context of the CHO-K1 genome to examine miRNA organization and develop sequence-specific miRNA resources for CHO cells. The identification and characterization of CHO miRNAs will facilitate the use of miRNA tools in cell line engineering efforts to improve product yield and quality.

The genomic sequence of the Chinese hamster ovary (CHO)-K1 cell line.

Chinese hamster ovary (CHO)-derived cell lines are the preferred host cells for the production of therapeutic proteins. Here we present a draft genomic sequence of the CHO-K1 ancestral cell line. The assembly comprises 2.45 Gb of genomic sequence, with 24,383 predicted genes. We associate most of the assembled scaffolds with 21 chromosomes isolated by microfluidics to identify chromosomal locations of genes. Furthermore, we investigate genes involved in glycosylation, which affect therapeutic protein quality, and viral susceptibility genes, which are relevant to cell engineering and regulatory concerns. Homologs of most human glycosylation-associated genes are present in the CHO-K1 genome, although 141 of these homologs are not expressed under exponential growth conditions. Many important viral entry genes are also present in the genome but not expressed, which may explain the unusual viral resistance property of CHO cell lines. We discuss how the availability of this genome sequence may facilitate genome-scale science for the optimization of biopharmaceutical protein production.

Gap junctions and hydrogen peroxide are involved in endothelium-derived hyperpolarising responses to bradykinin in omental arteries and veins isolated from pregnant women.

Altered endothelial function may underlie human cardiovascular diseases, including hypertension, diabetes and pre-eclampsia. While much is known about endothelial function in small arteries, very little is known about endothelial responses in small veins isolated from humans. Therefore, we assessed endothelium-dependent responses in omental arteries and veins isolated from healthy pregnant women, focussing on endothelium-dependent hyperpolarising (EDH) mechanisms. Human omental arteries and veins were obtained from women undergoing elective caesarean sections and examined using pressure myography. In pressurised vessels, the effects of proposed inhibitors of EDH production/function were examined on responses to bradykinin. The expression of connexins Cx37, 40 and 43 was assessed using immunohistochemistry. Bradykinin caused vasodilatation in human pressurised omental arteries and veins. In both vessels, responses to bradykinin were partially blocked in the presence of the gap junction uncoupler, carbenoxolone, and reduced further with the addition of catalase, which acts to degrade H(2)O(2). The effect of catalase alone was more pronounced in venous preparations. All three connexins were expressed in both arteries and veins, with a similar distribution pattern, where Cx37 and Cx40 were located mainly in the endothelium and Cx43 located mostly in the media. These data show that, in human omental vessels, an EDH mechanism is produced in response to bradykinin that involves gap junction communication and the production of H(2)O(2). These mechanisms may be involved in the haemodynamic alterations that take place during pregnancy, and any aberration in their function could contribute to raised blood pressure in hypertensive disorders of pregnancy, such as pre-eclampsia.

Genomic sequencing and analysis of a Chinese hamster ovary cell line using Illumina sequencing technology.

BACKGROUND: Chinese hamster ovary (CHO) cells are among the most widely used hosts for therapeutic protein production. Yet few genomic resources are available to aid in engineering high-producing cell lines. RESULTS: High-throughput Illumina sequencing was used to generate a 1x genomic coverage of an engineered CHO cell line expressing secreted alkaline phosphatase (SEAP). Reference-guided alignment and assembly produced 3.57 million contigs and CHO-specific sequence information for ~ 18,000 mouse and ~ 19,000 rat orthologous genes. The majority of these genes are involved in metabolic processes, cellular signaling, and transport and represent attractive targets for cell line engineering. CONCLUSIONS: This demonstrates the applicability of next-generation sequencing technology and comparative genomic analysis in the development of CHO genomic resources.