### Future Directions for the Surveillance of Agricultural Injuries Public Meeting (webinar) National Institute for Occupational Safety and Health

March 30, 2015

PLEASE STAND BY FOR REALTIME CAPTIONS.

>> Good morning or afternoon depending on your location. Welcome to the Agricultural Injury Surveillance public meeting h osted by the N ational Institute for O ccupational S afety and H ealth (NIOSH) . My name is Kara Perritt . I work for NIOSH and am located in Morgantown West Virginia. I will be serving as the facilitator for the public meeting which begins now. At this time , I re quest that you mute your phone and keep it muted unless you are recognized to speak. Additionally, please do not put this call on h old a s that sometimes results in music that can be heard by all conference participants. Please be advised that this meeting is being recorded and will be transcribed in its entirety. All presentations and comments will be posted without change to the

NIO SH docket associated with this effort . If you do not agree with these procedures you may disconnect now. Today's schedule of events will begin with opening remarks from the NIOSH director followed by two NIOSH presentations. After these presentations

, I will make administrative

announcements and set the ground rules for the participant presentations and the comment portion of the meeting that will immediately follow. And now without further ado it is my pleasure to

introduce the director of NIOSH, Dr. John Howard. Dr. Howard.

Thank you, Kara . I just want to check and make sure you can hear me

.

Yes we can. Thank you. >> Thanks. Good morning and good afternoon to everybody. Thank you very much for taking time out of your busy schedules t o atten d our public meeting on surveillance of ag injuries . I think we are in a very important transition time right now and so your ideas about

ag injury surveillance are very important to us as we struggle , along with everyone else , with decreasing budgets and other constraints that we have on our surveillance efforts. We want to probe

, you and us and anybody who is interested

, on new ways of doing surveillance.

I have adopted this term of smarter surveillance ; people have said what exactly does that mean? Certainly it means surveillance that is more cost effective than some of these very large, very expensive national surveillance programs that we have had. I think we were very advantaged in

other era of budgets where we were able to do that. O ne of the things , the value the national

surveillance has , is i n sort of comparing your country with another country. There is nothing wrong with that, but I wonder if local or regional surveillance, especially in ag , because it differs so much

acr oss the United States. I’m from California originally

, and California agriculture is extremely

different than Midwestern agriculture . So

, that type of shifting surveillance

, from national to regional and local approaches

, is something that I would like to hear s ome comments on. And what is the role of our partners? We are very happy that we have ten agricultural safety and health research

centers. W hat is the role that those partners and others can take on to address the need s in agricultural injury surveillan ce?

Clearly, we want to do our surveillance so that we know what is going on with ag injuries in various parts of the United S tates

. M ore than that

, we want to be able to take action to prevent them. I think that is the last point I would make. How we can do our surveillance so it is action oriented to the prevention side

.

Again, thank you all for attending and I look forward to hearing all of your comments . Thank you,

Kara

.Thank you very much, Dr. Howard. Now we will hear from Captain. Brad Husberg , director of the

NIOSH O ffice of A gricultural S afety and Health

.

Thanks, Kara . A s Kara mention ed, my name is Brad Husberg

. I’m the director of the NIOSH O ffice

of A gricultural S afety and Health

, a lso referred to as OASH.

The NIOSH O ffice of A gricultural S afety and Health was created in 2012 and sets the research priorities and coordinates safety and health research for the NIOSH Agriculture, F orestry and Fishing sector program . Duties also include : responsibility for the NIOSH Agriculture, F orestry and Fishing research budget; s trategic di rections on research priorities; a ssisting in the evaluation of program outputs and outcomes ; leading the Agriculture, F orestry and Fishing sector council of the National Occupational Research Agenda, also referred to as NORA, and responding to requests for

information about agriculture, fores t ry and fish ing research at NIOSH.

The NIOSH Agriculture, F orestry and Fishing program can be divided into the intramural program

, which includes work done by NIOSH researchers , and t he extramural programs

, which include

research that is funded by NIOSH and done by other organizations and ag e ncies

.

The intramural work includes providing guidance and direction of projects and coordination of the NIOSH Agriculture, F orestry and Fishing steering committee. Extramural efforts include working with the NIOSH funded agricultural safety and health centers and other groups d o ing research with NIOSH dollars, through contracts, grants and coop erative agreements.

NIOSH also helps to guide the Ag Center’s work with the Agriculture, F orestry and Fishing Sector

Council of the N ational O ccupational R esearch Agenda where long

- term priorities and goals are set for agricultural, forestry and fishing safety and health research. The NORA sector council includes representatives from business

, safety and health organizations

, and academia. NORA also

includes members from N IOSH. The research priorities set by the NORA s ector c ouncil and our

coordi nation are not just for NIOSH. I would like to thank you for taking the time to help us learn more about potential options for future surveillance in the Agriculture, F orestry and Fishin g sector. Thank you. >> Thank you very much Brad . The final NIOSH presentation will be made by Kitty Hendricks, project officer of the NIOSH Agricultural Injury Surveillance Program. Kitty.

Good afternoon. I'm going to be gin by provid ing some backgro und information on the NIOSH agricultural injury surveillance program. NIOSH has had an emphasis on agricultural safety and

health for more than 20 years.

NIOSH began its focus on agriculture in 1990 when Congress in part in response to the 1988

N ational C oalition for A gricultural Safety and H ealth report designated NIOSH to lead a national

effort in the prevention of occupational injury and illness in agriculture.

In the following years NIOSH began two agricultura l programs , f irst

, in 1993 the A gricultural Health

and S afety I nitiative ; and later in 1996 the Childhood Agricultur al Injury Prevention Initiative . >> The Agricultural Health and Safety Initiative was initiated to reduce the occurrence of occupational injuries and illnesses on farms in the United States.

NIOSH began working with the US D epartment of A griculture’s National Agricultural Statistics

Service to track occupational injuries and the presence of tractor safety devices on farms. >> The Childhood Agricultural Injury Prevention Initiative was introduced to reduce injuries to youth on US

f arms.

Tracking injuries has been a major part of this initiative. In addition to focusing solely on youth it also differs from previous efforts by including both work and nonwork injuries. >> NIOSH begantheir surveillance ef forts with two surveys in 1993

- The Farm Family Health and Hazard Survey

and the Traumatic Injury Surveillance of Farmers . In 1999

, t he first Childhood Agricultural Injury Survey

, also known as CAIS

, was conducted ; and in 2001 the first O ccupational I njury S urveillance

of P roduction A griculture , or OISPA survey, began.

Overtime NIOSH has collected multiple years of data for the se surveys , a nd also expanded our efforts to include surveys for both adults and youth which focused on minority operated farms

, as well as the F arm and R anch S afety S urvey

, which examined common hazards on farms . >> I n an effort to collect the most comprehensive data possible, NIOSH also collaborated with the Department of L abor to fund an injur y supplement to the N ational A gricultural Workers survey. This

surveys supplement is conducted through personal interviews and collect injury data for hired crop

workers. To date, data collection has been completed for two study periods.

These different surveys have provided valuable data that have shown that between 1998 and 2012:

i njuries to all youth on farms ha ve decreased by 63%, w ork

- related youth farm injuries ha ve decreased 82%, and i njury rates for household youth have decreased 51 %. Between 2001 and

2012

, a dult occupational farm injuries declined by 30%, and i njuries to working adult household members declined by 22%. Data from the NAWS injury supplement have shown that injury rates for

hired crop workers decreased by 33 % during the data collection periods. >> Data collection is ongoing for CAIS and OISPA which are currently collecting data for the 2014 calendar year . NAWS injury supplement data are also being collected for the 2014/2015 data cycle. >> Static d ata tables

from eac h of our USDA farm operator surveys are available on the CDC website. NIOSH is currently working on similar tables to provide public access to the NAWS injury supplement data. And NAWS data are also publicly available through special request of the US Depa rtment of L abor.

Beginning in 2015

, NIOSH will no t reestablish interagency agreements with USDA and the Department of L abor to collect survey data for the agricultural injury surve illance system. This includes the NAWS supplement and all farm operator surveys.

Therefore

, the following data will be discontinued after our c urrent data collection efforts end: t he numbers of youth living on, visiting, and working on farms; t he numbers and rates of injury to you th who live and work on farms; t he numbers a nd rates of injury to adults who work on farms; t he

number of tractors not equipped with ROPS; i njury info rmation for hired crop workers; and d ata on farm hazards, such as silos and manure storage.

One of the challenges we have encountered

, is that due to the decline in the number of injuries occurring on farms a much larger sample size is needed in order to provide sta b le injury estimates. NIOSH does not have the resources to support the cost of the necessary increase in sample size. However, NIOSH wi ll continue to explore ways to improve agricultural surveillance for the future

, and stakeholder input will be an essential part of this process.

I encourage anyone who is interested to submit any comments regarding the NIOSH agricultural surveillance p rogram to the public docket. All comments should reference the docket number

, th ey can be submitted either electronically or by mail

, and must be submitted by May 27, 2015. >>

Additional ly, if anyone has any questions or would like additional information you can contact me at

any time. Thank you. >> Thank you. Before we get into the participants’ presentation and the comment portion of the meeting

, I wanted to take a moment to introduce those of us from the NIOSH Agricultural Injury Surveillance Program who are in attendance today. We have Kitty

Hendricks

, who just heard from

, the project officer ; t eam members Michael Goldcamp and Larry

La y ne ; m e

, as a team leader , and Dawn Castill o, who is our division director. In attendance from

the NIOSH O ffice of A gricultural S afety and H ealth

, we have director

, Brad Husberg , who we heard

fro m, a nd Deputy Director , Pietra Check . We ha ve now come to the participant presentation s and comment portions of the meeting. The primary objective of this public meeting is for NIOSH toreceive comments , suggestions and questions that will be considered as we plan for the future of

agricultural injury surveillance. We will begin with the three schedule d participant presentations . If you did not request to make a presentation and you want to speak you may use the question and answer panel to make that request. You may make your request at any time starting right now.

Just click on the Q& A in the command menu and indicate you wish to speak by clicking on the raise your hand icon

, which is a small picture of a hand. The hand icon is located in the upper right corner of the Q&A panel. The hand icon is a toggle switch; do not click on it more than on c e unless

you wish to withdraw your re quest to speak. After the last scheduled presentation

, we will call on participants who request to speak in the order in which those requests were received. These participants will be allowed up to five minutes of speaking time.

Our first of three scheduled presenters is Dr. Barb Marlenga . Dr

. Marlenga, you have 10 minutes for your presentation. The timer will start when you begin speaking. Please un mute your phone to begin. >> Thank you. Dr. Howard and NIOSH colleagues, thank you for the opportunity to

comment on future directions for the su rveillance of agricultural injury. The National Children's

Center for Rural and Agricultural Health and Safety has been integrally involved with the NIOSH led national initiative for protecting children on farms since its inception in 1996. We commend

NIOS H ’s efforts to collect, analyze and disseminate data specific to injuries among children who

live on , visit

, and work on farms and ranches in the US. Data from six points in time have been extremely valuable for understanding the scope of the problem and g uiding priorities f or research

and interventions. We credit the C hild hood A gricultural I njury S urvey data for motivating action in the public and private sectors that has yielded significant impact . Our center used injury data and fatality reports to update the 1996 N ational A ction P lan for P rotecting C hildren in A griculture in both

2001 and 2012. We have used the data to publish an annual child ag injury fact sheet that is frequently accessed by the media, by researchers and by the general public. It is especially

valuable as a teaching tool in conjunction with new injury or fatality events. We have also used the

data to assess implications for changing trends, for exa mple, there is a higher priority on children younger than 10 years

, and w e have guided agricultural employers with a model policy for hired

adolescent workers.

We understand NIOSH ’s rationale for discontinuing the child agricultural injury survey and the importance of making wise investments with limited budgets. We acknowled ge the shortcomings of

surveillance efforts to date

, and appreciate the fact that there is no perfect system for occupational injury data collection. Moreover, there are compounded challenges when garnering information on injuries

, among children who are i njured in the agricultural worksite as bystanders

, or when

incidents occur within unique population such as foreign born workers and beginning farmers and

ranchers. The Blueprint for P rotecting C hildren in A griculture, the 20 12 National Action Plan was dev eloped through a consensus process of more than 100 child safety advocates. In the plan, specific attention was given to improving injury , disease and exposure data

, and we base our

comments

, in large part , on this document w hich includes recommendations f or agricultural injury

data collection and dissemination p ertaining to children younger than 18 years. There are many ideal components of a future agricultural injury surveillance system . In addition to the data

collected on demographics and agents of injuries and exposure

, there are specific elements

desired for guiding interventions to protect youth. Critical factors include at minimum: 1) a child specific data set with clear definitions and inclusion/exclusion criteria ; 2) d ata secured from multi ple

sources

, including n ontraditional agricultural data sources, f or example, child death reviews, with potential for merging or cross

- referencing; 3) d ata collected from parents and farmers via methods

other than landline telephone; 4) d ata collected from hard

- to

- reach populations

, such as migrating

workers , Anabaptists, beginning farmers, and urban agricultural producers; 5) variables regarding work versus nonwork, farm residency status

, and the relationship of the injured child to the responsible adults ; 6) p ublic access to regional and national data ; and 7) timely reports and postings of updated data.Presently there are several injury surveillance activities underway at various NIOSH Ag centers.

Here at our NIOSH funded center, Doctor Barbara Marlenga is c onducting a study on filling the gaps in child agricultural injury data . We anticipate that results from this exploration of some promising, existing public health surveillance system s will provide insights into options that may be considered for agricultural injury data collection for adults

, as well as children. Our recommendation for the next step is to convene a multidisciplinary advisory group that includes the public and private sector , is bipartisan

, and includes the agricultural industry. We propose options for building childhood agricultural injury and disease data into existing public health surveillance systems, a nd identify systems that could potentially be linked or merged

, inclu ding private sector data sources

, f or example, tractor manuf acturers or insurance companies t o create a more complete and robust picture of child agricultural injury and disease. An option for this advisory group could be a commissioned project for the N a tional A cademies Board on agricultural and natural resource s

. Thank you for considering our comments and our recommendations.

Thank you. Your presentation will be transcribed and posted to the NIOSH docket . At this time I would like to remind all partic ipants to please mute your phones . Our second scheduled presenter

is Dr. Thomas Arcury . You have 10 minutes for your presentation. The timer will begin when you start speaking. Please un mute your phone to begin. >> Thank you for allowing me the opportun ity to speak. Let me start by saying something about my background and expertise . I am professor and vice chair of research for the Department of family and community medicine and the director of

the Center for Worker Health at the Wake Forest School of Medicine . For the last 20 years I have been conducting research on the Occupational Health & Safety of agricultural workers

, both farmers and hired farm workers. My group has written over 150 peer

- reviewed scientific papers on the Occupational Health & Saf ety of agricultural workers . I'm happy to share a list of those publications with anyone. We have also written book chapters and developed educational materials to address occupational safety problems in agriculture. My major interests are migrant and

sea sonal farmworkers, t hese are largely immigrant workers ; and hired youth farmworkers; these

are largely US citizens who are often the children of migrant workers.

The focus of my remarks is on hired migrant and seasonal farmworkers, adults and children. My position is that we do not have accurate knowledge of occupational injuries and illnesses experienced by hired agricultural workers and therefore we should not a bandon collecting

surveillance data

.

NIOSH needs to institute an active surveillance system that collects data directly from the hired agricultural workers so that accurate data on occupational injuries and illnesses can direct policy and programs. >> A griculture

, as we all know is a hazardous industry with high rates of i njury, illness and mortality

. R esearch project s focused on adult agricultural workers routinely report high rates of injury and illness. In our own research with adult workers our rese arch on Green Tobacco

illness found that 25% of workers experience occupational illness , t hat farmworkers experience two days of the sickness for every 100 days of work. Our research based on clinical examinations of

adult farmworkers found that 16% of th ese workers had rotator cuff syndrome, 19% had epicondylitis

, and 14% had lower back injury. Our research on pesticide exposure documented high levels of pesticide s in urinary metabolites, and depressed cholinesterase among hired agricultural

workers.

O ur research on hired youth farmworkers age 10 to 17 found that over a 12 month period while doing far m work, 54% reported any musculoskeletal injury, 61 % reported any trauma and 72% reported any dermatological injury , which was mostly sunburn . Our research is not unique. Comparable results have been reported among adults and youth workers by investigators at the Western Center for Ag health and safety at UC Davis for musculoskeletal injuries

, by investigators

at the Northeast center of agricu ltural and occupational health for youth workers , and investigators

at the Southwest Center for Agricultural Health, Injury Prevention and E ducation. In most statesagricultural injuries are not reportable events. >> Agriculture does not have the same saf ety

requirements as other industries. Agriculture is exempt from many federal regulations and many states have not implement ed laws to address these gaps. For example, many states farmworkers

are not eligible for workers compensation.

When safety regul ations are present, research shows that these regulations are often not followed

or enforce d ; i ncluding enforcement of pesticide safety through the US E PA worker protection standard, f ield sanitation requirements

, and migrant housing. >>

Passive surveill ance based on the reporting of injuries and illness is not sufficient. Many workers

do not seek healthcare or report injuries.

They often fear losing their jobs, fear interact ion with government officials, do not have health insurance to help pay for ca re

, and do not have Workmen's Compensation

. B ecause they do not have workers comp

, agricultural workers are unlikely to report an injury or illness as work

- related.

B ecause migrant clinics are not reimbursed for care, the y do not ask if an injury or illnes s is work

related. >> Reporting system s often do not accurately capture occupational injuries of agricultural workers. This is detailed in research by investigators at the Northeast Center for agricultural and occupational health. >> Reporting systems greatly under calculate injuries of agricultural workers. This is detailed in research by investigators at the Western Center for agricultural health and safety. >> It is not appropriate for e mployers to report injuries and illnesses o f their workers. They often do not know a worker has been injured or is ill. Remember, workers do not tell them because they fear losing their jobs.

It is often in the best interest of the employers not to report employee injuries or illnesses.

In t hat situation

, we need an active surveillance system that asks workers directly about their work

related injuries and illnesses. Given the breadth of the problem and a wide geographic distribution of workers, creative approaches to surveillance need to be considered.

It would be appropriate to have a working group of occupational health experts and worker advocates with some input from industry to meet and develop creative approaches . T his could be managed by representatives of the NIOSH funded Ag healt h and safety centers. Ideas could include an area cluster design reflecting differences in farm systems across the US . However, direct interviews and examinations of workers should be included. Thank you.

Thank you very much Dr. Arcury . Your presentati on will be transcribed and posted along with your slides to the NIOSH docket. Our final scheduled presenter is Dr. Risto Rautiainen

. Sir, you have 10 minutes for your presentation. The timer will start when you begin speaking. Please un mute your phone to start speaking.

Thank you very much for the opportunity to provide my comments. I am a professor at the University of Nebraska M edical Center. I direct the central states Center for ag ricultural safety and

health and chair the NORA agriculture forestry and f ishing sector working group. >> NIOSH has really provided valuable information in the agricultural health and safety field by doing surveillance. The surveillance has provided information, especially on populations that are not covered b y the

Bureau of L abor S tatistics or other surveillance mechanisms. Some of the good features of the NIOSH injury surveillanc e are that it has been national; i t has included some regional data, h as used fairly large samples, had good response rates, covered the key populations

, and has provided

estimates and information on injury characteristics.

Some of the limitations have been that the reports have been fairly irregular , a nd not very local. There has not been enough information on the cost and lost time from injuries. Not really much information on how the injuries actually happened. The analyses of these data have been mainlydescriptive tables and not utilizing more advanced analytical statistics. Reports have been fairly

slow in coming and the data is not very easy to locate. >> The current position that NIOSH has been considering or has decided to discontinue surveillance activities and this really leaves an unmet need in the field. We do need surveillance to document the burden, need and impact of agricu ltural health and safety and to track progress and detect emerging issues and even to justify

the existence of the entire NIOSH agricultural forestry and f ishing program.

NORA strategic goals calls for surveillance and they are to improve surveillance w ithin the sector. There are goals, intermediate goals and action steps . I will not read them all but some of them include maintaining and expanding th e existing surveillance systems, which is now not going to happen

. S o

, I think this puts the NIOSH surve illance group in a new situation where we really have to look at new ways of addressing the issue.

One of the things already mentioned is that there might be a good rea son to hold a national meeting of surveillance experts to really explore the possibilities of developing an effective

s urveillance activity in the future. The NIOSH implementation of National Academy’s recommendations also recognizes the need for a comprehensive surveillance system. Con ducting

research on surveillance systems and creating a panel of experts to develop new approaches. And also, there is a mention of implementing pilot surveillance systems and we do have one such system going on at our center based out of Omaha. I would b e happy to discuss that at a different

time when there is more time. So, what types of information would be useful? Optimally, w e need

information on the populations, numbers, and demographics . We would really like to have information on working hours and even by task if possible.

We need information on the injuries, counts, rates, by personal and farm characteristics. Also, cost and lost time information would be helpful. >> With the inju ries, it might make sense to also collect information on illnesses and symptoms o f work related illnesses which are not very well known currently.

Also, it might be useful for information that producers are interested in

- to collect information on

mater ial damage related to it injury incidents, a nd possibly information on exposures such as noise,
dust, pesticides and other exposures. It would be also helpful to learn about the adoption of preventive measures including ROPS , PPE and other interventions to see if we are making

progress.

The new system should be regular, either one, two, or five

- year interval and using standardized

collection instruments. Covering key populations using established industry and occupation coding and hopefully also be compar able internationally. At least be comparable within the US with other industries and occupations. We would need information on incident characteristics such as time, location, task, cause/source, type of incident. And injury characteristics including ICD

- 9 or ICD

- 10 codes, body part, lost time, cost and possibly severity index.

How could this kind of information be collected?

We could continue similar collection mechanisms that NIOSH has conducted and maybe looking at if there is a way to modify it so that it could be more cost effective. We could possibly cooperate

with the N ational S afety Council that also collects information on injuries or possibly a new mechanism of conducting online surveys

-- for instance Farm Market iD has a fairly extensive d ata set for all US producers, agricultural producers which could be utilized for doing surveillance online but the response rate, in such a case, most likely would be lower than in the current surveys.

There might be some possibilities of unifying the s tate trauma systems and developing a more comprehensive national database out of state

- based systems. We also have ongoing pressclipping services that provide valuable information. FAC E investigations have been very helpful in

p r oviding information on specific cause and source or injury and providing recommendations to help prevent injuries. Also, current ly available and past available information that NIOSH has already collected should be analyzed with advanced epidemiological methods and that would

p rovide more detailed information from the data that has already be en collected. And, finally, there should be a national clearinghouse for pulling all of these are data together and reporting it

e ffectively to the public and to the farmers and to those wo rking in the field.

We need to keep the ultimate purpose in mind which is prevention. We need population information to know who is at risk. We need injury information to know what should be prevented , where , when, how and why. And putting those together we should learn more about the risk and protective factors for injury.

We need ongoing systems so that we know if we are making progress.

On the national level

, we also need to look at the size of the population and the size of the injury problem

, an d evaluate that against other occupations and industries

, to see if the current level of investment in the United States into agricultural health an d safety is at the right level w hen we are comparing agricultural forestry and f ishing to other occupations and industries.

That is all. I think you all for hearing my comments and recommendations. Thank you.

Thank you Dr. Rautiainen . Your presentation will be transcribed and posted along with your slides

to the NIOSH docket . We will now hear from parti cipants who requested an impromptu speaking opportunity through the Q&A feature. The speakers will be allowed five minutes. When you are recognized to speak please un mute your phone and identify yourselves. At that point your timer will begin. Michael Gold camp has been monitoring requests to speak and he will recognize the
requesters in turn . Michael, who is our first speaker?

We don't have one yet.

Alright . Is there anybody who wishes to speak ? If so please identify yourself.

This is Mary M iller from Washington S tate. I tried to raise my hand online but I may not have

succeeded , obviously. Can you hear me?

Yes we can.

Thank you. Sorry. So, I really appreciate this opportunity

, particular ly for the information provided by the presenters. I have a couple questions about this. I want reiterate all the recommendations by the speakers, I think they really provide us a hu ge foundation for going forward. What I'm

concerned about

, if there is not funding to do the basics that have be en done all this time, where will the funding come from for these new opportunities if we developed regional and pilot programs that need to be at least coordinated and developed so they are consistent to be able to compare across regions and countries, th at would take some funding and coordinating presumably or

h opefully by NIOSH

. S o, that is one question that I have. And, the other question is

, I'm just curious how would go about selecting a body that would be involved in providing some guidance and

feedb ack in a working group?

This is Dawn Castillo. So, I can try to it address the question regarding funding. One of the things that Kitty Hendricks had presented is that the methods that we have been using to

- date have now become more expensive because of our progress in reducing injuries. So

, we would have to expand our sample size. We are not facing a situation of no funds what we are facing is a situationwhere we need to look at these existing funds and how we can stretch it further. That addresses

th e first question. The second question is we very much welcome the suggestion s that we have had and one of the comments to date is to have some type of the advisory committee work

. W hen we opened up this meeting and we opened up the docket

, it was with the sincere interest in having suggestions from the stakeholder community. One of the recommendations so far has been to utilize the National Academy of Sciences . Another recommendation is to have the Ag centers manage a working group . We welcome t he opportunities. We don't have preconceived notions of who the advisory body would be.

Thank you very much.

Thank you Mary

. Is there anyone else who is on the phone who wishes to speak? If so, please

un mute your phone and identify yourself. >> [ Pause ]

Michael, do you have any additional speakers?

I do not.

W e don't have any additional speaking requests from participants . I f you have comments that were

not voice during this meeting I strongly encourage you to visit the Federal Register notice website

and follow the instructions for making comments. As Dawn indicated, we are sincerely interested in your comments. Comments must be received by May 27, 2015. At this time I thank you for participating in this public meeting. We look forward to considering your input in planning future

directions for agricultural injury surveillance. I will take one mo re moment to ask if there are any speakers who have comments. If so, please unmute your phone and identify yourself.

[ Pause ]

Thank you very much for participating in the public meeting. This p ublic meeting is now adjourned. [EVENT CONCLUDED ]