Establishing a Protocol to Address Workplace Violence and Increase the Perceptions of Safety Among Emergency Department Nurses: A Quality Improvement Initiative

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse\u27s job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally we have undervalued their lived experiences and have placed an expectation that violence is an acceptable consequence of their career choice. In doing so, we, as a culture, have also set a precedent that patients can continue to act in an aggressive and assaultive manner towards nurses with little to no consequence, of which, patients continue to engage in such behaviors and incidences of violence are on the rise. Local Problem: 70-90% of participants have experienced workplace violence in the emergency department within the last year. 30% of nurses believe that this violence is an expected consequence of their job. Methods: In this quality improvement project, answers from the validated Cooke-ENA Workplace Violence Assessment Tool were collected to assess the perception of safety among participatory staff nurses at a critical access hospital in rural New Hampshire in January 2023 and, again, in July 2023. Intervention: Endemic to the workplace, how do we address violence so that nurses are made to feel safe going to work just as we are made to feel safe when going to the hospital and being cared for by the nurse? Who will take care and advocate for them? A policy was implemented to enhance and require the presence of local law enforcement and/or facility security when caring for potentially aggressive and/or violent patients in the emergency department. Results: The results yielded that from January 2023 to July 2023, the perception of overall safety in the emergency department after policy implementation increased slightly with a mean change from 5.8 to 6.0 (SD 0.8944, range 1-10). In January 2023, 30% of the participants reported that workplace violence in the emergency department was to be considered “part of the job.” However, this number was decreased by half after implementation in July 2023 with results at 16% who believe violence is considered part of the job. Conclusion: The ability to sustain the results of this project may vary depending on the patients who arrive at the emergency department, the continued cooperation and support from local law enforcement, and diligence of the microsystem to continue to make strides to mitigate workplace violence and its effects. Success of this quality improvement project was imperative on addressing workplace violence from within the culture of the hospital and decreasing its tolerance as a cultural norm among healthcare agencies

Are different reading problems associated with different anxiety types?

There is a reliable association between poor reading and anxiety, but we do not completely understand the specifics of this relationship. The current study included a sample of children (N = 284; Mage = 9.30, SDage = 1.31) who completed a reading (word, nonword, and text reading accuracy, word, nonword, and text reading fluency, passage reading comprehension) and anxiety (social anxiety, generalized anxiety, separation anxiety, physical injury fears/phobias, panic, obsessive compulsive symptoms) assessment. Analyses included bivariate and partial correlations, principal components analysis, and hierarchical clustering. We found a very tentative suggestion in the data that there may be a specific yet weak association between reading accuracy and social anxiety. The clinical implications and directions for future research are discussed

Formal Availability Analysis using Theorem Proving

Availability analysis is used to assess the possible failures and their restoration process for a given system. This analysis involves the calculation of instantaneous and steady-state availabilities of the individual system components and the usage of this information along with the commonly used availability modeling techniques, such as Availability Block Diagrams (ABD) and Fault Trees (FTs) to determine the system-level availability. Traditionally, availability analyses are conducted using paper-and-pencil methods and simulation tools but they cannot ascertain absolute correctness due to their inaccuracy limitations. As a complementary approach, we propose to use the higher-order-logic theorem prover HOL4 to conduct the availability analysis of safety-critical systems. For this purpose, we present a higher-order-logic formalization of instantaneous and steady-state availability, ABD configurations and generic unavailability FT gates. For illustration purposes, these formalizations are utilized to conduct formal availability analysis of a satellite solar array, which is used as the main source of power for the Dong Fang Hong-3 (DFH-3) satellite.Comment: 16 pages. arXiv admin note: text overlap with arXiv:1505.0264

Obesity and Type 2 Diabetes Prevalence in Adults from Two Remote First Nations Communities in Northwestern Ontario, Canada

Objective. To assess the prevalence rates of obesity and type 2 diabetes in adults from two First Nations communities in northwestern Ontario, Canada. Methods. Body weight, height, and waist circumference as well as fasting and postprandial glucose levels following an oral glucose tolerance test were measured in 31 men and 41 women. Results. The mean age of the sample was 43 ± 13 y. The prevalence of obesity was 65.3% and was comparable between men and women. 90.3% of the individuals presented waist circumference levels greater than the thresholds associated with an increased risk of developing health problems. 26 of the 72 individuals (36.1%) were found to be type 2 diabetic. The prevalence of diabetes was not different between men and women. Conclusion. Using objective measurements, this study confirms that First Nations adults from remote communities of Canada continue to experience a disproportionately higher prevalence of obesity and type 2 diabetes than nonaboriginal Canadians

Women in pediatric radiology

Women represent a significant proportion of pediatric radiologists in the United States, as shown on surveys by the American College of Radiology (ACR) and the Society for Pediatric Radiology (SPR). This review discusses the characteristics of this subgroup of specialists and issues uniquely related to them

Epirubicin With Cyclophosphamide Followed by Docetaxel With Trastuzumab and Bevacizumab as Neoadjuvant Therapy for HER2-Positive Locally Advanced Breast Cancer or as Adjuvant Therapy for HER2-Positive Pathologic Stage III Breast Cancer: A Phase II Trial of the NSABP Foundation Research Group, FB-5

Background The purpose of this study was to determine the cardiac safety and clinical activity of trastuzumab and bevacizumab with docetaxel after epirubicin with cyclophosphamide (EC) in patients with HER2-positive locally advanced breast cancer (LABC) or pathologic stage 3 breast cancer (PS3BC). Patients and Methods Patients received every 3 week treatment with 4 cycles of EC (90/600 mg/m2) followed by 4 cycles of docetaxel (100 mg/m2). Targeted therapy with standard-dose trastuzumab with bevacizumab 15 mg/kg was given for a total of 1 year. Coprimary end points were (1) rate of cardiac events (CEs) in all patients defined as clinical congestive heart failure with a significant decrease in left ventricular ejection fraction or cardiac deaths; and (2) pathologic complete response (pCR) in breast and nodes in the neoadjuvant cohort. An independent cardiac review panel determined whether criteria for a CE were met. Results A total of 105 patients were accrued, 76 with LABC treated with neoadjuvant therapy and 29 with PS3BC treated with adjuvant therapy. Median follow-up was 59.2 months. Among 99 evaluable patients for cardiac safety, 4 (4%; 95% confidence interval [CI], 1.1%-10.0%) met CE criteria. The pCR percentage in LABC patients was 46% (95% CI, 34%-59%). Five-year recurrence-free survival (RFS) and overall survival (OS) for all patients was 79.9% and 90.8%, respectively. Conclusion The regimen met predefined criteria for activity of interest with an acceptable rate of CEs. Although the pCR percentage was comparable with chemotherapy regimens with trastuzumab alone the high RFS and OS are of interest in these high-risk populations

Wage losses in the year after breast cancer: Extent and determinants among Canadian women

This article is available open access through the publisher’s website at the link below. © The Author 2008.Background - Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer. Methods - We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided. Results - Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (Ptrend = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P < .001), self-employment (P < .001), shorter tenure in the job (Ptrend < .001), and part-time work (P < .001). Conclusion - Wage losses and their effects on financial situation constitute an important adverse consequence of breast cancer in Canada.The Canadian Breast Cancer Research Alliance, Canadian Institutes of Health Research, and Fondation de l’Université Laval

Associations of Adipose Tissue Architecture, Adipokines and Inflammatory Markers with Body Mass Index and Gestational Weight Gain in Non-diabetic Pregnancies

Background: Some pregnancy weight gain is stored as adipose tissue (AT). Human AT depots vary in their capacity for expansion. Data suggests that subcutaneous (SQ) is adapted for healthy lipid storage. Conversely visceral (V) accumulation is associated with inflammation, obesity-related co-morbidities and Type 2 diabetes (T2DM) risk. We investigated SQ and VAT histologic architecture along with insulin, adipokines and inflammatory markers in relationship to prepregnancy BMI and gestational weight gain (GWG). Methods: Subset of non-diabetic singleton gravidas from the Pregnancy & Postpartum Observational Dietary Study (PPODS), undergoing Cesareans and consenting to SQ & VAT biopsies were included. Average adipocyte size assessed in10 sections/depot/subject. Maternal and cord blood insulin, adiponectin, leptin, PAI-1, CRP, TNFα, IL1b, IL6 and IL8 evaluated using Luminex MAGPIX, laser based fluorescent analytical test instrumentation with MILLIPLEX® multi-analyte panels. GWG determined by difference in pre-pregnancy and last prenatal visit weight. Results: Of 110 subjects enrolled, 19 (17.3%) delivered by Cesarean with 14 consenting to AT sampling, and 7 (50%) having both SQ and VAT available for analysis. These 7 had mean pre-pregnancy BMI 27.8±5.6 kg/m2 and GWG 50.0±25.7 lb (range 19-83) with delivery age 39.2±0.7 wks. Mean SQ and VAT adipocyte sizes were 2892±716 pixels2 (range 1866-3775) and 2427±641 pixels2 (range 1416-3397) respectively (p=0.310); neither were statistically correlated with BMI or GWG. Pre-pregnancy BMI statistically correlated with maternal serum insulin (0.786, p=0.036) at delivery and cord blood leptin (0.886, p=0.019); GWG statistically correlated only with cord blood adiponectin (-0.900, p=0.037). Conclusions: In a small sample of normoglycemic pregnancies undergoing Cesareans and AT sampling, adipocyte size was no different in SQ versus visceral depots, and did not correlate with BMI or GWG. Surprisingly, pre-pregnancy BMI but not GWG correlated with maternal serum insulin at delivery, suggesting that pre-pregnancy weight status may be associated with glycemic control at pregnancy end

HER2 and ESR1 mRNA expression levels and response to neoadjuvant trastuzumab plus chemotherapy in patients with primary breast cancer

Introduction: Recent data suggest that benefit from trastuzumab and chemotherapy might be related to expression of HER2 and estrogen receptor (ESR1). Therefore, we investigated HER2 and ESR1 mRNA levels in core biopsies of HER2-positive breast carcinomas from patients treated within the neoadjuvant GeparQuattro trial. Methods: HER2 levels were centrally analyzed by immunohistochemistry (IHC), silver in-situ hybridization (SISH) and qRT-PCR in 217 pretherapeutic formalin-fixed, paraffin-embedded (FFPE) core biopsies. All tumors had been HER2-positive by local pathology and had been treated with neoadjuvant trastuzumab/ chemotherapy in GeparQuattro. Results: Only 73% of the tumors (158 of 217) were centrally HER2-positive (cHER2-positive) by IHC/SISH, with cHER2-positive tumors showing a significantly higher pCR rate (46.8% vs. 20.3%, p<0.0005). HER2 status by qRT-PCR showed a concordance of 88.5% with the central IHC/SISH status, with a low pCR rate in those tumors that were HER2-negative by mRNA analysis (21.1% vs. 49.6%, p<0.0005). The level of HER2 mRNA expression was linked to response rate in ESR1-positive tumors, but not in ESR1-negative tumors. HER2 mRNA expression was significantly associated with pCR in the HER2-positive/ESR1-positive tumors (p=0.004), but not in HER2-positive/ESR1-negative tumors. Conclusions: Only patients with cHER2-positive tumors - irrespective of the method used - have an increased pCR rate with trastuzumab plus chemotherapy. In patients with cHER2-negative tumors the pCR rate is comparable to the pCR rate in the non-trastuzumab treated HER-negative population. Response to trastuzumab is correlated to HER2 mRNA levels only in ESR1-positive tumors. This study adds further evidence to the different biology of both subsets within the HER2-positive group

Constructing the digitalized sporting body: black and white masculinity in NBA/NHL internet memes

In this article, I examine the ways sport fans construct and circulate discourses of race and masculinity in cyberspace. I do this through an examination of a set of Internet memes that juxtapose the bodies of National Hockey League players with National Basketball Association players in one single image. I argue these memes celebrate White masculinity, while at the same time constructing African American athletes as individualistic, selfish, and unwilling to sacrifice their bodies for the greater good of the team. More so, I argue that these memes construct a form of racial ideology that is representative of White backlash politics