Descriptive summary of fatal work-related injuries, Western States, 2011-2017.

Work-related deaths are a persistent occupational health issue that can be prevented. However, prevention opportunities can be hampered by a lack of adequate public health resources. The Western States Occupational Network (WestON) is a network of federal, state, and local occupational health professionals that includes a 19-state region of the United States. To encourage public health collaboration, WestON partners examined work-related fatalities within the region. Fatality counts (numerators) were obtained from the U.S. Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries restricted-access research files for all workers ages ≥15 years and fatally injured in WestON states from 2011 through 2017. Estimates of full-time equivalent hours worked (FTE) (denominators) were retrieved from the BLS Current Population Survey. Annual average fatality rates were calculated as number of fatalities per 100,000 FTE over the study period. Rates were stratified by state, select demographics, industry sector, and event/exposure types. Pearson chi-squared tests and rate ratios with 95% confidence probability limits were used to assess rate differences. All analyses were conducted using SAS v.9.4. From 2011 through 2017, the annual average overall occupational fatality rate for the WestON region was 3.5 fatalities per 100,000 FTE, comparable to the overall U.S. fatality rate. Male workers had a fatality rate almost 10 times higher than female workers in the region. Fatality rates increased with successive age groups. Alaska and New Mexico had significantly higher fatality rates for all racial/ethnic groups compared to respective regional rates. Wyoming, North Dakota, and Montana had the three highest occupational fatality rates among foreign-born workers. Agriculture/forestry/fishing, mining/oil/gas extraction, and transportation/warehousing/utilities were industry sector groups with the three highest fatality rates regionally. Transportation-related incidents were the most frequent event type associated with occupational fatalities for all 19 states. Work-related fatalities are a crosscutting occupational public health priority. This analysis can be an impetus for collaborative multistate initiatives among a dynamic and varied occupational public health network to better meet the needs of a rapidly changing workforce.

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.

BACKGROUND: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. METHODS: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. RESULTS: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. CONCLUSIONS: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Workplace Injuries Caused by Commercial Fishing Winches-Alaska, 2000-2020.

OBJECTIVES: Deck machinery is a leading source of hospitalized injury for commercial fishing workers in Alaska. More detailed data are needed about the specific circumstances leading to injuries for developing targeted prevention efforts. METHODS: This study analyzed claims submitted to the Alaska Fisherman's Fund (AFF) to identify patterns among injuries in Alaska from commercial fishing winches. RESULTS: During January 1, 2000-November 1, 2020, 125 traumatic injuries from commercial fishing winches were identified, mainly occurring among males (94%), frequently among fishermen aged 30 years or younger (54%). Over 80% of winch injuries occurred in salmon fisheries. By gear type, 40% of injuries occurred on vessels using purse seine gear, 30% on vessels using drift gillnet gear, and 12% among set gillnet operators. Most injuries involved a fisherman having a body part caught in or compressed by a winch or cables attached to a winch (67%). Injuries mainly affected upper extremities including fingers (50% of cases) or hands/wrists (together 22% of cases). Injury severity was not formally assessed, but injuries ranged from contusions, sprains, and strains to finger or hand crushing injuries, upper limb amputation, skull fracture, spinal fracture, and chest trauma. Most cases involved fractures (23%), amputations (18%), lacerations (16%), and contusions (16%). Of all injuries, 51% were caused by anchor winches, 32% were caused by deck winches, 9% were caused by trailer winches, and 9% were caused by other types of winches. CONCLUSIONS: Practical solutions are needed for avoiding entanglement and struck-by hazards when operating fishing winches. Anchor winches warrant focused attention, having accounted for more than half of all winch injuries identified in this study. Engineering solutions, including emergency stop devices or other simple mechanical interventions depending on winch type, could help to avert potentially disabling injuries from winches. Administrative controls such as task-specific training for winches should be emphasized, especially for younger or less experienced commercial fishing crew, who may be at increased risk for injury.

Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces.

We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

Patterns of Heat Strain Among a Sample of US Underground Miners.

OBJECTIVE: This study characterizes physiological measures of heat exposure among US underground miners. METHODS: Core body temperature measured by using ingestible sensors during subjects' normal work shifts was categorized into four temperature zones: less than 37.5 °C, 37.5 °C to less than 38 °C, 38 °C to less than 38.5 °C, and more than or equal to 38.5 °C. RESULTS: On average, subjects changed temperature zones 13.8 times per shift. Temperatures increased above the recommended limit of 38 °C nearly 5 times per shift for an average of 26 minutes each episode. CONCLUSIONS: Unlike previous heat stress research that reported only maximum and mean temperature measurements, this analysis demonstrates a dynamic pattern of physiologic heat strain, with core body temperatures changing frequently and exceeding the 38 °C limit multiple times per shift. Further research is needed on the impact of multiple short-term, intermittent heat exposures on miners.

Simultaneously reducing CO2 and particulate exposures via fractional recirculation of vehicle cabin air.

Prior studies demonstrate that air recirculation can reduce exposure to nanoparticles in vehicle cabins. However when people occupy confined spaces, air recirculation can lead to carbon dioxide (CO2) accumulation which can potentially lead to deleterious effects on cognitive function. This study proposes a fractional air recirculation system for reducing nanoparticle concentration while simultaneously suppressing CO2 levels in the cabin. Several recirculation scenarios were tested using a custom-programmed HVAC (heat, ventilation, air conditioning) unit that varied the recirculation door angle in the test vehicle. Operating the recirculation system with a standard cabin filter reduced particle concentrations to 1000 particles/cm3, although CO2 levels rose to 3000 ppm. When as little as 25% fresh air was introduced (75% recirculation), CO2 levels dropped to 1000 ppm, while particle concentrations remained below 5000 particles/cm3. We found that nanoparticles were removed selectively during recirculation and demonstrated the trade-off between cabin CO2 concentration and cabin particle concentration using fractional air recirculation. Data showed significant increases in CO2 levels during 100% recirculation. For various fan speeds, recirculation fractions of 50-75% maintained lower CO2 levels in the cabin, while still reducing particulate levels. We recommend fractional recirculation as a simple method to reduce occupants' exposures to particulate matter and CO2 in vehicles. A design with several fractional recirculation settings could allow air exchange adequate for reducing both particulate and CO2 exposures. Developing this technology could lead to reductions in airborne nanoparticle exposure, while also mitigating safety risks from CO2 accumulation.

Morbidity and Health Risk Factors Among New Mexico Miners: A Comparison Across Mining Sectors.

OBJECTIVE: This study examines differences in chronic health outcomes between coal, uranium, metal, and nonmetal miners. METHODS: In a cross-sectional study using data from a health screening program for current and former New Mexico miners, log-binomial logistic regression models were used to estimate relative risks of respiratory and heart disease, cancer, osteoarthritis, and back pain associated with mining in each sector as compared with coal, adjusting for other relevant risk factors. RESULTS: Differential risks in angina, pulmonary symptoms, asthma, cancer, osteoarthritis, and back pain between mining sectors were found. CONCLUSIONS: New Mexico miners experience different chronic health challenges across sectors. These results demonstrate the importance of using comparable data to understand how health risks differ across mining sectors. Further investigation among a broader geographic population of miners will help identify the health priorities and needs in each sector.

FlEx-based transgenic reporter lines for visualization of Cre and Flp activity in live zebrafish.

Site-specific recombinases such as Cre and Flp are invaluable tools for genetic manipulations, but their usage in zebrafish has been limited. Incorporating recently developed flip-excision (FlEx) design that allows stable inversions, we have established zebrafish reporter lines that express bright and ubiquitous EGFP, but switch to express mCherry in the presence of Cre or Flp. Here, we demonstrate the stable inversion in the reporter lines, both in somatic cells and in the germ line by Cre or Flp, and the subsequent reinversion using the other recombinase. Using the reporter lines, we characterized cardiomyocyte-specific Cre lines and neuronal progenitor-specific and tamoxifen-dependent Cre lines. We also used the reporter lines for screening Cre- and Flp-based enhancer trap lines. Similar to the widely used Cre reporter lines in mice, these FlEx-based reporter lines will facilitate the use of recombinases for genetic manipulations in zebrafish.

A gain-of-function screen in zebrafish identifies a guanylate cyclase with a role in neuronal degeneration.

Manipulation of gene expression is one of the most informative ways to study gene function. Genetic screens have been an informative method to identify genes involved in developmental processes. In the zebrafish, loss-of-function screens have been the primary approach for these studies. We sought to complement loss-of-function screens using an unbiased approach to overexpress genes with a Gal4-UAS based system, similar to the gain-of-function screens in Drosophila. Using MMLV as a mutagenic vector, a cassette containing a UAS promoter was readily inserted in the genome, often at the 5' end of genes, allowing Gal4-dependent overexpression. We confirmed that genes downstream of the viral insertions were overexpressed in a Gal4-VP16 dependent manner. We further demonstrate that misexpression of one such downstream gene gucy2F, a membrane-bound guanylate cyclase, throughout the nervous system results in multiple defects including a loss of forebrain neurons. This suggests proper control of cGMP production is important in neuronal survival. From this study, we propose that this gain-of-function approach can be applied to large-scale genetic screens in a vertebrate model organism and may reveal previously unknown gene function.

Surface markers for the murine oval cell response.

UNLABELLED: The biology of progenitor activation in the liver is of considerable medical and scientific interest. The powerful genetic tools available for the mouse make it an ideal model system to study this complex process involving many different cell types. However, reagents for the isolation and study of distinct hepatic subpopulations have been quite limited compared to those available for hematopoietic cells. To produce cell surface reactive reagents more specific for the oval cell response, we generated a new collection of monoclonal antibodies by immunization of Fischer rats with enzymatically dispersed nonparenchymal cells from the livers of adult mice treated with 3,5-diethoxycarbonyl-1,4-dihydrocollidine. Each of the resulting antibodies recognized a surface antigen present on a liver cell subset and permitted the viable isolation of the associated subpopulation by fluorescence-activated cell sorting. Differential activity was observed on normal liver cells and at different stages of oval cell activation, indicating potential utility for progenitor cell identification. The subdivision of liver cells using these tools should facilitate the study of the biology of ductal and periductal hepatic cell types, including progenitors. CONCLUSION: A new panel of surface reactive monoclonal antibodies to support investigation of the murine oval cell response has been developed.