Objective: To explore sequential steps of employee engagement in wellness interventions and the impact of wellness interventions on employee health. Methods: Using previously collected survey data from 23,667 UK employees, we tabulated intervention availability, awareness, participation, and associated health improvement and compared engagement by participation and risk status. Results: Employees’ awareness of wellness interventions at their workplaces was often low (mean 43.3%, range 11.6%–82.3%). Participation was highest in diet/nutrition initiatives (94.2%) and lowest in alcohol counseling and smoking cessation interventions (2.1%). Employees with health risks were less likely than lower-risk employees to report awareness, participation, and health improvements from wellness interventions addressing the relevant health concern. Conclusion: Employers and policymakers should consider variation in intervention engagement as they plan and implement wellness interventions. Engaging employee populations with higher health risks requires a more targeted approach.
Background This report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40 years after imperforate anus repair. Case presentation A 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum. Conclusions Although rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.
BackgroundTracheostomy is recommended within 7 days of intubation for patients with severe traumatic brain injury (TBI) or requiring prolonged mechanical ventilation. A quality improvement project aimed to decrease time to tracheostomy to ≤7 days after intubation for eligible patients requiring tracheostomy in the surgical intensive care unit (SICU).Local problemFrom January 2017 to June 2018, approximately 85% of tracheostomies were performed >7 days after intubation. The tracheostomy was placed a median of 10 days after intubation (range: 1–57).MethodsQuality improvement principles were applied at an American College of Surgeons-verified level I trauma centre to introduce and analyse interventions to improve tracheostomy timing. Using the electronic health record, we analysed changes in tracheostomy timing, hospital length of stay (LOS), ventilator-associated pneumonia and peristomal bleeding rates for three subgroups: patients with TBI, trauma patients and all SICU patients.InterventionsIn July 2018, an educational roll-out for SICU residents and staff was launched to inform them of potential benefits of early tracheostomy and potential complications, which they should discuss when counselling patient decision-makers. In July 2019, an early tracheostomy workflow targeting patients with head injury was published in an institutional Trauma Guide app.ResultsMedian time from intubation to tracheostomy decreased for all patients from 14 days (range: 4–57) to 8 days (range: 1–32, p≤0.001), and median hospital LOS decreased from 38 days to 24 days (p<0.001, r=0.35). Median time to tracheostomy decreased significantly for trauma patients after publication of the algorithm (10 days (range: 3–21 days) to 6 days (range: 1–15 days), p=0.03). Among patients with TBI, family meetings were held earlier for patients who underwent early versus late tracheostomy (p=0.008).ConclusionsWe recommend regular educational meetings, enhanced by digitally published guidelines and strategic communication as effective ways to improve tracheostomy timing. These interventions standardised practice and may benefit other institutions.
Human endogenous retroviruses (HERVs) are remnants of ancient germline infections that comprise 8% of the human genome. A number of HERVs are actively expressed—their products assume important physiological roles in embryonic development and have been associated with cancer and autoimmune diseases. Expression of a type of HERV, HERV‐K, has been associated with amyotrophic lateral sclerosis (ALS) and some cancers. Expression of the Env protein appears to be dependent on a cis‐acting signal, RcRe, and a viral protein called Rec that mediate nuclear export of unspliced mRNAs in Crm1‐dependent manner, similar to the Rev‐RRE system in HIV. Despite low sequence similarity, the HERV‐K RcRE and HIV RRE are both characterized by a long stem and several smaller stems centered around a junction at the top of the long stem. We recently reported the three‐dimensional structure of the HIV RRE RNA and found that it is a flat, “A”‐shaped molecule (Fang et al., 2013). Based on apparent secondary structure similarities, we hypothesized that the unique “A” shape may be conserved in complex retroviruses. We examined the tertiary structure of the RcRE RNA in solution using small‐angle X‐ray scattering. Our results suggest that the two divergent retroviral elements are structurally conserved, attesting to the significance of the three‐dimensional structure in Rev‐RRE recognition. We report a structure‐ and function‐based mutational analysis of the RcRE tertirary structure.Support or Funding InformationNaval Academy Research Council (NARC)DTRA CB Technologies Service Academy Research Initiative.US Naval Academy, Chemistry DepartmentThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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