Factors Associated With Timeliness and Equity of Access to Outpatient MRI Examinations.

OBJECTIVE: The role of MRI in guiding patients' diagnosis and treatment is increasing. Therefore, timely MRI performance prevents delays that can impact patient care. We assessed the timeliness of performing outpatient MRIs using the socio-ecological model approach and evaluated multilevel factors associated with delays. METHODS: This institutional review board-approved study included outpatient MRI examinations ordered between October 1, 2021, and December 31, 2022, for performance at a large quaternary care health system. Mean order-to-performed (OtoP) interval (in days) and prolonged OtoP interval (defined as >10 days) for MRI orders with an expected date of 1 day to examination performance were measured. Logistic regression was used to assess patient-level (demographic and social determinants of health), radiology practice-level, and community-level factors associated with prolonged OtoP interval. RESULTS: There were 126,079 MRI examination orders with expected performance within 1 day placed during the study period (56% of all MRI orders placed). After excluding duplicates, there were 97,160 orders for unique patients. Of the MRI orders, 48% had a prolonged OtoP interval, and mean OtoP interval was 18.5 days. Factors significantly associated with delay in MRI performance included public insurance (odds ratio [OR] = 1.11, P < .001), female gender (OR = 1.11, P < .001), radiology subspecialty (ie, cardiac, OR = 1.71, P < .001), and patients from areas that are most deprived (ie, highest Area Deprivation Index quintile, OR = 1.70, P < .001). DISCUSSION: Nearly half of outpatient MRI orders were delayed, performed >10 days from the expected date selected by the ordering provider. Addressing multilevel factors associated with such delays may help enhance timeliness and equity of access to MRI examinations, potentially reducing diagnostic errors and treatment delays.

Financial incentives to promote employment of persons with disabilities: a scoping review of when and how they work best.

PURPOSE: To assess the state of evidence on the use of financial incentives to employ, retain, and promote persons with disabilities. MATERIALS AND METHODS: We completed a scoping review of the peer-reviewed literature published from 1990 to 31 March 2022. Inclusion criteria were - populations with a disability; employment, retention, or promotion; and use of financial incentives targeted at employers. Articles were excluded if incentive was targeted solely at persons with disabilities. RESULTS: Seventeen articles met the inclusion criterion and were collated based on their study designs, type of incentive investigated, employment sector, and jurisdiction. We identified seven common themes that are relevant contextual and situational factors associated with the use of financial incentives to employ, retain, and promote persons with disabilities. CONCLUSIONS: While the literature identified the fact that financial incentives are widely used, the current state of the literature is modest and insufficient to make strong statements about the evidence on how and when financial incentives work well or do not work well. The themes identified allude to a subset of contextual factors requiring consideration for incentive use; however, evaluative research is still required to substantiate best practices for their use.Implications for rehabilitationFinancial incentives for the recruitment, retention, and promotion of workers with disabilities take many different forms and can incent different behaviours based on their form and context.Workers with disabilities are as diverse as workers without disabilities, consequently the supports required will differ from situation to situation.In some cases, a worker with a disability may require several types of supports, at a point in time, or over their employment journey.Employer knowledge and experience are important considerations in the use of financial incentives, as are employer skills in recruitment, retention, and promotion of workers with disabilities.

Differences between men and women in their risk of work injury and disability: A systematic review.

BACKGROUND: Health responses associated with occupational exposures can vary between men and women. AIMS: This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations. MATERIALS & METHODS: A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women. RESULTS: Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations. CONCLUSION: This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation-specific task differences.

Musculoskeletal disorder risk assessment tool use: A Canadian perspective.

Canadian ergonomics professionals from the Association of Canadian Ergonomists (ACE) and Board of Canadian Registered Safety Professionals (BCRSP) participated in a web-based survey of their awareness, use, and factors influencing use of ergonomics musculoskeletal disorder (MSD) risk assessment tools. A total of 791 respondents (21.0% response rate) participated in the survey. Certified ergonomics professionals represented an important subpopulation of MSD risk assessment tool users, however; the vast majority (86.4%) of users within Canada were certified safety professionals. Average tool use varied between ACE and BCRSP groups, where ACE respondents on average use more tools than BCRSP respondents, however the top 10 tools used were similar between the groups. Over 45% of assessment tools were learned at school and average tool use was not influenced by years of experience or continuing education.

Comparison Considerations Toward Investigating the Factors of Load and Age Group on the Maximum Reach Envelope.

OBJECTIVE: The objectives were to compare cylindrical and spherical coordinate representations of the maximum reach envelope (MRE) and apply these to a comparison of age and load on the MRE. BACKGROUND: The MRE is a useful measurement in the design of workstations and quantifying functional capability of the upper body. As a dynamic measure, there are human factors that impact the size, shape, and boundaries of the MRE. METHOD: Three-dimensional reach measures were recorded using a computerized potentiometric system for anthropometric measures (CPSAM) on two adult groups (aged 18-25 years and 35-70 years). Reach trials were performed holding .0, .5, and 1 kg. RESULTS: Three-dimensional Cartesian coordinates were transformed into cylindrical (r, θ, Z) and spherical (r, θ, ϕ) coordinates. Median reach distance vectors were calculated for 54 panels within the MRE as created by incremented banding of the respective coordinate systems. Reach distance and reach area were compared between the two groups and the loaded conditions using a spherical coordinate system. Both younger adults and unloaded condition produced greater reach distances and reach areas. CONCLUSIONS: Where a cylindrical coordinate system may reflect absolute reference for design, a normalized spherical coordinate system may better reflect functional range of motion and better compare individual and group differences. Age and load are both factors that impact the MRE. APPLICATION: These findings present measurement considerations for use in human reach investigation and design.

Integrating Safety and Health Promotion in Workplaces: A Scoping Review of Facilitators, Barriers, and Recommendations.

BACKGROUND: Growing evidence supports the integration and coordination of occupational health and safety and workplace health promotion activities instead of these coexisting as siloed efforts. Identifying implementation challenges and how these can be overcome is an important step to achieving truly integrated worker health efforts. We conducted a scoping review to identify the barriers and facilitators to integrated worker health approaches and described recommendations for implementing these efforts. METHOD: Peer-reviewed articles and gray literature from 2008 to 2019 were searched from the following electronic databases: EMBASE, Ovid Medline, PsycINFO, and ABI/INFORM. References from relevant articles and key informant suggestions also were collected. Data were extracted from documents if they focused on the occupational health and safety and health promotion of workers and described outcomes associated with integrated worker health approaches or outlined considerations relevant to the implementation of these approaches. RESULTS: Fifty-one documents met the inclusion criteria and were reviewed. Barriers and facilitators to implementing integrated worker health approaches were found at the extraorganizational, organizational, worker, and program levels, with limited resource availability the most reported barrier and support from leadership the most reported facilitator. Ten broad recommendations were identified and highlighted gaining leadership support, demonstrating leadership commitment, developing worker-centric approaches, and building capacity for workers. CONCLUSION: In reviewing the literature, we found clear and consistent recommendations relevant for integrated worker health approaches. Further research is needed to better understand how these recommendations apply to diverse workforces and organizations with varied resources.

Factors Associated With the Intention to Begin Physical Activity Among Inactive Middle-Aged and Older Adults.

Factors that affect physical activity (PA) behavior change are well established. Behavioral intention is a strong psychological predictor of behavior; however, there is less research on the factors that affect the intention to increase PA participation specifically, especially among adults in mid and later life who are inactive. Using data from the Canadian Community Health Survey, which was informed by the transtheoretical model (TTM), this study investigated the relationships between a range of demographic and biopsychosocial factors with the intention to become physically active among 1,159 inactive adults aged 40 years and older. Comparisons were made between participants reporting the intention to begin PA in the next 30 days (TTM Preparation; n = 610), 6 months (TTM Contemplation; n = 216), or not at all (TTM Precontemplation; n = 333). First, multinomial logistic regression identified age, sex, ethnicity, education, restriction of activities, self-perceived health, and community belonging as factors significantly associated with 30-day PA intention, while age and ethnicity were significantly associated with 6-month PA intention, compared with those reporting no intention. Second, binary logistic regression revealed that education was the only factor that differentially associated with intention timeframe as participants with lower levels of education were less likely to report PA intention in 30 days compared with 6 months. Findings demonstrate key demographic, biopsychosocial, and temporal factors that warrant consideration for tailored PA promotion programs that aim to effectively address the constraints and barriers that negatively influence PA intention among middle-aged and older adults.

Multivariate shoulder and spine relationship using planar range of motion assessment.

CONTEXT: Goniometry and posture are commonly used metrics in clinical assessment of the shoulder and spine. When both the shoulder and spine are assessed individually using these techniques, there are structural and functional musculoskeletal relationships between the two anatomical regions that may be overlooked. OBJECTIVE: To determine the relationships between and within the shoulder and spine as measured by active range of motion (ROM) and spine curvature. DESIGN: Cross-sectional. SETTING: Clinical assessment in university setting. PARTICIPANTS: 163 asymptomatic, right hand dominant, young adults; INTERVENTION: None. MAIN OUTCOME MEASURES: A multivariate canonical correlation was used to identify a shoulder-spine relationship using active ROM assessments. RESULTS: A shoulder-spine relationship was determined using planar assessments and multivariate analyses of these two areas. Measures contributing to this relationship included shoulder flexion, internal rotation, external rotation, and trunk flexion and lumbar lordosis. CONCLUSIONS: The findings of this study suggest that assessment of shoulder ROM should be interpreted with respect to spine region and vice versa, regardless of presenting region of concern, owing to the multivariate shoulder-spine ROM relationship when considering multiple measures of ROM and posture.

Investigating women's chest size, trunk muscle co-contraction and back pain during prolonged standing.

BACKGROUND: Chest size is a known factor in the development of back pain for women. However, the neuromuscular mechanisms associated with chest size and back pain are poorly understood. OBJECTIVE: The purpose of this study was to investigate chest size and its association with back pain development and muscle activity patterns during prolonged standing. METHODS: Twenty university-aged women were divided into two groups: small chest size (n= 10, ∼A/C cup) and large chest size (n= 10, ∼D/E cup). Participants completed a 2-hr standing protocol, where eight channels of bilateral trunk electromyography were collected. Muscle activity, specifically co-contraction, was compared between chest size groups, pain developers, and time. RESULTS: The large chest size group reported higher amounts of pain at the upper, middle, and low back. Women in the large chest group sustained higher levels of co-contraction for muscles involving the thoracic and lumbar erector spinae compared to those in the small chest size group during prolonged standing. CONCLUSIONS: Thoracolumbar co-contraction determined in this study may be a potential mechanism contributing to increased back pain development for women with large chest sizes during prolonged standing. This pain mechanism could be targeted and addressed in future non-invasive musculoskeletal rehabilitation to improve back pain for women.

Variation by state in Medicaid sterilization policies for physician reimbursement.

OBJECTIVE: To evaluate state-level variation in Medicaid sterilization reimbursement policies for physicians in terms of policy details, flexibility, and review process. STUDY DESIGN: We reviewed state Medicaid websites and interviewed state employees to better understand reimbursement policies and implementation. We attempted to obtain policy details and instructions for physicians from all 50 state Medicaid office websites. We invited employees in all 50 state Medicaid director's offices to participate in semi-structured qualitative interviews. RESULTS: We were able to collect data from 48 states' websites for analysis, conducted 15 telephone interviews, and received 4 written responses from state Medicaid employees. State policies varied greatly in terms of degree of instruction available online to clinicians, number of content-related and logistical changes made compared to the federal policy, type of procedures included, corrections permitted, flexibility in terms of surgeon and procedure changes, review process, reasons for and ramifications of denial, and date of last policy revision. CONCLUSION: There is need for increased transparency and instruction by state Medicaid offices as well as revision of the Medicaid policy to account for the contemporary clinical practice of female permanent contraception. Clinicians should communicate with state Medicaid employees in order to clarify important policy details and obtain greater understanding of their state's review process and ramifications to ensure their clinical practice is both correct and reimbursable. IMPLICATIONS: Greater consistency between states in terms of Medicaid policy and implementation is crucial to ensuring physicians are fairly reimbursed for their work, and female permanent contraception remains an accessible contraceptive method for women.

Perceptions and practice of state Medicaid officials regarding informed consent for female sterilization.

OBJECTIVE: To explore the attitudes, beliefs, and interpretations of individual state Medicaid office employees regarding their state's postpartum sterilization policy and its impact on patient care. STUDY DESIGN: We invited employees in all 50 state Medicaid director's offices who self- or peer-identified as best informed about the sterilization policy to participate in semi-structured qualitative interviews. Using a pilot-tested interview guide, we transcribed, coded, and analyzed each interview. We attempted to obtain supplemental data, including relevant policy details and instructions for physicians in the state, from all 50 state Medicaid office websites. RESULTS: We collected data from 15 telephone interviews, four written responses, and 48 states' websites for analysis. Participants had varying responses regarding the impact of the Medicaid-mandated sterilization consent form in terms of informed consent as well as the utility and ramifications of the waiting period. State policies varied in terms of the age of consent, complexity of the form, availability of translations, use of unclear terminology, and the consent-obtaining process. CONCLUSION: State Medicaid employees have differences in opinions regarding the intent of the Medicaid-mandated sterilization consent form and policies. Better understanding of the variation in individual state policies that may contribute to inequitable access to sterilization is necessary. IMPLICATIONS: Provision of consistent guidelines and widespread coordination of the Medicaid sterilization policies in identified areas impacting informed consent may reduce existing obstacles and provide more equitable access to contraceptive care.

Combining SPR with atomic-force microscopy enables single-molecule insights into activation and suppression of the complement cascade.

Activation and suppression of the complement system compete on every serum-exposed surface, host or foreign. Potentially harmful outcomes of this competition depend on surface molecules through mechanisms that remain incompletely understood. Combining surface plasmon resonance (SPR) with atomic force microscopy (AFM), here we studied two complement system proteins at the single-molecule level: C3b, the proteolytically activated form of C3, and factor H (FH), the surface-sensing C3b-binding complement regulator. We used SPR to monitor complement initiation occurring through a positive-feedback loop wherein surface-deposited C3b participates in convertases that cleave C3, thereby depositing more C3b. Over multiple cycles of flowing factor B, factor D, and C3 over the SPR chip, we amplified C3b from ∼20 to ∼220 molecules·µm-2 AFM revealed C3b clusters of up to 20 molecules and solitary C3b molecules deposited up to 200 nm away from the clusters. A force of 0.17 ± 0.02 nanonewtons was needed to pull a single FH molecule, anchored to the AFM probe, from its complex with surface-attached C3b. The extent to which FH molecules stretched before detachment varied widely among complexes. Performing force-distance measurements with FH(D1119G), a variant lacking one of the C3b-binding sites and causing atypical hemolytic uremic syndrome, we found that it detached more uniformly and easily. In further SPR experiments, KD values between FH and C3b on a custom-made chip surface were 5-fold tighter than on commercial chips and similar to those on erythrocytes. These results suggest that the chemistry at the surface on which FH acts drives conformational adjustments that are functionally critical.

The effect of ad hominem attacks on the evaluation of claims promoted by scientists.

Two experiments were conducted to determine the relative impact of direct and indirect (ad hominem) attacks on science claims. Four hundred and thirty-nine college students (Experiment 1) and 199 adults (Experiment 2) read a series of science claims and indicated their attitudes towards those claims. Each claim was paired with one of the following: A) a direct attack upon the empirical basis of the science claim B) an ad hominem attack on the scientist who made the claim or C) both. Results indicate that ad hominem attacks may have the same degree of impact as attacks on the empirical basis of the science claims, and that allegations of conflict of interest may be just as influential as allegations of outright fraud.

Infraspinatus Isolation During External Rotation Exercise at Varying Degrees of Abduction.

CONTEXT: External rotation (ER) strengthening exercises are a common component of shoulder injury prevention and rehabilitation programs. They are primarily intended to target the infraspinatus muscle, based on its role in glenohumeral stabilization and inferior humeral glide. ER also recruits the posterior deltoid, which can be undesirable due to its role in subacromial space narrowing. OBJECTIVE: To determine the angle of humeral abduction that maximizes the infraspinatus to posterior deltoid activation ratio (INFRA/PD) during ER. DESIGN: Within-subjects repeated-measures controlled lab trial. PARTICIPANTS: A total of 10 healthy participants (5 males, 5 females) aged 21 (0.67) years participated in the study. INTERVENTION: 7 consecutive repetitions of ER at 7 different abduction angles ranging from 0° to 90°, with resistance normalized to 3% body mass. MAIN OUTCOME MEASURES: Surface electromyography was performed on the infraspinatus, middle deltoid, and posterior deltoid. Surface electromyography data were processed to determine absolute muscle activation as well as INFRA/PD at each abduction angle. Group means were compared between abduction angles using 1-way analysis of variance. RESULTS: Abduction significantly reduced overall infraspinatus activity but increased posterior deltoid activity (P < .01). Average and peak INFRA/PD decreased as the angle of abduction increased (P < .001 and P < .01, respectively). CONCLUSION: Our findings suggest that ER should be performed in 0° of abduction to maximize infraspinatus isolation. Slight abduction, such as placing a towel under the humerus, as recommended by some clinicians, may improve patient comfort, but did not increase infraspinatus isolation in this study.

Replication Rate, Framing, and Format Affect Attitudes and Decisions about Science Claims.

A series of five experiments examined how the evaluation of a scientific finding was influenced by information about the number of studies that had successfully replicated the initial finding. The experiments also tested the impact of frame (negative, positive) and numeric format (percentage, natural frequency) on the evaluation of scientific findings. In Experiments 1 through 4, an attitude difference score served as the dependent measure, while a measure of choice served as the dependent measure in Experiment 5. Results from a diverse sample of 188 non-institutionalized U.S. adults (Experiment 2) and 730 undergraduate college students (Experiments 1, 3, and 4) indicated that attitudes became more positive as the replication rate increased and attitudes were more positive when the replication information was framed positively. The results also indicate that the manner in which replication rate was framed had a greater impact on attitude than the replication rate itself. The large effect for frame was attenuated somewhat when information about replication was presented in the form of natural frequencies rather than percentages. A fifth study employing 662 undergraduate college students in a task in which choice served as the dependent measure confirmed the framing effect and replicated the replication rate effect in the positive frame condition, but provided no evidence that the use of natural frequencies diminished the effect.

Naturally Inspired Peptide Leads: Alanine Scanning Reveals an Actin-Targeting Thiazole Analogue of Bisebromoamide.

Systematic alanine scanning of the linear peptide bisebromoamide (BBA), isolated from a marine cyanobacterium, was enabled by solid-phase peptide synthesis of thiazole analogues. The analogues have comparable cytotoxicity (nanomolar) to that of BBA, and cellular morphology assays indicated that they target the actin cytoskeleton. Pathway inhibition in human colon tumour (HCT116) cells was explored by reverse phase protein array (RPPA) analysis, which showed a dose-dependent response in IRS-1 expression. Alanine scanning reveals a structural dependence to the cytotoxicity, actin targeting and pathway inhibition, and allows a new readily synthesised lead to be proposed.

Selective and Efficient Generation of ortho-Brominated para-Substituted Phenols in ACS-Grade Methanol.

The mono ortho-bromination of phenolic building blocks by NBS has been achieved in short reaction times (15-20 min) using ACS-grade methanol as a solvent. The reactions can be conducted on phenol, naphthol and biphenol substrates, giving yields of >86% on gram scale. Excellent selectivity for the desired mono ortho-brominated products is achieved in the presence of 10 mol % para-TsOH, and the reaction is shown to be tolerant of a range of substituents, including CH3, F, and NHBoc.

Flexible, phase-transfer catalyzed approaches to 4-substituted prolines.

A range of 4-substituted prolines can be rapidly synthesized from a protected glycine Schiff base in only four steps and in 27-55% overall yield. Phase transfer catalysis allows direct access to both enantiomeric series, and the relative stereochemistry at the 4-position is readily controlled (>10:1 dr) through the choice of hydrogenation conditions.