The Lullaby Project: A Musical Intervention for Pregnant Women.

Background: This pilot study investigated the impact of a musical intervention on maternal/fetal attachment, psychiatric symptoms, and perceived stress in two centers. Materials and Methods: Forty-four pregnant women participated from the Virginia Commonwealth University in Richmond, VA, and Jacobi Medical Center in Bronx, NY. Participants were assigned to a lullaby intervention or control group. The Maternal Fetal Attachment Scale, Perceived Stress Scale (PSS), and Symptom Checklist (SCL-27) were completed at baseline and follow-up. Results: Although no significant differences were found in maternal/fetal attachment between control and intervention groups, there were within-group differences in both groups from baseline to follow-up. No statistically significant differences in change from baseline occurred on the SCL-27 and PSS. Conclusions: Exposure to a lullaby intervention was not statistically associated with maternal/fetal attachment, mental health, and perceived stress in this pilot study. Future studies with larger samples and different outcomes are suggested.

How was a national moving and handling people guideline intended to work? The underlying programme theory.

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their 'programme theory', how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP - the intended outcome.

The impact of national guidelines covering moving and handling of people on injury rates and related costs.

Objective National guidelines for moving and handling of people (MHP) were introduced in New Zealand in 2012 to reduce MHP-related injuries in the healthcare sector. This study assessed the effectiveness of this on MHP-related injury claims. Methods MHP-related injury claims were identified from the national injury claims database, which included 118 755 accepted claims for 2005-2016 across 14 industries. Interrupted time-series analysis was used to assess temporal changes in MHP-related claims rates, costs, and causes for the period before (2005-2012) and following (2013-2016) the introduction of the national guidelines. Results Prior to the introduction of the guidelines, MHP-related claims were estimated to be 39 209 (33.0% of all accepted injury claims), with claims rates and associated costs for the 14 industries decreasing by 0.4 [95% confidence interval (CI) -0.5‒ -0.2, P<0.001] and NZ$ 230 per claim (95% CI -324‒ -136, P=0.001) respectively. In the year following the introduction of the guidelines, there were no overall changes in claim rates or costs. However, significant increases in claim rates [ranging from 1.27-1.99 (P=0.004-0.010)] and claim costs [ranging from NZ$ 724-987 per claim (P=0.032-0.045)] were found 2-4 years later. More than 65% of all MHP-related claims were caused by lifting/carrying/strain, and there was a significant increase in claim numbers due to this cause, ranging from 431.7-594.0 (P=0.001-0.008) in the four years following the introduction of the guidelines. Conclusions The introduction of national MHP-guidelines in 2012 in New Zealand did not reduce MHP-related injury rates and costs. On the contrary, there were statistically significant increases 2-4 years after introduction of the guidelines.

Determination of a selection of anti-epileptic drugs and two active metabolites in whole blood by reversed phase UPLC-MS/MS and some examples of application of the method in forensic toxicology cases.

Quantitative determination of anti-epileptic drug concentrations is of great importance in forensic toxicology cases. Although the drugs are not usually abused, they are important post-mortem cases where the question of both lack of compliance and accidental or deliberate poisoning might be raised. In addition these drugs can be relevant for driving under the influence cases. A reversed phase ultra-performance liquid chromatography-tandem mass spectrometry method has been developed for the quantitative analysis of the anti-epileptic compounds carbamazepine, carbamazepine-10,11-epoxide, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, 10-OH-carbazepine, phenobarbital, phenytoin, pregabalin, and topiramate in whole blood, using 0.1 mL sample volume with methaqualone as internal standard. Sample preparation was a simple protein precipitation with acetonitrile and methanol. The diluted supernatant was directly injected into the chromatographic system. Separation was performed on an Acquity UPLC® BEH Phenyl column with gradient elution and a mildly alkaline mobile phase. The mass spectrometric detection was performed in positive ion mode, except for phenobarbital, and multiple reaction monitoring was used for drug quantification. The limits of quantification for the different anti-epileptic drugs varied from 0.064 to 1.26 mg/L in blood, within-day and day-to-day relative standard deviations from 2.2 to 14.7% except for phenobarbital. Between-day variation for phenobarbital was 20.4% at the concentration level of 3.5 mg/L. The biases for all compounds were within ±17.5%. The recoveries ranged between 85 and 120%. The corrected matrix effects were 88-106% and 84-110% in ante-mortem and post-mortem whole blood samples, respectively.

Prevalence of synthetic cannabinoids in blood samples from Norwegian drivers suspected of impaired driving during a seven weeks period.

From early year 2000 different herbal products containing synthetic cannabinoids (SC) have appeared on the drug market all over the world, and new substances are frequently introduced. The prevalence of SC use in different populations is however still mainly unknown, also in Norway. This information is difficult to obtain, but studies of drivers suspected of driving under the influence of drugs (DUID), might provide important information. The aim of this study was to assess the prevalence of SC in drivers suspected of being under the influence of drugs in Norway, and investigate if SCs impair driving performance. For two periods of three and four weeks all blood samples from drivers suspected of DUID in Norway were analyzed for the presence of 12 and 18 different SCs, respectively. A new ultra performance liquid chromatography tandem mass spectrometry method was developed. A total of 726 cases were analyzed during our study period, and SCs were detected in 16 cases (2.2%) in total. The mean age of these drivers was 29.6 years. High concentrations of other psychoactive drugs were detected in all the blood samples where a SC was found. AM-2201 and JWH-018 were the most frequently detected SCs, each found in five cases. In addition RSC-4, JWH-122, JWH-081 and JWH-250 were detected. None of the drivers had reported using SCs prior to driving. Despite the limited number of SCs investigated in this 7 week study period, a considerable percent of the cases were positive. Other psychoactive drugs of abuse were always found concomitant with the SCs, and the age of these drivers indicates that experienced drug users also ingest SCs. Since other drugs were found in all the samples, the psychomotor impairment caused by the SCs is difficult to estimate. Our study shows the importance of screening analyses of biological samples from different populations to assess the prevalence of drug use, since self-reporting might be encumbered with significant under-reporting.

Occupational health and safety professionals strategies to improve working environment and their self-assessed impact.

Research suggests that Occupational Health and Safety (OHS) practitioners have difficulty influencing the decision-making process because they are placed on the sidelines in the organisation. This paper analyses the strategies that OHS practitioners use to fulfill their job role and the impact they have on the working environment and OHS management systems. Semi-structured interviews were conducted with ten New Zealand OHS practitioners from mainly large private and public organisations about their job role, OHS tasks, strategies and their impact. The interviews were tape recorded, transcribed, entered into a qualitative data management programme and analysed thematically in relation to their strategies, barriers and their impact on the OHS management system and working environment. The analysis revealed that these OHS practitioners used multiple strategies - chosen in relation to the situation, the stakeholders and their own resources. They saw themselves as change agents or facilitators. They preferred to use a knowledge strategy, supported by an audit strategy. Their last resort was a regulation strategy. All of the practitioners had a positive impact on stakeholders' knowledge, attitude and behavior and on OHS management systems. Some practitioners improved the working environment but few were involved in introduction of new technology.

How to use programme theory to evaluate the effectiveness of schemes designed to improve the work environment in small businesses.

Due to the many constraints that small businesses (SBs) face in meeting legislative requirements, occupational health and safety (OHS) regulatory authorities and other OSH actors have developed programmes which can reach out to SBs and motivate and assist them in improving the work environment. A number of conceptual models help to enhance our understanding of OHS interventions in SBs and their effectiveness. However, they have mainly been evaluated on output rather than the process relating to the change theory underlying the intervention, and hence have seldom been rigorously evaluated. Thus little is known about how particular features of SBs can be taken into account when designing and implementing national programmes. This paper shows how realist analysis and programme theory may be used as a framework for evaluating, developing and improving national intervention programmes for the improvement of the work environment and reducing injuries in SBs. It illustrates this for a specific New Zealand intervention: the Workplace Safety Discount scheme and its implementation in the agriculture sector. In practice, realist analysis should be performed during the planning, implementation and management stages so that ongoing findings can be fed back to the participant social actors to help them make appropriate changes to enhance the likelihood of success.

Determination of γ-hydroxybutyrate (GHB), ß-hydroxybutyrate (BHB), pregabalin, 1,4-butane-diol (1,4BD) and γ-butyrolactone (GBL) in whole blood and urine samples by UPLC-MSMS.

The demand of high throughput methods for the determination of gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butane-diol (1,4BD) as well as for pregabalin is increasing. Here we present two analytical methods using ultra-high pressure liquid chromatography (UPLC) and tandem mass spectrometric (MS/MS) detection for the determination of GHB, beta-hydroxybutyrate (BHB), pregabalin, 1,4BD and GBL in whole blood and urine. Using the 96-well formate, the whole blood method is a simple high-throughput method suitable for screening of large sample amounts. With an easy sample preparation for urine including only dilution and filtration of the sample, the method is suitable for fast screening of urine samples. Both methods showed acceptable linearity, acceptable limits of detection, and limits of quantification. The within-day and between-day precisions of all analytes were lower than 10% RSD. The analytes were extracted from matrices with recoveries near 100%, and no major matrix effects were observed. Both methods have been used as routine screening analyses of whole blood and urine samples since January 2010.

Automated brain tissue assessment in the elderly and demented population: construction and validation of a sub-volume probabilistic brain atlas.

OBJECTIVES: To develop an automated imaging assessment tool that accommodates the anatomic variability of the elderly and demented population as well as the registration errors occurring during spatial normalization. METHODS: 20 subjects with Alzheimer's disease (AD), mild cognitive impairment, or normal cognition underwent MRI brain imaging and had their 3D volumetric datasets manually partitioned into 68 regions of interest (ROI) termed sub-volumes. Gray matter (GM), white matter (WM), and cerebral spinal fluid (CSF) voxel counts were then made in the subject's native space for comparison against automated volumetric measures within three sub-volume probabilistic atlas (SVPA) models. The three SVPAs were constructed using 12 parameter affine (12 p), 2nd order (2nd), and 6th order (6th) transforms derived from registering the manually partitioned scans into a Talairach compatible AD population-based target. The three SVPA automated measures were compared to the manually derived measures in the 20 subjects' native space with a "jack-knife" procedure in which each subject was assessed by an SVPA they did not contribute toward constructing. RESULTS: The mean left and right GM ratio (GM ratio = [GM + CSF] / CSF) "r values" for the 3 SVPAs compared to the manually derived ratios across the 68 ROIs were 0.85 for the 12p SVPA, 0.88 for the 2nd SVPA, and 0.89 for the 6th SVPA. The mean left and right WM ratio (WM ratio = [WM + CSF] / CSF) "r values" for the 3 SVPAs being 0.84 for the 12p SVPA, 0.86 for the 2nd SVPA, and 0.88 for the 6th SVPA. CONCLUSION: We have constructed, from an elderly and demented cohort, an automated brain volumetric tool that has excellent accuracy compared to a manual gold standard and is capable of regional hypothesis testing and individual patient assessment compared to a population.