Supporting Employee Lactation: Do U.S. Workplace Lactation Benefit Mandates Align with Evidence-Based Practice?

Within the United States, there are governmental benefits and policies in place to support breastfeeding mothers as they return to work. However, the effectiveness and inclusiveness of these policies is not always clear. Because of this, breastfeeding at work, in general, and governmental workplace mandates, specifically, often receive negative press and social media attention as women struggle to reconcile their workplace and lactation demands. To provide evidence-based recommendations for how to best support breastfeeding employees, we use an organizational science perspective to review the existing research for evidence on the (1) effectiveness of the existing legal benefits and supports within the US, and (2) barriers or facilitators that impact benefit success. Through this, we identify areas for improvement and provide suggestions for policy

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

Big team science initiatives: A catalyst for trustworthy advancements in IO psychology

Keener et al. (2023) raise concerns about the trustworthiness of Industrial/Organizational (IO) Psychology research and related fields due to the low reproducibility and replicability of research findings. The authors provide various solutions to resolve this crisis, such as improving training, realigning incentives, and adopting open science practices. Our commentary elaborates on one solution to which they briefly allude: Big Team Science Initiatives (BTSIs). BTSIs allow scholars to address the trustworthiness of our science by facilitating large sample theory testing, sharing and allocating resources, and selecting appropriate research strategies, all of which support the reproducibility and replication of research. Further, we propose that BTSIs may facilitate researcher training, encourage data sharing and materials, and realign incentives in our field. We discuss how BTSIs could be implemented in IO psychology and related fields, identifying and drawing upon similar BTSIs in related disciplines. Thus, our commentary is an extension of the focal article, encouraging scholars to collaboratively address the “crisis of confidence” facing our field using a big team science approach

Supporting Employee Lactation: Do U.S. Workplace Lactation Benefit Mandates Align with Evidence-Based Practice?

Within the United States, there are governmental benefits and policies in place to support breastfeeding mothers as they return to work. However, the effectiveness and inclusiveness of these policies is not always clear. Because of this, breastfeeding at work, in general, and governmental workplace mandates, specifically, often receive negative press and social media attention as women struggle to reconcile their workplace and lactation demands. To provide evidence-based recommendations for how to best support breastfeeding employees, we use an organizational science perspective to review the existing research for evidence on the (1) effectiveness of the existing legal benefits and supports within the US, and (2) barriers or facilitators that impact benefit success. Through this, we identify areas for improvement and provide suggestions for policy

Management of facial injuries in elite and professional sports – a consensus report

Whilst there have been great improvements in the management of injuries in elite and professional athletes with the formalisation of the clinical specialty of sports and exercise medicine, the management of facial injuries has perhaps lagged in this group. Professional athletic careers can be put in jeopardy by unnecessarily long absences from training and competition after facial injuries. Professional and elite sports athletes can benefit from different approaches to the management of their facial injuries that reduce time away from competing but maximise their safety. On 6 December 2018, a consensus meeting of interested clinicians involved in the management of facial injuries in this group was held at the Royal Society of Medicine, London, UK to provide a contemporary review of the approaches to conservative, operative, and recovery management. National experts with specialist experience of facial injuries and athletes’ needs from a range of elite and professional sports led the day’s programme and the discussions so that guidelines could be formulated. These are presented in this review

Waiting to Vote in the 2016 Presidential Election: Evidence from a Multi-county Study

This paper is the result of a nationwide study of polling place dynamics in the 2016 presidential election. Research teams, recruited from local colleges and universities and located in twenty-eight election jurisdictions across the United States, observed and timed voters as they entered the queue at their respective polling places and then voted. We report results about four specific polling place operations and practices: the length of the check-in line, the number of voters leaving the check-in line once they have joined it, the time for a voter to check in to vote (i.e., verify voter’s identification and obtain a ballot), and the time to complete a ballot. Long lines, waiting times, and times to vote are closely related to time of day (mornings are busiest for polling places). We found the recent adoption of photographic voter identification (ID) requirements to have a disparate effect on the time to check in among white and nonwhite polling places. In majority-white polling places, scanning a voter’s driver’s license speeds up the check-in process. In majority nonwhite polling locations, the effect of strict voter ID requirements increases time to check in, albeit modestly