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Injuries associated with hands and fingers are highly prevalent in mining and identifying factors associated with these injuries are critical in developing prevention efforts. This study identifies nonfatal injury incidence rates, nature of injury, work activities, glove usage, and sources of hand and finger injuries in the U.S. mining industry, as reported to the Mine Safety and Health Administration (MSHA) from 2011 - 2017. Hand and finger injuries occur at a rate of 6.53 per 1000 full-time employees, which is nearly double the rate of the next highest affected body part, the back. Most of the hand and finger injuries were classified as cuts/lacerations/punctures (53%) followed by bone fractures/chips (26%). Materials handling and maintenance/repair were common activities at the time of the incident with miscellaneous metals (pipe, wire, guarding) and hand tools as the primary sources of hand and finger injury. Although the information on glove use was limited, leather gloves were most often worn when an injury occurred. When worn, gloves were found to contribute to 20% of the injuries, indicating their potential to protect the hands, but also potentially put the hands at risk. Further research is necessary to determine performance requirements for gloves used in mining operations, specifically those offering cut and puncture resistance., Competing Interests: Conflicts of Interest: The authors declare no competing interests.

Footwear plays an important role in worker safety. Work boots with safety toes are often utilized at mine sites to protect workers from hazards. Increasingly, mining operations require metatarsal guards in addition to safety toe protection in boots. While these guards provide additional protection, the impact of metatarsal guards on gait are unknown. This study aimed to measure the effects of 4 safety work boots, steel toe, and steel toe with metatarsal protection in wader- and hiker-style boots, on level and inclined walking gait characteristics, during ascent and descent. A total of 10 participants completed this study. A motion capture system measured kinematics that allowed for the calculation of key gait parameters. Results indicated that gait parameters changed due to incline, similar to previous literature. Wader-style work boots reduced ankle range of motion when ascending an incline. Hip, knee, and ankle ranges of motion were also reduced during descent for this style of boot. Wader-style boots with metatarsal guards led to the smallest ankle range of motion when descending an inclined walkway. From these results, it is likely that boot style affects gait parameters and may impact a miner's risk for slips, trips, or falls.

Within the metal/nonmetal mining sector, fall-related incidents account for a large proportion of fatal and non-fatal injuries. However, the events and contributing factors leading up to these incidents have not been fully investigated. To help provide a clearer picture of these factors, an analysis of imminent danger orders issued by the Mine Safety and Health Administration (MSHA) between 2010 and 2017 at both surface and underground metal/nonmetal mine sites revealed that most orders are associated with fall risks. Of these cases, 84% involved the workers not using fall protection, fall protection not being provided, or the improper use of fall protection. Fall risks for workers most frequently occurred when standing on mobile equipment, performing maintenance and repairs on plant equipment, or working near highwalls. In most cases, a single, basic, corrective action (e.g., using fall protection) would have allowed workers to perform the task safely. Overall, these findings suggest that a systematic approach is needed to identify, eliminate, and prevent imminent danger situations. Furthermore, to protect mineworkers from falls from height, frequently performed tasks requiring fall protection should be redesigned to eliminate the reliance on personal fall protection., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest.

During a public health emergency, respirator shortages can have a profound impact on the national response, such as for the current coronavirus disease 2019 (COVID-19) pandemic. Due to a severe shortage of respirators (particularly filtering facepiece respirators [FFRs]), there may be contexts in which understanding the performance of FFRs that are approved for use as part of a crisis capacity strategy is desired. This includes FFRs that are not covered under the National Institute for Occupational Safety and Health (NIOSH) Respirator Approval Program because they have been stored past their designated shelf life, have been decontaminated, or are approved by international certification bodies other than NIOSH. The purpose of this document is to provide a general framework to assess the performance of FFRs that are only being used as a crisis capacity strategy. The intended audience are those who are responsible for managing large amounts of FFRs. This framework includes a four-step process consisting of: 1) defining the population of FFRs to be sampled; 2) providing sampling strategy options; 3) inspecting and testing the sampled units; and 4) evaluating the results. In addition to the four-step process, we provide an example of how NIOSH recently evaluated the quality of FFRs sampled from ten U.S. stockpiles.

Ergonomics is the scientific discipline that investigates the interactions between humans and systems to optimize both human and system performance for worker safety, health, and productivity. Ergonomics is frequently involved either in the design of emerging technologies or in strategies to alleviate unanticipated human performance problems with emerging technologies. This manuscript explores several such emerging issues and opportunities in the context of the mining sector. In mining, the equipment, tools, and procedures have changed considerably and continue to change. Body-worn technology provides a number of opportunities to advance the safety and health of miners, while teleoperation and autonomous mining equipment stand to benefit significantly from ergonomics applications in other sectors. This manuscript focuses on those issues and opportunities that can impact the safety and health of miners in the near term.

Introduction: Off-road trucks are one of the major sources of equipment-related accidents in the U.S. mining industries. A systematic analysis of all off-road truck-related accidents, injuries, and illnesses, which are reported and published by the Mine Safety and Health Administration (MSHA), is expected to provide practical insights for identifying the accident patterns and trends in the available raw database. Therefore, appropriate safety management measures can be administered and implemented based on these accident patterns/trends., Methods: A hybrid clustering-classification methodology using K-means clustering and gene expression programming (GEP) is proposed for the analysis of severe and non-severe off-road truck-related injuries at U.S. mines. Using the GEP sub-model, a small subset of the 36 recorded attributes was found to be correlated to the severity level., Results: Given the set of specified attributes, the clustering sub-model was able to cluster the accident records into 5 distinct groups. For instance, the first cluster contained accidents related to minerals processing mills and coal preparation plants (91%). More than two-thirds of the victims in this cluster had less than 5years of job experience. This cluster was associated with the highest percentage of severe injuries (22 severe accidents, 3.4%). Almost 50% of all accidents in this cluster occurred at stone operations. Similarly, the other four clusters were characterized to highlight important patterns that can be used to determine areas of focus for safety initiatives., Conclusions: The identified clusters of accidents may play a vital role in the prevention of severe injuries in mining. Further research into the cluster attributes and identified patterns will be necessary to determine how these factors can be mitigated to reduce the risk of severe injuries., Practical Application: Analyzing injury data using data mining techniques provides some insight into attributes that are associated with high accuracies for predicting injury severity., (Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.)

Work-related musculoskeletal disorder (WMSD) prevention measures have been studied in great depth throughout various industries. While the nature and causes of these disorders have been characterized in many industries, WMSDs occurring in the U.S. mining sector have not been characterized for several years. In this report, MSHA accident/injury/illness data from 2009 to 2013 were characterized to determine the most frequently reported WMSDs in the U.S. mining sector. WMSDs were most frequently reported in workers with less than 5 years or more than 20 years of mining experience. The number of days lost from work was the highest for shoulder and knee injuries and was found to increase with worker age. Underground and surface coal, surface stone and stone processing plants experienced the greatest number of WMSDs over the period studied. WMSDs were most commonly caused by an employee suffering from an overexertion, falls or being struck by an object while performing materials handling, maintenance and repair tasks, getting on or off equipment or machines, and walking or running. The injury trends presented should be used to help determine the focus of future WMSD prevention research in mining.

In a mine emergency where refuge is necessary, miners may sustain injuries that will render them unable to walk or crawl. In this situation, a miner may have to rely on others for transportation into the mobile refuge alternative (RA) while on a stretcher. Since requirements for mine first-aid stations were developed before RAs, stretchers should be evaluated to determine whether they are usable in an RA and within the physical capabilities of miners in a refuge. The size of the RA airlock is a concern, as it has not been determined if current airlocks will accommodate a miner on a stretcher. This study evaluated the time required to move three types of stretchers into two commercially available RAs. The splint stretcher had the longest average time to move into each RA as compared to the backboard and soft stretcher. This increase was mostly due to the increased time requirements for getting the splint stretcher into the airlock. For all stretchers, it took approximately two to three times longer to enter the inflatable tent-type RA compared to the rigid steel RA. Mining companies should consider how well their current first-aid implements work with their RAs and manufacturers of inflatable RAs should maximize the size of the outer doors leading into the airlock to allow an easier entry for stretchers.

During a mine disaster or emergency, underground air can quickly become contaminated. In these circumstances, all underground mine workers are taught to don breathable air supply units at the first sign of an emergency. However, no contemporary oxygen consumption data is available for the purposes of designing breathing air supply equipment specifically for mine escape. Further, it would be useful to quantify the oxygen requirements of breathing air supply users for various escape scenarios. To address this need, 14 participants crawled a distance of 305 m each while their breath-by-breath oxygen consumption measurements were taken. Using these data, linear regression models were developed to determine peak and average oxygen consumption rates as well as total oxygen consumption. These models can be used by manufacturers of breathing air supply equipment to aid in the design of devices that would be capable of producing sufficient on-demand oxygen to allow miners to perform self-escape.

Background: No specific guidelines or regulations are provided by the Mine Safety and Health Administration for the use of inclined grated metal walkways in mining plants. Mining and other companies may be using walkway materials that do not provide sufficient friction, contributing to slip and fall injuries., Purpose: The purpose of this study was to determine if there are significant differences in the required friction for different grated metal walkways during walking in diverse conditions., Methods: The normalized coefficients of friction were measured for 12 participants while walking up and down an instrumented walkway with different inclinations (0°, 5°, 10°, 15°, and 20°) and with and without the presence of a contaminant (glycerol). Self-reported slip events were recorded and the required coefficients of friction were calculated considering only the anterior/posterior components of the shear forces. Additionally, the available coefficients of friction for these walkway materials were measured at the 0° orientation using a tribometer, with and without the presence of the contaminant, using a boot heel as well as Neolite as the test feet., Results: The number of slips increased when the inclination angle reached 10° and above. Of all materials tested, the diamond weave grating was found to have the best performance at all inclines and when contaminated or dry. A high number of slips occurred for the perforated grating and serrated bar grating at 20° when contaminated., Conclusions: Results of this study suggest that the diamond weave grating provides significantly better friction compared to serrated bar and perforated gratings, especially at inclines greater than 10°.

Researchers at the National Institute for Occupational Safety and Health (NIOSH) are conducting mine illumination research with the objective of improving miner safety. Slips, trips, and falls (STFs) are the second leading accident class (18.1%, n = 2,374) of nonfatal lost-time injuries at underground mines (MSHA, 2005-2009). Factors contributing to STFs include recognition of hazards as well as postural balance and age. Improved lighting may enable better hazard recognition and reduce the impact of postural balance and age. Previous research has shown that cap lamp technology that used light-emitting diodes (LEDs) has improved hazard detection. This study was an initial investigation to determine if cap lamp lighting significantly influences measures of static postural stability (displacement and velocity of center of pressure). Results of this investigation showed no significant differences in the balance measures of interest between cap lamps tested. However, balance was shown to significantly decline ( p < 0.05) when tested in an underground coal mine compared to the laboratory testing condition. Relevance to industry: Underground coal mine workers wear cap lamps on their hard hats as their primary light source to illuminate nearby areas where their vision is directed. Proper illumination may improve miner safety by improving their STF hazard recognition and balance.

This article summarizes an extensive review of South American experiences with primary health care since the Declaration of Alma-Ata. It aims to address the following specific questions: What are the enabling and constraining historical and structural conditions for primary health care policies and practices? How has health care reform supported or undermined primary health care? What evidence exists on the effectiveness of primary health care? What strategies are common to best practices? What evidence exists on the roles of citizen participation and intersectoral action? And finally, what are the policy lessons to be learned from these experiences? Narrative synthesis was used to identify and examine patterns in the data consistent with these questions. Conditions that were found to promote successful implementation of primary health care are outlined, together with features of effective primary health care systems that help create more equitable health services and health outcomes.

Euler angle decomposition and inverse dynamics were used to determine the knee angles and net forces and moments applied to the tibia during kneeling and squatting with and without kneepads for 10 subjects in four postures: squatting (Squat), kneeling on the right knee (One Knee), bilateral kneeling near full flexion (Near Full) and bilateral kneeling near 90° flexion (Near 90). Kneepads affected the knee flexion (p = .002), medial forces (p = .035), and internal rotation moments (p = .006). Squat created loading conditions that had higher varus (p < .001) and resultant moments (p = .027) than kneeling. One Knee resulted in the highest force magnitudes and net moments (p < .001) of the kneeling postures. Thigh-calf and heel-gluteus contact forces decreased the flexion moment on average by 48% during Squat and Near Full.

Six diabetic patients with neuropathic ulceration of the sole of the foot (seven feet, eight ulcers) were treated by the application of a below knee walking plaster with a rubber rocker. All the ulcers healed with this treatment, greatly reducing the usual period of hospital inpatient stay. After healing, study of the forces acting on the sole of the foot showed that these ulcers occur at the site of maximal horizontal shear force and confirmed that they occur at the site of maximal vertical force. This treatment is highly effective for neuropathic ulcers of the sole not affecting bone or complicated by deep sepsis. There may be a high rate of recurrence, however, reflecting inadequacy of methods of protecting damaged neuropathic feet.

Although high tibial osteotomy for osteoarthrosis of the knee joint is well recognized, its place in the management of rheumatoid arthritis of the knee is much less well established. Thirty-six rheumatoid knees were reviewed 1 to 6 years following tibial osteotomy. The results were 42 per cent good, 19 per cent satisfactory and 39 per cent poor. No patient remained free of pain for more than 3 years, and recurrence of pain was not always associated with recurrence of deformity. Varus knees did considerably better than valgus knees despite some technical errors. Maintenance of a normal femoro-tibial angle range of 164 degrees to 177 degrees at follow-up was important but not as vital as in osteoarthrosis of the knee. The beneficial effect of tibial osteotomy in rheumatoid arthritis of the knee seldom lasted more than 3 years after which time an increasing number of bad results were seen. It was concluded that high tibial osteotomy was a satisfactory procedure for rheumatoid arthritis of the knee but its efficacy was not comparable to that seen in osteoarthrosis nor was its effect long-lasting.

A controlled prospective trial to compare the efficacy of the antibiotics cephaloridine and flucloxacillin in preventing infection after total hip replacement was conducted at three hospitals. The antibiotic regimens began before surgery, cephaloridine being continued for 12 hours and flucloxacillin for 14 days afterwards. Over an 18-month period 297 patients undergoing a total of 310 hip replacements were entered into the trial and randomly allocated to one of the regimens. The follow-up period ranged from one to two and a half years. All operations were performed in conventional operating theatres; at two of the hospitals these were also used by various other surgical disciplines. Four patients developed deep infection, two having received the cephaloridine and two the flucloxacillin regimen. The overall rate of deep infection was therefore 1.3%. Thus three doses of cephaloridine proved to be as effective as a two-week regimen of flucloxacillin. Giving a prophylactic systemic antibiotic reduced the incidence of infection to a level comparable with that obtained in ultra-clean-air operating enclosures.

A transducer has been developed to record the shear or horizontal components of force beneath the sole of the foot. When used with a vertical force transducer it has enabled a comprehensive analysis of the mechanical forces acting beneath the foot when walking in various types of footwear. Considerable differences have been recorded between the footwear. Particularly low forces are present in a plaster cast and to a lesser extent with Plastazote insoles. The possible application of these findings to the management of ulceration of the sole of the foot in diabetes mellitus and leprosy is discussed.

Using a system for measuring the load distribution under the foot, patients with hallux valgus were compared, before and after undergoing Keller's operation, with a group of normal subjects. Preoperatively the patients showed reduced loading under all their toes and increased loading under their lateral metatarsal heads; the decrease under the hallux was found to correlate with an increase in hallux valgus angle. Postoperatively there was a further decrease in loading under the hallux and an increase under the first metatarsal head.