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Despite documented harms and lack of benefit, PRN intravenous antihypertensives are administered routinely to lower asymptomatic elevated blood pressure. Implementation of a clinical assessment tool may increase nurse confidence and reduce the number of antihypertensive doses administered.

Overuse of continuous telemetry monitoring can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase costs. A nurse-driven protocol for discontinuing continuous telemetry without requiring consultation with the ordering provider effectively reduced institutional financial burden and reduced nurse-related telemetry tasks.

Cancer incidence is rising among adolescents (\"teens\"). The causes of the increase are unknown but studying incidence patterns and trends may produce insights into etiology. Using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program we described trends of cancer incidence among teens (15-19 year olds). We reviewed and summarized incidence patterns for histologic cancer groups and the most frequently diagnosed sites of cancer among teens during 2008-2012 reported by the SEER Cancer Statistics Review. We calculated annual incidence rates for the years 1975-2012 and used linear regression analysis to evaluate trends and calculate rates of change. Incidence for all sites combined increased annually by 0.67% for males and 0.62% for females during the period 1975 through 2012 -resulting in more than a 25% increase over 38 years. The biggest annual incidence increases occurred in non-Hodgkin lymphoma (NHL) (2.16% females; 1.38% males), thyroid cancer (2.12% females; 1.59% males), acute myeloid leukemia (AML) (1.73% females) and testicular cancer (1.55% males). Incidence rates for most histologic groups and sites showed steady long term increases over the 38 years of data. Despite improvements in survival, rising incidence trends mean growing numbers of young adults are undergoing painful and costly cancer treatments. A concerted research program is vital to investigate causes of steadily rising teen cancer rates.

Perfluorinated compounds (PFCs) have been in use for more than 60 years. Perfluorooctanoic acid (PFOA) was a primary PFC product at the 3M facility in Cottage Grove, Minnesota, but perfluorooctane sulfonate (PFOS) and other PFCs were also produced. The PFCs show high thermal, chemical, and biological inertness-properties that make them useful for certain industrial purposes, but at the same time also resulted in environmental persistence and potential human health risk. Little was published in scientific journals on PFC toxicology until the 1980s, perhaps because compounds resistant to breakdown were erroneously considered inert. Gradually, evidence for persistent, bioaccumulative effects has emerged, raising warning signs. A chronology of important events in understanding PFC health risks is provided in the Figure.

Part of this work involved support for a community-worker takeover of mental health services at Lincoln Hospital, which became a national model for bottom-up reorganization of care. Paul continued his tradition of providing intuitive, compassionate care for his patients and serving as a role model for young physicians in training. A recent report, on which I was a co-author, presents \"full cost accounting for the life-cycle of coal.\"

Background Debates over the importance of “lifestyle” versus “environment” contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates. Methods Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006—2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates. Results Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = − 0.8, 95% CI = − 1.0 to − 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = − 0.1, 95% CI = − 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties. Conclusions Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens.

First Published in 2017. Routledge is an imprint of Taylor & Francis, an Informa company. Section I CRITICAL SCIENCE Chapter 1. A Case Study of Pseudo-Science in Occupational Medicine Sven Ove Hansson Chapter 2. Endocrine Disruption Comes into Regulatory Focus Davis Baltz Chapter 3. The Relevance of Occupational Epidemiology to Radiation Protection Standards Steve Wing, David Richardson, and Alice Stewart Chapter 4. Science is Not Sufficient: Irving J. Selikoff and the Asbestos Tragedy Jock McCulloch and Geoffrey Tweedale Chapter 5. Silenced Science: Air Pollution Decision-Making at the EPA Threatens Public Health Kathleen Rest Section II PRECAUTIONARY SCIENCE Chapter 6. PCBs in School—Persistent Chemicals, Persistent Problems Robert F. Herrick Chapter 7. Chrysotile Asbestos Exposure: Cancer and Lung Disease Risks John M. Dement Chapter 8. Manganese in Gasoline: Are We Repeating History? Gina M. Solomon, Annette M. Huddle, Ellen K. Silbergeld, and Joseph Herman Chapter 9. Describing Community Health Risks: Can Epidemiology be Improved? David Kriebel Chapter 10. Have Risks Associated with the Presence of Synthetic Organic Contaminants in Land-Applied Sewage Sludges Been Adequately Assessed? Robert C. Hale and Mark J. La Guardia Chapter 11. Are We Winning or Losing the War on Cancer? Deciphering the Propaganda of NCI’s 33-Year War Genevieve K. Howe and Richard W. Clapp Section III SOLUTIONS SCIENCE Chapter 12. What is Yet to Be Done Barry Commoner Chapter 13. Good Practice Guidelines for Occupational Health Research Funded by the Private Sector Margaret Quinn, Charles Levenstein, and Gregory F. DeLaurier Chapter 14. Factors Influencing Ergonomic Intervention in Construction: Trunkman Case Study Scott Fulmer, Lenore S. Azaroff, and Susan Moir Chapter 15. Green Chemistry in California: A Framework for Leadership in Chemicals Policy and Innovation Michael P. Wilson, Daniel A. Chia, and Bryan C. Ehlers Chapter 16. The Sustainability Solutions Agenda Dan Sarewitz, Dick Clapp, Cathy Crumbley, Polly Hoppin, Molly Jacobs, David Kriebel, and Joel Tickner Meet the Contributors Index