For safe mobile plant, employers should select equipment that is fit for purpose and safe for use under the working conditions in which it will be employed. It should be inspected, tested, maintained and operated to comply with any OEM recommendations and applicable statutory requirements and best practice guidance. A programme of pre-use visual checks, regular inspections, routine servicing and thorough examination should be established according to the manufacturer’s instructions and the risks associated with the use of each vehicle. There should be a system in place to ensure that all reported defects are rectified and recorded.

We reviewed published literature and found three major series studying eye-of-the-tiger sign and PANK2 mutation (Table 1) (Hayflick et al. 2003; Hartig et al. 2006; McNeill et al. 2008). And there are several PANK2-negative eye-of-the-tiger sign cases reported (Hartig et al. 2006; McNeill et al. 2008; Kumar et al. 2006; Strecker et al. 2007; Valentino et al. 2006). The correlation between eye-of-the-tiger sign and PKAN was good, 94% (143/152) of eye-of-the-tiger sign had PANK2 mutation, combining the cases of these three series (Hayflick et al. 2003; Hartig et al. 2006; McNeill et al. 2008). All cases with PANK2 mutation have eye-of-the-tiger sign, but not all eye-of-the-tiger sign cases showed PANK2 mutation. One of the PANK2-negative eye-of-the-tiger sign case was multiple system atrophy and two were neuroferritinopathy (Strecker et al. 2007; McNeill et al. 2008).

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Practical measures to consider include: all-round visibility, seat belts, Roll-Over Protection (ROPS), Falling Objects Protection (FOPS), brake testing, lighting & warnings, operator protection from residual hazards (noise, vibration, fumes, etc.), guarding etc.

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Practical measures to consider include: effective supervision, communication, mobile phones, key control, loading / unloading operations (including tipping), rated capacity not exceeded, using quick hitches, safety zones and entry procedures etc.

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We observed most of the PANK2 negative eye-of-the-tiger sign cases were late onset (Hartig et al. 2006; McNeill et al. 2008; Kumar et al. 2006; Strecker et al. 2007) or adult cases (Valentino et al. 2006), early onset PANK2 negative eye-of-the-tiger sign cases were reported only by Hartig et al. (2006). Considering the lower incidence of late onset NBIA (46% in Hayflick et al. 2003 and 25% in Hartig et al. 2006), most of the PANK2-negative cases reported were late onset. The combination of aging process and some other pathologic conditions may lead to an eye-of-the-tiger sign in these adults. We suggest that an eye-of-the-tiger sign might not be interpreted in isolation. Further studies might be necessary before the diagnosis of PKAN, especially in adult cases.

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The Workplace (Health, Safety and Welfare) Regulations deal with the organisation etc. of traffic routes and workplaces (where applicable) and should be considered together with PUWER. CDM Regulations 2015 (regulations 27 & 28) apply to construction sites regarding safe use of vehicles.

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The man, Tyron Scott McAlpin, who also has cerebral palsy, was repeatedly punched and shocked with a Taser by the police during an arrest in August. The arrest ...

There are ACOPs specific to items of plant such as Rider-operated lift trucks and also British Standards for safe use of equipment such as BS 7121 - Code of practice for safe use of cranes, which give advice on how to comply with the law.

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An eye-of-the-tiger sign is a specific magnetic resonance imaging (MRI) pattern, a key diagnostic feature of pantothenate kinase associated neurodegeneration (PKAN). It is low-signal intensity rings surrounding the central high-signal intensity regions in the medial aspect of bilateral globus pallidus on T2-weighted MRI (Fig. 1). The surrounding hypointensity of the globus pallidus is due to excess iron accumulation. The central hyperintensity is possibly due to gliosis. PKAN, previously known as Hallervorden-Spatz syndrome, is one of the three extrapyramidal disorders associated with increased amount of brain iron, known as neurodegeneration with brain iron accumulation (NBIA). According to the time of onset, PKAN has been classified as early onset (classic) or late onset (atypical). PKAN is caused by mutation of the pantothenate kinase 2 (PANK2), the major causative gene of NBIA. A one-to-one correlation between an eye-of-the-tiger sign and PKAN was reported by Hayflick et al. (2003). There are few PANK2 negative eye-of-the-tiger sign cases being reported (Hartig et al. 2006; McNeill et al. 2008; Kumar et al. 2006; Strecker et al. 2007; Valentino et al. 2006). Here, we described a case.

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There are many potential causes of incidents including: unsafe vehicles, equipment failure, pedestrian collisions, communication failures, poor visibility, operator’s not trained or competent, risk taking behavior, operator distraction etc.

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For safe workplaces emphasis should be on site design and preventing pedestrians coming within the area of operation of mobile plant. Practical measures to consider include: segregated pedestrian routes to provide safe access to work areas, traffic routes planned to minimize congestion and risk of collision, layout of road systems i.e. one-way where appropriate with clear sight lines, exclusion zones, restrictions i.e. height / width, overhead lines, avoiding edges with height drops and steep gradients, access and parking areas including contractors and deliveries, loading / unloading areas, speed limits, traffic signage & lighting etc.

For safe mobile plant operators and operations it is essential that operators are adequately trained and competent for their role. There are a number of recognized competence schemes that provide evidence of training and in some cases assessment (CPCS, MPQC, NPORS etc.).

Employers should also ensure that plant operators have an appropriate level of fitness. Various industry good practice guides are available on-line regarding assessment processes.

Mobile plant operations have the potential to result in a major catastrophic event. Identifying and monitoring effective performance indicators will help to reduce the risk of such an event occurring and safeguard compliance.

It is also important that mobile plant operators are familiar with the specific machine they are operating as there can be significant differences in control layouts and operating characteristics from one manufacturer to another.

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T2-weighted brain MRI of the 39-year-old patient showed bilateral symmetrical hypointensity in the globus pallidus with central hyperintensity, giving an eye-of-the-tiger sign (arrow).

The Management of Health and Safety at Work Regulations require you to carry out a risk assessment. Those in control of workplaces should undertake a risk assessment identifying the hazards associated with mobile plant tasks. Management, employees and safety representatives should be involved in undertaking this risk assessment.

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An eye-of-the-tiger sign is previously known to have one-to-one correlation with pantothenate kinase-associated neurodegeneration (PKAN). Reviewing the literature on this subject, the correlation between eye-of-the-tiger sign and PKAN seems to show an interesting hypothesis that differs from conventional conclusion. We analyze the published papers in an attempt to reflect this trend and illustrate our points with findings in a 39-year-old man. His brain magnetic resonance imaging study shows typical eye-of-the-tiger sign suggestive of PKAN. Genetic analyses revealed no mutations in pantothenate kinase 2.

Statutory requirements include the Provision and Use of Work Equipment Regulations (PUWER) which apply to the provision and use of all work equipment including mobile equipment, in all workplaces. The Lifting Operations and Lifting Equipment Regulations (LOLER), deals with the specific risks arising from the use of work equipment to lift loads.

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Working with - or near - mobile plant and equipment is a high risk activity where employers should take particular care to ensure the safety of employees, contractors and members of the public. Mobile plant will generally be used for earthmoving or excavating, lifting or suspending loads or elevating work platforms.

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Since 1995, all new plant must meet the essential health and safety requirements of the Supply of Machinery (Safety) Regulations. The outward signs of compliance are CE marking and a Declaration of Conformity document. Some items of equipment are designed to a harmonized European Standard such as EN 474-5 for excavators.

Traffic rules should be established as part of a safe system of work following risk assessment and communicated to all relevant persons. The risk assessment and traffic rules should be monitored and reviewed on a regular basis.

Chih Ming Lin, M.D., Senior Consultant, Department of Neurology, Cathay General Hospital, 678, Section 2, Junghua Road, 30060 Hsinchu, Taiwan. Tel: 882-3-5278999 ext. 2660; E-mail: googlejoseph@yahoo.com.tw

A 39-year-old male patient presented to our hospital with a 3-month history of repetitive, intermittent head turning to right. The symptom showed no fluctuation and did not improve after rest. The physical examination and neurological examination were unremarkable except right cervical dystonia with positive sensory trick. Cervical spine X-ray, nerve conduction velocity, electromyography, electroencephalography, and laboratory evaluation were normal. T2-weighted MRI showed a typical eye-of-the-tiger sign (Fig. 1). This imaging finding suggested PKAN. But, further study of the patient revealed no evidence of PANK2 gene mutation, aceruloplasminaemia, neuroferritinopathy, or retinopathy.

Every year, a significant number of people are killed by accidents involving mobile plant in the workplace, and many more are injured. For safe workplaces Keith Dunbar, SHEQ manager at MRS Training & Rescue, says there should be more emphasis on site design and preventing pedestrians coming within the area of operation of mobile plant.

Keywords: Neurodegeneration with brain iron accumulation, pantothenate kinase-associated neurodegeneration, pantothenate kinase 2, eye-of-the-tiger sign, PKAN, NBIA, Hallervorden-Spatz syndrome