Risk-Based Framework for Safety Investment in Construction Organizations

The costs of construction injuries can have a substantial impact on the financial success of construction organizations and increase the overall costs of construction up to 15%. Following the Occupational Safety and Health Act of 1970, construction firms began to implement a variety of management techniques to reduce the frequency of injuries. Although these strategies decrease the cost of injuries, they consume time and other significant resources. Thus, it is imperative for construction organizations to objectively evaluate the cost-benefit of investments in injury prevention through formal and robust processes. This paper presents a risk-based framework that can be used to evaluate the incremental return on investment of a series of investments in highly effective injury prevention strategies. The framework was developed using foundational risk quantification and analysis techniques and is illustrated using a hypothetical case study that is based on archival data published by United States government agencies. The conclusion of this study is that the optimal investment strategy can be identified through a formal analysis and that optimization depends on the frequency and cost of injuries, the sequence in which the specific injury prevention techniques are implemented, the risk mitigated by each strategy, and the organization’s attitude toward acceptable risk.     

Review of applying implant-magnetic attachments to oral and maxillofacial prostheses]

The Postanesthesia Care Unit (PACU) is an area of high risk for the transmission of Mycobacterium tuberculosis. The Centers for Disease Control (CDC) have recommended administrative controls, engineering controls, and personal protection devices to reduce the risks; nevertheless, perianesthesia nurses inhale airborne pathogens. The CDC guidelines are enforced by the Occupational Safety and Health Administration (OSHA). If an exposure occurs, the health-care facility has an OSHA-mandated course of action. The cost of follow-up of exposed persons can be high, depending on the patient census of the PACU at the time of unprotected exposure. This report presents the CDC guidelines for follow-up of exposure and costs based on typical surgical volumes and admission patterns for a large hospital with 10 thousand or more annual surgical procedures.     

Mental health and the workplace: An interchangeable partnership.

Mental health is an important component of occupational health. The National Institute for Occupational Safety and Health recognizes psychological disorders as one of the 10 leading work-related diseases and injuries (J. D. Millar, 1984). Job-related stress is receiving an increasing amount of public attention, and several studies indicate that stress-related conditions are among the most important health problems of the 1990s for people at work and outside of work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The public health approach to youth violence and child maltreatment prevention at the Centers for Disease Control and Prevention.

Millions of people in the United States suffer the consequences of violence, including physical injuries, psychological trauma, and death. Solutions to violence have traditionally been reactive. Through the lens of the public health perspective, the Centers for Disease Control and Prevention (CDC) views violence as predictable based on various contributing factors, and thus as preventable. Within CDC, the Division of Violence Prevention (DVP) leads efforts to prevent injury, death, and disability, and to reduce the suffering and medical costs caused by violence. DVP employs a multidisciplinary, public health approach to identify factors associated with violence, and to develop, evaluate, and disseminate preventive interventions. Psychology is one discipline that has contributed to our approach. The authors present a series of violence prevention initiatives funded by the CDC that are framed within a public health perspective, with attention to the contributions of psychology to youth violence and child maltreatment prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prognostic importance of calcitonin screening in familial medullary thyroid carcinoma

A prospective study of 20 patients with traumatic amputations of the fingers and a thumb was carried out during a six week period at Mpilo Central Hospital, Bulawayo. Most of the adult injuries (17 patients) resulted from industrial accidents (76.5 pc) while two out the three children sustained their injury from domestic accidents. Inadequate safety precaution, ignorance and human error contributed significantly to the injuries. Safety education and preventive measures both at home and in industry should be inoculated into the daily life of individuals.     

Washington State's late night retail worker crime protection regulation. Relationships with employer practices

Washington's late night retail worker crime protection regulation, enforced by the state Occupational Safety and Health Administration (OSHA) program, was intended to prevent injuries by deterring violent crimes. We investigated whether the regulation was associated with businesses' violence prevention activities. We surveyed 1,516 employers at high risk of robbery, including gas stations, groceries, hotels, restaurants, and taverns, in 1995 to determine whether they had violence prevention training programs for their employees (a requirement of the standard). Awareness of the regulation was low (4.4%). Employers covered by the regulation were more likely to have programs (Odds Ratio [OR] = 1.4), as were those aware of a regulation (OR = 3.4). State OSHA plan contact (an inspection or consultation) was also associated with having a program (OR = 1.9). Despite low awareness of the standard, results suggested that regulatory efforts to protect high-risk employees were associated with employers' robbery and crime prevention activities.     

Air-powered guns: too much firepower to be a toy

OBJECTIVE: This study reviews our experience and calls attention to the potential danger of air-powered guns. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Review of patients with air-powered gun-injuries admitted to a Level I trauma center and air gun deaths reported to the United States Consumer Product Safety Commission over a 5-year period ending July 1994. RESULTS: Sixteen children (median age 10) were admitted after sustaining BB or pellet gun injuries. Three children had cranial penetration; one remains severely brain impaired. One of two thoracic injuries required left ventriculorrhaphy. All five children sustaining abdominal wounds underwent laparotomy for enteric perforations; one was complicated by an intra-arterial pellet embolus. Three of five children with neck wounds had penetrating tracheal injury. Overall nine children required operative intervention. No deaths occurred in our series, but there were 33 air gun deaths reported to the United States Consumer Product Safety Commission during this period. CONCLUSION: Our data demonstrate that injuries from air-powered guns should be treated in a manner similar to those from low velocity powder firearms. We can no longer continue to underestimate the potential for life-threatening injury from these weapons.     

Organizational injury rate underreporting: The moderating effect of organizational safety climate.

The goals of this study were (a) to assess the extent to which construction industry workplace injuries and illness are underreported, and (b) to determine whether safety climate predicts the extent of such underreporting. Data from 1,390 employees of 38 companies contracted to work at a large construction site in the northwestern United States were collected to assess the safety climate of the companies. Data from the Occupational Safety and Health Administration (OSHA) logs kept by the contractors allowed for calculation of each company's OSHA recordable injury rate (i.e., the reported injury rate), whereas medical claims data from an Owner-Controlled Insurance Program provided the actual experienced rate of injuries for those same companies. While the annual injury rate reported to OSHA was 3.11 injuries per 100 workers, the rate of eligible injuries that were not reported to OSHA was 10.90 injuries per 100 employees. Further, organizations with a poor safety climate had significantly higher rates of underreporting (81% of eligible injuries unreported) compared with organizations with a positive safety climate (47% of eligible injuries unreported). Implications for organizations and the accuracy of the Bureau of Labor Statistics's national occupational injury and illness surveillance system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing to daylight saving time cuts into sleep and increases workplace injuries.

The authors examine the differential influence of time changes associated with Daylight Saving Time on sleep quantity and associated workplace injuries. In Study 1, the authors used a National Institute for Occupational Safety and Health database of mining injuries for the years 1983–2006, and they found that in comparison with other days, on Mondays directly following the switch to Daylight Saving Time—in which 1 hr is lost—workers sustain more workplace injuries and injuries of greater severity. In Study 2, the authors used a Bureau of Labor Statistics database of time use for the years 2003–2006, and they found indirect evidence for the mediating role of sleep in the Daylight Saving Time–injuries relationship, showing that on Mondays directly following the switch to Daylight Saving Time, workers sleep on average 40 min less than on other days. On Mondays directly following the switch to Standard Time—in which 1 hr is gained—there are no significant differences in sleep, injury quantity, or injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unusual large cystic acoustic neurinomas: report of two cases

OBJECTIVE: Examine the current magnitude of the injury problem to children and adolescents on farms, and to compare these data to that from 1978-83. DATA SOURCES: US National Center for Health Statistics Mortality Multiple Cause of Death Tapes for the years 1991-3, and the US Consumer Product Safety Commission National Electronic Injury Surveillance System for data on emergency department visits for 1990-3. SUBJECTS: Children and adolescents 19 years and younger injured on farms. RESULTS: There were an average of 104 deaths per year due to injuries occurring on farms. The rate of 8.0 deaths per 100,000 child farm residents is 39% lower than in 1979-81. More of the deaths occurred in hospital than previously. There were an average of 22,288 emergency department treated injuries per year. The rate of 1717 injuries per 100,000 child farm residents is 10.7% higher than 1979-83. Males were injured more frequently than females. Tractors accounted for 20.9% of all injuries, followed by horses (8.4%), all terrain vehicles and minibikes (8.0%), and farm wagons (7.7%). CONCLUSIONS: Farm injuries continue to be a major problem to children living on farms. While improved medical care may have contributed to the reduction in mortality, the continued high rate of injuries warrants study of a variety of intervention strategies to reduce the injury toll. There is also a need for ongoing injury surveillance to provide accurate data on the farm injury problem.     

CDC42 and FGD1 cause distinct signaling and transforming activities

Activated forms of different Rho family members (CDC42, Rac1, RhoA, RhoB, and RhoG) have been shown to transform NIH 3T3 cells as well as contribute to Ras transformation. Rho family guanine nucleotide exchange factors (GEFs) (also known as Dbl family proteins) that activate CDC42, Rac1, and RhoA also demonstrate oncogenic potential. The faciogenital dysplasia gene product, FGD1, is a Dbl family member that has recently been shown to function as a CDC42-specific GEF. Mutations within the FGD1 locus cosegregate with faciogenital dysplasia, a multisystemic disorder resulting in extensive growth impairments throughout the skeletal and urogenital systems. Here we demonstrate that FGD1 expression is sufficient to cause tumorigenic transformation of NIH 3T3 fibroblasts. Although both FGD1 and constitutively activated CDC42 cooperated with Raf and showed synergistic focus-forming activity, both quantitative and qualitative differences in their functions were seen. FGD1 and CDC42 also activated common nuclear signaling pathways. However, whereas both showed comparable activation of c-Jun, CDC42 showed stronger activation of serum response factor and FGD1 was consistently a better activator of Elk-1. Although coexpression of FGD1 with specific inhibitors of CDC42 function demonstrated the dependence of FGD1 signaling activity on CDC42 function, FGD1 signaling activities were not always consistent with the direct or exclusive stimulation of CDC42 function. In summary, FGD1 and CDC42 signaling and transformation are distinct, thus suggesting that FGD1 may be mediating some of its biological activities through non-CDC42 targets.     

The costs of healthcare worker respiratory protection and fit-testing programs

OBJECTIVE: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB). DESIGN: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study. SETtING: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB. RESULTS: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526). CONCLUSIONS: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.     

ATV-related central nervous system injuries in Louisiana

All terrain vehicles (ATVs) have been associated with death and serious injury since their introduction into the marketplace. Fifteen cases of ATV-related brain and spinal cord injury reported to the Louisiana Central Nervous System Registry during 1995 were evaluated for severity, etiology, and outcome. Eleven (73%) of these injuries were sustained by persons under 18 years of age. Despite US Consumer Product Safety Commission and ATV manufacturer recommendations for age restrictions, ATVs continue to be popular recreational devices for children.     

Cancer risks among workers exposed to metalworking fluids: a systematic review

Metalworking fluids (MWFs) are commonly used in a variety of industrial machining and grinding operations. The National Institute for Occupational Safety and Health (NIOSH) estimates that more that one million workers are exposed to MWFs. NIOSH conducted a comprehensive and systematic review of the epidemiologic studies that examined the association between MWF exposure and cancer. Substantial evidence was found for an increased risk of cancer at several sites (larynx, rectum, pancreas, skin, scrotum, and bladder) associated with at least some MWFs used prior to the mid-1970s. This paper provides the evidence pertaining to cancer at these sites. Cancer at those sites found to have more limited or less consistent evidence for an association with MWF (stomach, esophagus, lung, prostate, brain, colon, and hematopoietic system) will not be discussed in this paper but are discussed in the recent NIOSH Criteria for a Recommended Standard-Occupational Exposure to MWFs. Because the changes in MWF composition that have occurred over the last several decades may not be sufficient to eliminate the cancer risks associated with MWF exposure, reductions in airborne MWF exposures are recommended.     

Deletion of cell division cycle 2-like 1 gene locus on 1p36 in non-Hodgkin lymphoma

Our laboratories have documented a significantly high occurrence of chromosome 1p36 rearrangements in non-Hodgkin lymphoma (NHL). The cell division cycle 2-like 1(CDC2L1) (also known as TP58 or PITSLRE) gene, a protein kinase implicated in apoptotic signaling, is located at the very distal region of chromosome 1p36 and is likely to be disrupted by structural rearrangements involving 1p36. To determine the molecular consequences of the recurrent involvement of the 1p36 region, we examined metaphases containing 1p36 abnormalities from 31 specimens derived from 26 patients for the possible deletion of CDC2L1 by fluorescence in situ hybridization (FISH) using the TP58clk-1 DNA probe. Twenty-three cases exhibited the loss of CDC2L1 from the abnormal chromosome 1. In 2 of 26 cases, the gene locus was translocated to the partner chromosome, and in four specimens, all derived from one case, CDC2L1 was not deleted. This pilot investigation suggests that 1p36 rearrangements, and consequently the loss of the CDC2L1 gene locus, is important in NHL. This work also opens avenues for further molecular studies and prognostic correlations.     

Activation of CDC 25 phosphatase and CDC 2 kinase involved in GL331-induced apoptosis

CDC 25 is a dual phosphatase responsible for dephosphorylation and, thus, activation of CDC 2 kinase in G2. Abnormal activation of cyclin B-associated CDC 2 kinase has been implicated in apoptosis induced by cancer chemotherapeutic agents such as paclitaxel (Taxol) and etoposide (VP-16). In this study, we found that the CDC 2 kinase could be transiently activated when nasopharyngeal carcinoma NPC-TW01 cells were treated for 3 h with a new anticancer agent, GL331. GL331 treatment also induced a concomitant increase in CDC 25A phosphatase activity and a reduced level of Tyr-15-phosphorylated CDC 2 in NPC-TW01 cells. Furthermore, subsequent apoptotic DNA fragmentation induced by GL331 could be interrupted by treatment of the cells with the cyclin B1-specific antisense oligonucleotides, suggesting that abnormal activation of cyclin B1-associated CDC 2 kinase and CDC 25A phosphatase was involved in GL331-induced apoptosis. Raf-1 has been shown to associate with CDC 25A and, thus, to stimulate its phosphatase activity. Our results revealed that GL331 could facilitate the association of CDC 25A with Raf-1, resulting in the cascade of CDC 25A phosphatase activation and CDC 2 kinase activation, as well as related signaling pathways, and ultimately causing apoptosis in cancer cells.     

Rhesus incompatibility and anti-D prevention in the Düsseldorf region (a ten-year survey) (author's transl)

Among 116 120 children born between 1964 and 1973, 512 (0.44%) required treatment for haemolytic disease of the newborn caused by the presence of irregular antibodies. While the incidence between 1964 to 1970 ranged between 0.42 to 0.56%, it fell from 1971 to 1973 to 0.28%, evidence for effective anti-D prophylaxis since 1971. Those cases still occurring after 1971 were largely due to pregnancies which had started before 1971. In addition there were abortions, sensitizations during the first pregnancy, but also blood transfusions as cause for new sensitizations. Sensitization after pregnancy despite anti-D prophylaxis was observed twice. In the last few years there has been a relative increase of rare antibodies, increasing the complexities of serological diagnosis. Safety and speed of treatment can be further improved by more frequent identification of irregular antibodies in the mother and regular reports to the paediatrician.