Dose Reconstruction Validation and Correlation with Fiber

Exposure Profile Characterization and
Dose Reconstruction Validation:
Frameworks, Correlation with Fiber Burden
Studies, and Litigation Considerations
Charles F. Redinger, Ph.D., MPA, CIH
Redinger 360, Inc.
6 Lancaster County Road, Suite 3
Harvard, MA 01451
(978) 772-8105
[email protected]
Charles F. Redinger is a principal with Redinger 360, Inc. in Harvard,
Massachusetts. He has a PhD in industrial health from the University of Michigan,
an MPA in public policy from the University of Colorado, and a BA in chemistry
from the University of California at Santa Cruz. He is a Certified Industrial Hygienist
(CIH) with over 30 years of experience. He is also an American Industrial Hygiene
Association Fellow. He has worked with a wide range of public- and private-sector
organizations, including the U.S. Department of Defense, OSHA, Global 500
Companies, and the ILO and ANSI committees that developed the global standards
for risk management. Dr. Redinger has performed complex occupational health
risk assessments for the U.S. Public Health Service and Environmental Protection
Agency. He is the American Industrial Hygiene Association’s (AIHA) Secretary and
serves on AIHA’s Executive Committee. He has was the President of AIHA’s Northern
California Section, and the Chair of AIHA’s Risk Assessment and Management
Committees. He has received numerous awards for his contribution to the industrial
health field. These include: the Warren Cook Award for outstanding scholarship
from the University of Michigan School of Public Health; the Edward Baier Award
for technical achievement from the American Industrial Hygiene Association;
and, the Outstanding Publication award from the AIHA Press. He was also give an
Award of Appreciation from the National Safety Council for service assessing the
Department of Defense’s Occupational Safety and Health programs and systems.
Exposure Profile Characterization and
Dose Reconstruction Validation:
Frameworks, Correlation with Fiber Burden
Studies, and Litigation Considerations
Table of Contents
I.Introduction..............................................................................................................................................1055
A. REA Importance in Occupational Health Risk Assessment...........................................................1055
B. National Academy of Science, Risk Assessment Framework.........................................................1055
C. National Institute for Occupational Safety and Health and National Cancer
Institute Workshop – Identifying a Need for Methods...................................................................1055
D. Methods Developement....................................................................................................................1056
II. Historical Context and Scientific Foundation.........................................................................................1056
A. Exposure Assessment Context..........................................................................................................1056
B. Roots in Work of Gamble and Spirtas (1976)..................................................................................1056
C. Berry and Lewinshon (1979) – Exposure-Years.............................................................................1057
D. McMicheal (1976) and Rinski (1981) – Similar Exposure Groups................................................1057
E. Dement (1983) and Kreibel (1988) – Daily Weighted Average by SEG.........................................1057
F. Rappaport (1991) and Seixas/Checkaway (1995) – Statistical Analysis........................................1058
III. Exposure Reconstruction – A 12-Step Methodology.............................................................................1058
A. American Industrial Hygiene Association Publications.................................................................1058
B. Armstrong (2009) – REA Methodology..........................................................................................1058
IV. Validity Frames.........................................................................................................................................1060
A. Face Validity.......................................................................................................................................1060
B. Content Validity.................................................................................................................................1060
C. Criterion and Construct Validity......................................................................................................1060
D. Measurement Levels..........................................................................................................................1060
V. An REA Validation Study Using Asbestos Fiber Burden Data...............................................................1060
VI. Considerations in Exposure Profile Characterization in a Litigation Context.....................................1061
A. Creating an Exposure Profile............................................................................................................1061
B. Collecting Data on Potential Exposure Ranges...............................................................................1061
C. Conducting a Qualitative or Quantitative Calculation....................................................................1062
VII. Select References.......................................................................................................................................1062
Exposure Profile Characterization and Dose Reconstruction Validation... ■ Redinger ■ 1053
Exposure Profile Characterization and
Dose Reconstruction Validation:
Frameworks, Correlation with Fiber Burden
Studies, and Litigation Considerations
I.Introduction
Retrospective Exposure Assessment (REA) is a term used to describe a bundle of activities associated
with characterizing exposure profiles. This paper presents several topics related to REA, including: the importance of REA in occupational health risk assessment; key REA distinctions; scientific foundation in exposure
assessment science; an REA methodology developed within the American Industrial Hygiene Association
(AIHA); REA validation; and considerations in a litigation context.
A. REA Importance in Occupational Health Risk Assessment
Performing REA’s is an important activity in the occupational health field. It is central to performing
occupation risk assessments. When there is a dose-response relationship between a stressor and an associated
disease outcome, it is necessary to know the level – or amount – of the dose. Determining cumulative dose, or
some would say – cumulative exposure – is what is done in an REA.
The common metric used in REA is the combination of time and concentration. The time component
is typically characterized by the exposure profile duration. The concentration component is characterized by
8-hour time-weighted-averages (8-hr TWA) within the profile. Common metrics are: ppm-year, mg/m3-year,
and f/cc-year.
B. National Academy of Science, Risk Assessment Framework
In the early 1980s, National Academy of Science (NAS) defined a 4-step risk assessment framework
(NAS, 1983). The steps are:
Hazard identification. The determination of whether a particular chemical is or is not causally
linked to particular health effects.
Dose-response assessment. The determination of the relation between the magnitude of exposure
and the probability of occurrence of the health effects in question.
Exposure assessment. The determination of the extent of human exposure before or after application of regulatory controls.
Risk characterization. The description of the nature and often the magnitude of human risk,
including attendant uncertainty.
Conducting and REA is linked to the exposure assessment step. Inherent in this step is looking at
past exposures, or said differently, performing retrospective exposure assessments.
C. National Institute for Occupational Safety and Health and National Cancer
Institute Workshop – Identifying a Need for Methods
In 1990, the National Institute for Occupational Safety and Health (NIOSH), and the National Cancer
Institute (NCI) sponsored a workshop on Retrospective Exposure Assessment for Occupational Epidemiologic
Studies. A robust body of information was presented at the workshop. While many important theoretical and
Exposure Profile Characterization and Dose Reconstruction Validation... ■ Redinger ■ 1055
methodological approaches were presented, several speakers identified the critical need for practical methods that both industrial hygienists and epidemiologists can use to conduct retrospective exposure assessment
(Herrick, 1991; Harris, 1991). Following the workshop, members of the American Industrial Hygiene Association (AIHA) began working on such methods. Some of these, and validation efforts are discussed below.
D. Methods Developement
The work of Gamble and Spirtas (1976) in the 1970s began to create a foundation for the development of
an exposure reconstruction process. They sought to address the problems encountered by industrial hygienists and
epidemiologists in the face of limited historical data. In the 1970s techniques for quantitatively determining inherent toxicity rapidly developed. These authors recognized that performing retrospective health risk assessments
would be quite difficult without a scientifically sound method to reconstruct past exposures to match the quantitative toxicology science. Since that time, the development of retrospective exposure assessment techniques have
been primarily used to enhance epidemiological studies, but today they also have application in computer modeling of workplace exposure controls, aiding regulators in establishing exposure regulations, and providing judges
and juries with information to guide their deliberations on workplace and environmental toxic tort cases.
Since Gamble and Spirtas’ initial work in this area, many papers have been published either considering issues of performing REAs or using them in health risk assessments. While some have focused on
elucidating a narrow aspect of REA, some analyses have had immense public impacts. One example was the
Rinsky, et al (1981), REA that quantified benzene exposures to workers in two American tire plants between
the 1920s and the 1960s and which was used by OSHA to regulate benzene exposures in the mid-1980s.
II. Historical Context and Scientific Foundation
A. Exposure Assessment Context
Retrospective Exposure Assessment has always relied on the foundational tenents of industrial
hygiene and exposure science. The same exposure assessment principles used for current-day and prospective
assessments, apply to retrospective assessments.
Industrial hygienists begin with a determination of the people who can possibly be exposed to the substance of concern. This is accomplished through a substance inventory analysis, process analysis and job task
analysis. The job tasks are matched up against the substance inventory and the work processes. The goal is to
identify the workers who are involved with tasks that can result in exposure with the substance(s) of concern.
The single most important element of matching up the substance inventory, work processes and
job tasks is interviewing the workers directly involved, taking a detailed occupational history, and finding
out what they do or did on the job. Sometimes there is historical company data that can be used when occupational histories are not available. Once the who, what, when, where, and how, of the exposure profile is
established, the patterns of exposure can be analyzed. Determining the frequency, duration and intensity of
exposure provides the essential quantitative input to the REA and permits the industrial hygienist to model
the pattern of exposure of individuals and groups. Where sufficient data exists, a deterministic or stochastic
analysis can yield a reliable exposure profile.
B. Roots in Work of Gamble and Spirtas (1976)
Gamble and Spirtas provided the fundamentals of REA when they published a paper examining
the factors that would be used to perform “occupational epidemiology.” They used basic job classifications
1056 ■ Asbestos Medicine ■ November 2014
to assume exposures though the concept of “average long-term exposure.” They also raised the ideas of “total
dose” and “biological response to total dose” in their work. The concept of using worker cohorts to create
health risk assessments was used by Selikoff ’s (1964) work on asbestos cohorts which led to such publications
as “Dose Response Relationships for Asbestos Related Disease” by Berry and Lewinshon (1979), Mortality
Among Rubber Workers by McMichael, et al (1976) and Rinsky’s (1981) work on pliofilm workers.
C. Berry and Lewinshon (1979) – Exposure-Years
Berry and Lewinshon utilized the process of developing “exposure-years” for re-creations of historical asbestos exposure in lieu of measurement data. They examined the issues surrounding the weighting of
older exposures, particularly given the biological nature of asbestos latency.
D. McMicheal (1976) and Rinski (1981) – Similar Exposure Groups
McMichael developed the process of grouping workers by their occupational titles into retrospective
exposure groups and combining those assumed exposures with duration though use of calendar records. The
finding that their assumptions had some associations with the mortality data led to a strengthened belief that
it was possible to retrospectively re-create exposure estimates without the full use of measurements.
Rinsky took the concept one step further. His team analyzed historical records, interviewed workers, and developed a task-based assessment that led to his creation of retrospective homogeneous exposure
groups. By combining this retrospective homogeneous exposure group concept with scant measurement data
and historical descriptions of exposure control, he was able to assign exposure levels to each group and establish a “cumulative dose” for workers based on task. By matching mortality within task groups to exposures in
task groups, he essentially established an adverse effect level that was used by US Department of Labor’s Occupational Safety and Health Administration to set the benzene permissible exposure limit currently in use.
E. Dement (1983) and Kreibel (1988) – Daily Weighted Average by SEG
Dement, et al combined the idea of retrospectively defined exposure task groups with cumulative dust concepts established for asbestos, and Kreibel, advanced that idea by developing a re-created “daily
weighted average” of exposure categorized by job rather than for an individual worker. Again, when Kreibel
et al, examined how well the exposure estimates agreed with the biological endpoints of concern, which in his
case were pulmonary function in beryllium workers, they found enough agreement with a dose response to
suggest a risk assessment for those endpoints. In the meantime, studies were being performed to assess the
validity of using worker histories and questionnaires to re-create exposure histories and even develop jobbased exposure classifications. Ahlborg (1990) and Bond (1991) found evidence that these approaches were
valid.
Also at this time, the concept of using expert panels to develop ordinal rankings of some of the elements used to reconstruct exposures began to appear in the literature. Dewar (1991) developed one the earliest matrix approaches where jobs tasks and exposure potential were matrixed, and compared that approach to
the combined ordinal ranking scores provided by a panel of experts in exposure assessment. The finding was
that either method has some statistical drawbacks, but by combining the two methods a powerful hybrid was
created. Hornung (1996) analyzed the error inherent in a matrix approach against the error generated by a
panel ranking approach, and found that while there were potential errors generated, the different approaches
produced different uncertainties. He did not find any strong reasons to avoid one approach or another as long
as the potential uncertainties were accounted for in the final analysis.
Exposure Profile Characterization and Dose Reconstruction Validation... ■ Redinger ■ 1057
F. Rappaport (1991) and Seixas/Checkaway (1995) – Statistical Analysis
The early 1990’s also saw the first pure statistical analyses of the different approaches to reconstructing exposures, with Rappaport, and Seixas and Checkaway looking at not only the goal of better exposure
reconstruction, but a new goal of minimizing random and inherent errors. These statistical analyses also
began to examine the concept of using statistics to address data gaps, and in some cases, to complete gaps in
matrices. Sexias and Sheppard (1996) followed up by developing the first look at how Monte Carlo analysis
(code name used for the mathematical simulations use during the Manhattan Project for the development of
the atomic bomb) (US EPA, 1997), could be applied to the REA process. Monte Carlo analysis can be applied
to creating exposure models that model the workplace and address (and help us statistically understand)
many of the uncertainties of real life exposure monitoring—retrospective, real time, or prospective. With the
dramatic improvements in computer power, Monte Carlo analysis brings an high level of quantification to the
development of retrospective exposure data sets.
III. Exposure Reconstruction – A 12-Step Methodology
A. American Industrial Hygiene Association Publications
The American Industrial Hygiene Association (AIHA) published several documents on general exposure assessment and retrospective exposure assessment principles, models and methods. These are:
Ignacio, J.S. and Bullock, W.H. (2006): A Strategy for Assessing and Managing Occupational Exposures. AIHA Press, Fairfax VA.
American Industrial Hygiene Association (2008): Guideline on Occupational Exposure Reconstruction. AIHA Guideline 11. Fairfax, VA.
Keil, C. B. et al (2009): Mathematical Modeling for Estimating Occupational Exposure to Chemicals. Second Edition, AIHA Press, Fairfax, VA. Chapter 17
Armstrong, Thomas W. et. al. (2009): “Exposure Reconstruction.” Mathematical Models for Estimating Occupational Exposures to Chemicals. Second Edition, Chapter 17, 157-186. Fairfax: AIHA Press.
B. Armstrong (2009) – REA Methodology
A 12-step REA methodology is presented in Armstrong et al (2009). The method uses well the established and generally accepted exposure assessment principles reflected in Ignacio (2006), and incorporates
methods, findings, results, and lessons-learned in cited references. The 12-steps are listed and depicted below:
Step 1: Define problem. Determine questions to be answered and establish goals. What is the purpose, what is the hypothesis, what information is necessary to test the hypothesis, identify subjects, chemical and/or agents to be evaluated?
Step 2: List jobs and tasks. Determine locations, processes, products, and time periods as part
of a basic characterization. The probability of exposure should be included when considering
whether a specific job or task needs to included.
Step 3: Exposure pathways. Air, water, soil, and direct contact are all potential exposure pathways.
Routes of entry include dermal, inhalation and oral. One pathway may dominate the model and
inputs and outputs.
Step 4: Gather data. This foundational data includes work histories, monitoring data, process
flow charts, SOPs, process standards, production data, personnel, engineering data, environmental reports, management reports, site visits, interviews, literature, etc.
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Step 5: Select outputs. If monitoring is to be done, determine appropriate validated methods. Is
the assessment numerical, single point, or stochastic? What is the unit or dose metric? Does the
literature report an exposure dose metric?
Step 6: Define SEGs. SEGs are groups having the same general exposure profile because of the
similarity and frequency of the tasks, the materials an processes, and similar way the are performed. SEGs are defined by environmental agents, process, job class, and task.
Step 7: Determine exposure profiles. Set up equations representing exposures or does of interest
that include the relevant exposure parameters; express equations in the basic form of C x t for
each event for estimating total exposure; include modifying factors; use monitoring; use monitoring surrogate data; use average 8-hr TWA; and verify data quality.
Step 8: Compare with benchmarks. Use the occupational exposure limit (OEL) expressed as a
concentration (e.g. ppm, f/cc, mg/m3, etc.) or expressed as total exposures (e.g. 45 yr x OEL).
Compare exposure profiles with disease thresholds or typical, total, lifetime ambient cumulative
exposures. Describe exposure profiles in terms of risk.
Step 9: Review biases, uncertainties, assumptions. Are the exposed assessment outputs (exposure
profiles) reasonable? Is there a need for revisions? Consider performing an uncertainty analysis.
Step 10: Sensitivity analysis/improve the analysis where appropriate and necessary. Which nonsensitive exposure parameters can be discounted after screening level analysis? Possible revisions may be needed for the most sensitive exposure parameters. Sensitivity analysis should be
included as part of a stochastic analysis.
Step 11: Validate. Do the results make sense? Compare the subject biomarkers/pathology or
medical evaluation with results of the exposure reconstruction. Possibly perform exposure
re-creation studies. Compare with alternative assessments performed by other individuals or
groups; and subject analysis to peer review.
Step 12: Report results. Summarize results and their significance. Craft a risk statement. Document and reference all source data.
Exposure Profile Characterization and Dose Reconstruction Validation... ■ Redinger ■ 1059
IV. Validity Frames
It is important to consider the validity of REA outputs. As with the range of REA approaches – qualitatitative to quantitative, and the continuum inbetween – there are several frames through which to address
validity.
A. Face Validity
This is the least scientific measure of validity. It is based on a cursory review by untrained judges to
determine if a metric makes sense from a common sense perspective. Decisions made during the initial stages
of a metrics development effort are based on face validity considerations.
B. Content Validity
This is a subjective measure of how appropriate the items seem to a set of reviewers who have some
knowledge of the subject matter. The assessment of content validity typically involves an organized review
of the metric (or instrument) to ensure that it includes everything it should and does not include anything it
shouldn’t. Content and face validity are very similar and can be confused. In many efforts, face validity considerations are performed in conjunction with content validity considerations.
C. Criterion and Construct Validity
Criterion validity addresses the relationship between an REA output results and another simultaneous assessment of the factor being measured. With construct validity, an assessment is made between the
findings generated from the REA model built and relevant theory and research.
D. Measurement Levels
There are numerous was to characterize exposure and exposure profiles. These range from qualitative
characterizations, such as in terms of “clouds of dust”, to quantitative characterizations, such as those from
industrial hygiene sampling, e.g. mg/m3 or ppm.
Measurements are often described in terms of four measurement levels: nominal, ordinal, interval,
and ratio. In REAs, exposure profiles are typically described at the nominal, ordinal and interval levels.
Nominal measurement tell only what class a unit falls with respect to the property (e.g.male/
female; yes/no). Exposure characterizations, such as “cloud of dust” is a nominal level characterization.
Ordinal measurements determines when one unit has more of a property than does another.
This allows for ranking. Ordinal measures do not indicate how much more of a the property is
present, in terms of a linear scale, simply that more or less is present.
Interval measurements identify when one unit differs by a certain amount of the property from
another. Industrial hygiene sampling data are typically interval data.
Ratio measurements are the same as interval, except that there is a zero point. Temperature is a
good example of a ratio measure.
V. An REA Validation Study Using Asbestos Fiber Burden Data
An REA validation study was initiated by a group of AIHA members in the early 2000s and published
in 2014 (Rasmuson, 2014). A goal of this study was to address criterion validity, as described above.
1060 ■ Asbestos Medicine ■ November 2014
The study included a detailed evaluation of the correlation and linearity of REAs done by a panel of
industrial hygienists and lung burden analysis (LBA) data. The objective of the study was to correlate REA
with asbestos LBA for a large number of cases from varied industries and exposure scenarios; in so doing, to
evaluate the linearity, precision, and applicability of both industrial hygiene exposure reconstruction and LBA;
and to demonstrate validation methods for REA.
A panel of four experienced industrial hygiene raters independently estimated the cumulative
asbestos exposure for 363 cases with limited exposure details in which asbestos LBA had been independently determined. Lung burden analyses for asbestos bodies were performed by a pathologist by both light
microscopy and scanning electron microscopy (SEM) and free asbestos fibers by SEM. Precision, reliability,
correlation, and linearity were evaluated via interclass correlation, regression analysis, and analysis of covariance.
The study found a linear relationships between REA and lung burden analyses were found when
adjustment was made for asbestos fiber-type exposure differences. The intraclass correlation coefficients (ICC)
for the industrial hygiene raters and laboratory analyses were found to be in the excellent range of reliability
and reproducibility.
The authors concluded that both REA and pathology assessment are reliable and complementary predictive methods to characterize asbestos exposures. Correlation analysis between the two methods effectively
validates both REA methodology and LBA procedures within the determined precision.
VI. Considerations in Exposure Profile Characterization in a
Litigation Context
Within a litigation context, and with a specific case, developing an exposure profile can be challenging. There is often variation in testimony, and efforts are made to link historical exposure data to the
wrong exposure group. Several of the key activities associated with conducting an REA, are reinforced here.
These activities are described and supported in the AIHA documents mentioned, as well as in cited references.
A. Creating an Exposure Profile
Exposure Profile is a well established principle. It refers to the totality of an individuals exposure history and includes an assessment of materials worked with, as well as the duration and frequency of the activities. Considerations in creating an Exposure Profile, include: determining what materials did, or may have
contained asbestos that a person worked with or around; and the frequency and duration of the activities.
B. Collecting Data on Potential Exposure Ranges
The exposure data used in an REA is often referred to as “foundation data.” It is a well established
principle that asbestos-related risk assessments need to be based on a cumulative exposure/dose metric. The
use of 8-hour Time Weighted Average (TWA) data is the norm to characterize an Exposure Profile, that captures a range of exposures, for use in an REA and risk determination.
Understanding peak exposures within an exposure profile is important and valuable. However, these
are often a “red herring” as presented in a litigation context. While peak values are part of an exposure profile,
they do not define it.
Exposure Profile Characterization and Dose Reconstruction Validation... ■ Redinger ■ 1061
C. Conducting a Qualitative or Quantitative Calculation
The key outcome of an REA for use in making risk determinations is a cumulative exposure, or dose
metric. In the asbestos risk arena, this metric is fiber/cc-years (f/cc-year). This metric is used in OSHA risk
assessments, as well as risk assessments used by other public health agencies.
Some litigation-related expert reports present exposure profiles using fibers-per-minute or hour. It
is possible to characterize exposure this way, but its relevance is questionable. To make a scientifically sound
risk determination, the metric used is f/cc-years. This metric is not mentioned or suggested the mentioned
reports. The exposure metrics presented (f/cc-min, -hour) can be characterized as instantaneous, “snap-shot”,
or peak exposures. These do not represent the 8-hour TWA metric that is the well established foundation for
making cumulative exposure/dose determinations in an asbestos-related risk assessment.
VII. Select References
Ahlborg, Gunnar (1990): “Validity of exposure data obtained by questionnaire.” Scand J Work Environ Health, 16:284.
American Industrial Hygiene Association (2008): Guideline on Occupational Exposure Reconstruction. AIHA Guideline 11. Fairfax, VA.
Armstrong, Thomas W. et. al. (1996): “Retrospective Benzene and Total Hydrocarbon Exposure
Assessment for a Petroleum Marketing and Distribution Worker Epidemiology Study.” American Industrial
Hygiene Association Journal, 57:333.
Armstrong, Thomas W. et. al. (2009): “Exposure Reconstruction.” Mathematical Models for Estimating Occupational Exposures to Chemicals. Second ed. 157-186. Fairfax: American Industrial Hygiene Association Press.
Ayer, H.E. et. al. (1973): “A Monumental Study – Reconstruction of a 1920 Granite Shed.” American
Industrial Hygiene Association Journal, 34(5):206.
Barnard, Anthony E. (1996); “Retrospective Beryllium Exposure Assessment at the Rocky Flats Environmental Technology Site.” American Industrial Hygiene Assoc. Journal, 57:804.
Bengt, Jarvholm, and Sanden, Ake (1987); “Estimating Asbestos Exposure: A Comparison of Methods.” Journal of Occupational Medicine, 29(4): 361363
Benke, Geza et. al (1997); “Retrospective Assessment of Occupational Exposure to Chemicals in
Community-Based Studies: Validity and Repeatability of Industrial Hygiene Panel Ratings.” International
Journal of Epidemiology, 26(3):635.
Berry, G and Lewinsohn, H.C. (1979): “Dose-Response Relationships for Asbestos-Related Disease:
Implications for Hygiene Standards: Part I – Morbity.” In Health Hazards of Asbestos Exposure, edited by
Selikoff, Irving J. and Hammond, Cuyler. The New York Academy of Science, New York, New York. Page 185.
Bond, Gregory G. (1991); “Validation of Work Histories for the Purpose of Epidemiological Studies.”
Appl. Occup. Environ. Hyg. 6(6), p. 521.
Dement, John M. et. al. (1983); “Exposure and Mortality Among Chrysotile Asbestos Workers. Part I:
Exposure Estimates.” American Journal of Industrial Medicine, 4:399.
Dewar, Ronald (1991): “Loss of Statistical Power Associated with the Use of a Job-Exposure Matrix in
Occupational Case-Control Studies.” Appl. Occup. Environ. Hyg. 6(6), p. 508.
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DiNardi, S.R. (1997): The Occupational Environment – Its Evaluation and Control. AIHA Press, Fairfax, VA.
Dosemeci, et. al. (1994); “Indirect validation of a retrospective method of exposure assessment used
in a nested case-control study of lung cancer and silica exposure.” Occup. Environ. Med., 51:136.
Esmen, Nurtan A. (1979); “Retrospective industrial hygiene surveys.” American Industrial Hygiene
Association Journal, 40:58.
Esmen, Nurtan A. (1991); Analysis of Strategies for Reconstructing Exposures.” Appl. Occup. Environ.
Hyg. 6(6), p. 488.
Esmen, Nuran A. (1998); “Exposure estimation in four major epidemiologic studies in the acrylonitrile industry.” Scand J Environ Health, 24(suppl 2):63.
Gamble, John and Spirtas, Robert (1976); “Job Classification and Utilization of Complete Work Histories in Occupational Epidemiology.” Journal of Occupational Medicine, 18(6):399.
Gerin, Michel, and Siemiatycki, Jack (1991); “The Occupational Questionnaire in Retrospective Epidemiologic Studies: Recent Approaches in Community Studies.” Appl. Occup. Environ. Hyg. 6(6), p. 495.
Hawkes, Allison P. and Wilkins, J.R. (1997); “Assessing agreement between two job-exposure matrices.” Scand J Work Environ Health, 23:140.
Herrick, Robert F., and Stewart, Patricia (1991); “International Workshop on Retrospective Exposure
Assessment for Occupational Epidemiologic Studies – Preface.” Appl. Occup. Environ. Hyg. 6(6), p. 417.
Harris, Robert L. (1991); “Measures to Facilitate Future Epidemiologic Studies.” Appl. Occup. Environ.
Hyg. 6(6), p. 555.
Hornung, Richard W. et. al. (1996); “An Experimental Design Approach to Retrospective Exposure
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Ignacio, J.S. and Bullock, W.H. (2006): A Strategy for Assessing and Managing Occupational Exposures.
AIHA Press, Fairfax VA.
Kauppinen, Timo P. (1991); “Development of a Classification Strategy of Exposure for Industry-Based
Studies.” Appl. Occup. Environ. Hyg. 6(6), p. 482.
Keil, C. B. et al (2009): Mathematical Modeling for Estimating Occupational Exposure to Chemicals.
Second Edition, AIHA Press, Fairfax, VA.
Kriebel, D. et. al. (1988); “Pulmonary function in beryllium workers: assessment of exposure.” British
Journal of Industrial Medicine, 45:83.
Rinsky, Robert A. et. al (1981); “Leukemia in Benzene Workers.” American Journal of Industrial Medicine, 2:217.
Lippmann, Morton (1991); “Research Needs: Retrospective Exposure Assessment for Occupational
Epidemiology.” Appl. Occup. Environ. Hyg. 6(6), p. 550.
McMichael, A.J. et. al. (1976); “Mortality Among Rubber Workers: Relationship to Specific Jobs.”
Journal of Occupational Medicine, 18(3):178.
National Academy of Sciences (1983) : Risk Assessment in the Federal Government : Managing the
Progress. National Academy Press, Washington DC.
Rappaport, S.M. (1991); “Selection of the Measures of Exposure for Epidemiology Studies.” Appl.
Occup. Environ. Hyg. 6(6), p. 448.
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Rappaport, S.M and Smith, T. (1991) : Exposure Assessment for Epidemiology and Hazard Control.
Lewis Publishers, Chelsa, Michigan.
Rasmuson, James O., Roggli, Victor L., Boelter, Fred W., Rasmuson, Eric J., Redinger, Charles F.
(2014): “Cumulative Retrospective Exposure Assessment (REA) as a predictor of amphibole asbestos lung burden: validation of procedures and results for industrial hygiene and pathology estimates.” Inhalation Toxicology, 26(1), 1-13.
Rice, Carol H. (1984); “Reconstruction of Silica Exposure in the North Carolina Dusty Trades.” American Industrial Hygiene Association Journal, 45(10):689.
Rice, Carol H. (1991); “Retrospective Exposure Assessment: A Review of Approaches and Directions
for the Future.” In Exposure Assessment for Epidemiology and Hazard Control, Rappaport, S.M. and Smith,
Thomas J., editors. Lewis Publishers, Inc. , Chelsea, MI. Page 185.
Rinsky, Robert A. et. al (1981); “Leukemia in Benzene Workers.” American Journal of Industrial Medicine, 2:217.
Seixas, Noah S. and Checkaway, Harvey (1995); “Exposure assessment in industry specific retrospective occupational epidemiology studies.” Occupational and Environmental Medicine, 52:625.
Seixas, Noah S. and Sheppard, Lianne (1996); “Maximizing accuracy in precision using individual
and grouped exposure assessments, Scand J Work Environ Health, 22:94.
Seidman, H. I.J. Selikoff and S.K. Gelb (1986): “Mortality Experience of Amosite Asbestos Factory
Workers: Dose Response Relationships 5 to 40 Years After onset of Exposure.” Am J Ind Med,10:479-514.
Selikoff, I.J. et al. (1964); Asbestos Exposure and Neoplasia. JAMA 188:22-26
Selikoff, I.J. and Lee, D.H.K. (1978), Asbestos and Disease. Academic Press. New York, NY.
Stewart, Patricia A. et. al. (1986); “Estimating historical exposure to formaldehyde in a retrospective
mortality study.” Applied Industrial Hygiene, 1(1):34.
Stewart, Patricia A. et. al (1991); “Highlights of the 1980 Leesburg, Virginia International Workshop
on Retrospective Exposure Assessment for Occupational Epidemiology Studies.” Scand J Work Environ Health,
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