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TLV and BEI Committees:

The Decision Making Process

Presented at AIHce

May 13, 2003, Dallas, TX

Bill Wells PhD, CIH, CSP, Moderator

Dennis Casserly, PhD, CIH & Marilyn Hallock, CIH Monitors


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Forum Overview

Pat Breysse: Introduction

Lisa Brosseau: TLV-CS Committee

Larry Lowry: BEI Committee

Tom Bernard: TLV-PA Committee

Ken Martinez: Bioaerosols Committee


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ACGIH,the TLVs and BEIs

Patrick N. Breysse, PhD, CIHJohns Hopkins University

Bloomberg School of Public HealthChair, ACGIH


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What Is ACGIH?

Membership Society(founded in 1938)

Not-for-profit, Non-governmentalAssociation(501(c)(6) organization)

Multi-Disciplinary Membership

Traditionally Neutral on Public Positions


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MembershipApril 2003

45%

4% 3%

48%

Regular Associate Student Retired

Government& AcademiaPrivateIndustry& Others


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Membership by

Profession, 2003Industrial Hygienist 39%

Administrator/Manager 12%

OH&S Professional 6%

Environmental Professional 4%

Safety Professional 3%

Other (Engineer, Scientist,Toxicologist, Professor, etc.)

~36%


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Technical

CommitteesCommittees provide the creativity,

initiative, and technical expertise that

has made ACGIHwhat it is today and

what it will be tomorrow.

.


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Core Mission

Ex. Director& Staff

BEI

TLV-CS

TLV-PA

ExposureAssessmentCriteria

Air SamplingInstruments

Bioaerosols

IndustrialVentilation

Assessment& ControlMethodology

Agr S&H

Construction

InfectiousAgents

SmallBusiness

OccupationalSector

Applications

Computer

International

PCCAIHA/ACGIH

Professional& IntersocietyCoordination

Awards

Finance

Nominating

Administration&

Governance

Air SamplingProcedures

AIHA/ACGIH

Outreach

PublicPositions

Taskforces

Board of Directors

ACGIH Members


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ACGIHStatementof Position

ACGIH is not a standards setting body.

TLVs and BEIs

Are an expression of scientific opinion.

Are not consensus standards.

Are based solely on health factors; it may

not be economically or technically feasibleto meet established TLVs or BEIs.


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ACGIHStatementof Position

TLVs and BEIs

Should NOT be adopted as standardswithout an analysis of other factorsnecessary to make appropriate riskmanagement decisions.

Can provide valuable input into the riskcharacterization process. The full writtenDocumentationfor the numerical TLV orBEI should be reviewed.


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Conflict of Interest

Basis for Conflicts of Interest:

Employment

Financial benefit

Personal

Professional

Avoid perceivedas well as real conflictof interest


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Conflict of Interest

Committee members serve asindividuals

they do not represent organizations and/orinterest groups

Members are selected based on

expertise, soundness of judgement, andability to contribute


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Full disclosure ofpossible conflicts of

interest

Discussion within full

committee and

subcommittees

Management of

perceived and

real COIs

Committee

and

subcommittee

chairs

Boa

rdofDirectors

Oversight

COI Process at ACGIH


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Todays Roundtable

Chemical Substances - TLV

Biological Exposure Indices (BEI)

Physical Agents TLV

Bioaerosols Committee


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ACGIH TLVs forChemical Substances

Committee UpdateChair: Lisa M. Brosseau, ScD, CIH

Associate ProfessorUniversity of Minnesota

School of Public Health


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Overview

TLV-CS Committee has 20 membersand 3 member-candidates, whovolunteer time towards developing

scientific guidelines and publications Primary goal is to serve the scientificneeds of industrial hygienists

Committee expenses (travel) are

supported by ACGIH Time is donated by the members


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Committee Structure

Chair and Vice Chair Three Subcommittees, Chair and Co-Chair

Dusts & Inorganics (D&I)

Hydrogen, Oxygen & Carbon Compounds (HOC)

Miscellaneous Compounds (MISCO)

Administrative Subcommittees Communications and Outreach

Membership

Notations Chemical Substance Selection

Staff Support Liaison, Clerical, Literature Searching


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Chemical Substance

Subcommittees Approximately 10 members on each Membership from academia, government,

unions, industry

Membership represents four keydisciplines: Industrial hygiene

Toxicology Occupational Medicine

Occupational Epidemiology


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Core TLV Principles

Focus on airborne exposures inoccupational settings

Utilize the threshold concept

Primary users are industrial hygienists Goal is towards protection of nearly allworkers

Technical, economic, and analyticfeasibility are NOT considered


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Committee Actions

in 2003 Adopted TLVs for 22 substances Proposed 6 new TLVs

(listed on the Notice of Intended Changes (NIC))

Revised 7 adopted TLVs (listed on the NIC) Proposed withdrawing TLVs for methane,

ethane, propane, butane and liquifiedpetroleum gas. (Will also withdraw iso-butane.)

All to be replaced with a proposal for AliphaticHydrocarbon Gases, Alkane (C1-C4)

Revised 3 proposals for TLVs and retained onthe NIC


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Committee Actions

in 2003 (Contd) Adopted a new Appendix E for Particulates

(Insoluble or Poorly Soluble) Not OtherwiseSpecified (PNOS)

Developed new Documentationfor 2substances (no change in values)

Changed the name of one TLV and kept on

the NIC with revised recommendations Retained 4 proposed TLVs on the NIC

Withdrew 2 proposed TLVs from the NIC


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Committee Actions

in 2003 (Contd) Proposed withdrawal of Appendix B:

Substances of Variable Composition

Proposed revision of Appendix C:Threshold Limit Values for Mixtures

Proposed a new Appendix F:

Commercially Important Tree SpeciesIdentified as Inducing Sensitization


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Substances and Issues

Under Study in 2003 115 chemical substances currently under study Issues under study include:

Ceiling limits, excursions, and STELs

Notations for reproductive effects

Skin notation

Reciprocal Calculation Procedure, Group Guidance

Values for refined C5 - C15 aliphatic and aromatichydrocarbon solvents and constituent chemicals


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Particulates(Insoluble or Poorly Soluble)

Not Otherwise Specified The recommendations are guidelines (not TLVs)

for limiting exposure to insoluble particles: 3 mg/m3 (respirable)

10 mg/m3 (inhalable)

Apply to particles that: Do not have a TLV

Are insoluble or poorly soluble in water or lung fluid Have low toxicity (not genotoxic, cytotoxic, etc.)

Only toxic effects are inflammation or lung overloadmechanisms


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ProposedNew Appendix C:

TLVsfor Mixtures In the absence of other information, assume

additivity of substances having similar effects Same outcomes, same target organs or systems

If1C

1T

2C

2T ...

nC

nT1

the TLV

for the mixture has been exceeded.

P d


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TLVsfor Mixtures Recommends using the TLVDocumentation, as well as the TLV

Basis information in the book Where possible, only combine TLVs

having a similar time basis

Table showing appropriate combinations ofdifferent types of TLVs

P d


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TLVsfor Mixtures Limitations and Special Cases

Do not use when suspect inhibition or

synergism Take care when considering mixtures of

A1, A2, or A3 carcinogens

Not appropriate for complex mixtures withmany different components (e.g., gasoline,diesel exhaust)


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Committee Activities Notations

Complete re-write of Introduction to the TLV-CS sectionof the book

Improved definition and categorization of TLVBasis

Communications Symposia on substances under study

Membership Recruitment, especially of physicians and

epidemiologists Bill Wagner Award & member recognition

Chemical Substance Selection Refining the selection process


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Committee Activities

Sponsored symposium on TDI (Spring 2002)

Attended ACGIH symposium on oil mists

and metalworking fluids (Fall 2002) Plenary talk on TLVsat AIOH in Australia

(Winter 2002)

Co-sponsored a colloquium on WorkplaceChemical Exposure Standards with IRSST inMontreal (Spring 2003)


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Committee Plans

Co-sponsor symposium on enzymes(Spring 2004)

Roundtables on TLVs at otherprofessional meetings (SOT, ACOEM)

Joint meetings with ACGIH BEI and

AIHA WEEL Committees


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Questions?


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Scheduled Break

Take a minute to stretch!


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Biological Exposure Indices(BEIs)

Process and Use

Larry K. Lowry, Ph.D.

Chair, ACGIHBEICommittee

The University of Texas Health Center at Tyler


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Where are we going

today? Current definitions of the BEI, 2002

The development of BEIs

The keyDocumentation Examples

Biomonitoring without limits

Current and future issues Resources


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Biological monitoring.

Why? Assess exposure and uptake by all routes

TLV not protective skin

Includes workload More closely related to systemic effects

Assess effectiveness of PPE

Legal or ethical drivers Regulations

Control workers compensation costs


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Guidelinesfor

biologicalmonitoring

The BEIs


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The BEIs 2003

BEIsare intended for use in thepractice of industrial hygiene as

guidelines or recommendations toassist in the control of potentialworkplace health hazards and forno other use.


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The BEI Definition

Biological monitoring entailsmeasurement of the concentration of achemical determinant in the biological

media of the exposed and is an indicatorof the uptake of the substance.

The BEIdeterminant can be the

chemical itself; one or more metabolites;or a characteristic reversible biochemicalchange induced by the chemical.


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BEIs

Represent levels of determinants that aremost likely to be observed in specimenscollected from a healthy worker who hasbeen exposed to chemicals to the same

extent as a worker with inhalation exposureto the TLV-TWA.

Generally indicate a concentration below

which nearly all workers should notexperience adverse health effects.


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Current basis for BEIs Bio-equivalent to TLV(traditional)

BEIsrepresent levels of determinantsthat are most likely to be observed inspecimens collected from a healthy workerwho has been exposed to chemicals to thesame extent as a worker with inhalation

exposure to the TLV

-TWA. Most of the BEIsare based on TLVs


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Current basis

Indicators of early, reversible health effect Approach developed in late 80s as

relationships did not always exist betweenairborne exposure and biomonitoringdeterminant.

Examples:

CO, Acetyl cholinesterase inhibiting

pesticides, Cd, Pb, Hg, Hexane-MnBK


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The BEI

CommitteeLarry Lowry, Ph.D., U TX Health Center at

Tyler Chair Phil Edelman, MD, CDC Vice Chair

Mike Morgan, Sc.D, CIH, U. of WA Past Chair

Joe Saady, Ph.D., VA Division of Forensic Science

Leena Nylander-French, Ph.D, CIH, UNC, Chapel Hill

John Cocker, Ph.D., HSE, UK

K. H. Schaller, Dipl. Ing., Univ Erlangen, Germany

M. Ikeda, Ph.D., Kyoto Ind Health Assoc, Japan Gary Spies, CIH, Pharmacia

Glenn Talaska, Ph.D., CIH, Univ of Cincinnati

Jan Yager, Ph.D., EPRI


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Volunteer assigned document

Prepares draft Documentation

Sources of data Human laboratory & workplace data Limited use of animal data

Simulation modeling with verification

Published peer-reviewed data

Draft Documentationdiscussed in committeemeetings, e-mail

BEI development


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Development Process

Select

Chemical

Review

Data

Assign

Author

Select

Determinant

Discuss

Justification

Develop

Feasibility

Prepare

Draft

BEI?

Review

Draft

Return to

AuthorRevise

Final

Document

Yes

No

No

Yes


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How are chemicalsselected?

Chemicals with human data

Potential for dermal absorption

Availability of adequate lab methods

Recommendations by others

Interest/experience of committee

member


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The Documentation

Who is the audience? The practicing occupational hygienist or other

practicing occupational health professional

What the Documentationis Justification supporting the BEI

Practical information on sampling, background, etc.

What the Documentationis not

An extensive review of toxicological data

A novel research approach to setting guidelines


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The Documentationcontents

Basis of the BEI

Uses and properties

Absorption

Elimination

Metabolic pathways & biochemicalinteractions

Possible non-occupational exposure

Summary of toxicology


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For each indexor BEI

Analytical methods, sampling, and storage

Levels without occupational exposure

Kinetics

Factors affecting interpretation Analytical procedures and sampling

Exposure

Population Justification the key

Current quality of database

Recommendations and references


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The notations

B - Background levels expected Nq- Nonquantitative

Biol. monitoring recommended, no BEI

Ns- Non-Specific Needs confirmation

Sq Semiquantitative (but specific)

Screening test

Confirmatory tests


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Practical applications

Bioavailability of metals Chromium Chromium VI (water soluble) fume

Specificity and Sensitivity Benzene

biomonitoring t,t-Muconic acid in urine (t,t-MA)

S-Phenylmercapturic acid in urine (SPMA)


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Bioavailability ofmetals Chromium

Physical properties and solubility

Cr (III), very insoluble particulates

Cr (VI) insoluble particulate the lung carcinogen Cr (VI) water soluble

Fume as generated in MMA arc welding

Mist as generated in electroplating

Health effects of Cr (VI) water soluble Fume lung irritant

Mist chrome ulcers on skin, mucus membranes


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Biological monitoringof Cr exposure

Cr (III) inappropriate not bioavailable

Cr (VI) insoluble not bioavailable

Cr (VI) water soluble

If fume, use BEIbased on welding studies

If mist, bioavailability less

See chrome ulcers at acceptable BEIvalues


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Biomonitoring of benzene


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Biomonitoring atthe current TLV

t,t-Muconic acid in urine (t,t-MA) Good sensitivity (to 0.1 ppm benzene)

HPLC methodology

Considerable variability in populations

S-Phenylmercapturic acid in urine(SPMA)

Ultimate sensitivity (to 0.01 ppm benzene) GC/MS methodology

Good data base, but expensive


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Biological monitoring

without limits What about substances

absorbed through the skinand with chronic systemichealth effects that occur after

a long lag time such ascancer?

Th t diti l


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The traditionalapproach

Cannot relate to airborne limits, TLVs

Irrelevant

Cannot relate to skin absorption

Difficult to quantitate dermal dose Cannot relate to health effect

Often wrong timeline

What to do?


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The BEI approach

Rationale Biological monitoring is essential to assess

dermal exposure

How do you correlate dermal dose with abiomarker of exposure?

Nq Approach Biological monitoring should be considered

for this compound based on the review;however, a specific BEIcould not bedetermined due to insufficient data.


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Criteria for an Nq

Dermal route of exposure significant

Good measurement methods

Good qualitative data on human exposure andbiomarker concentration

Poor quantitative data relating exposure &biomarker

Long lag time, exposure to health outcome

Low or no background in general population

If it i t


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If criteria are met,then

Develop full Documentation

Describe sampling and analysis

Define background levels Describe justification for biomonitoring

Note the lack of quantitative data

Cite guidance values from literature Publish BEIas Nq (no value)


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Examples MBOCA

Principal route of exposure dermal

Alleged health effect in humans cancer Good methods and human data on

exposure-response

Industry practice guidance from the HSE

H lth d S f t


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Health and SafetyExecutive, UK

Scientific basis to justify guidance values

Use "yardstick or benchmark" approach

Issues Results no "safe" or "unsafe" exposure levels

Results estimates of exposure areas and allowintervention to reduce exposures

No legal status

Examples MBOCA and MDA

The yardstick or


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The yardstick or

benchmark approach

Good analytical methods

All specimens analyzed by one

laboratory or with a single method Establish "best industry practice" using

an upper 90% confidence limit of the"best" industries

Benchmarks guidance value to provideusers with assessment of their results


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Current issues

Carcinogens? Is there a safe level of exposure?

The German EKA approach

Mixtures and interactions

Metabolism/toxicokinetics on pure chemical Workers exposed to mixtures

How does this effect BEI?

Biomarkers of effect irreversible effects?

Data gaps lack of human data

Animal data should this be used?

Skin absorption


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Skin absorptionJustification for

BEI

Existing BEIs for substances withsubstantial skin absorption

MBOCA Nq

EGME/EGMEA Nq

EGEE/EGEEA 100 mg/g creatinine (based on TLVof 5 ppm)

Is this a valid approach?

Are Nq notations appropriate? Should a chemical without a skin notation

have a BEI?


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The future

As TLVsdrop, BEIsbased on TLVsdrop Cannot distinguish exposure at TLV from

background

What do we do for substances that have nohuman data?

What is the future of modeling techniques?

Can these modeling techniques be validated?

Should animal data be used? What about mixtures?


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Other guidelines


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Germany

TheBATsfrom the

DFG


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The HSEUK

Biological

monitoringguidelines

Guidance from WHO


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Guidance from WHOHow to do biological

monitoring


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Other

Guidelines

New edition,

2001


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Your questions please

Thank you for your attention


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Scheduled Break



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ACGIH

TLVs

forPhysical Agents

Committee UpdateVice-Chair: Thomas Bernard

University of South Florida

College of Public Health


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TLV

Physical Agents CommitteeProcess for Hazardous Agent Selection

and Decision Making


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Mission

To foster, solicit, collect and evaluate dataon potential health hazards of exposures

to physical agents. When appropriate,recommend ACGIH Threshold LimitValues for physical agents.


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2002 PAC

Harry Mahar

Maurice Bitran

Thomas Bernard

Gerald Coles

Anthony Cullen

Daniel Johnson

John LeonowichWilliam Murray

Bhawani Pathak

Robert Patterson

Thomas Tenforde

Carla Treadwell

Consultants:

Thomas Adams

Thomas ArmstrongGregory Lotz

Martin Mainster

Gary Myers


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Overview

Physical Agents

Process

Committee Activities TLV Development

Future

Format Agents


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Disclaimer

The opinions expressed here are those ofthe author

and not of

his employer,

the Physical Agents Committee orthe ACGIH Worldwide.


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Physical Agents

Its the Movement of Energy

Risk of Health


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Risk of HealthEffects

What is the nature of the energy?

How much energy?

What is the interaction with tissue?


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Nature of Energy

Electric and Magnetic Fields

Photons

Kinetic Energy Pressure

Vibration

Mechanical

Heat


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Amount of Energy

Total Amount of Energy Absorbed

What does it take to raise water temperature?

Rate of Absorption (Power or Intensity)

How fast does the temperature rise?

Normalized to Surface Area

(e.g., mJ/cm2, mW/cm2)


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Interactions

Electric and Magnetic Fields Induce Currents

Align Molecules Vibrate Molecular Bonds

Photons Vibrate Molecular Bonds

Disrupt Molecular Bonds


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More Interactions

Mechanical Disruption of Tissue

Pressure

Vibration Force Applications

Loss of Tissue Function Thermal: Gain or Loss of Heat


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Bernard Watt-O-Meter

Power Limits for Various Exposures [mW/cm2]

Electric and Magnetic Fields 170,000Radiofrequency/Microwave 1.0

Infrared Light 10

Blue Light 0.0001

Ultraviolet Light 0.0012Ionizing Radiation 0.00000003

Noise 0.00003

Heat Stress 30

{Not Accepted, or Considered Acceptable, by Any Authority}


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Exposure

Energy Distribution in the ImmediateEnvironment

The distribution is usually described asPower or Intensity (directly or through a

surrogate) versus Frequency orWavelength in Bands


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Exposure Threshold

Total Energy

Ability to Absorb Energy

Rate of Energy (Power or Intensity)

Ability to Dissipate Absorbed Energy

In a Band

Integrated Over All Bands


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Process

Committee Activities

Development of TLVs


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Representation

Usually one or two members with anexpertise for a particular agent (e.g., a smallportion of the electromagnetic spectrum)

Small committee to maintain a working andcollegial group. We meet as a whole.

Leverage with outside experts


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Updating TLVs

PAC meets with outside experts

Members bring recommendations to thePAC for discussion

Consideration of actions taken bynational and international committees oragencies


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New TLVs

Quintessential Example: Hand Activity

Formed a cadre of consultants Convened a conference

Developed recommendation andDocumentation

Presented to PAC and discussed

PAC voted after internal deliberations


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Future

Format

Agents

F


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Format

TLV Book Use of Flow Charts

Evolving(see Heat Stress and RF/MW)

Training

Documentation

Expanded and Focused (see HAL and Lifting)

Health Effects and Exposure Indices

Guidance (see Heat Stress)

F


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Form

Physical agents have their own historyand character with respect tomeasurement and exposureassessment

There is an underlying similarity among

the physical agents that may beintroduced

E l S


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Example Set

Radiofrequency / Microwave Radiation

Optical Radiation (IR, Visible and UV)

Vibration (Hand-Arm and Whole Body) Noise

E Di t ib ti


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Energy Distribution

0.01

0.1

1

10

100

1000

0.001 0.01 0.1 1 10 100 1000

Energy

Bands

Energy Limits


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Energy LimitsWithin Bands

1

10

100

1000

10000

100000

1000000

0.001 0.01 0.1 1 10 100 1000

EnergyLim

it

Bands

Emin

Li it b B d


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Limits by Band

Is the limit exceeded within one or more bands?

0.01

0.1

1

10

100

1000

10000

100000

1000000

0.001 0.01 0.1 1 10 100 1000

Energy

Bands

PD Exp Lmt

S iti it C


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Sensitivity Curve

Sensitivity = Energy Limit / Emin

0.1

1

10

100

1000

0.001 0.01 0.1 1 10 100 1000

Sensitivity

Bands

H d F ti


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Hazard Function

0.001

0.01

0.1

1

0.001 0.01 0.1 1 10 100 1000

FilterMultiplier

Bands

Hazard Function = 1.0 / Sensitivity

Eff ti E


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Effective Exposure

0.00001

0.0001

0.001

0.01

0.1

1

10

100

1000

0.001 0.01 0.1 1 10 100 1000

Energy

Bands

ED E-eff

Effective Exposure = Energy Distribution x Hazard Function

T t l E


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Total Energy

Multiplying

Energy Limits by Band

Hazard Function by Band

and Integrating (Summing)

Yields a Constant Value:

A Total Energy Limit

Limit by Total


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yEnergy

Total Energy

In One Band

Under the Effective Energy Curve

Compared to

Total Energy Limit

I S


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In Summary

TLVs

Limit Power (Ability to Dissipate)

Limit Total Energy (Ability to Absorb)

Limit by

Band Total

Agents Under


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gReview

Lasers

Vibration

Cold Stress

HAL

Lifting WMSDs

Wide-Band RF

Altitude

Impulse Noise ELF H-Fields


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Scheduled Break



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Biologically Derived AirborneContaminants:

Bioaerosols and TLVs

Kenneth F. Martinez, MSEE, CIH

Chair, ACGIHBioaerosols Committee

NIOSH


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Where ?


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Where ?

Microorganisms


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Microorganisms

Obligate parasites (must have a living host)

viruses

bacteria

rickettsia

Facultative saprophytes (will utilize deadorganic material)

fungi bacteria

Size Ranges of


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gMicroorganisms

FungalSpore

Escherichiacoli

PolioVirus

RabiesVirus

1 m

Mechanisms for


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Mechanisms forMicrobial Dispersal

Linear Distances

Microbiological


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gConcerns

Infections

Immunologic Reactions

Toxic Effects

Infectious Disease


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Infectious Disease

Pathogenicity

Virulence

Relationship between virulence (V), numbers

of pathogens or dosage (D), and resistantstate of the host (RS)

Colonization

Invasiveness

Infectious Disease =V * D

RS

Infectious Disease


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Terminology

Portal of entry

Exposure vs. infection

Clinical vs. subclinical or asymptomaticinfection

Carrier state

Opportunistic infection

Human pathogen vs. virulence Immunosuppression

Infectious Disease


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Pathways

Respiratory

Oral (via ingestion)

Contact

Penetration

Vectors (via insect bite)

Allergic Disease


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Allergic Disease

Allergic rhinitis

Allergic asthma

Allergic bronchopulmonary aspergillosis

Extrinsic allergic alveolitis

(hypersensitivity pneumonitis)

U.S. Disease


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Prevalence 1 of 5 Americans suffer

from allergic disease

Indoor allergens

responsible forsignificant share

Environmental controlreduces disease

severity0% 10% 20% 30%

HP

ABPA

Allergic

Dermititis

Asthma

Sinistitis

Allergic

Rhinitis

Prevalence

Source: NHLBI, 1991

Allergen Exposure

Dust Mites


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Molds

Animal Dander

Pollen

Allergenic Chemicals

Other Exposures

Viruses

Air Pollution

Tobacco Smoke

Genetic

Predispositionor

Susceptibility

Immunologic

Sensitization

Allergic

DiseaseMild Moderate Severe

(Death)

Source: Pope AM, et al., eds., 1993

Important Mycotoxins


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Important MycotoxinsFungal Species Toxin

Aspergillus

Aspergillus parasiticus Aflatoxin

Aspergillus flavus

Aspergillus versicolor Sterigmatocystin

Aspergillus terreus Patulin

Citrinin

Fusarium

Fusarium moniliforme Zearalenone

Fusarium spp. Tricothecenes

Penicillium

Penicillium viridicatum OchratoxinPenicillium spp. Citrinin

Patulin

Stachybotrys

Stachybotrys chartarum (atra) Tricothecenes

Where Are We?


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Where Are We?

Outdoors2%

In Transit

5%

Indoors93%

Classification of


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Occupant Complaints

Sick Building Syndrome

Building-Related Disease

Occupant Discomfort

Sick Building Syndrome


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Sick Building SyndromeNon-specific Symptoms

Headache

Eye, nose, throat irritation

Sneezing Fatigue and lethargy

Skin irritation

Dizziness and nausea

Cough

Chest tightness

Building-Related


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Disease

Known etiologies

Related to identifiable exposure

Legionnaires DiseasePontiac FeverHumidifier FeverHypersensitivity Pneumonitis

Anthrax


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Why Not ScientificallyS bl ?


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Supportable?

Not a single entity

Human responses cover wide range

No single sampling method exists

No exposure/response relationshipsexist

TotalCulturable or CountableBioaerosols

Why Not Scientifically


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Supportable?

Data are derived from indicators ratherthan actual effector agents

Concentrations vary widely

Low statistical power in cause-effectrelationship studies

Specific Culturable or Countable Bioaerosols

- other than infectious


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Questions?


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Questions?

Pat Breysse

Lisa Brosseau

Larry Lowry Tom Bernard

Ken Martinez

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