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Major routes of exposure of MNPs
The major routes of exposure include ingestion, skin contact, and inhalation. MNPs can remain in the organ of entry or enter systemic circulation to bioaccumulate in various tissues.

Ingestion
Direct ingestion includes drinking water, beer , honey and sugar , table salt  , and indoor airborne particulates falling on open meals. Indirect ingestion includes toothpaste, face wash, scrubs, and soap  and enter systemic circulation.

Contact
This is skin penetration through wounds and pores such as sweat glands and hair follicles as the skin interacts with MNP-contaminated media such as soil or water  and cosmetics mentioned above and enter systemic circulation.

Inhalation
This is indoor and outdoor airborne entry into the respiratory system  from upholstery and household furniture to urban dust, rubber tires and synthetic fibers. MNPs can remain in the lungs or be ingested via mucociliary clearance to enter the systemic circulation.

Occupational exposure to MNPs
The main route of workplace exposure is acute inhalation. Workplace exposure can be high concentration and lasting the duration of a shift and thus short-term whereas exposure outside of work is at low concentration and long-term. The concentration of worker exposure is orders of magnitude higher than the general population (e.g., 4×1010 particles per m3 from extrusion 3D printers versus 50 particles per m3 in the general environment ).

Three Industries were found to have high chronic exposure to airborne MNPs: the synthetic textile industry, the flocking industry, and the plastics industry from the vinyl chloride supplier to the PVC manufacturer.

Manufacturing and processing of plastic

 * 3D printing. Additive Manufacturing processes such as commercial extrusion printing and multi-jet fusion printing using thermoplastics and resin emit MNPs and organic vapors (Volatile Organic Compounds) into the ambient workplace air . There is emerging evidence of allergic, respiratory,, and cardiovascular adverse effects from 3D printing . With desktop printing MNP emissions are printing......For extrusion printing Acrylonitrile butadiene styrene (ABS) filaments emit more MNPs than Polylactic acid (PLA) filaments.
 * Nylon flocking is the process of applying, cutting, sanding and machining of nylon polymers on surfaces where dust emission peaks during air blowing flocked surfaces.
 * Coating utensils and cookware. polytetrafluoroethylene, and high energy or heat processing of plastic products (Bello et al. 2010; Walter et al. 2015).
 * Dust generation occurs in a wide range of settings from composite material machining, drilling , hand-held grinding , and sanding of nanotube-containing composites , and sanding of dental composites , and cutting PVC piping and plastics.
 * PVC and plastic production produces PVC dust.

Environmental and mechanical degradation of plastic

 * Carpet and synthetic fibers. Indoor air contains high concentrations of degraded synthetic fibers with potential exposure to office workers and custodial staff; settled dust is ingested by adults, and particularly children.
 * Wastewater management, Recycling facilities, and Landfills. Plastic goods undergo environmental (weathering) and mechanical degradation and wastewater management  and recycling facilities  and landfills serve as a reservoirs of particulates workers may potentially be exposed to.

Medical plastic

 * Face masks and respirators. Globally up to 7 billion facemasks which amounts to 21,000 tons of synthetic polymer, were estimated to be used daily during the COVID-19 pandemic increasing plastic demand and waste . It is yet unknown if respirable NMP debris on the surface of facemasks poses adverse health effects.
 * Medical plastics include a wide range of products from bags to pharmaceutical containers that leach and expose patients and healthcare workers to MNPs . Further research is needed to assess toxicology and medical significance of MNPs from medical plastics.
 * Respiratory
 * Respiratory
 * Respiratory
 * Respiratory

Mitigating inhalation exposure to MNPs
Also see Health and safety hazards of nanomaterials.

Research from the U.S. National Institute of Occupational Safety and Health (NIOSH) Nanotechnology Research Center (NTRC) show local exhaust ventilation and High Efficiency Particulate Air (HEPA) filtration to be effective mitigation to theoretically filter 99.97% of nanoparticles down to 0.3 microns. As April 2024, there is no established NIOSH Recommended Exposure Limit (REL) for MNPs due to limited data on exposure levels to adverse health effects, the absence of standardization to characterize the heterogeneity of MNPs by chemical composition and morphology, and difficulty in measuring airborne MNPs. And thus, safety measures focus on the hierarchy of controls for nanomaterials with good industrial hygiene to implement source emission control with local exhaust ventilation, air filtration, and nonventilating engineering controls such as substitution with less hazardous materials, administrative controls, Personal Protective Equipment (PPE) for skin and respiratory protection.

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Occupational and Environmental Medicine Residency
Occupational and environmental medicine (OEM) is a specialized field of medicine that focuses on the health and well-being of workers in relation to their work environment and potential environmental exposures. Residency training enables one to practice in the medicine in the following key aspects:

Focus:


 * Work-related injuries and illnesses: OEM physicians diagnose and treat illnesses and injuries caused by work activities or exposures. This could include repetitive stress injuries, exposure to toxic chemicals, dust inhalation, and work-related psychological stress.
 * Prevention: A core aspect of OEM is preventing work-related health problems. This involves identifying workplace hazards, assessing worker health risks, and recommending preventive measures like safe work practices, use of personal protective equipment (PPE), hearing conservation programs, and workplace ventilation improvements.
 * Surveillance: OEM professionals monitor the health of workers over time to identify potential health trends related to workplace exposures.
 * Fitness for duty: They also assess worker fitness for specific jobs considering their physical and mental health capabilities in relation to the job demands.
 * Education: OEM physicians play a role in educating workers, employers, and healthcare providers about occupational hazards and preventive measures.

Expertise:

OEM doctors have a strong understanding of:


 * Occupational and environmental health hazards: This includes knowledge of various chemicals, physical agents (noise, vibration, radiation), and biological agents (viruses, bacteria) that can pose risks in the workplace.
 * Work practices: Familiarity with different work activities and their potential health implications is crucial.
 * Toxicology: Understanding the effects of various exposures on the human body is essential.
 * Occupational safety regulations: Knowledge of relevant safety regulations and guidelines helps ensure workplaces comply with safety standards.
 * Epidemiology: Residency programs require a Master's degree to be completed in tandem. For example, a Master's in Public Health with a concentration in Epidemiology or Biostatistics. Epidemiology is the foundation of public health and helps identify patterns of work-related illnesses and injuries, evaluate interventions, and develop effective prevention strategies.

Workplace Settings:

OEM professionals can be found in various settings, including:


 * Manufacturing facilities
 * Construction sites
 * Healthcare facilities
 * Agriculture
 * Government agencies such as the EPA, NIOSH, OSHA, FDA, the Military, and Intelligence Agencies
 * Environmental consulting firms
 * Private practice

Overall, occupational and environmental medicine plays a vital role in protecting the health and safety of workers by preventing work-related illnesses and injuries, promoting safe work practices, and promoting a healthy work environment.

Occupational and Environmental Medicine Residency Programs
The following is a list of accredited programs in alphabetical order:


 * Duke University - Durham, North Carolina
 * Harvard T.H. Chan School of Public Health - Boston, Massachusetts
 * HealthPartners Occupational & Environmental Medicine Residency - St. Louis Park, Minnesota
 * Icahn School of Medicine at Mount Sinai - New York, New York
 * Johns Hopkins Bloomberg School of Public Health - Baltimore, Maryland
 * Loma Linda University - Loma Linda, California
 * Meharry Medical College - Nashville, Tennessee
 * Occupational Medicine Program University of Alberta - Edmonton, Alberta (Canada)
 * Rutgers Occupational & Environmental Medicine Program - Piscataway, New Jersey
 * Uniformed Services Univ. of the Health Sciences - Bethesda, Maryland
 * United States Army - Fort Rucker, Alabama
 * University of California-San Francisco - San Francisco, California
 * University of California, Irvine - Irvine, California
 * University of Cincinnati Occupational Medicine - Cincinnati, Ohio
 * University of Colorado Denver/Colorado School of Public Health - Aurora, Colorado
 * University of Illinois at Chicago - Chicago, Illinois
 * University of Pennsylvania - Philadelphia, Pennsylvania
 * University of South Florida - Tampa, Florida
 * University of Texas Health Science Center at Houston - Houston, Texas
 * University of Texas Health Science Center at Tyler - Tyler, Texas
 * University of Toronto - Toronto, Ontario (Canada)
 * University of Utah - Salt Lake City, Utah
 * Université de Montréal, Faculté de médecine - Montréal, Quebec (Canada)
 * University of Washington - Seattle, Washington
 * West Virginia University School of Public Health - Morgantown, West Virginia
 * Yale Occupational and Environmental Medicine Program - New Haven, Connecticut

Applying to Occupational and Environmental Medicine Residency Programs
Entering an occupational medicine (OEM) residency program typically involves several steps:

Eligibility Requirements:


 * MD degree (Doctor of Medicine): You must have a Doctor of Medicine (MD) degree from an accredited medical school in the United States or Canada.
 * Residency completion in another specialty (preferred): While not always mandatory, most programs prefer applicants who have already completed a residency program in another clinical specialty, such as internal medicine, family medicine, pediatrics, or emergency medicine. This provides a strong foundation in patient care and clinical skills.
 * U.S. citizenship or work visa (for US programs): If applying to a program in the United States, you'll need to be a US citizen or have an appropriate work visa that allows you to practice medicine.

Application Process:


 * ERAS application: The application process typically occurs through the Electronic Residency Application Service (ERAS) during the fall of your intern year (first year after medical school). This centralized system allows you to apply to multiple programs.
 * Medical school transcript: Your official medical school transcript will be submitted through ERAS.
 * USMLE scores (for US programs): If applying to a program in the United States, you'll need to submit your scores from the United States Medical Licensing Examination (USMLE).
 * Curriculum vitae (CV) or resume: Include your education, professional experience (if any), and relevant skills.
 * Personal statement: This essay allows you to showcase your interest in occupational medicine, your career goals, and any relevant experiences.
 * Letters of recommendation: At least three letters of recommendation are typically required, with at least one from a physician familiar with occupational medicine.

Additional Considerations:


 * Research experience: Although not always mandatory, research experience, particularly in occupational health topics, can strengthen your application.
 * Volunteer work or extracurricular activities: Demonstrating your interest in occupational health through volunteer work or involvement in relevant organizations can be beneficial.
 * Networking: Connecting with occupational medicine professionals at conferences or through professional organizations can be helpful in learning more about the field and potentially getting mentorship.

Selection Process:


 * Review of applications: Programs review applications based on the criteria mentioned above.
 * Interviews: Shortlisted candidates are invited for interviews with faculty and residents at the program. This allows them to assess your fit for their program and your passion for occupational medicine.

Matching Process:


 * The National Resident Matching Program (NRMP): After interviews, you rank your program preferences, and programs rank their applicant preferences. The NRMP then uses an algorithm to match applicants and programs based on these rankings.
 * Outside the Matching Program: For one reason or another, programs may accept candidates outside the match.

Here are some resources that can provide more specific information about occupational medicine residency programs:


 * American College of Occupational and Environmental Medicine (ACOEM): https://acoem.org/Why-OEM/Entering-the-Field/Residents-and-Students This website has a section dedicated to residency programs, including a searchable database of programs and information about the application process.
 * Association of Occupational and Environmental Clinics (AOEC): http://www.aoec.org/ The AOEC website also has resources on occupational medicine residency programs.
 * ERAS website: https://students-residents.aamc.org/applying-residencies-eras/applying-residencies-eras-system This website provides information about the application process through ERAS.

By planning ahead, meeting the eligibility requirements, and preparing a strong application package, you can increase your chances of successfully matching with an occupational medicine residency program.

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work previously done:

National legislation and public organizations

Japan
Japan Industrial Safety and Health Association

Japan's primary occupational safety and health agency is the Japan Industrial Safety and Health Association (JISHA) JISHA is a non-profit organization established under the Industrial Safety and Health Act of 1972. It works closely with the Japanese Ministry of Health, Labor and Welfare (MHLW) the regulatory body, to promote workplace safety and health. The responsibilities of JISHA include: Providing education and training on occupational safety and health, conducting research and surveys on workplace safety and health issues, offering technical guidance and consultations to businesses, disseminating information and raising awareness about occupational safety and health, and collaborating with international organizations to share best practices and improve global workplace safety standards.

The Ministry of Health, Labor and Welfare (MHLW) itself plays a crucial role in overseeing occupational safety and health in Japan. The MHLW is responsible for enforcing the Industrial Safety and Health Act, setting regulations and guidelines, supervising labor inspectors who monitor workplaces for compliance with safety and health standards, and investigating accidents to issuing orders to improve safety conditions.

Additionally, other organizations that play a role in occupational safety and health in Japan include:


 * Japan National Institute of Occupational Safety and Health (JNIOSH): JNIOSH conducts research to support governmental policies in occupational safety and health. The organization categorizes its research into project studies, cooperative research, fundamental research, and government-requested research. Each category focuses on specific themes, from preventing accidents and ensuring workers' health, to addressing changes in employment structure. The organization sets clear goals, develops road maps, and collaborates with the Ministry of Health, Labor and Welfare to discuss progress and policy contributions.
 * Labor Standards Bureau: The labor standard inspection office supervises and guides businesses, inspects manufacturing facilities for safety and compliance, investigates accidents and collects statistics, carries our punishment for safety violations, and pays accident compensation for injured workers.

Worldwide
Among the most prevalent occupational risk factors, the highest attributable deaths in 2016 was long working hours (>50 hours per week) with over 745,000 deaths. In second place was occupational exposure to particulate matter, gases and fumes at over 450,000 deaths, followed by occupational injuries at over 363,000 deaths. In fourth place was occupational exposure to asbestos at over 209,000 deaths and in fifth place occupational exposure to silica at over 42,000 deaths.


 * 1) is it ok to copy/paste a chart from the one of the citation #5 directly into the text like this red chart? Yes, it is but add a link/information on the source. You might also add that information to Occupational fatality -TMorata
 * 2) do I have to create a chart in R or Excel to with the data to make it my own to upload?No, you should be ok to add it.- TMorata