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Due to the public health concerns of endocrine-disrupting chemicals, there is an increasing demand to develop improved high-throughput detection assays for enhanced exposure control and risk assessment. A substrate-free, autobioluminescent HEK293ARE/Gal4-Lux assay was developed to screen compounds for their ability to induce androgen receptor (AR)-mediated transcriptional activation. The assay was validated against a group of 40 recommended chemicals and achieved an overall 87.5% accuracy in qualitatively classifying positive and negative AR agonists. The HEK293ARE/Gal4-Lux assay was demonstrated as a suitable tool for Tier 1 AR agonist screening. By eliminating exogenous substrate, this assay provided a significant advantage over traditional reporter assays by enabling higher-throughput screening with reduced testing costs while maintaining detection accuracy., METHOD SUMMARY A human optimized version of the bacterial luciferase gene cassette was developed such that bioluminescence is controlled by exposure to androgen-disruptor chemicals. This cassette, along with the androgen receptor gene, was co-transfected into an HEK293 human cell host that naturally lacks hormone receptors. The resulting reporter cell line was used to screen compounds for androgenic activity in a low cost, high throughput format.

Human alcohol laboratory studies use two routes of alcohol administration: ingestion and infusion. The goal of this paper was to compare and contrast these alcohol administration methods. The work summarized in this report was the basis of a 2019 Research Society on Alcoholism Roundtable, "To Ingest or Infuse: A Comparison of Oral and Intravenous Alcohol Administration Methods for Human Alcohol Laboratory Designs." We review the methodological approaches of each and highlight strengths and weaknesses pertaining to different research questions. We summarize methodological considerations to aid researchers in choosing the most appropriate method for their inquiry, considering exposure variability, alcohol expectancy effects, safety, bandwidth, technical skills, documentation of alcohol exposure, experimental variety, ecological validity, and cost. Ingestion of alcohol remains a common and often a preferable, methodological practice in alcohol research. Nonetheless, the main problem with ingestion is that even the most careful calculation of dose and control of dosing procedures yields substantial and uncontrollable variability in the participants' brain exposures to alcohol. Infusion methodologies provide precise exposure control but are technically complex and may be limited in ecological validity. We suggest that alcohol ingestion research may not be the same thing as alcohol exposure research; investigators should be aware of the advantages and disadvantages that the choice between ingestion and infusion of alcohol invokes.

Information on knowledge (K), attitude (A), and practice (P) in terms of pesticide use is essential for an effective exposure control program. The objectives of this study were to survey the level of knowledge, attitude, and practice in terms of pesticide use, and the prevalence of acute health symptoms (AHSs) among farmers in Nakhon Sawan Province, Thailand. The study also tried to identify factors affecting the practice of pesticide use. Data from 680 farmers were collected using a face-to-face interview questionnaire. The relationship between safety practices and related factors was analyzed using ordinal logistic regression. This study found about 40% of the farmers had a good level of practice. Factors affecting practice were education, work experience, level of knowledge, or attitudes. Many participants experienced acute health symptoms in the past 24 h, and these symptoms were significantly associated with poor practice (p &lt, 0.05). Public health organizations should provide farmers with more information, especially on chronic effects of pesticides.

Objectives This study aimed to clarify the exposure characteristics and risks of ultrafine particles from the blast furnace process and to provide a reasonable control strategy for protecting the health of workers. Methods The blast furnace location of a steelmaking plant was selected as a typical investigation site. A membrane‐based sampling system was used to collect ultrafine particles to analyze their morphology and elemental compositions. A real‐time system was used to monitor the total number concentration (NC), total respirable mass concentration (MC), surface area concentration (SAC), and size distribution by number. The risk level of ultrafine particles was analyzed using the Stoffenmanager‐Nano model. Results The total NC, total MC, and SAC increased significantly relative to background concentrations after slag releasing started and decreased gradually after the activity stopped. The three highest total concentrations during slag releasing were 3‐10 times higher than those of the background or non‐activity period. The ultrafine particles were mainly gathered at 10.4 or 40 nm, and presented as lump‐like agglomerates. The metal elements (Al and Pt) in the ultrafine particles originated from slag and iron ore. The risk level of the ultrafine particles was high, indicating the existing control measures were insufficient. Conclusions The blast furnace workers are at high risk due to exposure to high levels of ultrafine particles associated with working activity and with a bimodal size distribution. The existing control strategies, including engineering control, management control, and personal protection equipment need to be improved.

β-Glucans are abundant bacterial, yeast, and fungal cell wall polysaccharides that have been shown to activate the immune system. Establishment of an occupational exposure limit (OEL) for β-glucan exposure is critical to the protection of worker health, as these exposures have been linked to immunosuppressive and inflammatory reactions and possibly the development of respiratory diseases. Detectable concentrations of β-glucans have been identified in common occupational inhalation exposure scenarios, such as in the agricultural and waste management sectors. However, no published exposure benchmarks for inhalation of β-glucans are available for workers or the general population. Thus, a health-based OEL for inhalation exposure of workers to β-glucans was derived based on consideration of human and non-human effect data for this class of compounds and contemporary risk assessment methods. The weight of the evidence indicated that the available data in humans showed significant methodological limitations, such as lack of a representative study size, appropriate control population, and clear dose-response relationship. Thus, an OEL of 150 ng/m3 was derived for β-glucans based on the most relevant nonclinical study. This OEL provides an input to the occupational risk assessment process, allows for comparisons to worker exposure, and can guide risk management and exposure control decisions.

Roasted coffee and many coffee flavorings emit volatile organic compounds (VOCs) including diacetyl and 2,3-pentanedione. Exposures to VOCs during roasting, packaging, grinding, and flavoring coffee can negatively impact the respiratory health of workers. Inhalational exposures to diacetyl and 2,3-pentanedione can cause obliterative bronchiolitis. This study summarizes exposures to and emissions of VOCs in 17 coffee roasting and packaging facilities that included 10 cafés. We collected 415 personal and 760 area full-shift, and 606 personal task-based air samples for diacetyl, 2,3-pentanedione, 2,3-hexanedione, and acetoin using silica gel tubes. We also collected 296 instantaneous activity and 312 instantaneous source air measurements for 18 VOCs using evacuated canisters. The highest personal full-shift exposure in part per billion (ppb) to diacetyl [geometric mean (GM) 21 ppb; 95th percentile (P95) 79 ppb] and 2,3-pentanedione (GM 15 ppb; P95 52 ppb) were measured for production workers in flavored coffee production areas. These workers also had the highest percentage of measurements above the NIOSH Recommended Exposure Limit (REL) for diacetyl (95%) and 2,3-pentanedione (77%). Personal exposures to diacetyl (GM 0.9 ppb; P95 6.0 ppb) and 2,3-pentanedione (GM 0.7 ppb; P95 4.4 ppb) were the lowest for non-production workers of facilities that did not flavor coffee. Job groups with the highest personal full-shift exposures to diacetyl and 2,3-pentanedione were flavoring workers (GM 34 and 38 ppb), packaging workers (GM 27 and 19 ppb) and grinder operator (GM 26 and 22 ppb), respectively, in flavored coffee facilities, and packaging workers (GM 8.0 and 4.4 ppb) and production workers (GM 6.3 and 4.6 ppb) in non-flavored coffee facilities. Baristas in cafés had mean full-shift exposures below the RELs (GM 4.1 ppb diacetyl; GM 4.6 ppb 2,3-pentanedione). The tasks, activities, and sources associated with flavoring in flavored coffee facilities and grinding in non-flavored coffee facilities, had some of the highest GM and P95 estimates for both diacetyl and 2,3-pentanedione. Controlling emissions at grinding machines and flavoring areas and isolating higher exposure areas (e.g., flavoring, grinding, and packaging areas) from the main production space and from administrative or non-production spaces is essential for maintaining exposure control.

Background: Reliable exposure control measures are needed to avoid occupational exposures from hazardous drugs. However, there is little information on blister packages concerning exposure. We investigated the contamination and exposure control methods of lenalidomide. Materials and Methods: Nine facilities involved with the RevMate program (the Japanese REMS program) participated in this study. Blister packages (10 capsules/ sheet, no cuts) were collected from each institution after the administration of 5-mg Revlimid capsules. Additionally, the safety performance of different gloves was tested. Results: A total of 18 samples were analyzed and the results revealed that all samples were contaminated with lenalidomide. Our questionnaire revealed that all pharmacists handled the blister packages with their bare hands when they were checking the remaining capsules of lenalidomide. We analyzed gloves made from four different materials (nitrile, polyvinyl chloride, latex, and polyethylene) and found no permeability in any glove type. Conclusion: We conclude that the spent blister package is a potential source of exposure to lenalidomide. All medical staff and caregivers should wear gloves when they handle lenalidomide.

Silicosis and other respirable crystalline silica-associated diseases, most notably tuberculosis, have long been substantial causes of morbidity and mortality in South Africa. For the mining and non-mining industries, silicosis elimination programmes have been developed with milestones regarding reduction of levels of exposure to respirable crystalline silica (RCS) and targets regarding the date of eradication. The present paper explores the feasibility of achieving these targets by investigating the evidence that levels of exposure and silicosis incidence rates have declined by an appraisal of the methods for data collection and reporting. In the mining industry the silicosis elimination programme is supported by the development and advocacy of leading practices to reduce the exposure. RCS exposure data are routinely collected according to a Code of Practice (CoP) and the results are reported to the Mine Health and Safety Inspectorate. As the CoP and the actual workplace practices have been demonstrated to have some flaws, there is some concern about the accuracy of the actual exposure data and the data interpretation. The annually reported levels of exposure suggest a decline, however, the actual levels of RCS as well as the number of exposed workers, were not reported over the last few years. With regard to the silicosis incidence rates, a steady decline of new cases is reported. However, there is a risk of under-diagnosis and- reporting especially in former miners. In the non-mining industries, a systematic baseline of RCS exposure levels and silicosis incidence is lacking. The reporting by industries on assigning of the workforce to exposure categories seems to be fragmented and incomplete. Consequently, any evidence of progress toward achieving the silicosis elimination target cannot be documented. Both the silicosis elimination target and the exposure milestone are aspirational but are unlikely to be achieved. Nevertheless, the formal mining industry may get close. Exposure control interventions, especially in the non-mining industries, should be developed and implemented and pragmatic methods need to be put in place to identify sources of new silicosis cases for targeted intervention.

As one of the most important energy resources in the world, coal contributes a great deal to the world economy. Coal mining and processing involve multiple dust generation processes including coal cutting, transport, crushing and milling etc. Coal dust is one of the main sources of health hazard for the coal workers. Exposure of coal dusts can be prevented through administrative controls and engineering controls. Ineffective control of coal dust exposure can harm coal workers' health. Although many efforts have been made to eliminate these threats, recent years have seen an unexpected increase in coal workers' pneumoconiosis (CWP) in Appalachian basin in US. To explore the reasons for this phenomenon, in this review, we first reviewed the historical studies on coal mine dust including the regulation and engineering controls. Then, the effects of coal dust on human health was comprehensively reviewed. Next, the effects of nanoparticles on human health were reviewed, with an emphasis on toxicity of nanoparticles such as carbon nanotubes in other industries. From all this information, we hypothesize that nano-sized coal dust has contributed to the increase of CWP prevalence in recent years. As no research has been reported in this area, four directions which may need further investigation and future studies are recommended in this review. They include: 1) Systematic characterization of physicochemical properties of nano-size coal dust; 2) Toxicity and pathogenesis of nano-sized coal dust; 3) Development of real-time monitoring technology and equipment for nano-sized coal dust; 4) Development of exposure control technology and equipment. The intent of this review paper is to demonstrate the variation of coal dust properties and their impact on the mine worker's health. We suggest that the impact of nano-sized coal mine dust on miner's health has not yet been understood well and further improvements are necessary.

Objective: Aim of the present study is to investigate the levels of endotoxins on product samples from potatoes, onions, and seeds, representing a relevant part of the agro-food industry in the Netherlands, to gather valuable insights in possibilities for exposure control measures early in the process of industrial processing of these products. Methods: Endotoxin levels on 330 products samples from companies representing the potato, onion, and seed (processing) industry (four potato-packaging companies, five potato-processing companies, five onion-packaging companies, and four seed-processing companies) were assessed using the Limulus Amboecyte Lysate (LAL) assay. As variation in growth conditions (type of soil, growth type) and product characteristics (surface roughness, dustiness, size, species) are assumed to influence the level of endotoxin on products, different types, and growth conditions were considered when collecting the samples. Additionally, waste material, rotten products, felt material (used for drying), and process water were collected. Results: A large variation in the endotoxin levels was found on samples of potatoes, onions, and seeds (overall geometric standard deviation 17), in the range between 0.7 EU g-1 to 16 400 000 EU g-1. The highest geometric mean endotoxin levels were found in plant material (319 600 EU g-1), followed by soil material (49 100 EU g-1) and the outer side of products (9300 EU g-1), indicating that removal of plant and soil material early in the process would be an effective exposure control strategy. The high levels of endotoxins found in the limited number of samples from rotten onions indicate that these rotten onions should also be removed early in the process. Mean endotoxin levels found in waste material (only available for seed processing) is similar to the level found in soil material, although the range is much larger. On uncleaned seeds, higher endotoxin levels were found than on cleaned seeds, indicating that cleaning processes are important control measures and also that the waste material should be handled with care. Conclusions: Although endotoxin levels in batches of to-be-processed potatoes, onions, and seeds vary quite dramatically, it could be concluded that rotten products, plant material, and waste material contain particularly high endotoxin levels. This information was used to propose control measures to reduce exposure to endotoxins of workers during the production process.

Toxicology studies suggest that exposure to certain types of engineered nanomaterials (ENMs) may cause adverse health effects, but little is known about the workforce in the United States that produces or uses these materials. In addition, occupational exposure control strategies in this industry are not well characterized. This study identified U.S. ENM manufacturers and users (other than carbon nanotubes and nanofibers, which have been characterized elsewhere), determined workforce size, characterized types and quantities of materials used, occupational exposure control strategies, and the feasibility of occupational ENM exposure studies.Eligible companies were identified and information was collected through phone surveys on nanomaterials produced or used, workforce size, location, work practices, and exposure control strategies. The companies were classified into groups for additional examinations.Forty-nine companies producing or using ENMs in the U.S. were identified. These companies employed at least 1,500 workers. Most companies produced or used some form of nanoscale metal. More than half of the eligible companies were suppliers for the coatings, composite materials, or general industries. Each company provided information about worker exposure reduction strategies through engineering controls, administrative controls, or personal protective equipment. Production-scale companies reported greater use of specific exposure control strategies for ENMs than laboratory-scale companies.Workplaces producing or using ENMs report using engineering and administrative controls as well as personal protective equipment to control worker exposure. Industrywide exposure assessment studies appear feasible due to workforce size. However, more effort must be taken to target industries using specific ENMs based on known toxicological effects and health risks.

Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls (i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth) was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training, ambient air and exposure monitoring, and medical surveillance.

OBJECTIVE The aim of this study was to examine military occupational specialty (MOS) codes to identify those at risk from inhalation exposures during Southwest Asia deployment. METHODS Exposure intensity to diesel exhaust, sandstorms, burn pit smoke, combat dust, and occupational vapors/dusts/gases/fumes (VDGF) were scored for all Army/Marine MOS codes by an expert panel. Based on MOS code, panel-rated exposure scores were compared with questionnaire data from military personnel with postdeployment respiratory illnesses. RESULTS All exposures except VDGF were rated higher (range P

Background Total paper dust exposure has been associated with respiratory problems among workers in the soft tissue paper industry. However, a comprehensive job exposure matrix (JEM) has not been developed for application to this industry. Our study was intended to address this need and to support further studies of mortality and morbidity in a cohort of Swedish workers from this industry. Methods We evaluated four participating soft tissue paper mills in Sweden. We combined information on process and equipment status from the mills with knowledge of the mills obtained through research efforts and paper dust measurements made at all four mills to develop a semi-quantitative JEM with seven dust exposure levels. The JEM was targeted at workers enrolled into a soft tissue paper mill cohort and working any time between 1960 and 2009. Results The JEM includes a total of 14 421 cells, with each cell corresponding to the exposure for a job title, department, or work location for a one-year period. Exposure levels in the JEM were estimated to decline at three of the four mills from 1971 to 2009, but overexposures (ie, exceedances of the relevant occupational exposure limits) remained common at the end of the period. Conclusions The JEM results highlight the need for ongoing exposure control efforts in the soft tissue paper industry, and will inform ongoing epidemiological studies of the health effects of exposure to paper dust in Sweden. It is freely available for use by other researchers.

The current endoscope design is not ergonomic. There is a high prevalence of endoscopy-related injury reported in the literature, and studies have demonstrated high-risk biomechanical exposures during the performance of routine colonoscopy. Endoscopy ergonomics focuses on understanding the endoscopist's interaction with the endoscope and the endoscopy unit and re-designing these tasks to minimize the risk of endoscopy-related injury. The discussion to date has focused on what the endoscopist can do to minimize his or her risk of injury. It is imperative that we re-frame that discussion because the implication that physicians are responsible for implementing personal or workplace interventions places an undue burden on physicians and will be the least effective exposure control method. Endoscope companies need to consider the endoscopist in their design process. As a profession, we need to collectively advocate for endoscopist safety. We offer a perspective on how ergonomic endoscopy can become a realistic and achievable goal.

BACKGROUND Cyanogen is a toxic flammable gas used as a fumigant in numerous industries. Occupational exposure to cyanogen can occur during its production and use. The most serious human health risk from exposure to cyanogen is via the respiratory system. However, there is also potential for skin exposure in many workplace situations. The extent of skin absorption under occupational exposure scenarios has not been directly assessed. Understanding skin uptake potential may inform risk assessment and exposure control measures. RESULTS We describe an in vitro experimental system using human epidermis and dynamic atmosphere exposure to cyanogen to mimic potential workplace exposures. The influence of clothing and ventilation on skin permeation outcomes were also assessed. No evidence of transdermal permeation was found at 100 or 1000 ppm exposures, while permeation of 0.99 ± 0.38 μg cm-2 was observed after 60 min exposure to 10 000 ppm. Fabric on skin and skin ventilation had no additional influence on transdermal permeation compared with naked skin, but fabric provided a reservoir for potential secondary exposures. CONCLUSION Results show dermal uptake following cyanogen exposure is possible, but only at very high atmospheric concentrations (10 000 ppm after >15 min exposure). Importantly, this could have implications for fumigant applicators who may only be wearing personal respiratory protection. These empirical data may be used in conjunction with other relevant toxicological information in determining whether a Skin Notation is warranted for Workplace Exposure Standard setting. © 2019 Society of Chemical Industry.

This work describes a new approach to automatic dose rate control (ADRC) for dynamic x-ray imaging, utilizing a spatial frequency weighted signal difference to noise ratio (SDNR(u)). Three aspects of ADRC programming using SDNR(u), which contains information on the target material, velocity and size, were examined. First, whether SDNR(u) can be held constant at the requested level over some patient thickness range for five materials relevant to interventional imaging (iron, gadolinium, platinum, bismuth, and tantalum). Second, the efficiency of the new ADRC was compared to the current settings using a figure of merit (FOM), defined as SDNR(u)2/reference air kerma rate for iron and platinum, over a range of simulated patient thicknesses. Third, the ability of the new ADRC to optimize exposure parameters for iron, iodine, gadolinium, tantalum, platinum and bismuth was examined. A phantom of 20 mm PMMA and 2 mm Al sheets was used to simulate patient equivalent thicknesses between 25 mm to 375 mm. The relevant metal foil targets were placed at the phantom centre and imaged on a Siemens Artis Q cardio-angiography system. SDNR(u) and reference air kerma were measured, along with the FOM for the relevant conditions. The optimal exposure factor study was made for patient equivalent thicknesses of 100 mm, 200 mm and 300 mm. The new ADRC regulation held SDNR(u) constant versus phantom thickness within 5%, for the five materials studied. FOM increase compared to the current regulation used on the Artis Q ranged between 18% and 296% (averaged over all thicknesses), and depended on acquisition mode and material. Material optimization via the new ADRC increased FOM by 68%, 165%, 164% and 32% for gadolinium, tantalum, platinum and bismuth respectively, corresponding to potential dose savings of 40%, 62%, 62% and 24% for the same target SDNR(u). An SDNR(u) driven approach to the ADRC logic of dynamic imaging systems is a viable alternative to current programming, with a resulting improvement in imaging efficiency and corresponding dose reduction. ispartof: PHYSICS IN MEDICINE AND BIOLOGY vol:64 issue:4 ispartof: location:England status: published

Our goal was to define a pediatric head CT protocol able to provide images of diagnostic quality, using the least amount of radiation, in children

Biological monitoring is a useful tool to assess occupational and environmental exposure following a wide range of chemical incidents. Guidance values are available from international organisations to help interpret the result of biological monitoring. In addition, guidance values based on the 90th percentile of biological monitoring data obtained under conditions of good exposure control may help identify lapses in control and the need for remedial action to improve controls and reduce risk. In all cases interpretation of biomonitoring results following incidents needs care and in particular reference to the time of sample collection and basis of the guidance values. Biomonitoring guidance values specifically derived for chemical incident scenarios are not available but would be of great help to interpret biological monitoring results.

Automatic exposure control (AEC) is particularly well-suited for pediatric CT scanning. However the importance of the localizer scan portion of exams that relies on AEC is frequently underestimated. This paper explains in detail several crucial aspects of the localizer and their effect on the subsequent cross-sectional (axial or helical) image acquisition. The paper also covers general suggestions regarding AEC influence on the cross-sectional images. AEC systems on CT scanners are becoming more complex; using them effectively in the setting of pediatric CT requires careful selection of scan parameters.

Adequate dose management during computed tomography is important. In the present study, the dosimetric application software ImPACT was added to a functional calculator of the size-specific dose estimate and was part of the scan settings for the auto exposure control (AEC) technique. This study aimed to assess the practicality and accuracy of the modified ImPACT software for dose estimation. We compared the conversion factors identified by the software with the values reported by the American Association of Physicists in Medicine Task Group 204, and we noted similar results. Moreover, doses were calculated with the AEC technique and a fixed-tube current of 200 mA for the chest-pelvis region. The modified ImPACT software could estimate each organ dose, which was based on the modulated tube current. The ability to perform beneficial modifications indicates the flexibility of the ImPACT software. The ImPACT software can be further modified for estimation of other doses.

To establish whether CT dose variation occurs in breast cancer localization procedures between radiation therapy (RT) centres in Ireland and to propose diagnostic reference levels (DRLs) for this procedure.All RT centres in Ireland were invited to participate in a dose audit survey, providing data on the CT dose index volume (CTDIvol), dose-length product (DLP), current-time product (mAs), tube potential, scan length, slice thickness, scanning margins, use of automated exposure control (AEC) and scanner technology for 10 patients with breast cancer who were average sized. DRLs were derived for each dose descriptor by calculation of the rounded 75th percentile of the distribution of mean doses.Data were returned for 60 patients from 6 RT centres (50% response rate). Significant variation in mean CTDIvol and mean DLP was observed between centres (p 0.0001). Mean scan lengths and mean mAs differed significantly between centres (p 0.0001). Tube potential was 120 kV for all sequences across centres. AEC was employed in all but one centre. Proposed DRLs for breast localization are 26 mGy and 732 mGy cm for CTDIvol and DLP, respectively.CT dose variation occurs between centres, establishing a need for optimization. DRLs for breast cancer localization have been proposed with the potential for reduction in CT dose.This article provides the first reported DRL for breast cancer CT localization procedure in RT and can be used as a benchmark for comparison for other RT centres.

Fifty posterior-anterior chest radiographs taken using an auto exposure control were evaluated in order to find an optimum determination method of the exposure index (EI). Four types of the relevant image regions were tested: (a) full image, (b) central 25% area, (c) full image excluding direct x-ray area, and (d) pulmonary area only, whereas four types of the value of interest (VOI) were adopted to each relevant image region: mean, median, mode, and middle. When the target EI was determined as the average of the 50 images, the deviation index (DI) was within ±1.0 only if pulmonary area was selected as the relevant image region, with the VOI of mean, median, and middle. This result strongly suggests that pulmonary area should be selected as the relevant image region of an EI when an auto exposure control is used.

In this article, we propose a simplified version of the maximum information per time unit method (MIT; Fan, Wang, Chang, & Douglas, Journal of Educational and Behavioral Statistics 37: 655-670, 2012), or MIT-S, for computerized adaptive testing. Unlike the original MIT method, the proposed MIT-S method does not require fitting a response time model to the individual-level response time data. It is also computationally efficient. The performance of the MIT-S method was compared against that of the maximum information (MI) method in terms of measurement precision, testing time saving, and item pool usage under various item response theory (IRT) models. The results indicated that when the underlying IRT model is the two- or three-parameter logistic model, the MIT-S method maintains measurement precision and saves testing time. It performs similarly to the MI method in exposure control; both result in highly skewed item exposure distributions, due to heavy reliance on the highly discriminating items. If the underlying model is the one-parameter logistic (1PL) model, the MIT-S method maintains the measurement precision and saves a considerable amount of testing time. However, its heavy reliance on time-saving items leads to a highly skewed item exposure distribution. This weakness can be ameliorated by using randomesque exposure control, which successfully balances the item pool usage. Overall, the MIT-S method with randomesque exposure control is recommended for achieving better testing efficiency while maintaining measurement precision and balanced item pool usage when the underlying IRT model is 1PL.

Granite countertop fabricators are at risk of exposure to respirable crystalline silica, which may cause silicosis and other lung conditions. The purpose of this study was to estimate the prevalence of exposure control methods, especially wet methods, in granite countertop fabrication in Oklahoma to assess how many workers might be at risk of overexposure to crystalline silica in this industry. Granite fabrication shops in the three largest metropolitan areas in Oklahoma were enumerated, and 47 of the 52 shops participated in a survey on fabrication methods. Countertop shops were small businesses with average work forces of fewer than 10 employees. Ten shops (21%) reported using exclusively wet methods during all fabrication steps. Thirty-five shops (74%) employing a total of about 200 workers reported using dry methods all or most of the time in at least one fabrication step. The tasks most often performed dry were edge profiling (17% of shops), cutting of grooves for reinforcing rods (62% of shops), and cutting of sink openings (45% of shops). All shops reported providing either half-face or full-face respirators for use during fabrication, but none reported doing respirator fit testing. Few shops reported using any kind of dust collection system. These findings suggest that current consumer demand for granite countertops is giving rise to a new wave of workers at risk of silicosis due to potential overexposure to granite dust.

Dust reduction equipment adapted for single-person operation was evaluated for gas-powered, commercially available cut-off saws during concrete curb cutting. Cutting was performed without dust control and with two individual exposure control methods: wet suppression and local exhaust ventilation (LEV). The wet suppression system comprised a two-nozzle spray system and a 13.3-L hand-pressurized water supply system with an optimum mean flow rate of 0.83 L/min for 16 min of cutting. The LEV system consisted of a spring-loaded guard, an 18.9-L collection bag, and a centrifugal fan with an estimated exhaust rate of 91 ft(3)/min. Task-based, personal filter samples were obtained for four saw operators during cutting durations of 4 to 16 min on five job sites. Seventeen filter samples were collected without dust control, 14 with wet suppression, and 12 with LEV, yielding a geometric mean respirable dust concentration of 16.4 mg/m(3), 3.60 mg/m(3), and 4.40 mg/m(3), respectively. A dust reduction of 78.0% for wet suppression and 73.2% for LEV was observed vs. no dust control. A statistically significant difference (p0.001) was also revealed for wet suppression and LEV when compared with no dust control; however, a significant difference (p = 0.09) was not observed between wet suppression and LEV. Despite these significant dust reductions, workers are still projected to exceed the ACGIH 8-hr time-weighted average threshold limit value for quartz (0.025 mg/m(3)) in less than 1 hr of cutting for both dust control methods. Further research is still needed to improve dust reduction and portability of both control methods, but the current LEV system offers important advantages, including a drier, less slippery work area and year-round functionality in cold weather.

Rationale and Objectives Since the introduction of computed tomographic (CT) imaging in the 1970s, the number of examinations has increased steadily. CT imaging is an essential part of routine workup in diagnostic radiology. The great advantage of multidetector computed tomography is the acquisition of a large amount of data in a short time period, thus speeding up diagnostic procedures. To protect patients from unnecessary radiation exposure, different approaches have been developed. In this study, the efficacy of automated exposure control (AEC) software in multidetector CT imaging with a focus on dose reduction in pediatric examinations was assessed. Materials and Methods Between August 2004 and September 2005, a total of 71 children (40 male, 31 female; age range, 2–13 years; mean age, 7.2 years) were examined using a multisource CT scanner. Three different regions (chest, upper abdomen, and pelvis) were examined. Overall image quality was assessed with a subjective scale (1 = excellent, 2 = diagnostic, 3 = nondiagnostic). For all examinations, AEC was used. From the scanner’s patient protocol, dose-length product, volume CT dose index, and tube current–time product were calculated for each examination. Results With AEC, a mean dose reduction of 30.6% was calculated. Images were rated as excellent (n = 39) or diagnostic (n = 32). Nondiagnostic image quality was not seen. Dose-length product and volume CT dose index were reduced by 30.4% and 29.5%, respectively. Overall, a mean dose reduction of 30.1% of the effective dose (5.8 ± 3.1 vs 8.4 ± 4.6 mSv) was achieved (P Conclusions With AEC software, a mean dose reduction of 30% without any loss in diagnostic image quality is possible.

Stakeholders have raised numerous issues regarding the scientific basis of radiation dose reconstruction for compensation. These issues can be grouped into three broad categories: data issues, dosimetry issues, and compensation issues. Data issues include demographic data of the worker, changes in site operations over time (both production and exposure control), characterization of episodic vs. chronic exposures, and the use of coworker data. Dosimetry issues include methods for assessment of ambient exposures, missed dose, unmonitored dose, and medical x-ray dose incurred as a condition of employment. Specific issues related to external dose include the sensitivity, angular and energy dependence of personal monitors, exposure geometries, and the accompanying uncertainties. Those related to internal dose include sensitivity of bioassay methods, uncertainties in biokinetic models, appropriate dose coefficients, and modeling uncertainties. Compensation issues include uncertainties in the risk models and use of the 99 th percentile of the distribution of probability of causation for awarding compensation. A review of the scientific literature and analysis of each of these issues distinguishes factors that play a major role in the compensation decision from those that do not.

The National Institute for Occupational Safety and Health (NIOSH) conducted 21 field surveys in selected industries to characterize workers' exposures to hexavalent chromium-containing airborne particulate and to evaluate existing technologies for controlling these exposures. Hexavalent chromium Cr(VI) is a respiratory irritant and chronic inhalation may cause lung cancer. Primary evaluation methods included collection of full work shift, personal breathing-zone (PBZ) air samples for Cr(VI), measurement of ventilation system parameters, and documentation of processes and work practices. This study emphasized evaluation of engineering exposure control measures, so PBZ exposures were measured on the outside of personal protective equipment, for example, respirators. Field surveys were conducted in two chromium electroplating facilities, including one where full-shift PBZ exposures to Cr(VI) ranged from 3.0 to 16 times the 1 micro g/m(3)NIOSH recommended exposure limit (REL) despite several engineering controls on the plating tanks. At a painting and coating facility that used Cr(VI)-containing products, full-shift exposures of painters and helpers (2.4 to 55 micro g/m(3)) exceeded the REL, but LEV effectiveness was limited. Other operations evaluated included welding in construction; metal cutting operations on chromium-containing materials in ship breaking; chromate-paint removal with abrasive blasting; atomized alloy-spray coating; foundry operations; printing; and the manufacture of refractory brick, colored glass, prefabricated concrete products, and treated wood products. NIOSH researchers concluded that, in many of the evaluated processes, Cr(VI) exposures at or below the current NIOSH REL are achievable. However, for some processes, it is unclear whether controlling exposures to this range is consistently achievable without respirator use. Some operations involving the application of coatings and finishes may be among those most difficult to control to this range. Most operations judged to be moderately difficult to control to this range involve joining and cutting metals with relatively high chromium content. Nonetheless, exposures in a wide variety of other processes were judged more easily controllable to the current REL or below, or were found to be minimal, including some operations meeting the general descriptions named above but with different specific operating parameters producing lower Cr(VI) exposures.

To test an economically reasonable method to reduce thermal stress, we performed an alternated intervention-control study on 2 groups of 8 male steel workers performing the same jobs, using 2 l of water at ambient temperature (23.5 degrees C +/- 1.4), poured on the head and hands. Each group participated for 2 d as control and 2 d as intervention during 4 consecutive summer days in Brazil, 5 h per shift per day. Testing was done by: 1) recording of temperature by thermistors placed on the external ear canal through earplug, skin (chest, upper arm, inner thigh, outer calf) and clothes; 2) recording of heart rate; and 3) Wet Bulb Globe Temperature recording. The intervention was held hourly, when body weight and water intake were evaluated. Symptoms and subjective sensations were evaluated in the beginning and at the end of each shift. No differences were observed in external ear canal and skin temperatures. Subjective thermal sensation (p = 0.018), sweat perception (p = 0.043), and tiredness (p = 0.028) presented positive statistically significant results when comparing intervention to control measurements. In conclusion, our results could not provide evidence that the proposed method cools the analyzed temperatures, although the subjective evaluation suggests a decrease in the head skin temperature, which could be a useful comfort measure.

Item bank stratification has been shown to be an effective method for combating item overexposure in both uni- and multidimensional computer adaptive testing. However, item bank stratification cannot guarantee that items will not be overexposed—that is, exposed at a rate exceeding some prespecified threshold. In this article, we propose enhancing stratification for multidimensional computer adaptive tests by combining it with the item eligibility method, a technique for controlling the maximum exposure rate in computerized tests. The performance of the method was examined via a simulation study and compared to existing methods of item selection and exposure control. Also, for the first time, maximum likelihood (MLE) and expected a posteriori (EAP) estimation of examinee ability were compared side by side in a multidimensional computer adaptive test. The simulation suggested that the proposed method is effective in suppressing the maximum item exposure rate with very little loss of measurement accuracy and precision. As compared to MLE, EAP generates smaller mean squared errors of the ability estimates in all simulation conditions.

X-ray dose reduction in pediatrics is particularly important because babies and children are very sensitive to radiation exposure. We present new developments to further decrease pediatric patient dose. With the help of an advanced exposure control, a constant image quality can be maintained for all patient sizes, leading to dose savings for babies and children of up to 30%. Because objects of interest are quite small and the speed of motion is high in pediatric patients, short pulse widths down to 4 ms are important to reduce motion blurring artifacts. Further, a new noise-reduction algorithm is presented that detects and processes signal and noise in different frequency bands, generating smooth images without contrast loss. Finally, we introduce a super-resolution technique: two or more medical images, which are shifted against each other in a subpixel region, are combined to resolve structures smaller than the size of a single pixel. Advanced exposure control, short exposure times, noise reduction and super-resolution provide improved image quality, which can also be invested to save radiation exposure. All in all, the tools presented here offer a large potential to minimize the deterministic and stochastic risks of radiation exposure.

Background Engineering or administrative methods are often insufficient or impractical to control exposure to chemicals in anatomy laboratories. This study explored the feasibility of wearing one or a combination of respirators and goggles used as personal protective equipment (PPE) to control exposure in one such laboratory. Methods A group of 28 subjects were briefly trained in wearing PPE, fit-tested, and asked to complete a questionnaire regarding their subjective reaction after wearing the assigned PPE ensemble while working in the laboratory. The subjects' exposure to formaldehyde was also measured and generally exceeded the recommended limits. Results When a full-face respirator or the combination of a half-mask respirator and goggles was worn, a majority of subjects reported no odor problem and no irritation to eyes or upper respiratory system. Subjects accepted the PPE to certain degrees, but those using respirators encountered difficulties communicating with others. Conclusions The combination of a half-mask respirator and goggles was the most feasible ensemble to control exposure to air pollutants in an anatomy laboratory. Am. J. Ind. Med. 43:326–331, 2003. © 2003 Wiley-Liss, Inc.

A new dental radiographic unit (DXRU) with a contactless switch for adjusting exposure conditions and a foot-pedal exposure switch was developed to prevent bacterial or viral contamination from patients and was compared with a conventional DXRU with a panel push-button switch with respect to user friendliness.45 fourth-year dental school students carried out intraoral radiography using both types of DXRU. Errors regarding dose shortages of X-rays were compared and a questionnaire completed.22 (49%) of the 45 students failed to provide the correct radiographic exposure and the number of errors was 32 for the conventional DXRU, and 4 (9%) students failed to provide the correct radiographic exposure and the number of errors was 4 for our new DXRU, at the first stage (p0.001). At the second stage, the number of students who failed to provide the correct radiographic exposure and the number of errors decreased to 12 and 16, respectively, for the conventional DXRU (p 0.05). 37 (82%) of the 45 students preferred our DXRU because of its contactless switch and the push-pedal exposure switch.These data suggested that our new contactless mechanism should be used for other DXRUs for contamination control.

This article gives a detailed description of a program to control workplace exposure to enzymes during manufacture of laundry detergents. We believe this same program could, in large part, be re-applied to control exposure to enzymes in other industries or to control exposure to other industrial allergens. We chose to publish at this time because we believe enzyme use will increase in the future. The information contained here could potentially help new users ensure safe deployment of enzyme technology. Also, we have recently acquired new knowledge to improve our management system: this knowledge could help current enzyme users. We offer two new approaches that greatly increase worker participation and also improve understanding of the production process. We also highlight limitations of traditional air sampling. The new approaches are semi-quantitative tools to detect, rank, and control sources of dust release and product spillage. Our main conclusions are that detergent enzymes can be handled safely in the workplace provided there is no visible dust or spillage. Finally, we highlight the value of prick testing as a safe, simple tool to objectively asses the effectiveness of a hygiene program and to provide an "early alert" in the event of outages in the management system.

The results of a survey sent to all U.S. and Canadian dental schools clearly indicate that several substantial changes have occurred in infection control and exposure control in the past fifteen to twenty years. Predominant among these are that the responsibility for instrument preparation and sterilization in most schools has passed from the student to trained staff, the routine practice of universal precautions has eliminated the need to treat patients known to carry bloodborne diseases in a special area, and pre-admission and enrollment vaccination and health screening requirements have changed significantly. Other important changes result from the fact that the majority of U.S. schools responding to the survey are now, to a great extent, in compliance with the OSHA Bloodborne Pathogens Standard or equivalent requirements.

This article has presented some tips for developing an exposure control/infection control program that is practical, protective and cost-effective. OSHA state that "employers may create the most protective and cost-effective programs possible." We do not jeopardize employee safety by using science to create a cost-effective program. In order for staff to understand this issue, proper education and training must be provided. Often times agencies look for the "quick fix", and that may come back to haunt you. Send time conducting a proper assessment of risk and needs and develop a program that is a "win-win" for both staff and management.

Implanted ports give many of our patients a sense of freedom that they have not known since they have been sick. Between infusions, they do not have to be reminded constantly of their illness through an external vascular access device. However, this patient advantage does carry some degree of risk for the nurse working with the patient and the device. Needlestick injuries are serious and expensive. There is a financial and emotional toll that cannot be measured. Each employer is required by OSHA to have an exposure control plan for eliminating or minimizing employee exposure to bloodborne pathogens (OSHA, 1991, 1994). Inventions such as the HuberLoc meet the criteria for devices that can reduce the risk of injury through engineering controls. Agencies need to know that OSHA-mandated worker protection can be both easy to use and cost effective. Home care nurses need to be more proactive in informing agencies about such devices and lobbying for their use.

Jay Portnoy, MD; Jeffrey D. Miller, MD; P. Brock Williams, PhD; Ginger L. Chew, ScD *; J. David Miller, PhD; Fares Zaitoun, MD; Wanda Phipatanakul, MD, MS; Kevin Kennedy, MPH; Charles Barnes, PhD; Carl Grimes, CIEC; Desiree Larenas-Linnemann, MD; James Sublett, MD; David Bernstein, MD; Joann Blessing-Moore, MD; David Khan, MD; David Lang, MD; Richard Nicklas, MD; John Oppenheimer, MD; Christopher Randolph, MD; Diane Schuller, MD; Sheldon Spector, MD; Stephen A. Tilles, MD; and Dana Wallace, MD Chief Editors: Jay Portnoy, MD; Jeffrey D. Miller, MD; P. Brock Williams, PhD; Ginger L. Chew, ScD* Members of the Joint Taskforce on Practice Parameters: David Bernstein, MD; Joann Blessing-Moore, MD; David Khan, MD; David Lang, MD; Richard Nicklas, MD; John Oppenheimer, MD; Jay Portnoy, MD; Christopher Randolph, MD; Diane Schuller, MD; Sheldon Spector, MD; Stephen A. Tilles, MD; Dana Wallace, MD

Chest radiographs obtained with either automatic exposure control (AEC) technique, or manual exposure control (MEC) technique, were compared in a sample of 329 cardiological and cardiosurgery patients. Parameters evaluated, were various anatomical regions, according to their appearance in both posteroanterior (PA) and lateral radiographs. Lateral radiographs obtained with the AEC technique demonstrated better image quality than those obtained with the manual technique. There was no definite advantage of the AEC technique in PA radiographs. The AEC technique has the potential to improve the quality of lateral chest radiographs of cardiological and cardiosurgery patients. It is considered to be a useful tool in chest radiography.

Adherence to written infection control policies and procedures was studied and on-site education was provided for 1 year at a children's hospital. There was significant improvement in sharp objects disposal, hazardous waste handling, availability of personal protective equipment, isolation precautions, and staff knowledge regarding location of the exposure control plan.

After the rapid development of medical equipment including CT or PET-CT, radiation doses from medical exposure are now the largest source of man-made radiation exposure. General principles of radiation protection from the hazard of ionizing radiation are summarized as three key words; justification, optimization, and dose limit. Because medical exposure of radiation has unique considerations, diagnostic reference level is generally used as a reference value, instead of dose limits. In Korea, medical radiation exposure has increased rapidly. For medical radiation exposure control, Korea has two separate control systems. Regulation is essential to control medical radiation exposure. Physicians and radiologists must be aware of the radiation risks and benefits associated with medical exposure, and understand and implement the principles of radiation protection for patients. The education of the referring physicians and radiologists is also important.

Introduction The aim of this study was to identify important determinants of dust exposure in the Norwegian silicon carbide (SiC) industry and to suggest possible control measures. Methods Exposure to total dust, respirable dust, quartz, cristobalite, SiC, and fiber was assessed in three Norwegian SiC plants together with information on potential determinants of exposure. Mixed-effect models were constructed with natural log-transformed exposure as the dependent variable. Results The exposure assessment resulted in about 700 measurements of each of the sampled agents. Geometric mean (GM) exposure for total dust, respirable dust, fibers, and SiC for all workers was 1.6mg m(-3) [geometric standard deviation (GSD) = 3.2], 0.30mg m(-3) (GSD = 2.5), 0.033 fibers cm(-3) (GSD = 5.2), and 0.069mg m(-3) (GSD = 3.1), respectively. Due to a large portion of quartz and cristobalite measurements below the limit of detection in the processing and maintenance departments (>58%), GM for all workers was not calculated. Work in the furnace department was associated with the highest exposure to fibers, quartz, and cristobalite, while work in the processing department was associated with the highest total dust, respirable dust, and SiC exposure. Job group was a strong determinant of exposure for all agents, explaining 43-82% of the between-worker variance. Determinants associated with increased exposure in the furnace department were location of the sorting area inside the furnace hall, cleaning tasks, building and filling furnaces, and manual sorting. Filling and changing pallet boxes were important tasks related to increased exposure to total dust, respirable dust, and SiC in the processing department. For maintenance workers, increased exposure to fibers was associated with maintenance work in the furnace department and increased exposure to SiC was related to maintenance work in the processing department. Conclusion Job group was a strong determinant of exposure for all agents. Several tasks were associated with increased exposure, indicating possibilities for exposure control measures. Recommendations for exposure reduction based on this study are (i) to separate the sorting area from the furnace hall, (ii) minimize manual work on furnaces and in the sorting process, (iii) use remote controlled sanders/grinders with ventilated cabins, (iv) use closed systems for filling pallet boxes, and (v) improve cleaning procedures by using methods that minimize dust generation.

Aims: The purpose of this work was to assess the changes in control of exposure to hexamethylene diisocyanate based paints used in vehicle spraying after a Health & safety Executive (HsE) national project. Methods: Paint sprayers and managers from motor vehicle repair (MVr) bodyshops across the UK, were invited to one of 32 safety and Health Awareness Days (sHADs) to increase their understanding of the hazards, and practical ways of controlling of exposure to isocyanate based paints. Exposure measurement based on biological monitoring was offered, free of charge, to each of the roughly 4000 participants and used to assess the effectiveness of controls and methods of working. results are compared with pre and post sHAD measurements. results: Urine samples were received from 995 paint sprayers. Hexamethylene diamine (HDA) levels in urine, indicative of exposure to hexamethylene diisocyanate (HDI), were significantly lower (Mann-Whitney, p

In radiographic examination, not all medical imaging tasks require the same level of image quality or diagnostic information. Criteria should be established for different imaging tasks to avoid excessive doses where there is no clear net benefit in the diagnosis or the image quality. An exposure index provided by manufacturers would be a useful tool for this purpose. This study aims to establish an optimum exposure index to be used as a guideline for clinical imaging tasks to minimize radiation exposure for chest digital radiography. A three-level classification of image quality (high, medium, and low) for chest imaging tasks was carried out. An anthropomorphic phantom was employed to establish minimum exposure index and exposure (mAs) for clinical imaging task type I (corresponding to high image quality). The exposures of medium and low quality images derived from it. Thirty patients were exposed consecutively with these optimized exposure factors, and clinical tasks were considered, while another 30 patients were exposed with the exposure factors routinely used in practice. Image quality was assessed objectively by a consensus panel. The optimized exposure provided a significant reduction of the mean exposure index from 1,556 to 1,207 (p < 0.0001) and mean patient's entrance surface dose from 0.168 mGy to 0.092 mGy (p < 0.0001). The results show that a clinical-task-determined radiographic procedure is more conducive to radiation protection of patients. In this study, the posteroanterior chest imaging examination was chosen as an example. This procedure can also apply to other body parts and views.

This article summarizes the outcome of the discussions at the international workshop on nano reference values (NRVs), which was organized by the Dutch trade unions and employers’ organizations and hosted by the Social Economic Council in The Hague in September 2011. It reflects the discussions of 80 international participants representing small- and medium-size enterprises (SMEs), large companies, trade unions, governmental authorities, research institutions, and non-governmental organizations (NGOs) from many European countries, USA, India, and Brazil. Issues that were discussed concerned the usefulness and acceptability of precaution-based NRVs as a substitute for health-based occupational exposure limits (OELs) and derived no-effect levels (DNELs) for manufactured nanoparticles (NPs). Topics concerned the metrics for measuring NPs, the combined exposure to manufactured nanomaterials (MNMs) and process-generated NPs, the use of the precautionary principle, the lack of information about the presence of nanomaterials, and the appropriateness of soft regulation for exposure control. The workshop concluded that the NRV, as an 8-h time-weighted average, is a comprehensible and useful instrument for risk management of professional use of MNMs with a dispersible character. The question remains whether NRVs, as advised for risk management by the Dutch employers’ organization and trade unions, should be under soft regulation or that a more binding regulation is preferable.

Members of the Joint Task Force onPractice Parameters:David Bernstein,MD, Joann Blessing-Moore,MD, Linda Cox,MD, David Khan,MD, David Lang,MD, RichardNicklas, MD, John Oppenheimer, MD, Jay Portnoy, MD, Christopher Randolph, MD, Diane Schuller, MD, Sheldon Spector, MD, Stephen A. Tilles, MD, Dana Wallace, MD Practice ParameterWork Group: James Sublett, MD, cochair, Kevin Kennedy, MPH, cochair, Charles Barnes, PhD, David Bernstein, MD, Jonathan Bernstein, MD, Carl Grimes, Elizabeth Matsui, MD, Jeffrey D. Miller, MD, J. David Miller, PhD, Wanda Phipatanakul, MD, MS, James Seltzer, MD, P. Brock Williams, PhD Invited Reviewers: Jack Armstrong, Hans Gr×nlund, PhD, Kraig W. Jacobson, MD, Jill A. Poole, MD, Matthew A Rank, MD, Megan Taylor, MD This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthmaand Immunology, and the Joint Council of Allergy, Asthmaand Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “Environmental Assessment and Remediation: A Practice Parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changingenvironment, andnotall recommendationswillbeappropriate forallpatients.Because thisdocument incorporatedtheeffortsofmanyparticipants,nosingle individual, including thosewhoservedontheJointTaskForce, isauthorizedtoprovideanofficialAAAAIorACAAIinterpretationofthesepracticeparameters.Anyrequestforinformationaboutoraninterpretation of these practice parameters by the AAAAI or ACAAI should be directed to the executive offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use bypharmaceutical companies in drugpromotion. Reprints: Joint Council of Allergy, Asthmaand Immunology, 50NBrockway St, #3-3 Palatine, IL 60067. Disclosures: The following is a summaryof interests disclosedonWorkGroupmembers’ Conflict of InterestDisclosure Statements (not including information concerning familymember interests). Completed Conflict of Interest Disclosure Statements are available on request. Dr. Sublett is the owner of AllergyZone. Dr. Portnoy is a speaker and consultant for ThermoFisher (Phadia). Dr. Barnes is a consultant for and has received research funding from Clorox Corporation. Mr. Grimes is the owner of Healthy Habitats LLC. Dr. Matsui is speaker for Indoor BioTechnologies.Dr.Miller is theownerofMission:Allergy Inc.Dr. Seltzer is thePresident of JamesM. Seltzer, Assoc. TheotherWorkGroupmembershaveno conflicts todisclose. The Joint Task Force recognizes that experts in a field are likely to have interests that could come into conflictwith development of a completely unbiased and objective practice parameter. To take advantage of that expertise, a process has beendeveloped to prevent potential conflicts from influencing thefinal document in a negativeway. At theworkgroup level,memberswhohaveapotential conflictof interest eitherdonotparticipate indiscussions concerning topics related to thepotential conflictor, if theywrite a section onthattopic, theworkgroupcompletelyrewritesitwithouttheir involvementtoremovepotentialbias. Inaddition,theentiredocumentisreviewedbytheJointTaskForce,andanyapparent bias is removedat that level. Finally, thepracticeparameter is sent for reviewbothby invited reviewersandbyanyonewithan interest in the topicbyposting thedocumenton thewebsites of theACAAI and theAAAAI. In particular, the 2 owners of companies that produce products discussed in this practice parameter are Jeffrey D. Miller, MD, and James Sublett, MD. DrMiller wrote an initial section on mattress encasings. This section was then completely rewritten by other members of the work groupwithout his participation. Dr Sublett wrote a preliminary draft of the section on air filtration. That sectionwas also subsequently rewritten by othermembers of thework groupwithout his participation. Neither participant provided subsequent input into those sections. The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions ismade subsequently. Work Group Cochairs: James Sublett,MD, FamilyAllergy andAsthma, Louisville, Kentucky; KevinKennedy,MPH, Center for EnvironmentalHealth, Children’sMercyHospitals C JointTaskForceLiaison:JayM.Portnoy,MD,SectionofAllergy,Asthma& Immunology, TheChildren’sMercyHospitalsC JointTaskForceMembers:David I. Bernstein,MD,DepartmentofClinical,MedicineandEnvironmentalHealth,Division ofAllergy/Immunology,UniversityofCincinnati,CollegeofMedicine,Cincinnati,Ohio; JoannBlessing-Moore,MD,Departmentof Immunology,StanfordUniversityMedicalCenter,PaloAlto, California; Linda Cox, MD, Department of Medicine, Nova Southeastern University College of Osteopathic Medicine, Davie, Florida; David A. Khan, MD, Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas; David M. Lang, MD, Allergy/Immunology Section, Division of Medicine, Allergy and Immunology Fellowship Training Program, Cleveland Clinic Foundation, Cleveland, Ohio; Richard A. Nicklas, MD, Department of Medicine, George Washington Medical Center, Washington, DC; John Oppenheimer, MD, Departmentof InternalMedicine,NewJerseyMedicalSchool,PulmonaryandAllergyAssociates,Morristown,NewJersey; JayM.Portnoy,MD,SectionofAllergy,AsthmaI Christopher C. Randolph, Department of Pediatrics,YaleAffiliatedHospitals,Center forAllergy,Asthma,IDianeE.Schuller,MD,DepartmentofPediatrics,PennsylvaniaStateUniversityMilton S.HersheyMedical College,Hershey, Pennsylvania; SheldonL. Spector,MD,DepartmentofMedicine,UCLASchool ofMedicine, LosAngeles, California; StephenA. Tilles,MD,Departmentof Medicine,UniversityofWashington,SchoolofMedicine,Redmond,Washington;DanaWallaceMD,DepartmentofMedicine,NovaSoutheasternUniversityCollegeofOsteopathicMedicine, Davie, Florida;ParameterWorkGroupMembers:CharlesBarnes,PhD,AllergyResearch,TheChildren’sMercyHospitalsCDavid I.Bernstein,MD,Department of Clinical Medicine, Division of Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Jonathan A. Bernstein, MD, Department of Internal Medicine, Division of Immunology/Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio; Carl Grimes, CIEC, Healthy Habitats LLC, Denver, Colorado; Elizabeth Matsui, MD, MHS, Department of Pediatrics, Johns Hopkins School ofMedicine, Baltimore,Maryland; Jeffrey D.Miller, MD, Department of Pediatrics, NewYorkMedical College, Valhalla, NewYork; J. David Miller,PhD,DepartmentofBiochemistry,CarltonUniversity,Ottawa,Ontario,Canada;WandaPhipatanakul,MD,MS,DepartmentofPediatrics,DivisionofAllergyandImmunology,Harvard Medical School, Children’s Hospital Boston, Boston, Massachusetts; JamesM. Seltzer, MD, RelianceMedical Group, Department of Allergy and Immunology,Worcester, Massachusetts; P. BrockWilliams,PhD,DepartmentofAllergy/Immunology,UniversityofMissouri–KansasCitySchoolofMedicineandTheChildren’sMercyHospitalsC Invited Reviewers: Jack Armstrong, MD, Medical Arts Allergy, P.C., Carlisle, Pennsylvania; Hans Gr×nlund, PhD, Department of Immunology, Clinical Immunology and Allergy Unit Karolinska Institute,Stockholm,Sweden;KraigW.Jacobson,MD,CPI,OregonAllergyAssociates,AllergyandAsthmaResearchGroup,Eugene,Oregon;JillA.Poole,MD,DepartmentofMedicine,Division ofAllergy, Asthma& Immunology,University ofNebraskaMedical Center,Omaha,Nebraska;MatthewARank,MD,DivisionofAllergicDiseases,MayoClinic, Rochester,Minnesota;Megan Taylor,MD, Allergy&AsthmaCare, Jenkintown, Pennsylvania.

This article compares the use of single- and multiple-item pools with respect to test security against item sharing among some examinees in computerized testing. A simulation study was conducted to make a comparison among different pool designs using the item selection method of maximum item information with the Sympson–Hetter exposure control and content balance. The results from the simulation study indicate that two-pool designs have a better degree of resistance to item sharing than do the single-pool design in terms of measurement precision in ability estimation. This article further characterizes the conditions under which employing a multiple-pool design is better than using a single, whole pool in terms of minimizing the number of compromised items encountered by examinees under a randomized item selection method. Although no current computerized testing program endorses the randomized item selection method, the results derived in this study can shed some light on item pool designs regarding test security for all item selection algorithms, especially those that try to equalize or balance item exposure rates by employing a randomized item selection method locally, such as the a-stratified-with-b-blocking method.

Objective To determine whether environmental control using nocturnal temperature controlled laminar airflow (TLA) treatment could improve the quality of life of patients with persistent atopic asthma. Design Randomised, double-blind, placebo-controlled, parallel-group trial. Setting Nineteen European asthma clinics. Participants 312 patients aged 7-70 with inadequately controlled persistent atopic asthma. Main outcome measure Proportion of patients with an increase of >= 0.5 points in asthma quality of life score after 1 year of treatment. Results TLA devices were successfully installed in the bedrooms of 282 (90%) patients included in the primary efficacy analysis. There was a difference in treatment response rate between active (143 of 189, 76%) and placebo (56 of 92, 61%) groups, difference 14.8% (95% CI 3.1 to 26.5, p=0.02).(3) In patients aged >= 12, on whom the study was powered, the difference in response rate was similar-active 106 of 143 (74%), placebo 42 of 70 (60%), difference 14.1% (0.6 to 27.7, p=0.059). There was a difference between groups in fractional exhaled nitric oxide change of -7.1 ppb (-13.6 to -0.7, p=0.03). Active treatment was associated with less increase in cat-specific IgE than placebo. There was no difference in adverse event rates between treatment groups. Conclusion Inhalant exposure reduction with TLA improves quality of life, airway inflammation and systemic allergy in patients with persistent atopic asthma. TLA may be a treatment option for patients with inadequately controlled persistent atopic asthma. funding agencies|Airsonett AB||National Institute for Health Research||National Institute for Health Research Biomedical Research Centre||MRC||Asthma UK Centre in Allergic Mechanisms of Asthma

In a study on workers in a chemical plant where ethylene oxide (EtO) is manufactured and partly used for ethylene glycol production, exposure to EtO was monitored during annual periodic health assessments in January 1988, December 1988, and March 1990 by the determination of the level of 2-hydroxyethylvaline (HOEtVal) in hemoglobin. The HOEtVal levels in workers corresponded with the potential EtO exposures. The highest level was found in December 1988, in blood samples collected 1-2 months after a shut-down, maintenance, and start-up program. The range of adduct levels found in the three examinations indicated that average EtO exposures during the 4 months preceding blood sampling were below 0.5 ppm. It was demonstrated that the method allows for the accurate monitoring of low levels of EtO exposure and provides personalized time-integrated exposure data with great discriminative power. In addition, the method may serve to identify unexpected personal exposures, which may lead to targeted exposure control measures.