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Viviparity (live birth) represents a significant evolutionary innovation that has emerged in hundreds of lineages of invertebrate and vertebrate animals. The evolution of this trait from the ancestral state of egg laying has involved complex morphological, behavioral, physiological, and genetic changes, which enable internal development of embryos within the female reproductive tract. Comparable changes have also occurred in oviparous, brooding species that carry developing embryos in locations other than the female reproductive tract. This review explores the taxonomic distribution of vertebrate viviparity and brooding (collectively termed pregnancy), discusses the adaptations associated with internal incubation, and examines hypotheses surrounding the evolution of pregnancy in different lineages. Understanding the mechanisms that have led to the emergence of this trait can illuminate questions about the evolution of reproductive complexity and the processes that led to the emergence of evolutionary innovations that have shaped the remarkable diversity of Earth's fauna.

Objective: To examine violence inspections at the Occupational Safety and Health Administration (OSHA)., Methods: The authors examined all inspections that involved violence against workers begun by January 1, 2019. They conducted semi-structured interviews with compliance officers who had conducted inspections on a sample of facilities that received General Duty Clause (GDC) citations (n = 22) or Hazard Alert Letters (HALs) (n = 22)., Results: By January 1, 2019, OSHA initiated 726 "violence" inspections, with 502 (69.1%) in healthcare. In healthcare, 45 (11.1%) resulted in GDC citations and 241 (67.7%) in HALs. GDC facilities received statistically significantly lower scores in 5 of 6 domains examined through semi-structured interviews than HAL facilities. Both groups of facilities had poorly designed recordkeeping systems., Conclusions: Health care facilities continue to generate worker complaints with poorly designed violence prevention programs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Objectives: To characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries., Methods: Two data sources were analysed: archived case files of the Occupational Safety and Health Administration's (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture-recapture analysis assessed under-reporting in SIR., Results: There were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis., Conclusions: Workers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Workers exposed to metalworking fluids (MWF) can develop respiratory illnesses including hypersensitivity pneumonitis (HP). These respiratory manifestations are likely due to microbial contamination of aerosolized MWF. This paper reports a cluster of HP and respiratory symptoms at a manufacturing plant where MWF and workplace air were contaminated with bacterial endotoxin despite frequent negative bacterial cultures of MWF., Methods: A pulmonologist assessed and treated three workers with respiratory symptoms. The Occupational Safety and Health Administration (OSHA) inspected the plant. OSHA's investigation included bacterial culture of MWF, measurement of endotoxin concentrations in MWF and workplace air, review of the employer's fluid management program, and distribution of a cross-sectional symptom questionnaire., Results: Three workers had biopsy-confirmed HP. In addition, 30.8% of questionnaire respondents reported work-related respiratory symptoms. OSHA detected endotoxin levels as high as 92,000 endotoxin units (EU)/ml in MWF and 3200 EU/m 3 in air. Endotoxin concentrations and risk of MWF inhalation were highest near an unenclosed multistation computer numerical control machine. A contractor had tested this machine's MWF for bacterial growth weekly during the preceding three years, and most (96.0%) of those tests were negative., Conclusions: Contaminated MWF can cause severe occupational lung disease even if microorganisms do not grow in fluid cultures. Endotoxin testing can increase the sensitivity of detection of microbial contamination. However, employers should not rely solely upon MWF testing data to protect workers. Medical surveillance and meticulous source control, such as engineering controls to suppress MWF mist and prevent its inhalation, can reduce the likelihood of respiratory disease., (© 2021 Wiley Periodicals LLC.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Ectotherms utilise a complex array of behavioural and physiological mechanisms to cope with variation in suboptimal thermal environments. However, these mechanisms may be insufficient for population persistence under contemporary climate change, resulting in a greater need to understand how local populations respond to geographic variation in climate. In this study, we explored the potential for local adaptation and acclimation in thermal traits and behaviours using wild and captive populations of a small agamid lizard (the jacky lizard, Amphibolurus muricatus). We predicted that wild lizards from a high elevation site would have cooler thermal preferences compared to those at low elevation sites to match the more restricted thermal resources at higher, cooler elevations. We additionally explored whether variation in thermal traits was due to recent acclimation or fixed population differences, such as due to developmental plasticity or local adaptation. In contrast to our predictions, we found high-elevation lizards began panting at higher temperatures and had higher thermal preferences relative to lower elevation lizards. When allowed to bask freely, there was no difference in the intensity of basking or daily duration of time spent basking between lizards from different elevations. Although the high-elevation lizards appeared to show stronger acclimation to recent air temperatures compared to low-elevation lizards, this difference was not significant. Similarly, captive lizards acclimated under long and short basking regimes showed no major differences in thermal traits or basking behaviour. Our results are consistent with the presence of counter-gradient variation in thermal phenotypes of lizards, and suggest that these are driven by local adaptive responses or developmental effects rather than recent acclimation., (Copyright © 2019. Published by Elsevier Ltd.)

Heat stress occupational exposure limits (OELs) were developed in the 1970s to prevent heat-related illnesses (HRIs). The OELs define the maximum safe wet bulb globe temperature (WBGT) for a given physical activity level. This study's objectives were to compute the sensitivity of heat stress OELs and determine if Heat Index could be a surrogate for WBGT. We performed a retrospective analysis of 234 outdoor work-related HRIs reported to the Occupational Safety and Health Administration in 2016. Archived NOAA weather data were used to compute each day's maximum WBGT and Heat Index. We defined the OELs' sensitivity as the percentage of incidents with WBGT > OEL. Sensitivity of the OELs was between 88% and 97%, depending upon our assumption about acclimatization status. In fatal cases, the OELs' sensitivity was somewhat higher (92-100%). We also computed the sensitivity of each possible Heat Index discrimination threshold. A Heat Index threshold of 80 °F (26.7 °C) was exceeded in 100% of fatalities and 99% of non-fatal HRIs. In a separate analysis, we created simulated weather data to assess associations of WBGT with Heat Index over a range of realistic outdoor heat conditions. These simulations demonstrated that for a given Heat Index, when radiant heat was included, WBGT was often higher than previously reported. The imperfect correlation between WBGT and Heat Index precluded a direct translation of OELs from WBGT into Heat Index. We conclude that WBGT-based heat stress exposure limits are highly sensitive and should be used for workplace heat hazard assessment. When WBGT is unavailable, a Heat Index alert threshold of approximately 80 °F (26.7 °C) could identify potentially hazardous workplace environmental heat.

Objective: We examined relationships between employee safety climate and patient safety culture. Because employee safety may be a precondition for the development of patient safety, we hypothesized that employee safety culture would be strongly and positively related to patient safety culture., Methods: An employee safety climate survey was administered in 2010 and assessed employees' views and experiences of safety for employees. The patient safety survey administered in 2011 assessed the safety culture for patients. We performed Pearson correlations and multiple regression analysis to examine the relationships between a composite measure of employee safety with subdimensions of patient safety culture. The regression models controlled for size, geographic characteristics, and teaching affiliation. Analyses were conducted at the group level using data from 132 medical centers., Results: Higher employee safety climate composite scores were positively associated with all 9 patient safety culture measures examined. Standardized multivariate regression coefficients ranged from 0.44 to 0.64., Conclusions: Medical facilities where staff have more positive perceptions of health care workplace safety climate tended to have more positive assessments of patient safety culture. This suggests that patient safety culture and employee safety climate could be mutually reinforcing, such that investments and improvements in one domain positively impacts the other. Further research is needed to better understand the nexus between health care employee and patient safety to generalize and act upon findings.

Objective: The aim of this study was to describe risk factors for heat-related illness (HRI) in U.S. workers., Methods: We reviewed a subset of HRI enforcement investigations conducted by the Occupational Safety and Health Administration (OSHA) from 2011 through 2016. We assessed characteristics of the workers, employers, and events. We stratified cases by severity to assess whether risk factors were more prevalent in fatal HRIs., Results: We analyzed 38 investigations involving 66 HRIs. Many workers had predisposing medical conditions or used predisposing medications. Comorbidities were more prevalent in workers who died. Most (73%) fatal HRIs occurred during the first week on the job. Common clinical findings in heat stroke cases included multiorgan failure, muscle breakdown, and systemic inflammation., Conclusion: Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.

Heat stress, an environmental and occupational hazard, is associated with a spectrum of heat-related illnesses, including heat stroke, which can lead to death. CDC's National Institute for Occupational Safety and Health (NIOSH) publishes recommended occupational exposure limits for heat stress (1). These limits, which are consistent with those of the American Conference of Governmental Industrial Hygienists (ACGIH) (2), specify the maximum combination of environmental heat (measured as wet bulb globe temperature [WBGT]) and metabolic heat (i.e., workload) to which workers should be exposed. Exposure limits are lower for workers who are unacclimatized to heat, who wear work clothing that inhibits heat dissipation, and who have predisposing personal risk factors (1,2). These limits have been validated in experimental settings but not at outdoor worksites. To determine whether the NIOSH and ACGIH exposure limits are protective of workers, CDC retrospectively reviewed 25 outdoor occupational heat-related illnesses (14 fatal and 11 nonfatal) investigated by the Occupational Safety and Health Administration (OSHA) from 2011 to 2016. For each incident, OSHA assessed personal risk factors and estimated WBGT, workload, and acclimatization status. Heat stress exceeded exposure limits in all 14 fatalities and in eight of 11 nonfatal illnesses. An analysis of Heat Index data for the same 25 cases suggests that when WBGT is unavailable, a Heat Index screening threshold of 85°F (29.4°C) could identify potentially hazardous levels of workplace environmental heat. Protective measures should be implemented whenever the exposure limits are exceeded. The comprehensive heat-related illness prevention program should include an acclimatization schedule for newly hired workers and unacclimatized long-term workers (e.g., during early-season heat waves), training for workers and supervisors about symptom recognition and first aid (e.g., aggressive cooling of presumed heat stroke victims before medical professionals arrive), engineering and administrative controls to reduce heat stress, medical surveillance, and provision of fluids and shady areas for rest breaks., Competing Interests: No conflicts of interest were reported.

Objective: To describe development and validation of the work-related well-being (WRWB) index., Methods: Principal components analysis was performed using Federal Employee Viewpoint Survey (FEVS) data (N = 392,752) to extract variables representing worker well-being constructs. Confirmatory factor analysis was performed to verify factor structure. To validate the WRWB index, we used multiple regression analysis to examine relationships with burnout associated outcomes., Results: Principal Components Analysis identified three positive psychology constructs: "Work Positivity", "Co-worker Relationships", and "Work Mastery". An 11 item index explaining 63.5% of variance was achieved. The structural equation model provided a very good fit to the data. Higher WRWB scores were positively associated with all three employee experience measures examined in regression models., Conclusions: The new WRWB index shows promise as a valid and widely accessible instrument to assess worker well-being.

Context: In the United States, regional poison centers frequently receive calls about toxic workplace exposures. Most poison centers do not share call details routinely with governmental regulatory agencies. Worker health and safety could be enhanced if regulators such as the Occupational Safety and Health Administration (OSHA) had the ability to investigate these events and prevent similar incidents. With this goal in mind, the Georgia Poison Center (GPC) began referring occupational exposures to OSHA in July 2014., Methods: GPC began collecting additional employer details when handling occupational exposure calls. When workers granted permission, GPC forwarded call details to the OSHA Regional Office in Atlanta. These referrals enabled OSHA to initiate several investigations. We also analyzed all occupational exposures reported to GPC during the study period to characterize the events, detect violations of OSHA reporting requirements, and identify hazardous scenarios that could form the basis for future OSHA rulemaking or guidance., Results: GPC was informed about 953 occupational exposures between 1 July, 2014 and 7 January, 2016. Workers were exposed to 217 unique substances, and 70.3% of victims received treatment in a healthcare facility. Hydrogen sulfide was responsible for the largest number of severe clinical effects. GPC obtained permission to refer 89 (9.3%) calls to OSHA. As a result of these referrals, OSHA conducted 39 investigations and cited 15 employers for "serious" violations. OSHA forwarded several other referrals to other regulatory agencies when OSHA did not have jurisdiction. At least one employer failed to comply with OSHA's new rule that mandates reporting of all work-related hospitalizations. This collaboration increased OSHA's awareness of dangerous job tasks including hydrofluoric acid exposure among auto detailers and carbon monoxide poisoning with indoor use of gasoline-powered tools., Conclusions: Collaboration with the GPC generated a useful source of referrals to OSHA. OSHA investigations led to abatement of existing hazards, and OSHA acquired new knowledge of occupational exposure scenarios.

Decellularization of whole porcine hearts followed by recellularization with fully differentiated cells made from patient-specific human induced pluripotent stem cells (iPSCs) may provide the ultimate solution for patients with heart failure. Decellularization is the process of completely disrupting all cells and removing the cellular components (e.g., antigenic proteins, lipids, DNA) from organic tissue, leaving only the extracellular matrix (ECM). The decellularization of porcine hearts can be accomplished in 24 h and results in 98% DNA removal with only 6 h of detergent exposure. Automatically controlling the pressure during decellularization reduces the detergent exposure time while still completely removing immunogenic cell debris.

Introduction: A 2009 Government Accounting Office (GAO) report, along with numerous published studies, documented that many workplace injuries are not recorded on employers' recordkeeping logs required by the Occupational Safety and Health Administration (OSHA) and consequently are under-reported to the Bureau of Labor Statistics (BLS), resulting in a substantial undercount of occupational injuries in the United States., Methods: OSHA conducted a Recordkeeping National Emphasis Program (NEP) from 2009 to 2012 to identify the extent and causes of unrecorded and incorrectly recorded occupational injuries and illnesses., Results: OSHA found recordkeeping violations in close to half of all facilities inspected. Employee interviews identified workers' fear of reprisal and employer disciplinary programs as the most important causes of under-reporting. Subsequent inspections in the poultry industry identified employer medical management policies that fostered both under-reporting and under-recording of workplace injuries and illnesses., Conclusions: OSHA corroborated previous research findings and identified onsite medical units as a potential new cause of both under-reporting and under-recording. Research is needed to better characterize and eliminate obstacles to the compilation of accurate occupational injury and illness data., Practical Applications: Occupational health professionals who work with high hazard industries where low injury rates are being recorded may wish to scrutinize recordkeeping practices carefully. This work suggests that, although many high-risk establishments manage recordkeeping with integrity, the lower the reported injury rate, the greater the likelihood of under-recording and under-reporting of work-related injuries and illnesses., (Published by Elsevier Ltd.)

Objective: The study examined the relationship between onsite occupational health practice characteristics, provider choice, and workers' compensation outcome metrics., Methods: Cross-sectional survey of 140 medical center occupational health clinics within the Department of Veterans Affairs. Multivariate regression models examined how specific clinical quality factors influenced provider choice and workers' compensation measures., Results: Several practice characteristics were associated with higher rates of in-house care selection-longer hours of operation, greater availability of workers' compensation-related medical services, clinic administration by a board certified physician, physician tenure, and adherence to clinical practice guidelines. Access to onsite, occupational and environmental medicine certified physician-directed care was associated with reductions in disability duration among injured healthcare workers., Conclusions: These findings suggest that occupational medicine board certification can positively impact provider choice among fully insured patients, which may have implications for other healthcare systems.

Objective: The objective of this article is to introduce the reader to this special supplement to the Journal of Occupational and Environmental Medicine regarding Federal Workers' Compensation Programs., Methods: The short history of both the VHA and DoD Federal Workers' Compensation Programs are provided and a short synopsis of each author's article is provided., Results: The lessons learned from the articles in the supplement are summarized in this article and 6 key findings are highlighted., Conclusions: Cooperation between human resources workers' compensation personnel, safety and occupational health personnel is a must for successful management of the WC program. Information and data sharing are critical for root cause and injury prevention, case management, and cost containment efforts. Enhancing efforts in these areas will save an estimated $100 million through cost avoidance efforts.

Background: The Veterans Health Administration undertook a series of performance improvement projects (PIP) using local initiatives identified through a national committee of regional workers' compensation representatives., Methods: A steering committee identified five types of risks and interventions that were considered worthwhile. They defined performance metrics as outcome measures and distinguished short-term from long-term disability management success., Results: Eight specific PIPs were implemented. No statistically significant differences in the planned outcome metrics were identified, although cost-benefit evaluations did identify a benefit., Conclusions: Conducting quantitative PIPs in a large system requires top management commitment, sequestration of funds, and mature systems.

Objective: The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes., Methods: A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases., Results: Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance., Conclusions: Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.

Objective: Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration., Methods: We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified., Results: Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability., Conclusions: The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.

Background: Veterans Health Administration (VHA) is a national health care system with variation in hand hygiene (HH) measurement and improvement practices across its facilities. The objective of this national survey was to characterize this variability and identify opportunities for standardization., Methods: Survey covered 3 major areas of HH: (1) methods of measuring HH compliance, (2) interventions to improve HH compliance, and (3) site-specific targets for HH compliance., Results: One hundred forty-one (100%) VHA medical centers returned the survey. A majority (98.6%) of the medical centers conduct direct observations to measure HH compliance rates. Fewer than half (45.3%) validate the observer process at the onset, and fewer still (39.6%) continue to validate observers. Main behaviors that are considered HH opportunities are room entry (69.1%) and exit (71.9%). Improvement interventions include posters (97.2%), feedback (eg, 98.6% to leadership), and improved access to HH products (eg, 90.6% provide individual hand sanitizers to staff). Mandatory education programs for clinical staff are conducted in 88.5% of the medical centers. The majority of the medical centers (77.3%) set their HH compliance target over 90%., Conclusion: Although HH improvement interventions are relatively similar across VHA medical centers, variation exists in compliance monitoring. Findings will assist in standardizing surveillance and next steps in hand hygiene policy in VHA., (Published by Mosby, Inc.)

Objective: To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership., Methods: Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data., Results: Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors., Conclusion: Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

Use of a stability ball alone and stability ball chair were evaluated in the Veterans Health Administration as possible alternatives to incorporate with regular office chair use. The evaluation of stability ball use was conducted under the auspices of a work site health promotion program as a cross-over trial with participants rotating through use of the stability ball, stability ball chair, and regular office chair on a monthly basis for a total duration of 3 months. Rotations on regular office chairs served as the control. Three medical facilities participated. A total of 193 employees completed a baseline questionnaire; 159 completed at least one post-rotation questionnaire. Self-reported measures included perceived posture when sitting, perceptions of overall balance, energy levels, job performance, safety, and pain. Use was associated with improvements in perceived posture (p < 0.0001) and energy levels (p = 0.007) for stability ball users compared with the office chair control, and improvements in perceived posture (p < 0.0001) and overall balance (p = 0.05) for stability ball chair users compared with the control. Use of stability balls at work decreases the likelihood of reporting pain from regular office chair use from approximately 45% to 21%. Alternatively, a high number of participants reported pain with use of the stability ball alone and stability ball chair, 42% and 45%, respectively. The perceived risks and benefits of stability ball use should be weighed when incorporating use.

Background: We sought to describe the components and processes in a violence risk assessment and management system, including electronic record requirements in the Veterans Health Administration (VA). We present information on system-level variation among program elements and their association with perceived and measured effectiveness., Methods: We conducted a cross-sectional survey of Chiefs of Staff (COS) at 140 VA hospitals across the United States about specific disruptive behavior program elements, such as committee processes, patient referrals, and outcome patterns. We assessed COS perceived effectiveness of the processes. We compared COS perceptions with employee-reported assault-related incident rates and workers compensation lost time claim rates for assault-related injuries for 2009 and 2010., Results: We found the violence risk assessment and management system is heavily used, often with guidance to provide police protection for providers. COS respondents were generally satisfied with design and performance of the system. Committee processes and perceptions of effectiveness were associated with reduction in assault-related incident rates., Conclusions: VA's system was considered effective by system owners and users may be effective at reducing assaulted-related injuries., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability., Design: A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey., Setting: National single-payer healthcare system with 152 hospitals., Participants: Employees of the healthcare system in 2010 who responded to the survey., Methods: Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability., Results: Four factors were identified related to vaccine declination and were labeled as (1) "don't care," (2) "don't want," (3) "don't believe," and (4) "don't know." Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor., Conclusions: Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.

Objective: To determine baseline prevalence of health behaviors and chronic health conditions in Veterans Health Administration (VHA) employees and highlight disparities by occupation group., Methods: There were 29,834 responses to the survey. Age-standardized prevalence estimates for VHA employees were compared to national estimates from BRFSS surveys. The VHA estimates were analyzed for physicians and dentists; physician assistants and nurse practitioners; registered nurses; licensed practical nurses and nursing assistants; other clinical; nonclinical; and wage grade staff. Multilevel regression explored the effect of worksite., Results: The VHA employees have higher rates of unhealthy behaviors and chronic health conditions than US adults, except for smoking. Results illustrated significant disparities between occupation groups by demographics and variability by worksite., Conclusions: Veterans Health Administration's population appears less healthy than the US general population. Disparities between occupation groups support the establishment of targeted health promotion programs, with attention paid to differences in local culture.

Objective: To determine relations between sick leave use and the 2009 novel influenza A (H1N1) influenza pandemic among clinical and nonclinical staff in the Veterans Health Administration (VHA)., Methods: Aggregate sick leave use for all VHA employees was monitored in near-real time during the 2009 H1N1 influenza pandemic and compared with historical data from 2004 to 2008. The ratio of sick leave use between clinical and nonclinical staff was examined. An autoregressive integrated moving average model was used to assess whether the pandemic had a significant effect on sick leave use., Results: The H1N1 influenza pandemic was associated with a significant effect on sick leave use in the VHA during the second wave of the pandemic. During this wave, the ratio of clinical to nonclinical sick leave use changed; clinical staff began taking more leave than nonclinical staff for 3 successive 2-week pay periods, with ratio measures of 1.004, 1.018, and 1.011, respectively. Using an autoregressive integrated moving average model with a pulse variable representing the pandemic, there was a significant effect on sick leave use. The average hours of sick leave used per full-time equivalent staff member per month increased by 0.3904 hours (P = .003) for clinical staff and 0.3898 hours (P = .01) for nonclinical staff over previous months during the first month of the second pandemic wave., Conclusions: Work loss associated with a pandemic is an important indicator of disease activity and may be a more sensitive indicator of emerging strains than deaths. Monitoring sick leave use in near real time in a large national health care system may be an important early indicator of pandemic severity with practical implications that should be considered in addition to more traditional measures of influenza epidemic and pandemic severity.

Objective: This study examined the relationship between changes in assault rates over time and the implementation of a workplace violence prevention (WVP) program in 138 Department of Veterans Affairs health care facilities., Methods: Data on WVP implementation were assessed for each facility by a three-person team. We computed three WVP dimension scores: training, workplace practices, and environmental control and security. We obtained 6 years of assault rate data from the national injury system. Using a linear mixed model, we analyzed whether the WVP implementation was associated with lower assault rates controlling for time and organizational characteristics., Results: Training implementation was negatively associated with assault rates. Facilities with smaller bed sizes and without academic affiliates had lower assault rates., Conclusions: Particular attention should be given to these dimensions because they may be associated with lower facility-level assault rates.

Unlabelled: The contractile history of muscle can potentiate electrically evoked force production. A link to voluntary force production, related in part to an increase in reflex excitability, has been suggested., Purpose: Our purpose was to quantify the effect of postactivation potentiation on voluntary force production and spinal H-reflex excitability during explosive plantar flexion actions., Methods: Plantar flexor twitch torque, soleus H-reflex amplitudes, and the rate of force development of explosive plantar flexion were measured before and after 4 separate conditioning trials (3 x 5 s maximal contractions)., Results: Twitch torque and rate of force production during voluntary explosive plantar flexion were significantly increased (P < .05) while H-reflex amplitudes remained unchanged. Although twitch torque was significantly higher after conditioning, leading to a small increase in the rate of voluntary force production, this was unrelated to changes in reflex excitability., Conclusion: We conclude that postactivation potentiation may result in a minor increase in the rate of voluntary isometric force production that is unrelated to neural excitability.

Recently there has been considerable interest and research into the functional significance of postactivation potentiation (PAP) on sport performance. The interest has evolved around the potential for enhancing acute performance or the long-term training effect, typically in the form of complex training. Complex training usually involves performing a weight-training exercise with high loads before executing a plyometric exercise with similar biomechanical demands. Despite a considerable amount of research in the past 10 years it would seem there is still much research to be done to fully determine whether PAP has a functional role and, if so, how to best exploit it. It is clear from the research that there are many factors that need to be considered when attempting to apply PAP to an athlete. It is possible that a well-conceived sport-specific warm-up might be as or more effective in enhancing acute performance and easier to apply in a practical setting. In addition, despite its current popularity, there has not been 1 study that has effectively examined the efficacy of complex training and whether it has any advantage over other forms of training that combine weight training and plyometrics but not in the same training session.