Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jun 2023
The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry.
While the cannabis industry is one of the fastest growing job markets in the United States and globally, relatively little is known about the occupational hazards that cannabis production workers face. Based on the closely related hemp industry and preliminary studies from recreational cannabis grow facilities, there is concern for significant respiratory exposures to bioaerosols containing microbial and plant allergens, chemicals such as pesticides, volatile organic compounds, and other irritant gases. ⋯ Disentangling causal relationships is difficult given the heterogeneity of mixed exposures, diagnostic challenges, and confounding by personal cannabis use. Despite and because of these uncertainties, better regulatory guidance and exposure controls need to be defined in order to reduce the risk of work-related disease.
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Semin Respir Crit Care Med · Jun 2023
Artificial Intelligence in Quantitative Chest Imaging Analysis for Occupational Lung Disease.
Occupational lung disease manifests complex radiologic findings which have long been a challenge for computer-assisted diagnosis (CAD). This journey started in the 1970s when texture analysis was developed and applied to diffuse lung disease. Pneumoconiosis appears on radiography as a combination of small opacities, large opacities, and pleural shadows. ⋯ The tasks of CAD are systematically described as classification, detection, and segmentation of the target lesions. Alex-net, VGG16, and U-Net are among the most common algorithms used in the development of systems for the diagnosis of diffuse lung disease, including occupational lung disease. We describe the long journey in the pursuit of CAD of pneumoconioses including our recent proposal of a new expert system.
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Lung diseases caused by workplace exposure are too often mis- or underdiagnosed due in part to nonexistent or inadequate health surveillance programs for workers. Many of these diseases are indistinguishable from those that occur in the general population and are not recognized as being caused at least in part by occupational exposures. More than 10% of all lung diseases are estimated to result from workplace exposures. ⋯ Where available, prevalence and incidence data are also presented. These diseases are unique in that they are theoretically 100% preventable if appropriate exposure controls and workplace medical surveillance are implemented. This remains a continuing challenge globally and requires steadfast commitment on the part of government, industry, organized labor, and the medical profession.
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Pneumoconioses represent the spectrum of lung diseases caused by inhalation of respirable particulate matter small enough (typically <5-µm diameter) to reach the terminal airways and alveoli. Pneumoconioses primarily occur in occupational settings where workers perform demanding and skilled manual labor including mining, construction, stone fabrication, farming, plumbing, electronics manufacturing, shipyards, and more. Most pneumoconioses develop after decades of exposure, though shorter latencies can occur from more intense particulate matter exposures. ⋯ Close collaboration and information-sharing with the pathologist prior to biopsy is of great importance for diagnosis, as many occupational lung diseases are missed due to insufficient communication. The pathologist has a broad range of analytic techniques including bright-field microscopy, polarized light microscopy, and special histologic stains that may confirm the diagnosis. Advanced techniques for particle characterization such as scanning electron microscopy/energy dispersive spectroscopy may be available in some centers.