Strength Test for Pre-ROPS Tractor Axle Housings

SUMMARY

Tractor rollovers are a major cause of farm-related deaths. A rollover protective structure (ROPS) dramatically reduces fatalities during tractor overturns. However, pre-ROPS (before ROPS were available) tractor axle housings were not designed to support the ROPS. This paper presents the strength test investigating pre-ROPS tractor axle housings, evaluating their suitability for accepting reliable ROPS. The factor of safety between longitudinal yield torque of the axle housing and the maximum torque subjected during ASAE S519 longitudinal static test is determined. The relationship between twisting angle and torque of the axle housing is established. The results show that a particular pre-ROPS axle housing can successfully support the ROPS with a safety factor of about two. The test was conducted in accordance to ASAE Standard S519 on a single axle housing.     

ROPS Design for Pre-ROPS Tractors

SUMMARY

Tractor overturns are the leading cause of agricultural fatalities in the United States. Many of these fatalities could be prevented if the tractor was equipped with a rollover protective structure (ROPS). Of the estimated 4.8 million tractors, 2.8 million are considered pre-ROPS tractors (tractors that were designed prior to ROPS availability).¹ This project involves the design, construction and testing of ROPS for pre-ROPS tractors. Testing was successfully conducted with Ford and John Deere pre-ROPS tractors. Current testing involves a Farmall pre-ROPS tractor.

The ASAE Standard S519 is utilized for the testing. Static longitudinal (rear), transverse (side) and vertical (top) tests are conducted in addition to field upset testing. Tractors are equipped with remote controls to perform side and rear field upset tests. Axle housing drawings have been obtained from the tractor manufacturer to assist the ROPS and axle mounting design process. Commercialization of the ROPS is in progress with a ROPS manufacturing company.     

Hodgkin Lymphoma and Pesticides Exposure in Men: A Canadian Case-Control Study

ABSTRACT

Tractor overturns are the leading cause of work-related death in an industry with the highest occupational fatality rate. Rollover protective structures (ROPS) and seatbelts are 99% effective in reducing the risk of an overturn fatality. However, kits are not available for 20% of tractors currently lacking ROPS. For these tractor owners, two potential solutions have been discussed: (1) technology for reinforcing tractor axles to accommodate ROPS and (2) a pre-ROPS tractor removal program. The purpose of this study was to conduct preliminary research to assess the feasibility of a tractor trade-in program. Focus groups were conducted with pre-ROPS tractor owners and tractor dealers. The data were analyzed using a concept development analytical approach and results were reviewed in an industry stakeholder's workgroup session. Data from the research indicates that tractor owners and dealers would need persuasive financial incentives to participate in a trade-in program. The workgroup session also indicated that it would be difficult to fund or support a large-scale initiative, and the economics of removing a large group of older tractors from the marketplace may exacerbate financial roadblocks. However, the data from this study could be used to pilot test a small-scale, focused, tractor buy-back program.     

Action Learning: A New Method to Increase Tractor Rollover Protective Structure (ROPS) Adoption

ABSTRACT

Action Learning is a problem-solving process that is used in various industries to address difficult problems. This project applied Action Learning to a leading problem in agricultural safety. Tractor overturns are the leading cause of fatal injury to farmworkers. This cause of injury is preventable using rollover protective structures (ROPS), protective equipment that functions as a roll bar structure to protect the operator in the event of an overturn. For agricultural tractors manufactured after 1976 and employee operated, Occupational Safety and Health Administration (OSHA) regulation requires employers to equip them with ROPS and seat belts. By the mid-1980s, US tractor manufacturers began adding ROPS on all farm tractors over 20 horsepower sold in the United States (http://www.nasdonline.org/document/113/d001656/rollover-protection-for-farm-tractor-operators.html). However, many older tractors remain in use without ROPS, putting tractor operators at continued risk for traumatic injury and fatality. For many older tractor models ROPS are available for retrofit, but for a variety of reasons, tractor owners have not chosen to retrofit those ROPS. The National Institute for Occupational Safety and Health (NIOSH) attempted various means to ameliorate this occupational safety risk, including the manufacture of a low-cost ROPS for self-assembly. Other approaches address barriers to adoption. An Action Learning approach to increasing adoption of ROPS was followed in Virginia and New York, with mixed results. Virginia took action to increase the manufacturing and adoption of ROPS, but New York saw problems that would be insurmountable. Increased focus on team composition might be needed to establish effective Action Learning teams to address this problem.     

Non-Fatal Tractor Accidents and Their Prevention

SUMMARY

Non-fatal tractor accidents are often quite serious, resulting in disability for an average period of 26 days. The most common injuries are strains and sprains of the lower limbs and contusions of the limbs. In this study, the incidence of non-fatal tractor accidents was found not to be very high, but there are certain jobs that are relatively dangerous where tractors are used. These include dismounting and mounting the tractor, and coupling and uncoupling implements. The most dangerous work phases can be made safer with traditional countermeasures, e.g., by developing ergonomic and engineering solutions for safety and by educating tractor users. However, more emphasis in research and consulting should be put on improving safety management on farms, because the quality of management defines the safety of operation.     

Longitudinal tobit regression: A new approach to analyze outcome variables with floor or ceiling effects

BackgroundIn many epidemiologic longitudinal studies, the outcome variable has floor or ceiling effects. Although it is not correct, these variables are often treated as normally distributed continuous variables.ObjectivesIn this article, the performance of a relatively new statistical technique, longitudinal tobit analysis, is compared with a classical longitudinal data analysis technique (i.e., linear mixed models).Study Design and SettingThe analyses are performed on an example data set from rehabilitation research in which the outcome variable of interest (the Barthel index measured at on average 16.3 times) has typical floor and ceiling effects. For both the longitudinal tobit analysis and the linear mixed models an analysis with both a random intercept and a random slope were performed.ResultsBased on model fit parameters, plots of the residuals and the mean of the squared residuals, the longitudinal tobit analysis with both a random intercept and a random slope performed best. In the tobit models, the estimation of the development over time revealed a steeper development compared with the linear mixed models.ConclusionAlthough there are some computational difficulties, longitudinal tobit analysis provides a very nice solution for the longitudinal analysis of outcome variables with floor or ceiling effects.     

An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals

Objective

Development of an aggregate quality index to evaluate hospital performance in cardiovascular events treatment.

Methods

We applied a two-stage regression approach using an accelerated failure time model based on variance weights to estimate hospital quality over four cardiovascular interventions: elective coronary bypass graft, elective cardiac resynchronization therapy, and emergency treatment for acute myocardial infarction. Mortality and readmissions were used as outcomes. For the estimation we used data from a statutory health insurer in Germany from 2005 to 2016.

Results

The precision-based weights calculated in the first stage were higher for mortality than for readmissions. In general, teaching hospitals performed better in our ranking of hospital quality compared to non-teaching hospitals, as did private not-for-profit hospitals compared to hospitals with public or private for-profit ownership.

Discussion

The proposed approach is a new method to aggregate single hospital quality outcomes using objective, precision-based weights. Likelihood-based accelerated failure time models make use of existing data more efficiently compared to widely used models relying on dichotomized data. The main advantage of the variance-based weights approach is that the extent to which an indicator contributes to the aggregate index depends on the amount of its variance.

     

On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure,Timing of Assessment,Women’s Characteristics and Outcome of Pregnancy

Objectives

Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention.

Methods

We compared the test–retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher’s exact tests, and calculated odds ratios to estimate effect size.

Results

The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51–0.66); the DHS had moderate reliability (0.56–0.58). The LMUP’s stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p?=?0.033), number of children (p?=?0.048) and postnatal depression (p?<?0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy.

Conclusions for Practice

The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.

     

Integrating Cost-effective Rollover Protective Structure Installation in High School Agricultural Mechanics: A Feasibility Study

ABSTRACT

This study with three Appalachian county agricultural education programs examined the feasibility, effectiveness, and impact of integrating a cost-effective rollover protective structure (CROPS) project into high school agricultural mechanics classes. The project aimed to (1) reduce the exposure to tractor overturn hazards in three rural counties through the installation of CROPS on seven tractors within the Cumberland Plateau in the east region; (2) increase awareness in the targeted rural communities of cost-effective ROPS designs developed by the National Institution for Occupational Safety and Health (NIOSH) to encourage ROPS installations that decrease the costs of a retrofit; (3) test the feasibility of integration of CROPS construction and installations procedures into the required agricultural mechanics classes in these agricultural education programs; and (4) explore barriers to the implementation of this project in high school agricultural education programs. Eighty-two rural students and three agricultural educators participated in assembly and installation instruction. Data included hazard exposure demographic data, knowledge and awareness of CROPS plans, and pre-post knowledge of construction and assessment of final CROPS installation. Findings demonstrated the feasibility and utility of a CROPS education program in a professionally supervised secondary educational setting. The project promoted farm safety and awareness of availability and interest in the NIOSH Cost-effective ROPS plans. Seven CROPS were constructed and installed. New curriculum and knowledge measures also resulted from the work. Lessons learned and recommendations for a phase 2 implementation and further research are included.     

Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios

Objectives: Tractors are a source of injury and fatality in agriculture. Despite this farmers continue to engage in risk-taking behaviors, including operating tractors without appropriate equipment. In order to change behaviors and attitudes toward safety, it is important to understand how farmers approach different types of risk relevant to tractor use. The current study used a qualitative approach to investigate farmer perception of four types of tractor-based risk related to self, equipment, lack of safety features, and environment.

Method: A sample of 148 farmers from the United Kingdom and Ireland was recruited from farming forums to take part in an online scenario-based qualitative study. Participants were presented with 12 tractor-based scenarios, three from each category of risk, and asked to indicate if they would proceed to use the tractor (go) or not (no-go), then report their reasoning. Thematic analysis was used to identify data patterns.

Results: Farmers appeared to assess the consequences of risk in broader terms than the risk of injury to themselves; they also evaluated risk in terms of potential costs (e.g., repair bill) and losses (e.g., delay). Analysis indicated that financial risk was considered with more caution than personal risk in many cases. Farmers also considered usability, such as the functionality of tractor seat belts, indicating the importance of ensuring all safety equipment is fit for purpose.

Conclusion: The management of agricultural risk should consider farmer priorities (such as financial costs) in order to develop effective messaging that focuses on those priorities, with the aim of reducing risk-taking behaviors.     

Risk factors of chronic childhood malnutrition: an analysis of the Bangladesh demographic and health survey 2014 data

Aim

In Bangladesh, 36% of children under the age of 5 are moderately or severely stunted, impeding the country’s overall public health outcomes. Some differences have been found in the associations of risk factors and two forms of stunting; therefore, investigating why these differences exist is necessary. This study aimed to determine the prevalence and risk factors for moderate and severe stunting in Bangladeshi children < 5 years old.

Methods

Bangladesh Demographic and Health Survey 2014 (BDHS 2014) data were analyzed in this study; the information of 7131 mother-child pairs was available. Height-for-age z-scores (HFAz) according to the World Health Organization (WHO) 2006 growth standards were used to define moderate (HFAz <?2 SD) and severe stunting (HFAz<?3 SD). The associations between selected independent factors and nutritional status were assessed using chi-square tests, and potential risk factors were explored using multiple multinomial logistic regression analyses.

Results

The multinomial analysis demonstrated that child age (0–11 months), small size at birth, fever and diarrhea within 2 weeks before the survey, maternal height?≤?145 cm, and maternal body mass index (BMI) ≤18.50 kg/m² were significant risk factors for both moderate and severe childhood stunting. The area of residence (rural), mother’s exposure to television, father’s engagement in agricultural work, and residence in Chittagong and Sylhet were associated with severe stunting, whereas residence in Rajshahi, maternal BMI (18.51–25.00 kg/m²), and maternal primary or secondary education level were associated with moderate stunting.

Conclusion

A low number of children under the age of 5 had fever and diarrhea, but these factors were significantly associated with developing moderate or severe stunting and demand further study. Along with ongoing nutritional programs, the government should make comprehensive targeted efforts to change the nutritional status of mothers and children.

     

Psychometric evaluation of the Finnish version of the impact on participation and autonomy questionnaire in persons with multiple sclerosis

Objective: The objective of this study was to evaluate the psychometric properties of the impact on participation and autonomy (IPA) questionnaire. The Finnish version of IPA (IPAFin) was translated into Finnish using the protocol for linguistic validation for patient-reported outcomes instruments.

Methods: A total of 194 persons with multiple sclerosis (MS) (mean age 50 years SD 9, 72% female) with moderate to severe disability participated in this study. A confirmatory factor analysis (CFA) was used to confirm the four factor structure of the IPAFin. The work and educational opportunities domain was excluded from analysis, because it was only applicable to 51 persons. Internal consistency was investigated by calculating Cronbach’s alpha.

Results: CFA confirmed the construct validity of the IPA (standardized root mean square residual (SRMR)?=?0.06, comparative fit index (CFI)?=?0.93, Tucker–Lewis index =0.93, root mean square error of approximation (RMSEA)?=?0.06), indicating a good fit to the model. There was no difference in the models for females and males. Cronbach’s alpha for the domains ranged between 0.80 and 0.91, indicating good homogeneity.

Conclusions: The construct validity and reliability of the IPAFin is acceptable. IPAFin is a suitable measure of participation in persons with MS.     

Reflections on technologies for studying children and media

ABSTRACT

There is a great opportunity for modern technologies to advance research on children and media. Noninvasive data collection and analysis of a large variety of behaviors and bodily functions are becoming more possible, affordable, and useable with children. These include brain imaging, genetic and epigenetic analysis, hormonal assays, eye tracking, actigraphy, point of view video recording, content analysis, and language analysis. The possibilities for entirely new perspectives and forms of knowledge are exciting and growing.     

Preliminary Ergonomic Evaluation of Barn Tasks in Intensive Swine Production

ABSTRACT

This exploratory pilot study analyses musculoskeletal symptoms and working exposures of intensive pig barn tasks. Methods included a questionnaire phase to gather information about workers’ symptoms and video analysis to assess exposures during typical production tasks. Ninety-two percent of workers reported symptoms in the last 12 months in any body part; 58% reported interruption of work activities in the last 12 months. The task “moving dead pigs” exceeded 3400 N during 6 of 18 observations. Frequency of hand gripping and trunk bending >45 degrees were moderate to high in many tasks. These biomechanical exposures suggest a need for further study, particularly on interventions to limit bending, lifting, and repetitive gripping.     

Depressive Symptoms in Adolescence: A Poor Indicator of Increases in Body Mass Index

PurposeThe purpose of this study was to examine the association between depressive symptoms and subsequent body mass index (BMI) z scores among early-to-mid adolescents, extending previous research by using objectively measured weight and height data.MethodsLatent growth curve analysis was used to examine whether growth parameters of zBMI could be predicted by depressive symptoms (n = 2,051 adolescents, 48.5% female, at baseline; 1,465 with data at all three time points). Specifically, we tested whether depressive symptoms were associated with the initial assessment of BMI (intercept) as well as with changes in BMI over time (slope). Analyses were performed for the total group, and separately for boys and girls.ResultsDepressive symptoms were not associated with the slope of zBMI. In girls, but not boys, depressive symptoms were positively associated with the intercept of zBMI.ConclusionsFindings suggest that although depressive symptoms among females are associated with a higher zBMI, they do not predict excessive weight gain during early-to-mid adolescence.     

Measuring the quality of motivational interviewing in primary health care encounters: The development and validation of the motivational interviewing assessment scale (MIAS)

Background: Motivational interviewing (MI) is a collaborative, goal-oriented method to help patients change behaviour. Tools that are often used to measure MI are the motivational interviewing skills code' (MISC), the ‘motivational interviewing treatment integrity’ (MITI) and the ‘behaviour change counselling index’ (BECCI). The first two instruments have not been designed to be used in primary healthcare (PHC) settings. The BECCI actually is time-consuming. The motivational interviewing assessment scale (MIAS, 'EVEM' in Spanish) was developed to measure MI in PHC encounters as an alternative to the previous instruments.

Objectives: To validate MIAS as an instrument to assess the quality of MI in PHC settings.

Methods: (a) Development: Sixteen experts in MI participated in the design, face and consensus validity, using a Delphi-type methodology. (b) Validation: Setting: 27 PHC centres located in Spain. Subjects: four experts in MI tested its psychometric properties with 332 video recordings coming from the Dislip-EM study (consultations provided by 37 practitioners). Measurements: dimensionality, internal consistency, reliability (intra-class correlation coefficient—ICC), sensitivity to change and convergent validity with the BECCI scale.

Results: A 14-item scale was obtained after the validation process. Factor analysis: two factors explained 76.6% of the total variance. Internal consistency, α?=?0.99. Reliability: intra-rater ICC?=?0.96; inter-rater ICC?=?0.97. Sensitivity to change: means before and after training were 23.63 versus 38.57 (P?P?Conclusion: The MIAS is a consistent and reliable instrument to assess the use of MI in PHC settings.

Key Messages

• The motivational interviewing assessment scale is a valid tool to assess motivational interviewing skills in physicians.

• It has been tested in a wide variety of clinical situations in primary healthcare settings and can also be used as a tool for evaluation of training.

     

Potential Exposure to Hazardous Work Activities

Abstract

Farmwomen are often an unacknowledged workforce, leading to a lack of targeted safety interventions. This study examined the involvement and work patterns of 665 women in Texas and 657 women in Louisiana who were 18 years old and older and whose family participated in farming operations. Surveys were used to gather specific data regarding tractor work patterns, tractor knowledge, sources of information about tractors, and demographic information in two southern states in which cattle and dairy were the major agricultural commodity. Among the sample of 1,322 women, 577 (43.6%) reported driving tractors at least one day a year. This subset was used to describe characteristics of tractors and tractor-related activities. Findings indicate that women learn to drive tractors in their 20s, use husbands as the primary source of their information about tractors, engage in a wide variety of farm activities including bush-hogging and plowing, and acknowledge knowing an average or less than an average amount about driving tractors. Women most often reported driving between 1 to 12 days/year (n = 321, 55.6%). When examining patterns of ROPS-equipped tractor use, women were 1.47 times more likely to drive a tractor without ROPS or enclosed when driving less than 12 days a year as opposed to 13–103 days/year or greater than 104 days/year. The results of this study support the need for health care professionals and safety specialists to design appropriate interventions that target women to become more knowledgeable regarding the injury risks associated with farm work while driving tractors.     

Isomeric fatty acids in the US diet: levels and health perspectives.

Objective: Alcohol drinkers are generally considered to underreport their alcohol intake, but little is known about whether they correctly report their energy intake (EI). We assessed the validity of the reported energy intake of alcohol drinkers using the 24-hour urinary (U) excretion of potassium (K) and sodium (Na) as biomarkers.

Methods: A total of 2,124 men and 1,998 women 25 to 74 years of age with a 24-hour urine collection, a random sample of the Belgian Interuniversity Research on Nutrition and Health (BIRNH), were studied. Dietary intake (D), including alcohol consumption, was assessed by a one-day food record. Basal metabolic rate (BMR) was predicted from age, gender and weight. As a measure for the degree of reporting error, D-K/U-K, D-Na/U-Na, EI/U-K, Non-alcohol EI/U-Na (NAEI/U-Na), EI/U-Na, EI/U-creatinine and EI/BMR ratios were calculated and compared among non-, moderate and heavy drinkers in both genders.

Results: EI, NAEI and all seven ratios examined generally increased with the level of alcohol intake in both genders. After adjustment for age, body mass index, smoking and educational level, most ratios were significantly higher in moderate drinkers (p < 0.02 to p < 0.0001) and in heavy drinkers (all p < 0.0001) than in non-drinkers. These differences were most significant in male heavy drinkers. The exceptions were D-K/U-K, D-Na/U-Na and NAEI/U-Na in moderate and female heavy drinkers and EI/U-K in male moderate drinkers. The estimated amount of the overreporting of EI by heavy drinkers was 27.8% in men and 13.7% in women.

Conclusions: This study provides evidence that EI and NAEI obtained from the BIRNH study was overreported among alcohol drinkers, especially among male heavy drinkers. It also indicates that EI from alcohol replaced EI from food.     

应用中断时间序列分析评价医院等级评审对医务人员手卫生依从性的影响

目的 应用中断时间序列分析模型, 评价综合干预措施对医务人员手卫生依从性的影响。 方法 选取某三级医院全部临床和医技科室的工作人员为研究对象, 在三级医院等级评审迎检筹备期间, 实施培训、调查、竞赛等多种形式的手卫生综合干预措施。收集干预前后手卫生依从性监测数据, 应用中断时间序列方法进行模型构建, 评价干预的即刻效果和远期效果。 结果 医务人员手卫生依从率由干预前的67.58%提升至干预后的81.43%。中断时间序列分析结果显示, 干预实施后总体医务人员的手卫生依从率即刻提升19.717%(t=5.473, P < 0.001);但其斜率改变量为-1.995(t=-2.249, P=0.048), 提示干预实施后手卫生依从率的下降趋势扩大; 干预对不同岗位工作人员均有即刻提升效果, 以医生群体提升幅度最大; 对不同岗位工作人员的斜率改变量均为负值, 以护士群体的改变量绝对值最小。 结论 综合干预措施可以有效提升医务人员手卫生依从性, 但其远期效果不甚理想。中断时间序列模型可有效用于手卫生依从性监测数据的分析。     

The daily practice of (suspected) coeliac disease management by general practitioners: A qualitative approach

Background: General practitioners (GPs) play a crucial role in diagnosing coeliac disease (CD). However, data on GP management of (suspected) CD patients is sparse.

Objectives: To provide insights into the daily practice of diagnosis, treatment, and follow-up of CD by GPs.

Methods: A qualitative study using topic list-based semi-structured in-depth interviews with Dutch GPs with more than five years’ experience carried out between January and March 2017. GPs were purposively sampled. The number of GPs interviewed depended on when data saturation was reached. We applied content analysis to the semi-structured interviews.

Results: Seven GPs were interviewed, five of whom were female. Analysis of the interviews resulted in three main themes: ‘awareness,’ ‘diagnostics’ and ‘management.’ Vague gastrointestinal symptoms and diarrhoea were often mentioned as a possible presentation of CD. Antibodies were used in CD diagnosis, although some GPs would start a gluten-free diet as a first diagnostic tool. Some GPs diagnosed CD only based on positive antibodies without referring to secondary care or duodenal biopsy analysis. GPs mentioned no role for primary care physicians in the follow-up of CD and noted the important role of dieticians in CD management.

Conclusion: The different views of GPs on how to diagnose and monitor CD could be a basis for further research to improve CD detection rate and CD care.