Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Franko J [original query] |
---|
Historical shift in pathological type of progressive massive fibrosis among coal miners in the USA
Go LHT , Rose CS , Zell-Baran LM , Almberg KS , Iwaniuk C , Clingerman S , Richardson DL , Abraham JL , Cool CD , Franko AD , Green FHY , Hubbs AF , Murray J , Orandle MS , Sanyal S , Vorajee NI , Sarver EA , Petsonk EL , Cohen RA . Occup Environ Med 2023 80 (8) 425-430 BACKGROUND: Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features. METHODS: We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF. RESULTS: Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF. CONCLUSIONS: Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners. |
Mining tenure and job duties differ among contemporary and historic underground coal miners with progressive massive fibrosis
Zell-Baran L , Go LHT , Sarver E , Almberg KS , Iwaniuk C , Green FHY , Abraham JL , Cool C , Franko A , Hubbs AF , Murray J , Orandle MS , Sanyal S , Vorajee N , Cohen RA , Rose CS . J Occup Environ Med 2022 65 (4) 315-320 OBJECTIVE: To characterize differences in mining jobs and tenure between contemporary (born 1930+, working primarily with modern mining technologies) and historic coal miners with progressive massive fibrosis (PMF). METHODS: We classified jobs as designated occupations (DOs) and non-DOs based on regulatory sampling requirements. Demographic, occupational characteristics, and histopathological PMF type were compared between groups. RESULTS: Contemporary miners (n = 33) had significantly shorter mean total (30.4 years vs. 37.1 years, p = 0.0006) and underground (28.8 years vs. 35.8 years, p = 0.001) mining tenure compared to historic miners (n = 289). Silica-type PMF was significantly more common among miners in non-DOs (30.1% vs. 15.8%, p = 0.03) and contemporary miners (58.1% vs. 15.2%, p < 0.0001). CONCLUSIONS: Primary jobs changed over time with the introduction of modern mining technologies and likely changed exposures for workers. Elevated crystalline silica exposures are likely in non-DOs and require attention. |
Pathology and mineralogy demonstrate respirable crystalline silica is a major cause of severe pneumoconiosis in US coal miners
Cohen RA , Rose CS , Go LHT , Zell-Baran LM , Almberg KS , Sarver EA , Lowers HA , Iwaniuk C , Clingerman SM , Richardson DL , Abraham JL , Cool CD , Franko AD , Hubbs AF , Murray J , Orandle MS , Sanyal S , Vorajee NI , Petsonk EL , Zulfikar R , Green FHY . Ann Am Thorac Soc 2022 19 (9) 1469-1478 RATIONALE: The reasons for resurgent coal workers' pneumoconiosis and its most severe forms, rapidly progressive pneumoconiosis and progressive massive fibrosis (PMF), in the United States (US) are not yet fully understood. OBJECTIVE: To compare the pathologic and mineralogic features of contemporary coal miners suffering severe pneumoconiosis to their historical counterparts. METHODS: Lung pathology specimens from 85 coal miners with PMF were included for evaluation and analysis. We compared the proportion of cases with pathologic and mineralogic findings in miners born between 1910 and 1930 (historical) to those born in or after 1930 (contemporary). RESULTS: We found a significantly higher proportion of silica-type PMF (57% vs. 18%, p<0.001) among contemporary miners compared to their historical counterparts. Mineral dust alveolar proteinosis (MDAP) was also more common in contemporary miners compared to their historical counterparts (70% vs. 37%, p<0.01). In situ mineralogic analysis showed the percentage (26.1% vs. 17.8%, p<0.01) and concentration (47.3 x 108 vs. 25.8 X 108 particles/cm3, p=0.036) of silica particles was significantly greater in specimens from contemporary miners compared to their historical counterparts. The concentration of silica particles was significantly greater when silica-type PMF, MDAP, silicotic nodules, or immature silicotic nodules were present (p<0.05). CONCLUSIONS: Exposure to respirable crystalline silica appears causal in the unexpected surge in severe disease in contemporary miners. Our findings underscore the importance of controlling workplace silica exposure in order to prevent the disabling and untreatable adverse health effects afflicting US coal miners. Primary Source of Funding: Alpha Foundation for the Improvement of Mine Safety and Health, Inc. |
Evidence for environmental-human microbiota transfer at a manufacturing facility with novel work-related respiratory disease
Wu BG , Kapoor B , Cummings KJ , Stanton ML , Nett RJ , Kreiss K , Abraham JL , Colby TV , Franko AD , Green FHY , Sanyal S , Clemente JC , Gao Z , Coffre M , Meyn P , Heguy A , Li Y , Sulaiman I , Borbet TC , Koralov SB , Tallaksen RJ , Wendland D , Bachelder VD , Boylstein RJ , Park JH , Cox-Ganser JM , Virji MA , Crawford JA , Edwards NT , Veillette M , Duchaine C , Warren K , Lundeen S , Blaser MJ , Segal LN . Am J Respir Crit Care Med 2020 202 (12) 1678-1688 INTRODUCTION: Workers' exposure to metalworking fluid (MWF) has been associated with respiratory disease. As part of a public health investigation of a manufacturing facility, we performed paired environmental and human sampling to evaluate cross-pollination of microbes between environment and host and possible effects on lung pathology present among workers. METHODS: Workplace environmental microbiota was evaluated in air and MWF samples. Human microbiota was evaluated in lung tissue samples from workers with respiratory symptoms found to have lymphocytic bronchiolitis and alveolar ductitis with B-cell follicles and emphysema, lung tissue controls, and in skin, nasal and oral samples from 302 workers from different areas of the facility. In vitro effects of MWF exposure on murine B-cells were assessed. RESULTS: Increased similarity of microbial composition was found between MWF samples and lung tissue samples of case workers compared to controls. Among workers in different locations within the facility, those that worked in machine shop area had skin, nasal and oral microbiota more closely related to the microbiota present in MWF samples. Lung samples from four index cases, and skin and nasal samples from workers in machine shop area were enriched with Pseudomonas, the dominant taxa in MWF. Exposure to used MWF stimulated murine B-cell proliferation in vitro, a hallmark cell subtype found in pathology of index cases. CONCLUSIONS: Evaluation of a manufacturing facility with a cluster of workers with respiratory disease supports cross-pollination of microbes from MWF to humans and suggests the potential for exposure to these microbes to be a health hazard. |
Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers
Cummings KJ , Stanton ML , Nett RJ , Segal LN , Kreiss K , Abraham JL , Colby TV , Franko AD , Green FHY , Sanyal S , Tallaksen RJ , Wendland D , Bachelder VD , Boylstein RJ , Park JH , Cox-Ganser JM , Virji MA , Crawford JA , Green BJ , LeBouf RF , Blaser MJ , Weissman DN . Am J Ind Med 2019 62 (11) 927-937 BACKGROUND: A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS: Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS: Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION: This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention. |
Modeling risks of infection with transient maternal antibodies and waning active immunity: application to Bordetella pertussis in Sweden
Feng Z , Glasser JW , Hill AN , Franko MA , Carlsson RM , Hallander H , Tull P , Olin P . J Theor Biol 2014 356 123-32 Serological surveys provide reliable information from which to calculate forces (instantaneous rates) of infection, but waning immunity and clinical consequences that depend on residual immunity complicate interpretation of results. We devised a means of calculating these rates that accounts for passively acquired maternal antibodies that decay or active immunity that wanes, permitting re-infection. We applied our method to pertussis (whooping cough) in Sweden, where vaccination was discontinued from 1979 to 1995. A national cross-sectional serosurvey of antibodies to pertussis toxin, which peak soon after infection and then decay, was conducted shortly after vaccination resumed. Together with age-specific contact rates in Finland, contemporary forces of infection enable us to evaluate the recent assertion that the probability of infection upon contact is age-independent. We find elevated probabilities among children, adolescents and young adults, whose contacts may be more intimate than others. Products of contact rates and probabilities of infection permit transmission modeling and estimation of the intrinsic reproduction number. In contrast to another recent estimate, ours approximates the ratio of life expectancy and age at first infection. Our framework is sufficiently general to accommodate more realistic sojourn distributions and additional lifetime infections. |
Evaluation of the hypersensitivity potential of alternative butter flavorings
Anderson SE , Franko J , Wells JR , Lukomska E , Meade BJ . Food Chem Toxicol 2013 62C 373-381 Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3=17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25-50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers. |
Exposure to triclosan augments the allergic response to ovalbumin in a mouse model of asthma
Anderson SE , Franko J , Kashon ML , Anderson KL , Hubbs AF , Lukomska E , Meade BJ . Toxicol Sci 2012 132 (1) 96-106 During the last decade there has been a remarkable and unexplained increase in the prevalence of asthma. These studies were conducted to investigate the role of dermal exposure to triclosan, an endocrine-disrupting compound, on the hypersensitivity response to ovalbumin (OVA) in a murine model of asthma. Triclosan has had widespread use in the general population as an antibacterial and antifungal agent and is commonly found in consumer products such as soaps, deodorants, toothpastes, shaving creams, mouth washes, and cleaning supplies. For these studies, BALB/c mice were exposed dermally to concentrations of triclosan ranging from 0.75-3% (0.375-1.5 mg/mouse/day) for 28 consecutive days. Concordantly, mice were intraperitoneally injected with OVA (0.9 mcg) and aluminum hydroxide (0.5 mg) on days 1 and 10 and challenged with OVA (125 mcg) by pharyngeal aspiration on days 19 and 27. Compared to the animals exposed to OVA alone, increased spleen weights, OVA-specific IgE, Interleukin (IL)-13 cytokine levels, and lung eosinophils were demonstrated when mice were co-exposed to OVA and triclosan. Statistically significant increases in OVA-specific and non-specific airway hyperreactivity (AHR) were observed for all triclosan co-exposed groups when compared to the vehicle and OVA controls. In these studies exposure to triclosan alone was not demonstrated to be allergenic, however; co-exposure with a known allergen resulted in enhancement of the hypersensitivity response to that allergen, suggesting that triclosan exposure may augment the allergic responses to other environmental allergens. |
Immunotoxicity and allergic potential induced by topical application of dimethyl carbonate (DMC) in a murine model
Anderson SE , Franko J , Anderson KL , Munson AE , Lukomska E , Meade BJ . J Immunotoxicol 2012 10 (1) 59-66 Dimethyl carbonate (DMC) is an industrial chemical, used as a paint and adhesive solvent, with the potential for significant increases in production. Using select immune function assays, the purpose of these studies was to evaluate the immunotoxicity of DMC following dermal exposure using a murine model. Following a 28-day exposure, DMC produced a significant decrease in thymus weight at concentrations of 75% and greater. No effects on body weight, hematological parameters (erythrocytes, leukocytes, and their differentials), or immune cell phenotyping (B-cells, T-cells, and T-cell sub-sets) were identified. The IgM antibody response to sheep red blood cell (SRBC) was significantly reduced in the spleen but not the serum. DMC was not identified to be an irritant and evaluation of the sensitization potential, conducted using the local lymph node assay (LLNA) at concentrations ranging from 50-100%, did not identify increases in lymphocyte proliferation. These results demonstrate that dermal exposure to DMC induces immune suppression in a murine model and raise concern about potential human exposure and the need for occupational exposure regulations. |
Irritancy and allergic responses induced by exposure to the indoor air chemical 4-oxopentanal
Anderson SE , Franko J , Jackson LG , Wells JR , Ham JE , Meade BJ . Toxicol Sci 2012 127 (2) 371-81 Over the last two decades, there has been an increasing awareness regarding the potential impact of indoor air pollution on human health. People working in an indoor environment often experience symptoms such as eye, nose and throat irritation. Investigations into these complaints have ascribed the effects, in part, to compounds emitted from building materials, cleaning/consumer products, and indoor chemistry. One suspect indoor air contaminant that has been identified is the dicarbonyl 4-oxopentanal (4-OPA). 4-OPA is generated through the ozonolysis of squalene and several high volume production compounds that are commonly found indoors. Following preliminary workplace sampling that identified the presence of 4-OPA, these studies examined the inflamatory and allergic responses to 4-OPA following both dermal and pulmonary exposure using a murine model. 4-OPA was tested in a combined local lymph node assay (LLNA) and identified to be an irritant and sensitizer. A Th1-mediated hypersensitivity response was supported by a positive response in the mouse ear swelling test (MEST). Pulmonary exposure to 4-OPA caused a significant elevation in nonspecific airway hyperreactivity, increased numbers of lung associated lymphocytes and neutrophils and increased interferon-gamma production by lung associated lymph nodes. These results suggest that both dermal and pulmonary exposure to 4-OPA may elicit irritant and allergic responses and may help to explain some of the adverse health effects associated with poor indoor air quality. |
Dermal penetration potential of perfluorooctanoic acid (PFOA) in human and mouse skin
Franko J , Meade BJ , Frasch HF , Barbero AM , Anderson SE . J Toxicol Environ Health A 2012 75 (1) 50-62 Recent data, using a murine model, have indicated that dermal exposure to perfluorooctanoic acid (PFOA) induces immune modulation, suggesting that this may be an important route of PFOA exposure. To investigate the dermal penetration potential of PFOA, serum concentrations were analyzed in mice following topical application. Statistically significant and dose-responsive increases in serum PFOA concentrations were identified. In vitro dermal penetration studies also demonstrated that PFOA permeates both mouse and human skin. Investigation into the mechanisms mediating PFOA penetration demonstrated that dermal absorption was strongly dependent upon the ionization status of PFOA. In addition, PFOA solid, but not 1% PFOA/acetone solution, was identified as corrosive using a cultured epidermis in vitro model. Despite its corrosive potential, expression of inflammatory cytokines in the skin of topically exposed mice was not altered. These data suggest that PFOA is dermally absorbed and that under certain conditions the skin may be a significant route of exposure. |
Evaluation of furfuryl alcohol sensitization potential following dermal and pulmonary exposure: enhancement of airway responsiveness
Franko J , Jackson LG , Hubbs A , Kashon M , Meade BJ , Anderson SE . Toxicol Sci 2011 125 (1) 105-15 Furfuryl alcohol is considered by the United States Environmental Protection Agency to be a high volume production chemical with over 1 million pounds produced annually. Due to its high production volume and its numerous industrial and consumer uses there is considerable potential for work-related exposure, as well as exposure to the general population, through pulmonary, oral, and dermal routes of exposure. Human exposure data reports a high incidence of asthma in foundry mold workers exposed to furan resins, suggesting potential immunologic effects. Although furfuryl alcohol was nominated and evaluated for its carcinogenic potential by the National Toxicology Program, studies evaluating its immunotoxicity are lacking. The studies presented here evaluated the immunotoxic potential of furfuryl alcohol following exposure by the dermal and pulmonary routes using a murine model. When tested in a combined irritancy local lymph node assay (LLNA), furfuryl alcohol was identified to be an irritant and mild sensitizer (EC3 = 25.6%). Pulmonary exposure to 2% furfuryl alcohol resulted in enhanced airway hyperreactivity, eosinophilic infiltration into the lungs, and enhanced cytokine production (IL-4, IL-5 and IFN-gamma) by ex vivo stimulated lung-associated draining lymphoid cells. Airway hyperreactivity and eosinophilic lung infiltration were augmented by prior dermal exposure to furfuryl alcohol. These results suggest that furfuryl alcohol may play a role in the development of allergic airway disease and encourages the need for additional investigation. |
Potential immunotoxicological health effects following exposure to COREXIT 9500A during cleanup of the Deepwater Horizon oil spill
Anderson SE , Franko J , Lukomska E , Meade BJ . J Toxicol Environ Health A 2011 74 (21) 1419-30 Workers involved in the Deepwater Horizon oil spill cleanup efforts reported acute pulmonary and dermatological adverse health effects. These studies were undertaken to assess the immunotoxicity of COREXIT 9500A, the primary dispersant used in cleanup efforts, as a potential causative agent. COREXIT 9500A and one of its active ingredients, dioctyl sodium sulfosuccinate (DSS), were evaluated using murine models for hypersensitivity and immune suppression, including the local lymph node assay (LLNA), phenotypic analysis of draining lymph node cells (DLN), mouse ear swelling test (MEST), total serum immunoglobulin E (IgE), and the plaque-forming cell (PFC) assay. Dermal exposure to COREXIT 9500A and DSS induced dose-responsive increases in dermal irritation and lymphocyte proliferation. The EC3 values for COREXIT 9500A and DSS were 0.4% and 3.9%, respectively, resulting in a classification of COREXIT 9500A as a potent sensitizer and DSS as a moderate sensitizer. A T-cell-mediated mechanism underlying the LLNA was supported by positive responses in the MEST assay for COREXIT and DSS, indicated by a significant increase in ear swelling 48 h post challenge. There were no marked alterations in total serum IgE or B220+/IgE+ lymph-node cell populations following exposure to COREXIT 9500A. Significant elevations in interferon (IFN)-gamma but not interleukin (IL)-4 protein were also observed in stimulated lymph node cells. The absence of increases in IgE and IL-4 in the presence of enhanced lymphocyte proliferation, positive MEST responses, and elevations in IFN-gamma suggest a T-cell-mediated mechanism. COREXIT 9500A did not induce immunosuppression in the murine model. |
Evaluation of dicarbonyls generated in a simulated indoor air environment using an in vitro exposure system
Anderson SE , Jackson LG , Franko J , Wells JR . Toxicol Sci 2010 115 (2) 453-61 Over the last two decades, there has been increasing awareness regarding the potential impact of indoor air pollution on health. Exposure to volatile organic compounds (VOCs) or oxygenated organic compounds formed from indoor chemistry has been suggested to contribute to adverse health effects. These studies use an in vitro monitoring system called VitroCell, to assess chemicals found in the indoor air environment. The structurally similar dicarbonyls diacetyl, 4-oxopentanal (4-OPA), glyoxal, glutaraldehyde, and methyl glyoxal were selected for use in this system. The VitroCell module was used to determine whether these dicarbonyls were capable of inducing inflammatory cytokine expression by exposed pulmonary epithelial cells (A549). Increases in the relative fold change in mRNA expression of the inflammatory mediators, interleukin (IL)-6, interleukin (IL)-8, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor alpha (TNF-alpha) were identified following exposure to diacetyl, 4-OPA, glyoxal, glutaraldehyde, and methyl glyoxal when compared to a clean air control. Consistent results were observed when the protein levels of these cytokines were analyzed. Exposure to 4-OPA significantly elevated IL-8, IL-6, GM-CSF and TNF-alpha while glutaraldehyde caused significant elevations in IL-6, IL-8 and TNF-alpha. IL-6 and IL-8 were also significantly elevated after exposure to diacetyl, glyoxal and methyl glyoxal. These studies suggest that exposure to structurally similar oxygenated reaction products may be contributing to some of the health effects associated with indoor environments and may provide an in vitro method for identification and characterization of these potential hazards. |
Irritancy and allergic responses induced by topical application of ortho-phthalaldehyde
Anderson SE , Umbright C , Sellamuthu R , Fluharty K , Kashon M , Franko J , Jackson LG , Johnson VJ , Joseph P . Toxicol Sci 2010 115 (2) 435-43 Although ortho-phthalaldehyde (OPA) has been suggested as an alternative to glutaraldehyde for the sterilization and disinfection of hospital equipment the toxicity has not been thoroughly investigated. The purpose of these studies was to evaluate the irritancy and sensitization potential of OPA. The Epiderm Skin Irritation Test was used to evaluate in vitro irritancy potential of OPA and glutaraldehyde. Treatment with 0.4125% and 0.55% OPA induced irritation, while gluteraldehyde exposure at these concentrations did not. Consistent with the in vitro results, OPA induced irritancy, evaluated by ear swelling, when mice were treated with 0.75%. Initial evaluation of the sensitization potential was conducted using the local lymph node assay (LLNA) at concentrations ranging from 0.005% to 0.75%. A concentration-dependent increase in lymphocyte proliferation was observed with a calculated EC3 value of 0.051% compared to that of 0.089%, previously determined for glutaraldehyde. IgE-inducing potential was evaluated by phenotypic analysis of draining lymph node cells and measurement of total and specific serum IgE levels. The 0.1% and 0.75% exposed groups yielded significant increases in the IgE+B220+ cell population in the lymph nodes while the 0.75% treated group demonstrated significant increases in total IgE, OPA-specific IgE, and OPA-specific IgG(1). In addition, significant increases in IL-4 mRNA and protein expression in the draining lymph nodes were observed in OPA treated groups. The results demonstrate the dermal irritancy and allergic potential of OPA and raise concern about the proposed/intended use of OPA as a safe alternative to glutaraldehyde. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 23, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure