NIOSH eNews - May, 2008

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Volume 6  Number 1  May  2008 

 

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From the Director's Desk
Control Banding, a Sneak Peek

PtD Initiative Is Showcased in April Journal

NIOSH Recognizes Excellence in Occupational Safety and Health
Alice Hamilton Awards presented.

Mitch Singal Honored with James P. Keogh Award

Save the Date: NIOSH To Host DREAM Workshop in November
Workshop will set research priorities for direct reading exposure assessment methods.

Nominations Being Accepted for First “Safe in Sound” Award

Workers Memorial Day 2008

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NIOSH Seeks Comment on Surveys of Healthcare Safety, Health

NIOSH Researchers, Partners Publish Third Paper in Bacteria and Fungi Aircraft Sampling Study

NIOSH Requests Comments on NIOSH Alert on Lead and Noise Exposure at Indoor Firing Ranges

New Faces at the NIOSH Office of Extramural Programs

REMINDERS
Comments Accepted Until May 12 on NIOSH Alert on Preventing Chronic Beryllium Disease

Applications Accepted Until May 31 for 2008 Robert W. Campbell Award

 

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NIOSH Science Blog

r2p Corner

NORA
NORA Symposium Program Available

State-based Occupational Health updates
Asthma Mortality

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News From Our Partners
National Safety Council Webinar Schedule for May and June

Communication Products
Mining Publications

Spanish versions of the following NIOSH publications and Web pages are now available

Four New Health Hazard Evaluation Reports are now available.

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Upcoming Events
Look for Us

Call for Abstracts

Upcoming Conferences

Word of the Month
Prevention through Design (PtD)

 

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 From the Director's Desk

 

Please plan to visit NIOSH’s web topic page on control banding on May 12, 2008. http://www.cdc.gov/niosh/topics/ctrlbanding. On that day, we expect to post for public comment our draft document, Qualitative Risk Characterization and Management of Occupational Hazards (Control Banding [CB]): A Literature Review and Critical Analysis. The comment period will remain open until July 11, 2008.

The draft document will represent a major step in our partnership with stakeholders to address a priority health and safety need for the 21st Century. We hope you will look at it closely and provide your comments and suggestions.

Qualitative Risk Characterization and Management of Occupational Hazards (Control Banding [CB]): A Literature Review and Critical Analysis, will describe the evolution and concepts of control banding, a qualitative approach for assessing and managing hazards associated primarily with chemical exposures in the workplace. The comprehensive literature review is intended to inform employers, workers, safety and health practitioners, and other audiences about the concepts of control banding and to stimulate further dialogue about its potential usefulness in the United States by providing the appropriate background information and resources.

As background to the topic of control-focused chemical hazard strategies, NIOSH recognized that the number of chemicals in commerce is far greater than the number of occupational exposure limits (OELs, of which there are roughly 1000). Setting additional OELs for new and existing chemicals, and monitoring to ensure exposures are maintained below the OELs, are important but resource-intensive activities. In addition, if the majority of chemical substances in commerce have no established OELs, employers and workers often lack the necessary guidance on the extent to which occupational exposures should be controlled.

Consequently, to fill this gap, control banding evolved as an approach to address these challenges, drawing upon mature knowledge and practices in occupational hygiene practice regarding exposure assessment, chemical hazard assessment, and control technology options. The conceptual basis for control banding is a framework for the grouping of chemical exposures according to similar physical and chemical characteristics, intended processes/handling, and anticipated exposure scenarios (amount of chemical used and how workers would be exposed).

The promise of such a qualitative risk assessment and management approach is further increased given appropriate consideration for evolving developments in international chemical commerce, including the globally harmonized system of classification and labeling of chemicals (GHS), the Occupational Safety and Health Administration (OSHA) proposed-rulemaking for the Hazard Communication standard, and European Union regulations (i.e., Registration, Evaluation, Authorisation and Restriction of Chemical substances, or REACH). These and other factors will be discussed in the draft document, which will evaluate the state-of-the-science of control banding as reflected in research and practice. Information was gleaned from the published scientific literature, proceedings of recent international workshops, symposia, and conferences to ensure a broad and comprehensive treatment of the topic.

Among the conclusions that are expected to appear in the draft document, NIOSH will indicate that control banding is a potentially valuable tool for risk management of some chemical agents and other occupational hazards; however, continued research and validation efforts are needed. Control banding is not meant to reduce the need for OELs but to serve as a supplemental risk management tool. In the draft document, we expect to recommend that the following actions should occur, if control banding is to be useful in the United States:

  1. Increase the awareness and standardization of control banding concepts;
  2. Ensure validation of qualitative risk assessment and management strategies, tools, and the control-focused solutions;
  3. Coordinate efforts for developing, implementing, evaluating, and disseminating qualitative risk assessment and risk management approaches to improve awareness and utility of task specific hazard control guidance;
  4. Foster national and international coordination and collaboration in focusing on applications for control-focused solutions for high-risk tasks, industries, and small business enterprises;
  5. Consider control banding models for broader applications to address additional workplace hazards (e.g., more complex chemical exposures, dermal exposure hazards, ergonomic hazards, and other physical hazards).

Thanks to Dr. T.J. Lentz with the NIOSH Education and Information Division for helping me to provide this sneak peek, and to all who have helped to ready the draft for public review. The draft document will include points of contact for submitting comments, and for getting additional information. I hope you will look for it.

 

 PtD Initiative Is Showcased in April Journal

 

A new resource by the National Institute for Occupational Safety and Health (NIOSH) and the National Safety Council (NSC) on the national "Prevention through Design" (PtD) initiative was released on May 1 as a special edition of the Journal of Safety Research, April 2008. The journal contains the proceedings from a July 9-11, 2007, PtD Workshop held in Washington DC by NIOSH, NSC, and other co-sponsors, including break-out session reports by industry sector and functional area, as well as technical papers authored by experts in PtD. More information, including a link to abstracts, is available at http://www.cdc.gov/niosh/updates/upd-05-01-08a.html.

 

 NIOSH Recognizes Excellence in Occupational Safety and Health

 

On May 1, 2008 NIOSH Director John Howard, M.D., announced the winners of the 2008 Alice Hamilton Awards. Named after Dr. Alice Hamilton, a pioneering researcher and occupational physician, the Alice Hamilton Award is given for outstanding NIOSH contributions in the areas of biological sciences, engineering and physical sciences, human studies, and educational materials. The submissions go through a rigorous review by panels of scientific experts, including peers from both outside and inside NIOSH. This year's projects contributed to a wide range of sectors including construction, mining, manufacturing and services, as well as major workplace safety and health issues, including exposure to asbestos, inhalation of toxic fumes, and respiratory diseases. The full list of the 2008 Alice Hamilton Award recipients can be found at http://www.cdc.gov/niosh/awards/hamilton.

 

 Mitch Singal Honored with James P. Keogh Award

 

Each year, the James P. Keogh Award for Outstanding Service in Occupational Safety and Health is given to current or former NIOSH employees who have, through their work, demonstrated exceptional commitment to the field. For 2008, we are proud to honor Mitch Singal, M.D., M.P.H. and his exemplary commitment to the occupational safety and health field. Dr. Singal's work has contributed to the training of occupational health professionals, improved the scientific understanding of occupational disease, and facilitated the control of hazardous exposures in the workplace. Learn more about Dr. Keogh and this year’s recipient, Dr. Singal, at http://www.cdc.gov/niosh/awards/keogh.

 

 Save the Date: NIOSH To Host DREAM Workshop in November

 

NIOSH will host the “DREAM (Direct Reading Exposure Assessment Methods) Workshop” on November 13 – 14, 2008, in Arlington, VA. The workshop will bring together stakeholders from academia, labor, management, method development and research, government and manufacturing to discuss research needs in the area of direct reading methods for assessing occupational exposures. Input from the workshop will be used to set research priorities for the methods. Information on the workshop will be available on the NIOSH Web page, http://www.cdc.gov/niosh/topics/drm.

 

 Nominations Being Accepted for First ?Safe in Sound? Award

 

Safe in Sound logoNIOSH and the National Hearing Conservation Association (NHCA) have established a new award to be given each year to companies or organizations that exemplify Excellence in Hearing Loss Prevention. The first “Safe in Sound” award will be presented at the NHCA annual conference in February 2009 and will recognize organizations that document measurable achievements in hearing loss prevention programs, obtain information on their real-world successes, and widely disseminate information on how others can use these successful strategies or benchmark their own programs. Additional information and submission details can be found at http://www.safeinsound.us. Nominations will be accepted until September 1, 2008.

 

 Workers Memorial Day 2008

 

Did you receive a CDC e-card? In recognition of Workers Memorial Day 2008, NIOSH prepared and distributed to eNews readers an electronic card. We encourage you to send the e-card to your friends and colleagues as a reminder to mourn those who have died from workplace injuries and illnesses, and to keep the workplace safe and healthy. Also, NIOSH contributed several articles to the April 25, 2008 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).

  • “Workers Memorial Day – April 28, 2008”
  • “Commercial Fishing Fatalities – California, Oregon, and Washington, 2000 – 2006”
  • “Fatalities Among Oil and Gas Extraction Workers – United States, 2003 – 2006”

Links to the e-card and the MMWR articles are available on the NIOSH Workers Memorial Day Web page, http://www.cdc.gov/niosh/topics/workmemorial.

 

 NIOSH Seeks Comment on Surveys of Healthcare Safety, Health

 

NIOSH is requesting public comment on the content and conduct of a survey of healthcare workers’ safety and health practices and a separate but related survey of healthcare employers’ safety and health practices. Information collected from these surveys will be useful for benchmarking, identifying gaps relative to the use of best practices and defining future research priorities. Additional information on the surveys and instructions for submitting comments to the NIOSH Docket can be found at http://www.cdc.gov/niosh/review/public/135.

 

 NIOSH Researchers, Partners Publish Third Paper in Bacteria and Fungi Aircraft Sampling Study

 

The third and latest of three papers authored by NIOSH researchers Lauralynn Taylor McKernan, Misty J. Hein, and Kenneth Wallingford, detailing measurements of bacteria and fungi found inside aircraft cabins, was published in the March 2008 issue of The Annals of Occupational Hygiene. Outside partners Harriet Burge, Robert Herrick and Christine Rogers also co-authored the new paper. As part of a larger NIOSH program to assess potential health concerns for flight crews, this work represents the most comprehensive study to date on the bacteria and fungi in the aircraft environment. Overall, the bacteria found were either common skin surface organisms or organisms common in dust and outdoor air. The results do not by themselves indicate whether air travel places flight crews or passengers at risk for infectious or contagious diseases. However, the study does illustrate time periods which may be of higher risk for potential disease transmission on aircraft. The latest article is available on the journal's web page at http://annhyg.oxfordjournals.org/cgi/content/full/52/2/139. The other articles can be found at http://annhyg.oxfordjournals.org/cgi/content/full/51/3/281 and
http://www.informaworld.com/smpp/content~content=a787379685.

 

 NIOSH Requests Comments on NIOSH Alert on Lead and Noise Exposure at Indoor Firing Ranges

 

NIOSH is conducting public review of a draft NIOSH document, “NIOSH Alert: Preventing Occupational Exposures to Lead and Noise at Indoor Firing Ranges.” The draft Alert describes the health effects that can occur from occupational exposures to lead and noise at indoor firing ranges and recommends steps that firing range operators, employers and workers should take to minimize the health risks to workers and shooters. Guidelines for submissions of comments can be found at http://www.cdc.gov/niosh/review/public/128.

 

 New Faces at the NIOSH Office of Extramural Programs

 

Captain Steve Inserra, U.S. Public Health Service, has transferred from the Agency for Toxic Substances and Health Registry to the NIOSH Office of Extramural Programs. He is working on new awards, close-out of completed projects and an analysis of the NIOSH extramural portfolio of Construction grants. He can be reached at SInserra@xxxxxxx.

Ms. Lata Kumar is currently on a 120-day detail from the U.S. Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. She is working on new awards, close-out of completed projects, and analysis of the NIOSH extramural portfolio of Healthcare and Social Assistance grants. She can be reached at LKumar@xxxxxxx.

Dr. Viji Potula is currently on a 120-day detail from the Air Pollution and Respiratory Health Branch, Asthma Control Program, at CDC’s National Center for Environmental Health. She is finishing an analysis of the extramural Hearing Loss Prevention portfolio and recently attended the Steering Committee Meeting for this cross-sector. She is also working on new awards and close-out of completed projects. She can be reached at VPotula@xxxxxxx.

 

 REMINDERS

 

The word Beryllium on a beige background over a light blue sphereComments Accepted Until May 12 on NIOSH Alert on Preventing Chronic Beryllium Disease

NIOSH is conducting public review of a draft NIOSH document, “NIOSH Alert: Preventing Chronic Beryllium Disease and Beryllium Sensitization.” The draft Alert describes the nature of chronic beryllium disease and other health effects that can occur from exposure to beryllium and beryllium-containing materials. Recommendations to minimize health risks to workers are also provided. Guidelines for submissions can be found at http://www.cdc.gov/niosh/review/public/120.

Applications Accepted Until May 31 for 2008 Robert W. Campbell Award

The Robert W. Campbell Award is currently accepting applications for the 2008 Award year. This international award honors organizations that achieve high levels of excellence by integrating environmental, health and safety management into their overall business operating system. Final submittals for the Campbell Award must be postmarked by May 31, 2008. Please visit http://www.CampbellAward.org for further information or email CampbellAward@xxxxxxx.

 

 NIOSH Science Blog

 

Be sure to check out and comment on the latest NIOSH Science Blog topics.

  • The April 14, 2008, posting by Hope Tiesman, Epidemiologist in the NIOSH Division of Safety Research, solicits comments and ideas for research concerning workplace violence prevention programs in schools, and perceptions of what is and is not working to protect teachers and other school staff. http://www.cdc.gov/niosh/blog/nsb041408_teacher.html.
  • Posted April 21, 2008, Edward Fries, Engineer, and Ziqing Zhuang, Senior Researcher, of the NIOSH National Personal Protective Technology Laboratory, describe a proposed NIOSH study to assess respirator fit and facial dimension changes as a function of time. http://www.cdc.gov/niosh/blog/nsb042108_respiratorfit.html.
  • Commercial fishing safety was the topic of the April 28, 2008, posting. Jennifer Lincoln, Epidemiologist, of the NIOSH Alaska Pacific Regional Office discusses NIOSH research to identify specific activities and associated risk factors contributing to a high rate of fatalities in West Coast fisheries. http://www.cdc.gov/niosh/blog/nsb042808_fishing.html.
  • The May 5, 2008, posting by NIOSH Director John Howard, M.D., defines the NIOSH Portfolio Management system, including how NIOSH sets priorities, utilizes a sector-based approach, generates new knowledge, transfers our research findings into research, and evaluates our progress. http://www.cdc.gov/niosh/blog.

 

 r2p Corner

 

The Bullard-Sherwood Research-to-Practice Award, named for the inventor of the hard hat, Edward W. Bullard, and R. Jeremy Sherwood, the inventor of the personal industrial hygiene sampling pump, is given by NIOSH to recognize recipients for outstanding contributions in three categories: Knowledge, Interventions, and Technology. This year the award and honorable mentions went to projects addressing issues around flavoring-related lung disease, reproductive concerns associated with occupational cycling, protective clothing analysis, commercial fishing, toxic metals, and risk of serious injuries among responders and health-care workers from ignition of portable oxygen resuscitators. To view the list of recipients of the 2008 Bullard-Sherwood Award visit http://www.cdc.gov/niosh/awards/bullard-sherwood.

 

 NORA

 

NORA logoNORA Symposium Program Available

The preliminary program is now available for the “NORA Symposium 2008: Public Market for Ideas and Partnerships,” which will be held July 29, 2008, in Denver CO. The program includes keynote speakers, award presentations, and a list of accepted posters. To view the program go to http://www.cdc.gov/niosh/nora/symp08/ and choose the preliminary program from the menu on the right.

 

 State-based Occupational Health updates

 

Asthma Mortality

NIOSH partners in Michigan recently reported the death of a young waitress who died from asthma after collapsing at her worksite. The cause of death was attributed to secondhand cigarette smoke (Am J Ind Med 2008; 51:111-116). According to the Michigan investigators, this is the first reported case of an acute death from second hand tobacco smoke and is one of nine work-related asthma deaths that have been identified in Michigan since 2003. Isocyanates were the cause of four of these deaths. Although only 0.01% of individuals with asthma die annually from asthma, these deaths highlight factors that increase morbidity among the millions of people with asthma. Michigan’s program to identify these preventable deaths and initiate interventions to improve the diagnosis and management of individuals with asthma is based on three CDC funded projects. Two are funded by NIOSH: 1) work-related asthma surveillance, Sentinel Event Notification Systems for Occupational Risk (SENSOR); and 2) acute traumatic work-related death surveillance, Fatality Assessment and Control Evaluation (FACE). The third project on asthma mortality is funded by the CDC National Center for Environmental Health. The Michigan Department of Labor and Economic Growth, the Michigan Department of Community Health, and Michigan State University work together on these projects. Information on all three projects can be found at http://www.oem.msu.edu. For details about this case, contact Dr. Ken Rosenman at Ken.Rosenman@xxxxxxxxxx or Ms. Martha Stanbury at StanburyM@xxxxxxxxxxxx.

 

 News >From Our Partners

 

The National Safety Council will host the following webinars in May and June

May

June

 

 Communication Products

 

New NIOSH Safety and Health Topic Page “Hazards to Outdoor Workers”
http://www.cdc.gov/niosh/topics/outdoor
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Mining Publications

Spanish versions of the following NIOSH publications and Web pages are now available

Four New Health Hazard Evaluation Reports are now available.

Manufacturing Sector: Evaluation of potential ergonomic hazards.

The HHE program responded to a management request at a cabinet mill and assembly plant. The request concerned potential musculoskeletal hazards resulting from job tasks. The investigators found that workers use high force, awkward postures, and repetitive motions, all of which increase their risk for developing musculoskeletal disorders. Most of the reported injuries were musculoskeletal disorders involving the upper extremities. HHE program investigators recommended that managers provide adjustable tables and carts to reduce the physical stresses that employees endure during work practices. Investigators also recommended that the facility consider improving tool design to reduce vibration and to decrease the force required to handle and operate tools effectively. The final report is available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0038-3057.pdf.

Construction Sector: Evaluations of exposure to respirable silica and noise.

The HHE program responded to a union request at three roofing companies. The request concerned workers’ exposure to dust and noise during saw cutting of cement roofing tiles. Testing showed that workers were overexposed to silica and noise during saw cutting of cement roofing tiles. Most of the roofers had normal lung function, but lung function decreased with increased years of performing dry-cutting of cement roofing tiles. HHE program investigators recommended that managers implement engineering controls and work practice controls to reduce airborne silica levels. Recommendations were also made regarding implementing mandatory respiratory protection programs and hearing conservation programs. The final reports are available at http://www.cdc.gov/niosh/hhe/reports/pdfs/2005-0030-2968.pdf; http://www.cdc.gov/niosh/hhe/reports/pdfs/2005-0031-3055.pdf; and http://www.cdc.gov/niosh/hhe/reports/pdfs/2005-0032-2985.pdf.

 

 Upcoming Events

 

Look for Us

At the “American Industrial Hygiene Conference and Exposition,” June 2-4, 2008, Minneapolis, MN

Your visit to the NIOSH booth this year will be interactive and informative. Learn more about the NIOSH Science Blog and go on-line and give us your comments on research to practice (r2p). Bring your flash drive and we will download NIOSH research information for your immediate access. Representatives from the NIOSH Personal Protective Technology Program will be available for your input and concerns regarding personal protective equipment and technologies. See you at booths 1822-1826.

Also, take a tour of the NIOSH Field Evaluations and Response Vehicle. The creation of this vehicle has resulted in improved efficiency in executing the mission of protecting worker health in workplaces and during emergency response activities. The vehicle houses a command center equipped with a television, a laptop computer, and a roof-mounted satellite including data, cable, and local digital feeds. NIOSH investigators use the vehicle for on-site base of operations, an improved method of shipping equipment to the worksite, and a means for on-site materials organization.

Don't forget about the NIOSH Emerging Issues/Current Trends Luncheon Discussions 12:30-1:30 in the exhibit hall on Tuesday, June 3. Topics include Direct Reading Exposure Assessment Methods; Engineering Controls; Exposure Assessment and Toxicology for New Substances; Occupational Exposures Sampling Strategy Manual Update; Safe Patient Handling and Movement; NIOSH Emergency Preparedness and Response Activities: Where Do We Go From Here?; PPE for Healthcare Workers Action Plan; NIOSH Respirator Certification Program; Skin Notation Update; Updating IDLH Values; Nanotechnology; and Prevention Through Design.

Call for Abstracts

“2009 SME Annual Meeting” and “CMA 111th Annual National Western Mining Conference”
February 22 – 25, 2009, Denver, CO. Deadline is May 15, 2008.
http://sme2009.abstractcentral.com

“Fire Department Instructors Conference (FDIC) 2009”
April 20 – 25, 2009, Indianapolis, IN. Deadline is June 27, 2008. http://downloads.pennnet.com/fe/fdic2008/2009indycallforpapers.doc

“14th International Society for Respiratory Protection”
September 14 – 18, 2008, Dublin, Ireland. Deadline is June 30, 2008. http://www.isrp.com/dublin/index.html

ASSE Professional Development Conference and Exposition “SAFETY 2009”
June 23 – July 1, 2009, San Antonio, TX. Deadline is July 18, 2008. http://www.asse.org

“29th Triennial Congress of the International Commission on Occupational Health (ICOH 2009)”
March 22 – 27, 2009, Cape Town, South Africa. Deadline is July 31, 2008.
http://www.icoh2009.co.za

“Association of periOperative Registered Nurses Congress 2009”
March 15 – 19, 2008, Chicago, IL. Deadline is October 1, 2008.
http://www.aorn.org/Education/EducationEvents/CallForProposals

Upcoming Conferences

“Fatigue and Work Seminar”
May 9, 2008, Chicago, IL. http://www.thebigsleepshow.com

“International Association of Fire Chiefs 2008 International Hazardous Materials Response Teams Conference”
May 29 – June 1, 2008, Hunt Valley, MD. http://iafc.confex.com/iafc/haz08/cfp.cgi

“2008 American Industrial Hygiene Conference and Exposition”
May 31 – June 5, 2008, Minneapolis, Minnesota. http://www.aiha.org/aihce08. As part of AIHce, the Ergonomics Committee will sponsor the “Ergonomics Symposium: Making a Business Case for Ergonomics (and Other Safety and Health Programs)” on June 1, 2008. http://www.aiha.org/aihce08/education/symposium.htm

“NSTI Nanotech Annual Conference”
June 1 – 5, 2008, Boston, MA. http://www.nsti.org/Nanotech2008

“2008 World Safety Conference and Exposition”
June 2 – 6, 2008, Las Vegas, NV. http://www.nfpa.org/wsce

"American Society of Safety Engineers “SAFETY 2008” Professional Development Conference and Exposition"
June 9 – 12, 2008, Las Vegas, NV. http://www.asse.org/speakerpage08

“12th US/North American Mine Ventilation Symposium”
June 11 – 18, 2008, Reno, NV. http://www.unr.edu/ventsymp2008

“2008 Johnson Conference: Critical Issues in Monitoring Asbestos”
July 14 – 18, 2008, Burlington, VT. http://www.astm.org/cgi-bin/SoftCart.exe/filtrexx40.cgi?U+mystore+rnme8276+-P+MAINCOMM+D22+-P+EVENT_ID+1126+-P+MEETING_ID+32970+/usr6/htdocs/newpilot.com/MEETINGS/sympotherinfo.frm

“International Association of Fire Chiefs Fire Rescue International 2008”
August 14 – 16, 2008, Denver, CO. http://www.iafc.org

“2008 National Occupational Injury Research Symposium (NOIRS)”
October 21 – 23, 2008, Pittsburgh, PA. http://www.cdc.gov/niosh/noirs/2008

“PCIH 2008”
November 8 – 11, 2008, Tampa, FL. http://www.aiha.org/pcih08/

“8th Conference of the European Academy of Occupational Health Psychology”
November 12 – 14, 2008, Valencia, Spain. http://www.ea-ohp.org

“International Roofing Expo”
February 3 – 5, 2009, Las Vegas, NV. http://www.theroofingexpo.com

“19th International Symposium on Shiftwork and Working Time”
August 2 – 6, 2009, Venezia, Italy. http://www.shiftwork2009.it

 

 Word of the Month

 

Prevention through Design (PtD): The concept that occupational injuries, illness, and fatalities are most effectively prevented by “designing out” hazards and hazardous exposures from the workplace.

 

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