Search

Editorial. Focuses on efforts in the identification of serious occupational illness in the U.S. Collection of information by the San Francisco Bay Area Regional Poison Control Center on occupational illnesses; Need for a broader study to verify the usefulness of the data collected; Types of occupational illness described by the Bureau of Labor Statistics.

Objectives: This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion., Background: Although FFR has become a key invasive tool to guide treatment, questions remain regarding its repeatability and stability during intravenous adenosine infusion because of systemic effects that can alter driving pressure and heart rate., Methods: We reanalyzed data from the VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice) study, which enrolled consecutive patients who were infused with intravenous adenosine at 140 μg/kg/min and measured FFR twice. Raw phasic pressure tracings from the aorta (Pa) and distal coronary artery (Pd) were transformed into moving averages of Pd/Pa. Visual analysis grouped Pd/Pa curves into patterns of similar response. Quantitative analysis of the Pd/Pa curves identified the "smart minimum" FFR using a novel algorithm, which was compared with human core laboratory analysis., Results: A total of 190 complete pairs came from 206 patients after exclusions. Visual analysis revealed 3 Pd/Pa patterns: "classic" (sigmoid) in 57%, "humped" (sigmoid with superimposed bumps of varying height) in 39%, and "unusual" (no pattern) in 4%. The Pd/Pa pattern repeated itself in 67% of patient pairs. Despite variability of Pd/Pa during the hyperemic period, the "smart minimum" FFR demonstrated excellent repeatability (bias -0.001, SD 0.018, paired p = 0.93, r(2) = 98.2%, coefficient of variation = 2.5%). Our algorithm produced FFR values not significantly different from human core laboratory analysis (paired p = 0.43 vs. VERIFY; p = 0.34 vs. RESOLVE)., Conclusions: Intravenous adenosine produced 3 general patterns of Pd/Pa response, with associated variability in aortic and coronary pressure and heart rate during the hyperemic period. Nevertheless, FFR - when chosen appropriately - proved to be a highly reproducible value. Therefore, operators can confidently select the "smart minimum" FFR for patient care. Our results suggest that this selection process can be automated, yet comparable to human core laboratory analysis., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.

Employee happiness can impact substantially on an organization's performance. It can influence employee retention, absenteeism, and work performance. Because of this importance, such happiness is inseparable from the real business of the organization and should be considered a business goal. Implementation and development of the strategic plan associated with this goal becomes the responsibility of a highly placed project team that has as its mission ensuring employee satisfaction. The strategic plan includes procedures that allow management to listen effectively to employees, assessing and responding to their values and needs. In this paper we discuss the workforce and environmental characteristics that are involved planning for employee happiness and the steps in creating an organizational culture in which this can become a business goal.

The authors surveyed participants in a National Cancer Institute, or NCI, training program that provides brief tobacco cessation services. They found significant improvements in the frequency with which practitioners ask patients about tobacco use and assist patients in stopping tobacco use. Improvements also were found in the participants' level of confidence and preparedness to help patients quit. Despite some limitations, the NCI training was shown to be an effective program for the oral health care team.

This article examines, from a therapeutic jurisprudence (TJ) perspective, the rights of institutionalized mentally disabled persons to determine whether TJ is compatible with positions advancing civil rights and liberties, and whether lawyers for such individuals should look more closely to TJ as a source of rights. It concludes (a) that despite harsh criticisms of mental disability law reform, most of the important decisions in the areas of involuntary civil commitment, right to treatment, and right to refuse treatment law have a strong TJ component and (b) that TJ analyses may be the appropriate tool to reinvigorate this area of mental disability law.

The recognition, evaluation, and control of embryotoxins in the workplace are toxicologically and administratively complex and present challenging circumstances to the occupational health professional and to the workplace manager. Accommodating the expectations of society and complying with existing laws and regulations make this complex problem even more difficult. By carefully applying the same toxicological considerations and control measures as are used for other chemicals which present different toxic hazards, exposures of susceptible persons to embryotoxins can be prevented or maintained at safe levels without unnecessary restriction of the opportunity for meaningful employment for any class of persons.