Reduction in Urinary Arsenic with Bottled-water Intervention

The study was conducted to measure the effectiveness of providing bottled water in reducing arsenic exposure. Urine, tap-water and toenail samples were collected from non-smoking adults residing in Ajo (n=40) and Tucson (n=33), Arizona, USA. The Ajo subjects were provided bottled water for 12 months prior to re-sampling. The mean total arsenic (μg/L) in tap-water was 20.3±3.7 in Ajo and 4.0±2.3 in Tucson. Baseline urinary total inorganic arsenic (μg/L) was significantly higher among the Ajo subjects (n=40, 29.1±20.4) than among the Tucson subjects (n=32, 11.0±12.0, p<0.001), as was creatinine-adjusted urinary total inorganic arsenic (μg/g) (35.5±25.2 vs 13.2±9.3, p<0.001). Baseline concentrations of arsenic (μg/g) in toenails were also higher among the Ajo subjects (0.51±0.72) than among the Tucson subjects (0.17±0.21) (p<0.001). After the intervention, the mean urinary total inorganic arsenic in Ajo (n=36) dropped by 21%, from 29.4±21.1 to 23.2±23.2 (p=0.026). The creatinine-adjusted urinary total inorganic arsenic and toenail arsenic levels did not differ significantly with the intervention. Provision of arsenic-free bottled water resulted in a modest reduction in urinary total inorganic arsenic

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.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

Pulmonary Biomarkers Based on Alterations in Protein Expression after Exposure to Arsenic

OBJECTIVE: Environmental exposure to arsenic results in multiple adverse effects in the lung. Our objective was to identify potential pulmonary protein biomarkers in the lung-lining fluid of mice chronically exposed to low-dose As and to validate these protein changes in human populations exposed to As. METHODS: Mice were administered 10 or 50 ppb As (sodium arsenite) in their drinking water for 4 weeks. Proteins in the lung-lining fluid were identified using two-dimensional gel electrophoresis (n = 3) or multidimensional protein identification technology (MUDPIT) (n = 2) coupled with mass spectrometry. Lung-induced sputum samples were collected from 57 individuals (tap water As ranged from ~ 5 to 20 ppb). Protein levels in sputum were determined by ELISA, and As species were analyzed in first morning void urine. RESULTS: Proteins in mouse lung-lining fluid whose expression was consistently altered by As included glutathione-S-transferase (GST)-omega-1, contraspin, apolipoprotein A-I and A-IV, enolase-1, peroxiredoxin-6, and receptor for advanced glycation end products (RAGE). Validation of the putative biomarkers was carried out by evaluating As-induced alterations in RAGE in humans. Regression analysis demonstrated a significant negative correlation (p = 0.016) between sputum levels of RAGE and total urinary inorganic As, similar to results seen in our animal model. CONCLUSION: Combinations of proteomic analyses of animal models followed by specific analysis of human samples provide an unbiased determination of important, previously unidentified putative biomarkers that may be related to human disease

Statistical Considerations in the Development of Injury Risk Functions

<div><p><b>Objective:</b> We address 4 frequently misunderstood and important statistical ideas in the construction of injury risk functions. These include the similarities of survival analysis and logistic regression, the correct scale on which to construct pointwise confidence intervals for injury risk, the ability to discern which form of injury risk function is optimal, and the handling of repeated tests on the same subject.</p><p><b>Methods:</b> The statistical models are explored through simulation and examination of the underlying mathematics.</p><p><b>Results:</b> We provide recommendations for the statistically valid construction and correct interpretation of single-predictor injury risk functions.</p><p><b>Conclusions:</b> This article aims to provide useful and understandable statistical guidance to improve the practice in constructing injury risk functions.</p></div

Crash safety concerns for out-of-position occupant postures: A look toward safety in highly automated vehicles

<p><b>Objective:</b> Highly automated vehicle occupants will all be passengers and may be free to ride while in postures for which existing occupant safety systems such as seat belts and airbags were not originally designed. These occupants could therefore face increased risk of injury when a crash occurs. Given that current vehicles are capable of supporting a variety of occupant postures outside of the normal design position, such as reclined or turned passengers, an evaluation of current field data was performed to better understand the risks of being out of position.</p> <p><b>Methods:</b> We investigated the frequency, demographics, and injury outcomes for out-of-position occupants using NASS-CDS. A matched analysis was performed to compare injury outcomes for out-of-position passengers with in-position drivers involved in similar crashes. Finally, case studies for out-of-position occupants were examined in the Crash Injury Research (CIREN) database.</p> <p><b>Results:</b> Only 0.5% of occupants in NASS-CDS with a coded posture were out of position at the time of crash. Of the out-of-position occupants, being turned or seated sideways was almost as likely as being reclined. Out-of-position occupants were younger and less likely to be belted than their in-position counterparts. Analysis of the injury data indicated a trend that being out of position was associated with an elevated risk for serious injury. However, the number of out-of-position occupants was too small to provide a definitive or statistically significant conclusion on injury outcome.</p> <p><b>Conclusion:</b> Though highly automated vehicles may eventually reduce the number of crashes and traffic fatalities in the future, there will be a transition period when these vehicles remain at risk from collisions with human-driven vehicles. These crashes could cause higher than anticipated rates of injury if occupants are less likely to be belted or tend to be in positions for which restraints are not optimized. This study highlights the need for future research on occupant response and countermeasure design for out-of-position occupants.</p

Survival Model for Foot and Leg High Rate Axial Impact Injury Data

<div><p><b>Objectives:</b> Understanding how lower extremity injuries from automotive intrusion and underbody blast (UBB) differ is of key importance when determining whether automotive injury criteria can be applied to blast rate scenarios. This article provides a review of existing injury risk analyses and outlines an approach to improve injury prediction for an expanded range of loading rates. This analysis will address issues with existing injury risk functions including inaccuracies due to inertial and potential viscous resistance at higher loading rates.</p><p><b>Methods:</b> This survival analysis attempts to minimize these errors by considering injury location statistics and a predictor variable selection process dependent upon failure mechanisms of bone. Distribution of foot/ankle/leg injuries induced by axial impact loading at rates characteristic of UBB as well as automotive intrusion was studied and calcaneus injuries were found to be the most common injury; thus, footplate force was chosen as the main predictor variable because of its proximity to injury location to prevent inaccuracies associated with inertial differences due to loading rate. A survival analysis was then performed with age, sex, dorsiflexion angle, and mass as covariates. This statistical analysis uses data from previous axial postmortem human surrogate (PMHS) component leg tests to provide perspectives on how proximal boundary conditions and loading rate affect injury probability in the foot/ankle/leg (<i>n</i> = 82).</p><p><b>Results:</b> Tibia force-at-fracture proved to be up to 20% inaccurate in previous analyses because of viscous resistance and inertial effects within the data set used, suggesting that previous injury criteria are accurate only for specific rates of loading and boundary conditions. The statistical model presented in this article predicts 50% probability of injury for a plantar force of 10.2 kN for a 50th percentile male with a neutral ankle position. Force rate was found to be an insignificant covariate because of the limited range of loading rate differences within the data set; however, compensation for inertial effects caused by measuring the force-at-fracture in a location closer to expected injury location improved the model's predictive capabilities for the entire data set.</p><p><b>Conclusions:</b> This study provides better injury prediction capabilities for both automotive and blast rates because of reduced sensitivity to inertial effects and tibia–fibula load sharing. Further, a framework is provided for future injury criteria generation for high rate loading scenarios. This analysis also suggests key improvements to be made to existing anthropomorphic test device (ATD) lower extremities to provide accurate injury prediction for high rate applications such as UBB.</p></div

Efficacy of a proactive health and safety risk management system in the fire service

Abstract Background This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. Methods Injury data were collected for the intervention fire department and a contemporary control department. Workers’ compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. Results There was a post-intervention average annual reduction in injuries (13%), workers’ compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. Conclusions Reduced workers’ compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant