Interstitial pulmonary disease and aluminum trihydrate exposure: A single case report and detailed workplace analysis.

Exposure to aluminum compounds is clearly associated with pulmonary function decrements, and several animal models document possible mechanisms of aluminum- compound-induced pulmonary toxicity. Nevertheless, disagreements remain about the precise mechanism by which exposures lead to damage. We present a strong case for attributing a case of interstitial pulmonary disease to occupational exposure to aluminum trihydrate. This report follows a 2014 publication of another case of interstitial pulmonary disease following a similar exposure. Our patient eventually underwent double lung transplantation nearly 5 years postexposure. Detailed pulmonary particulate elemental analysis suggested that aluminum metal, including aluminum trihydrate, was the most likely cause. A detailed assessment of the worker's relevant occupational exposures accompanies this case report.

The effect of increasing work rate amplitudes from a common metabolic baseline on the kinetic response of V̇o2p, blood flow, and muscle deoxygenation.

A step-transition in external work rate (WR) increases pulmonary O2 uptake (V̇o2p) in a monoexponential fashion. Although the rate of this increase, quantified by the time constant (τ), has frequently been shown to be similar between multiple different WR amplitudes (ΔWR), the adjustment of O2 delivery to the muscle (via blood flow; BF), a potential regulator of V̇o2p kinetics, has not been extensively studied. To investigate the role of BF on V̇o2p kinetics, 10 participants performed step-transitions on a knee-extension ergometer from a common baseline WR (3 W) to: 24, 33, 45, 54, and 66 W. Each transition lasted 8 min and was repeated four to six times. Volume turbinometry and mass spectrometry, Doppler ultrasound, and near-infrared spectroscopy were used to measure V̇o2p, BF, and muscle deoxygenation (deoxy[Hb + Mb]), respectively. Similar transitions were ensemble-averaged, and phase II V̇o2p, BF, and deoxy[Hb + Mb] were fit with a monoexponential nonlinear least squares regression equation. With increasing ΔWR, τV̇o2p became larger at the higher ΔWRs (P < 0.05), while τBF did not change significantly, and the mean response time (MRT) of deoxy[Hb + Mb] became smaller. These findings that V̇o2p kinetics become slower with increasing ΔWR, while BF kinetics are not influenced by ΔWR, suggest that O2 delivery could not limit V̇o2p in this situation. However, the speeding of deoxy[Hb + Mb] kinetics with increasing ΔWR does imply that the O2 delivery-to-O2 utilization of the microvasculature decreases at higher ΔWRs. This suggests that the contribution of O2 delivery and O2 extraction to V̇O2 in the muscle changes with increasing ΔWR.NEW & NOTEWORTHY A step increase in work rate produces a monoexponential increase in V̇o2p and blood flow to a new steady-state. We found that step transitions from a common metabolic baseline to increasing work rate amplitudes produced a slowing of V̇o2p kinetics, no change in blood flow kinetics, and a speeding of muscle deoxygenation kinetics. As work rate amplitude increased, the ratio of blood flow to V̇o2p became smaller, while the amplitude of muscle deoxygenation became greater. The gain in vascular conductance became smaller, while kinetics tended to become slower at higher work rate amplitudes.

Filter Fluorometer Calibration Without the Fluorometer.

We recently described a lightweight, low-power, waterproof filter fluorometer using a 180° backscatter geometry for chlorophyll-a (chl-a) detection. Before it was constructed it was modeled to ensure it would have satisfactory performance. This manuscript repeats the modeling process that allows the calibration slope and detection limit for a fluorescent analyte in water to be estimated from system component performance and conventional spectrofluorometry alone. These values are validated by comparison to the experimental result of calibration from the completed instrument. Our model yields a calibration slope of 8.22 mV-L/µg for dissolved chl-a, consistent with the experimentally measured slope of 8.21 mV-L/µg. The detection limit modeled from this slope and an estimate of the baseline noise of the instrument was 0.15 µg/L chl-a, while the measured detection limit using real blank samples was 0.18 µg/L, in 0.1 s differential measurements.

Chlorophyll Fluorometer for Intelligent Water Sampling by a Small Uncrewed Aircraft System (sUAS).

We describe a waterproof, lightweight (1.3 kg), low-power (∼1.1 W average power) fluorometer operating on 5 V direct current deployed on a small uncrewed aircraft system (sUAS) to measure chlorophyll and used for triggering environmental water sampling by the sUAS. The fluorometer uses a 450 nm laser modulated at 10 Hz for excitation and a standard photodiode and transimpedance amplifier for the detection of fluorescence. Additional detectors are available for measuring laser intensity and light scattering. Control of the fluorometer and communication between the fluorometer and the Raspberry Pi 4B computer controlling the sampler were provided by an Arduino microcontroller using the robot operating system (ROS). Calibrations were based on standards of dissolved chlorophyll extracted from Chlorella powder (a widely available dietary supplement). The detection limit for chlorophyll from these calibrations was found to be 0.2 µg per liter of water for a single 0.1 s differential measurement. The detection limit decreases with the square root of the integration time as expected. Detection limits increase by a factor of two to three when mounted in the sUAS due to electrical noise; sUAS acoustic noise and vibration do not appear to contribute significantly.

Fluorometer Control and Readout Using an Arduino Nano 33 BLE Sense Board.

We describe the control and interfacing of a fluorometer designed for aerial drone-based measurements of chlorophyll-a using an Arduino Nano 33 BLE Sense board. This 64 MHz controller board provided suitable resolution and speed for analog-to-digital (ADC) conversion, processed data, handled communications via the Robot Operating System (ROS) and included a variety of built-in sensors that were used to monitor the fluorometer for vibration, acoustic noise, water leaks and overheating. The fluorometer was integrated into a small Uncrewed Aircraft System (sUAS) for automated water sampling through a Raspberry Pi master computer using the ROS. The average power consumption was 1.1 W. A signal standard deviation of 334 µV was achieved for the fluorescence blank measurement, mainly determined by the input noise equivalent power of the transimpedance amplifier. An ADC precision of 130 µV for 10 Hz chopped measurements was achieved for signals in the input range 0-600 mV.

Severe asthma and death in a worker using methylene diphenyl diisocyanate MDI asthma death.

Diisocyanates are well-recognized to cause occupational asthma, yet diisocyanate asthma can be challenging to diagnose and differentiate from asthma induced by other allergens. The present study assesses the potential contribution of methylene diphenyl diisocyanate (MDI) to a workplace fatality. Examination of medical records, tissue, and blood from the deceased worker were undertaken. Formalin-fixed paraffin-embedded lung tissue sections were assessed through histologic and immunochemical stains. Serum MDI-specific IgE and IgG, and total IgE, were measured by enzyme-linked immunosorbent assays and/or Western blot. Information about potential chemical exposures and industrial processes in the workplace were provided by the employer and through interviews with co-workers. Review of the worker's medical records, occupational history, and autopsy findings were consistent with severe asthma as the cause of death, and ruled out cardiac disease, pulmonary embolism, or stroke. Lung pathology revealed hallmarks of asthma including smooth muscle hypertrophy, eosinophilia, basement membrane thickening, and mucus plugging of bronchioles. Immunochemical staining for MDI was positive in the thickened basement membrane of inflamed airways. MDI-specific serum IgE and IgG were significantly elevated and demonstrated specificity for MDI versus other diisocyanates, however, total serum IgE was normal (24 IU/ml). The workplace had recently introduced MDI into the foundry as part of a new process, but MDI air levels had not been measured. Respirators were not required. In summary, post-mortem findings support the diagnosis of diisocyanate asthma and a severe asthma attack at work as the cause of death in a foundry worker.

OSHA Workplace Violence Enforcement.

OBJECTIVE: To examine violence inspections at the Occupational Safety and Health Administration (OSHA). METHODS: The authors examined all inspections that involved violence against workers begun by January 1, 2019. They conducted semi-structured interviews with compliance officers who had conducted inspections on a sample of facilities that received General Duty Clause (GDC) citations (n = 22) or Hazard Alert Letters (HALs) (n = 22). RESULTS: By January 1, 2019, OSHA initiated 726 "violence" inspections, with 502 (69.1%) in healthcare. In healthcare, 45 (11.1%) resulted in GDC citations and 241 (67.7%) in HALs. GDC facilities received statistically significantly lower scores in 5 of 6 domains examined through semi-structured interviews than HAL facilities. Both groups of facilities had poorly designed recordkeeping systems. CONCLUSIONS: Health care facilities continue to generate worker complaints with poorly designed violence prevention programs.

Hospitalised heat-related acute kidney injury in indoor and outdoor workers in the USA.

OBJECTIVES: To characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries. METHODS: Two data sources were analysed: archived case files of the Occupational Safety and Health Administration's (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture-recapture analysis assessed under-reporting in SIR. RESULTS: There were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis. CONCLUSIONS: Workers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.

Data analysis technique influences blood flow kinetics parameter estimates for moderate- and heavy-intensity exercise transitions.

NEW FINDINGS: What is the central question of this study? During exercise, there are fluctuations in conduit artery blood flow (BF) caused by both cardiac and muscle contraction-relaxation cycles. What is the optimal method to process Doppler ultrasound-measured BF for the purpose of characterizing the dynamic response of BF during step-transitions in exercise? What is the main finding and its importance? Continuous BF data were processed in relation to either cardiac or muscle contraction-relaxation cycles and computed based on 'binned' or 'rolling' averages over one, two or five consecutive cycles. Kinetics characterization revealed no data processing technique-specific differences in steady-state BF, but variability in the rapidity at which BF attained steady-state (i.e., mean response time) was observed. ABSTRACT: The overall rate of blood flow (BF) adjustment (i.e., kinetics) from the onset of an exercise transition can be quantified by the mean response time (MRT). However, the BF response profile can be distorted during rhythmic, dynamic exercise consequent to variations caused by the cardiac cycle (HR) and the muscle contraction-relaxation (CR) cycle. We examined the extent to which distortions imposed by HR and CR cycles affected BF kinetics. Eight healthy, young men (27 (4) years; mean (SD)) performed transitions of alternate-leg knee-extension exercise from 3 W to either a moderate- (MOD) or heavy-intensity (HVY) power output. Femoral artery BF was continuously measured by Doppler ultrasound and averaged over one, two or five 'binned' (e.g., HR2b, etc.) or 'rolling' (e.g., CR5r, etc.) HR and CR cycles. Among analysis techniques, there were no differences for steady-state BF values at the 3 W baseline. In MOD, MRT using contraction-relaxation cycle (CR1) was smaller than most other analysis techniques. For both MOD and HVY, the 95% confidence interval for MRT was generally larger when using HR- compared to CR-related methods, and monoexponential fits based on 'rolling' averages (HR2r, HR5r, CR2r, CR5r) had a poorer ability to estimate the true end-exercise BF in HVY than in MOD. When modelling BF kinetics, we conclude that the CR1 method is a good option because of its ability to accurately estimate the 'data-determined' end-exercise BF value from the 'model-derived' response, maintain a relatively high density of data points during the transition and yield a relatively small 95% CI.

A cluster of hypersensitivity pneumonitis associated with exposure to metalworking fluids.

BACKGROUND: Workers exposed to metalworking fluids (MWF) can develop respiratory illnesses including hypersensitivity pneumonitis (HP). These respiratory manifestations are likely due to microbial contamination of aerosolized MWF. This paper reports a cluster of HP and respiratory symptoms at a manufacturing plant where MWF and workplace air were contaminated with bacterial endotoxin despite frequent negative bacterial cultures of MWF. METHODS: A pulmonologist assessed and treated three workers with respiratory symptoms. The Occupational Safety and Health Administration (OSHA) inspected the plant. OSHA's investigation included bacterial culture of MWF, measurement of endotoxin concentrations in MWF and workplace air, review of the employer's fluid management program, and distribution of a cross-sectional symptom questionnaire. RESULTS: Three workers had biopsy-confirmed HP. In addition, 30.8% of questionnaire respondents reported work-related respiratory symptoms. OSHA detected endotoxin levels as high as 92,000 endotoxin units (EU)/ml in MWF and 3200 EU/m3 in air. Endotoxin concentrations and risk of MWF inhalation were highest near an unenclosed multistation computer numerical control machine. A contractor had tested this machine's MWF for bacterial growth weekly during the preceding three years, and most (96.0%) of those tests were negative. CONCLUSIONS: Contaminated MWF can cause severe occupational lung disease even if microorganisms do not grow in fluid cultures. Endotoxin testing can increase the sensitivity of detection of microbial contamination. However, employers should not rely solely upon MWF testing data to protect workers. Medical surveillance and meticulous source control, such as engineering controls to suppress MWF mist and prevent its inhalation, can reduce the likelihood of respiratory disease.

Measuring global multi-scale place connectivity using geotagged social media data.

Shaped by human movement, place connectivity is quantified by the strength of spatial interactions among locations. For decades, spatial scientists have researched place connectivity, applications, and metrics. The growing popularity of social media provides a new data stream where spatial social interaction measures are largely devoid of privacy issues, easily assessable, and harmonized. In this study, we introduced a global multi-scale place connectivity index (PCI) based on spatial interactions among places revealed by geotagged tweets as a spatiotemporal-continuous and easy-to-implement measurement. The multi-scale PCI, demonstrated at the US county level, exhibits a strong positive association with SafeGraph population movement records (10% penetration in the US population) and Facebook's social connectedness index (SCI), a popular connectivity index based on social networks. We found that PCI has a strong boundary effect and that it generally follows the distance decay, although this force is weaker in more urbanized counties with a denser population. Our investigation further suggests that PCI has great potential in addressing real-world problems that require place connectivity knowledge, exemplified with two applications: (1) modeling the spatial spread of COVID-19 during the early stage of the pandemic and (2) modeling hurricane evacuation destination choice. The methodological and contextual knowledge of PCI, together with the open-sourced PCI datasets at various geographic levels, are expected to support research fields requiring knowledge in human spatial interactions.

Measuring Global Multi-Scale Place Connectivity using Geotagged Social Media Data.

Shaped by human movement, place connectivity is quantified by the strength of spatial interactions among locations. For decades, spatial scientists have researched place connectivity, applications, and metrics. The growing popularity of social media provides a new data stream where spatial social interaction measures are largely devoid of privacy issues, easily assessable, and harmonized. In this study, we introduced a global multi-scale place connectivity index (PCI) based on spatial interactions among places revealed by geotagged tweets as a spatiotemporal-continuous and easy-to-implement measurement. The multi-scale PCI, demonstrated at the US county level, exhibits a strong positive association with SafeGraph population movement records (10% penetration in the US population) and Facebook's social connectedness index (SCI), a popular connectivity index based on social networks. We found that PCI has a strong boundary effect and that it generally follows the distance decay, although this force is weaker in more urbanized counties with a denser population. Our investigation further suggests that PCI has great potential in addressing real-world problems that require place connectivity knowledge, exemplified with two applications: 1) modeling the spatial spread of COVID-19 during the early stage of the pandemic and 2) modeling hurricane evacuation destination choice. The methodological and contextual knowledge of PCI, together with the launched visualization platform and open-sourced PCI datasets at various geographic levels, are expected to support research fields requiring knowledge in human spatial interactions.

Noise and Occupational Medicine: Common Practice Problems.

: Noise-induced hearing loss (NIHL) represents the second most common occupational disease in the United States. Although the Occupational Safety and Health Administration (OSHA) has promulgated an occupational noise exposure standard and associated recordkeeping requirements, OSHA inspections increasingly document practices that violate both the noise standard and recordkeeping regulation. This article describes five deviations from good clinical practices masking the true societal costs of NIHL, leading to missed prevention opportunities, and creating burdens for individuals and society. These include attributing NIHL to nonoccupational sources, exculpating the workplace because of audiogram patterns without careful documentation, ignoring symptoms or physical examination findings, and simply denying work-relatedness, leading to employers inappropriately lining out cases from the OSHA 300 log. The practices identified by OSHA suggest that many individuals are not following widely recognized and accepted practices when administering hearing conservation programs.

Actual and simulated weather data to evaluate wet bulb globe temperature and heat index as alerts for occupational heat-related illness.

Heat stress occupational exposure limits (OELs) were developed in the 1970s to prevent heat-related illnesses (HRIs). The OELs define the maximum safe wet bulb globe temperature (WBGT) for a given physical activity level. This study's objectives were to compute the sensitivity of heat stress OELs and determine if Heat Index could be a surrogate for WBGT. We performed a retrospective analysis of 234 outdoor work-related HRIs reported to the Occupational Safety and Health Administration in 2016. Archived NOAA weather data were used to compute each day's maximum WBGT and Heat Index. We defined the OELs' sensitivity as the percentage of incidents with WBGT > OEL. Sensitivity of the OELs was between 88% and 97%, depending upon our assumption about acclimatization status. In fatal cases, the OELs' sensitivity was somewhat higher (92-100%). We also computed the sensitivity of each possible Heat Index discrimination threshold. A Heat Index threshold of 80 °F (26.7 °C) was exceeded in 100% of fatalities and 99% of non-fatal HRIs. In a separate analysis, we created simulated weather data to assess associations of WBGT with Heat Index over a range of realistic outdoor heat conditions. These simulations demonstrated that for a given Heat Index, when radiant heat was included, WBGT was often higher than previously reported. The imperfect correlation between WBGT and Heat Index precluded a direct translation of OELs from WBGT into Heat Index. We conclude that WBGT-based heat stress exposure limits are highly sensitive and should be used for workplace heat hazard assessment. When WBGT is unavailable, a Heat Index alert threshold of approximately 80 °F (26.7 °C) could identify potentially hazardous workplace environmental heat.

Evaluation of Occupational Exposure Limits for Heat Stress in Outdoor Workers - United States, 2011-2016.

Heat stress, an environmental and occupational hazard, is associated with a spectrum of heat-related illnesses, including heat stroke, which can lead to death. CDC's National Institute for Occupational Safety and Health (NIOSH) publishes recommended occupational exposure limits for heat stress (1). These limits, which are consistent with those of the American Conference of Governmental Industrial Hygienists (ACGIH) (2), specify the maximum combination of environmental heat (measured as wet bulb globe temperature [WBGT]) and metabolic heat (i.e., workload) to which workers should be exposed. Exposure limits are lower for workers who are unacclimatized to heat, who wear work clothing that inhibits heat dissipation, and who have predisposing personal risk factors (1,2). These limits have been validated in experimental settings but not at outdoor worksites. To determine whether the NIOSH and ACGIH exposure limits are protective of workers, CDC retrospectively reviewed 25 outdoor occupational heat-related illnesses (14 fatal and 11 nonfatal) investigated by the Occupational Safety and Health Administration (OSHA) from 2011 to 2016. For each incident, OSHA assessed personal risk factors and estimated WBGT, workload, and acclimatization status. Heat stress exceeded exposure limits in all 14 fatalities and in eight of 11 nonfatal illnesses. An analysis of Heat Index data for the same 25 cases suggests that when WBGT is unavailable, a Heat Index screening threshold of 85°F (29.4°C) could identify potentially hazardous levels of workplace environmental heat. Protective measures should be implemented whenever the exposure limits are exceeded. The comprehensive heat-related illness prevention program should include an acclimatization schedule for newly hired workers and unacclimatized long-term workers (e.g., during early-season heat waves), training for workers and supervisors about symptom recognition and first aid (e.g., aggressive cooling of presumed heat stroke victims before medical professionals arrive), engineering and administrative controls to reduce heat stress, medical surveillance, and provision of fluids and shady areas for rest breaks.

Lung disease associated with occupational styrene exposure.

Despite reports of pulmonary toxicity due to styrene, guidelines on acceptable styrene exposure levels have been based on risk of cancer and central nervous system and liver toxicity and not on respiratory effects. Many reports have linked exposure to styrene vapor in occupational settings to various forms of non-malignant pulmonary disorders including bronchiolitis, hypersensitivity pneumonitis, and occupational asthma. We report two cases in which the same tasks performed in a single workplace resulted in exposure to styrene vapor with subsequent development of acute respiratory symptoms associated with impaired gas exchange and imaging and histopathologic findings consistent with bronchiolitis and organizing pneumonia. Both patients gradually recovered once their workplace exposure to styrene was terminated. Clinicians, employers, and insurers should be aware of the potential for pulmonary toxicity from exposure to styrene.

Risk Factors for Heat-Related Illness in U.S. Workers: An OSHA Case Series.

OBJECTIVE: The aim of this study was to describe risk factors for heat-related illness (HRI) in U.S. workers. METHODS: We reviewed a subset of HRI enforcement investigations conducted by the Occupational Safety and Health Administration (OSHA) from 2011 through 2016. We assessed characteristics of the workers, employers, and events. We stratified cases by severity to assess whether risk factors were more prevalent in fatal HRIs. RESULTS: We analyzed 38 investigations involving 66 HRIs. Many workers had predisposing medical conditions or used predisposing medications. Comorbidities were more prevalent in workers who died. Most (73%) fatal HRIs occurred during the first week on the job. Common clinical findings in heat stroke cases included multiorgan failure, muscle breakdown, and systemic inflammation. CONCLUSION: Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.