Summarization of Injury and Fatality Factors Involving Children and Youth in Grain Storage and Handling Incidents.

This article summarizes data gathered on 246 documented cases of children and youth under the age of 21 involved in grain storage and handling incidents in agricultural workplaces from 1964 to 2013 in the U.S. that have been entered into the Purdue Agricultural Confined Space Incident Database. The database is the result of ongoing efforts to collect and file information on documented injuries, fatalities, and entrapments in all forms of agricultural confined spaces. While the frequency of injuries and fatalities involving children and youth in agriculture has decreased in recent years, incidents related to agricultural confined spaces, especially grain storage and handling facilities, have remained largely unchanged during the same period. Approximately 21% of all documented incidents involved children and youth (age 20 and younger), and more than 77% of all documented incidents were fatal, suggesting an under-reporting of non-fatal incidents. Findings indicate that the majority of youth incidents occurred at OSHA exempt agricultural worksites. The states reporting the most incidents were Indiana, Iowa, Nebraska, Illinois, and Minnesota. Grain transport vehicles represented a significant portion of incidents involving children under the age of 16. The overwhelming majority of victims were male, and most incidents (50%) occurred in June, October, and November. Recommendations include developing intervention strategies that target OSHA exempt farms, feedlots, and seed processing facilities; preparing engineering design and best practice standards that reduce the exposure of children and youth to agricultural confined spaces; and developing gender-specific safety resources that incorporate gender-sensitive strategies to communicate safety information to the population of young males with the greatest risk of exposure to the hazards of agricultural confined spaces.

Worker hazards associated with the use of grain vacuum systems.

Over the past two decades, there has been more widespread use of pneumatic handling of grain at commercial grain storage facilities and on farms as these operations have increased grain storage capacity and handle larger volumes of grain and feed In some cases, manufacturers have suggested that the use of these systems is a safer alternative to removing residual grain manually in conjunction with the use of sweep augers. The use of grain vacuum systems has also been increasingly documented as a strategy in responding to grain storage fires and human entrapment and engulfment in flowing grain. With greater utilization of these machines have come reports of entrapments and engulfments. This article summarizes 27 such documented incidents, including 21 fatalities, that resulted from the use of portable grain vacuum systems. It includes specific recommendations for engineering, educational, and regulatory strategies to reduce the risks associated with the use of these systems.

Summation of the frequency, severity, and primary causative factors associated with injuries and fatalities involving confined spaces in agriculture.

A project was undertaken to estimate the frequency, severity, and primary causative factors associated with injuries and fatalities involving confined spaces in agriculture, including grain bins, silos, and manure storage and handling facilities. A total of 1255 cases from 41 states were analyzed. These cases were included in the Purdue Agriculture Confined Space Database and occurred during the period 1964-2010. During the period 2001-2010, an average of 51 cases were documented annually. Approximately 71% of all documented cases involved grain, and over 16% of all cases involved children under the age of 16. This article presents a summary of the identified incidents and offers conclusions drawn from the study's findings.

Topographical analysis of the centration of excimer laser photorefractive keratectomy.

A major advantage of myopic photorefractive keratectomy (PRK) is the precision with which the excimer laser ablates corneal tissue. But like other refractive surgery procedures, PRK must solve the problem of accurately centering the treatment zone. We present our technique for PRK centration with postoperative corneal topographic data on 110 patients from Phase IIB and III of the clinical trials. The distance between the center of the post-PRK flat zone and the corneal vertex was determined by topography in millimeters and meridian degrees. On average, treatment zones were decentered down and right 0.52 mm at 196.74 degrees; 92.73% were centered within 1.00 mm, while 57.27% were within 0.50 mm. The centration data were correlated to postoperative visual acuity as well as treatment zone diameter. Mean uncorrected visual acuity was 20/20 for decentrations up to 1.00 mm but fell to 20/30 for deviations greater than 1.00 mm. Best corrected acuity was also preserved below 1.00 mm but compromised above this level. No difference in decentration was found between 4.5 mm and 5.0 mm ablation zones. Our findings indicate that PRK centration is accurate within 1.0 mm in over 92% of cases and that visual acuity is relatively preserved despite deviations from perfect centration. Further technical improvements will enhance the accuracy of PRK.

Centration of excimer laser photorefractive keratectomy relative to the pupil.

The centration of excimer laser photorefractive keratectomy (PRK) is critical to the procedure's success. We evaluated PRK centration in 49 patients using the EyeSys topography system. Ablation zone centration was measured from the corneal vertex and from the pupillary center using the pupil-finding software. Centration was measured more accurately from the pupillary center (0.40 mm) than from the corneal vertex (0.44 mm). Right eyes were decentered less than left eyes. There was an unpredictable correlation between amount of decentration and postoperative visual acuities. The ability to measure centration of keratorefractive procedures precisely from the pupil is an important advance in topography technology.