Philip Harber

The University of Arizona, Tucson, Arizona, United States

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Publications (102)273.54 Total impact

  • Chengcheng Hu · Philip Harber · Jing Su
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    ABSTRACT: Purpose: To describe a statistical approach to predicting a respirator user's fit factor in the future based upon results from initial tests. Methods: A statistical prediction model was developed based upon joint distribution of multiple fit factor measurements over time obtained from linear mixed effect models. The model accounts for within-subject correlation as well as short-term (within one day) and longer-term variability. As an example of applying this approach, model parameters were estimated from a research study in which volunteers were trained by three different modalities to use one of two types of respirators. They underwent two quantitative fit tests at the initial session and two on the same day approximately 6 months later. Results: The fitted models demonstrated correlation and gave the estimated distribution of future fit test results conditional on past results for an individual worker. Conclusions/implications: This approach can be applied to (1) establishing a criterion value for passing an initial fit test to provide reasonable likelihood that a worker will be adequately protected in the future; (2) optimizing the repeat fit factor test intervals individually for each user for cost-effective testing.
    No preview · Article · Jan 2016 · Journal of Occupational and Environmental Hygiene
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    ABSTRACT: Background: Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year. Methods: Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers' compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes. Results: The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%. Conclusions: We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential.
    Preview · Article · Nov 2015 · Injury Prevention
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    ABSTRACT: Objective: Evidence-based diagnostic and treatment guidelines for occupationally related interstitial lung diseases (ILDs) have been developed and are summarized herein. Methods: Comprehensive literature reviews were conducted with article abstraction, critiquing, objective grading, and evidence table compilation. A multidisciplinary expert panel drafted evidence- and consensus-based guidance. External peer-review was incorporated. Results: Recommendations for diagnosis (n = 12) and management (n = 4) of ILD were developed. Spirometric testing, chest radiographs, and high-resolution computerized tomographic scans were recommended based upon evidence. In addition to a detailed clinical history, carbon monoxide diffusion capacity, sputum sampling, exposure assessment, 6-minute walk test, and bronchoalveolar lavage were also recommended. There was no recommendation regarding chest magnetic resonance imaging due to lack of evidence. Conclusions: Recommendations for diagnosis and management of ILD are supported by quality evidence. These guidelines may be useful to help guide providers who are tasked with diagnosing and/or treating patients with occupationally related ILD.
    No preview · Article · Nov 2015 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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    ABSTRACT: Objective: Summarize developed evidencebased diagnostic and treatment guidelines for work-related asthma (WRA). Methods: Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. Results: Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. Conclusion: Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA. © 2015 American College of Occupational and Environmental Medicine.
    No preview · Article · Oct 2015 · Journal of Occupational and Environmental Medicine
  • Philip Harber · Gondy leroy
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    ABSTRACT: Objectives: To illustrate the utility of crowdsourcing for occupational health surveillance. Methods: Amazon Mechanical Turk was used to recruit and obtain information from employed persons with asthma, who answered questions about work-asthma interactions. Results: Data collection from 60 subjects required only a few hours. Participants spent on average 7 minutes responding to 7 questions (1 optional) and used an average of 708 words. Work exacerbation, interference of asthma with work, and suggested workplace accommodation are frequent (83% reported at least one interaction). Conclusions: The full spectrum of work-asthma interactions should be considered. Modern crowdsourcing methods have considerable potential as occupational health surveillance tools because of their effectiveness, efficiency and financial viability are additional important advantages.
    No preview · Article · Apr 2015 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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    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.
    No preview · Article · Jan 2015 · Journal of Occupational and Environmental Hygiene
  • 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.
    No preview · Article · Jan 2015 · Current opinion in pulmonary medicine
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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.
    No preview · Article · Jan 2015 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • Myles Druckman · Philip Harber · Yihang Liu · Robert L Quigley
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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.
    No preview · Article · Nov 2014 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • 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.
    No preview · Article · Aug 2014 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • 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.
    No preview · Article · Aug 2014 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • 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.
    No preview · Article · Aug 2014 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • 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.].
    No preview · Article · Jun 2014 · Workplace health & safety
  • Philip Harber · Jing Su · Cheng Cheng Hu
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    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 6 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. Subjects (n = 175) were assigned randomly to use either a filtering facepiece N95 (FFR) or dual cartridge half facemask (HFM) respirator. Each was assigned randomly to one of three training methods-printed brochure, video, or computer-based training. Soon after initial training, quantitative fit and measures of proper technique were determined. These measurements were repeated 6 months later. In the six-month followup, subjects were randomized to receive either a brief reminder card or a placebo card. Total performance score, major errors, and quantitative fit all became significantly worse at 6 months. An individual's result soon after training was the most important predictor of performance 6 months later. There was a marginal not statistically significant tendency for those initially trained by video to have better protection 6 months later. The study suggests that persons who use respirators intermittently should be thoroughly retrained and reevaluated periodically. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: Additional statistical analyses.
    No preview · Article · May 2014 · Journal of Occupational and Environmental Hygiene
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    Full-text · Article · May 2014 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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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.
    Full-text · Article · Feb 2014 · International Journal of Environmental Research and Public Health
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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.
    No preview · Article · Nov 2013 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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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.
    Preview · Article · Nov 2013 · American Journal of Respiratory and Critical Care Medicine
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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.
    No preview · Article · Oct 2013 · Journal of Occupational and Environmental Hygiene
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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.
    No preview · Article · Apr 2013 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine

Publication Stats

1k Citations
273.54 Total Impact Points


  • 2012-2015
    • The University of Arizona
      Tucson, Arizona, United States
  • 1988-2011
    • University of California, Los Angeles
      • • Department of Family Medicine
      • • Department of Medicine
      Los Angeles, 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
  • 2002
    • University of Birmingham
      • Department of Occupational and Environmental Medicine
      Birmingham, England, United Kingdom
    • County of Los Angeles Public Health
      Los Ángeles, California, United States
  • 1989
    • CSU Mentor
      Long Beach, California, United States