Alice Hamilton Award Winners and Honorable Mentions: Descriptions, 2013

Education and Guidance Category

Winner:

• Title: Ergonomic hazards and controls for elevated devices in construction

• Authors: Pan CS, Chiou S, Hsiao H, Keane P

• Source: Occupational ergonomics: theory and applications, second edition. Bhattacharya A, McGlothlin JD, eds., Boca Raton, FL: CRC Press, pp. 653-693, 2012

• Description:This book chapter aimed to help users apply engineering and ergonomics theories to work practices that address falls, one of the most common causes of injury and fatality in construction. Research methods and results addressed the following needs that relate to elevated devices:

  • Specific design criteria and standards for elevated devices in the construction industry: Users can follow specific test procedures and guidelines to design and build elevated devices that aresafe and reliable in preventing falls.
  • Equipment design software and information: Users can use these resources to design elevated devices that adhere to safety criteria and standards.
  • Marketing materials: Users can compare the features of new and safer elevated devices.
  • Safety training materials: Users can learn and incorporate the methods shown to be the most effective in preventing and avoiding falls.
  • Recommendations for standard operating procedures: Users can choose procedures that best ensure safety and improve existing work practices.

  The book chapter reported on several studies that involved extensive collaboration with industry partners. Active collaboration with industry partners continues, and stakeholders are participating in efforts to disseminate and publicize findings from this research. NIOSH also continues to partner with stakeholders in several committees that develop safety standards as well as with states that are working to better understand and control the risks associated with the use of elevated devices. An estimated 60 percent of construction workers in the U.S. could benefit from the injury-prevention recommendations from this book chapter. Other potential users include telecommunication and warehouse workers, occupational safety and health students, safety professionals, and manufacturers.

Link to abstract in NIOSHTIC-2

Honorable Mention:

• Title: A systematic review of the effectiveness of occupational health and safety training

• Authors: Robson LS, Stephenson CM, Schulte PA, Amick BC, Irvin EL, Eggerth DE, Chan S, Bielecky AR, Wang AM, Heidotting TL, Peters RH, Clarke JA, Cullen K, Rotunda CJ, Grubb PL

• Source: Scand J Work Environ Health 38(3):193–208, 2012

• Description: This paper reported the results of an extensive collaboration between the Canadian Institute for Work and Health and NIOSH. The authors conducted a systematic review of studies on the effectiveness of occupational safety and health (OSH) training to impact knowledge, attitudes and beliefs, behaviors, and health outcomes. The authors considered publications that were disseminated between 1996 and 2007, reported on training that was actually delivered to workers and focused on primary prevention of an occupational illness or injury, and provided information on pre and post intervention metrics. A rigorous process was used to determine the methodological quality of each paper. Data were extracted and summarized for each effectiveness outcome of interest, and standardized mean differences were calculated. The strength of the evidence for each effectiveness outcome of interest was assessed using CDC’s Guide to Community Prevention Services, a previously published methodology. Searching over 10 scientific databases in English and French, and starting with a non-duplicative set of 6,469 scientific publications, the screening process eliminated all but 22 studies that met the review criteria. Results indicated that the methodological quality of training effectiveness studies varied widely but the available evidence provided strong support for the effects of training on knowledge, attitudes and beliefs, and behaviors, thus supporting the findings of an earlier NIOSH review of training effectiveness. However, there was insufficient evidence of the effect of training on specific health outcomes. The authors provided recommendations to improve the quality of future studies on OSH training effectiveness and the reporting of those studies in the literature. The authors also recommended employers to continue using high-quality OSH training and to mitigate workplace hazards through approaches that include but are not solely dependent upon training, such as administrative and engineering controls. Training is a common approach used to mitigate the effects of workplace hazards; over 100 OSHA standards require it as a component of OSH programs. Training also empowers workers to effectively advocate for safe and healthy workplaces and to collaborate with management in implementing hazard mitigation approaches. This paper helps users to sort through a training literature that contains a bewildering array of studies. The journal reported that the paper was downloaded 1,404 times in its first year of publication.

Link to abstract in NIOSHTIC-2

Engineering and Control Category

Winner:

• Title: A CART technique to adjust production from longwall coal operations under ventilation constraints

• Authors: Karacan CÖ, Goodman GVR

• Source: Safety Science 50:510-522, 2012

• Description: The ability to predict methane emissions in longwall operations is important because high gas levels in mines threaten safety. Adequate ventilation air is necessary to dilute high gas levels, but it is difficult to accurately predict methane inflows into the ventilation system. Many variables affect potential emission sources, including the general geology of the area, coal and coal reservoir properties, longwall panel layout and operating parameters, and whether degasification is applied. This study used a nonparametric modeling approach, CART (classification and regression tree) analysis, to define the relationships between methane emissions levels and their causative factors, so that coal production can be adjusted to not overwhelm the existing ventilation capacity or to not exceed constrained values at various stages of the longwall operation. Methane emissions from the ventilation system were selected as the dependent variable and various levels of branching were implemented to find the optimum tree size. The predictive capability of various tree models was tested using Kolmogorov-Smirnov goodness-of-fit tests and regression analyses. The analyses presented in this study and the decision rules proposed can predict the extent of methane emissions into a ventilation system for different levels of coal productivity. In addition, the decision rules provided in this paper were explicit in terms of the interactions of different predictors with methane emissions and coal productivity, and can be analyzed and interpreted easily by users.

Link to abstract in NIOSHTIC-2

Honorable Mention:

• Title: A dust control handbook for industrial mineral mining and processing

• Authors: Cecala AB, O'Brien AD, Schall J, Colinet JF, Fox WR, Franta RJ, Joy J, Reed WR, Reeser PW, Rounds JR, Schultz MJ

• Source: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2012-112, 2012

• Description: This handbook represented a successful collaborative effort by government and industry in protecting the health of U.S. mine workers. The two principal partnerships were between the NIOSH Office of Mine Safety and Health Research (OMSHR) and the Industrial Minerals Association–North America (IMA-NA). The mission of the NIOSH OMSHR is to eliminate mining fatalities, injuries, and illnesses through research and prevention, while IMA-NA represents companies that extract and process the raw materials known as industrial minerals. The handbook was written by a task force of safety and health specialists, industrial hygienists, and engineers to provide information on effective control technologies that lower workers’ dust exposures during all stages of minerals processing, including drilling, crushing, screening, conveyance, bagging, loadout, and transport. Implementation of the engineering controls discussed in the handbook can assist in lowering personal exposure to hazardous particulates, including crystalline silica, in the minerals industry. This in turn is expected to lower the incidence of several adverse health effects commonly found in mine workers that have been associated with exposure to crystalline silica, including silicosis, tuberculosis, chronic bronchitis, emphysema, and chronic renal disease. Jointly promoted by NIOSH and IMA-NA, over 700 hardcopies of the NIOSH-numbered publication have been distributed to health and safety professionals in the minerals industry. Both organizations, as well as others, are actively promoting the handbook on their organization websites.

Link to abstract in NIOSHTIC-2

Epidemiology and Surveillance Category

Winner:

• Title: The Diesel Exhaust in Miners study: a cohort mortality study with emphasis on lung cancer

• Authors: Attfield MD, Schleiff PL, Lubin JH, Blair A, Vermeulen R, Coble JE, Silverman DT

• Source: J Natl Cancer Inst 104:1-15, 2012

• Description: This paper resulted from years of intensive research by a collaborating team from NIOSH and the National Cancer Institute (NCI). It is part of a collection of seven papers that were published in 2011 and 2012 and include exposure-assessment, case-control study, and cohort study findings. The findings were published despite intense industry scrutiny and legal actions. The research addressed the carcinogenicity of occupational and environmental exposure to inhaled diesel engine exhaust. Because millions of individuals are exposed to diesel exhaust (DE) while working, commuting, and living close to roads in cities, many studies had been conducted to determine whether DE was a carcinogen and what the risk might be for individuals. However, these studies were either inadequate for assessing risk because of little or no information on individual exposure levels or flawed due to other reasons. The NIOSH/NCI study specifically addressed the problems of previous studies, such as study size and control for smoking and other potential confounders, and used a thorough exposure assessment via extensive industrial hygiene sampling at the mines, coupled with the collection and use of surrogate information for retrospective estimation of historical exposure levels. This was the only study of DE and lung cancer that examined risk in workers having a wide range of exposures. The research was innovative in deriving quantitative exposure estimates for each worker included. State-of-the-art methods were employed, including a newly-developed and published NIOSH sampling and analytical approach to assessing DE. The International Agency for Research on Cancer (IARC) deliberately waited until the study findings were published before voting to change the status of DE from probable carcinogen to carcinogenic to humans. This designation has a clear implication for governments around the world to reduce both occupational and environmental exposures to DE.

Link to abstract in NIOSHTIC-2

Honorable mention (Jointly submitted):

• Title: Body Mass Index, playing position, race, and the cardiovascular mortality of retired professional football players

• Authors: Baron SL, Hein MJ, Lehman EJ, Gersic CM

• Source: Am J Cardiol 109:889-896, 2012

• Link to abstract in NIOSHTIC-2

• Title: Neurodegenerative causes of death among retired National Football League players

• Authors: Lehman EJ, Hein MJ, Baron SL, Gersic CM

• Source: Neurology 79(19): 1970-1974, 2012

• Link to abstract in NIOSHTIC-2

• Description: These two articles reported the results of the first study to systematically examine the mortality experience of a complete cohort of National Football League (NFL) players who played at least five seasons between 1959 and 1988. First, the study examined whether professional football players had a lower life expectancy compared to the general population; this was the first study that compared the risk experienced by NFL players to that of the US population. Second, the study systematically assessed whether the large size of players playing certain positions was associated with greater mortality from cardiovascular disease (CVD). Finally, the study examined whether there was increased player mortality from neurodegenerative disease and whether there was an association between increased mortality due to neurodegenerative conditions and playing positions that increased the risk for recurrent head trauma. The first article reported on players’ overall mortality and an in depth analysis of CVD mortality. The second article examined mortality due to neurodegenerative conditions. Findings demonstrated that while the overall mortality risk was lower for professional football players compared to the US population, certain playing positions were at increased risk for CVD and neurodegenerative diseases. This study has led the NFL to initiate several efforts to address players’ health risks. In part as a result of the CVD findings, the NFL has established a committee to investigate risk factors and to develop health screening programs. NIOSH has collaborated with this committee which is now considering expanding the mortality study to include players from the post-1988 period. The study also caught the attention of the NFL Players Association (NFLPA). NIOSH collaborations with the NFL and NFLPA are expected to continue. The findings made important scientific contributions to ongoing concerns about the health impact of playing professional football. Study findings have implications that extend beyond professional football. In occupational health, the neurodegenerative results are of interest to those studying warzone veterans who were exposed to head trauma during combat. In public health, press sources have been very interested in both the CVD and neurodegenerative results, since the number of individuals playing football non- professionally, especially those involved in collegiate and high school sports, far exceeds the number of professional players.

Exposure and Risk Assessment Category

Winner:

• Title: Multi-walled carbon nanotubes: sampling criteria and aerosol characterization

• Authors: Chen BT, Schwegler-Berry D, McKinney W, Stone S, Cumpston JL, Friend S, Porter DW, Castranova V, Frazer DG

• Source: Inh Toxicol 24(12):798-820, 2012

• Description: While the unique properties and widespread applications of multi-walled carbon nanotubes (MWCNTs) have led to their increased production and use, there have been concerns about the potential for human exposure to MWCNT-containing aerosol particles and the possible health risks they may pose. This is partly a result of the physical resemblance of MWCNTs to asbestos and other pathogenic fibers, whose toxicity is associated with their morphology. Currently there is little guidance for adequate sampling and characterization of MWCNT aerosols for evaluating exposures and obtaining dose metrics for risk assessment. The tendency of aerosolized MWCNT particles to form large entangled “bird’s nest”-like structures and to combine into bundled rope configurations makes particle counting difficult. To address this problem, the authors conducted detailed sampling and characterization studies of MWCNTs that had similar particle morphologies to those found in the workplace. This study has made the following contributions to occupational safety and health:

  • Developed a sampling protocol for microscopic observations of MWCNT particles that can be used by industrial hygienists to design a sampling strategy in a workplace. The method is applicable to filter samples for gravimetric measurement as well as impactor samples for particle size distribution. In addition, a similar protocol can be established for other types of nanoparticles.
  • Presented an approach for converting between particle mass concentration and number concentration. This is essential for nanoparticle characterization because particle numbers may be as important as their mass as the index of exposure for risk estimation.
  • Demonstrated that even though direct reading instruments measured the number concentration of MWCNT aerosols realistically, without data on particle agglomerates, this information was insufficient for adequate risk assessment.
  • Raised the concern of particle agglomeration in characterizing nanoparticles-containing aerosols and consequent biological effects after their deposition in the respiratory tract. The consideration of agglomeration is important when addressing airborne nanoparticles in high number concentrations, such as nano-sized titanium dioxide, carbon nanofibers, and carbon nanotubes.
  • Developed an MWCNT inhalation exposure system that allows the use of animals to mimic occupation exposures. This approach provides potential guidance for other animal exposure studies using different nanomaterials.
  • Assisted in exposure and risk assessment of MWCNTs. Information about different particle shape categories, e.g. irregular, isometric, and fibrous particle structures, has proved useful for designing an improved lung deposition model that considers not only the size but also the shape of the MWCNT particle structures.

Link to abstract in NIOSHTIC-2

Honorable Mention:

• Title: Detection of infectious influenza virus in cough aerosols generated in a simulated patient examination room

• Authors: Noti JD, Lindsley WG, Blachere FM, Cao G, Kashon ML, Thewlis RE, McMillen-CM, King WP, Szalajda JV, Beezhold DH

• Source: Clin Infect Dis 54(11):1569-1577, 2012

• Description: Influenza can be spread by a wide range of aerosol particles that are generated in the breaths, coughs, and sneezes of an infected individual. Infection is thought to occur by either direct or indirect contact with these respiratory secretions (contact transmission), spraying of large droplets of mucous from an infected person onto the mucous membranes of an uninfected person (droplet spray transmission), and by inhalation of small respirable particles laden with influenza deeply into the lungs (airborne transmission). The contribution of each potential mode of transmission and particularly airborne transmission remains a controversial issue. Transmission of influenza on respirable particles is a concern because these particles may remain airborne for prolonged periods and place healthcare workers and their patients at considerable risk during an influenza outbreak. The authors of this study constructed a patient examination room that contained a coughing manikin that “coughed” influenza virus into the room to simulate a patient with influenza, and a breathing manikin positioned 6 feet away to simulate a healthcare worker. Aerosol samplers positioned within the breathing manikin’s mouth and at various locations throughout the room collected and size-fractionated the airborne particles. Findings demonstrated that infectious virus was present on a range of particles collected from all samplers. To evaluate their effectiveness, surgical masks and N95 respirators were sealed to the manikin’s face (simulating properly-fitted PPE) or unsealed to the manikin’s face (simulating usual mask fit and poor respirator fit). Masks and N95 respirators that were not properly fitted blocked approximately two-thirds of infectious virus from entering the manikin’s mouth, while properly fitted respirators blocked more than 99 percent of the virus. This demonstrates that gaps between the wearer’s face and the PPE can have a large impact on the protection offered and that the use of properly-fitted N95 respirators is essential for maximal protection against infectious airborne influenza. Results also showed that infectious influenza can persist on the outer surfaces of PPE. This is important because masks and respirators may be frequently adjusted by gloved hands and may not be changed routinely, which may inadvertently transfer the virus. Findings suggest that vaccinated healthcare worker protection can be augmented by a properly-fitted N95 respirator since currently available vaccines cannot provide complete protection and vaccination of healthcare workers is low in many countries.

Link to abstract in NIOSHTIC-2

Methods and Laboratory Science Category

Winner:

• Title: Respiratory and olfactory cytotoxicity of inhaled 2,3-pentanedione in Sprague-Dawley rats

• Authors: Hubbs AF, Cumpston AM, Goldsmith WT, Battelli LA, Kashon ML, Jackson MC, Frazer DG, Fedan JS, Goravanahally MP, Castranova V, Kreiss K, Willard PA, Friend S, Schwegler-Berry D, Fluharty KL, Sriram K

• Source: Am J Pathol 181(3): 829-844, 2012

• Description: This article provided a new theoretical perspective on the causes of flavorings-related lung disease. The authors compared the respiratory toxicity of diacetyl, a butter flavoring that has been implicated in the etiology of flavorings-related lung disease, to the respiratory toxicity of 2,3-pentanedione (PD), a butter flavoring that is a diacetyl analog and potential substitute. Findings demonstrated that the two flavorings can cause remarkable and comparable damage to the epithelium lining airways of the nose, trachea, and lung. This is important because damage to the airway lining can lead to fixed airways obstruction, a functional change described in workers with flavorings-related lung disease. Findings also identified the specific structural features that diacetyl and PD share and that are implicated in causing the fundamental injury leading to flavorings-related lung disease. Post-exposure clinical observations of PD-exposed rats demonstrated delayed onset of clinical signs, which suggests a concern for the potential delay in clinical signs in highly exposed workers. The study demonstrated that the enzyme which metabolizes both diacetyl and PD to the corresponding and less reactive α-hydroxyketone was expressed differently in the different cells that comprise the neuroepithelium of the nose. Because detoxifying enzymes often produce toxic byproducts during substrate metabolism, understanding the cell type-specific compartmentalization of these enzymes is important in understanding mechanisms and cellular targets for injury. Finally, findings indicated that PD-induced damage extended beyond the respiratory tract. This work involved the coordinated effort of 16 authors from multiple disciplines and provided data supporting the NIOSH Criteria for a Recommended Standard: Occupational Exposures to Diacetyl and 2,3-Pentanedione. The rapid identification of PD as a respiratory hazard allowed the publication of exposure limits at the same time limits were proposed for diacetyl, thus preventing the substitution of one hazard for another. Results supported the NIOSH recommendation that toxicity evaluation of substitute flavorings be conducted before a substitute is selected. By identifying the specific shared features of butter flavorings that are respiratory hazards, the study also informed ongoing studies aiming to identify hazardous flavorings before workers are harmed. This paper received attention from both the scientific community and the lay press.

Link to abstract in NIOSHTIC-2

Honorable Mention:

• Title: Miniature dual-corona ionizer for bipolar charging of aerosol

• Authors: Qi C, Kulkarni P

• Source: Aerosol Science and Technology 47(1): 81-92, 2013 [Published online in 2012]

• Description: This paper described the development of a charger that is a key component of hand-held spectrometers for workplace measurement of airborne nanoparticles and ultrafine aerosols. Unlike currently available devices, the new charger is very small, does not employ any radioactive source of energy, and costs a few hundred rather than several thousand dollars. A U.S. patent application for the new charger is currently under review. The charger has been licensed by Kanomax USA Inc. for use in a portable aerosol mobility spectrometer (model 3300) that the company co-developed with NIOSH. The charger is also being currently licensed by TSI Inc., a leading aerosol instrument manufacturer. A first of its kind, the Kanomax hand-held direct-reading instrument allows particle size distribution measurement of airborne nanoparticles and sub-micrometer aerosols with accuracy and precision comparable to that of laboratory spectrometers. The commercial availability of such aerosol spectrometers by various instrument manufactures will significantly advance industrial hygiene and public health practice by improving the ability to monitor and control aerosols that affect occupational and public health.

Link to abstract in NIOSHTIC-2