The qualitative fit testing procedure would be challenging due to severe shortages, high cost, and unavailability of commercial fit test kits in the marketplaces during pandemics of respiratory infectious diseases. Assessment of alternatives for commercial fit test kits to be prepared for emergencies is critically required. This study aimed to investigate the feasibility of an alternative of the Accumed NF60 nebulizer for the Occupational Safety and Health Administration (OSHA)-approved Allegro nebulizer.
Thirty-two participants were randomly allocated to 6 filtering facepiece respirators (FFRs). They were qualitatively fit tested by both manual Allegro and automated Accumed NF60 nebulizers.
There was no statistically significant difference between the Allegro and Accumed NF60 nebulizers by passing rates. The odds for passing fit testing using the Accumed NF60 nebulizer was similar to that of the Allegro one (odds ratio=1.0, 95% confidence interval [0.58-1.74]).
The Accumed NF60 nebulizer could be used as a cost-benefit substitute for the standard fit test nebulizers in the pandemic situation where there is a shortage and difficulty of access. It is more convenient, decreases the time investment, and reduces the contact stress in the operators\' hands as it does not require squeezing the nebulizer bulb frequently. The test solutions\' preparation and fit testing procedures on many personnel are more straightforward, efficient, and hygienic than the Allegro one.

Acoustic trauma (AT) is permanent hearing loss after a single noise exposure. A few human cases resulting from continuous, i.e., nonimpulsive noise, have been reported as reviewed by Ward [(1991). \"Hearing loss from noise and music,\" presented at Audio Engineering Society, New York, October 4-8]. This paper updates that review by examining 11 cases in nine reports, from 1950 to 2006, with the intention of determining minimum exposures that may cause AT, including the potential risk of exposure to noise from magnetic resonance imaging machines. Diffuse-field related levels above 120 dBA for 10 s or more, or above 130 dBA for 2-3 s (values well above OSHA\'s unprotected exposure limits), can lead to AT. These cases appear to represent a susceptible fraction of the population, because much more intense exposures (e.g., 130 dBA for 32 min) have been tolerated by groups of volunteers who suffered only temporary threshold shifts. AT from continuous noise is unlikely to occur in OSHA-compliant hearing conservation programs, and probably rare enough in the general civilian population that clinical trials of drugs aimed at treating it are unlikely to be practical. AT from impulse noise, such as gunfire, which is specifically not the topic of the current work, is more amenable to clinical trials, especially in military settings.

BACKGROUND: State and Territorial Health Departments (SHDs) have a unique role in protecting and promoting workers\' health. This mixed-methods study presents the first systematic investigation of SHDs\' activities and capacity in both Occupational Safety and Health (OSH) and Workplace Health Promotion (WHP) in the United States (US).
METHODS: National survey of OSH and WHP practitioners from each of 56 SHDs, followed by in-depth interviews with a subset of survey respondents. We calculated descriptive statistics for survey variables and conducted conventional content analysis of interviews.
RESULTS: Seventy percent (n = 39) of OSH and 71% (n = 40) of WHP contacts responded to the survey. Twenty-seven (n = 14 OSH, n = 13 WHP) participated in follow-up interviews. Despite limited funding, staffing, or organizational support, SHDs reported a wide array of activities. We assessed OSH and WHP surveillance activities, support that SHDs provided to employers to implement OSH and WHP interventions (implementation support), OSH and WHP services provided directly to workers, OSH follow-back investigations, and OSH standard and policy development. Each of the categories we asked about (excluding OSH standard and policy development) were performed by more than half of responding SHDs. Surveillance was the area of greatest OSH activity, while implementation support was the area of greatest WHP activity. Respondents characterized their overall capacity as low. Thirty percent (n = 9) of WHP and 19% (n = 6) of OSH respondents reported no funds at all for OSH/WHP work, and both groups reported a median 1.0 FTEs working on OSH/WHP at the SHD. Organizational support for OSH and WHP was characterized as \"low\" to \"moderate\". To increase SHDs\' capacity for OSH and WHP, interview respondents recommended that OSH and WHP approaches be better integrated into other public health initiatives (e.g., infectious disease prevention), and that federal funding for OSH and WHP increase. They also discussed specific recommendations for improving the accessibility and utility of existing funding mechanisms, and the educational resources they desired from the CDC.
CONCLUSIONS: Results revealed current activities and specific strategies for increasing capacity of SHDs to promote the safety and health of workers and workplaces - an important public health setting for reducing acute injury and chronic disease.

Approximately 870,000 U.S. workers are employed as landscaping and groundskeeping workers who perform various tasks and use a variety of tools that expose them to high noise levels, increasing their risk to noise-induced hearing loss (NIHL). Several studies on noise exposure and NIHL in other job sectors have been published, but those on groundskeepers are very limited. This study aims to characterize the noise exposure of groundskeepers. Participants were monitored over their entire work shift for personal noise exposure by wearing noise dosimeters at shoulder level, 4 in from the ear. Using two different dosimeter settings (OSHA and NIOSH), the time-weighted averages (TWAs) and 1-min averages of noise exposure levels in decibels (dBA) were obtained. The participants were also asked to fill out an activity card daily to document their tasks, tools used, location and noise perception. Sound pressure levels (SPLs) produced by various groundskeeping equipment and tools were measured at full throttle near the ear of the operator using a sound level meter. These measurements were used to assess worker noise exposure profiles, particularly the contributing source of noise. The overall mean OSHA and NIOSH TWA noise exposures were 82.2±9.2 (range of 50.9-100 dBA) and 87.8±6.6 dBA (range of 67.2-102.9 dBA), respectively. Approximately 46% of the OSHA TWAs exceeded the OSHA action limit of 85 dBA. About 76% of the NIOSH TWAs exceeded 85 dBA, and 42% exceeded 90 dBA. The SPLs of equipment and tools measured ranged from 75- 106 dBA, most of which were at above 85 dBA and within the 90-100 dBA range. Hand-held power tools and ride-on equipment without enclosed cab may have contributed significantly to worker noise exposure. This study demonstrates that groundskeepers may be routinely exposed to noise levels above the OSHA and NIOSH exposure limits, and that the implementation of effective hearing conservation programs is necessary to reduce their risk to NIHL.

Heat stress monitoring is a vital component of an effective health and safety program when employees work in exceptionally warm environments. Workers at hazardous waste sites often wear personal protective equipment (PPE), which increases the body heat stress load. No specific Occupational Safety and Health Administration (OSHA) regulations address heat stress; however, OSHA does provide several guidance documents to assist employers in addressing this serious workplace health hazard. This article describes a heat stress and surveillance plan implemented at a hazardous waste site as part of the overall health and safety program. The PPE requirement for work at this site, coupled with extreme environmental temperatures, made heat stress a significant concern. Occupational health nurses and industrial hygienists developed a monitoring program for heat stress designed to prevent the occurrence of significant heat-related illness in site workers. The program included worker education on the signs of heat-related illness and continuous physiologic monitoring to detect early signs of heat-related health problems. Biological monitoring data were collected before workers entered the exclusion zone and on exiting the zone following decontamination. Sixty-six site workers were monitored throughout site remediation. More than 1,700 biological monitoring data points were recorded. Outcomes included improved worker health and safety, and increased operational effectiveness.

Latino day laborers often work at dangerous construction sites with little power to change conditions. We describe the development, implementation, and early-stage results of a program to train immigrant day laborers as safety liaisons. These are construction workers prepared to recognize and respond to health and safety hazards. Based in Newark, NJ, the project involves collaboration between New Labor, a membership-based worker center, and university researchers and labor educators. Safety liaisons undergo training and receive ongoing support for their roles. Both qualitative and quantitative data are collected to monitor progress. Although lacking in formal authority, safety liaisons have prompted improvements at specific sites, filed OSHA complaints, and developed a local worker council. Participatory training methods, opportunities for leadership outside the classroom, and participation in project planning have strengthened liaisons\' effectiveness, leadership skills, and commitment. The safety liaison approach could be adapted by worker centers and their partner organizations.

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A pilot evaluation of the ANSI B11-TR3 Machinery Risk Assessment/Risk Reduction (RA/RR) Guideline was conducted. The TR3 guideline was introduced into five companies on one machinery system in each company with a second machine system serving as a control. A pre-post investigation was performed with safety conditions measured pre and post in both treatment and control and with risk reduction score measured only in the treatment machine system. NIOSH provided a commercially available risk assessment software to facilitate the process. Evaluation measures included avoided injuries, reduced exposure to machinery hazards, pretest and posttest knowledge demonstration, assessment of group processes following training, correct implementation of the guidelines, and degree to which risk reduction recommendations were implemented. The qualitative results of this pilot effort appear to be the best indicators for the way ahead in industrial machine risk assessment. All companies indicated that they derived value in participating in this study and in conducting risk assessments. Quantitative study results suggest that: (1) as measured by the knowledge of the participants before and after the TR3 training, the guidelines can be effective at enhancing employee knowledge of safe machine operations and (2) although the injury reduction trends appear successful, the small sample size in the study size should be considered in interpreting these early results.

In 1983, in the face of mounting evidence of excess leukemia among workers at Shell Oil\'s Wood River (IL) and Deer Park (TX) petroleum refineries, Shell initiated the Benzene Historical Exposure Study (BHES). Shell\'s prior research had implicated occupational exposure to benzene as the source of the excess leukemia. The BHES report submission, which ultimately found no link between exposure and the excess morbidity, coincided with OSHA\'s planned hearings over a new regulatory standard for benzene. Over the next two decades, Shell published several papers based on or expanding the BHES data, all of which concluded that the excess of leukemia was unrelated to benzene. A review of the raw data on which Shell and its consultants relied reveals that Shell manipulated and omitted data in order to reach conclusions that exculpated it from liability and helped delay stricter benzene regulation.

Increased reliance on subcontractors in all economic sectors is a serious occupational health and safety challenge. Short-term cost savings are offset by long-term liability. Hiring subcontractors brings specialized knowledge but also young, inexperienced, inadequately trained workers onto industrial and hazardous waste sites, which leads to increased rates of accidents and injuries. Reliable data on subcontractor occupational health and safety programs and performance are sparse. The US Department of Energy has an excellent safety culture on paper, but procurement practices and contract language deliver a mixed message--including some safety disincentives. Its biphasic safety outcome data are consistent with underreporting by some subcontractors and underachievement by others. These observations are relevant to the private and public sectors. Occupational health and safety should be viewed as an asset, not merely a cost.