Improving Emergency Airway Knowledge and Self-Efficacy Levels of Outpatient Gastroenterology Staff via Implementation of Online Education and In Situ Simulation.

Twenty percent of all ambulatory surgery cases utilizing monitored anesthesia care and sedation report at least one perioperative respiratory complication such as bronchospasm, hypoxia, laryngospasm, or aspiration (). However, the national Standards of Practice for both surgical technicians and ambulatory care nurses do not mandate emergency airway education beyond cardiopulmonary resuscitation and Basic Life Support training. A local outpatient gastroenterology clinic noticed the gap in education, and the anesthesia team decided to implement an evidence-based dual-factorial quality improvement project utilizing online education and in situ simulation.

Computational Exposure Science: An Emerging Discipline to Support 21st-Century Risk Assessment.

Background: Computational exposure science represents a frontier of environmental science that is emerging and quickly evolving.

Objectives: In this commentary, we define this burgeoning discipline, describe a framework for implementation, and review some key ongoing research elements that are advancing the science with respect to exposure to chemicals in consumer products.

Discussion: The fundamental elements of computational exposure science include the development of reliable, computationally efficient predictive exposure models; the identification, acquisition, and application of data to support and evaluate these models; and generation of improved methods for extrapolating across chemicals.

A biomonitoring framework to support exposure and risk assessments.

Background: Biomonitoring is used in exposure and risk assessments to reduce uncertainties along the source-to-outcome continuum. Specifically, biomarkers can help identify exposure sources, routes, and distributions, and reflect kinetic and dynamic processes following exposure events. A variety of computational models now utilize biomarkers to better understand exposures at the population, individual, and sub-individual (target) levels.

Review of pesticide urinary biomarker measurements from selected US EPA children's observational exposure studies.

Children are exposed to a wide variety of pesticides originating from both outdoor and indoor sources. Several studies were conducted or funded by the EPA over the past decade to investigate children's exposure to organophosphate and pyrethroid pesticides and the factors that impact their exposures. Urinary metabolite concentration measurements from these studies are consolidated here to identify trends, spatial and temporal patterns, and areas where further research is required.

Assessing the quantitative relationships between preschool children's exposures to bisphenol A by route and urinary biomonitoring.

Limited published information exists on young children's exposures to bisphenol A (BPA) in the United States using urinary biomonitoring. In a previous project, we quantified the aggregate exposures of 257 preschool children to BPA in environmental and personal media over 48-h periods in 2000-2001 at homes and daycares in North Carolina and Ohio. In the present study for 81 Ohio preschool children ages 23-64 months, we quantified the children's urinary total BPA (free and conjugated) concentrations over these same 48-h periods in 2001.

Adapting concepts from systems biology to develop systems exposure event networks for exposure science research.

Systems exposure science has emerged from the traditional environmental exposure assessment framework and incorporates new concepts that link sources of human exposure to internal dose and metabolic processes. Because many human environmental studies are designed for retrospective exposure evaluations they often do not provide practical toxicological outcome parameters. Our goal was to examine concepts from systems biology research and adapt them to a network approach that maps forward to a perturbation event using two hypothetical examples.

The reliability of using urinary biomarkers to estimate children's exposures to chlorpyrifos and diazinon.

A few studies have reported concurrent levels of chlorpyrifos (CPF) and diazinon (DZN) and their environmentally occurring metabolites, 3,5,6-trichloro-2-pyridinol (TCP) and 2-isopropyl-6-methyl-4-pyrimidinol (IMP), in food and in environmental media. This information raises questions regarding the reliability of using these same metabolites, TCP and IMP, as urinary biomarkers to quantitatively assess the everyday exposures of children to CPF and DZN, respectively. In this study, we quantified the distributions of CPF, DZN, TCP, and IMP in several environmental and personal media at the homes and day-care centers of 127 Ohio preschool children and identified the important sources and routes of their exposures.

Organophosphorus and pyrethroid insecticide urinary metabolite concentrations in young children living in a southeastern United States city.

Pesticide metabolites are routinely measured in the urine of children in the United States. Although the sources of these metabolites are believed to include residues in food from agricultural applications and residues from applications in everyday environments (e.g.

Assessment of a pesticide exposure intensity algorithm in the agricultural health study.

The accuracy of the exposure assessment is a critical factor in epidemiological investigations of pesticide exposures and health in agricultural populations. However, few studies have been conducted to evaluate questionnaire-based exposure metrics. The Agricultural Health Study (AHS) is a prospective cohort study of pesticide applicators who provided detailed questionnaire information on their use of specific pesticides.

Exposure as part of a systems approach for assessing risk.

Background: The U.S. Environmental Protection Agency is facing large challenges in managing environmental chemicals with increasingly complex requirements for assessing risk that push the limits of our current approaches.

Urinary biomarker, dermal, and air measurement results for 2,4-D and chlorpyrifos farm applicators in the Agricultural Health Study.

A subset of private pesticide applicators in the Agricultural Health Study (AHS) epidemiological cohort was monitored around the time of their agricultural use of 2,4-dichlorophenoxyacetic acid (2,4-D) and O,O-diethyl-O-3,5,6-trichloro-2-pyridyl phosphorothioate (chlorpyrifos) to assess exposure levels and potential determinants of exposure. Measurements included pre- and post-application urine samples, and patch, hand wipe, and personal air samples. Boom spray or hand spray application methods were used by applicators for 2,4-D products.

The design and field implementation of the Detroit Exposure and Aerosol Research Study.

The US Environmental Protection Agency recently conducted the Detroit Exposure and Aerosol Research Study (DEARS). The study began in 2004 and involved community, residential, and personal-based measurements of air pollutants targeting 120 participants and their residences. The primary goal of the study was to evaluate and describe the relationship between air toxics, particulate matter (PM), PM constituents, and PM from specific sources measured at a central site monitor with those from the residential and personal locations.

Adult and children's exposure to 2,4-D from multiple sources and pathways.

In this study, we investigated the 2,4-dichlorophenoxyacetic acid (2,4-D) herbicide exposures of 135 preschool-aged children and their adult caregivers at 135 homes in North Carolina (NC) and Ohio (OH). Participants were randomly recruited from six NC and six OH counties. Monitoring was performed over a 48-h period at the participants' homes.

An observational study of 127 preschool children at their homes and daycare centers in Ohio: environmental pathways to cis- and trans-permethrin exposure.

The potential exposures of 127 preschool children to the pyrethroid insecticides, cis- and trans-permethrin, in their everyday environments were examined. Participants were recruited randomly from 127 homes and 16 daycare centers in six Ohio (OH) counties. Monitoring was performed over a 48-h period at the children's homes and/or daycare centers.

The use of biomonitoring data in exposure and human health risk assessments.

Biomonitoring uses analytic methods that permit the accurate measurement of low levels of environmental chemicals in human tissues. However, depending on the intended use, biomonitoring, like all exposure tools, may not be a stand-alone exposure assessment tool for some of its environmental public health uses. Although biomonitoring data demonstrate that many environmental chemicals are absorbed in human tissues, uncertainty exists regarding if and at what concentrations many of these chemicals cause adverse health outcomes.

Strategic biomonitoring initiatives: moving the science forward.

Biomonitoring programs in the United States and Europe demonstrate the vast array of data that are publicly available for the evaluation of exposure trends, identification of susceptible populations, detection of emerging chemical risks, the conduct of epidemiology studies, and evaluation of risk reduction strategies. To cultivate international discussion on these issues, the ILSI Health and Environmental Sciences Institute convened a scientific session at its annual meeting in January 2006 on "Integration of Biomonitoring Exposure Data into the Risk Assessment Process." This Forum paper presents perspectives from session speakers on the biomonitoring activities of the Centers for Disease Control and Prevention, the U.

An observational study of the potential exposures of preschool children to pentachlorophenol, bisphenol-A, and nonylphenol at home and daycare.

The Children's Total Exposure to Persistent Pesticides and Other Persistent Organic Pollutants (CTEPP) study investigated the potential exposures of 257 preschool children, ages 1 1/2-5 yr, and their primary adult caregivers to more than 50 anthropogenic chemicals. Field sampling took place in selected counties in North Carolina (NC) and Ohio (OH) in 2000-2001. Over a 48-h period in each child's daycare center and/or home, food, beverages, indoor air, outdoor air, house dust, soil, participants' hand surfaces and urine were sampled.

Pesticides and their metabolites in the homes and urine of farmworker children living in the Salinas Valley, CA.

In support of planning efforts for the National Children's Study, we conducted a study to test field methods for characterizing pesticide exposures to 20 farmworker children aged 5-27 months old living in the Salinas Valley of Monterey County, California. We tested methods for collecting house dust, indoor and outdoor air, dislodgeable residues from surfaces and toys, residues on clothing (sock and union suits), food, as well as spot and overnight diaper urine samples. We measured 29 common agricultural and home use pesticides in multiple exposure media samples.

Children's residential exposure to chlorpyrifos: application of CPPAES field measurements of chlorpyrifos and TCPy within MENTOR/SHEDS-Pesticides model.

The comprehensive individual field-measurements on non-dietary exposure collected in the Children's-Post-Pesticide-Application-Exposure-Study (CPPAES) were used within MENTOR/SHEDS-Pesticides, a physically based stochastic human exposure and dose model. In this application, however, the model was run deterministically. The MENTOR/SHEDS-Pesticides employed the CPPAES as input variables to simulate the exposure and the dose profiles for seven children over a 2-week post-application period following a routine residential and professional indoor crack-and-crevice chlorpyrifos application.

Optimizing a dansylhydrazine (DNSH) based method for measuring airborne acrolein and other unsaturated carbonyls.

The Passive Aldehydes and Ketones Sampler (PAKS) method has been developed to measure airborne carbonyls (aldehydes and ketones) by derivatizing the carbonyls with dansylhydrazine (DNSH) on a solid sorbent. The method collection efficiencies are approximately 100% for most saturated carbonyls, but are significantly lower for unsaturated carbonyls. In this study, we examined the mechanisms of DNSH reactions with unsaturated carbonyls, focusing on acrolein.

Chlorpyrifos accumulation patterns for child-accessible surfaces and objects and urinary metabolite excretion by children for 2 weeks after crack-and-crevice application.

The Children's Post-Pesticide Application Exposure Study (CPPAES) was conducted to look at the distribution of chlorpyrifos within a home environment for 2 weeks after a routine professional crack-and-crevice application and to determine the amount of the chlorpyrifos that is absorbed by a child living within the home. Ten residential homes with a 2- to 5-year-old child in each were selected for study, and the homes were treated with chlorpyrifos. Pesticide measurements were made from the indoor air, indoor surfaces, and plush toys.

Exposures of preschool children to chlorpyrifos and its degradation product 3,5,6-trichloro-2-pyridinol in their everyday environments.

As part of the Children's Total Exposure to Persistent Pesticides and Other Persistent Organic Pollutants (CTEPP) study, we investigated the exposures of preschool children to chlorpyrifos and its degradation product 3,5,6-trichloro-2-pyridinol (TCP) in their everyday environments. During this study, the participants were still able to purchase and apply chlorpyrifos at their homes or day care centers. Participants were recruited randomly from 129 homes and 13 day care centers in six North Carolina counties.

Design and sampling methodology for a large study of preschool children's aggregate exposures to persistent organic pollutants in their everyday environments.

Young children, because of their immaturity and their rapid development compared to adults, are considered to be more susceptible to the health effects of environmental pollutants. They are also more likely to be exposed to these pollutants, because of their continual exploration of their environments with all their senses. Although there has been increased emphasis in recent years on exposure research aimed at this specific susceptible population, there are still large gaps in the available data, especially in the area of chronic, low-level exposures of children in their home and school environments.

Contributions of children's activities to pesticide hand loadings following residential pesticide application.

The role of children's activities in leading to pesticide exposure was evaluated by comparing pesticide loadings on the hands of children with the activities of the same children observed over a 4-h period. In all, 10 children ranging in age from 24 to 55 months were videotaped on the second day following a routine professional crack and crevice chlorpyrifos application in their homes. Before and following the video session, the children's hands were rinsed in isopropyl alcohol.