Steven E Lacey

University of Pittsburgh, Pittsburgh, PA, United States

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Publications (28)46.85 Total impact

  • 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; · 1.28 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; · 1.28 Impact Factor
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    ABSTRACT: 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; · 1.76 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; · 1.88 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; · 1.88 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; · 1.88 Impact Factor
  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2013; · 1.88 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; · 1.88 Impact Factor
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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). · 0.57 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. · 1.88 Impact Factor
  • Journal of Occupational and Environmental Hygiene 09/2011; 8(9):D81-5. · 1.28 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. · 1.28 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. · 0.87 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. · 2.95 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. · 2.37 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. · 1.88 Impact Factor
  • Steven Lacey
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    ABSTRACT: Organizations dedicated to applying engineering solutions to improve health in developing countries may lack sufficient expertise in the public health aspects of these efforts to ensure successful project design and implementation. The occupational hygienist is a valuable complement to the efforts needed for development-oriented public health engineering projects.
    Annals of Occupational Hygiene 01/2010; 54(1):5-7. · 2.16 Impact Factor
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    ABSTRACT: Workers service the lavatories of commercial aircraft approximately 11 million times per year in the United States and may have exposure to the spectrum of pathogenic viruses, bacteria and parasites potentially found in human waste. An industrial hygiene walk-through of the workplace was conducted by an interdisciplinary occupational health and safety team, and lavatory waste operators and supervisors and the process was observed. Exposure to untreated waste can occur through dermal, ingestion, and inhalation in quantities ranging from droplets to large spills. Several engineering and administrative measures were advised to minimize worker exposure, including the effective locking of a critical valve, and a mechanism for communicating valve locking problems.
    Industrial Health 01/2010; 48(1):123-8. · 0.87 Impact Factor
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    ABSTRACT: The authors traced incidence of central nervous system cancer in a large occupational cohort of jet engine manufacturing workers from 1976 to 2004 in the 24 US states that comprised 95% of the cohort deaths. The cohort of approximately 224,000 employees was matched with cancer registry data; all central nervous system cancer matches were requested with their diagnostic data. This paper highlights the obstacles encountered while conducting this retrospective cancer incidence study. The authors spent approximately 700 hours completing applications and obtaining the cohort matches. Approximately 70% of the cases were identified in the state in which the facility of interest is located. In addition to the large amount of time involved, identified issues include complicated approval processes, high costs, temporal differences among the registries, and registry agency difficulty in performing the matching. Several states do not allow individual-level data to be used for research purposes. Researchers can gain important cancer incidence information by matching retrospective cohorts to multiple state cancer registries. However, they should carefully weigh the time and costs required and plan accordingly. Despite some serious obstacles, many of which are potentially resolvable, cancer incidence studies of retrospective cohorts using multiple cancer registries are feasible.
    American journal of epidemiology 06/2009; 170(1):112-9. · 5.59 Impact Factor