Total Exposure Health: An Introduction

Section I: Overview and FundamentalsTotal Exposure Health: An Exposure Science Framework for the Fourth Industrial AgeOrigins of Total Exposure HealthThe Steadfast Practice of Industrial HygieneExposures and Exposed Populations Are DecreasingSensors Are (Almost) UbiquitousExpanded Knowledge of Disease, Mechanisms of Disease, and GeneticsAims of Total Exposure HealthThe Totals ExplainedTotal Worker Health®Total Worker Exposure (TWE)Total Exposure Health(TEH)TEH Exposures of ConcernOccupationalEnvironmentLifestyleClinicalTEH Exposure Data SourcesWorkplace IHEnvironmental and Community HealthPersonal Environmental Exposure Sensors and the Internet of ThingsHealthcare Is Changing—Personalized HealthcarePatient CentricExposure Curves: Where Does an Individual Fit InThe Fourth Industrial Revolution and TEHComputational ToxicologyGenetic ExpressionNovel Controls Additions to the HierarchyIndividual Exposure Health Risk Profile (IEHRP)Preexposure ProphylaxisSelf-Limiting ExposuresNonoccupational PPE/Increased Occupational PPEDurable Medical EquipmentBlood Chemistry TrackingTEH—Bringing It All TogetherReferencesThe Individual Exposure Health Risk Profile (IEHRP)— Developing a Risk Profile Tool beyond Dose ResponseIntroductionTotal Exposure Health (TEH)Noise Exposure Demonstration Project (NEDP)Individual Exposure Health Risk Profile (IEHRP)ConclusionReferencesIn Pursuit of Total Exposure Health: Leveraging Exposure Science, the Omics, and Other Emerging TechnologiesIntroductionExposure Science: Key Principles Useful for Total Exposure HealthHigh-Throughput Metabolomics in Total Exposure HealthThe OmicsMetabolomicsTargeted MetabolomicsUntargeted MetabolomicsGrowth of MetabolomicsThe Human Microbiome as a Modifier of Personalized ExposuresThe Microbiome of a BabyThe Gut MicrobiomePharmacokineticsAbsorption, Distribution, Metabolism, and ExcretionPhysiologically Based Pharmacokinetic (PBPK) ModelingConclusionsReferencesTotal Worker Health : Bridging Worker Exposure and Well-BeingIntroductionWhat Is TWH?Comparing the TWH ApproachIssues Relevant to Advancing Worker Well-Being through Total Worker Health®What TWH Looks Like in PracticeThe 1st and 2nd International Symposia to Advance Total Worker Health®Advances in ResearchNational Total Worker Health® AgendaTotal Worker Health Research Methodology WorkshopWorker Well-Being FrameworkCenters of Excellence for TWHResearch to PracticeFundamentals of Total Worker Health® ApproachesHierarchy of Controls Applied to NIOSH Total Worker Health®Determining Overall Risk and Exposure for Worker Safety, Health, and Well-BeingCumulative Risk AssessmentTotal Exposure HealthTWH, CRA, and TEHPartnership and Stakeholder InvolvementNIOSH TWH AffiliatesCollaborative ActivitiesConclusionReferencesIndustrial Hygiene: A Foundational Role in Total Exposure HealthIntroductionWhat Is Industrial Hygiene?Definition of Industrial HygieneOSHA ComplianceHistory of Industrial HygieneEarly Names in IHAcademic Programs and ABETProfessional OrganizationsAmerican Conference of Governmental Industrial Hygienists (ACGIH®)American Industrial Hygiene Association (AIHA®)Board for Global EHS Credentialing (BGC®)Occupational Safety and Health Administration (OSHA)National Institute for Occupational Safety and Health (NIOSH)Today’s Industrial HygieneAnticipation-Recognition-Evaluation-Control-ConfirmAnticipationRecognitionEvaluationControlConfirmExposure Assessment: A Core Function of Industrial HygieneExposure Assessment—DefinedComprehensive Exposure Assessment—More than ComplianceThe Future of Industrial Hygiene and Total Exposure HealthIndustrial Hygienists: Ready for Total Exposure HealthChallenges for Industrial Hygienists in Fulfilling TEHReferencesSection II: Advances in Toxicology and the -OmicsPersonalizing Environmental Health for the Military—Striving for PrecisionThe Need for Precision in Military Environmental HealthFrom Past to Present: The Changing Landscape of Precision MedicineTechnology and MedicineGenetics versus GenomicsGenomics and the Overpromise of GWASSequencing and ‘Omics’ Technology AdvancementsThe ‘Great GWAS Do-over’?Incorporating the Changing Landscape of Genomics into the Clinic over TimePrecision beyond Genomics: Environment, Exposures, and Social BackgroundGetting More Personal: The Microbiome as an InterfaceModels of Risk and ExposureLikelihood Ratio (LR)Social Determinants of Health (SDOH)Precision Medicine and Environmental Health for the MilitaryThe Million Veterans ProgramEthical, Legal, and Social Issues (ELSI)OutlookReferencesIn Silico Identification of Protein Targets for Chemical Neurotoxins Using ToxCast in Vitro Data and Read-Across within the QSAR ToolboxIntroductionMaterials and MethodsToxCast Compound DatasetBioactivity Data Associated with NeurotoxicityPerformance EvaluationSoftwareResults and DiscussionConclusionsConflict of InterestAcknowledgmentsReferences“Omics”: An IntroductionIntroductionGenomicsSequencing TechnologiesUtility of Whole-Genome Sequence in Total Exposure HealthTranscriptomicsAnalytic Methods for TranscriptomicsTranscriptomics Role in TEHEpigenomicsMeasuring Epigenomic MarksThe Epigenome in TEHProteomeProteomics MethodsProteomics Utility in TEHMetabolomeMetabolome MethodsMetabolome in TEHMicrobiomeEnumerating the MicrobiomeMicrobiome Relevance in TEHPan-Omics in a TEH ModelReferencesSilicone Wristbands and Wearables to Assess Chemical ExposuresPersonal Chemical ExposuresPassive SamplingPassive Sampling BackgroundSilicone WristbandsSilicone Wristband CharacterizationWristband AdvantagesChemical UptakeWristband Data ApplicationsSilicone Wristband Limitations and Additional ConsiderationsLaboratory PracticesWristband Preparation and ShipmentChemical Stability in WristbandsChemical ExtractionChemical and Biological AnalysisHuman Research EthicsSilicone Wristband ApplicationsInitial Field ApplicationsComparisons with Conventional Exposure Assessment TechnologiesHealth EffectsAdditional Configurations of Silicone WristbandsFuture DirectionsChemical MixturesDisaster-Related ExposuresBehavioral Health InterventionsPrecision Health and Precision PreventionAcknowledgmentsConflict of InterestReferencesTotal Exposure Hearing Health PreservationIntroductionOverview of Hearing HealthAuditory and Non-Auditory Health EffectsExposure LifetimeNoise Type: Continuous and ImpulseNon-Noise ExposuresGeneticsHow Do I Measure Risk?How Do I Control Risk?ConclusionReferencesThe Role of Noise Exposure as an Element of Total Exposure Health: Determination of 24-Hour Noise Exposure Profiles on U.S. Navy Aircraft CarriersIntroductionNoise Exposure on U.S. Navy Aircraft CarriersAuditory EffectsNon-Auditory EffectsRegulation-Hour Noise Exposure Aboard U.S. Navy Aircraft Carriers (Schaal et al., 2019c)Characterization of Extended Shift Noise Exposures among Low Noise Hazard U.S. Navy Aircraft Carrier Support Personnel (Schaal et al., 2019a)Noise Characterization of “Effective Quiet” Areas on a U.S. Navy Aircraft Carrier (Schaal et al., 2019d)Sound Level Measurements in Berthing Areas of an Aircraft Carrier (Schaal et al., 2019b)DiscussionConclusionsDisclaimerCopyright StatementReferencesIdentifying Exposures and Health Outcomes in Former Worker PopulationsIntroductionBackgroundFoundations of the U.S. Department of Energy National Supplemental Screening ProgramMedical Screening Program ObjectivesNSSP MethodologySelected Program ResultsSummaryAcknowledgmentsReferencesPersonal Environmental Exposure Sensors and the Internet of ThingsIntroductionOverview of Personal SensorsMicro Gas ChromatographyAnalyte PreconcentrationSeparation ColumnMicrocolumn FabricationMicrocolumn CongfiurationMicrocolumn HeatingDetectorsThermal Conductivity Detector (TCD)Surface Acoustic Wave (SAW)Photoionization Detector (PID)Electron Capture Detector (ECD)Surface Plasmon Resonance Imaging (SPRi)Flame Ionization Detector (FID)Mass Spectrometry (MS)Practical Use of Micro Gas ChromatographyParticulate Matter MeasurementsNoise MeasurementsInternet of ThingsData ManagementLocation TrackingSystem ArchitectureSecurity, Reliability, and UsabilityExtensibilityPerformanceSimplicity and OrganizationFeasible Systems for TodayConclusionsDisclaimerReferencesSensor Platforms and Wireless NetworksIntroductionSampling/Transmission BackgroundCommercial ContextTerminologyChallengesSensor Interfaces and ProtocolsSensor PlatformWireless Radios, Topologies, and ProtocolsConclusionAcknowledgmentsData Integration and ServicesBack-End Infrastructure/Cloud ServicesData IntegrationAnalyticsVisualizationCollaborationConclusionExposure Health Informatics EcosystemDeterminants of HealthThe Exposome and Its GenerationThe Pediatric Research Using Integrated Sensor Monitoring Systems ProgramsExposomic Research Challenges and Informatics SolutionsExposure Health Informatics EcosystemData Acquisition PipelineParticipant-Facing ToolsResearcher-Facing ToolsComputational Modeling PlatformCentral Big Data Integration PlatformUtilization of Exposome in Translational StudiesDiscussion and ConclusionAcknowledgmentsReferencesSection III: BioethicsBioethics and Precision Medicine: Focus on Information TechnologyIntroductionFrom Papyrus to Silicon: Precision Medicine and the History of the Medical RecordEthical IssuesClinical Decision SupportSoftware EngineeringBig Data, Machine Learning and Learning Healthcare SystemsConclusionReferencesUnresolved Ethical Questions Raised by Genomic Sequencing ResearchIntroductionAn Emerging Obligation to Return Secondary FindingsReturning Results in Different Kinds of StudiesReconsent and Research with Stored SamplesThe Right-Not-to-Know Genetic Information about OneselfOther Unresolved Ethical Issues Relating to Return of Genetic ResultsConclusionReferencesGenomics, Big Data, and Broad Consent: A New Ethics Frontier for Prevention ScienceIntroductionChanges in Federal Regulations Governing Key Elements of Informed ConsentFormat Changes: A Concise Summary of Key InformationSuggested Key Elements for ConsentTransparency Requirements for Consent Forms Related to Clinical TrialsBroad ConsentBackground and Rationale: Balancing Privacy Concerns with Advancing TechnologiesDefinition and Overview of Broad Consent RequirementsDefinition and Description of Identifiable Information or BiospecimensTime Period for Storage and UseDisclosure of Future UsersCommercial Use of DataDisclosure of Future UseParticipant PerspectivesConclusionsAcknowledgmentsReferences
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