Philip Harber

The University of Arizona, Tucson, Arizona, United States

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Publications (90)225.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Infrared imaging (IRI) can detect airflow through and near respirator masks based upon temperature differences between ambient and exhaled air. This study investigated the potential usefulness of IRI for detecting leaks and providing insight into the sites and significance of leaks. Subjects (n=165) used filtering facepiece N95 respirators (N95 FFR) in the course of a research study concerning training modalities. Short sequence video infrared images were obtained during use and with intentionally introduced facial seal leaks. Fit factor (FF) was measured with condensation nuclei count methods (PortaCount). IRI detected leaks were scored on a four-point scale and summarized as the Total Leak Score (TLS) over 6 coding regions and the presence or absence of a "Big Leak (BL)" in any location. A semi-automated interpretation algorithm was also developed. IRI detected leaks are particularly common in the nasal region, but these are of limited significance. IR imaging could effectively identify many large leaks. The TLS was related to FF. Although IRI scores were related to FF, the relationship is insufficiently close for IRI to substitute for quantitative fit testing. Infrared techniques have potential for identifying situations with very inadequate respiratory protection using FFR's.
    Journal of Occupational and Environmental Hygiene 01/2015; 12(6). DOI:10.1080/15459624.2015.1006636 · 1.21 Impact Factor
  • Philip Harber
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    ABSTRACT: This review summarizes recent advances concerning respiratory impairment and disability. The traditional impairment assessment approach, depending heavily on clinical pulmonary function testing to estimate the match between the patient's sustainable oxygen consumption and the workplace requirements, continues to be widely used. Recent work indicates the need to reassess underlying concepts for several reasons: The relationship between basic pulmonary function tests and sustainable oxygen consumption varies among patients and conditions. Studies of the respiratory demands of modern workplaces need to be updated. The concepts are less easily applied to asthma than other disorders. Research studies present differing definitions of 'disability', and therefore the methods of relating impairment (function loss) and disability require reassessment. Recent advances provide improved understanding of the large societal and personal impacts of respiratory impairment and disability. Clinicians, policymakers, and researchers should carefully consider how well the current highly specified impairment rating systems can be improved for accuracy and relevance to current home and work activities. In addition to measuring 'impairment', clinicians should consider factors affecting how impairments lead to disability.
    Current opinion in pulmonary medicine 01/2015; DOI:10.1097/MCP.0000000000000141 · 2.96 Impact Factor
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    ABSTRACT: To outline the knowledge gaps and research priorities identified by a broad base of stakeholders involved in the planning and participation of an international conference and research agenda workshop on isocyanates and human health held in Potomac, Maryland, in April 2013. A multimodal iterative approach was used for data collection including preconference surveys, review of a 2001 consensus conference on isocyanates, oral and poster presentations, focused break-out sessions, panel discussions, and postconference research agenda workshop. Participants included representatives of consumer and worker health, health professionals, regulatory agencies, academic and industry scientists, labor, and trade associations. Recommendations were summarized regarding knowledge gaps and research priorities in the following areas: worker and consumer exposures; toxicology, animal models, and biomarkers; human cancer risk; environmental exposure and monitoring; and respiratory epidemiology and disease, and occupational health surveillance.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 01/2015; 57(1):44-51. DOI:10.1097/JOM.0000000000000278 · 1.80 Impact Factor
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    ABSTRACT: Objective: To identify factors affecting the likelihood of requiring medical services during international business trips. Methods: Data from more than 800,000 international trips and medical assistance cases provided to 48 multinational corporations in 2009. Travel destination countries were grouped into four a priori risk-related categories. Results: Travel to "low" medical risk countries in aggregate accounted for more hospitalizations and medical evacuations than travel to "high" medical risk countries. Nevertheless, the risk per trip was much higher for travel to higher medical risk countries. Conclusions: Corporations with employees on international travel should allocate sufficient resources to manage and ideally prevent medical issues during business travel. Travel medicine must focus on more than infectious diseases, and programs are necessary for both high-and low-risk regions. Improved understanding of travel-related needs determines resource allocation and risk mitigation efforts.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2014; 56(11):1161-6. DOI:10.1097/JOM.0000000000000314 · 1.80 Impact Factor
  • Philip Harber, Jing Su
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    ABSTRACT: Objective: To optimize beryllium worker screening. Methods: Beryllium-exposed persons are classified as beryllium-exposed, beryllium-sensitized (BeS), or chronic beryllium disease. Implications of defining BeS by two or more positive lymphocyte proliferation tests (LPTs) were investigated with a simple binomial model. The potential effect of adjusting the interval for repeated intensive testing to detect chronic beryllium disease among persons with BeS was assessed with a Markov model. Results: Accuracy of properly identifying BeS is reduced as the number of repeated tests increases. Markov simulation illustrates that adjusting second-stage screening intervals on the basis of personal risk may significantly affect cost-effectiveness. Conclusions: The criteria for classification as BeS should be adjusted depending on the number of LPTs performed. Modifying the interval for repeated intensive testing on the basis of each worker's data can improve cost-effectiveness.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2014; 56(8):861-6. DOI:10.1097/JOM.0000000000000200 · 1.80 Impact Factor
  • Philip Harber, Jing Su, Gabriela Alongi
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    ABSTRACT: Objective: To incrementally improve the use of beryllium lymphocyte proliferation test (LPT) results. Methods: Beryllium BioBank data were analyzed for 532 subjects in three groups: beryllium-exposed, sensitized, or chronic beryllium disease. Predictor variables were LPT stimulation index (SI) at the date of the earliest available data and at the study entry date. Results: Cross-sectionally, LPT SI magnitude does not distinguish among the three groups. The likelihood of progression from sensitization to disease is associated with the absolute value of SI, but LPT SI interpreted by traditional cut point criteria was not predictive. Conclusions: Updating the criteria for interpreting beryllium LPT data should be considered. Prediction of progression to chronic beryllium disease may be improved by changing the cut point for interpretation or by using the SI as a continuous variable.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2014; 56(8):857-60. DOI:10.1097/JOM.0000000000000199 · 1.80 Impact Factor
  • Philip Harber, Jing Su, Gabriela Alongi
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    ABSTRACT: Objective: To assess the importance of occupational history for beryllium-exposed workers. Methods: Beryllium BioBank data were analyzed for 532 subjects in the following three groups: beryllium-exposed, beryllium-sensitized, and chronic beryllium disease. Predictor variables were several questionnaire-derived exposure indices. Results: Cumulative exposure estimated from a standardized interview contributes to differentiating beryllium-exposed from chronic beryllium disease. The likelihood of progression from sensitization to disease was associated with peak-level weighted exposure hours. Conclusions: Selecting workers for extensive diagnostic testing should consider each worker's duration and characteristics of exposure. The intensity and total hours of exposure should be evaluated rather than relying on only the total years.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2014; 56(8):852-6. DOI:10.1097/JOM.0000000000000190 · 1.80 Impact Factor
  • Philip Harber, Gabriela Alongi, Jing Su
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    ABSTRACT: Occupational health nurses have diverse backgrounds and their practices require the ability to perform unique professional tasks. This study empirically evaluated their activities and skills using a web-based log system to describe activities at 15 specific sampled times. A national sample of 128 occupational health nurses provided 1,893 activity logs revealing occupational health nurses use both clinical and management skills on a regular basis; indirect client care is as common as direct "hands-on" client care. Most occupational health nurses are directly paid by their employer and activities serve to benefit both individual workers and their employers. Occupational health nurses have specific knowledge and skills in addition to general nursing competencies. Understanding the actual work of occupational health nurses is necessary to align training, certification, and competency maintenance systems such as continuing education with the unique skills used in actual practice activities. [Workplace Health Saf 2014;62(6):233-242.].
    06/2014; 62(6):233-242. DOI:10.3928/21650799-20140514-03
  • Philip Harber, Jing Su, Cheng Cheng Hu
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    ABSTRACT: ABSTRACT Although retraining and repeat fit testing are needed for respirator users, the optimal frequency is uncertain. The persistence of proper respirator donning/doffing techniques and changes in quantitative fit factor over six months after initial training were measured in this study. Initial training was designed for rapid rollout situations in which direct contact with well-trained occupational health professionals may be infeasible.
    Journal of Occupational and Environmental Hygiene 05/2014; DOI:10.1080/15459624.2014.925115 · 1.21 Impact Factor
  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 05/2014; 56(5):e21-40. DOI:10.1097/JOM.0000000000000173 · 1.80 Impact Factor
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    ABSTRACT: Arsenic exposure from drinking water is associated with adverse respiratory outcomes, but it is unknown whether arsenic affects pulmonary microbiota. This exploratory study assessed the effect of exposure to arsenic in drinking water on bacterial diversity in the respiratory tract of non-smokers. Induced sputum was collected from 10 subjects with moderate mean household water arsenic concentration (21.1 ± 6.4 ppb) and 10 subjects with low household water arsenic (2.4 ± 0.8 ppb). To assess microbiota in sputum, the V6 hypervariable region amplicons of bacterial 16s rRNA genes were sequenced using the Ion Torrent Personal Genome Machine. Microbial community differences between arsenic exposure groups were evaluated using QIIME and Metastats. A total of 3,920,441 sequence reads, ranging from 37,935 to 508,787 per sample for 316 chips after QIIME quality filtering, were taxonomically classified into 142 individual genera and five phyla. Firmicutes (22%), Proteobacteria (17%) and Bacteriodetes (12%) were the main phyla in all samples, with Neisseriaceae (15%), Prevotellaceae (12%) and Veillonellacea (7%) being most common at the genus level. Some genera, including Gemella, Lactobacillales, Streptococcus, Neisseria and Pasteurellaceae were elevated in the moderate arsenic exposure group, while Rothia, Prevotella, Prevotellaceae Fusobacterium and Neisseriaceae were decreased, although none of these differences was statistically significant. Future studies with more participants and a greater range of arsenic exposure are needed to further elucidate the effects of drinking water arsenic consumption on respiratory microbiota.
    International Journal of Environmental Research and Public Health 02/2014; 11(2):2299-313. DOI:10.3390/ijerph110202299 · 1.99 Impact Factor
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    ABSTRACT: This study addresses methods for training respirator users, particularly when occupational health professionals are not immediately available. A randomized trial compared three training methods-printed brochure, video, and computer-based training-for two respirator types (filtering facepiece and a dual-cartridge half facemask). Quantitative fit testing (PortaCount) measured the effectiveness of training. The study included 226 subjects. For both respirator types, video was significantly superior to either print or computer-based training methods. Conclusions were consistent, whether determined by average fit factor (analysis of variance), log-transformed fit factors, or the number of users in the lowest quartile of achieved fit. Video training for proper respirator use can be effective when direct training from an occupational health professional is unavailable. These methods are particularly relevant to "rapid rollout" situations, such as natural disasters, epidemics, or bioterrorism concerns.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2013; DOI:10.1097/JOM.0000000000000010 · 1.80 Impact Factor
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    ABSTRACT: Rationale: Psychosocial characteristics likely play an important role in the severity of workplace disability for workers with a respiratory impairment. Objectives: We performed a systematic review of the available literature to examine the impact of psychosocial characteristics on workplace disability among workers with a respiratory impairment. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, we searched Medline and other published and unpublished sources using the PubMed and Cochrane Central Register of Controlled Clinical Trials (CENTRAL) search engines from January 1, 1990 through March 8, 2013 for quantitative studies that examined the association of psychosocial characteristics with workplace disability among workers with a respiratory impairment. We also searched related citations and the bibliographies of selected studies and relevant review articles. One investigator abstracted data about study design and quality, psychosocial characteristics, and outcome measures. Measurements and Main Results: Of 5,746 potentially relevant studies, 20 met eligibility criteria and were included. Studies reported heterogeneous outcomes among heterogeneous samples of workers that precluded a quantitative synthesis. In general, mental illness was associated with increased workplace disability among workers with respiratory impairments. Few studies adjusted for disease severity, so the independent association of psychosocial characteristics and workplace disability is unclear. Most studies were cross-sectional, so the direction of the association could not be determined. We found only one trial of targeted therapy for the psychosocial condition, which was not effective at reducing disability. Conclusions: Psychosocial characteristics likely influence workplace disability in workers with respiratory impairments. The impact of targeted therapies is unclear and warrants further study.
    American Journal of Respiratory and Critical Care Medicine 11/2013; 188(9):1147-60. DOI:10.1164/rccm.201309-1656ST · 11.99 Impact Factor
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    ABSTRACT: Respirators must be properly used to be effective. In an experimental protocol, 145 subjects were trained and then observed donning and doffing respirators. Filtering facepiece and dual cartridge half face mask types were studied. Subjects were then tested for knowledge and for proper performance using video recording analysis. Knowledge tests showed adequate learning, but performance was often poor. Inspection, strap tension (half mask), seal checking, and avoiding mask contact during doffing were particularly problematic. Mask positioning was generally well done. Correlation between knowledge and performance for specific items was generally poor, although there was a weak correlation between overall knowledge and overall performance (rho = 0.32) for the half mask users. Actual unprompted performance as well as knowledge and fit-testing should be assessed for user certification. Respirator design approval should consider users' ability to learn proper technique.
    Journal of Occupational and Environmental Hygiene 10/2013; 10(10):556-63. DOI:10.1080/15459624.2013.818235 · 1.21 Impact Factor
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    ABSTRACT: OBJECTIVE:: To assess the impact of occupational medicine board certification and career stage on practice characteristics. METHODS:: Two hundred sixty occupational medicine physicians completed a questionnaire and 25 activity log descriptions about 72 items in 9 major domains. For each item, the percentage of activities involving the item and the percentage of physicians conducting the item at least once were calculated. Results were analyzed by board certification status and career stage. RESULTS:: Board-certified physicians had more-diverse practice activities and skills. They were more involved in management and public health-oriented activities, with greater emphasis on toxicology and less on musculoskeletal disorders. The noncertified physicians received more payment from workers' compensation. Early-career physicians spent more time in direct injury/illness treatment, being paid by workers' compensation, and addressing musculoskeletal problems. CONCLUSIONS:: Formal training confers advantages in practice diversity and population medicine orientation.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 04/2013; DOI:10.1097/JOM.0b013e31828515b8 · 1.80 Impact Factor
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    ABSTRACT: OBJECTIVE:: To describe career path patterns for occupational medicine (OM) physicians. METHODS:: A convenience sample of 129 occupational physicians described work activities and locations at several career points up to 20 years ago, first OM position, and 10 years after expectations. RESULTS:: Clinical activities were important throughout (eg, 41% and 46% of occupational physicians reported frequently treating patients 20 years ago and currently). Practice locations changed more markedly, with increased multisite clinics and hospital/medical center-based practices. Performing mainly clinical activities in a first job increased from 82% to 97% over the past 20 years. Career transitions between clinical and nonclinical roles were common (40% of participants). Many anticipate transition to nonclinical work over 10 years. CONCLUSIONS:: Activities have not fundamentally changed, but practice locations have evolved. Both clinical and management activities remain important, and path to managerial positions increasingly begins in clinical practice.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 10/2012; DOI:10.1097/JOM.0b013e31826bb509 · 1.80 Impact Factor
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    ABSTRACT: : To assess country factors associated with the risk of requiring aeromedical evacuation and hospitalization among expatriate workers and their dependents. : The 2009-2010 data including 5725 aeromedical evacuations and 17,828 hospitalizations, and 2009 data of hospitalizations and aeromedical evacuations among 94,651 at-risk expatriates, were analyzed to assess 2 country risk rating tools. Each tool utilized four risk categories and reflected level of development and medical capabilities. : Country risk category was strongly associated with risk of evacuation and/or hospitalization for each risk rating tool (eg, 46-fold increase from lowest to highest country risk category). : Country risk tools strongly associate hospitalization and aeromedical evacuation with country risk category, and thus can be important indicators of relative medical risk. Employers may use these results to implement targeted prevention programs to support expatriate workers and their families.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2012; 54(9):1118-25. DOI:10.1097/JOM.0b013e3182677d75 · 1.80 Impact Factor
  • Philip I. Harber
    American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
  • Samantha Wu, Philip I. Harber, Johnny Bontemps
    American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012

Publication Stats

804 Citations
225.74 Total Impact Points

Institutions

  • 2013–2015
    • The University of Arizona
      • Division of Community, Environment and Policy
      Tucson, Arizona, United States
  • 1989–2011
    • University of California, Los Angeles
      • • Department of Family Medicine
      • • Department of Medicine
      Los Angeles, California, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2009
    • VA Greater Los Angeles Healthcare System
      Los Ángeles, California, United States
  • 2006
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States