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Viral Aerosols in Laboratory and Medical Environments: Generation, Detection, and Mitigation
No full textRespiratory viruses, demonstrated by severe acute respiratory syndrome in 2003, Middle East respiratory syndrome in 2012, and coronavirus disease 2019 outbreaks, pose a recurring occupational hazard in both medical and laboratory environments due to their potential for aerosol transmission. However, quantitative research characterizing the generation and effective mitigation of these viral bioaerosols is limited. This dissertation addresses this gap by characterizing and mitigating viral aerosol risks across these interconnected environments through four studies: a historical review of aerosol-linked laboratory-acquired infections; a controlled laboratory study quantifying aerosol generation during routine procedures and simulated accidents; a hospital field study measuring viral contamination; and the design and testing of a patient emission mitigation tool. The laboratory work, using a viral surrogate, demonstrated that all tested procedures generated detectable aerosols. The hospital study revealed that activating workflow policies, such as limiting patient movement, reduced environmental viral persistence. Furthermore, the novel mitigation tool contained mock patient emissions during aerosol therapy while preserving treatment efficacy. These findings advance the characterization and mitigation of viral aerosol hazards for future viral respiratory outbreaks. Future work is needed to address strategies to mitigate occupational exposure to viral aerosols in laboratory and medical environments during outbreaks
Salt Vs. Scalpel: A Surprisingly Simple Solution to Pyogenic Granulomas
No full textBackground. Pyogenic granulomas (PGs) are benign vascular lesions commonly encountered in primary care settings. They are often linked to trauma, hormonal changes, infections, or medications. While traditional treatments such as excision, curettage, and silver nitrate application are the treatment of choice, recurrence is possible, and they may result in discomfort, anxiety, or scarring. This case highlights the successful use of salt packing, a low-cost, minimally invasive alternative, for a PG resistant to conventional therapy.
Case. A 57-year-old female presented with a 10 mm PG on the right ventral thumb, which bled intermittently and increased in size over three months. An incisional biopsy confirmed the diagnosis. Despite undergoing curettage, electrodesiccation, and silver nitrate application, the lesion persisted. Daily salt packing under occlusion was initiated, leading to a 20% reduction in size within one week. After three additional weeks of continued therapy, the lesion was nearly completely resolved. The patient was advised to monitor for recurrence and restart salt application if necessary.
Conclusion. Salt application, previously reported for umbilical granulomas, is believed to work as a desiccant, dehydrating the lesion and causing vascular tissue shrinkage. This treatment method remains underreported, particularly in the United States. Given the risk of recurrence and scarring associated with surgical treatments, salt packing presents a well-tolerated, cost-effective alternative. This case adds to the growing evidence supporting its use, particularly for lesions resistant to traditional interventions. Importantly, because PGs have a broad differential diagnosis, including malignant lesions such as amelanotic melanoma, biopsy is recommended prior to conservative therapy, and any lesion that does not improve within 2–3 weeks should undergo repeat evaluation. Further studies are needed to evaluate its broader applicability in PG management
Research Productivity Variation in Applicants Who Matched into Home Orthopaedic Surgery Programs
No full textBackground. Research output among orthopaedic surgery applicants remains an important factor in the orthopaedic surgery residency selection process. However, there is limited literature comparing objective measures such as research productivity across different types of orthopaedic surgery applicants. We aim to determine if students who match at their home programs have significantly different research productivity and, secondarily, Alpha Omega Alpha (AOA) membership rates, compared to those who match at external programs.
Methods. This study was conducted in April 2024. A list of orthopaedic surgery residents was acquired from publicly available websites using a Python script. Programs were stratified into four geographic regions. Comparisons were made using Welch’s t-test, and statistical significance was set at p \u3c 0.05.
Results. A total of 3,034 residents from 114 residency programs were identified; 2,247 were external residents and 787 were internal. The average number of total publications was 4.33 and 3.79 for external residents and internal residents, respectively (p = 0.08). External residents had an average number of 1.23 first-author publications, and internal residents had 0.91 (p = 0.01). The largest difference in residents’ average number of total and first-author publications was identified in the northeast region (6.29, 4.76, p = 0.02), (1.75, 1.15, p = 0.01).
Conclusion. Applicants who matched at their home institution had, on average, 12.5% fewer total and 26% fewer first-author publications compared to those who matched externally. The largest noted difference in total and first-authorship publications was from residents who matched in the Northeast
Assessing Access to Orthopaedic Care for Patients With Osteogenesis Imperfecta
No full textBackground. Osteogenesis Imperfecta (OI) is a rare disorder caused by variations in collagen. Clinical manifestations include multiple fractures, short stature, scoliosis, blue sclera, hearing loss, and opalescent teeth. Patients often need many different medical providers frequently, which may place financial burdens on families. This study sought to identify and understand barriers to care for children with OI.
Methods. We utilized an Institutional Review Board (IRB)-approved survey for primary caregivers of children with OI. Questions included demographic data, type of health insurance, history of and reasons for insurance denials, access to multidisciplinary OI care, and travel to receive OI care. The Osteogenesis Imperfecta Foundation (OIF) emailed a survey invitation to the OI members.
Results. There were 72 respondents. The median age was 8 years old. The most frequent OI subtypes were types I (37%), IV (21%), and III (16%). Thirty percent of families reported at least one primary caregiver left the workforce to care for their child’s needs. The most reported health insurance type is private (62%), 22% have both private and public insurance, 16% have public only. Fourteen percent of families reported that they declined an orthopaedic procedure for their child due to the fear of high costs and debt.
Conclusion. To our knowledge, this survey is the first of its kind to investigate barriers to care for pediatric OI patients. This survey demonstrates the need for significant improvements in access to care for OI patients and their families, specifically regarding financial constraints, care coordination, and lack of access to multidisciplinary care centers
Catalytic Effect of Amyloid-β on Native Tau Aggregation at Physiologically Relevant Concentrations
No full textAlzheimer\u27s disease (AD) is characterized by the accumulation and aggregation of tau and amyloid-β (Aβ). The pathophysiology and progression of AD are facilitated by the neurotoxic effects of these aggregated proteins, resulting in neurodegeneration and memory loss. In this context, the interaction between tau and Aβ42 is considered, but the mechanism underlying their pathogenic interplay remains unclear. Here, we addressed this question by studying the aggregation of full-length, unmodified tau and Aβ42 at physiologically low concentrations using atomic force microscopy (AFM). AFM imaging and data analyses demonstrate an increase in tau aggregation in the presence of Aβ42, characterized by increased sizes and number of aggregates. Importantly, tau aggregation occurs without the need for phosphorylation or any other post-translational changes. The analysis of the data demonstrates that tau and Aβ42 form co-aggregates, with no visible accumulation of Aβ42 aggregates alone. Given that the catalysis of tau aggregation by Aβ42 is observed at physiological low nanomolar concentrations of Aβ42, the finding suggests that such aggregation catalysis of tau by Aβ42 can be a molecular mechanism underlying the pathological tau aggregation process associated with the onset and development of Alzheimer\u27s disease
The Effects of Arbitrary Reinforcers on DRO Efficiency, Reinstatement, and Reacquisition
No full textDifferential reinforcement of other behavior (DRO) is an effective and widely used procedure for reducing challenging behavior, yet relapse following DRO has received limited empirical attention. Prior research has shown that behavior reduced via DRO is susceptible to renewal and resurgence but is generally resistant to reinstatement and rapid reacquisition. However, the majority of this research has been conducted using a single reinforcer. Several lines of evidence suggest that reinforcers acquire discriminative properties. Consistent with this role, DRO reinforcers may function as discriminative stimuli for response inhibition which could explain why behavior reduced via DRO is resistant to reinstatement and reacquisition. In applied settings, however, DRO is often implemented with arbitrary reinforcers, different from the functional reinforcer maintaining the response in baseline. This translational study compared the effects of using a functional reinforcer versus an arbitrary reinforcer during DRO on behavior reduction efficiency, reinstatement, and reacquisition. Our results found that the type of reinforcer, whether functional or arbitrary, did not significantly affect DRO efficiency, the magnitude of reinstatement, and the speed of reacquisition
Occupational Therapy Interventions Supporting Return-To-Work After Cancer Treatment: A Systematized Review
No full textPURPOSE: Return to work (RTW) is a key milestone in cancer survivorship, supporting identity, stability, and quality of life. Many survivors face physical, social, and psychological barriers (Wilson et al., 2023). Occupational therapy practitioners (OTPs) are well positioned to address these challenges through energy conservation, environmental modification, and work reintegration strategies (Désiron et al., 2016). This systematized review synthesized evidence on OT interventions that support RTW for adult cancer survivors.
DESIGN: A systematized review was conducted by a medical librarian from the McGoogan Health Sciences Library. Articles were included if published in English between 2003–2024 and classified as Level I–VI evidence.
METHOD: Titles and abstracts of 352 articles from MEDLINE, CINAHL, and Scopus were screened; 62 underwent full-text review, and 14 met inclusion criteria. U.S. Preventive Services Task Force guidelines were used to determine strength of evidence and guide clinical recommendations.
RESULTS: Four themes emerged: multicomponent/multidisciplinary, self-management, physical activity, and vocational/workplace collaboration. Four Level 1A studies provide strong evidence for multicomponent/multidisciplinary interventions. Two Level 1A, one Level 1B, and one Level 2B study provide strong evidence for self-management. Two Level 1A and one Level 6 study provide strong evidence for physical activity. One Level 1A, one Level 1B, and one Level 5 study provide moderate evidence for vocational or workplace collaboration.
CONCLUSION: Findings support routine use of these interventions to promote RTW. OTPs play a key role through coordination with employers, advocacy for OT in oncology, and education on workplace rights and accommodations. Further research is needed to determine optimal timing and dosage. IMPACT STATEMENT: This review supports OTPs in applying evidence-based interventions that improve RTW outcomes for cancer survivors.
References:
Désiron, H. A. M., Crutzen, R., Godderis, L., Van Hoof, E., & de Rijk, A. (2016). Bridging health care and the workplace: Formulation of a return-to-work intervention for breast cancer patients using an intervention mapping approach. Journal of Occupational Rehabilitation, 26(3), 350–365. https://doi.org/10.1007/s10926-015-9620-3
Wilson, T. N., Nambiema, A., Porro, B., Descatha, A., Aublet-Cuvelier, A., Evanoff, B., & Roquelaure, Y. (2023). Effectiveness of physical activity interventions on return to work after a cancer diagnosis: A systematic review and meta-analysis. Journal of Occupational Rehabilitation, 33(1), 4–19. https://doi.org/10.1007/s10926-022-10052-9https://digitalcommons.unmc.edu/cahp_ot_sysrev/1024/thumbnail.jp
Peripheral Blood Biomarkers for Rheumatoid Arthritis-Associated Interstitial Lung Disease
No full textRheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a common extra-articular complication of rheumatoid arthritis (RA). Measuring peripheral blood biomarkers represents an appealing strategy to inform the screening and prediction of RA-ILD. In these studies, I aimed to further characterize the associations of peripheral blood biomarkers with prevalent and incident RA-ILD. First, I evaluated the associations of matrix metalloproteinases (MMPs) with RA-ILD among a multicenter cohort of RA U.S. Veteran patients (n = 2,312). Higher concentrations of MMP-7 and MMP-9 were independently associated with both prevalent and incident RA-ILD, including a nearly four-fold increased odds of prevalent RA-ILD (adjusted odds ratio 3.78 [95% CI: 1.86-7.65]) and greater than two-fold increased risk of incident RA-ILD (adjusted hazard ratio 2.45 [95% CI 1.55-3.88]) among those in the highest quartile of MMP-7 concentrations. I next evaluated the performance of a multibiomarker score consisting of seven idiopathic pulmonary fibrosis (IPF)-associated peripheral biomarkers in independent derivation and validation cohorts. This IPF-derived biomarker score was similarly associated with both prevalent RA-ILD (adjusted odds ratio 2.14 [95% CI 1.18-3.87]) and incident RA-ILD (adjusted hazard ratio 2.45 [95% CI 1.55-3.88]). These findings lend further support to a shared etiopathogenesis of RA-ILD and IPF, while also providing support for a potential pathogenic role of MMPs in RA-ILD. Future studies of peripheral biomarkers in RA-ILD are needed to clarify not only their roles in diagnosis and prediction, but also their associations with disease severity, progression, and treatment response
Exposures, Protections, and Barriers: Advancing Understanding of Agricultural Worker Health
No full textFarming is a hazardous occupation. Exposures are multifactorial, variable, and shaped by overlapping tasks, environments, and social contexts. This dissertation aimed to illustrate the complexity of agricultural exposures and the barriers to protective practices through three complementary studies.
The first study examined co-exposures to solvents and noise as risk factors for hearing loss (HL) among 7,495 farmers and ranchers in a 7-state region. Results indicated nearly 60% of co-exposed participants reported hearing loss, with an adjusted odds ratio nearly six-fold (OR=6.03, [4.67-7.78]) for moderate/severe HL. This work highlights the importance of recognizing chemical exposures as a modality in HL in addition to noise.
The second study presented a case of a family-operated pullet barn in rural Nebraska. Ammonia and dust concentrations were measured temporally during one growth cycle spanning approximately 16.5 weeks. Results indicated concentrations increased substantially with bird age, reaching levels capable of inducing adverse respiratory effects. Motivation to perform this exposure assessment was via the primary operators’ uncertainty as to what personal protective equipment (PPE) to use and when. This work highlights opportunities for outreach and education that support the health and safety of producers, particularly those new to poultry farming.
The third study focused on PPE use, fit, training, preferences, and self-reported adverse health effects despite the use of PPE among women in agriculture. Results indicated women were active users of PPE, but deficits in training and fit were evident. Nearly 90% of women expressed interest in purchasing PPE designed specifically for women, underscoring unmet demand for appropriately fitted and affordable protection.
Taken together, these studies show that agricultural exposures are complex and constantly changing, while protective behaviors remain inconsistent and limited. Using Protection Motivation Theory, this dissertation develops a framework that interprets coping appraisal constructs to predict behaviors in complex agricultural settings. By connecting exposure science with behavioral theory, this work highlights the importance of prevention strategies that focus on workers and enhance motivation and ability for personal protection
Infectious Disease Crisis Communication after the COVID-19 Pandemic
No full textSince the COVID-19 pandemic, the United States has experienced a proliferation of mis- and disinformation, an increasing politicization of health and science, and growing distrust in government, science, and institutions. While these trends present challenges for normal public health communications, during a public health emergency, such as an infectious disease outbreak, these challenges are even more acute. To address challenges at the local level, health departments need plans, products, and tools that adapt health crisis communications to the current media environment and meet community members where they are across the trust continuum. To develop an infectious disease incident communication plan, this project examines previous public health communication by the East Central District Health Department in Nebraska, analyzes target audiences and key partners, and applies existing communication and health behavior theory. The resulting products are a communication plan and a communication workbook. To demonstrate the use of these tools, a notional Tuberculosis outbreak in the East Central District Health Department service area was used. Strategies for addressing mis- and disinformation, distrust of institutions, and politicization of health topics are incorporated in the communication plan. The communication workbook centralizes and organizes information related to incident action planning, so public health emergency responders can best manage crisis communications during an incident. While entities at every level will be essential in addressing the multifaceted challenges of today’s communication environment, with plans, products, and tools, local public health departments will be better postured to respond during the next incident