Steven E Lacey

Indiana University East, Ричмонд, Indiana, United States

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Publications (32)47.74 Total impact

  • Ramon Lopez · Steven E Lacey · Rachael M Jones
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    ABSTRACT: ABSTRACT We estimated particulate matter exposures for two simulated medical laser procedures using a near-field/far-field model. Size-specific mass emission rates obtained from a laboratory-based emission chamber study were used with estimated room size, air exchange rate and interflow between zones to demonstrate the potential exposure range. Modeled steady-state concentrations for the near-field ranged between 80 and 2140 µg/m(3) and between 40 and 1650 µg/m(3) in the far-field. Results indicate concentrations in the simulated scenarios are similar to those obtained from limited field assessments conducted in hospital operating rooms. Since new medical laser technologies and applications continue to grow, modeled occupational exposures of medical laser generated particulate matter can be useful in better understanding these exposures in the clinical environment, and to inform control strategies.
    Journal of Occupational and Environmental Hygiene 01/2015; 12(5). DOI:10.1080/15459624.2014.989361 · 1.17 Impact Factor
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    ABSTRACT: Prior investigation on medical laser interaction with tissue has suggested device operational parameter settings influence laser generated air contaminant emission, but this has not been systematically explored. A laboratory-based simulated medical laser procedure was designed and pilot tested to determine the effect of laser operational parameters on the size-specific mass emission rate of laser generated particulate matter. Porcine tissue was lased in an emission chamber using two medical laser systems (CO2, λ = 10600nm; Ho:YAG, λ = 2100nm) in a fractional factorial study design by varying three operational parameters (beam diameter, pulse repetition frequency, and power) between two levels (high and low) and the resultant plume was measured using two real-time size-selective particle counters. Particle count concentrations were converted to mass emission rates before an analysis of variance was used to determine the influence of operational parameter settings on size-specific mass emission rate. Particle shape and diameter were described for a limited number of samples by collecting particles on polycarbonate filters, and photographed using a scanning electron microscope (SEM) to examine method of particle formation. An increase in power and decrease in beam diameter led to an increase in mass emission for the Ho:YAG laser at all size ranges. For the CO2 laser, emission rates were dependent on particle size and were not statistically significant for particle ranges between 5 and 10 µm. When any parameter level was increased, emission rate of the smallest particle size range also increased. Beam diameter was the most influential variable for both lasers, and the operational parameters tested explained the most variability at the smallest particle size range. Particle shape was variable and some particles observed by SEM were likely created from mechanical methods. This study provides a foundation for future investigations to better estimate size-specific mass emission rates and particle characteristics for additional laser operational parameters in order to estimate occupational exposure, and to inform control strategies. © The Author 2015. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.
    Annals of Occupational Hygiene 01/2015; 59(4). DOI:10.1093/annhyg/meu115 · 2.10 Impact Factor
  • Julia F Lippert · Steven E Lacey · Rachael M Jones
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    ABSTRACT: ABSTRACT Exposure monitoring data indicate the potential for substantive exposure to laser generated air contaminants (LGAC), however the diversity of medical lasers and their applications limit generalization from direct workplace monitoring. Emission rates of seven previously reported gas-phase constituents of medical laser generated air contaminants (LGAC) were determined experimentally and used in a semi-empirical two-zone model to estimate a range of plausible occupational exposures to healthcare staff. Single source emission rates were generated in an emission chamber as a one-compartment mass balance model at steady state. Clinical facility parameters such as room size and ventilation rate were based on standard ventilation and environmental conditions required for a laser surgical facility in compliance with regulatory agencies. All input variables in the model including point source emission rates were varied over an appropriate distribution in a Monte Carlo simulation to generate a range of time weighted average concentrations in the near and far field zones of the room in a conservative approach inclusive of all contributing factors to inform future predictive models. The concentrations were assessed for risk and the highest values were shown to be at least three orders of magnitude lower than the relevant occupational exposure limits. Estimated values do not appear to present a significant exposure hazard within the conditions of our emission rate estimates.
    Journal of Occupational and Environmental Hygiene 04/2014; 11(11). DOI:10.1080/15459624.2014.916810 · 1.17 Impact Factor
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    ABSTRACT: Abstract The U.S. Occupational Safety and Health Administration (OSHA) estimates that half a million healthcare workers are exposed to laser surgical smoke each year. The purpose of this study was to establish a methodology to (1) estimate emission rates of laser generated air contaminants (LGACs) using an emission chamber and to (2) perform a screening study to differentiate the effects of three laser operational parameters. An emission chamber was designed, fabricated, and assessed for performance to estimate the emission rates of gases and particles associated with LGACs during a simulated surgical procedure. Two medical lasers (Holmium Yttrium Aluminum Garnet [Ho:YAG] and carbon dioxide [CO2]) were set to a range of plausible medical laser operational parameters in a simulated surgery to pyrolyze porcine skin generating plume in the emission chamber. Power, PRF, and beam diameter were evaluated to determine the effect of each operational parameter on emission rate using a fractional factorial design. The plume was sampled for particulate matter and seven gas phase combustion by-product contaminants (benzene, ethylbenzene, toluene, formaldehyde, hydrogen cyanide, carbon dioxide, and carbon monoxide)-the gas phase emission results are presented here. Most of the measured concentrations of gas phase contaminants were below their limit of detection (LOD), but detectable measurements enabled us to determine laser operation parameter influence on CO2 emissions. Confined to the experimental conditions of this screening study, results indicated that beam diameter was statistically significantly influential and power was marginally statistically significant to emission rates of CO2 when using the Ho:YAG laser but not with the carbon dioxide laser; PRF was not influential to emission rates of these gas phase contaminants.
    Journal of Occupational and Environmental Hygiene 02/2014; 11(6). DOI:10.1080/15459624.2014.888074 · 1.17 Impact Factor
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    ABSTRACT: Objective: Photodynamic therapy (PDT) as a medical treatment for cancers is an increasing practice in clinical settings, as new photosensitizing chemicals and light source technologies are developed and applied. PDT involves dosing patients with photosensitizing drugs, and then exposing them to light using a directed energy device in order to manifest a therapeutic effect. Healthcare professionals providing PDT should be aware of potential occupational health and safety hazards posed by these treatment devices and photosensitizing agents administered to patients. Materials and methods: Here we outline and identify pertinent health and safety considerations to be taken by healthcare staff during PDT procedures. Results: Physical hazards (for example, non-ionizing radiation generated by the light-emitting device, with potential for skin and eye exposure) and chemical hazards (including the photosensitizing agents administered to patients that have the potential for exposure via skin, subcutaneous, ingestion, or inhalation routes) must be considered for safe use of PDT by the healthcare professional. Conclusions: Engineering, administrative, and personal protective equipment controls are recommendations for the safe use and handling of PDT agents and light-emitting technologies.
    Photomedicine and laser surgery 07/2013; 31(8). DOI:10.1089/pho.2013.3496 · 1.67 Impact Factor
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    ABSTRACT: Objective: To evaluate mortality rates among a cohort of jet engine manufacturing workers. Methods: Subjects were 222,123 workers employed from 1952 to 2001. Vital status was determined through 2004 for 99% of subjects and cause of death for 95% of 68,317 deaths. We computed standardized mortality ratios and modeled internal cohort rates. Results: Mortality excesses reported initially no longer met the criteria for further investigation. We found two chronic obstructive pulmonary disease-related mortality excesses that met the criteria in two of eight study plants. Conclusions: At the total cohort level, chronic obstructive pulmonary disease-related categories were not related to any factors or occupational exposures considered. A full evaluation of these excesses was limited by lack of data on smoking history. Occupational exposures received outside of work or uncontrolled positive confounding by smoking cannot be ruled out as reasons for these excesses.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; 55(6). DOI:10.1097/JOM.0b013e318289eeba · 1.63 Impact Factor
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    ABSTRACT: Objective: To reconstruct agent-specific occupational exposures for a cohort of jet engine manufacturing workers for use in an epidemiological mortality study. Methods: Potential chemical and physical exposures at eight jet engine manufacturing and overhaul/repair plants were evaluated for the period 1952 to 2001. Eleven agents were selected for detailed examination, and a job-exposure matrix was constructed. Results: Quantitative exposure estimates were generated for metalworking fluids, nickel, cobalt, chromium, solvents, and incomplete combustion aerosol from metalworking fluids. Qualitative exposure estimates were assigned for ionizing radiation, electromagnetic fields, polychlorinated biphenyls, and lead-cadmium. All exposures showed decreasing trends over the study period. Conclusions: The quantitative exposure levels generated in this study were lower than early contemporaneous professional practice recommendations and were similar to or lower than published data from other industries.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; 55(6). DOI:10.1097/JOM.0b013e3182717e8f · 1.63 Impact Factor
  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; 55(6). DOI:10.1097/JOM.0b013e3182851605 · 1.63 Impact Factor
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    ABSTRACT: Objective: To determine whether glioblastoma (GB) incidence rates among jet engine manufacturing workers were associated with specific chemical or physical exposures. Methods: Subjects were 210,784 workers employed from 1952 to 2001. We conducted a cohort incidence study and two nested case-control studies with focus on the North Haven facility where we previously observed a not statistically significant overall elevation in GB rates. We estimated individual-level exposure metrics for 11 agents. Results: In the total cohort, none of the agent metrics considered was associated with increased GB risk. The GB incidence rates in North Haven were also not related to workplace exposures, including the "blue haze" exposure unique to North Haven. Conclusions: If not due to chance alone, GB rates in North Haven may reflect external occupational factors, nonoccupational factors, or workplace factors unique to North Haven unmeasured in the current evaluation.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; 55(6). DOI:10.1097/JOM.0b013e3182749c4a · 1.63 Impact Factor
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    ABSTRACT: Objective: To determine whether glioblastoma (GB) incidence rates among jet engine manufacturing workers were associated with workplace experiences with specific parts produced and processes performed. Methods: Subjects were 210,784 workers employed between 1952 and 2001. We conducted nested case-control and cohort incidence studies with focus on 277 GB cases. We estimated time experienced with 16 part families, 4 process categories, and 32 concurrent part-process combinations with 20 or more GB cases. Results: In both the cohort and case-control studies, none of the part families, process categories, or both considered was associated with increased GB risk. Conclusions: If not due to chance alone, the not statistically significantly elevated GB rates in the North Haven plant may reflect external occupational factors or nonoccupational factors unmeasured in the current evaluation.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; 55(6). DOI:10.1097/JOM.0b013e3182871583 · 1.63 Impact Factor
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    ABSTRACT: In the Municipality of Chimaltenango, Guatemala, we sampled groundwater for total inorganic arsenic. In total, 42 samples were collected from 27 (43.5%) of the 62 wells in the municipality, with sites chosen to achieve spatial representation throughout the municipality. Samples were collected from household faucets used for drinking water, and sent to the USA for analysis. The only site found to have a concentration above the 10 μg/L World Health Organization provisional guideline for arsenic in drinking water was Cerro Alto, where the average concentration was 47.5 μg/L. A health risk assessment based on the arsenic levels found in Cerro Alto showed an increase in noncarcinogenic and carcinogenic risks for residents as a result of consuming groundwater as their primary drinking water source. Using data from the US Geological Survey and our global positioning system data of the sample locations, we found Cerro Alto to be the only site sampled within the tertiary volcanic rock layer, a known source of naturally occurring arsenic. Recommendations were made to reduce the levels of arsenic found in the community's drinking water so that the health risks can be managed.
    Journal of Water and Health 01/2013; 12(3). DOI:10.2166/wh.2013.100 · 1.46 Impact Factor
  • J. Pierce · S. Lacey · R. Lopez · J. Lippert · J. Franke
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    ABSTRACT: An estimated 650 fires occur in the surgical environment annually in the U.S.; a figure which may be severely underreported. Any fire in the surgical environment can have devastating implications for patient safety and is clearly an occupational risk to healthcare personnel. Literature searches of the PubMed and Rockwell Laser Industries Laser Accident Databases were performed in order to (1) identify factors and sources affecting the risk of fire in the medical environment, namely, oxidizers, ignition sources, and fuels, and (2) to identify areas of future research for prevention. All papers relevant to the flammability of commonly used medical supplies when subjected to laser radiation, including clinical case reports and publicly available incident data, were identified, reviewed, and summarized. There are numerous materials that are ubiquitous within the medical setting that can ignite when accidentally contacted with laser radiation, including gauze, drapes, sponges, adhesive tapes, and gowns, skin preparatory solutions and ointments, and endotracheal tubes. Future research is warranted to determine the dependence of the ignition potential of the various fuels on laser type and operational parameters. The purpose of this analysis is to summarize and present all of the seminal published literature pertaining to medical laser-related fires and their prevention in order to understand the contributing factors and extent to which these hazards exist, to inform the medical laser community about these hazards, and to prioritize future areas of occupational health and safety research.
    Journal of Laser Applications 05/2012; 24(3). DOI:10.2351/1.4704850 · 1.80 Impact Factor
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    ABSTRACT: Occupational hazards associated with medical laser applications remain poorly understood and uncharacterized. A literature search was performed using PubMed, and all articles relevant to beam and nonbeam medical laser hazards were reviewed. The Rockwell Laser Industries Laser Accident Database was searched for medical laser injuries and abstracted. Eye injuries, skin burns, injuries related to the onset of fires, and electric shock have been reported in relation to medical laser use. It is probable that both acute and chronic health effects have been experienced by medical personnel as the result of exposure to laser generated air contaminants. Because of the clinical benefits they provide, the growth of laser technologies and applications are anticipated to result in an increase in the number and type of medical personnel with future exposure to laser hazards.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2011; 53(11):1302-9. DOI:10.1097/JOM.0b013e318236399e · 1.63 Impact Factor
  • Journal of Occupational and Environmental Hygiene 09/2011; 8(9):D81-5. DOI:10.1080/15459624.2011.596470 · 1.17 Impact Factor
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    ABSTRACT: The clinical use of lasers in surgery began in 1973 with applications of the carbon dioxide laser in otolaryngology, and since then the use of lasers has become commonplace in many medical and surgical specialties. Nonetheless, when biological tissue is subjected to laser radiation, the target cells can be vaporized, resulting in the aerosolization of their contents and the subsequent exposure of health care workers to laser-generated air contaminants (LGACs). The purpose of our analysis was to summarize and present all of the published literature pertaining to the laser-induced plume chemical and physical composition, health effects, and methods of control. The objective was to identify knowledge gaps within exposure science to set a research agenda for the protection of health care personnel exposed to LGACs. A literature search was performed using the PubMed database using a variety of search strategies and keyword combinations. To locate additional studies, we systematically searched the reference lists of all studies identified by our search, as well as key review papers. To date, researchers have identified roughly 150 chemical constituents of plume, as well as fine and ultrafine particulate matter, which has been shown to include viable cellular material, viruses, and bacteria. However, very few studies have attempted to characterize the effects of laser system type, power, and tissue treated, as it relates to LGAC exposure. Furthermore, current control strategies do not appear to be adequate in preventing occupational exposure to LGACs.
    Journal of Occupational and Environmental Hygiene 07/2011; 8(7):447-66. DOI:10.1080/15459624.2011.585888 · 1.17 Impact Factor
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    ABSTRACT: The objective of this study was to characterize personal exposures to welding-related metals and gases for production welders and non-welders in a large manufacturing facility. Welding fume metals and irritant gases nitrogen dioxide (NO(2)) and ozone (O(3)) were sampled for thirty-eight workers. Personal exposure air samples for welding fume metals were collected on 37 mm open face cassettes and nitrogen dioxide and ozone exposure samples were collected with diffusive passive samplers. Samples were analyzed for metals using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and welding fume metal exposure concentrations were defined as the sum of welding-related metals mass per volume of air sampled. Welding fume metal exposures were highly variable among similar types of welding while NO(2) and O(3) exposure were less variable. Welding fume metal exposures were significantly higher 474 μg/m(3) for welders than non-welders 60 μg/m(3) (p=0.001). Welders were exposed to higher concentrations of NO(2) and O(3) than non-welders but the differences were not statistically significant. Welding fume metal exposure concentrations for welders performing gas metal arc welding (GMAW) and shielded metal arc welding (SMAW) were higher than welders performing gas tungsten arc welding (GTAW). Non-welders experienced exposures similar to GTAW welders despite a curtain wall barrier separating welding and non-welding work areas.
    Industrial Health 01/2011; 49(1):63-72. DOI:10.2486/indhealth.MS1150 · 1.12 Impact Factor
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    ABSTRACT: We attempted to examine non-malignant central nervous system (CNS) neoplasms incidence rates for workers at 8 jet engine manufacturing facilities in Connecticut. The objective of this manuscript is to describe difficulties encountered regarding these analyses to aid future studies. We traced the cohort for incident cases of CNS neoplasms in states where 95% of deaths in the total cohort occurred. We used external and internal analyses in an attempt to obtain the true risk of non-malignant CNS in the cohort. Because these analyses were limited by data constraints, we conducted sensitivity analyses, including using state driver's license data to adjust person-year stop dates to help minimize underascertainment and more accurately determine cohort risk estimates. We identified 3 unanticipated challenges: case identification, determination of population-based cancer incidence rates, and handling of case underascertainment. These factors precluded an accurate assessment of non-malignant CNS neoplasm incidence risks in this occupational epidemiology study. The relatively recent (2004) mandate of capturing non-malignant CNS tumor data at the state level means that, in time, it may be possible to conduct external analyses of these data. Meanwhile, similar occupational epidemiology studies may be limited to descriptive analysis of the non-malignant CNS case characteristics.
    J Registry Manag 01/2011; 38(3):115-9.
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    ABSTRACT: To compare ascertainment of central nervous system (CNS) neoplasms with the use of mortality and incidence data as part of an occupational epidemiology study. Deaths were identified by matching the cohort of 223,894 jet engine manufacturing employees to the U.S. Social Security Administration death files and the National Death Index. Incident cancer cases were identified by matching the cohort to 19 state cancer registries. We identified 718 cases overall: 59% by the use of both mortality and cancer incidence tracing; 24% by the use of only mortality tracing, and 17% by the use of only cancer incidence tracing. Compared with state cancer registries, death certificates missed 38% of the malignant, more than six times the benign and nearly 1.5 times the unspecified CNS cases. The positive predictive value of death certificates, with cancer registry as gold standard, was 6% for unspecified, 35% for benign, and 86% for malignant histologies. Death certificates seriously underascertained benign and unspecified CNS tumors; analyses determined with mortality data would not accurately capture the true extent of disease among the cohort. Most state cancer registries have only collected nonmalignant CNS tumor information since 2004, which currently limits the usefulness of state cancer registries as a source of nonmalignant CNS tumor identification. Underascertainment of CNS deaths could seriously affect interpretation of results, more so if examining nonmalignant CNS.
    Annals of epidemiology 10/2010; 20(10):759-65. DOI:10.1016/j.annepidem.2010.06.008 · 2.00 Impact Factor
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    ABSTRACT: To explore a perceived unusual occurrence of glioblastoma at one jet engine manufacturing facility located in North Haven (NH), Connecticut (CT). Subjects were 212,513 workers ever employed in 1 of 8 manufacturing facilities from 1952 to 2001 and at risk from 1976 to 2004. We identified 722 cases of CNS neoplasms mainly by tracing through 19 state cancer registries. We computed standardized incidence ratios (SIRs) based on CT state and national rates and modeled internal relative risks (RRs). We found overall deficits in cases for glioblastoma (275 cases, SIR = 0.77, CI = 0.68-0.87) and most other histology categories examined. NH workers had a not statistically significant overall 8% excess in glioblastoma (43 cases, SIR = 1.08, CI = 0.78-1.46). Salaried NH workers had a statistically significant twofold risk of glioblastoma compared with hourly workers (17 cases, RR = 2.04, CI = 1.15-3.57). Other subgroups of NH workers revealed elevated but not statistically significant glioblastoma risks but little evidence of an association with duration of employment or time since first employment. Incidence rates for glioblastoma and other malignant CNS neoplasm histologies were not elevated in the total cohort. The glioblastoma excesses observed among NH workers may reflect external occupational factors, non-occupational factors or workplace factors unique to NH unmeasured in the current study.
    Neuroepidemiology 08/2010; 35(2):123-41. DOI:10.1159/000310348 · 2.56 Impact Factor
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    ABSTRACT: To characterize needlestick injuries (NSIs) among airport workers, and to suggest preventive strategies. A retrospective chart review (2003-2008) of workers evaluated at a clinic in a large US airport that provides occupational health services. Over a period of 6 years, 14 NSI cases were seen. The majority of injuries occurred while workers cleaned lavatories in the airport or on airplanes. Insulin needles were involved in most cases, and the injuries typically occurred on the hand. No cases of hepatitis B, C, or HIV seroconversion were documented, although follow-up was typically incomplete. The improper disposal of used insulin needles among travelers can result in potential bloodborne pathogen exposure among airport workers. Occupational NSIs have not previously been described among airport workers. A multilevel approach to prevention is recommended.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2010; 52(5):551-4. DOI:10.1097/JOM.0b013e3181dbc896 · 1.63 Impact Factor

Publication Stats

156 Citations
47.74 Total Impact Points


  • 2015
    • Indiana University East
      Ричмонд, Indiana, United States
  • 2013–2014
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
  • 2004–2013
    • University of Illinois at Chicago
      • Division of Environmental and Occupational Health Sciences
      Chicago, Illinois, United States
  • 2011
    • University of Pittsburgh
      • Department of Biostatistics
      Pittsburgh, PA, United States