SUMMARYClinical medicine has embraced the use of evidence for patient treatment decisions; however, the evaluation strategy for evidence in laboratory medicine practices has lagged. It was not until the end of the 20th century that the Institute of Medicine (IOM), now the National Academy of Medicine, and the Centers for Disease Control and Prevention, Division of Laboratory Systems (CDC DLS), focused on laboratory tests and how testing processes can be designed to benefit patient care. In collaboration with CDC DLS, the American Society for Microbiology (ASM) used an evidence review method developed by the CDC DLS to develop a program for creating laboratory testing guidelines and practices. The CDC DLS method is called the Laboratory Medicine Best Practices (LMBP) initiative and uses the A-6 cycle method. Adaptations made by ASM are called Evidence-based Laboratory Medicine Practice Guidelines (EBLMPG). This review details how the ASM Systematic Review (SR) Processes were developed and executed collaboratively with CDC's DLS. The review also describes the ASM transition from LMBP to the organization's current EBLMPG, maintaining a commitment to working with agencies in the U.S. Department of Health and Human Services and other partners to ensure that EBLMPG evidence is readily understood and consistently used.

BACKGROUND: Astrovirus is a leading cause of acute gastroenteritis in children worldwide. However, few prospective studies have analyzed astrovirus in community-dwelling pediatric populations in low- and middle-income countries. METHODS: We assessed the incidence, risk factors, clinical characteristics, genotypes, viral coinfections, and time distribution of astrovirus gastroenteritis in 443 healthy Nicaraguan children born in 2017 to 2018 who were followed for 36 months. Children were recruited from hospitals and birth records in an economically diverse neighborhood of León city. Astrovirus-positive episodes and genotypes were identified from stool with reverse transcription quantitative polymerase chain reaction and Sanger sequencing. RESULTS: Of 1708 total specimens tested, 80 children (18%) experienced at least 1 astrovirus episode, and 9 experienced repeat episodes, mostly during the rainy season (May-October). Initial astrovirus episodes were not associated with a lowered risk against future episodes. In exploratory analyses, home toilets were associated with a lower risk of future astrovirus episodes (hazard ratio, 0.19; 95% CI, .04-.91). Human astrovirus 5 episodes, representing 15% of all typed episodes, were associated with longer diarrhea and more symptomatic rotavirus coinfections. CONCLUSIONS: Astrovirus was a common cause of gastroenteritis in this cohort, and future studies should clarify the role of astrovirus genotype in clinical infection severity.

The PDM3600 and PDM3700 are two closely related person-wearable dust monitors manufactured by Thermo Fisher Scientific. Both are based on tapered element oscillating microbalance technology and provide nearly real-time, mass-based readings of respirable dust concentrations. From a monitoring perspective, the primary difference between the models is the PDM3600 has an integrated cap lamp with attached inlet, while the PDM3700 has no cap lamp and a revised inlet attaches to the worker’s lapel. Using coals of varied origin and employing a wide range of concentrations, side-by-side measurements from these instruments were collected under controlled laboratory conditions and then compared. By use of ordinary least squares and weighted least squares regression methods, followed by mixed model analysis, results suggest there is no statistically significant or practical difference in instrument performance. The two monitors are equivalent for the field dust concentration measurements for which they were designed. © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024.

This study simulates the impact of a shale gas well casing breach near a longwall mine. Field studies are conducted to measure mining-induced permeability changes over the abutment pillar of a longwall mine, and a geomechanical model is developed in 3DEC, a three-dimensional numerical modeling code, to predict the aperture of fractures in the overburden at the study site. The predicted aperture values are used to determine mining-induced permeabilities and the results are compared with the field measurements. These aperture values are provided as inputs into fracture flow code (FFC), which generates a stochastic discrete fracture network (DFN) model for the study site and predicts the potential shale gas flow to the mine. Results from 100 DFN realizations are statistically analyzed using the bootstrapping method to compensate for notable variation in fracture geometry. The results show a significant difference between the gas inflow for nearby panels due to increase in the induced permeability during mining of the second panel. The average gas flow to the mine was calculated as 4.72×10−2 m3/s (49 cfm) for a hypothetical breach at the Sewickley horizon during the first panel mining, 8.97×10−3 m3/s (19 cfm) for a hypothetical breach at the Uniontown horizon during the first panel mining, 2.16×10−1 m3/s (458 cfm) for a hypothetical breach at the Sewickley horizon during the second panel mining, and 8.07×10−2 m3/s (171 cfm) for a hypothetical breach at the Uniontown horizon during the second panel mining. Depending on the mine ventilation system, this could result in methane concentrations exceeding regulatory limits. Hence, these findings provide insights into the potential risk of an unconventional gas well casing breach near a longwall mine under shallow cover. © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

The objective of the present study is to find a fast and accurate procedure to measure the length and width of asbestos fibers using images acquired by a scanning electron microscope (SEM), a phase contrast microscope (PCM), and a polarized light microscope (PLM). The accuracy of the procedure was evaluated by comparing fiber length and width measurements to manual measurements. Four different types of images were used in the evaluation: 1) backscattered electron SEM images of fibrous tremolite, 2) secondary electron SEM images of fibrous grunerite, 3) PCM images of fibrous grunerite, and 4) PLM images of fibrous grunerite. Fiber length and width were measured with ImageJ (manual measurement) and Image-Pro software and were compared on an individual fiber basis and over the number-length and number-width distribution of each sample. The results of the comparison showed that the individual length and width measurements with ImageJ and Image-Pro software had a nearly 1:1 relationship except for the width measurement in PLM images (8% of the variance in ImageJ width measurements was not explained by Image-Pro width measurements). Similarly, the number-length distributions were not significantly different (p>0.05) between ImageJ and Image-Pro, but the number-width distributions were significantly different (p<0.05) for PLM and secondary electron SEM images. Although the image analysis procedure for measuring fiber length and width with Image-Pro is not a fully automated procedure and still requires some manual intervention, it can be a more efficient and equally accurate alternative to time-consuming manual fiber length and width measurements for well dispersed fibers with high aspect ratios.

BACKGROUND: Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS: Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS: Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS: Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.

OBJECTIVES: Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. CONTENT: Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. SUMMARY: An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. OUTLOOK: There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

It is critical for the safety of miners to be able to escape, unaided, during a mine emergency. Self-escape is challenging in the presence of smoke that can occur during a mine emergency. To assist self-escape, coloured markers in underground mines designate the primary/secondary escapeways, but no universal colour code exists. Ten participants were tested to recognize the colour and designation (primary/secondary) of fluorescent yellow–green (FYG), yellow (Y), white (W) and green (G) escapeway markers in both a clear and smoked-filled environment. The overall misidentification rate for all colours was 1.9% and 18.1%, respectively, in clear and smoke conditions. FYG had the highest misidentification percentage for both conditions. For the marker designation tests, participants were most accurate in clear conditions (100.0%) for the FYG + W, Y + G, G + W and W + FYG combinations, and least accurate (89.6%) for the Y + FYG combination, while for smoke conditions participants were most accurate for the G + Y combination (95.8%). The overall effect of colour combination was significant, indicating that the colour combination for primary/secondary recognition is a significant factor where the G + Y combination was best. It can be inferred from these data that the colour combination is an important factor in participants’ ability to recognize primary/secondary escapeway markers in smoke conditions.

Exposure to dusts containing respirable crystalline silica is a recognized hazard affecting various occupational groups such as miners. Inhalation of respirable crystalline silica can lead to silicosis, which is a potentially fatal lung disease. Currently, miners' exposure to respirable crystalline silica is assessed by collecting filter samples that are sent for laboratory analysis. A more timely field-based silica monitoring method using direct-on-filter (DoF) analysis is being developed by researchers at the National Institute for Occupational Safety and Health (NIOSH) to provide mine operators with the option to evaluate miners' exposure at the mine. This field-based silica monitoring technique involves the use of portable Fourier transform infrared (FTIR) instruments. As a step in the development of this new analytical technique, four commercially available portable FTIR instruments were evaluated for their ability to provide reproducible measurements from filter samples containing respirable crystalline silica. Reported testing indicates that measurements varied within +/-4.1% between instruments for filter samples that contained high-purity respirable crystalline silica. Measurements varied within +/-3.0% between instruments for filter samples that contained varying mineral composition. Filter samples were repeatedly analyzed by the same instrument over short and extended periods of time, and mean coefficients of variation did not exceed +/-1.6 and +/-2.4%, respectively. Mixed model analysis revealed that there was no statistically significant (P < 0.05) change in average measurements made over an extended period of time for all instruments. Results suggest that each of the four FTIR instruments evaluated in this study were able to generate precise and reproducible DoF analysis results of respirable dust samples.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) developed a light-emitting diode (LED) area luminaire called the Saturn and conducted a laboratory study using a Fletcher High Dual-boom Mast Feed (HDDR) roof bolting machine. The Saturn luminaire was designed to (1) enhance floor illumination to enable better detection of trip hazards in the interior spaces of a roof bolter and (2) reduce glare that has typically been an issue of concern on roof bolters. This paper reports on the results of achieving the second objective. The existing roof bolter lighting was the baseline and was compared with three versions of the Saturn luminaire relative to light intensity (100%, 75%, and 50%). Discomfort and disability glare data were obtained from 30 participants that comprised three age groups. Discomfort glare perceptions were obtained using the De Boer rating scale, and disability glare was quantified by using Mars Letter Contrast Sensitivity tests. Discomfort glare was reduced at least 3 levels with all Saturn versions. Also, a predictive model was used to estimate discomfort glare, and the results were similar. Disability glare was the least for the Saturn’s 50% intensity, and all Saturn versions had significantly less disability glare than with the baseline lighting. Veiling luminance was calculated and used as another indicator of disability glare. Veiling luminance was 28 to 42 times greater with the baseline lighting as compared with that of the Saturn lighting. Lastly, visibility levels were calculated. The Saturn versions were 4 to 6.5 times better in terms of visibility level.

Video techniques for monitoring exposure, such as NIOSH’s “Helmet-CAM,” employ both real-time dust monitors and mobile video cameras to assess workers’ respirable dust exposures. Many real-time personally worn dust monitors utilize light scattering sensing elements, which are subject to measurement biases as a function of dust type (size, composition, shape factor) and environmental conditions such as relative humidity. These biased and inaccurate dust measurements impair the monitor’s ability to properly represent actual respirable dust concentrations. In the testing described, instrument mass concentration data was collected using three different types of commonly used commercial off-the-shelf personal dust monitors and compared to a reference standard. This testing was performed in a calm air (Marple) dust chamber in which three units of each make and model (for a total of nine monitors) were used for each test. Equivalency factors (EF, a multiplier to match the Thermo TEOM 1400a reference instrument) ranged between 0.746 and 1.879 across all dusts and environmental conditions tested, and between 0.821 and 1.519 on the ISO test dust.

SUMMARYThe evidence base for the optimal laboratory diagnosis of Clostridioides (Clostridium) difficile in adults is currently unresolved due to the uncertain performance characteristics and various combinations of tests. This systematic review evaluates the diagnostic accuracy of laboratory testing algorithms that include nucleic acid amplification tests (NAATs) to detect the presence of C. difficile The systematic review and meta-analysis included eligible studies (those that had PICO [population, intervention, comparison, outcome] elements) that assessed the diagnostic accuracy of NAAT alone or following glutamate dehydrogenase (GDH) enzyme immunoassays (EIAs) or GDH EIAs plus C. difficile toxin EIAs (toxin). The diagnostic yield of NAAT for repeat testing after an initial negative result was also assessed. Two hundred thirty-eight studies met inclusion criteria. Seventy-two of these studies had sufficient data for meta-analysis. The strength of evidence ranged from high to insufficient. The uses of NAAT only, GDH-positive EIA followed by NAAT, and GDH-positive/toxin-negative EIA followed by NAAT are all recommended as American Society for Microbiology (ASM) best practices for the detection of the C. difficile toxin gene or organism. Meta-analysis of published evidence supports the use of testing algorithms that use NAAT alone or in combination with GDH or GDH plus toxin EIA to detect the presence of C. difficile in adults. There is insufficient evidence to recommend against repeat testing of the sample using NAAT after an initial negative result due to a lack of evidence of harm (i.e., financial, length of stay, or delay of treatment) as specified by the Laboratory Medicine Best Practices (LMBP) systematic review method in making such an assessment. Findings from this systematic review provide clarity to diagnostic testing strategies and highlight gaps, such as low numbers of GDH/toxin/PCR studies, in existing evidence on diagnostic performance, which can be used to guide future clinical research studies.

Lifelines are used to aid self-escape of underground miners, but they are difficult to find in low-visibility conditions of smoke, therefore a self-illuminating lifeline could facilitate miners in locating the lifeline. The detection distance, colour recognition, and miss rate for 10 subjects were determined for red-, green- and blue-lighted diffuse fibre-optic cables, used to create a lighted lifeline, and a traditional rope lifeline in a smoked-filled environment. The testing was conducted with and without a cap lamp. The use of a cap lamp resulted in all cases being undetected in 98.3% of trials. With the cap lamp off, there was no significant difference in the detection distance for blue- and green-lighted fibres; however, the miss rate for the green-lighted fibre was slightly higher. The red-lighted fibre was not detected in 93.3% of trials. The green- and blue-lighted fibres enabled the best visual performance, but subjects had difficulty correctly identifying the colour of the fibre. The lighted fibre-optic cable appears to have merit for improving self-escape from underground mines, and may have other mining and non-mining applications that include improving self-escape visibility.

A person-wearable dust monitor that provides nearly real-time, mass-based readings of respirable dust was developed for use in underground coal mines. This personal dust monitor (PDM) combined dust sampling instrumentation with a cap lamp (and battery) into one belt-wearable unit, with the air inlet mounted on the cap lamp. However, obsolescence of belt-carried cap lamp and batteries in coal mining ensued and led end users to request that the cap lamp and battery be removed from the PDM. Removal of these components necessitated the design of a new air inlet to be worn on the miner's lapel. The revised inlet was tested for dust collection equivalency against the original cap-mounted inlet design. Using calculated inlet respirable fractions and measured dust mass collection, the performance of the two inlets is shown to be similar. The new inlet requires a 1.02 factor for converting dust masses obtained from it to equivalent masses collected from the original inlet.

Proper lighting plays a critical role in enabling miners to detect hazards when operating a roof bolter, one of the most dangerous mining machines to operate; however, there has not been any lighting research to address the walk-thru type of roof bolter commonly used today. To address this, the Saturn light was designed to directly address walk-thru roof bolter safety by improving trip hazard illumination. The visual performances of 30 participants that comprised three age groups were quantified by measuring each participant's visual performance in detecting trip objects positioned on the two floor locations within the machine's interior working space. The lighting conditions were the existing compact fluorescent lights (CFLs) and the Saturn LED area light developed by NIOSH researchers. Three intensities of the Saturn lights were used, 100%, 75%, and 50%, all of which resulted in better visual performance, and up to a 48% reduction in average trip detection time compared to the CFL. For the Saturn trip object miss rates were <0.5% for all age groups in contrast to the CFL, which ranged between 32.5% for the youngest group and 50.4% for the oldest group.

Objectives: To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. Methods: This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality). Results: Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient. Conclusion: Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.

The incidence of Legionnaires' disease in the United States has been increasing since 2000. Outbreaks and clusters are associated with decorative, recreational, domestic, and industrial water systems, with the largest outbreaks being caused by cooling towers. Since 2006, 6 community-associated Legionnaires' disease outbreaks have occurred in New York City, resulting in 213 cases and 18 deaths. Three outbreaks occurred in 2015, including the largest on record (138 cases). Three outbreaks were linked to cooling towers by molecular comparison of human and environmental Legionella isolates, and the sources for the other 3 outbreaks were undetermined. The evolution of investigation methods and lessons learned from these outbreaks prompted enactment of a new comprehensive law governing the operation and maintenance of New York City cooling towers. Ongoing surveillance and program evaluation will determine if enforcement of the new cooling tower law reduces Legionnaires' disease incidence in New York City.

Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013-2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed.

Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking.

Roof bolting typically follows the extraction of a commodity to help keep the roof from collapsing. During 2004 to 2013, roof bolter operators had the highest number of machinery-related injuries, accounting for 64.7 percent, at underground coal mines. This paper analyzes U.S. roof bolter fatal and nonfatal lost-time injury data at underground work locations for all commodities from 2004 through 2013 and determines risk indices for six roof bolting tasks. For fatal and nonfatal incidences combined, the roof bolting tasks in order of the highest to lowest risk index were bolting, handling of materials, setting the temporary roof support (TRS), drilling, tramming, and traversing. For fatalities, the roof bolting tasks in order of the highest to lowest risk index were handling of materials, setting the TRS, bolting, drilling, traversing, and tramming. Age was found to be a significant factor. Severity of injury, indicated by days lost, was found to increase with increasing age as well as with increasing experience, largely due to the confounding of age and experience. The operation of the roof bolting machine used in underground mining should be a research priority given the high frequency and severity of incidents. The results also suggest that temporal factors may exist, so additional research is warranted to better understand these factors and potentially develop interventions. This research provides a data-driven foundation from which future research can be conducted for safety interventions to reduce the frequency and severity of incidences involving the roof bolter activities of bolting, handling of materials, and setting the TRS.

The goal of this investigation was to evaluate the physiologic stresses of powered air-purifying respirators (PAPRs) used by workers in many industries (e.g., health care, automobile repair, public safety, building trades, etc.) during rest and three levels of energy expenditure. Twelve men and twelve women wore one tight-fitting and three loose-fitting PAPRs at rest (REST) and while walking for four minutes at oxygen consumption (V̇O(2)) rates of 1.0 l·min(-1)(LOW), 2.0 l·min(-1) (MODERATE), and 3.0 l·min(-1) or maximum (HIGH). Minimum inhaled carbon dioxide concentration (F(I)CO(2)), maximum inhaled oxygen concentration (F(I)O(2)), peak inhalation pressure, and end inhalation temperature were measured continuously breath-by-breath. Repeated measures analysis of variance found that neither the main effect of gender, nor any interactions involving gender were significant. The highest minimum F(I)CO(2) among PAPRs occurred for MODERATE and HIGH energy expenditures while wearing the loose-fitting PAPR with the largest dead space. The lowest maximum F(I)O(2) was observed during HIGH intensity energy expenditure also for the loose-fitting PAPR with the largest dead space. Among all PAPR models, peak inhalation pressures were negative at V̇O(2) > LOW, suggesting that peak inhalation flow was greater than blower flow. Results using the variables reported here suggest that PAPRs used at various levels of energy expenditure may be tolerated among healthy workers. Further research is needed to determine the source of supplemented air when inhalation flow exceeds blower flow.

While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.

OBJECTIVE: We examined the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect (USN). METHOD: People with USN ≥6 mo poststroke participated in a single-group, repeated-measures study. Attendance, total repetitions, and satisfaction indicated feasibility and pain indicated tolerability. Paired t tests and effect sizes were used to estimate changes in upper-extremity use (Motor Activity Log), function (Action Research Arm Test), and attention (Catherine Bergego Scale). RESULTS: Twenty participants attended 99.4% of sessions and completed a high number of repetitions. Participants reported high satisfaction and low pain, and they demonstrated small, significant improvements in upper-extremity use (before Bonferroni corrections; t = -2.1, p = .04, d = .30), function (t = -3.0, p < .01, d = .20), and attention (t = -3.4, p < .01, d = -.44). CONCLUSION: Repetitive task-specific practice is feasible and tolerable for people with USN. Improvements in upper-extremity use, function, and attention may be attainable.

OBJECTIVE: This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history. METHODS: A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6month follow-up, adjusting for age, site and practice clustering. RESULTS: A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's<.01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not. Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases. CONCLUSION: Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.

This manuscript provides nomenclature recommendations developed by an international workgroup to increase transparency and standardization of pharmacogenetic (PGx) result reporting. Presently, sequence variants identified by PGx tests are described using different nomenclature systems. In addition, PGx analysis may detect different sets of variants for each gene, which can affect interpretation of results. This practice has caused confusion and may thereby impede the adoption of clinical PGx testing. Standardization is critical to move PGx forward.

The National Institute for Occupational Safety and Health conducted a study on leakage rates through underground coal mine seals. Leakage rates of coal bed gas into active workings have not been well established. New seal construction standards have exacerbated the knowledge gap in our understanding of how well these seals isolate active workings near a seal line. At a western US underground coal mine, we determined seal leakage rates ranged from about 0 to 0.036m3/s for seven 340 kPa seals. The seal leakage rate varied in essentially a linear manner with variations in head pressure at the mine seals.

In the United States, total carbon (TC) is used as a surrogate for determining diesel particulate matter (DPM) compliance exposures in underground metal/nonmetal mines. Since TC can be affected by interferences and elemental carbon (EC) is not, one method used to estimate the TC concentration is to multiply the EC concentration from the personal sample by a conversion factor in order to avoid the influence of potential interferences. Since there is no accepted single conversion factor for all metal/nonmetal mines, one is determined every time an exposure sample is taken by collecting an area sample that represents the TC/EC ratio in the miner's breathing zone and is away from potential interferences. As an alternative to this procedure, this paper investigates the relationship between TC and EC from DPM samples to determine if a single conversion factor can be used for all metal/nonmetal mines. In addition, this paper also investigates how well EC represents DPM concentrations in Australian coal mines since the recommended exposure limit for DPM in Australia is an EC value. When TC was predicted from EC values using a single conversion factor of 1.27 in 14 US metal/nonmetal mines, 95% of the predicted values were within 18% of the measured value, even at the PEL concentration of 160 mug/m3 TC. A strong correlation between TC and EC was also found in nine underground coal mines in Australia.

PURPOSE: With the accelerated implementation of genomic medicine, health-care providers will depend heavily on professional guidelines and recommendations. Because genomics affects many diseases across the life span, no single professional group covers the entirety of this rapidly developing field. METHODS: To pursue a discussion of the minimal elements needed to develop evidence-based guidelines in genomics, the Centers for Disease Control and Prevention and the National Cancer Institute jointly held a workshop to engage representatives from 35 organizations with interest in genomics (13 of which make recommendations). The workshop explored methods used in evidence synthesis and guideline development and initiated a dialogue to compare these methods and to assess whether they are consistent with the Institute of Medicine report "Clinical Practice Guidelines We Can Trust." RESULTS: The participating organizations that develop guidelines or recommendations all had policies to manage guideline development and group membership, and processes to address conflicts of interests. However, there was wide variation in the reliance on external reviews, regular updating of recommendations, and use of systematic reviews to assess the strength of scientific evidence. CONCLUSION: Ongoing efforts are required to establish criteria for guideline development in genomic medicine as proposed by the Institute of Medicine.

This research study examined the gaps in documentation that occur when coding in ICD-10-CM. More than 4,000 diagnoses from all chapters were coded from 656 electronic documents obtained from a large integrated healthcare facility at the time the study was conducted (2012). After the documents were coded, areas for documentation improvement were identified for chapters that resulted in deficiencies in documentation, and a quick reference guide was developed. The overall absent documentation percentage was 15.4 percent. The 10 chapters with the highest percentage of absent documentation were chapter 7 (Diseases of Eye and Adnexa), with 67.65 percent (p < .001); chapter 8 (Diseases of Ear and Mastoid Process), with 63.64 percent (p < .001); chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue), with 46.05 percent (p < .001); chapter 14 (Diseases of the Genitourinary System), with 40.29 percent (p < .001); chapter 10 (Diseases of Respiratory System), with 35.52 percent (p < .001); chapter 1 (Infectious and Parasitic Diseases), with 32.88 percent (p < .001); chapter 12 (Diseases of the Skin and Subcutaneous Tissue), with 32.35 percent (p < .001); chapter 2 (Neoplasms), with 25.45 percent (p < .001); chapter 4 (Endocrine, Nutritional and Metabolic Diseases), with 14.58 percent (p < .001); and chapter 17 (Congenital Malformations, Deformations, and Chromosomal Abnormalities), with 12.50 percent. We addressed the deficient areas in the quick reference guide developed for clinicians and technology vendors. Having complete and accurate documentation would benefit both the clinician and the patient in providing the highest quality of care.

Chagas disease-associated cardiomyopathy is clinically similar to other causes of cardiomyopathy and, therefore, the diagnosis can be easily overlooked. We found a 13% point prevalence of Chagas disease in a sample of New York City immigrants with dilated cardiomyopathy.