Sexual harassment in the workplace: guidelines for educating healthcare managers

Actionable sexual harassment is defined as a violation of Title VII of the Civil Rights Act of 1964. In recent years, there have been a number of significant developments in sexual harassment case law and litigation including: (1) nationwide legal recognition for same-sex sexual harassment; (2) increased standards on employer liability for sexual harassment perpetrated by supervisory and managerial personnel; and (3) guidelines for mitigating damages when employers are found liable. These developments are of particular concern in those professions such as healthcare in which women historically have been represented as a significant portion of the workforce. Moreover, because management and supervisory relationships in healthcare are often cloudy, harassment by "supervisors" in healthcare settings can be an issue of special concern. In this article, we review relevant issues related to sexual harassment and provide guidance in dealing with the issue in the workplace.     

Starch granule initiation is controlled by a heteromultimeric isoamylase in potato tubers

Starch granule initiation is not understood, but recent evidence implicates a starch debranching enzyme, isoamylase, in the control of this process. Potato tubers contain isoamylase activity attributable to a heteromultimeric protein containing Stisa1 and Stisa2, the products of two of the three isoamylase genes of potato. To discover whether this enzyme is involved in starch granule initiation, activity was reduced by expression of antisense RNA for Stisa1 or Stisa2. Transgenic tubers accumulated a small amount of a soluble glucan, similar in structure to the phytoglycogen of cereal, Arabidopsis, and Chlamydomonas mutants lacking isoamylase. The major effect, however, was on the number of starch granules. Transgenic tubers accumulated large numbers of tiny granules not seen in normal tubers. These data indicate that the heteromultimeric isoamylase functions during starch synthesis to suppress the initiation of glucan molecules in the plastid stroma that would otherwise crystallize to nucleate new starch granules.     

Intratumoural FOXP3-positive regulatory T cells are associated with adverse prognosis in radically resected gastric cancer

We investigated the clinical significance of tumour-infiltrating FOXP3-positive regulatory T cells (Tregs) in radically resected (R0) gastric cancer. From a single-institution database, tumors of 110 patients who underwent R0 resection for stage II-III disease were studied for FOXP3-positive Tregs by immunohistochemistry. The observed median number of FOXP3-positive Tregs was used as the cut-point in analyses (<6 versus >or=6 count). Tregs were significantly higher in gastric carcinomas than in normal tissue (P = 0.0001). Tregs count >or=6 was significantly associated with vascular/lymphatic/perineural invasion (VELIPI) in the tumour (P = 0.03). Multivariate analysis showed association between adverse relapse-free survival and grading 3, stage III, VELIPI and Tregs count >or=6 (P = 0.02). Adverse overall survival was associated with grading 3, stage III, VELIPI and Tregs count >or=6 (P = 0.006). FOXP3-positive Tregs may be a novel marker for identifying high-risk gastric cancer patients. Present findings deserve additional investigation as Tregs may also represent an innovative therapeutic target.     

Registration of prostate histology images to ex vivo MR images via strand‐shaped fiducials

Purpose:

To present and evaluate a method for registration of whole‐mount prostate digital histology images to ex vivo magnetic resonance (MR) images.

Materials and Methods:

Nine radical prostatectomy specimens were marked with 10 strand‐shaped fiducial markers per specimen, imaged with T1‐ and T2‐weighted 3T MRI protocols, sliced at 4.4‐mm intervals, processed for whole‐mount histology, and the resulting histological sections (3–5 per specimen, 34 in total) were digitized. The correspondence between fiducial markers on histology and MR images yielded an initial registration, which was refined by a local optimization technique, yielding the least‐squares best‐fit affine transformation between corresponding fiducial points on histology and MR images. Accuracy was quantified as the postregistration 3D distance between landmarks (3–7 per section, 184 in total) on histology and MR images, and compared to a previous state‐of‐the‐art registration method.

Results:

The proposed method and previous method had mean (SD) target registration errors of 0.71 (0.38) mm and 1.21 (0.74) mm, respectively, requiring 3 and 11 hours of processing time, respectively.

Conclusion:

The proposed method registers digital histology to prostate MR images, yielding 70% reduced processing time and mean accuracy sufficient to achieve 85% overlap on histology and ex vivo MR images for a 0.2 cc spherical tumor. J. Magn. Reson. Imaging 2012; 36:1402–1412. © 2012 Wiley Periodicals, Inc.     

Impact of a Simple Inexpensive Quality Assurance Effort on Physician's Choice of Thrombolytic Agents and Door-to-Needle Time: Implication for Costs of Management

The objective of this study were to assess the impact of a quality assurance effort on the door-to-needle time and the choice of thrombolytic agent for the management of acute myocardial infarction in the emergency department. The study design involved a prospective collection of data on a series of consecutive patients who received a thrombolytic agent for a presumed acute myocardial infarction. The study was carried out in the emergency department of a major university urban tertiary care center. A total of 349 patients were studied from September 1989 to March 1994. The quality assurance program began in 1989 and included chart review of all patients receiving thrombolytic therapy, with special attention to all patients with door-to-needle times >60 minutes to identify causes for delay. Feedback was directed to pharmacy, nursing, and physician staff. Biannual reports were distributed throughout the hospital and the emergency department. Nursing-specific feedback led to the development of protocols for all aspects of the delivery of thrombolytic agents. The choice of thrombolytic agent was not dictated by the protocol, but the physician staff was continuously updated on the results of the latest clinical trials comparing one thrombolytic agent with another. The mean age was 58 years for men and 67 years for women in this cohort consisting of 78% men and 22% women. Thirty-seven percent of the myocardial infarctions were in an anterior location and 56% were in an inferior location. The median duration of chest pain before presentation to the emergency department was 120 minutes. Hospital mortality was 3%. Median door-to-needle time fell from 46 (1989–1991) to 36 (1992–1994) minutes, P < 0.01. The percentage of patients with a door-to-needle time >60 minutes decreased from 35% (1989–1991) to 16% (1992–1994) minutes, P < 0.0001. Corresponding with the ISIS-3 report, there was a significant increase in the proportion of patients receiving streptokinase over the first 3 years of the study (P < 0.0001), which changed to a trend toward increased utilization of tissue plasminogen activator with the GUSTO report in the final 6 months of the study. In conclusion, a quality assurance program led to a significant reduction in the door-to-needle time, and recent megatrials were found to influence the choice of thrombolytic agent used.     

Lactation intensity and fasting plasma lipids,lipoproteins, non-esterified free fatty acids,leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: The SWIFT cohort

Objectives

Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance.

Methods

The Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100 g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008–2011. Research staff conducted 2-h 75 g OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6–9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6–9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models.

Results

Increasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5%–8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20%–28% lower fasting triglycerides, 15%–21% lower leptin (all trend P-values < 0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value = 0.04).

Conclusion

Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.