Respiratory Diseases Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health (2008) / Chapter Skim
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2 Evaluation of the Respiratory Diseases Research Program
2 Evaluation of the Respiratory Diseases Research Program
Pages 34-119
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From page 34... ...
The committee also notes selected activities related to respiratory disease research that occurred before 1996. As stated previously, the committee's use of the term RDRP also indicates NIOSH activities and programs related to occupational respiratory diseases that predate formal creation of the RDRP under NORA2.
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From page 35... ...
Table 2-2 provides the budget for the RDRP classified by program goal. The largest fraction of the RDRP budget goes to airway diseases, followed closely by research budgeted for interstitial lung diseases.
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From page 36... ...
• Protect workers from occupational exposures that make them susceptible to respiratory infections • Prevent outbreaks of occupational histoplasmosis by maintaining worker and employer awareness Strategic Goal 4: Prevent and reduce work-related respiratory malignancies • Determine occupation etiologies of lung cancer • Reduce metal-induced lung cancer (hexavalent chromium) • Prevent and reduce silica-induced lung cancer • Prevent and reduce lung cancer induced by diesel engine exhaust • Produce lung cancer diagnostic tools Strategic Goal 5: Prevent respiratory and other diseases potentially resulting from occupational exposures to nanomaterials • Determine the relative toxicity of nanomaterials • Conduct exposure assessment and engineering control evaluations in 10 nanomaterial production or use facilities by 2008 • Produce dose-response data for carbon nanotubes sufficient to conduct a quantitative risk assessment by 2008 Abbreviation: WRA, work-related asthma.
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From page 37... ...
TABLE 2-2 NIOSH Respiratory Diseases Research Program Budget and Staffing by Research Goals (in Millions of Dollars) Total FY1996 FY1997 FY1998 FY1999 FY2000 FY2001 FY2002 FY2003 FY2004 FY2005 FY2006 Intramural 7.35 7.09 10.90 13.20 15.50 16.20 16.06 16.39 16.31 17.17 Extramural 2.31 3.08 4.51 7.31 7.29 8.61 10.08 10.30 8.64 11.40 14.50 Strategic Goal 1: Prevent and reduce work-related airway diseases Intramural 1.66 1.56 2.07 4.35 6.38 5.90 5.64 5.97 7.31 5.80 Extramural 0.62 1.51 2.37 3.13 3.72 3.42 3.10 2.83 2.52 2.74 2.94 Strategic Goal 2: Prevent and reduce work-related interstitial lung diseases Intramural 1.73 3.56 4.60 5.61 6.82 6.14 6.25 6.60 5.61 6.64 Extramural 0.08 0.08 0.35 0.70 0.65 1.48 0.92 1.09 0.38 0.68 0.38 Strategic Goal 3: Prevent and reduce work-related infectious respiratory diseases Intramural 2.89 1.74 3.57 1.89 1.40 3.10 3.63 3.05 2.45 2.70 Extramural 0.30 0.50 0.65 0.65 0.29 0.26 0.25 0.00 0.08 0.08 0.75 Strategic Goal 4: Prevent and reduce work-related respiratory malignancies Intramural 1.08 0.23 0.66 1.34 0.90 1.06 0.54 0.76 0.74 0.76 Extramural .043 0.19 0.09 1.68 1.68 1.19 1.25 1.91 1.78 1.40 1.35 Strategic Goal 5: Prevent respiratory and other diseases potentially resulting from occupational exposures to nanomaterials Intramural 0 0 0 0 0 0 0 0 0.67 1.27 3.31 Extramural 0.10 0.38 0.38 0.29 0.10 0.66 0.82 Abbreviations: FY, fiscal year; FTE, full-time equivalent.
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From page 38... ...
. Although there is a Division of Respiratory Disease Studies, it is only one part of the RDRP, albeit the leading one.
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From page 39... ...
One prominent surveillance activity is the summary of occupation respiratory disease and associated exposure data in the series of Work-Related Lung Disease (WoRLD) Surveillance Reports and the web-based eWoRLD Surveillance System.
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From page 40... ...
This activity has also helped spur work in developing a standardized approach to mortality data on occupational lung disease. It has also helped give rise to NIOSH's Worker Health Chartbook (NIOSH 2004)
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From page 41... ...
For example, the HHE of the Missouri microwave popcorn plant, which investigated flavoring-induced bronchiolitis obliterans, gave rise to a coordinated research program on flavoring-related obstructive airway disease. The response to that specific HHE request can be considered a model of how the surveillance and initial data-gathering activities related to an HHE can be used as a key production input for setting priorities and planning research objectives.
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From page 42... ...
Such activities are incorporated into RDRP program goals to varying degrees. For example, activities related to the goal of preventing and reducing work-related infectious respiratory diseases have been informed by the anthrax attacks of 2001 and outbreaks of SARS and avian influenza.
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From page 43... ...
The committee developed a consensus through deliberations at meetings and discussions of written materials, including a lengthy scoring discussion. STRATEGIC GOAL 1: PREVENT AND REDUCE WORK-RELATED AIRWAY DISEASES Introduction Obstructive airway diseases as a group comprise the most prevalent type of occupationally related chronic respiratory disease.
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From page 44... ...
Ample rationale exists for including such specific objectives in an overall WRA program. The prevalence of sensitization to natural rubber latex among health care workers increased dramatically between 1987 and 1996 because of a huge increase in the use of latex gloves as part of the universal precautions for preventing exposure to blood-borne pathogens.
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From page 45... ...
. Planning and Production Inputs NIOSH-funded surveillance efforts through the SENSOR program assisted in determining the extent of the latex-induced occupational asthma problem and, importantly, identified its prominence relative to other HMW antigens for which latex can serve as a prototype.
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From page 46... ...
Data from the SENSOR program also identified indoor air pollutants as a category of agents frequently associated with WRA. The RDRP developed an approach to this problem that resulted in a major investment of intramural funds through the Asthma Research Program Project.
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From page 47... ...
. Similarly, although NIOSH has not committed substantive resources to extramural or intramural research into the biological mechanisms or outcomes of latex-induced occupational asthma, it has supported work related to allergic sensitization to egg protein and asthma asso ciated with crab processing as related examples of HMW protein caused WRA (Boeniger et al.
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From page 48... ...
Exposure During Spray-on Truck Bed Liner and R elated Applications" (NIOSH 2006c) , summarized four case reports: one death and several incidents of asthma or other respiratory disease that followed exposure to MDI during spray-on truck bed lining operations.
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From page 49... ...
. Although the potential for loss of focus does exist with indoor air investigations, RDRP work on bioaerosols in office buildings and schools has relevance to occupational exposures to bioaerosols in other settings -- for example, from contaminated metalworking fluids and in animal confinement facilities.
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From page 50... ...
This document and the RDRP-ATS part nership are discussed below in the subsection on fixed obstructive airway disease. Beyond the activities and outputs specifically related to the subgoal of improved detection of WRA summarized above, the RDRP partnered with the ATS to develop a survey instrument to assess respiratory symptoms in adults that included an occu pational module; the RDRP cosponsored a meeting of the committee for further development of the questionnaire.
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From page 51... ...
. Assessment of Relevance Given the high prevalence of new cases of adult asthma that may be related to occupational exposures, the four WRA subgoals are highly relevant to improved occupational safety and health among the U.S.
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With regard to WRA and indoor air quality, the greatest impact of RDRP research appears to be in the development of methods for improved quantitative assessment of exposure to fungi. The impact of RDRP efforts to improve detection of WRA in the broad sense is more difficult to assess given the lack of adequate surveillance data, but the quality of transfer activities in this area (e.g., the ATS statement on the "Occupational Contribution to the Burden of Obstructive Airway Disease")
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From page 53... ...
lung diseases are addressed separately, activities that address airway effects of exposures to fibrotic agents are discussed in this section. Planning and Production Inputs As noted above, a partnership between the RDRP and the ATS grew out of the NORA asthma and COPD team deliberations and led to the establishment of a committee that undertook a systematic review of the published literature on the question of work relatedness of COPD as well as of asthma.
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From page 54... ...
This multidisciplinary approach is similar to that used in the RDRP response to the initial report of nylon flock workers' lung disease (see interstitial lung diseases below)
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From page 55... ...
. These and related data helped support an updated NIOSH criteria document for coal mine dust published in 1995.
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From page 56... ...
NIOSH also has provided extramural support for studies of grain-dust related and diesel-exhaust-related respiratory health effects that are highly relevant to occupationally related COPD. In addition, NIOSH's support of the Agricul tural Research Centers has helped to promote research relevant to organic-dust r elated obstruction -- for example, research on the mechanisms underlying chronic b ronchitis in farmers (Lambert et al.
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From page 57... ...
Presentations to the Flavor and Extract Manufacturers Association have been made in an effort to establish partnerships with member companies to work with the RDRP to assess worker risk throughout the industry. RDRP investigators also have partnered with the California OSHA and Department of Health Services to conduct surveillance for flavoring-related respiratory disease and to help develop a state-based standard for California, an ongoing process (MMWR 2007b)
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From page 58... ...
RDRP efforts that included the ATS statement, industry-specific studies (especially those in coal mining) , and population-based studies directly addressed underrecognition of the work relatedness of COPD.
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From page 59... ...
STRATEGIC GOAL 2: PREVENT AND REDUCE WORK-RELATED INTERSTITIAL LUNG DISEASES Introduction Historically, research and prevention activities, outputs, and outcomes that pertain to work-related interstitial lung diseases generally categorized as pneumo conioses have been a critical part of the RDRP mission. Because of the importance of CWP, initial RDRP research focused on it almost entirely.
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From page 60... ...
More recently, novel emerging occu pational lung conditions have been recognized that also have prominent fibrotic features -- for example "flock worker's lung." The following sections summarize the activities of the RDRP that pertain to interstitial lung diseases. The four subgoals related to the prevention and reduction of work-related interstitial disease as formulated by the RDRP are as follows: • Prevent and reduce respiratory diseases induced by coal mine dust.
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From page 61... ...
Asbestos is by far the most prominent of these exposures in terms of past commercial applications and ongoing and likely future respiratory morbidity and mortality. Other natural mineral fibers closely resemble commercial asbestos and also cause interstitial lung disease (e.g., amphibole fibers that contaminate vermiculite ore once mined in Libby, Montana)
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From page 62... ...
. The four subgoals, as formulated, are not as inclusive as they might be insofar as certain occupationally related fibrotic lung disease is concerned.
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From page 63... ...
CWP has been documented to occur among both underground and surface coal miners. The legacy of exposure to respirable coal mine dust has been the well-documented impairment from advanced pneumoconiosis and airway obstruction that results in significant morbidity and accompanying compensation costs.
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From page 64... ...
coal miners. Led first by the Appalachian Laboratory for Occupational Respiratory Diseases, which then became the Division of Respiratory Disease Studies, the RDRP pub lished more than 220 epidemiologic studies, surveillance laboratory-based studies, and dust control reports that documented a decreasing prevalence of CWP, declin
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From page 65... ...
Assessment of Relevance Current program efforts for RDRP research to further reduce pneumoconiosis among coal miners have developed the following objectives: • Improve technologies for dust assessment and dust control. • Monitor and evaluate the extent, severity, and characteristics of CWP.
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From page 66... ...
RDRP activities affect other issues related to lung disease in coal workers that are substantive NIOSH outputs, most notably for occupationally related COPD (see
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From page 67... ...
. Silica-Induced Respiratory Diseases Planning and Production Inputs RDRP research on silicosis has addressed six primary objectives: • Reduce deaths due to silicosis through research and policy development.
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From page 68... ...
. On the basis of RDRP research, NIOSH has pub lished 12 official policy documents on silica in the workplace that began with the 1974 criteria document "Occupational Exposure to Crystalline Silica" completed and disseminated in 1974 (NIOSH 1974)
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From page 69... ...
On the basis of the RDRP joint campaign on prevention of silicosis, OSHA developed a Special Emphasis Program to reduce silicosis. Similarly, MSHA undertook efforts to reduce occupational exposures based on RDRP research that included the Miners Choice Examination Program for surface coal miners who are at particular risk for silicosis associated with drilling overburden rock.
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From page 70... ...
. RDRP research continues to evaluate engineering control technology for selected silica-generating activities, development of a silica-focused workplace solutions document to provide practical guidance for dust control, and transfer of engineering control knowledge from mining to selected general industry applications (Flanagan et al.
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From page 71... ...
, and to the EPA and the International Life Sciences Institute in their effort to develop short-term screening strategies for fiber toxicities and nanomaterials. RDRP research will continue to focus on the role of oxidant stress and occu pational lung disease with an emphasis on developing inhibitors, therapeutic interventions, and delivery systems to treat pulmonary disease.
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From page 72... ...
Assessment of Relevance The wide range of occupations and activities with silica exposures, the severe health effects of silicosis, and a direct causal link to occupational exposures all underscore the high relevance of this focus area to NIOSH's core mission and the RDRP's specific goals. In that context, the goals of the RDRP for silica-induced lung diseases focus on key areas that can contribute to a better understanding of the adverse health effects of silica and to better protect workers.
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From page 73... ...
Fiber-Induced Interstitial Lung Disease Planning and Production Inputs NIOSH's very first criteria document was "Criteria for a Recommended S tandard: Occupational Exposure to Asbestos" (NIOSH 1972)
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From page 74... ...
At OSHA's request, RDRP investigators undertook field studies to determine current levels of occupational exposure to vermiculite through asbestos fibers in expansion plants for agricultural uses. More recently, RDRP scientists used findings from their studies of asbestos-contaminated vermiculite to document and support development of a MSHA PEL for asbestos applicable to the mining industry to bring it in line with the more protective OSHA PEL for asbestos in general industry.
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From page 75... ...
Brown University and RDRP scientists reported a new interstitial lung disease in MMWR, a disease dubbed "flock worker's lung" (MMWR 1997)
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From page 76... ...
RDRP scientists have documented the efficacy of engineering controls and have transferred their findings to fiber-manufacturing industries, labor interests, academia, and OSHA (Dunn et al.
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Efforts to document lung disease from exposure to other synthetic fibers are also highly relevant RDRP research on natural and synthetic fibers likely to elicit toxicity; to identify the biologic mechanisms driving that toxicity, it is necessary to better understand disease causation and develop protective measures. Assessment of Impacts The RDRP's efforts related to fiber-induced diseases have had a substantial impact on worker safety and health, with decreases in exposures to causative agents, decreases in disease incidence, important findings about the etiology and biology of these lung diseases, and improvements in worker health and safety.
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From page 78... ...
. From an intramural perspective, RDRP scientists have collaborated with Brush Wellman Inc., the sole manufacturer of beryllium in the United States, to conduct epidemiologic studies, collect airborne and other work process samples, and assess transfer of their research to practice.
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From page 79... ...
To better understand this hierarchy of risk, RDRP scientists have collaborated with investigators at Lawrence Berkeley National Laboratory to develop transgenic mouse models with different degrees of risk for beryllium sensitization and granulomatous inflammation that will allow experimental gene-exposure and gene-gene interaction studies to be conducted. RDRP researchers have forged an innovative partnership with Brush Wellman that could serve as a model for cooperative NIOSH-industry research activities in other sectors.
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From page 80... ...
The program has contributed substantially to the peer-reviewed literature on multiple aspects of beryllium exposure and disease. An innovative cooperative research program with the country's major beryllium producer, which includes applying findings in that producer's facilities, has showed promising results in decreasing beryllium sensitization to workers; the improvement presumably results from engineering controls and use of protective equipment to control exposures.
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From page 81... ...
However, several themes would provide such structure. For example, work on engineering controls and personal respirator technology, the current subgoal to understand mechanisms of pulmonary susceptibility to infection resulting from occupational exposures, and the need for surveillance to detect work-related infectious respiratory diseases extend across the disease-specific subgoals.
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From page 82... ...
, helped to develop a range of recommendations that have been disseminated in the form of 5 documents and 9 websites. Occupational – 33 peer-reviewed publications showing that diesel exhaust, welding fumes, exposures and and silica exposures increase susceptibility of rodents to experimental susceptibility respiratory infections.
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From page 83... ...
with resulting reductions in lung disease among workers at risk. – Recommendations adopted as guidance by – Occupational outbreaks of histoplasmosis are OSHA, Center to Protect Workers' Rights, infrequent.
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From page 84... ...
To a large extent, these strategic goals appear to be driven largely, and appropriately, toward national priorities that were established through the CDC. The NIOSH TB program has brought specific expertise to the occupational setting, especially in areas of respirators and environmental controls.
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From page 85... ...
Nonetheless, systematic TB surveillance in high-risk occupational settings depends on other programs for data. Intermediate outcomes are listed in Table 2-4.
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From page 86... ...
. Engineering Controls and Respirator Technology In the evidence package materials, this area is presented as part of the IDP's TB control program.
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From page 87... ...
. Almost all guidance documents in the latter areas include recommendations for personal protection that directly reflect RDRP investigations into personal and building environmental controls to minimize transmission and infection.
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From page 88... ...
Other Components of the Infectious Diseases Program Goal The evidence package presented several other elements of the RDRP under the headings of "anthrax," "emerging infectious diseases," and "understanding mechanisms of occupational exposures on pulmonary susceptibility." These do not represent a coherent related set of programs, but they are presented together here for the following reasons: (1) Anthrax presented a unique event that likely contributed to the RDRP's capacity to handle such events but does not represent an ongoing research program apart from its work on respirators and engineering controls.
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From page 89... ...
. This program appears to be of interest historically since "no new RDRP research is planned or anticipated at this time. . . ." Ample documentation was provided about the success of the RDRP efforts to protect workers in environments were the fungus is common and where outbreaks represent a threat.
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From page 90... ...
No further comments are made about this program in the following sections. Planning and Production Inputs Anthrax The RDRP played a major role in the national effort to protect workers from the threat of anthrax-contaminated mail by sending personnel to staff the CDC and Department of Health and Human Services Emergency Operations Centers and to the six locations where workers were at risk.
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From page 91... ...
Understanding the Effects and Mechanisms of Occupational Exposures and Pulmonary Susceptibility Under the overall strategic goal of preventing and reducing occupational respiratory infectious diseases, the intermediate goal relevant to this work is to protect workers from occupational exposures making them susceptible to respiratory infections. NIOSH states that "Because this work is at the more basic end of the research to practice spectrum, its intermediate outcomes relate to influencing the thoughts and actions of others" (NIOSH 2006a)
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From page 92... ...
. Emerging Infectious Diseases With respect to SARS, the main outputs have been guidance documents (CDC 2004a,b; NIOSH 2007b)
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From page 93... ...
Studies have found that exposing rats to diesel exhaust particulate matter but not carbon black (the carbonaceous core of
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From page 94... ...
The RDRP research on occupational respiratory diseases in welders won the 2006 American Welding Society Safety and Health Award. The major intermediate outcome related to partnerships with other federal agencies involves an interagency agreement with the Department of Defense (DOD)
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From page 95... ...
Again, this work is highly relevant and rests on the RDRP's capacity to develop rapid methods of detection and worker protection through respirators and engineering controls for workplace facilities. Understanding the Effects and Mechanisms of Occupational Exposures and Pulmonary Susceptibility As described above, the committee determined that the RDRP's research is distinct from that of other federal agencies.
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From page 96... ...
A major challenge to the IDP is the limited availability of BSL-3 labora tory space in which to carry out studies of aerobiology, transmission potential, exposure assessment methods, engineering controls, and personal protective equipment. Efforts are under way through the CDC to establish an appropri ate facility to be located on the National Biodefense Research Campus in Fort Detrick, Maryland.
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From page 97... ...
Strategic Goal 4: Prevent and reduce work-related respiratory malignancies Introduction Within the overall RDRP mission the goal of this component is to "prevent and reduce work-related respiratory malignancies." Before NORA, the strategic plan for preventing occupational lung diseases did not include lung cancer as a specific disease target. While occupational cancer was a general NIOSH priority, this work was performed by investigators in the Division of Surveillance, Field Studies and Hazard Evaluation.
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From page 98... ...
Including specific respiratory cancers as a part of the RDRP portfolio rather than in a program addressing occupational cancers in general appears somewhat arbitrary and awkward. Presumably, their inclusion in the RDRP stems from the major involvement of Division of Respiratory Disease Studies personnel in these programs (e.g., silica and diesel exhaust)
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From page 99... ...
On the other hand, the management of respiratory malignancies in the new matrix structure of the RDRP may ensure better communication among units in different cities within the reorganized RDRP programs. Although the choice of the three exposure-specific subgoals -- chromium, silica, and diesel exhaust -- appears to be highly relevant, the rationale for choosing these particular risks over other ongoing lung carcinogen exposures, or other non respiratory occupational carcinogens, is not addressed.
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From page 100... ...
In addition to contributing to the development of these standards, the RDRP has also responded with a series of projects and studies to comprehensively respond to several challenges. The studies include detailed quantitative epidemiologic and risk assessment studies; development of air-sampling technologies suitable for monitoring diesel exhaust in the presence of other carbon-containing particulate matter, such as that found in underground coal mines; and studies of alternative approaches to control technologies for diesel exhaust.
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From page 101... ...
For each of the five goals associated with the prevention of occupational respiratory malignancy (determination of occupational etiologies; reduction of metal-induced lung cancer, silica-induced lung cancer, and diesel exhaust-induced lung cancer; and development of diagnostic tools) consideration was given to evidence of impact in terms of intermediate end points and current program activities.
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From page 102... ...
Other agencies, however, have made good use of the NIOSH research to affect public policy, as evidenced by the California Air Resources Board action on diesel particulate matter (see below)
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From page 103... ...
after consideration of the results of such research and experimental programs make recommendations concerning new or improved occupational safety and health standards" [Section 22(d)
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From page 104... ...
. The work of RDRP scientists is cited in OSHA's "Final Rule on Occupational Exposure to Hexavalent Chromium" along with the work of others (71 Fed.
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From page 105... ...
. Similarly, RDRP research documenting the likely success when available control technologies for diesel particulate matter were applied in metal/nonmetal mines was important in gaining acceptance of the new MSHA rule.
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From page 106... ...
Research, expected to begin soon, is being planned by RDRP scientists to address long-term implementation issues relating to the MSHA diesel exhaust rule. NIOSH estimates that approximately 1.35 million workers are occupation ally exposed to diesel exhaust particulate matter in about 80,000 workplaces in the United States (MMWR 1989b)
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From page 107... ...
While the committee found evidence of the impact of the RDRP research effort in addressing the development of early markers for lung cancer starting with a mouse model, the potential for this work to lead to biomarkers of occupational exposures was not documented or explained. The research appears to the committee to be distant from addressing occupationally related respiratory malignancies and might equally well be carried out by the National Cancer Institute or the National Institute of Environmental Health Sciences, each of which has significantly more research resources and a mandate closer to this particular goal.
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From page 108... ...
Assessment of Impact After review of the contributions presented by the RDRP and the input of stakeholders, there is evidence of solid and effective research that has had a direct impact on the control of occupationally related cancer risk in today's workplaces. There is current evidence that the research products have been of direct use both to OSHA and to MSHA in their standard-setting process as seen in the value of the RDRP risk assessments for both hexavalent chromium and for diesel exhaust particulate matter.
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From page 109... ...
Focusing the early detection biomarkers on workplace-specific prevention efforts would make these efforts more relevant to NIOSH's mission and would increase the likelihood of the program's having a significant impact. Strategic Goal 5: Prevent respiratory and other diseases potentially resulting from occupational exposures to nanomaterials Introduction The overarching theme for the NIOSH Nanotechnology Research Program is to understand and prevent injuries and illnesses due to occupational exposure to
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From page 110... ...
• To promote healthful workplaces through intervention, recommenda tion, and capacity building. This involves developing and evaluating engineer ing controls, personal protective equipment, and guidance on safe handling of nanomaterials.
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From page 111... ...
The role of this committee is to develop and guide the Institute's plan for health research related to nanomaterials in the workplace as well as to guide research on the application and utilization of nanomaterials in occupational safety and health. The project activities managed and coordinated by the NTRC contribute to several sector, cross-sector, and coordinated emphasis areas, including respiratory disease, manufacturing, exposure assessment, personal protective technology, and engineering controls.
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From page 112... ...
Activities: Intramural Research Program The intramural program is concerned with determining nanomaterial expo sure concentrations in occupational environments and potential adverse health outcomes from exposure as well as assessing appropriate engineering controls. These activities are reviewed and prioritized by the NTRC Steering Committee and are funded through various sources, including the NORA program, NTRC projects, and supplemental NORA funding.
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From page 113... ...
• NIOSH cosponsored the Second International Symposium on Nanotechnology and Occupational Health in October 2005. • NIOSH cosponsored the First International Symposium on Nanotechnology and Occupational Health in October 2004.
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From page 114... ...
Three peer-reviewed articles were mentioned in the evidence package (Maynard and Kuempel 2005; Shvedova et al. 2005; Oberdorster et al.
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From page 115... ...
This provides NIOSH with a unique opportunity to prevent disease before it occurs rather than to control it after workers develop occupationally related pathology. Intermediate Impacts The NIOSH program should ultimately have an impact on setting federal regulations as well as voluntary and professional standards for handling nanomaterials.
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From page 116... ...
This probably reflects the newness of the field and the fact that NIOSH, with limited funds, has placed higher priority in areas where NIOSH is particularly well suited to have an impact -- that is, in continuing successful research into methods to monitor exposures to nanomaterials and to develop appropriate engineering controls to prevent such exposures. The com mittee thinks this is appropriate because many other agencies, particularly NIH, are conducting basic research on the health effects of engineered nanomaterials.
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From page 117... ...
This reflects the judgment of the committee that the activities related to most of the subgoals are in the highest-priority subject areas and highly relevant to improvements in workplace protection and that the RDRP is engaged in transfer activities at a significant level. This is particularly true for its activities related to interstitial lung disease as well as many parts of the activities related to airways and infectious
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From page 118... ...
The committee also noted that the activities related to nanotechnology were highly relevant, even though this emerging area has yet to see any impacts related to intermediate or end outcomes. Activities related to parts of some subprograms, including some of the activities related to malignancies and infectious diseases, do not reach this highest level of relevance as reflected in the assessment of the subprograms earlier in this chapter.
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From page 119... ...
Some activities may have large and welldocumented impacts, whereas others are smaller and less easily discernable. Again, given the size of the RDRP and the notion that some elements of the RDRP have objectives besides respiratory diseases, the outcome is not surprising.
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