Evaluation of the Effectiveness of a Smoke Extraction System at Reducing Veterinarian Exposures to Surgical Smoke During Electrocautery
Principal Investigator: Dr. Shiori Arai, DVM, PhD, DACVS-SA – Assistant Professor, Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota
Co-Investigator: Kimberly R. Anderson, Ph.D – Assistant Professor, Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Electrocautery use generates surgical smoke which is comprised of highly hazardous compounds. The concentration, composition, and size-distribution of surgical smoke varies significantly with surgery type, duration, and number of electrocautery use. While there is a growing body of literature surround surgical smoke generated from human tissues, no research has been conducted evaluating exposures generated during animal surgeries. We will assess occupational exposures among veterinary surgeons and evaluate the efficacy of a smoke evacuator system at reducing occupational exposures. This research will provide critical knowledge for hazards that have been unquantified in this population to-date as well as provide guidance on potential control options.

Characterizing Emimssions Generated by 3D Printing Operations
Principal Investigator: Rebecca M. Burton, MPH, CIH – PhD Student
Academic and Research Advisor: Susan Arnold, PhD, CIH – AssistantProfessor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Additive Manufacturing (AM), constitutes a rapidly emerging technology. No longer confined to the design industry, these technologies are seen with exponentially increasing frequency in research and development, manufacturing, medicine, education, and even home use. Open source designs for 3D printing are readily accessible through the internet. New opportunities in the business world for expansion of AM technology are appearing daily. However, the occupational exposures and risks associated with this technology have not been thoroughly characterized, making appropriate risk management very challenging. Existing research has focused upon fused deposition modeling, but much of the most innovative and promising research being done in this field makes greater use of other AM methods, including vat photopolymerization and powder bed methods such as binder jetting. Very little information is available regarding exposures or controls for these AM technologies. This study aims to characterize airborne emissions during tasks associated with binder jetting and vat photopolymerization, and use the exposure determinant data generated with predictive models to recommend ideal engineering controls for this technology. Exposures will be studied in a field laboratory environment, using real-time detection and integrated methods for detecting and quantifying potentially sensitizing metals (PSM), aerosols from nanometer range to 20 μm, acrylate monomers, and volatile organics. This data will enable us to better understand employee exposures during the various tasks of AM processes, and recommend optimal controls for their management.

Predicting Trends in Hypertension among Black and White Healthcare Workers: The Critical Assessment of an Upstream Factor
Principal Investigator: Tongtan Chantarat, MPH – Doctoral Student
Academic and Research Advisors: Eva A. Enns, PhD, – Assistant Professor; Rachel R. Hardeman, PhD, MPH – Assistant Professor; Patricia McGovern, PhD – Professor

Division of Health Policy and Management, School of Public Health, University of Minnesota

Abstract
Occupational status of healthcare workers greatly influences levels of exposure to the psychosocial risk factors of hypertension. Disproportionate exposure to job strain, characterized as high psychological job demand and low control over work activities, is observed among healthcare workers with low-status occupations (low earnings and educational requirements), which are disproportionately held by Black workers. Modifying how Black and White workers are systematically segregated to occupational classes may result in significant reductions of the racial disparity in hypertension. Historically, employment inequities and the racial disparity in hypertension are studied by researchers from different disciplines, hindering our ability to understand how changes in the labor market determine population health. Our study will be the first to link discriminative employment practices, occupational segregation, racialized exposure to job strain, and its impact on hypertension as one continuous process, leveraging knowledge and methods from sociology, occupational health and engineering. First, we will estimate hypertension risk equation models that account for exposure to job strain. Data for this analysis will come from the Coronary Artery Risk Development in Young Adults. This is novel because all existing risk equation models only include biomedical and demographic risk factors. Second, we will develop a simulation model called a state-transition model (STM), which tracks employment dynamics and hypertension progression among a hypothetical population of US healthcare workers. Assignment of occupations will be informed by labor market probabilities (the status quo model). We will then conduct the counterfactual analysis by assigning occupations for Black and White healthcare workers using nondiscriminatory probabilities, then compare the racial disparity trends in hypertension from this model to the status quo model. Research findings will inform the refinement of labor market policies to prevent occupational segregation, considering their impact on health equity. Novel applications of STM in occupational health research will also be highlighted.

Moral Injury: Need for a Measurement Tool for Firefighters
Principal Investigator: Doug DeMoulin, MN, GSP – PhD Student
Academic and Research Advisor: Hyun Kim, ScD – Assistant Professor
Committee Members: Bruce H. Alexander, PhD – Professor and Head, Division of Environmental Health Sciences; Timothy J. Beebe, PhD – Mayo Professor and Head, Division of Health Policy and Management

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract

Firefighter suicides exceed line-of-duty deaths in the fire force, and are the leading cause of firefighter mortality. Firefighters’ responsibilities place them in unique situations where decisions are made that can significantly affect their physical and psychological well-being. The moral code of firefighters is to save the lives of others while putting themselves in harm’s way. Moral injury occurs when an individual is perpetrating, failing to prevent, bearing witness to, or learns about acts that transgress deeply held moral beliefs; or experiencing a betrayal of what’s right, by someone who holds legitimate authority, in high-stakes situations.

Research on moral injury surfaced over the past decade in mental health literature, primarily on war veterans. Studies on war veterans have shown moral injury and posttraumatic stress disorder (PTSD) to be risk factors for suicidal traits. The Moral Injury Symptom Scale—Military Version (MISS-M) is a valid and reliable questionnaire-based measuring tool that measures symptoms of moral injury in war veterans. However, no measuring tool exists that measures symptoms of moral injury in firefighters and studies assessing firefighter moral injury is limited.

This proposed study aims to explore the facets of moral injury emerging in firefighters. The goal of this study is to develop an instrument that measures moral injury in firefighters by modifying the MISS-M and testing the reliability and validity of the modified MISS-M. Reliability will be assessed through an alpha-coefficient test and validity will be tested by the panel of experts and through factor analysis. This proposed pilot study will provide the basis for a statewide assessment of the prevalence of moral injury in firefighters. The long-term objective is to investigate the relations between suicidal ideation, firefighter moral injury and PTSD. Findings will be disseminated to fire departments, fire organizations, and conferences to increase awareness of moral injury in firefighters.

Evaluation of the Efficacy of Commercially Available Downdraft Tables for Controlling Exposures in Nail Salons
Principal Investigator: Kate Greenberg – PhD student
Academic and Research Advisor: Kimberly R. Anderson, PhD – Assistant Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Nail salon technicians are exposed to complex mixtures of hazardous chemicals. Many compounds used in nail products are suspected to be toxic and have been associated with adverse health outcomes. Despite evidence of hazardous exposures, control technologies for this industry are lacking. In recognition of the need for effective controls to secure worker health, many states have adopted guidelines for mechanical ventilation to reduce chemical exposures, with enforcement of the standard starting in areas as soon as 2021. This standard lacks essential guidance on local exhaust ventilation geometry and size, which would have a substantial impact on effectiveness and contaminant capture. Consequently, local exhaust ventilation systems may meet the International Mechanical Code requirement but may not effectively control the hazardous exposures in salons. The absence of information on the effectiveness of ventilation systems may dissuade owners from investing in these controls. We will evaluate the efficacy of five commercially available local exhaust systems designed for nail technician work in laboratory testing. We will evaluate capture velocity and efficiency and simulate realistic nail salon tasks to determine contaminant reductions for each unit. This study will provide crucial information on control options that is currently lacking in this industry.

Investigation of the Reaction Chemistry of Antineoplastic Drugs and a Cleaning Product
Principal Investigator: Hannah Kaup, MS – PhD student
Academic and Research Advisor: Susan Arnold, PhD, CIH – Assistant Professor and Director, Exposure Science and Sustainability Institute

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Antineoplastic drugs pose an occupational hazard to workers handling these medications. Persistent widespread contamination of antineoplastic drug residues on surfaces in cancer clinics has been well documented in the literature. This is due to multiple complex sources of contaminations, including patients, which cannot be controlled by engineering controls alone. The control of antineoplastic drug surface contamination in healthcare settings relies heavily on cleaning products to deactivate drugs and decontaminate surfaces. Current hazardous drug handling guidelines require the use of strong oxidizing agents to clean surfaces. The consequent chemical interaction can produce breakdown products that have been found, in some cases, to be more mutagenic than their parent drug. The reaction chemistry of antineoplastic drugs by cleaning products at the molecular level is not well understood. Without this information, it is difficult to recommend safe, effective cleaning methods. Current surveillance protocols do not account for these byproducts. The limited surveillance capabilities and lack of validated decontamination protocols creates exposure risks for workers handling these medications and potentially toxic byproducts. Thus, there is an urgent need to understand the breakdown chemistry of antineoplastic drugs and identify potentially toxic byproducts. In this pilot study we will investigate the breakdown chemistry of two antineoplastic drugs (cyclophosphamide and 5-fluorouracil) when combined with one decontamination product (sodium hypochlorite). In our first aim we will identify any byproducts that form and characterize their molecular structures. In our second aim current methods used to analyze surface wipe samples for antineoplastic drug surveillance will be modified to include identified byproducts. In our last aim we will characterize the kinetic trends of these breakdown chemistries at different concentrations and reaction times. Describing the reaction chemistry between antineoplastic drugs and decontamination products is the first critical step to determine safe, and effective deactivation and decontamination protocols.

An Effectiveness Evaluation of the Minnesota Safe Patient Handling Act
Principal Investigator: Christina Rosebush, MPH – Doctoral Student
Academic and Research Advisors: Patricia McGovern, PhD – Professor; Katherine Schofield, PhD – Assistant Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
In 2017, 10,390 nursing home workers suffered a lost time musculoskeletal injury in the U.S.,1 many attributable to lifting and transferring patients. Patient handling injuries can result in work-related disability and absence, loss of productivity, and job separation. The 2007 Minnesota Safe Patient Handling (MN SPH) Act aims to control occupational injury rates by requiring implementation of a multicomponent safe patient handling program and use of mechanical lifting equipment in most health care facilities. The statewide impacts of the law in nursing homes and other health care settings are unknown. Facility-level data are needed to assess trends in patient handling injuries, identify modifiable risk factors for injuries, and target state resources to facilities in need of support. Our proposed study will evaluate the effectiveness of the MN SPH Act by assessing patient handling injury rates and facility-level risk factors for injuries pre- and post-law. For Aim 1, we will use data from a single workers’ compensation insurer to compare rates of lost time and medical-only claims between health care facilities in Minnesota and other Midwestern states without safe patient handling laws. We will also assess differential effectiveness of the law by health care setting within Minnesota. For Aim 2, we will use statewide workers’ compensation data to compare rates of lost time patient handling injury claims in Minnesota nursing homes with different staffing characteristics. Our study will assess the impacts of time, staffing levels, and staff turnover on injury rates. We will include data on injury severity and cost of claims. The results will provide important information on effectiveness of a state safe patient handling law that can be used inform future patient handling policy initiatives in the U.S.

Impacts of the ‘Shared Environment’ on the Microbiome and Antimicrobial Resistance Transmission Between Swine and Swine Workers in Animal Production Facilities: Analysis of Showering Protocols as an Occupational, Animal Health, and Public Health Intervention
Principal Investigator: Ilya B. Slizovskiy, DVM, MPH
Academic and Research Advisor: Noelle R. Noyes, MA, DVM, PhD – Assistant Professor

Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota

Abstract
Due to concerns about increasing frequency and severity of antibiotic resistant (AMR) infections worldwide, AMR dynamics in livestock production systems have gained increasing attention. Of interest are AMR dynamics at the interface between livestock animals, production facilities and human populations. While some data exist regarding transmission of specific resistant pathogens at these interfaces, much less is known about microbiome-level AMR transmission. Moreover, the scientific evidence describing the health consequences to agricultural workers posed by sharing microbial communities with animals, is relatively unknown. This project seeks to implement shotgun metagenomic sequencing and bioinformatic techniques to evaluate the potential for transfer of the microbiome and corresponding resistome (i.e., all of the AMR genes in the microbiome) at one of the most direct livestock-human interfaces, i.e., between swine and the human workers who care for them. Additionally, we intend to explore whether existing biosecurity interventions (i.e., showering) serve as critical control points to mitigate the potential extension of swineworker microbiome-resistome sharing into the general public. In order to achieve these objectives, we outline a proposed pilot project that will result in validated methods for collection and analysis of human and animal microbial communities in agricultural occupational settings, while also providing pilot data for microbiome-resistome dynamics in swine workers. The proposed pilot study will be conducted in a sow facility in Minnesota, a leading state in pig production.

Subjective and Objective Assessment of Pharmacist Fatigue
Principal Investigator: Taylor L. Watterson, PharmD, MS – Graduate Student
Academic and Research Advisor: Michelle A. Chui, PharmD, PhD – Associate Professor

University of Wisconsin-Madison School of Pharmacy

Abstract
Occupational fatigue, a characteristic of excessive workload that inhibits workers’ abilities to function at normal capacity, is a serious concern that has been studied in healthcare professionals such as nurses and physicians. Research in these professions has demonstrated the potential for occupational fatigue to impact patient, employer, and organizational outcomes but it has been dangerously overlooked in pharmacists. A community pharmacist is an individual who is licensed by a State Board of Pharmacy and who works at a retail location (such as Walgreens or Medicine Shoppe) and has access to the public and members of the community. Community pharmacists face unique challenges compared to other healthcare professionals and are experiencing negative consequences due to the demands placed on them by the health care system. However, pharmacists are crucial members to the health care team and have been cited as the most accessible health care professional. Especially in rural areas that lack sufficient primary care providers to meet the health care needs of the population, such as Wisconsin, pharmacists provide critical access points for care. Although previous research has assessed components of pharmacists’ workload, the goal of this project is to measure occupational fatigue in pharmacists through the following aims: 1) Objectively measure the occurrence and severity of occupational fatigue in pharmacists using a commercially available actigraphy device and 2) Evaluate concordance between objective and subjective measures of occupational fatigue in pharmacists. This project will generate critical data needed to shed light on a potentially critical but overlooked concern of occupational fatigue in pharmacists. This project serves as a pilot and integral cornerstone for future projects that will validate the survey instrument—providing a feasible tool to measure fatigue that can be used in the assessment of interventions and innovative strategies to reduce these outcomes.

The Association between Particulate Matter 2.5 with Cardiovascular Disease and Chronic Obstructive Pulmonary Disease Mortality in Minnesota Taconite Workers
Principal Investigator: Ashley Hernandez, MSPH – PhD Student
Academic and Research Advisors: Bruce Alexander, PhD – Professor and Division Head; Jeffrey Mandel, MD – Associate Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are leading causes of death in the United States and worldwide. A leading cause of CVD is atherosclerosis, which inhibits blood flow, while COPD is characterized by airflow obstruction. Despite their differences, CVD and COPD share similar risk factors that include age and smoking, but may also include environmental factors such as exposure to PM2.5 and PM2.5 components. Additionally, CVD and COPD both share similar mechanistic pathways that include inflammation and oxidative stress. Similarly, PM2.5 and components of PM2.5, such as iron oxides, have also been associated with inflammation and oxidative stress. Although the association between PM2.5 and CVD and COPD has been well-established in population-based studies, the association between PM2.5 and CVD and COPD mortality in taconite workers has not been explored. Additionally, associations between PM2.5 components with CVD and COPD mortality are limited. To investigate the role PM2.5 and PM2.5 components have on CVD and COPD mortality, the proposed study will utilize data collected from the Taconite Workers Health Study in order to help determine cumulative exposures that lead to CVD and COPD mortality in taconite workers.

Coping with Low Back Pain (LBP): An Industrial Cohort’s Experience
Principal Investigator: Ruoliang Tang, PhD – Post-doctoral Fellow
Academic and Research Advisor: Jay Kapellusch, PhD – Associate Professor

Occupational Science and Technology, University of Wisconsin-Milwaukee

Abstract
In the United States (US), low back pain (LBP) remains as one of the most prevalent and costly musculoskeletal disorders (MSDs), with lifetime cumulative incidence rates estimated at 49% to 80%. Each year, 15% of the US adult population makes a physician visit for LBP. Direct annual costs of LBP are estimated between $20 and $98 billion. In industry, LBP is also a major cause of lost productivity among working population, and a primary reason for early retirement and disability pensions. Back pain results in 16% of total worker’s compensation (WC) claims, but disproportionately one third of total claim costs. Unfortunately, risk factors for LBP vary by case definition used in the studies. In the literature, LBP is commonly classified as a binary outcome (i.e., present or absent), which would capture nearly all LBP cases including very mild cases and might be too sensitive to effectively study the association between LBP and work-related risk factors. A few studies have attempted to use medication use for LBP or visit to healthcare provider as case definition to describe LBP characteristics in clinical populations. So far, there is little reported information regarding these LBP case definition alternatives, particularly as the incidence measure, simultaneously from a large working population to allow for comparability. The purpose of this prospective cohort study is (a) to describe the pain characteristics of work-related LBP experienced by a large industrial cohort, (b) investigate LBP involved medication use, healthcare visit, and lost productivity, and (c) compare worker demographics, pain characteristics, psychosocial factors, and job physical exposures according to these LBP incidence measures. Findings from this study are expected to provide more comprehensive descriptions of the LBP characteristics and LBP management experienced by the working population and help improve future investigations regarding the exposure-response relationship for the work-related LBP.

Assessing Burden of Post-Traumatic Stress Disorder among Firefighters in Minnesota
Principal Investigator: Hyun Kim, ScD – Assistant Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Post-traumatic stress disorder (PTSD) is a growing occupational health concern among firefighters. The current prevalence of PTSD among firefighters (7.3%) in the United States is double than general population. The rate is higher when firefighters are exposed to more extreme rescue situations. For example, PTSD prevalence was as high as 14.4% among the firefighters that responded to the World Trade Center attack. In Minnesota, however, only three firefighters filed PTSD-related Workers’ Compensation (WC) claims from 2008 to 2016. In light of the fact that, on a national scale, police officers have much lower PTSD prevalence than firefighters, there is a high likelihood of underreporting among Minnesota firefighters. This proposed pilot study is designed to establish a baseline for a long-term investigation to firefighters’ PTSD and co-morbidities including secondary impact to their family members. A mixed-methods approach will be used. First, qualitative methods will be used to generate research hypotheses for PTSD specific to MN firefighters. The findings from the qualitative assessment will be used to develop a survey. An online survey will be used in order to protect anonymity of study participants. The findings will be disseminated to the state-wide firefighter community by providing short- and full-versions of reports. The findings also will be disseminated to other firefighter communities and stakeholders nationally and internationally by issuing press releases, presenting at professional conferences, and publishing at least one peer-reviewed journal article within two months after study completion. The long term objective of this research is to develop a better understanding of PTSD risks and related morbidity and disability in firefighters. The proposed study will provide preliminary data and develop methods that will lead to a more comprehensive study. Opportunities for such funding include a targeted program, the Federal Emergency Management Agency (FEMA) and National Institute for Occupational Health and Safety (NIOSH).

Occupational Lower Back Pain and Trunk Dynamics During Manual Lifting Using Computer Vision
Principal Investigator: Robert G. Radwin, PhD – Professor

Department of Industrial and Systems Engineering, University of Wisconsin-Madison

Abstract
As one of the most common and costliest workplace injuries, lower back pain is a significant occupational health issue. The introduction of readily accessible ergonomic tools for practitioners will greatly facilitate the prevention of lower back injuries, and a comprehensive model for predicting risks of lower back injuries in lifting tasks is fundamental for the development of these tools. One widely used tool for guiding safe lifting, the NIOSH lifting equation, assesses risks in lifting tasks based on static task factors. Evidence has revealed the association between dynamic factors and risks of lower back disorders, not accounted for in the NIOSH equation. This research will quantify the contribution of these dynamic factors (speed and acceleration) to risks of lower back disorders using a new computer vision algorithm. The video recordings, health outcome data, and data of NIOSH equation task variables for 78 healthy workers at a manufacturing plant in the Midwest US has been provided to us from a previous NIOSH epidemiologic study. Computer vision algorithms will be used to identify video frames of the origin and destination of lifts, and to extract kinematic data of the load at the origin and the destination. We plan to use logistic regression models to test if there is a significant relationship between load kinematics and risk of lower back pain, and to compare the significance of these factors with that of the static NIOSH lifting equation. With the advantage of non-intrusive, low cost, objective, digital video technology, computer vision has the potential to provide occupational health and safety practitioners with a risk assessment tool that offers more accuracy, is more suitable than instruments for the workplace, while being more accessible to medium and small businesses.

Understanding the Occupational Health and Safety Needs of Cosmetologists in Minnesota
Principal Investigator: Jennifer B. Saunders, MSW – Doctoral Student
Dissertation Advisor: Patricia McGovern, PhD – Professor
Dissertation Committee Member: Susan Arnold, PhD, CIH, FAIHA – Assistant Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Employment for hairdressers, barbers and cosmetologists is expected to continue to grow faster than most occupations through 2024. The potential occupational hazards facing this growing workforce, however, are not well understood. Beauty Salon Professionals (BSPs)—the collective term for cosmetologists, estheticians and nail technicians—are exposed to a range of chemicals from performing a variety of services ranging from hair dyeing and bleaching to artificial nail application and hair removal. These workers may also have low wages, lack employer-sponsored health insurance, or coverage under workers’ compensation insurance. Despite these barriers to health care access, the potential influence of their occupation on health disparities is not well known. Within their industry, consumer protections are emphasized to prevent spread of disease or injuries, but occupational health and safety education for workers is comparatively lacking. This study aims to (1) assess the knowledge, attitudes and beliefs regarding work-related exposures, health conditions, and use of protective measures among licensed BSPs, and (2) estimate the association between occupation and unmet health care needs among BSPs in Minnesota. For Aim 1 we will survey Minnesota’s approximately 19,800 licensed cosmetologists, estheticians and nail technicians. Multivariate regression models will be used to examine the relationship between occupational characteristics and occupational safety behaviors. For Aim 2 we will use the Minnesota Behavioral Risk Factor Surveillance System dataset to examine the association between the occupation of BSPs and unmet health care needs. Analysis will be stratified by occupation to compare odds ratios for unmet health care needs among personal appearance workers relative to a comparison group. Study findings will contribute to the development of occupational health and safety trainings and continuing education curriculum. The results will also provide important information on the relationship between the BSP occupation and health disparities, and characterize the health care needs of this workforce.

Microsurgery Exposure Assessment and Intervention to Improve Musculoskeletal Health
Principal Investigator: Amro Abdelrahman, MBBS – PhD Student
Academic and Research Advisors: Valerie Lemaine MD, MPH, FRCSC, FACS; Susan Hallbeck, PhD, PE, CPE

Mayo Clinic

Abstract
Microsurgery is a widespread surgical practice where a growing number of healthcare professionals are working to deliver highly specialized surgical care (i.e., surgeons, trainees, and allied health staff) for very complex reconstructive problems. However, microsurgery is considered one of the most demanding surgical techniques and its effect on microsurgery professionals’ health, career longevity and satisfaction is not well understood and has yet to be studied. The long-term goal of the proposed research is to study the ergonomic risk exposure of microsurgery professionals, then develop and implement innovative ergonomic interventions to minimize the high prevalence of musculoskeletal health (MSH) symptoms and injuries for microsurgery professionals in many surgical subspecialties. The objective of this research proposal is to pilot the assessment of exposure to postural risk factors for MSH symptoms of the neck, shoulders, arms and hands for microsurgery professionals. Then use the pilot data to develop and implement one intervention into the microsurgery practice, an ergonomic armrest, and set up the evaluation parameters for future proposals for study. This proposed research is innovative because it will set up metrics to quantify the currently unsafe postures in microsurgery and result in the user-centered design of a novel cost-effective tool to facilitate the good ergonomic surgical practice and reduce MSH risk factors in microsurgery. This research is expected to have translational importance in the prevention of musculoskeletal disorders (MSD) because it includes 1) quantitative measurements of MSH symptoms and workload of microsurgery professionals intraoperatively during full surgical workdays, 2) a quantitative metric for measuring hand tremor in microsurgery and 3) the development of an ergonomic, reliable, and cost-effective microsurgery armrest intervention that can reduce ergonomic risks factors for MSH fatigue, pain, and injuries among microsurgery professionals.

Air Pollutants, Categories of Biomarkers and Health Outcomes in Taconite Workers in Minnesota
Principal Investigator: Rony F. Arauz, MPH – PhD Student
Academic and Research Advisor: Jeffrey Mandel, MD, MPH – Associate Professor
Co-Investigators: Richard F. MacLehose, PhD – Associate Professor; Irina Stepanov, PhD – Associate Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Respiratory diseases are diseases of the airways and other structures of the lungs. Lung disease can be classified into physiologic obstructive and/or restrictive types. The mainstay for the current assessment of lung structure and function have been chest x-ray, pulmonary function test (PFT) and medical symptoms. These all lack both sensitivity and specificity when exposure to pollutants is low, but may still able to influence disease. Of importance are respirable silica (RS), respirable dust (RD), and particulate matter with aerodynamic diameter less than 2.5 microns (PM 2.5), which have been associated with disease. The mechanism(s) by which inhaled substances contribute to and/or influence diseased state in organ systems remain uncertain. Inflammation is a major biological mechanism thought to be associated between inhalation-mediated and organ systems toxicity. The suggested link between air pollutants and systemic inflammation may lead to the production of certain biomarkers that depending on the time that this cascade occurs, could contribute to the early onset and progression of disease. This proposed work presents a unique opportunity to study those mechanisms in a cohort of 250 taconite workers in Minnesota. We will develop exploratory relationship with workplace exposures and biomarkers, as well as biomarkers and disease to be used in future hypothesis research. We will obtain categories of biomarkers relevant to inflammation (CRP, CBC (eosinophils, WBC, platelets), TNF-α, IL-1β, IL-6, IL-8 IL-15, IFNα2, sRAGE, fibrinogen, adiponectin, pro-surfactant protein B, SAA, SP-D, PARC/CCL18, MIP-1β, MCP-1, IP-10, MIG, TARC, and ENA78) in blood provided by participants and respiratory disease (chest x-ray, PFT and medical symptoms), along with information on clinical characteristics. We will use state-of-the art personal and ambient exposures to the pollutants and linked them to disease. This multidisciplinary study will evaluate potential occupational, environmental and clinical determinants of respiratory disease with the goal of developing unique knowledge with the possibility of prevention implications.

Functional Seated Vertical Traction for Rehydration Promotion in Lumbar Intervertebral Discs
Principal Investigator: Marit E. Johnson, MSPT – PhD Student
Academic and Research Advisor: Adam K. Piper, PhD, CSP

Biomedical Engineering, South Dakota School of Mines & Technology

Abstract
Prolonged occupational sitting tends to have negative influences on the lumbar spine and overall health of the worker. There is a growing trend toward sedentary jobs coinciding with increasingly technology-integrated workplaces in recent years. Despite medical advances, rest breaks and ergonomic work conditions, low back pain (LBP) continues to rise, both nationally and globally. Troubling still is if one incurs a lumbar spine injury, he/she may be switched to a more sedentary job for recovery, only to contribute to LBP through sitting more. This evolution can negatively impact both medical and occupational settings. During prolonged sitting, the intervertebral discs (IVDs) are exposed to static, large compressive loads hindering fluid exchange and nutrition, or dehydration. Without reciprocal unloading, or rehydration, the avascular IVDs starve for nutrition, cascading to expedited degradation, injury vulnerability and accelerated osteoarthritis to surrounding lumbar facet joints. Current multidisciplinary IVD studies range from viewing disc integrity during compressive stresses, resiliency of the IVD tissues promoting fluid transport, and regenerative applications for improving disc degeneration. What is lacking in these studies is a means for IVD hydration while maintaining a posture of function; a sitting posture where tasks can be performed during a vertical lumbar traction. Aim #1 of this study will involve construction of a seated vertical traction setup devised to allow upper extremity function, along with construction of a seated stadiometer in order to measure linear spinal height following intervention. Aim #2 will focus on recruitment of healthy subjects to determine a body weight percentage dosage versus supine lying. Aim #3 involves taking the body weight percentage protocol and conducting a study with subjects from a local call center for testing within the prolonged occupational setting.

Caring for Care-Givers: Testing the Impact of a Worksite Health Improvement Intervention
Principal Investigator: Pat McGovern, PhD, MPH, BSN – Bond Professor
Co-Principal Investigator: Jean Bey, FAAOHN, COHN-S, CCM

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Minnesota’s population is aging like never before. Residents 65 and older will represent one of four Minnesotans by 2030. These demographics have increased demand for organizations providing stable residences where seniors transition from assisted living to long-term and memory care. While facilities vary greatly in setting and size, they commonly experience staff turnover and job dissatisfaction which is problematic for employees, residents and the employer. Scant literature addresses this employee population, particularly those providing direct care and social services. Their work is characterized by variable shifts, physical and emotional strain and low wages. The most common job in the industry – nurse or personal aide – is reported as having some of the poorest health behaviors (lack of regular exercise, obesity and lack of recommended amounts of fruits and vegetables). Effective and sustainable interventions for this important population of workers have yet to be identified.

This project will pilot-test a health improvement program for employees providing health and social services to the aged using a Community-Based Participatory Research (CBPR) approach. Conditions prioritized by employees including a healthier diet, increased levels of activity and fitness and greater workplace social support will be targeted for interventions. We will also examine the impact of interventions on job satisfaction and retention given employer concerns and existing data.

A pre and post-test study design will be used to evaluate worksite interventions (N=116 employees). Associated changes in outcomes of health behaviors (diet, activity and fitness levels), workplace social support, job satisfaction and employee turnover will be assessed using surveys, physical measurements and administrative data. Changes in outcomes relative to the interventions will be analyzed with multivariate models. If successful, this research will be integrated with a test of safety interventions and brought to scale across this organization and similar employers with external grant support.

Geospatial Trends in Occupational Injury and Workers’ Compensation Utilization
Principal Investigator: Katherine E. Schofield, PhD, CSP – Assistant Professor

Mechanical and Industrial Engineering Department, University of Minnesota Duluth

Abstract
Workers’ compensation data provide a source of information on occupational injuries and their burden on workers and the workplace. The data is rich in descriptive characteristics about the injury as well as treatment, including cost and severity measures, such as days away from work and permanent disability ratings.

Injured workers utilize healthcare systems for treatment of their compensable injuries and various factors may influence access to care and the ultimate outcome of the workers’ compensation claim. Some factors may be dependent wholly, or in part, on geographical access to care. Many injuries occur where opportunity exists for intervention to lessen claim severity, i.e. to prevent lost-time, partial, or whole
disability.

Factors beyond the workplace affect employee well-being. The health of a worker community may contribute to occupational injury or severity, or, conversely, a dense distribution of workplace injuries in a community may affect the health of the community.

Geographical information systems (GIS) is an emerging tool in the public health arena to investigate injury, illness, and disease. This technology creates new ways to study factors that involve location, relating directly to geospatial health care accessibility or community health indicators of geographic areas.

This multi-faceted study will combine data from where employee live, work, and seek injury treatment to shed a more holistic light on injuries at work. This innovative way of combining and visualizing data may identify risk factors for occupational injury previously deemed unrelated to the workplace and may provide new strategies for proactive injury prevention or severity reduction efforts.

A Randomized Controlled Trial of Driving Behaviors Among Teenage Drivers During the First Year of Licensure: Implications for Prevention of Occupational Transportation-related Mortality and Morbidity
Principal Investigator: Disi Tian, MS – PhD student
Academic and Research Advisor: Susan Goodwin Gerberich, PhD – Mayo Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Motor vehicle crashes (MVCs) consistently rank as the leading cause of work-related fatalities across all industries in the United States. Although risky driving behaviors are strongly predictive of future crashes, literature assessing the potential risk factors associated with these behaviors appears to be limited. The proposed study will conduct analysis using data collected from a randomized controlled trial that aims to prevent risky driving behaviors among 274 novice teenage drivers during the first year of licensure. A smartphone-based intervention system was designed to provide real-time feedback and warnings to teenage drivers about detected risky driving behaviors (known as “partial intervention”) and notify parents of risky events via text message, should teenager drivers choose not to comply with the warnings (known as “full intervention”). By treating the teenage drivers as a proxy of the young worker population, the overall objective of this study is to identify how personal, roadway and environmental factors contribute to occurrences of risky driving behaviors among teenage drivers, as well as to understand how the intervention approach affects these potential associations over time. To accomplish the research goals, multivariable analysis will be conducted for each exposure of interest, while also controlling for potential confounders identified using Directed Acyclic  Graphs. Negative Binomial Models will be used to ascertain associations between various personal factors and the frequency of risky driving occurrences. Estimates of adjusted Hazard Ratios of events by different roadway and environmental factors over time will be provided using Cox Proportional Hazard Models. Growth Curve Models will be utilized to identify distinct risk sub-groups and analyze the associations between risk sub-groups and risky driving behaviors at different follow-up times. Research findings can be translated into occupational implications for developing intervention efforts to mitigate work-related risky driving events, and consequently mitigate work-related MVC fatalities and injuries.

A Meta-Analytic Comparison of Universal versus Industry-Specific Safety Climate Measures
Principal Investigator: Lixin Jiang, PhD – Assistant Professor

Department of Psychology, University of Wisconsin Oshkosh

Abstract
Nearly three million nonfatal work injuries were reported in the United States in 2014. This figure represented a rate of 3.2 cases per 100 equivalent full-time workers. Unfortunately, the total recordable cases of injuries and illnesses were higher in the Upper Midwest region. For example, in 2014, Wisconsin reported a rate of 4.0 cases per 100 FTE workers and Minnesota reported a rate of 3.6 cases per 100 FTE workers. These data highlight the continuing need to identify strategies to reduce workplace accidents and injuries and to improve overall workplace safety in the United States and in the Upper Midwest region.

Previous research has demonstrated that safety climate is a robust predictor of safetyrelated outcomes. However, there is little consensus about the optimal strategy to measure safety climate. One of the main issues has been whether the safety climate measure should be universal or industry-specific. As such, this study is designed to examine the criterion-related validity of universal and industry-specific safety climate measures by conducting a meta-analytic comparison. This proposed meta-analysis would reveal an optimal scale type (either universal or industry-specific) that offers better prediction of safety-related outcomes.

The knowledge gained from this project will impact the future direction of the occupational health and safety field by: 1) encouraging researchers either to develop and validate the industry-specific safety climate measures or to build large standardized databases based on studies using universal safety climate measures, 2) informing practitioners of the optimal safety climate measure (either universal or industry-specific) in the field study, and 3) providing insight into developing potential intervention strategies designed at safety climate improvement. Therefore, by demonstrating an optimal measure of safety climate, this project can provide new information that will influence the practice of occupational health and safety and lead to further research activities.

Association Between Personal and Work-Related Exposures and the Occurrence of Occupational Injuries in an Aging Working Population
Principal Investigator: Navneet Kaur Baidwan, MPH – PhD Student
Academic and Research Advisor: Susan G. Gerberich, PhD – Mayo Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
By 2020, workers aged 55 years and older will account for 25% of the United States (US) labor force. While the rate of nonfatal injuries among older workers is lower than their younger counterparts, the subsequent consequences are more severe. The fatal occupational injury rate among workers 65 years and older is four times that of younger workers. Although research has identified some work-related exposures that may affect the outcome of occupational injuries, this study is designed to analyze exposures using a longitudinal study design for a broad spectrum of occupations to identify key risk factors that can serve as a basis for injury prevention and control. The data for this study will be obtained from the Health and Retirement Study (HRS), which is longitudinal panel survey of representative Americans over the age of 50 years. The HRS was implemented in 1992 and has, subsequently, conducted surveys every two years. The proposed work will start with a cohort of 7,835 workers who reported working for pay in 2004 and follow them until 2012. This study enables a comprehensive analytical approach to examine relations between ages, personal and work-related factors, and occupational injuries over time. Exposures of interest include personal exposures comprised of demographic variables, health-related variables, income and assets, and work-related exposures including occupation, industry, number of jobs, work hours, and work-requirement factors; they will be analyzed for potential association with occupational injury occurrences. Data analysis for this innovative research will involve descriptive and multivariable analysis that will include the application of Generalized Estimating Equations, and Cox Proportional Hazard models. For each exposure of interest, Directed Acyclic Graphs will be used to identify the minimum set of confounders to control for while estimating the Hazard Ratios. Research results will be essential for targeted interventions and future research efforts.

Health and Injury Study of Janitorial Service Employees
Principal Investigator: Deirdre Green, MS – PhD Student
Academic and Research Advisor: Susan G. Gerberich, PhD – Mayo Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Janitorial service work is labor-intensive, requiring heavy workloads. In the United States, during 2010, workers classified as janitors and cleaners incurred more than 46,000 work-related injuries resulting in days away from work, accounting for the 16th highest injury rate among all occupations. Despite the exposures to numerous occupational risks and resulting high injury occurrences, there is a lack of research addressing the burden of injuries in this population, comprised primarily of immigrants; further, is evidence of a lack of reporting of injuries due to intimidation. While few studies have examined the relation between janitor workloads and injury outcomes, no studies have incorporated direct sampling measurements to account for the varying workloads and the frequent mobility of these workers. The primary aims of this study are to: 1) Determine the injury incidence and severity in janitors and identify potential associated risk factors, based on their exposures that include workload and sleep quality; and 2) Evaluate and improve janitors’ knowledge of workers’ rights and responsibilities for assessing and reporting work-related injuries through intervention. A prospective cohort study of 4,000 janitors in the SEIU Local 26 will be conducted from March 2016 to March 2017. Injuries to janitors will be collected through six-month retrospective baseline and follow-up surveys and workload will be collected using fitness bracelet and survey data; fitness bracelets will measure heart rate, steps taken, calories expended, and sleep quality. Finally, an intervention study will be implemented to ideally improve workers’ recognition and reporting of work-related injuries. Analyses include both univariate and multivariable approaches to examine injury incidence and severity and potential risk factors. Directed acyclic graphs enable a priori confounder selection for multivariable logistic regression analyses and reweighting will adjust for potential biases. This longitudinal cohort study addresses a major knowledge deficiency using an innovative measurement approach.

Injury Severity in Alternative Workers’ Compensation Arrangements in Minnesota
Principal Investigator: Katherine E. Schofield, PhD, CSP – Assistant Professor

Mechanical and Industrial Engineering Department, University of Minnesota Duluth

Abstract
The construction industry experiences a high frequency of severe. Ideally, when an employee is injured, the injury is managed to minimize long-term disability and the employee makes a full recovery and returns to employment at full wages. This is especially important in the construction industry because of high physical job demands. Adequately protecting workers while controlling and managing costs is a concern of industry. Over the last several years, 33 states have cut workers’ compensation benefits or given more control to employers. This can shift the cost of injury from workers’ compensation to the injured employee, private insurance, or federal benefit systems. One possible solution to this problem exists in alternative workers’ compensation systems developed in cooperation with union collective bargaining agreements.

The Union Construction Workers Compensation Program (UCWCP) of Minnesota uses an exclusive provider network for medical care, rehabilitation, and independent medical exams for injured workers, plus access to an alternative dispute resolution process. Examination of this Minnesota program and similar programs elsewhere have indicated positive aspects of programs, but often lack quantitative evidence to speak for reduction of injury severity.

In this study we will partner with multiple workers’ compensation carriers and utilize their data to follow a well-defined cohort of employees who have been injured in the workplace and have utilized the workers’ compensation system. We will examine the effect of UCWCP membership and its defining characteristics, such as use of exclusive provider network and alternative dispute resolution, on injury severity and outcomes. Outcomes of interest include promptness of medical treatment, days of temporary total disability (TTD), days of temporary partial disability (TPD), permanent partial disability (PPD) and permanency ratings (%), permanent total disability (PTD) cases, and returning to work with same employer.

This study reflects NIOSH goals to use workers’ compensation data for surveillance and injury research. The research will provide data that may be useful for practice insofar as identifying possible ways to save money and maximize worker quality of life. The results and corresponding potential business case for this research is of significant interest to industry stakeholders, policymakers, and workers.

Risk Factors for Employee Injury in Schools
Principal Investigator: Katherine Schofield, PhD, SFM
Co-Investigator: Craig Stroinski, MBA, SFM

The Work Comp Experts

Abstract
The educational services industry sector employs a large percentage of United States workers. Workplace injuries have profound effects on injured employees and their families, along with the students, school districts, and citizens of the community. Violence towards staff and musculoskeletal injuries have been shown to be of particular risk, especially to teaching staff. The goal of this study is to determine risk of injury among employee groups in school districts, examine risk of specific injury types and outcomes, and identify measurable risk factors. Special attention will be focused on employee injuries resulting from students and student behavior.

Minnesota Department of Education data will be paired with workers’ compensation data for 138 school districts over a six year period. The districts experienced approximately 8,000 claims with an incurred cost of upwards $35,514,908 for medical care and lost wages during the time period. Data will be used to determine rate, risk, and severity of injury. Multiple risk factors will be examined including; employment group, anatomical location of injury, type of injury, mechanism/cause of injury as well as school district demographics such as total payroll, enrollment, public vs. non-public, location (urban, suburban, out-state), and presence of return to work program. A Poisson regression model will account for time- dependent factors and estimate rate ratios (RR) and 95% confidence intervals (CI) as a function of injury rate. Generalized estimating equations will used to account for correlated observations within districts over time.

Insight into risk of injury that can be used to guide injury prevention and assist in workers’ compensation management. Also, precedence for further study and collaboration with the worker’s compensation carrier on occupational safety and health programs, safety resources and funding, and injury prevention practices and their effectiveness in schools, meeting additional NORA objectives for this sector.

Necessary Drugs; Unnecessary Exposures: An Intervention to Protect Oncology Healthcare Workers
Principal Investigator: Catherine Graeve, MPH, BSN – PhD Student
Academic and Research Advisor:  Pat McGovern, PhD – Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
It is estimated that as many as 8 million health care workers have the potential for exposure to antineoplastic drugs, with pharmacists and nurses having the highest incidences of exposure. Studies have documented surface contamination of pharmacy, nursing and patient care areas with antineoplastic drugs and healthcare worker indicators of exposure. Emerging literature has examined how individual and workplace factors influence drug safe handling and found important links in workplace safety climate, barrier reductions and adequate nurse-patient ratios. Our long term goal is to identify key factors that influence compliance with NIOSH’s 2004 Alert addressing recommendations for appropriate engineering controls, procedures and protective equipment to reduce health care workers’ exposures to antineoplastic drugs. This study will adapt and test a research model with oncology nurses and pharmacists for factors affecting potential exposures and expand on the current literature base by developing and testing a solution to the known problem: an effective, research-based intervention to reduce antineoplastic drug exposure.

The study design will be a pre- and post-test of an intervention designed and implemented using the Model for Improvement in three oncology units at Fairview University hospital. The population of 157 employees potentially exposed to antineoplastic drugs will be invited to participate in a survey based upon a theoretical model, “Factors Predicting Use of Hazardous Drugs Safe Handling Precautions (PHDP)” and survey instruments adapted from Dr. Martha Polovich. Exposure to antineoplastic drugs will be assessed using a new technology, “ChemoAlert,” which tests for four agents. Multivariate analyses will be used to evaluate changes in the outcomes of safe handling practices, factors associated with change and chemical contamination of work surfaces. Findings will enhance workplace policies and procedures affecting employee health at this institution and provide a methodology that could be tested and refined in future research at other healthcare systems.

Exposure Assessment of Ergonomic Risks to Office Workers Using Hands-free Computing
Principal Investigator: Adam K. Piper, PhD, CSP

Industrial Engineering Department, South Dakota School of Mines & Technology

Abstract
The paradigm of office computing activities originating with desktop personal computers has evolved substantially over the past 25 years to include large flat-panel displays, small notebook computers, and ultraportable tablets. New commercially available innovations in input technology may evolve this paradigm further. The PCEYE Go device uses eye gaze to control human-computer input, and the MYO armband uses EMG and accelerometry (ACC) to do the same. As when prior computing evolutions entered the marketplace, these new technologies are not well understood with regard to the posture and muscle-use requirements they place on their users. Laboratory researchers and device manufacturers have proposed these devices to workers who have age-related limitations and physical disabilities as alternatives to traditional input technologies. However, since certain postures and muscle activities are associated with musculoskeletal disorder development, it is important to determine if these new input devices increase, decrease or simply alter these exposures. This study proposes to assess the posture and muscle activities of users of these two devices using wearable wireless EMG and goniometer sensors. By profiling the exposure to risky postures and muscle activities of eye gaze tracking and EMG/ACC gesture recognition and comparing them to traditional keyboarding and mousing, the foundation of understanding the ergonomic impact of hands-free computing can be laid. Preliminary guidelines for safe use of these devices and for their potential to offset age-related limitations and physical disabilities will be developed, and the groundwork for a comprehensive future study involving these input devices will be laid.

The Effectiveness of Conducted Electrical Weapon Carriage in Reducing Hospital Staff Injuries
Principal Investigator: Joshua Gramling, MSN – PhD Student
Academic and Research Advisor: Pat McGovern, PhD – Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Health care workers in hospital settings are at increased risk for violent injury relative to all workers in private industry, with employees in the emergency department (ED) and psychiatric areas having the highest risk. While studies have examined the risk factors for violence-related injuries to nurses, physicians, and mental health workers, empirical studies specifically focused on hospital security workers are lacking even though these workers incur the highest rates of these injuries. The primary aim of this study is to determine whether arming security officers with conducted electrical weapons, such as TASERs, decreases risk of violence-related injury to security officers and nursing staff in the ED. Our central hypothesis is that introduction of TASERs will decrease assault injuries to security guards and nursing staff in the ED. Injuries to nursing personnel in the ED will be investigated as this is the primary location in the hospital where security officers proactively intervene with potentially violent patients and thus may deter violence from occurring. Elsewhere in the hospital security officers generally intervene reactively after violence has occurred. Our long-term goal is to decrease violence in hospitals’ emergency departments nationwide.

We will conduct a retrospective cohort study of security and ED nursing personnel at Hennepin County Medical Center from January 1, 2004 to December 31, 2014 using a pre- and post-test evaluation of the introduction of an intervention of arming security guards in the ED with TASERs. The dependent variable is an injury rate; the numerator will be violence-related injuries incurred by each employee and the denominator will be the hours worked by each individual during the pre- and post-TASER phase. Co-variates in the model will include individuals’ years of experience and age, staffing levels per patient in the ED, patient census counts, and the timing of introduction of violence prevention training programs.

Dust and Noise Exposure While Using a Woodworking Mobile Dust Collector
Principal Investigator: Donna J.H. Vosburgh, PhD

Department of Occupational and Environmental Safety and Health, College of Business and Economics, University of Wisconsin-Whitewater

Abstract
This pilot study will assess exposure to wood dust aerosol and noise while using a mobile dust collector to control wood dust aerosol during sawing or sanding wood. Mobile dust collectors have the possibility of providing a solution to small businesses for the problem of high wood dust aerosol exposures. Little is known about the effectiveness of canister filters for mobile dust collectors, and there are currently no studies that look at the noise exposure from using a mobile dust collector. The advantage of using a mobile dust collector over a traditional local exhaust ventilation system is the considerably cost saving for the initial purchase of the equipment and, in climates such as Minnesota, North Dakota, South Dakota, and Wisconsin, the continual energy savings associated with not having to temper replacement air. Before mobile dust collectors can be recommended, research is needed to look at their effectiveness as well as determine if an increase in noise exposure is caused by their use.

This experimental, laboratory study will first develop sampling protocols to assure appropriate personal sample loading. Then sampling with ACCU-CAP samplers will be conducted to determine if the mobile dust collector with a bag filter or the mobile dust collector with a canister filter are effective at reducing exposure to wood dust aerosol. The samples will be collected during the tasks of cutting wood and sanding wood using two types of wood. While the wood dust aerosol samples are collected, noise monitoring will be conducted to determine if using the mobile dust collector causes an increase in noise exposure. This research is expected to show if a relatively cheap mobile dust collection unit is effective in reducing exposure to wood dust and whether they increase the worker’s noise exposure.

Exposure Assessment and Intervention for Reducing Musculoskeletal Stresses and Work-related Injuries among Allied Health Professionals in Surgical Care
Principal Investigator: Denny Yu, PhD
Faculty Mentor: Susan Hallbeck, PhD
Co-Investigator: Nirusha Lachman, PhD

Mayo Clinic

Abstract
Performance, health, and safety can be compromised when workload demands exceeds individual’s capability on the surgical team. However, most studies have focused on quantifying and addressing surgeon’s workload and limited studies have quantified workload for the other surgical team members. The proposed research aims to quantify full-day work exposures on allied health professionals in surgical care (e.g., scrub nurses, surgical assistants, and circulating nurse) and translate ergonomics knowledge into surgical assistant training and clinical practice to reduce musculoskeletal injuries and fatigue that can impact the safety of both patients and allied health professionals. The proposed study advances occupational health and safety innovation by A) being one of the first studies to quantify whole-body biomechanics and operating room workflow of surgical allied health professionals to construct detailed full-workday exposures to musculoskeletal risk factors, and B) designing, applying, and evaluating new user-centered wireless wearable vibrotactile devices that can provide postural feedback during surgical assistant training and clinical practice for reducing musculoskeletal fatigue and injuries in the workplace.

Pilot Intervention Study to Reduce Chemical Exposures of Beauty Salon Professionals
Principal Investigator: Susan Arnold, MSOH, CIH – PhD Student
Academic and Research Advisor: Gurumurthy Ramachandran, PhD – Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
An estimated 1.45 million Beauty Salon Professionals (BSP) in the U.S., most of them in hair and nail salons are potentially exposed to a wide range of chemicals while working with professional formulations of personal care products. While these chemicals have been associated with assorted adverse health outcomes such as asthma, dermal sensitization and cancer, exposure profiles for this cohort remain poorly characterized and thus limit the ability of concerned health professionals and BSP to develop effective exposure reduction strategies. There is a need to develop exposure assessment tools to predict these exposures before they occur and translate the information from the tools into interventions that reduce BSP exposures. Exposure modeling, which has been shown to improve decision making across a broad range of domains, provides a systematic and transparent approach for making exposure judgments and enables predictions about exposures before they occur. We propose to conduct a pilot exposure assessment to assess BSP exposures to chemicals found in professional formulations of personal care products using novel methods, characterizing their exposure profiles and compare the measured exposures to the modeled exposures generated from three candidate models. We further propose to develop training materials based on the outcome of the exposure assessment, conduct an intervention and evaluate its effectiveness on reducing the BSP exposures by conducting a follow up assessment. The Concerned Beauty Professionals (CBP) is a membership organization of licensed cosmetologist (CS), estheticians (ES), nail technicians (NT) and barbers (BA) who desire to have additional training and education to maintain their safety and the safety of the clients that they serve, and has expressed the desire to collaborate with us. This work will generate at least one manuscript to be submitted to a top-tier journal and support the development of a larger grant application seeking more substantial funding.

Pilot Study to Assess the Quantitative Dermal Transfer Efficiencies of Solids for Multiple Transfer Pathways
Principal Investigator: Jennifer Sahmel, MPH, CIH, CSP – PhD Student
Academic and Research Advisor: Gurumurthy Ramachandran, PhD – Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Exposure assessment modeling is an important tool for occupational health professionals in the absence of measured data for individual exposure scenarios in the workplace. As occupational inhalation hazards to chemicals and other substances of concern are progressively identified and mitigated, dermal exposures are increasingly of greater relative concern in workplaces where exposures could occur to substances with the potential to remain on surfaces or the skin of workers. A number of models have been developed to help improve the characterization of the dermal exposure pathway to substances of concern in the workplace. These models have identified the potential importance of contact and subsequent transfer of substances of concern to and from the skin surface. This quantitative transfer has been hypothesized to occur through a number of different pathways and compartments, including: object(s) to skin, skin to skin, clothing to skin, gloves to skin, air to skin, skin to lips, and skin to saliva. However, many of these identified compartments with the potential for dermal transfer have been only minimally studied to determine the potential for measurable transfer of substances between each of these compartments. Further, the comparative transfer efficiency between the different compartments has not been well characterized. As a result, few data are available to inform the relative importance of each compartment in terms of accurately estimating dermal exposure potential, despite the possibility for significant impact to workers from dermal exposure by these different compartments. We propose to conduct a pilot study on several substances in the solid form using a systematic series of measurements with human subjects to quantitatively characterize dermal transfer efficiency for each identified compartment. We also propose to construct a probability distribution for each measured transfer pathway so that the inputs to these important dermal exposure assessment models can be further validated and refined.

Acetaldehyde-derived DNA Adducts for the Investigation of Alcohol Hangover
Principal Investigator: Sylvia Balbo, PhD

Masonic Cancer Center/Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Alcohol Hangover is represented by a variety of adverse effects experienced after alcohol consumption and after alcohol has been eliminated from the blood. These symptoms may coincide with compromised cognitive performance, which can affect negatively daily activities such as driving and working, ultimately leading to work impairment and increased risk of injury and other adverse events. The underlying mechanisms explaining the biological origin of hangover are not well understood. Overall, research on alcohol hangover has been neglected in comparison to what has been done in the field of acute and chronic alcohol effects. The lack of tools to allow for more rigorous studies of hangover effects and, in particular, lack of biomarkers to help assess these effects in a more accurate and quantitative manner, may have contributed to the paucity of significant results from hangover studies. Acetaldehyde, the major metabolite of ethanol, is believed to play a role in contributing to hangover effects. Acetaldehyde has been proven to induce DNA damage in the oral cells of individuals exposed to alcohol. This proposal aims at investigating the potential use of a specific acetaldehyde-derived DNA modification: N2-ethylidene-dG as potential marker of alcohol hangover effects. Healthy volunteers (18) will be recruited to participate to a drinking session where they will be administered an alcoholic beverage to reach a blood alcohol level of 0.11%, usually inducing alcohol hangover. We will investigate the persistence of N2-ethylidene-dG at various time-points before and after the dose and we will investigate how the levels of this adduct correlate with the severity and persistence of the hangover effects. Finding tools to improve the investigation of the effects of alcohol hangover is crucial to convince policy makers of the profound impact of alcohol hangover on daily activities and thus ultimately on prevention of injury and other adverse effects.

The Role of Electrical Effects between Surfactant Sprays and Particles on Respirable Dust Control
Principal Investigator: Mei Wang, MS – PhD Student
Academic and Research Advisor: Peter Raynor, PhD – Associate Professor

Division of Environmental Health Sciences, School of Public Health, University of Minnesota

Abstract
Modern dust control technologies, such as water-based sprays, are used to reduce coal dust levels in underground coal mines. However, respirable coal dust concentrations frequently exceed federal standards. Recent studies found that surfactant-containing droplets carry different charges depending on surfactant type. Therefore, the electrical effects between charged surfactant-containing spray droplets and dust particles may enhance dust collection.

The long-range goal of the proposed study is to reduce the concentration of respirable coal dust in coal mines. The near-term objective is to measure the electrical charge distribution of spray droplets containing different surfactants. Three types of surfactant — anionic, cationic, and nonionic — will be used to make both high and low concentration surfactant solutions. The effects of surfactant type and concentration on droplet net charge will be determined statistically using a two-way analysis of variance. These data will eventually be combined with particle collection efficiency measurements to determine the impact of spray charge on efficiency. The proposed study will take one year to complete.

Characterizing Burden of Injury and Illness in Minnesota Animal Agriculture Workers
Principal Investigator: Andrew Whitman, PhD

Carlson School of Business, University of Minnesota

Abstract
Animal agriculture is an important and growing industry in the Minnesota and across the Upper Midwest. Agriculture is recognized as one of the most hazardous industries and working with animals has specific hazards. Prevention efforts, however, are hampered by lack of data to characterize the problem, to entice stakeholders into collaborations, and to evaluate prevention programs. The long-term goal of this project is to use worker compensation and other data to direct injury prevention efforts in animal agriculture. The proposed research will engage the Minnesota Worker Compensation Insurance Association (MWCIA) to:

1. Characterize the available MWCIA data on animal agriculture operations to identify compensable (time-loss) claims, medical only claims, and disability claims.
2. Estimate the number of each type of claim, worker population at risk, and various costs associated with the claim and
3. Summarize baseline data to engage stakeholders in efforts to promote animal agriculture worker health and safety in Minnesota.

To meet these aims we will work with MWCIA to understand how the Minnesota worker compensation data can be used in a public health model. Using reported claims and denominators estimated from payroll data, we will estimate the rate of injury and illness within and between specific sectors of animal agriculture. The costs of the claims and attendant disability will be characterized. The results will be used to engage stakeholders in agriculture to explore avenues for prevention and additional research.

Assessment of Injury Impact on Non-Industry Workers in Countries with Increased Oil and Gas Extraction
Principal Investigator: Tracy Miller, MPH

Division of Disease Control, North Dakota Department of Health

Abstract
The North Dakota Department of Health is looking for an opportunity to further determine the impact that oil and gas extraction is having on not only industry employees but all employees in oil country. We plan to focus on insurance claims data to look for pattern in injuries among the non-industry employees such as hotel aids, road and construction workers, restaurant works, and healthcare personnel. The purpose of this portion is to assess the impact that the oil industry (high paying positions) has on the health and wellness of the non-industry work force (typically lower paying jobs). We will be focusing on surveillance objectives related to fata and non-fatal occupational injuries. Industry partners and agencies within the health department have indicated that there is a need for the analysis of this data in order to gain perspective on where intervention focuses should be targeted.

An Assessment of Firefighter’s Exposure to Toxic Materials
Principal Investigator: Stefan Saravia, MPH

Public Health Laboratory Division, Minnesota Department of Health

Abstract
Firefighters face hazards every day when conducting their job. The risk of getting trapped in a burning building or falling from a ladder is obvious, but there are many unseen hazards as well. Firefighters are exposed to a wide variety of toxic materials related to the burning of building contents. Researchers from the Minnesota Department of Health, Public Health laboratory plan to evaluate these risks by analyzing the air around fires and the surfaces that these individuals come in contact with for a panel of toxic elements, semi-volatile and volatile compounds. The researchers will attend training fires where they will collect air samples from individuals and areas around the fire. These samples will be used to determine exposures associated with specific tasks and will help group the firefighters into similar exposure groups. They will also conduct air sampling of the inside of fire stations an surface sampling of firefighting equipment to determine if toxic materials are brought back to the fire station after fighting a fire.

Comparison of Exposures to Diesel Exhaust from Airport Maintenance and Emergency Vehicles with and without Diesel Oxidation Catalysts
Principal Investigator: Dawn Errede, PhD
Co-Investigator: John Snawder, PhD

Metropolitan Airports Commission

Abstract
In 2012, Diesel engine exhaust was classified as carcinogenic to humans. We propose to investigate differences in exposure to diesel exhaust between two groups of airport workers. The first uses vehicles for airport field maintenance with diesel oxidation catalysts (DOCs) installed in the exhaust systems. The second group uses emergency response vehicles with unmodified exhaust systems. Our hypothesis is that workers using diesel vehicles with unmodified exhaust systems will have higher exposures than workers using vehicles retrofitted with DOCs. We will sample for diesel particulate matter, polynuclear aromatic hydrocarbons (PAHs) and nicotine (due to potential interference from exposure to cigarette smoke). The MAC will also use an existing real-time particle counter and datalogger to characterize ultrafine particle concentrations in many of these sampling locations. For samples, such as semivolatile PAHs, where temperature and humidity levels are important, the MAC will use an existing air quality monitor and datalogger to record this information simultaneously with sample collection.

Biomarkers of Furan Exposure and Bioactivation
Principal Investigator: Lisa Peterson, PhD – Professor

Masonic Cancer Center, University of Minnesota

Abstract
Furan is a product of incomplete combustion and is a gas phase component of cigarette smoke, wood smoke and exhaust from diesel and gas engines. In rodents, furan is a potent liver toxicant and carcinogen. Assessments of the human health risks associated with furan exposure have been stymied by the lack of appropriate exposure and metabolism biomarkers. Furan’s toxicity requires metabolism to reactive intermediate, cis-2-butene-1, 4-dial (BDA). BDA is toxic and mutagenic. The major urinary metabolites of furan in rodents are derived from degraded BDA-protein adducts. Human hepatocytes produce the same metabolic products as rodent hepatocytes; therefore, the BDA-derived metabolites are expected to appear in the urine of humans exposed to furan. In addition, since BDA is a toxic molecule, the ability of humans to generate this compound in vivo will indicate that they may be susceptible to the harmful effects of furan. The specific objectives of this pilot project are 1) to develop sensitive LC-MS/MS assays for the detection of furan metabolites in urine and 2) to apply these assays to determine if the levels of these metabolites are higher in smokers relative to nonsmokers. We have chosen this particular population because smokers are known to be exposed to significant amount of furan in tobacco smoke. Once we establish that humans convert furan to the expected metabolites, we can apply these assays to determine if workers who come in contact with high levels of wood smoke or diesel or gas engine exhaust are being exposed to furan. Since these biomarkers are not only a measure furan exposer but are also a measure of bioactivation, they can be applied to determine if furan exposure and metabolism are linked to adverse human health effects in these work environments.

Health Risk Assessment of Occupational Exposure to Hazardous Volatile Organic Compounds in Swine Production Sites
Principal Investigator: Neslihan Akdeniz, PhD

Department of Bioproducts and Biosystems Engineering, University of Minnesota

Abstract
The Environmental Protection Agency’s most recent data indicated that 95% of the U.S. citizens face an increased likelihood of developing cancer or other serious illnesses as a result of breathing hazardous air pollutants (HAP). Over the last decade, a number of studies have been conducted to treat hazardous volatile organic compound (VOC) emissions from industrial and mobile sources. Another significant source of hazardous VOCs is livestock production sites. So far, all studies about the livestock production sites have focused on the VOCs that cause odor problems. Currently, there are no solid data about the hazardous VOC concentrations of animal production sites and the level of risk that threaten individuals who work in livestock buildings.
The research proposed herein will assess health risk of occupational exposure to hazardous VOCs at a commercial swine production site. This site will be visited three times and VOC samples will be collected from three representative swine production rooms (sow gestation, farrowing, and nursery) and a representative ambient location. Concentrations of 12 different VOCs (acetaldehyde, formaldehyde, benzene, toluene, ethyl benzene, o-xylene, pxylene, m-xylene, phenol, o-cresol, m-cresol, p-cresol) will be measured. Measured VOC concentrations will be compared to their recommended exposure limits. Cumulative cancer and hazard risks of the VOCs will be calculated as described in U.S. Environmental Protection Agency (EPA) standards. Preliminary data from previous studies shows that pcresol concentrations inside gestation barns may exceed its recommended exposure limits and the workers exposed to this VOC may have serious long term health problems. If the health risk of the hazardous VOCs is found to be high, the results of this project will be used to develop a new proposal to develop mitigation technologies of these hazardous VOC emissions from livestock facilities.

The Application of the Universal Nanoparticle Analyzer for the Real-Time Measurement of Nanoparticles in the Workplace
Principal Investigator: Drew Thompson, MS – PhD Student
Academic and Research Advisor: David Pui, PhD

Department of Mechanical Engineering, University of Minnesota

Abstract
Engineered nanoparticle-enabled nanotechnology is experiencing unprecedented growth. With this comes greater opportunity for workers to be exposed to nanomaterials which some toxicological studies have shown to be hazardous. There is clear need for the monitoring of this potential worker exposure. The purpose of the proposed research will be to extend the capabilities of the recently developed Universal Nanoparticle Analyzer (UNPA) for use in occupational nanoparticle exposure measurements. The UNPA consists of a differential mobility analyzer (DMA), a condensation particle counter (CPC), and a Nanoparticle Surface Area Monitor (NSAM). In the UNPA monodisperse nanoparticles are simultaneously measured by a CPC and NSAM, which measure particle number concentration and lung-deposited surface area concentration, respectively. The ratio of these two measures, coined the UNPA sensitivity, can be used to characterize the morphology of nanoparticles. The instrument has already been demonstrated to be well suited for process control in nanomaterial manufacturing. In this pilot project the potential use of the UNPA in nanoparticle exposure measurements will be investigated. There are three goals of this pilot project. One, relate UNPA sensitivity to parameters frequently used in toxicology studies, the mass concentration and BET surface area. Two, evaluate the UNPA response to nanoparticles which are heterogeneous in shape. Three, operate the UNPA in a scanning mode, by varying the voltage in the DMA, to allow for the simultaneous measurement of size distributions, surface area distributions, and UNPA sensitivity distributions. The proposed project would be of interest to researchers in nanomaterial occupational health and safety, nanotoxicology, aerosol instrumentation, and aerosol physics and would allow future opportunities for research in occupational nanoparticle exposure measurement, particle charging modeling, and instrument development.

Using Biometrically Adaptive Ergonomics to Accommodate Workers with Disabilities
Principal Investigator: Adam Piper, PhD
Co-Investigator: Dean H. Jensen, PhD

Industrial Engineering Department, South Dakota School of Mines & Technology

Abstract
Biometrics is a growing research area that focuses on recognition of individuals by certain identifiable characteristics such as fingerprints, retinas, voices or signatures. Currently, much of this technology is focused on security applications associated with keeping legitimate or illegitimate persons in or out of sensitive locations. However, there is also great opportunity to utilize biometrics for ergonomic benefit by recognizing and automatically adjusting workstation characteristics to match individual needs. With the passage of the ADA Amendments of 2008, there is a renewed focus on disability accommodation in employment and a growing number of individuals for which accommodations will be needed. There is more need than ever to develop means of accommodating physical disabilities in a reliable and easy-to-use manner to ensure that the full breadth of disabled Americans are properly accommodated. This study proposes the development of a biometrically adaptive manufacturing workstation in the Manufacturing Innovation and Learning Laboratory at the South Dakota School of Mines and Technology that will adjust to the swipe of a finger, the voice of a user, etc. to ensure that individual accommodation needs (disability-related or merely for proper ergonomics) are met quickly and reliably without the user or other staff needing to make repeated physical changes to the workstation. The proposed research study will pilot test the usability of this workstation by inviting the students routinely using this equipment for pedagogical purposes to provide feedback on the usability and reliability of the biometrics systems, the accommodation prototype designs, and the likelihood of activating the accommodations every time the workstation is used. In addition, best practices guidelines will be published for implementing biometrics for accommodating workers in manufacturing, and future research proposals will follow once this functional biometrics adaptive workstation has been constructed and tested.

Advanced Vehicle-Based Driver Support System for Emergency Vehicle Detection
Principal Investigator: Chris Drucker, MS – PhD Student
Academic and Research Advisor: Michael Manser, PhD

Department of Mechanical Engineering, University of Minnesota

Abstract
Among emergency medical services personnel (EMSP), the fatality rate for transportation-related events, which is the leading cause of death for this occupation, is approximately four times greater that the United States (US) national average occupationally-related transportation fatality rate. The National Occupational Research Agency (NORA) Public Safety Council has targeted this public health issue within the National Agenda by developing strategic goals to reduce vehicle-related traumatic injuries and fatalities in fire fighters, police officers and emergency medical technicians (EMT) by the end of the ten year (2006-2016) agenda period. The most current Census of Fatal Occupational Injuries data indicates trends in different directions for vehicle-related fatalities based on the type of emergency medical services occupation. The goal of this pilot project is to investigate the degree to which the use of an advanced vehicle-based driver support system that provides warnings can influence the behaviors of drivers who are being approached by emergency vehicles. The objective of the driver support system is to provide advance warning to drivers in order to prevent or mitigate fatal crashes with emergency vehicles, ultimately preserving the lives of the emergency medical services personnel and civilian motor vehicle operators and passengers. This pilot project has the opportunity to directly address the National Agenda in addition to serving as a basis for further research with the Department of Transportation National Highway Traffic Safety Administration’s Vehicle-to-Vehicle and Vehicle-to-Infrastructure Communication for Safety initiative.

Farm Mapping to Assist, Protect and Prepare Emergency Responders
Principal Investigator: Matthew Keifer, MD, MPH

National Farm Medicine Center, Marshfield Clinic Research Foundation

Abstract
This feasibility project explores using Quick Response tags (QR codes) to provide emergency responders on-site information about hazards and physical layouts of agricultural operations. The project will develop model system for farmers to input data such as locations of chemicals, solvents, fuels and other hazards, where power and gas cut-off valves and water sources are and where farming operations occur. These data will be linked to QR tags attached to easily accessible sites, where emergency responders may read them. The QR code, when read by the responder will lead to a securitized website where the farm information is stored. This will assist in fighting a fire, rescuing a victim while permitting emergency responders to avoid injury from explosions, chemicals, electrical or other on farm hazards. This Marshfield Bioinformatics group project will develop a secure online system for farm data storage, and the QR linking method and the Computer Usability Laboratory at the Marshfield Clinic Research Foundation will test and improve the functionality of the data collection interface. The National Farm Medicine Center will work with the Pittsville Fire department to test the usability of this system by first responders. This project is one of a suite of projects designed to apply QR tags to great advantage in rural and agricultural health and safety settings. Following this proof of concept project, using funding from other sources, we will explore the ability and willingness of farmers to list their larger equipment, and will develop a controlled trial which will compare the efficacy of two or three methods for recruiting farmer participation in farm map preparation and will improve on the tools developed by the pilot project.

Regulating the Unknown: Ensuring Health and Safety of Research Personnel Working with Novel Nanotechnologies and Materials
Principal Investigator: Ozlem Ersin, MBS

College of Pharmacy, University of Minnesota

Abstract
Novel products and emerging technologies push the limits of current regulatory processes. The as-of-yet unknown health and safety risks associated with novel materials and technologies pose a potential threat to faculty, students, and technicians in research institutions who work with novel materials and technologies even before their commercialization and subsequent regulation. Academic institutions are grappling with how best to ensure occupational health and safety of research personnel, yet not stifling creativity and innovation. The goal of this pilot case study is to examine efforts at a Carnegie Classification Research University (RU/VH) institution in the Midwest as its Institutional Biosafety Board deliberates on oversight of nanotechnology research on campus. The aims of this pilot study are (1) to increase the knowledge-base of the field of occupational health and safety, (2) to draw attention to a problem that has received little attention in literature, and in practice, and (3) to document institutional best practices for the benefit of other institutions and industry members. Understanding how this particular institution ensures that occupational health and safety of those under its umbrella as they conduct research on nanotechnologies will have important policy and practice implications for other research entities.

Cultural Competency Assessment of Occupational Health Nurses
Principal Investigator: Wendy Kvale, MPH, MS, RN
Co-Investigator: Patricia McGovern, PhD, MPH, RN – Professor

Minnesota Department of Health

Abstract
The work force demographics are changing and becoming more diverse in the United States. Work is being accomplished through global networks from around the world. Occupation health nurses are critical to promoting health and safety as well as decreasing occupational disease and injury through systems and policies, as well as working directly with employees. Cultural beliefs and practices at the organizational and individual levels are key to define, promote and maintain health and well-being within all populations. Health care workers and services that are culturally competent contribute to decreased health disparities, increased productivity and a competitive edge in the marketplace. Cultural competence is required for meeting legislative and regulatory mandates. However, cultural competence training for occupational health nurses has been very limited. Cultural competency levels have not been assessed for occupational health nurses. The Cultural Competency Assessment of Occupational Health Nurses Cross-sectional study will administer a voluntary online self-assessment to a convenience sample of occupational health nurses and graduate students to assess for cultural sensitivity and awareness, behaviors and overall cultural competency. Data will be analyzed for associations between level of cultural competency and age, years of practice, prior competency training, level of education and diversity experience in bivariate and multivariate analyses. This study will highlight the topics and need for more training and research to contribute to the ongoing development of cultural competency of occupational health nurses.