Abandon Informed Consent in Favor of Probability-Based, Shared Decision-Making Following the Wishes of a Reasonable Person.

Legally and ethically physicians must provide information to patients so they may make an informed decision about invasive procedures. The problem is who decides what information to provide. Is it the reasonable patient or the reasonable physician? Individual patients and individual physicians may differ from the norm on what is reasonable. This problem may be solved by shared decision-making in which the preferences of the patient and the probability-based knowledge of the physician are used to co-produce an optimal choice. Currently, patients are seldom prepared to engage in shared decision-making, and vestiges of meaningless "informed consent" are common. The present case study illustrates how "reasonable person" survey data may be used by a patient to engage in probability-based, shared decision-making with a surgeon planning to perform a laminectomy. Recommendations include probability-based, shared decision-making training for patients and physicians and improved documentation to facilitate learning.

Comparative pulmonary toxicities of lunar dusts and terrestrial dusts (TiO2 & SiO2) in rats and an assessment of the impact of particle-generated oxidants on the dusts' toxicities.

Humans will set foot on the Moon again soon. The lunar dust (LD) is potentially reactive and could pose an inhalation hazard to lunar explorers. We elucidated LD toxicity and investigated the toxicological impact of particle surface reactivity (SR) using three LDs, quartz, and TiO2. We first isolated the respirable-size-fraction of an Apollo-14 regolith and ground two coarser samples to produce fine LDs with increased SR. SR measurements of these five respirable-sized dusts, determined by their in-vitro ability to generate hydroxyl radicals (•OH), showed that ground LDs > unground LD ≥ TiO2 ≥ quartz. Rats were each intratracheally instilled with 0, 1, 2.5, or 7.5 mg of a test dust. Toxicity biomarkers and histopathology were assessed up to 13 weeks after the bolus instillation. All dusts caused dose-dependent-increases in pulmonary lesions and toxicity biomarkers. The three LDs, which possessed mineral compositions/properties similar to Arizona volcanic ash, were moderately toxic. Despite a 14-fold •OH difference among these three LDs, their toxicities were indistinguishable. Quartz produced the lowest •OH amount but showed the greatest toxicity. Our results showed no correlation between the toxicity of mineral dusts and their ability to generate free radicals. We also showed that the amounts of oxidants per neutrophil increased with doses, time and the cytotoxicity of the dusts in the lung, which supports our postulation that dust-elicited neutrophilia is the major persistent source of oxidative stress. These results and the discussion of the crucial roles of the short-lived, continuously replenished neutrophils in dust-induced pathogenesis are presented.

Informed consent, shared-decision making and a reasonable patient's wishes based on a cross-sectional, national survey in the USA using a hypothetical scenario.

OBJECTIVE: In approximately half the states in the USA, and more recently in the UK, informed consent is legally defined as what a reasonable patient would wish to know. Our objective was to discern the information needs of a hospitalised, 'reasonable patient' during the informed-consent process. DESIGN: We performed a cross-sectional study to develop a survey instrument and better define 'reasonable person' in relation to informed consent in a hypothetical scenario where an invasive procedure may be an option. SETTING: A 10-question survey was administered from April 19 through 22 October 2018 to three groups: student nurses (n=76), health professions educators (n=63) and a US national population (n=1067). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the average intensity, on a 5-point scale, by which survey groups wished to have each of 10 questions answered. The secondary outcome was to discern relationships between survey demographics and the intensity by which participants wanted an answer. RESULTS: Despite substantial demographic differences in the nursing-student group and health-professions-educator group, the average intensity scores were within 0.2 units on nine of 10 questions. The national survey revealed a strong desire to have an answer to each question (range 3.98-4.60 units). It showed that women desired answers more than men and older adults desired answers more than younger adults. CONCLUSIONS: Based on responses to 10 survey questions regarding wishes of people in a situation where an invasive procedure may be necessary, the vast majority want an answer to each question. They wanted to know about all treatment options, risky drugs, decision aids, who will perform the procedure, and the cost. They wanted their advocate present, periodic review of their medical record, a full day to review documents and expected outcomes and restrictions after the procedure.

Predicting Air Quality at First Ingress into Vehicles Visiting the International Space Station.

INTRODUCTION: NASA regularly performs ground-based offgas tests (OGTs), which allow prediction of accumulated volatile pollutant concentrations at first entry on orbit, on whole modules and vehicles scheduled to connect to the International Space Station (ISS). These data guide crew safety operations and allow for estimation of ISS air revitalization systems impact from additional pollutant load. Since volatiles released from vehicle, module, and payload materials can affect crew health and performance, prediction of first ingress air quality is important. METHODS: To assess whether toxicological risk is typically over or underpredicted, OGT and first ingress samples from 10 vehicles and modules were compared. Samples were analyzed by gas chromatography and gas chromatography-mass spectrometry. The rate of pollutant accumulation was extrapolated over time. Ratios of analytical values and Spacecraft Maximum Allowable Concentrations were used to predict total toxicity values (T-values) at first entry. Results were also compared by compound. RESULTS: Frequently overpredicted was 2-butanone (9/10), whereas propanal (6/10) and ethanol (8/10) were typically underpredicted, but T-values were not substantially affected. Ingress sample collection delay (estimated by octafluoropropane introduced from ISS atmosphere) and T-value prediction accuracy correlated well (R2 = 0.9008), highlighting the importance of immediate air sample collection and accounting for ISS air dilution. DISCUSSION: Importantly, T-value predictions were conservative 70% of the time. Results also suggest that T-values can be normalized to octafluoropropane levels to adjust for ISS air dilution at first ingress. Finally, OGT and ingress sampling has allowed small leaks in vehicle fluid systems to be recognized and addressed.Romoser AA, Scully RR, Limero TF, De Vera V, Cheng PF, Hand JJ, James JT, Ryder VE. Predicting air quality at first ingress into vehicles visiting the International Space Station. Aerosp Med Hum Perform. 2017; 88(2):104-113.

Establishment of exposure guidelines for lead in spacecraft drinking water.

BACKGROUND: Setting Spacecraft Water Exposure Guidelines (SWEGs) for lead (Pb) in spacecraft drinking water has special challenges related to estimating the increase in blood lead levels (PbB) due to the release of lead to systemic circulation via microgravity-induced bone loss. METHODS: The effects on the PbB of lead in drinking water (PbW) and lead released from bones, and changes in lead exposure before, during, and after spaceflight, were evaluated using a physiologically based pharmacokinetic model that incorporated environmental lead exposure on Earth and in flight and included temporarily increased rates of osteoporosis during spaceflight. RESULTS: The model predicts that in 2030 (the earliest potential launch date for a long-duration mission), the average American astronaut would have a PbB of 1.7 microg x dl(-1) at launch and that, while in microgravity, PbB levels would decrease at PbW values less than about 9 microg L(-1) because of reduced exposure within the spacecraft to environmental lead. Astronauts with high concentrations of lead stored in bones could experience increases in PbB due to microgravity-accelerated release of lead from bones. While the resultant in-flight PbB would depend on their preflight bone lead levels, their PbB will not be significantly further elevated (< 1 microg x dl(-1)) by consuming water with a PbW of < or = 9 microg x dl(-1). Selection of a SWEG that would not result in an increase in blood lead is prudent given uncertainties about health effects at low exposures. CONCLUSION: A SWEG of 9 microg x L(-1) would protect astronauts on long-duration spaceflights by ensuring that PbB values will not exceed prelaunch levels.

Estimating safe human exposure levels for lunar dust using benchmark dose modeling of data from inhalation studies in rats.

The pulmonary toxicity of airborne lunar dust was assessed in rats exposed by nose-only inhalation to 0, 2.1, 6.8, 20.8 and 60.6 mg/m3 of respirable size lunar dust. Rats were exposed for 6 h/d, 5 d/week, for 4 weeks (120 h). Biomarkers of toxicity were assessed in bronchial alveolar lavage fluid (BALF) collected at 1 d, 1 week, 4 weeks or 13 weeks post-exposure for a total of 76 endpoints. Benchmark dose (BMD) analysis was conducted on endpoints that appeared to be sensitive to dose. The number of endpoints that met criteria for modeling was 30. This number was composed of 13 endpoints that produced data suitable for parametric analysis and 17 that produced non-normal data. Mean BMD values determined from models generated from non-normal data were lower but not significantly different from the mean BMD of models derived from normally distributed data. Thus BMDs ranged from a minimum of 10.4 (using the average BMD from all 30 modeled endpoints) to a maximum of 16.6 (using the average BMD from the most restricted set of models). This range of BMDs yields safe exposure estimate (SEE) values of 0.6 and 0.9 mg/m3, respectively, when BMDs are extrapolated to humans, using a species factor of 3 and extrapolated from a 1-month exposure to an anticipated 6-month lunar surface exposure. This estimate is very similar to a no-observable-adverse-effect-level (NOAEL) determined from the same studies (0.4 mg/m3) and a SEE derived from a study of rats that were intratracheally instilled with lunar dusts (0.5-1.0 mg/m3).

Safe human exposure limits for airborne linear siloxanes during spaceflight.

BACKGROUND: Low molecular weight siloxanes are used in industrial processes and consumer products, and their vapors have been detected in the atmospheres of the Space Shuttle and International Space Station. Therefore, the National Aeronautics and Space Administration (NASA) developed spacecraft maximum allowable concentrations (SMACs) for siloxane vapors to protect astronaut health. Since publication of these original SMACs, new studies and new risk assessment approaches have been published that warrant re-examination of the SMACs. OBJECTIVE: To reevaluate SMACs published for octamethyltrisiloxane (L3) for exposures ranging from 1 hour to 180 days, to develop a 1000-day SMAC, and to expand the applicability of those values to the family of linear siloxanes. METHODS: A literature review was conducted to identify studies conducted since the SMACs for L3 were set in 1994. The updated data were reviewed to determine the sensitive toxicity endpoints, and current risk assessment approaches and methods for dosimetric adjustments were evaluated. RESULTS: Recent data were used to update the original 1-hour, 24-hour, 30-day, and 180-day SMACs for L3, and a 1000-day SMAC was developed to protect crewmembers during future exploration beyond Earth orbit. Group SMACs for the linear siloxane family, including hexamethyldisiloxane (L2), L3, decamethyltetrasiloxane (L4), and dodecamethylpentasiloxane (L5), were set for exposures of 1-hour to 1000 days. CONCLUSION: New SMACs, based on acute pulmonary and neurotoxicity at high doses only achievable with L2 and potential liver effects following longer-term exposures to L2 and L3, were established to protect crewmembers from the adverse effects of exposure to linear siloxanes.

Medical management of a potentially toxic accidental trialkylamine ingestion during spaceflight.

INTRODUCTION: To reduce excessive iodine consumption by astronauts, the National Aeronautics and Space Administration (NASA) has developed various methods of removing residual iodine after iodine-based water purification aboard spacecraft. The Low Iodine Residual System (LIRS) was developed as an iodine removal system for use aboard the space shuttle. This is a case report of an accidental, potentially toxic ingestion by astronauts aboard a space shuttle mission following exposure to contaminated water from LIRS filtration and the medical response operations that followed. CASE REPORT: Astronauts ingested significant levels of trialkylamines from water that had passed through gamma-irradiated, de-iodination resin in the LIRS hardware. Medical response operations included crew evaluations, consultations with toxicologists and systems experts, hardware testing, contaminant evaluation, and close crewmember follow-up. DISCUSSION: Despite the significant ingestion there were no adverse clinical symptoms in any of the exposed astronauts; however, the case highlights a simple pitfall in the classification of hardware that ultimately lead to a potentially harmful toxic ingestion among the crewmembers, and the real-time response of medical personnel to ensure crew safety.

Toxicity of lunar dust assessed in inhalation-exposed rats.

Humans will again set foot on the moon. The moon is covered by a layer of fine dust, which can pose a respiratory hazard. We investigated the pulmonary toxicity of lunar dust in rats exposed to 0, 2.1, 6.8, 20.8 and 60.6 mg/m(3) of respirable-size lunar dust for 4 weeks (6 h/day, 5 days/week); the aerosols in the nose-only exposure chambers were generated from a jet-mill ground preparation of a lunar soil collected during the Apollo 14 mission. After 4 weeks of exposure to air or lunar dust, groups of five rats were euthanized 1 day, 1 week, 4 weeks or 13 weeks after the last exposure for assessment of pulmonary toxicity. Biomarkers of toxicity assessed in bronchoalveolar fluids showed concentration-dependent changes; biomarkers that showed treatment effects were total cell and neutrophil counts, total protein concentrations and cellular enzymes (lactate dehydrogenase, glutamyl transferase and aspartate transaminase). No statistically significant differences in these biomarkers were detected between rats exposed to air and those exposed to the two low concentrations of lunar dust. Dose-dependent histopathology, including inflammation, septal thickening, fibrosis and granulomas, in the lung was observed at the two higher exposure concentrations. No lesions were detected in rats exposed to ≤6.8 mg/m(3). This 4-week exposure study in rats showed that 6.8 mg/m(3) was the highest no-observable-adverse-effect level (NOAEL). These results will be useful for assessing the health risk to humans of exposure to lunar dust, establishing human exposure limits and guiding the design of dust mitigation systems in lunar landers or habitats.

A new, evidence-based estimate of patient harms associated with hospital care.

OBJECTIVES: Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011. METHODS: A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm. RESULTS: Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. CONCLUSIONS: The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients' voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.

Estimate of safe human exposure levels for lunar dust based on comparative benchmark dose modeling.

Brief exposures of Apollo astronauts to lunar dust occasionally elicited upper respiratory irritation; however, no limits were ever set for prolonged exposure to lunar dust. The United States and other space faring nations intend to return to the moon for extensive exploration within a few decades. In the meantime, habitats for that exploration, whether mobile or fixed, must be designed to limit human exposure to lunar dust to safe levels. Herein we estimate safe exposure limits for lunar dust collected during the Apollo 14 mission. We instilled three respirable-sized (∼2 µ mass median diameter) lunar dusts (two ground and one unground) and two standard dusts of widely different toxicities (quartz and TiO2) into the respiratory system of rats. Rats in groups of six were given 0, 1, 2.5 or 7.5 mg of the test dust in a saline-Survanta® vehicle, and biochemical and cellular biomarkers of toxicity in lung lavage fluid were assayed 1 week and one month after instillation. By comparing the dose--response curves of sensitive biomarkers, we estimated safe exposure levels for astronauts and concluded that unground lunar dust and dust ground by two different methods were not toxicologically distinguishable. The safe exposure estimates were 1.3 ± 0.4 mg/m³ (jet-milled dust), 1.0 ± 0.5 mg/m³ (ball-milled dust) and 0.9 ± 0.3 mg/m³ (unground, natural dust). We estimate that 0.5-1 mg/m³ of lunar dust is safe for periodic human exposures during long stays in habitats on the lunar surface.

Prediction of crew health effects from air samples taken aboard the International Space Station.

INTRODUCTION: Spaceflight aboard the International Space Station (ISS) involves stays of individual crewmembers for up to 6 mo during which they are exposed to a complex mixture of airborne pollutants. Methods to predict specific health effects from exposure to a mixture of air pollutants are not well developed. Herein, air monitoring data from the ISS are used to demonstrate a new method to estimate a threshold for possible health effects from exposure to mixtures. METHODS: An empirical, additive approach was developed to transform monthly air pollutant data, which had been obtained primarily by gas chromatography-mass spectrometry from samples of ISS air, to threshold (T) values for 16 adverse health effect groups. Spacecraft maximum allowable concentrations (SMACs), available for most spacecraft air pollutants, were used to form target-organ/effect groups, from which group T values were estimated. If T >1 for a group, then there is an unacceptable risk of the toxic effect. RESULTS: Samples of air taken from the ISS in 2010 revealed that all 16 toxicological groups were within safe limits. Highest T values were as follows: mucosal irritants (0.53 +/- 0.44), headache (0.52 +/- 0.06), central nervous system depression (0.25 +/- 0.06), and cardiac sensitization (0.13 +/- 0.04). DISCUSSION: The additive model is supported by limited inhalation data on rats in the literature. Our predictions of no adverse effect on crew health are useful as part of NASA's Lifetime Surveillance of Astronaut Health (LSAH). If one of the 16 levels had exceeded T=1, then standard surveillance could be supplemented to address this potential health risk.

Ocular toxicity of authentic lunar dust.

BACKGROUND: Dust exposure is a well-known occupational hazard for terrestrial workers and astronauts alike and will continue to be a concern as humankind pursues exploration and habitation of objects beyond Earth. Humankind's limited exploration experience with the Apollo Program indicates that exposure to dust will be unavoidable. Therefore, NASA must assess potential toxicity and recommend appropriate mitigation measures to ensure that explorers are adequately protected. Visual acuity is critical during exploration activities and operations aboard spacecraft. Therefore, the present research was performed to ascertain the ocular toxicity of authentic lunar dust. METHODS: Small (mean particle diameter = 2.9 ± 1.0 µm), reactive lunar dust particles were produced by grinding bulk dust under ultrapure nitrogen conditions. Chemical reactivity and cytotoxicity testing were performed using the commercially available EpiOcularTM assay. Subsequent in vivo Draize testing utilized a larger size fraction of unground lunar dust that is more relevant to ocular exposures (particles <120 µm; median particle diameter = 50.9 ± 19.8 µm). RESULTS: In vitro testing indicated minimal irritancy potential based on the time required to reduce cell viability by 50% (ET50). Follow-up testing using the Draize standard protocol confirmed that the lunar dust was minimally irritating. Minor irritation of the upper eyelids was noted at the 1-hour observation point, but these effects resolved within 24 hours. In addition, no corneal scratching was observed using fluorescein stain. CONCLUSIONS: Low-titanium mare lunar dust is minimally irritating to the eyes and is considered a nuisance dust for ocular exposure. No special precautions are recommended to protect against ocular exposures, but fully shielded goggles may be used if dust becomes a nuisance.

Acceptable levels for ingestion of dimethylsilanediol in water on the International Space Station.

INTRODUCTION: Water is recovered aboard the International Space Station (ISS) from humidity condensate and treated urine. The product water is monitored for total organic carbon (TOC). In 2010 the TOC readings indicated that a new contaminant had entered the potable water and was steadily increasing toward the TOC screening limit of 3 mg x L(-1). In a ground-based laboratory, chemists discovered that dimethylsilanediol (DMSD) was the principal new contaminant. As no standard existed for safe levels of DMSD in water, the Toxicology Office at Johnson Space Center was asked to set such a standard. METHODS: The Toxicology Office used methods developed over the past decade, in collaboration with the National Research Council Committee on Toxicology, for setting Spacecraft Water Exposure Guidelines (SWEGs). These methods require a thorough literature search and development of an acceptable concentration (AC) for each potential toxic effect, keeping in mind that the adverse effects that accompany spaceflight could increase toxicity for certain end points. Benchmark dose modeling was encouraged if sufficient data were available. The most sensitive AC becomes the driver for the SWEG. RESULTS: Hematotoxicity, hepatotoxicity, and possibly neurotoxicity were the most sensitive toxicological endpoints for DMSD. CONCLUSIONS: The SWEG for DMSD for 100 d of ingestion was set at 35 mg x L(-1), which is equivalent to 9 mg x L(-1) as TOC. This is well above the TOC SWEG of 3 mg x L(-1) and the peak DMSD level of processed water observed on orbit, which was 2.2 mg x L(-1) asTOC (8.5 mg x L(-10 of DMSD).

Space toxicology: protecting human health during space operations.

Space toxicology is a unique and targeted discipline for spaceflight, space habitation, and occupation of celestial bodies including planets, moons, and asteroids. Astronaut explorers face distinctive health challenges and limited resources for rescue and medical care during space operation. A central goal of space toxicology is to protect the health of the astronaut by assessing potential chemical exposures during spaceflight and setting safe limits that will protect the astronaut against chemical exposures while in a physiologically altered state. In order to maintain sustained occupation in space on the International Space Station (ISS), toxicological risks must be assessed and managed within the context of isolation, continuous exposures, reuse of air and water, limited rescue options, and the need to use highly toxic compounds for propulsion and other purposes. As we begin to explore other celestial bodies, in situ toxicological risks, such as inhalation of reactive mineral dusts, must also be managed.

Toxicity of lunar and martian dust simulants to alveolar macrophages isolated from human volunteers.

NASA is planning to build a habitat on the Moon and use the Moon as a stepping stone to Mars. JSC-1, an Arizona volcanic ash that has mineral properties similar to those of lunar soil, is used to produce lunar environments for instrument and equipment testing. NASA is concerned about potential health risks to workers exposed to these fine dusts in test facilities. The potential toxicity of JSC-1 lunar soil simulant and a Martian soil simulant (JSC-Mars-1, a Hawaiian volcanic ash) was evaluated using human alveolar macrophages (HAM) isolated from volunteers; titanium dioxide and quartz were used as reference dusts. This investigation is a prerequisite to studies of actual lunar dust. HAM were treated in vitro with these test dusts for 24 h; assays of cell viability and apoptosis showed that JSC-1 and TiO2 were comparable, and more toxic than saline control but less toxic than quartz. HAM treated with JSC-1 or JSC-Mars 1 showed a dose-dependent increase in cytotoxicity. To elucidate the mechanism by which these dusts induce apoptosis, we investigated the involvement of scavenger receptors (SR). Pretreatment of cells with polyinosinic acid, an SR blocker, significantly inhibited both apoptosis and necrosis. These results suggest HAM cytotoxicity may be initiated by interaction of the dust particles with SR. Besides being cytotoxic, silica is known to induce shifting of HAM phenotypes to an immune active status. The immunomodulatory effect of the dust simulants was investigated. Treatment of HAM with either simulant caused preferential damage to the suppressor macrophage subpopulation, leading to a net increase in the ratio of activator (RFD1+) to suppressor (RFD1+7+) macrophages, an effect similar to that of treatment with silica. It is recommended that appropriate precautions be used to minimize exposure to these fine dusts in large-scale engineering applications.

A review of carbon nanotube toxicity and assessment of potential occupational and environmental health risks.

Nanotechnology has emerged at the forefront of science research and technology development. Carbon nanotubes (CNTs) are major building blocks of this new technology. They possess unique electrical, mechanical, and thermal properties, with potential wide applications in the electronics, computer, aerospace, and other industries. CNTs exist in two forms, single-wall (SWCNTs) and multi-wall (MWCNTs). They are manufactured predominately by electrical arc discharge, laser ablation and chemical vapor deposition processes; these processes involve thermally stripping carbon atoms off from carbon-bearing compounds. SWCNT formation requires catalytic metals. There has been a great concern that if CNTs, which are very light, enter the working environment as suspended particulate matter (PM) of respirable sizes, they could pose an occupational inhalation exposure hazard. Very recently, MWCNTs and other carbonaceous nanoparticles in fine (<2.5 microm) PM aggregates have been found in combustion streams of methane, propane, and natural-gas flames of typical stoves; indoor and outdoor fine PM samples were reported to contain significant fractions of MWCNTs. Here we review several rodent studies in which test dusts were administered intratracheally or intrapharyngeally to assess the pulmonary toxicity of manufactured CNTs, and a few in vitro studies to assess biomarkers of toxicity released in CNT-treated skin cell cultures. The results of the rodent studies collectively showed that regardless of the process by which CNTs were synthesized and the types and amounts of metals they contained, CNTs were capable of producing inflammation, epithelioid granulomas (microscopic nodules), fibrosis, and biochemical/toxicological changes in the lungs. Comparative toxicity studies in which mice were given equal weights of test materials showed that SWCNTs were more toxic than quartz, which is considered a serious occupational health hazard if it is chronically inhaled; ultrafine carbon black was shown to produce minimal lung responses. The differences in opinions of the investigators about the potential hazards of exposures to CNTs are discussed here. Presented here are also the possible mechanisms of CNT pathogenesis in the lung and the impact of residual metals and other impurities on the toxicological manifestations. The toxicological hazard assessment of potential human exposures to airborne CNTs and occupational exposure limits for these novel compounds are discussed in detail. Environmental fine PM is known to form mainly from combustion of fuels, and has been reported to be a major contributor to the induction of cardiopulmonary diseases by pollutants. Given that manufactured SWCNTs and MWCNTs were found to elicit pathological changes in the lungs, and SWCNTs (administered to the lungs of mice) were further shown to produce respiratory function impairments, retard bacterial clearance after bacterial inoculation, damage the mitochondrial DNA in aorta, increase the percent of aortic plaque, and induce atherosclerotic lesions in the brachiocephalic artery of the heart, it is speculated that exposure to combustion-generated MWCNTs in fine PM may play a significant role in air pollution-related cardiopulmonary diseases. Therefore, CNTs from manufactured and combustion sources in the environment could have adverse effects on human health.

Research strategies for safety evaluation of nanomaterials, part IV: risk assessment of nanoparticles.

Nanoparticles are small-scale substances (<100 nm) with unique properties and, thus, complex exposure and health risk implications. This symposium review summarizes recent findings in exposure and toxicity of nanoparticles and their application for assessing human health risks. Characterization of airborne particles indicates that exposures will depend on particle behavior (e.g., disperse or aggregate) and that accurate, portable, and cost-effective measurement techniques are essential for understanding exposure. Under many conditions, dermal penetration of nanoparticles may be limited for consumer products such as sunscreens, although additional studies are needed on potential photooxidation products, experimental methods, and the effect of skin condition on penetration. Carbon nanotubes apparently have greater pulmonary toxicity (inflammation, granuloma) in mice than fine-scale carbon graphite, and their metal content may affect toxicity. Studies on TiO2 and quartz illustrate the complex relationship between toxicity and particle characteristics, including surface coatings, which make generalizations (e.g., smaller particles are always more toxic) incorrect for some substances. These recent toxicity and exposure data, combined with therapeutic and other related literature, are beginning to shape risk assessments that will be used to regulate the use of nanomaterials in consumer products.

Pulmonary toxicity of single-wall carbon nanotubes in mice 7 and 90 days after intratracheal instillation.

Nanomaterials are part of an industrial revolution to develop lightweight but strong materials for a variety of purposes. Single-wall carbon nanotubes are an important member of this class of materials. They structurally resemble rolled-up graphite sheets, usually with one end capped; individually they are about 1 nm in diameter and several microns long, but they often pack tightly together to form rods or ropes of microscopic sizes. Carbon nanotubes possess unique electrical, mechanical, and thermal properties and have many potential applications in the electronics, computer, and aerospace industries. Unprocessed nanotubes are very light and could become airborne and potentially reach the lungs. Because the toxicity of nanotubes in the lung is not known, their pulmonary toxicity was investigated. The three products studied were made by different methods and contained different types and amounts of residual catalytic metals. Mice were intratracheally instilled with 0, 0.1, or 0.5 mg of carbon nanotubes, a carbon black negative control, or a quartz positive control and euthanized 7 d or 90 d after the single treatment for histopathological study of the lungs. All nanotube products induced dose-dependent epithelioid granulomas and, in some cases, interstitial inflammation in the animals of the 7-d groups. These lesions persisted and were more pronounced in the 90-d groups; the lungs of some animals also revealed peribronchial inflammation and necrosis that had extended into the alveolar septa. The lungs of mice treated with carbon black were normal, whereas those treated with high-dose quartz revealed mild to moderate inflammation. These results show that, for the test conditions described here and on an equal-weight basis, if carbon nanotubes reach the lungs, they are much more toxic than carbon black and can be more toxic than quartz, which is considered a serious occupational health hazard in chronic inhalation exposures.