The forensic pathologist's public health role

While historically some have viewed the work of medical examiners/coroners (ME/C) and death investigators as predominantly serving the criminal justice system, in fact, the act of certifying a death is—in and of itself—a public health endeavor. The purpose of the death certificate is to track how and why individuals die as a means of helping others survive. Death certificates do save lives. In addition to generating these vital statistics, which guide public health policy, ME/C also perform a public health service in a variety of other ways. For instance, autopsy pathologists report unsafe consumer products, warn of recreational hazards (e.g., the dangers of snowmobile or all-terrain vehicle use), publicize and report occupational hazards (e.g., falls and electrocution risks), identify toxic exposures (e.g., carbon monoxide from defective heating units), and evaluate the safety of medical therapies. At autopsy, ME/C perform infectious disease surveillance, diagnosing and reporting communicable diseases such as bacterial meningitis, tuberculosis, and Legionella, thereby helping to mitigate disease spread in the community. They identify and characterize emerging infectious threats, such as COVID-19. They track violent deaths, including homicides, suicides, accidents, child and domestic abuse deaths, maternal mortality, and overdose deaths—to name a few—and participate as members of death review teams that attempt to identify systemic issues and prevent further such deaths. © 2023 Elsevier Inc. All rights reserved.

The effects of enhanced formaldehyde clearance in a gross anatomy laboratory by floor plan redesign and dissection table adjustment.

Formaldehyde has carcinogenic properties. It is associated with nasopharyngeal cancer and causes irritation of the eyes, nose, throat, and respiratory system. Formaldehyde exposure is a significant health concern for those participating in the gross anatomy laboratory, but no learning method can substitute cadaver dissection. We performed a formaldehyde level study in 2018, which found that most of the breathing zone (S-level) and environment (R-level) formaldehyde levels during laboratory sessions at the Faculty of Medicine Siriraj Hospital exceeded international ceiling standards. In the academic year 2019, we adapted the engineering rationale of the NIOSH hierarchy of controls to facilitate formaldehyde clearance by opening the dissection table covers and increasing the area per dissection table, then measured formaldehyde ceiling levels by formaldehyde detector tube with a gas-piston hand pump during (1) body wall, (2) upper limb, (3) head-neck, (4) thorax, (5) spinal cord removal, (6) lower limb, (7) abdomen, and (8) organs of special senses dissection sessions and comparing the results with the 2018 study. The perineum region data were excluded from analyses due to the laboratory closure in 2019 from the COVID-19 outbreak. There were statistically significant differences between the 2018 and 2019 S-levels (p < 0.001) and R-levels (p < 0.001). The mean S-level decreased by 64.18% from 1.34 ± 0.71 to 0.48 ± 0.26 ppm, and the mean R-level decreased by 70.18% from 0.57 ± 0.27 to 0.17 ± 0.09 ppm. The highest formaldehyde level in 2019 was the S-level in the body wall region (1.04 ± 0.3 ppm), followed by the S-level in the abdomen region (0.56 ± 0.08 ppm) and the spinal cord removal region (0.51 ± 0.29 ppm). All 2019 formaldehyde levels passed the OSHA 15-min STEL standard (2 ppm). The R-level in the special sense region (0.06 ± 0.02 ppm) passed the NIOSH 15-min ceiling limit (0.1 ppm). Three levels for 2019 were very close: the R-level in the head-neck region (0.11 ± 0.08 ppm), the abdomen region (0.11 ± 0.08), the body wall region (0.14 ± 0.12 ppm), and the S-level in the special sense region (0.12 ± 0.04 ppm). In summary, extensive analysis and removal of factors impeding formaldehyde clearance can improve the general ventilation system and achieve the OSHA 15-min STEL standard.

The OSHA COVID-19 Case and the Scope of the Occupational Safety and Health Act.

The Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) for COVID-19 applicable to private sector employers with 100 or more employees. Among other things, the ETS required employers either to mandate employee vaccination or weekly testing and wearing masks.

Improving Construction Safety: Lessons Learned from COVID-19 in the United States

During the COVID-19 pandemic, construction accidents in the United States (US) dropped dramatically compared to previous years. This research uses Saunders’ research onion approach to conduct a deep and systematic analysis of pre- and post-COVID-19 data to understand this phenomenon. The proposed research framework examines safety and prevention measures implemented by the US government, using data collected from various US government agencies, including the Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), and US Bureau of Labor Statistics. COVID-19’s effects on construction site health and safety were analyzed and ranked in order of efficacy in a hierarchy of control, and findings reveal a number of safety measures that can potentially be implemented to promote improved construction safety even after COVID-19 is over.

The Sad, Sad Story of OSHA's Failure to Protect Workers From COVID-19.

In the face of a global pandemic posing unprecedented risks to worker health, the Occupational Safety & Health Administration (OSHA), the agency charged with protecting workers from occupational illness, has floundered. Its efforts to protect workers have been too little, too late, poorly designed, and entangled in legal controversy. Two years into a pandemic that has posed the greatest threat to worker health in our lifetimes, OSHA has adopted no effective, COVID-19-specific protections for workers. This article chronicles OSHA's efforts and the response of the courts.

Predicting the trends and cost impact of COVID-19 OSHA citations on US construction contractors using machine learning and simulation

Purpose Occupational Safety and Health Administration (OSHA) of the U.S. government ensures that all health and safety regulations, protecting the workers, are enforced. OSHA officers conduct inspections and assess fines for non-compliance and regulatory violations. Literature discussion on the economic impact of OSHA inspections with COVID-19 related citations for the construction sector is lacking. This study aims to investigate the relationships between the number of COVID-19 cases, construction employment and OSHA citations and it further evaluates the total and monthly predicted cost impact of OSHA citations associated with COVID-19 violations. Design/methodology/approach An application of multiple regression analysis, a supervised machine learning linear regression model, based on K-fold cross validation sampling and a probabilistic risk-based cost estimate Monte Carlo simulation were utilized to evaluate the data. The data were collected from numerous websites including OSHA, Centers for Disease Control and the World Health Organization. Findings The results show that as the monthly construction employment increased, there was a decrease in OSHA citations. Conversely, the cost impact of OSHA citations had a positive relationship with the number of COVID-19 cases. In addition, the monthly cost impact of OSHA COVID-19 related citations along with the total cost impact of citations were predicted and analyzed. Originality/value The application of the two models on cost analysis provides a thorough comparison of predicted and overall cost impact, which can assist the contractors to better understand the possible cost ramifications. Based on the findings, it is suggested that the contractors include contingency fees within their contracts, hire safety managers to implement specific safety protocols related to COVID-19 and request a safety action plan when qualifying their subcontractors to avoid potential fines and citations.

Effectiveness of barrier devices, high-volume evacuators, and extraoral suction devices on reducing dental aerosols for the dental operator: A pilot study.

BACKGROUND: The COVID-19 pandemic has increased the importance of minimizing exposure to aerosols generated during dental procedures. The authors' objective was to measure the aerosolized particles in the breathing zone of operators using several facial protection and filtration methods. METHODS: Twenty-one dentists performed maxillary anterior incisor veneer preparations using a microscope and drape and loupes with or without a face shield. In each test condition, the following 3 levels of filtration were tested: no filtration, a high-volume evacuator [HVE], and an HVE with an extraoral suction device. Measurements were made using a mass monitor attached to the operator's chest with inlet within 10 inches of the operator's face. RESULTS: The authors found that the microscope and drape provided the lowest levels of aerosolized particles compared with loupes with or without a face shield (P < .001). There was no detectable difference in the concentration of particles between operators wearing a face shield and wearing loupes alone (P = .47). The particles in each test condition were lowered when an HVE was used (P < .001) and further lowered with an extraoral suction device. CONCLUSIONS: The findings of this study suggest that the use of a surgical microscope and bag barrier drape, HVE, and extraoral suction device result in the lowest concentration of aerosolized particles. The face shield did not appear to offer any protection from aerosolized particles. HVE and extraoral suction were effective in decreasing aerosols regardless of the type of facial protection used. PRACTICAL IMPLICATIONS: Dentists can reduce exposure to aerosols with a drape, HVE, and extraoral suction.

Employer Liability for "Take-Home" COVID-19.

Workplace exposure to SARS-CoV-2 has sickened workers and, subsequently, their family members. Family members might be able to recover from the employer in a negligence action using "take-home" liability theory.

Needlestick Injuries Among Healthcare Workers Administering COVID-19 Vaccinations in the United States.

As mass COVID-19 vaccination programs roll out across the country, we are potentially faced with compromising workers' health for the sake of the broader public health, as it relates to occupational exposure to contaminated needles and syringes. We have the opportunity to provide recommendations that advance protection of workers through the industrial hygiene hierarchy of controls, especially in light of the twentieth anniversary of the Needlestick Safety and Prevention Act. Specifically, greater focus on institutional controls that can dictate the safety culture and climate of institutions that roll out COVID-19 vaccination programs, while maintaining careful focus on preventing sharps injuries and blood exposure. In addition, we provide suggestions for the role that engineering controls, such as devices with sharps injury prevention features play in protecting workers from exposure to bloodborne pathogens, as well as the importance of ongoing injury incident surveillance.

Modified full-face snorkel mask as COVID-19 personal protective equipment: Quantitative results.

The COVID-19 crisis has resulted in a shortage of personal protective equipment (PPE). Adapting commercially available full-faced snorkel masks has been proposed as an alternative to narrow the gap in PPE. An advantage of the full-faced snorkel mask design is that it serves two critical purposes: eye and face protection, and high quality air filtration to protect against SARS-CoV-2. We performed quantitative testing on various full-faced snorkel masks with 3D printed adapters that accept commercially available particulate filters, and report on a design that passed Occupational Safety and Health Administration (OSHA) full-facepiece respirator standards.

A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry.

With the 2019 emergence of coronavirus disease 19 (colloquially called COVID-19) came renewed public concern about airborne and aerosolized virus transmission. Accompanying this concern were many conflicting dialogues about which forms of personal protective equipment best protect dental health care practitioners and their patients from viral exposure. In this comprehensive review we provide a thorough and critical assessment of face masks and face shields, some of the most frequently recommended personal safeguards against viral infection. We begin by describing the function and practicality of the most common mask types used in dentistry: procedural masks, surgical masks, and filtering respirator facemasks (also called N95s). This is followed by a critical assessment of mask use based on a review of published evidence in three key domains: the degree to which each mask type is shown to protect against airborne and aerosolized disease, the reported likelihood for non-compliance among mask users, and risk factors associated with both proper and improper mask use. We use this information to conclude our review with several practical, evidence-based recommendations for mask use in dental and dental educational clinics.

Hazard Pay for COVID-19? Yes, But It's Not a Substitute for a Living Wage and Enforceable Worker Protections.

The COVID-19 pandemic is exposing critical failures in public and occupational health in the United States. So-called hazard pay for essential workers is a necessary but insufficient response to the lack of workplace protections. The roots of these failures in the weakening of the Occupational Safety and Health Administration enforcement and pandemic preparedness and the dramatic shifts in the economy and labor market in recent decades are explored along with the history of hazard pay. The current prominence of COVID-19-related workplace hazards, and the mobilization by both nonunion and union workers experiencing them, presents opportunities amid the crisis and tragic losses to envision a revival of worker protection measures. Strategies are needed for organizing and legislative advocacy to address the disparate impact of both normal and crisis conditions on low-wage workers, especially women and workers of color.