A 5-day Heat Acclimation Program Improves Heat Stress Indicators While Maintaining Exercise Capacity.

ABSTRACT: Wardenaar, FC, Ortega-Santos, CP, Vento, K, Beaumont, JS, Griffin, SC, Johnston, C, and Kavouras, SA. A 5-day heat acclimation program improves heat stress indicators while maintaining exercise capacity. J Strength Cond Res 35(5): 1279-1286, 2021-This study aimed to evaluate whether a daily 60 minutes isothermic biking protocol during a 5-day period could improve physiological heat acclimation and exercise performance capacity in partially acclimated subjects. A quasi-experimental study consisted of an intervention (INT, n = 7) and control (CON, n = 7) group completing 2 12 minutes Cooper tests (pre-CT on day 1 and post-CT on day 7) and a heat stress test (HST, on day 9). INT performed additional intensive exercise 1 hour per day on days 1-5, whereas CON did not. During CTs and HST, core temperature (Tc, telemetric capsule), skin temperature (Tsk, sensors at neck, right shoulder, left hand, and right shin), and heart rate (HR, chest strap) were continuously monitored and baseline, average, peak, and increment were calculated. During the HST, the INT group showed a smaller baseline-peak Tc increment (INT 0.88 ± 0.27 vs. CON 1.64 ± 0.90° C, p = 0.02), a lower HR peak (150.2 ± 12.6 vs. 173.0 ± 16.8 b·min-1, p = 0.02), and lower Tsk peak (36.47 ± 0.62 vs. 36.54 ± 0.46° C, p = 0.04). There was a nonsignificant, but practical difference based on a moderate effect size for change in pre-CT to post-CT performance of nearly +2.7 ± 12.3% in INT and -3.0 ± 8.5% in CON (p = 0.32 and d = 0.51), and HST distance covered resulting in a nonsignificant difference of 464 ± 849 m between INT and CON (p = 0.38 and d = 0.44). In conclusion a short-term 5-day heat acclimation program including 300 minutes of extra exercise resulted in positive physiological adaptions to heat stress, as indicated by lower core temperature and HR in comparison with a control group.

Measuring Patient Mobility in the ICU Using a Novel Noninvasive Sensor.

OBJECTIVES: To develop and validate a noninvasive mobility sensor to automatically and continuously detect and measure patient mobility in the ICU. DESIGN: Prospective, observational study. SETTING: Surgical ICU at an academic hospital. PATIENTS: Three hundred sixty-two hours of sensor color and depth image data were recorded and curated into 109 segments, each containing 1,000 images, from eight patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three Microsoft Kinect sensors (Microsoft, Beijing, China) were deployed in one ICU room to collect continuous patient mobility data. We developed software that automatically analyzes the sensor data to measure mobility and assign the highest level within a time period. To characterize the highest mobility level, a validated 11-point mobility scale was collapsed into four categories: nothing in bed, in-bed activity, out-of-bed activity, and walking. Of the 109 sensor segments, the noninvasive mobility sensor was developed using 26 of these from three ICU patients and validated on 83 remaining segments from five different patients. Three physicians annotated each segment for the highest mobility level. The weighted Kappa (κ) statistic for agreement between automated noninvasive mobility sensor output versus manual physician annotation was 0.86 (95% CI, 0.72-1.00). Disagreement primarily occurred in the "nothing in bed" versus "in-bed activity" categories because "the sensor assessed movement continuously," which was significantly more sensitive to motion than physician annotations using a discrete manual scale. CONCLUSIONS: Noninvasive mobility sensor is a novel and feasible method for automating evaluation of ICU patient mobility.

Correction to: Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations.

CORRECTION: After publication of the article [1], it has been brought to our attention that the second author's name was published incorrectly. Previously included as "Keshia P. Porter", the full and correct name should be "Keshia Pollack Porter". This has now been corrected in the original version of the article.

Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations.

BACKGROUND: Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. METHODS: Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. RESULTS: Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. CONCLUSIONS: Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department's needs and priorities.

Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits.

BACKGROUND: Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year. METHODS: Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers' compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes. RESULTS: The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%. CONCLUSIONS: We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential.

Establishing a proactive safety and health risk management system in the fire service.

BACKGROUND: Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service. METHODS: In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting. RESULTS: The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury. CONCLUSIONS: As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

An economic model demonstrating the long-term cost benefits of incorporating fertility control into wild horse (Equus caballus) management programs on public lands in the United States.

In recent years, the Bureau of Land Management's (BLM) Wild Horse and Burro Management program costs have increased dramatically due to a rise in the number of animals removed from public lands coupled with significantly decreased adoption rates. To assist with development and implementation of effective, cost-containing management programs, a robust economic model to project the costs and optimize outcomes of various management scenarios was created. For example, preliminary demonstration model runs show that by gradually replacing "removal-only" programs with contraception-and-removal programs on one hypothetical Herd Management Area (HMA), the BLM could save about US$8 million over 12 years while maintaining an area target population of 874 horses. Because the BLM estimates that more than 38,000 wild horses roam on 179 HMAs in the United States, the use of this economic model could result in a cost-savings of tens of millions of dollars if applied broadly across all HMAs.

Primary Mucosal Melanoma of the Lip With GNA11 Mutation in a 23-Year-Old Pregnant Woman.

Mucosal melanoma represents a small proportion of all melanoma cases and is associated with a worse prognosis. Primary malignant melanoma of the lip (PMML) is far less common, and only a few cases have been reported since 1997, most commonly in China, Japan, Uganda, and India. Most of these cases have been associated with the gene C-KIT. As a result, treatment guidelines surrounding mucosal melanoma are unclear, especially in complicated populations such as pregnant women. Mutations in theGNAQ and GNA11 genes have been found to be associated with uveal melanoma, while they are rarely associated with mucosal melanoma. We present the case of a 23-year-old pregnant woman who was found to have likely primary malignant melanoma of the lip that metastasized to the left jaw, neck, breast, lungs, and ovaries and was found to be positive for both the BRAF-MLL3 and GNA11 mutation.

Studying full-shift inhalation exposures to volatile organic compounds (VOCs) among Latino workers in very small-sized beauty salons and auto repair shops.

Background: One in every 200 US jobs is in a beauty salon or auto repair shop, where workers are regularly exposed to volatile organic compounds (VOCs) that may cause a range of short- and long-term health issues. In these shops, Latino workers are overrepresented and lack culturally and linguistically appropriate industrial hygiene resources. This leaves a gap in knowledge on inhalation exposures to VOCs in this hard-to-reach and ubiquitous worker population. Objective: Our goal was to recruit hard-to-reach, predominantly Spanish-speaking workers in beauty salons and auto repair shops and monitor total VOC inhalation exposures for over entire work shifts, with minimal impact on workers, clients, and business. Methods: We developed and refined measurement and exposure assessment methods for personal and area full-shift VOC inhalation exposures. Results: With minimal participant loss, we measured over 500 h of real-time, personal VOC exposures and recorded activities and other exposure factors for 47 participants, while also documenting chemical inventories and quantifying indoor area concentrations of specific VOCs among 10 auto repair shops and 10 beauty salons. Conclusion: Lessons learned from our study can assist future studies of inhalation exposures in other hard-to-reach occupational populations.

Reducing the Risk of Healthcare Associated Infections from Legionella and Other Waterborne Pathogens Using a Water Management for Construction (WMC) Infection Control Risk Assessment (ICRA) Tool.

Construction activities in healthcare settings potentially expose building occupants to waterborne pathogens including Legionella and have been associated with morbidity and mortality. A Water Management for Construction-Infection Control Risk Assessment (WMC-ICRA) tool was developed addressing gaps in building water management programs. This enables healthcare organizations to meet the requirements of ANSI/ASHRAE Standard 188 referenced in numerous guidelines and regulations. A WMC-ICRA was modeled after the ICRA required for prevention and control of airborne pathogens to reduce the risk of healthcare associated infections. The tool allows users to evaluate risk from waterborne pathogen exposure by analyzing construction activities by project category and building occupant risk group. The users then select an appropriate level of risk mitigation measures. Technical aspects (e.g., water age/stagnation, flushing, filtration, disinfection, validation testing), are presented to assist with implementation. An exemplar WMC-ICRA tool is presented as ready for implementation by infection prevention and allied professionals, addressing current gaps in water management, morbidity/mortality risk, and regulatory compliance. To reduce exposure to waterborne pathogens in healthcare settings and improve regulatory compliance, organizations should examine the WMC-ICRA tool, customize it for organization-specific needs, while formulating an organizational policy to implement during all construction activities.

Evaluation of CBRN Respirator Protection in Simulated Fire Overhaul Settings.

Overhaul is the phase of firefighting after flames have been extinguished but when products of combustion are still being released. While positive pressure self-contained breathing apparatus (SCBA) provide the highest level of respiratory protection during overhaul, use of air-purifying respirators (APRs) with suitable filters could potentially provide a lower weight, longer duration option for first responders. The objective of this study was to assess whether an APR with a chemical, biological, radiological, and nuclear (CBRN) canister could be recommended as substitution for SCBA during overhaul. A total of 15 simulated standard overhaul environments were created by burning household materials. Sampling was conducted using mannequin heads fitted with full facepiece respirators with either a CBRN canister or SCBA. In-mask and personal samples were collected for aldehydes, polynuclear aromatic hydrocarbons, inorganic acids, aromatic hydrocarbons, nitrogen dioxide, and particulate matter. An additional six simulated high-exposure overhaul environments were created in a flashover chamber by continuously adding household materials to a smoldering fire. The sampling train was the same for both the standard and high-exposure environments; however, the facepiece was sealed to the mannequin head in the high-exposure environments. In the standard overhaul environment, the CBRN canister effectively reduced the level of exposure for most contaminants, while in the high-exposure overhaul exposure setting in-mask acetaldehyde and formaldehyde were detected. In both exposure settings, the SCBA prevented almost all exposure, and therefore remains the recommended respiratory protection during overhaul.

Proposing a social ecological approach to address disparities in occupational exposures and health for low-wage and minority workers employed in small businesses.

Occupational disease and injuries are the 8th leading cause of death in the United States. Low-wage and minority workers are more likely to work in hazardous industries and are thus at greater risk. Within the small business sector, in particular, the health of low-wage and minority workers is threatened by a multitude of complex and interrelated factors that increase their risk for injuries, death, and even chronic disease. The COVID-19 pandemic has amplified these concerns, as many low-wage and minority workers are essential workers, and many small businesses are reopening with little to no guidance. The article describes work-related health risks and reviews current research on occupational and social ecological approaches to improving the health of minority and low-wage workers primarily employed by small businesses. We propose a conceptual framework that integrates the social ecological model with the hierarchy of controls to address work-related health among low-wage and minority workers specifically in the small business sector. Community-based strategies are recommended to engage small business owners and workers in efforts to address their immediate needs, while building towards sustainable policy change over time. These strategies are of particular importance as small businesses reopen in the ongoing pandemic.

Evaluation of fireground exposures using urinary PAH metabolites.

BACKGROUND: Firefighters have increased cancer incidence and mortality rates compared to the general population, and are exposed to multiple products of combustion including known and suspected carcinogens. OBJECTIVE: The study objective was to quantify fire response exposures by role and self-reported exposure risks. METHODS: Urinary hydroxylated metabolites of polycyclic aromatic hydrocarbons (PAH-OHs) were measured at baseline and 2-4 h after structural fires and post-fire surveys were collected. RESULTS: Baseline urine samples were collected from 242 firefighters. Of these, 141 responded to at least one of 15 structural fires and provided a post-fire urine. Compared with baseline measurements, the mean fold change of post-fire urinary PAH-OHs increased similarly across roles, including captains (2.05 (95% CI 1.59-2.65)), engineers (2.10 (95% CI 1.47-3.05)), firefighters (2.83 (95% CI 2.14-3.71)), and paramedics (1.84 (95% CI 1.33-2.60)). Interior responses, smoke odor on skin, and lack of recent laundering or changing of hoods were significantly associated with increased post-fire urinary PAH-OHs. SIGNIFICANCE: Ambient smoke from the fire represents an exposure hazard for all individuals on the fireground; engineers and paramedics in particular may not be aware of the extent of their exposure. Post-fire surveys identified specific risks associated with increased exposure.

An Occupational Heat Stress and Hydration Assessment of Agricultural Workers in North Mexico.

Expanding agribusiness in Northern Mexico has increased demand for workers from Southern Mexico, with hundreds of thousands migrating for work annually. Extreme temperatures, physical labor, and low fluid consumption place workers at risk for heat strain and dehydration, commonly underreported hazards in the agricultural industry. The objectives of this pilot study were to assess heat exposure and hydration status of a population of migratory agricultural workers in Northern Mexico throughout the grape harvest season. In addition to demographic information, environmental conditions, hydration status, and core body temperatures were collected. The majority listed Chiapas as their home state, nearly half spoke an Indigenous language, and none had completed high school. The wet-bulb globe temperature was significantly higher during the harvest and post-harvest seasons compared to the pre-harvest season. Across the different seasons, the majority were dehydrated post-shift, and mean core body temperature of workers was not significantly different. This project highlights the need for targeted interventions to improve hydration and prevent heat stress in this region. As the number of warm days is expected to rise each year worldwide, it will be increasingly important to engage in practices to protect vulnerable populations, such as migratory agriculture workers.

Evaluation of Interventions to Reduce Firefighter Exposures.

OBJECTIVE: Evaluate the effectiveness of firefighter exposure reduction interventions. METHODS: Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station. Urinary polycyclic aromatic hydrocarbon metabolites (PAH-OHs) were measured after structural fire responses before and after intervention implementation. Separately, infrared sauna use following live-fire training was compared to standard postfire care in a randomized trial. RESULTS: The fireground interventions significantly reduced mean total urinary postfire PAH-OHs in engineers (-40.4%, 95%CI -63.9%, -2.3%) and firefighters (-36.2%, 95%CI -56.7%, -6.0%) but not captains (-11.3% 95%CI -39.4%, 29.9%). Sauna treatment non-significantly reduced total mean PAH-OHs by -43.5% (95%CI -68.8%, 2.2%). CONCLUSIONS: The selected fireground interventions reduced urinary PAH-OHs in engineers and firefighters. Further evaluation of infrared sauna treatment is needed.

Indicators of hearing protection use: self-report and researcher observation.

Hearing protection devices (HPD) are commonly used to prevent occupational noise-induced hearing loss. There is a large body of research on hearing protection use in industry, and much of it relies on workers' self-reported use of hearing protection. Based on previous studies in fixed industry, worker self-report has been accepted as an adequate and reliable tool to measure this behavior among workers in many industrial sectors. However, recent research indicates self-reported hearing protection use may not accurately reflect subject behavior in industries with variable noise exposure. This study compares workers' self-reported use of hearing protection with their observed use in three workplaces with two types of noise environments: one construction site and one fixed industry facility with a variable noise environment, and one fixed industry facility with a steady noise environment. Subjects reported their use of hearing protection on self-administered surveys and activity cards, which were validated using researcher observations. The primary outcome of interest in the study was the difference between the self-reported use of hearing protection in high noise on the activity card and survey: (1) over one workday, and (2) over a 2-week period. The primary hypotheses for the study were that subjects in workplaces with variable noise environments would report their use of HPDs less accurately than subjects in the stable noise environment, and that reporting would be less accurate over 2 weeks than over 1 day. In addition to noise variability, other personal and workplace factors thought to affect the accuracy of self-reported hearing protection use were also analyzed. This study found good agreement between subjects' self-reported HPD use and researcher observations. Workers in the steady noise environment self-reported hearing protection use more accurately on the surveys than workers in variable noise environments. The findings demonstrate the potential importance of noise exposure variability as a factor influencing reporting accuracy.

The use of proactive risk management to reduce emergency service vehicle crashes among firefighters.

INTRODUCTION: Emergency service vehicle crashes (ESVCs), including rollovers and collisions with other vehicles and fixed objects, are a leading cause of death among U.S. firefighters. Risk management (RM) is a proactive intervention to identifying and mitigating occupational risks and hazards. The goal of this study was to assess the effect of RM in reducing ESVCs. METHODS: Three fire departments (A, B and C), representing urban and suburban geographies, and serving medium to large populations, participated in facilitated RM programs to reduce their ESVCs. Interventions were chosen by each department to address their department-specific circumstances and highest risks. Monthly crash rates per 10,000 calls were calculated for each department an average of 28 months before and 23 months after the start of the RM programs. Interrupted time series analysis was used to assess the effect of the RM programs on monthly crash rates. Poisson regression was used to estimate the number of crashes avoided. Economic data from Department A were analyzed to estimate cost savings. RESULTS: Department A had a 15.4% (P = 0.30) reduction in the overall monthly crash rate immediately post-RM and a 1% (P = 0.18) decline per month thereafter. The estimated two-year average cost savings due to 167 crashes avoided was $253,100 (95%CI= $192,355 - $313,885). Department B had a 9.7% (P = 0.70) increase in the overall monthly crash rate immediately post-RM and showed no significant changes in their monthly crash rate. Department C had a 28.4% (P = 0.001) reduction in overall monthly crash rate immediately post-RM and a 1.2% (P = 0.09) increase per month thereafter, with an estimated 122 crashes avoided. CONCLUSIONS: RM programs have the potential to reduce ESVCs in the fire service and their associated costs; results may vary based on the interventions chosen and how they are implemented. Practical applications: Risk management may be an effective and broadly implemented intervention to reduce ESVCs in the US fire service.

DNA methylation among firefighters.

Firefighters are exposed to carcinogens and have elevated cancer rates. We hypothesized that occupational exposures in firefighters would lead to DNA methylation changes associated with activation of cancer pathways and increased cancer risk. To address this hypothesis, we collected peripheral blood samples from 45 incumbent and 41 new recruit non-smoking male firefighters and analyzed the samples for DNA methylation using an Illumina Methylation EPIC 850k chip. Adjusting for age and ethnicity, we performed: 1) genome-wide differential methylation analysis; 2) genome-wide prediction for firefighter status (incumbent or new recruit) and years of service; and 3) Ingenuity Pathway Analysis (IPA). Four CpGs, including three in the YIPF6, MPST, and PCED1B genes, demonstrated above 1.5-fold statistically significant differential methylation after Bonferroni correction. Genome-wide methylation predicted with high accuracy incumbent and new recruit status as well as years of service among incumbent firefighters. Using IPA, the top pathways with more than 5 gene members annotated from differentially methylated probes included Sirtuin signaling pathway, p53 signaling, and 5' AMP-activated protein kinase (AMPK) signaling. These DNA methylation findings suggest potential cellular mechanisms associated with increased cancer risk in firefighters.

An Evaluation of the World Health Organization and American Medical Association Ratings of Hearing Impairment and Simulated Single-Sided Deafness.

BACKGROUND: According to the World Health Organization (WHO), a pure-tone threshold average (PTA) ≤25 dB HL for the better ear represents "no impairment." This implies that patients with single-sided deafness (SSD) would have "no or very slight hearing problems." According to the American Medical Association (AMA), a patient with SSD would receive a binaural hearing impairment rating of 16.7%. The premise of the WHO and AMA methods is that PTA is related to the ability to perceive speech in everyday environments. PURPOSE: The overall goal of the study was to evaluate the WHO and AMA criteria for the rating of hearing impairment. The purpose of this study was to quantify the impact of simulated SSD on the ability to recognize speech in the presence of background noise in terms of binaural and spatial advantage measures. RESEARCH DESIGN: Study participants were tested using the standard protocol for the Hearing in Noise Test (HINT) in both binaural and monaural conditions using a simulated soundfield environment under headphones. The target sentences were presented at 0°. Binaural thresholds were obtained for the Noise Front (0°), Noise Left (270°), and Noise Right (90°) listening conditions. Monaural thresholds were collected for each ear for the Noise Front condition and for the unshadowed ear for the Noise Left and Noise Right conditions. Binaural advantage was determined by subtracting the binaural from the monaural thresholds. Spatial advantage was determined by subtracting the Noise Side from the Noise Front thresholds. STUDY SAMPLE: Twenty-five young native speakers of English with normal pure-tone thresholds (≤25 dB HL, 250-8000 Hz) participated in the study. DATA COLLECTION AND ANALYSIS: Pure-tone threshold data were collected using the modified Hughson-Westlake procedure. Speech recognition in noise data were collected using a Windows-based HINT software system. The binaural and spatial advantage measures were calculated from the HINT thresholds. Statistical analyses included descriptive statistics, correlation coefficients, and matched-pairs t-tests. RESULTS: The average binaural advantage for the Noise Front conditions was 1.21 dB (p < 0.01) or a maximum estimated intelligibility improvement of 12.01% when the speech and noise were presented at 0°. The average binaural advantage across the Noise Side conditions was 11.25 dB (p < 0.01) or a maximum estimated intelligibility improvement of 84.09% when the noise was spatially separated from the speech. The average spatial advantage for the binaural conditions was 6.72 dB (p < 0.01) or a maximum estimated intelligibility improvement of 60.03%. The average spatial advantage for the monaural conditions was -3.32 dB or a maximum estimated decrease in intelligibility of 32.27%. CONCLUSIONS: The results do not support the WHO or AMA hearing impairment ratings for SSD. The WHO and AMA criteria for the determination of hearing impairment should be updated to include speech recognition in noise testing with and without the spatial separation of the speech and noise stimuli. In this way actual, as opposed to inferred perceptions of speech in noisy environments, may be determined. This will provide a much-needed improvement in the ratings of hearing impairment.

Risk Management Interventions to Reduce Injuries and Maximize Economic Benefits in U.S. Mining.

OBJECTIVE: Risk management (RM) is a cyclical process of identifying and ranking risks, implementing controls, and evaluating their effectiveness. This study aims to identify effective RM interventions in the U.S. mining industry. METHODS: RM interventions were identified in four companies representing metal, aggregate, and coal mining sectors. Injury rates were determined using Mine Safety and Health Administration (MSHA) data and changes in injury rates identified through change point analysis. Program implementation costs and associated changes in injury costs were evaluated for select interventions. RESULTS: Six of 20 RM interventions were associated with a decline in all injuries and one with a reduction in lost-time injuries, all with a positive return on investment. CONCLUSION: Reductions in injuries and associated costs were observed following implementation of a limited number of specific RM interventions.