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S. Kippler, M.A., M.D.

Clinical Director, University of California, Merced School of Medicine

Rate of fatal and nonfatal injuries in construction, by age group, 2008-2010 average 41d. Rate of fatalities in construction, by Hispanic ethnicity, three time periods from 1992-2010 (All employment) 41f. Rate of nonfatal injuries in construction, by Hispanic ethnicity, three time periods from 1992-2010 42. Number of fatalities, selected construction occupations, 2008-2010 total (All employment) 42b. Number of nonfatal injuries resulting in days away from work, selected construction occupations, 2010 42c. Rate of fatalities, selected construction occupations, 2008-2010 average (All employment) 42d. Rate of nonfatal injuries resulting in days away from work, selected construction occupations, 2008-2010 average 42e. Lifetime risk of fatal injuries, selected construction occupations (All employment) 42f. Lifetime risk of nonfatal injuries resulting in days away from work, selected construction occupations 43. Distribution of leading causes of fatalities in construction, 2010 (All employment) 43b. Distribution of leading causes of nonfatal injuries resulting in days away from work in construction, 2010 (Private wage-and-salary workers) 43c. Rate of leading causes of nonfatal injuries resulting in days away from work in construction, 1992-2010 (Private wage-and-salary workers) 44. Distribution of fatalities from falls in construction, by establishment size, 2008-2010 total (Wage-andsalary workers) 44c. Rate of fatalities from falls, selected construction occupations, 2008-2010 average (All employment) 44d. Causes of fatalities from falls in construction, 20082010 total (All employment) 44f. Causes of nonfatal injuries from falls resulting in days away from work in construction, 2010 (Private wageand-salary workers) 45. Number of electrocution deaths in construction, selected construction occupations, 2008-2010 total 45c. Lifetime risk of electrocution deaths in construction, selected construction occupations 45d. Overhead power-line electrocution deaths, by construction occupation, 2008-2010 total 46. Fatal events involving vehicles and heavy equipment, by location, 2008-2010 total 46d. Fatalities involving vehicles and heavy equipment in construction, selected occupations, 2008-2010 total 46e. Fatalities involving vehicles and heavy equipment at road construction sites, selected occupations in construction, 2008-2010 total 47. Number and rate of work-related musculoskeletal disorders in construction, 1992-2010 47b. Work-related musculoskeletal disorders resulting in days away from work in construction, by body part, 2003-2010 47c. Distribution of risk factors for work-related musculoskeletal disorders resulting in days away from work in construction, 2010 47d. Rate of overexertion injuries resulting in days away from work, selected industries, 2010 47e. Rate of overexertion injuries resulting in days away from work, selected construction subsectors, 2010 47f. Distribution of types of nonfatal injuries resulting in days away from work in construction, by nature of injury, 2010 48. Distribution of nonfatal injuries resulting in days away from work in construction, by body part, 2010 (Private wage-and-salary workers) 48b. Number and rate of back injuries resulting in days away from work in construction, 1992-2010 (Private wage-and-salary workers) 48c. Rate of back injuries resulting in days away from work, selected industries, 2010 (Private wage-andsalary workers) 48d. Rate of back injuries resulting in days away from work, by construction subsector, 2010 (Private wageand-salary workers) 48e.

Diseases

• Alopecia macular degeneration growth retardation
• Chlamydia pneumoniae
• Agammaglobulinemia
• Omenn syndrome
• Costocoracoid ligament congenitally short
• Verloes Bourguignon syndrome
• Supranuclear ocular palsy
• Adenosine deaminase deficiency
• Gliosarcoma
• Myasthenia gravis

Radioscintigraphy shows increased activity around the sternoclavicular joints and affected vertebrae. There is no effective treatment but in the long term symptoms tend to diminish or disappear; however, the patient may be left with ankylosis of the affected joints. It usually starts during the first few months of life with painful swelling over the tubular bones and/or the mandible. Infection may be suspected but, apart from the swelling, there are no local signs of inflammation. X-rays characteristically show periosteal new-bone formation resulting in thickening of the affected bone. After a few months the local features may resolve spontaneously, only to reappear somewhere else. The lesions gradually cleared up, leaving little or no trace of their former ominous appearance. In infants it is often difficult to tell whether the infection started in the metaphyseal bone and spread to the joint or vice versa. In practice it hardly matters and in advanced cases it should be assumed that the entire joint and the adjacent bone ends are involved. The causal organism is usually Staphylococcus aureus; however, in children between 1 and 4 years old, Haemophilus influenzae is an important pathogen unless they have been vaccinated against this organism. Occasionally other microbes, such as Streptococcus, Escherichia coli and Proteus, are encountered. In adults the effects are usually confined to the articular cartilage, but in late cases there may be extensive erosion due to synovial proliferation and ingrowth. If the infection goes untreated, it will spread to the underlying bone or burst out of the joint to form abscesses and sinuses. With healing there may be: (1) complete resolution and a return to normal; (2) partial loss of articular cartilage and fibrosis of the joint; (3) loss of articular cartilage and bony ankylosis; or (4) bone destruction and permanent deformity of the joint. The baby is irritable and refuses to feed; there is a rapid pulse and sometimes a fever. The joints should be carefully felt and moved to elicit the local signs of warmth, tenderness and resistance to movement. Special care should be taken not to miss a concomitant osteomyelitis in an adjacent bone end. All movements are restricted, and Pathology the usual trigger is a haematogenous infection which settles in the synovial membrane; there is an acute inflammatory reaction with a serous or seropurulent exudate and an increase in synovial fluid. As pus appears in the joint, articular cartilage is eroded and destroyed, partly by bacterial enzymes and partly by proteolytic enzymes released from synovial cells, inflammatory cells and pus. In infants the entire epiphysis, which is still largely cartilaginous, may be (a) (b) (c) (d) 2. Widening of the space between capsule and bone of more than 2 mm is indicative of an effusion, which may be echo-free (perhaps a transient synovitis) or positively echogenic (more likely septic arthritis). However, special investigations take time and it is much quicker (and usually more reliable) to aspirate the joint and examine the fluid. A white cell count and Gram stain should be carried out immediately: the normal synovial fluid leucocyte count is under 300 per mL; it may be over 10 000 per mL in non-infective inflammatory disorders, but counts of over 50 000 per mL are highly suggestive of sepsis. Samples of fluid are also sent for full microbiological examination and tests for antibiotic sensitivity. Differential diagnosis Acute osteomyelitis In young children, osteomyelitis may be indistinguishable from septic arthritis; often one must assume that both are present. Other types of infection Psoas abscess and local infection of the pelvis must be kept in mind. Trauma Traumatic synovitis or haemarthrosis may be associated with acute pain and swelling. Irritable joint At the onset the joint is painful and lacks some movement, but the child is not really ill and there are no signs of infection. Ultrasonography may help to distinguish septic arthritis from transient synovitis.

At the periphery is an annular (clear) zone believed to seal off the ruffled border. The periosteum consists of cambium (inner) and reticular layers (outer) that are up to 10 to 12 cells thick. In active bone growth or following injury a prominent osteoblastic (osteoclastic) zone is seen. The endosteum lines the inner surface of marrow cavities and larger Haversian canals. It is the internal equivalent of the cambium layer of the periosteum (Rhodin, 1974). Clinical Considerations Boyne (1965) studied the healing extraction site in humans using tetracycline to label newly mineralized bone. The first evidence of calcified osseous matrix was noted at days 7 and 8 outside the alveolus along the entire length of the cribriform plate. Bone formation in the socket was first observed 9 to 10 days postoperatively along the lateral walls. Elliott and Bowers (1963) studied human skulls and reported: 1) an average of 20% of the sites had some type of defect; 2) fenestrations were more common in the maxilla while dehiscences were more common in the mandible; 3) both types of defects frequently occur bilaterally; and 4) defects were most often seen in areas where a thin alveolus was present. Manson (1963) used radiographs and microradiography to examine human mandibles (autopsy) with teeth in situ. He reported no difference in the mineral content of the bone in regions of the tooth socket and the adjacent bone. The authors suggested that caution be exercised when using the integrity of the crestal lamina dura as an indicator for periodontal treatment. The cuticle occupied the space from the subgingival plaque to the junctional epithelium. The authors suggested that the cuticle represented an accumulation of inflammatory infiltrates or metabolites of plaque. Speculation was offered that the cuticle may mediate attachment of junctional epithelium as well as bacteria to the tooth surface. The effectiveness of in vivo root planing in removing bacteria endotoxin from roots of periodontally involved teeth. The distribution of bacterial lipopolysaccharide (endotoxin) in relation to periodontally involved root surfaces. Endotoxin penetration into root cementum of periodontally healthy and diseased human teeth. Hand instrumentation versus ultrasonics in the removal of endotoxins from root surfaces. Ultrastructural changes in cementum and adjacent connective tissue in periodontitis. Identity of limulus amoebocyte lysate active root surface materials from periodontally involved teeth. The intermediate flexus of the periodontal ligament: History and further observations. Healthy gingiva sulci typically contains a flora of Streptococcus and additional species including Actinomyces, Veillonella, and Capnocytophaga. Streptococci and Actinomyces may comprise over 85% of the microbial flora in health (Slots, 1979; Moore et al. Gingivitis has been characterized by a shift from a Streptococcus-dominated plaque to an Actinomyces-dominated plaque. Gingivitis has also been associated with an increase in motile bacteria and spirochetes (Listgarten et al. They associated gingivitis with specific Actinomyces, Streptoccocus, Fusobacterium, Veillonella, and Treponema. Prevotella intermedia has been associated with pregnancy gingivitis (Kornman and Loesche, 1980). Keratinized tissue (attached gingiva) is not an essential prerequisite to the maintenance of periodontal health when dental plaque is controlled (Kennedy et al. Usually a progressively destructive change leading to loss of bone and periodontal ligament. Adult Periodontitis: A form of periodontitis that usually has an onset beyond age 35. Bone resorption usually progresses slowly and predominantly in the horizontal direction.

Even though ranchers incur additional costs to graze on federal lands, federal grazing permits are coveted by ranchers. In addition to granting permit holders access to forage during a critical period of the year when forage on private hay fields and meadows is being grown, federal grazing permits add to the resale value of local ranches. In addition, to the value of forage supplied by federal lands, livestock grazing on these grasslands lands supports local area employment and income. Since the distinction between farm 264 and home is often not well-defined, the majority of the labor used in agricultural production is provided by unpaid family workers and is not reflected in general industry reporting. Traditional labor statistics only reflect hired employment, which are estimated to make up only one-third of the total workforce in the agricultural sector (Kandel, 2008). When labor contributions of unpaid family workers are considered alongside those of hired agricultural workers, the farming and ranching is revealed to play a much larger role in the local economy. In terms of local area contributions from Forest Service supplied forage, permitted use levels of grazing on the Pawnee support 102 total jobs44 and approximately $1. While grazing on the Pawnee can only be attributed with supporting a small share of economic opportunities in surrounding communities, this forage is essential to supporting traditional ranching lifestyles in Logan and Weld counties. Most ranching families view raising livestock as more of a tradition than a job and only obtain a small portion of their household income from livestock production. Many ranches are dependent upon one or more family members working off-ranch and continue to raise livestock because the tradition is often deeply rooted in their personal history and identity. Livestock ownership and ranch life are powerful forces that bind communities and families, and responsibility toward land and livestock are often enmeshed in family values. Continuing this way of life maintains traditional values and connects families to ancestral lands and heritage. Oil and Gas Exploration and Development the diverse geography and geology of Colorado provides the state with an abundance of conventional and renewable energy resources. Between 2007 and 2012, crude oil production in Colorado rose 89% while marketed natural gas production rose 38%. Most of these economic opportunities are supported by oil and gas related activities in Weld County. In 2012, Colorado approved 3,773 permits to drill in Weld County, which accounted for 48 percent of all permits approved that year (Department of Energy 2013). Development associated with oil and gas occurs on both public and private lands in Weld County. Currently the Pawnee National Grasslands has 62 active oil and gas wells and 199 plugged or abandoned wells. These sales are competitive and parcels with high potential for oil and gas production command bonus bids in excess of the minimum bid. While federal minerals on the Pawnee have not been auctioned for leasing in several years, private and state trust lands have been commanding very bonus bids. State administered minerals in Weld County sold at the May 2014 lease sale earned an average bonus bid of $638 per acre and limited information from private parcels have ranged from $125 per acre up to a reported sale of over $10,000 per acre. In addition to bonus bids, lessees are required to pay rent annually until production begins on the leased parcel, or until the lease expires. Annual rental revenue to the Federal Government from leasing Federal minerals on the Pawnee is estimated to be $45,39546. Forty-nine percent of which, is distributed back to the State of Colorado in accordance with the Mineral Leasing Act for Acquired Lands. Ad valorem taxes are assessed on the actual value of oil and gas production and paid directly by producers to the county. Although oil and gas production in Colorado is subject to a progressive state severance tax which range from 2 to 5 percent of gross income, Colorado Law allows state severance taxes to be reduced by a credit equal to 87. Depending on the applicable severance and ad valorem tax rates, the severance tax liability of working or royalty interest owners can be reduced to $0. While severance tax dollars are collected based on the value of production (minus a number of credits, exemptions, and deductions) and property local property tax mills, these revenues are distributed based on production and the number of industry workers in a county. Oil and gas companies pay are also required to pay a conservation levy every quarter. This levy rate is designed to meet the expenses of the Colorado Oil and Gas Conservation Commission, the state agency responsible for regulating oil and gas development. These payments are intended to improve public schools, maintain infrastructure, improve the health of watersheds and ecosystems, protect communities, and strengthen local economies.