Abstract Information & Notes

Professor Tang G. Lee, AAA Date of talk: Thursday, June 19, 2003, 1:30pm

Faculty of Environmental Design

The University of Calgary Phone: 403/220-6608

2500 University Dr. NW Fax: 403/284-4399

Calgary, Alberta T2N 1N4 E-mail: [email protected]

Canada

Major and date of Graduation: Site planning and architecture, 1975

Current Faculty Appointments: Professor of Architecture (Building Science and Environmental Health). Also Adjunct Professor at the University of Manitoba, and visiting scholar at the Lyle center for Regenerative Studies, California State Polytechnic University, Pomona

Current Job Description: Conducting research investigations and teaching environmental health, particularly indoor air quality, building science and sustainability.

Other Information: Conducts comprehensive indoor air quality investigations in an interdisciplinary team for those cases that could not be solved by other indoor air quality consultants. Also designs buildings such as medical clinics, institutions and residences that feature low toxicity.

Disclosure Statement: None

SPEECH TITLE: “Molds in Native Housing and SIDS Potential”

The speaker has provided the information below.

1.) Goals and objectives: To understand the environmental conditions of native housing and its impact on occupant health. To develop appropriate housing design, construction and maintenance of native housing to minimize building deterioration and resulting health impacts.

2.) Outline of talk/abstract: Many native houses are built without regards to climate and cultural needs. Premature deterioration of these houses created conditions for microbial amplification. The resulting occupant symptoms reduced their potential for achieving a quality of life and may even aggravate SIDS. Recommendations for proper site planning, design and maintenance is presented.

3.) Conclusion of what is to be learned: Building deterioration will impact occupant health and well-being. Better quality buildings are needed to ensure occupant health.

4.) References:

Wilson, C.E. Sudden infant death syndrome and Canadian Aboriginals: bacteria and infections. FEMS Immunology and Medical Microbiology 25 (1999) 221-226. Federation of European Microbiological Societies, Elsevier Science.

Lee, T.G. and Stooke, T. Mould propagation resulting from air pressure differences across the building envelope. Proceedings of the 9^th International Conference on Indoor Air Quality and Climate (Indoor Air 2002), Monterey, California, June 30 B July 5.

Abstract Information & Notes

William A. Croft, D.V.M., Ph.D. Date of talk: Thursday, June 19, 2003, 2:00pm

Environmental Diagnostic Group Inc. Phone: 715/757-3756

521 Hilltop Dr. Fax: 715/757-9302

Madison, WI 53711 E-mail: [email protected]

Veterinary School Attended: University of Minnesota

Medical School Attended: University of Wisconsin, Madison, Wisconsin

Major and date of Graduation: Ph.D. in Medical Pathology from the University of Wisconsin, Madison, Wisconsin.

Current Job Description: Study Human diseases within the environment from outbreak of human disease as a Medical Pathologist.

Other Information: Was on Faculty of the University of Wisconsin as Medical Pathologist, was accepted by the National Institute of Health as a Medical Pathologist, qualified to research human diseases. Obtain over $900,000 of highly competitive research grants from the national Institute of Health while at the University of Wisconsin.

Disclosure Statement: None

SPEECH TITLE: “Pathology of Trichothecene Mycotoxins in Man”

The speaker has provided the information below.

1.) Goals and objectives: To demonstrate the pathologic changes in the primary target organs after inhalation verses ingestion exposure to Trichothecene Mycotoxins in man.

2.) Outline of talk/abstract: A. History of Mycotoxicosis, B. Detection of "Sick Buildings” ingestion verses inhalation exposure. Signs and Symptoms expressed by over 6,000 patients exposed to Trichothecene Mycotoxins, attempting to establish diagnosis. C. The pathologic changes associated with inhalation exposure to trichothecene mycotoxins. D. The primary organs involved with inhalation Mycotoxicosis.

3.) Conclusion of what is to be learned: The primary target organs of this disease and how this mycotoxin affects every cell in the body.

4.) References:

a. Croft, W.A., Jarvis, B.B., and Yatawara, C.S.,: Airborne Outbreak of Trichothecene Toxicosis, In: Atmospheric Environ, 20(3), 549-552 (1986).

b. Croft, W.A., Jastromski, B.M., Croft, A.L., and Peters, H.A., "Clinical Confirmation of Trichothecene Mycotoxicosis In Patient Urine," In: Journal of Environmental Biology 23(3), 301-320 (2002).

The Pathology of Trichothecene Mycotoxicosis In Humans

1. The Fingerprint of the Agent Causing the Disease is Displayed Within the Cells or Tissue of The Body.

2. Degeneration and Necrosis of The Entire Central Nervous System, Cardiovascular, lung, Digestive Tract, Spleen, Liver, Kidney, Pancreas, Immune, Skin, Reproductive, Eye, Urinary Bladder and Prostate.

3. The Signs and Symptoms Described For Trichothecene Mycotoxicosis Match the Pathology Observed.

4. Every Cell in The Body is Affected or Susceptible to Trichothecene Mycotoxins When Exposed.

5. The Exposed Cells Are Not Allowed to Grow and Make Cellular Products in The Rough Endoplasm Reticulum Represents of First Mechanism of Action on The Cells.

6. The Burning or Denaturation of Tissue From the Epoxide Molecule is Another Mechanism of Action on The Cells of The Body Causing Intense Scarring of Organs. (Like Phenol)

7. The Rapidly Turnover Organs Systems Are Affected The Most Severe, G.I. Tract, Immune System and Reproductive, (like radiation damage)

8. The Central Nervous System is Severely Affected and is A Primary Target Organ. The Neurons in the Cerebral Hemispheres, White and Grey Matter, Brain Stem and even the Ependymal Cells. The Purkinje Cells of The Cerebellum Are Severely Affected That Affect Motion and Balance. The Dorsal and Ventral Motor Neurons Are Destroyed Causing Amyotrophic Lateral Sclerosis. Peroxidation of Peripheral Nerves is Also Observed. The Central Nervous System is The Organ Most Affected as Reported By People Exposed to Toxic Mold.

9. Lack of Cellular Production, Epoxide- Peroxidation of Lipid Membranes, Loss of Vessels, Loss of Oxygen From Severe Lung Scarring, and Loss of Proper Nutrients Due Loss of Functional Absorption of Intestine Affect the Brain and All Organs of The Body.

10. The Trichothecene Mycotoxins are Cumulative in Their Health Effects on Organ Systems.

11. Trichothecene Mycotoxins are “Hit and Run” Poisons and are not Stored in The Body.

12. Inhalation of Trichothecene Mycotoxins Are More Poisonous As Observed by The Intense Scarring of The Alveolar Tissue Than Consumption Due To The Neutralization of Mycotoxin by Bacteria.

13. Depression of the Immune System Allows for Increase Infections by Bacteria, Viral, Fungal and Cancer to Form.

14. Yeasts are allowed to Colonize the Intestine Tract Because They Are Resistant to Trichothecene Mycotoxins.

15. Yeast Can Cause Diabetes Mellitus, Gout and Prevent Proper Liver Function to Detoxify Xenobiotics.

16. Trichothecene Mycotoxins are Released Within the Urine and Feces as Evidenced by The Pathology Observed Within Those Tissues.

17. Children Exposed to Trichothecene Mycotoxins are 100 to 1000 X more susceptible because stems are killed not allowing for additional growth within the individual.

18. There is No Safe Level of Exposure to Trichothecene Mycotoxins.

19. The third Mechanism For Trichothecene Mycotoxicosis is To Develop Anaphylaxis to Mold Allergens When Mycotoxin Leaves The Body.

Dr. William Croft, (Medical Pathologist)

Stages of Mycotoxicosis: For Inhalation of Mycotoxin

The three Stages (1-3) ranging from lower to higher severity of poisoning were modified according to exposure via the air as opposed to ingestion already established (Forgacs et al., 1962; Joffe, 1971). A separate Stage of convalescence occurs when a patient is completely removed from the contaminated premises and the source of mycotoxin or mold spores.

Stage 1: The primary changes are in the brain, respiratory and immune systems, mucus membranes and gastrointestinal tract. Signs and symptoms may include burning sensation in the mouth, tongue, throat, palate, esophagus, and stomach, which is a result of the action of the toxin on the mucous membranes and skin in the exposed areas. Moist areas of the body armpits, under breasts, belt line and groin are more sensitive or first affected. Patients may report burning within the eyes, ears and nose. Patients also reported that their tongues felt swollen and stiff. Mucosa of the oral cavity may be hyperemic. Mild gingivitis, stomatitis, glositis, and esophagitis developed. Inflammation, in addition to gastric and (small and large) intestinal mucosal, resulted in vomiting, diarrhea and abdominal pain. Excessive salivation, headache, dizziness, weakness, fatigue and tachycardia were also present.

There may be fever and sweating. The respiratory system develops burning sensations and congestion. Severe exposure to mycotoxin within the lungs may lead to congestion, edema and failure, due to caustic action. Body temperature remains normal and controllable by the patient. The poisoning appears and disappears relatively quickly in this Stage with the exception of, lungs and central nervous system. Initially (Stage 1), the patient’s symptoms are very uncomfortable or painful. As the poisoning continues and the patient progress toward Stage 2, he or she becomes accustomed to the presence of the mycotoxin and a quiescent period follows due to lack of nerve sensation. Depending on exposure levels, the first Stage may last from 3 - 9 days. In scoring the 50 signs and symptoms listed in Tables-1 and 2, an average score range of 20-45 represents Stage 1.

Stage 2 : This Stage is often called the latent Stage or incubation period because the patient feels apprehensive, but is capable of normal activity in the beginning of this Stage. Every organ of the body is affected by degeneration and necrosis with continued exposure. The primary target organs for an individual become evident over time, due to biological variation. These are disturbances in the central and autonomic nervous systems resulting in headaches, mental depression, loss of short-term memory, loss of problem-solving ability, various neuropsychiatric manifestations, meningism, severe malaise and fatigue, narcolepsy, loss of temperature control, hyperesthesia or numbness of body areas, and cerebellar dysfunction including hypotonia, attitude and gait, dysmetria, asthenia, vertigo, disturbances of speech, and loss of balance (Best, 1961). Spinal cord degeneration may also be observed in gait and reflex abnormalities, such as the ability to drive vehicles, ride bicycles or pass sobriety tests (inability to tolerate ethyl alcohol). Attention deficient disorder may be observed in children. Various systems may include: Eyes: visual disturbances, floating objects, light sensitive, lack of tears, burning and itching. Ears: burning, itching, and loss of hearing. Immune and hematopoietic: progressive loss of white and red cells including a decrease of platelets and hemoglobin, and high susceptibility to bacterial, mycotic and viral infections, debilitating chemical and allergies. Gastrointestinal: metallic taste in mouth, tooth loss, gum problems, stomatitis, sores in gums and throat, nausea, vomiting, diarrhea or constipation, excessive flatulence, abdominal distention, hepatitis, pancreatitis, and diabetes mellitus. Respiratory : burning and bleeding from nasal membranes, respiratory difficulty, asthma, extreme susceptibility to cold, flu and pneumonia. Skin: thinning of hair on head, burning on face, rashes, irritation, and edema. Renal: proteinuria, possible hematuria. Reproductive: irregular ovarian cycles, increased menstrual flow, fibroid growths in uterus, cystic development in mammary glands, and tumors of mammary and prostate glands. Musculoskeletal : somatitis, muscle weakness, spasms, cramps, joint pain, enlargement of joints in hand, and clubbing of fingers. Cardiovascular: chest pain, palpitations, ruptures of atrial walls, myocardial infection and aneurysm of arteries.

The skin and mucous membranes may be icteric, pupils dilated, the pulse soft and labile, and blood pressure may decrease or increase. The body temperature does not exceed 38 degree C and the patient may be afebrile, or chilled. Visible hemorrhagic spots may appear on the skin. Thoughts of suicide may be prominent in the person’s mind at this time or anytime in Stage 2. Human bonding is very important for survival.

Degeneration and hemorrhages of the vessels marks the transition from the second to the third Stage of the disease and may not be consistently observed. The degeneration of the vital organs including serious respiratory insufficiency or asthma and CNS degeneration will take the patient into Stage three along with development of necrotic angina. If exposure continues, depending on exposure levels, Stage 2 may continue from weeks to months or even years until the symptoms of the third Stage develop. Evaluating the 50 signs and symptoms (Table-1 and 2) by assigning a score (0-least intense to 5-most intense or severe) to each symptom, we have determined that an average score range of 45-180 represents Stage 2.

Stage 3: Severe degeneration of the vital organs. The transition from the second to the third Stage is sudden. In this Stage, the patient’s resistance is already low, and violent severe symptoms are present, especially under the influence of stress, or associated with physical exertion and fatigue. The first visible sign of this Stage may be lung, brain or heart failure (heart attack), with or without the appearance of petechial hemorrhage on the skin of the trunk, the axillary and inguinal areas, the lateral surfaces of the arms and thighs, the face and head, and in serious Cases, the chest. The petechial hemorrhages vary from a few millimeters to a few centimeters in diameter. There is increased capillary fragility and any slight trauma may cause the hemorrhages to increase in size.

Aneurysms of the brain or aorta may be observed by angiography. Hemorrhages may also be found on the mucous membranes of the mouth and tongue, and on the soft palate and tonsils. There may be severe interstitial thickening or scarring of the lungs, or respiratory failure. Nasal, gastric and intestinal hemorrhages and hemorrhagic diathesis may occur. Necrotic angina begins in the form of catarrhal symptoms and necrotic changes soon appear in the mouth, throat, and esophagus with difficulty and pain on swallowing. Severe degeneration of the skin on the face, eyelids, and loss of lashes is also often present.

Necrotic lesions may extend to the uvula, gums, buccal mucosa, larynx, vocal cords, lungs, stomach, and intestines and other internal organs such as the liver and kidneys and are usually contaminated with a variety of avirulent bacteria. Bacteria infection causes an unpleasant odor from the mouth due to the enzymatic activity of bacteria on proteins. Areas of necrosis may also appear on the lips and on the skin of the fingers, nose, jaws, and eyes. Regional lymph nodes are frequently enlarged. Esophageal lesions may occur and involvement of the epiglottis may cause laryngeal edema and aphonia (loss of voice). Death may occur by strangulation.

Patients may suffer an acute parenchymatous hepatitis accompanied by jaundice. Bronchopneumonia, pulmonary hemorrhages, and lung abscesses are frequent complications. Tumors may develop of various organs, including skin, urinary bladder, brain, mammary gland, bone, immune, liver, prostate, possibly resulting in death. The most common cause of death is brain failure due to both direct effects of the mycotoxin on the central nervous system and indirect effects due to respiratory failure or lack of oxygen to the brain caused by the severe caustic inflammation (fibrinous exudation) reaction with the lung tissue, rendering it non-functional. Again, using the scoring system represented in Tables-1 and 2, an average score of greater or equal 180 represents Stage 3.

Stage of Convalescence: The course and duration of this Stage 3 depends on the intensity of the poisoning and complete removal of the patient from the premises or source of mycotoxin. Therefore, the duration of the recovery period is variable. There is considerable cellular necrosis and scarring to all major organs of the body in which cells will not regenerate, including the brain, spinal cord, eyes, lung, heart, liver, pancreas, kidney, adrenal, and blood vessels. If the disease is diagnosed during the first Stage, hospitalization is usually unnecessary, but allergies and asthma should be monitored closely. If the disease is diagnosed during the second Stage and even at the transition from the second to third Stages, early hospitalization may preserve the patient’s life. If however, the disease is only detected during the third Stage, death cannot be prevented in most Cases.

1. Croft, W. A., Jastromski, B. M., Croft, A. L., and Peters, H. A., “Clinical

Confirmation of Trichothecene Mycotoxicosis in Patients Urine”, In: Journal of

Environmental Biology 23(3), 301-320 (2002)

2. .Forgacs, J., and W. T. Carll : Mycotoxicoses. In : Advances in Veterinary

Science. Academic Press, New York and London, pp 273-372 (1962).

a) Orienting the building and fenestration for day lighting and ultraviolet light, passive solar and winter heat movement, and passive cooling and prevailing winds;

b) Radon resistant construction practices;

c) Interior spatial arrangement to facilitate movement of building occupants with low stamina and exhaustion of pollutants in a depressurized building;

d) Interior spatial arrangement to isolate sleeping quarters to provide a pollutant-free sanctuary; and

e) Specification of building materials, and interior finishes, fabrics, and equipment to remove contaminants from the interior-breathing zone.

3.) Conclusion of what is to be learned: This environmental education project represents a first attempt to partner with the Environmental Protection Agency to employ student design competitions as a vehicle for disseminating scientific environmental information to post-secondary schools of interior design in the U.S. Fulfilling sponsor expectations for developing a curriculum inclusive of the major threats to human health by indoor air was complicated by conflicting assumptions within the scientific community as to what constitutes environmental disease. Although this curricular tool was successful in providing a thorough overview of indoor air quality design considerations, deliberately retaining the complexity of issues within a multi disciplinary framework challenged the definition of acceptable boundaries for a problem addressed by interior designers. Future efforts to integrate environmental health issues in interior design curricula must balance the need to avoid unidimensional problem solving with limitations to the scope of training for interior design students. Increasing collaboration among schools of design and health sciences to provide opportunities for multi disciplinary problem solving would ensure design solutions are grounded in current knowledge of the effects to health of biological and chemical indoor contaminants.

4.) References: See attached

Teaching Design for Good Indoor Air Quality

Katherine Warsco

East Carolina University

Goals and objectives

The purpose of this speech is to report on the development of an environmental education curriculum that bridges fields of medicine, building science, and design to address indoor air pollution, environmental illness, and interior design. As a result of participation in this curriculum, students of interior design will be able to apply design criteria to address the following issues:

a. Application of non-toxic and radon-resistant construction practices;

b. Removal, isolation, and/or dilution of chemicals released into indoor air by appliances, cleaning solvents, pesticides, and the off gassing of synthetic materials, adhesives, and finishes;

c. Selection and layout of HVAC and lighting systems to avoid the buildup of moisture and the collection of dust;

d. Selection of furniture, cabinetry, and surface finishes that provide inhospitable conditions for microbial growth; and

e. Accessible design of living quarters to facilitate movement by a chemically sensitized client suffering from episodes of reduced stamina and mobility.

Outline

A curriculum was proposed for improving the quality of interior design instruction for addressing indoor air pollution and environmental illness through residential interior design. The purpose of the project was:

a. To develop, disseminate, and implement materials and methods for assisting post-secondary instructors and students of design to increase their knowledge of indoor air quality issues;

b. To promote the application of this knowledge to develop innovative solutions for radon-resistant, non-toxic, and allergy-free interiors; and

c. To provide opportunities for interdisciplinary problem solving, drawing from the fields of medicine, architecture and engineering to address residential design solutions for medically at-risk populations such as the elderly and the infirm.

This project targeted 460 faculty and their students in two- and four-year university interior design programs in the US. The coastal southeast region was the focus of this environmental illness project because the following factors make indoor air quality concerns critical components of the building design process:

a. The population exceeds the national average for age 65 years and older and percent of elderly both in poverty and in poor health;

b. For coastal states such as Florida, housing stock exists with radon levels exceeding EPA limits; and

c. Hot and humid climate conditions increase microbial growth and the release of chemicals that incite toxic and allergic reactions among the hypersensitive.

The vehicle used to improve the quality of interior design instruction was a national student design competition and teacher’s supplement. A competition was developed incorporating requirements for the design of a residential setting for a retired couple who suffered from environmental illness. Included in the competition were the following components linked to principles of environmental design:

a. Site profile. Students were asked to design a retirement residence in Northern Florida in a county where radon gas is prevalent in levels that exceed the EPA limit. The hot, humid micro-climate posed medical problems concerning microbial growth. Lots were selected from a housing development that adheres to tenets of sustainable design in order to integrate principles of enviroscaping (i.e., environmentally safe & energy conscious landscaping practices) and sustainable construction with the residential design problem. Sustainable construction building codes released by the John D. and Catherine T MacArthur Foundation and information from a market survey conducted by the University of Florida Center for Construction and the Environment were made available for use in this competition.

b. Building profile. Students were asked to modify a design given of a Florida Cracker House, a vernacular archetype suitable for hot, humid climates predating mechanized air conditioning and development of synthetic building materials. Focusing on a process of archetypal ideation developed by Ronald Haase, students explored traditional principles of passive cooling to address good indoor air quality.

c. Client profile. Students were given information concerning the needs and characteristics of a hypothetical client family. The medical case histories were based on actual patient case reports from the Environmental Health Center-Dallas, Texas. Students were introduced to medical profiles as a source of information regarding client responses to toxin and allergen exposures within building interiors.

d. Drawings. Site plans, building elevations, foundation plan, roof plan and floorplan were included in hard copy and made available in electronic format. Information was provided to assure compliance with the Southern Building Code regarding foundation design and break-away construction to address the velocity of hurricane-force winds and coastal flooding of the foundation.

e. Resources. Order forms were included for literature and electronic media pertaining to designing for indoor air quality, hot humid climates, and environmental illness.

A supplement to the competition provided a suggested teaching plan for integrating the competition in university instruction. The teaching plan included learning objectives, suggested readings, discussion questions, and examples of student outcomes. In the context of the national design competition, students applied a series of programming exercises to develop solutions for a hypothetical residential problem:

a. Patient Profile. In Table 1, students were required to identify effects of chemical and biological contaminants on building occupants based on patient profiles published in Volume III of William Rea’s Series on chemical sensitivity (Rea, W., 1996). In Table 2, students were required to identify sources, paths of entry and design solutions for chemical and biological irritants based on information provided in the suggested textbook, Your Home, Your Health and Well-Being (Rousseau, Rea, and Enwright, 1990). The purpose of these exercises was to gain understanding of the linkages between pollutant sources in the built environment and medical symptom behaviors of building occupants. Students explored translating medical data into design parameters for use in the process of design ideation for a hypothetical client family.

b. Disability Compensation. In Table 3, students were required to identify the effects of chemical sensitivity on physical dexterity as applied to “The Enabler,” an anthropometric model developed by Ralph Faste (Rashko, B., 1991). The purpose of this exercise was to identify design requirements associated with selective physical disabilities for use in the process of design ideation for a hypothetical client family.

c. IAQ Solutions. In Table 4, students were required to outline design solutions for controlling indoor air quality in the “sanctuary;” the primary sleeping quarters for their hypothetical client couple. In Table 5, students provide a material assessment for client health and well-being. Building materials, finishes and furnishing materials, and building systems (i.e., plumbing, electrical, heating and appliances) were chosen according to a rating-for-safety system developed by Rousseau and Rea (Rousseau, et. al., 1990). Students intertwined issues of materials science with aesthetic considerations in their development of a residential prototype for benign design.

Students applied a series of schematic diagramming exercises to a hypothetical building and residential site located in a hot, humid climate as a means to explore principles from the following areas of design:

a. Micro-Climate Design. Students explored orientation of openings in the architectural shell for daylighting, passive solar and winter heat movement, and passive cooling and prevailing winds to address building occupant thermal comfort, reduce consumption of fossil fuels for heating and cooling, and dilute airborne contaminants in the near environment.

b. Enviroscaping and Sustainable Development. In the manner of case studies of the Kanapaha Botanical Gardens and the Florida House Learning Center, students were required to develop conceptual plot plans. Specification of drought tolerant plants indigenous to the climate minimized irrigation as a habitat for mold and use of chemical fertilizers that were a source of toxins for their chemically sensitive clients.

c. Radon-Resistant Construction Practices. Students explored radon mitigation techniques for homes with above-grade foundations in terrain prone to coastal flooding.

d. Accessible Design. Students considered human activity patterns influenced by loss of stamina, general muscle weakness, and chronic fatigue characteristic of medical conditions of the age and chemical sensitivity of their clients. Structural and nonstructural design solutions were explored to support daily routines of the non-ambulatory and infirm.

e. Non-Toxic, Allergy-Free Design of the “Sanctuary.” Students explored the design of sleeping quarters free of environmental irritants that might interfere with healing and revitalization. Strategies for removing and isolating indoor contaminants were explored with regards to design of mechanical systems, space planning, and specification of furnishings, finishes, equipment, and accessories for residential interiors.

Evaluation of Competition Submissions

Of the 460 competition packets mailed to US members of the Interior Design Educators Council, thirteen universities participated with thirty-nine submissions. Although every region except the Northwest was represented in the competition, three-fourths of the submissions were from universities in hot, humid climates. A three-member jury independently ranked student entries. Criteria used to evaluate submissions included the following:

a. The design solution is appropriate for sustainable development considerations of the climate, terrain, and vernacular archetype (15%)

b. The design solution reflects an accurate and sensitive application of principles of radon-resistant, non-toxic, allergy-free, and accessible design (40%)

c. The solution represents innovative design for the “sanctuary,” addressing specific medical conditions of the clients as explained in the patient profiles of the design program (10%)

These criteria constituted 65% of the overall evaluation score. Winning submissions were selected from top scores, ranging from 81-90/100 points. Jurors provided numerical and open-ended responses to student submissions. Faculty and students participating in the competition received written feedback as to the strengths and weaknesses of each submission according to disciplinary perspectives represented by the jury.

Evaluation of Student Contributions to Teacher’s Supplement

Student outcomes presented as illustration for exercises in the teacher’s supplement received national attention. Conceptual designs prepared by an undergraduate research assistant, Michelle Puckett Jenkins were awarded first place in two national student competitions: a) a call for student design entries sponsored by Affordable Comfort Inc., an interdisciplinary organization that promotes environmentally friendly, energy-efficient, healthy building practices; and b) a national lighting competition sponsored by Cooper/Halo Metalux, Inc. These projects received external validation from juries comprised of educators and practitioners in the fields of building construction, architecture, and mechanical engineering.

Conclusions

This environmental education project demonstrated viable linkages between the arts and sciences in addressing indoor air quality and environmental illness. Employing a student design competition as a vehicle for disseminating scientific environmental information provided a thorough overview of indoor air quality design considerations. Increasing collaboration among schools of design and health sciences to provide opportunities for multidisciplinary problem solving would ensure design solutions would be grounded in current knowledge of the effects to health of biological and chemical indoor contaminants.

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US Environmental Protection Agency. (2001a, May 28, 2002). Healthy Buildings, Healthy People: A Vision for the 21st Century, [Guidance Document]. US Environmental Protection Agency. Available: http://www.epa.gov/iaq/hbhp/index.html [2002, November 11].

US Environmental Protection Agency. (2001b, December 31, 2001). Mold Remediation in Schools and Commercial Buildings, [Guidance Document]. US Environmental Protection Agency. Available: http://www.epa.gov.iaq/pubs [2002, November 11].

Warsco, K. (1997a). Designing for Good Indoor Air Quality in a Hot, Humid Climate: Student Design Competition . Unpublished competition materials prepared for US EPA Environmental Education Grants Program, Washington, D.C.

Warsco, K. (1997b). Teaching Supplement to the Student Design Competition: Designing for Good Indoor Air Quality in a Hot, Humid Climate: Unpublished supplement to competition materials prepared for US EPA Environmental Education Grants Program, Washington, DC.

Waxman, H. A. (1993). The view from congress. EPA Journal, 19(4), 38-39.

Wilson, K. P. (2002). The Case for Green Design. Perspective: Journal of the International Interior Design Association(Winter 2002), 21-26.

Zummos, S. M., & Karol, M. H. (1996). Indoor air pollution: Acute adverse health effects and host susceptibility. Environmental Health, January-February, 25-29.

Abstract Information & Notes

Michael R. Gray, M.D., M.P.H. Date of talk: Thursday, June 19, 2003, 4:30pm

300 S. Ocotillo Phone: 520/586-9111

Benson, AZ 85602 Fax: 520/586-9091

E-mail: [email protected]

Medical School Attended: University of Cincinnati, College of Medicine; University of Illinois School of Public Health

Major and date of Graduation: M.D., 1974; M.P.H., 1978

Residency: 1975-77 Internal Medicine, Cook County Hospital, Chicago, IL; 1977-78 Chief Resident, Internal Medicine, Cook County Hospital, Chicago, IL

Current Job Description: Medical Director, Progressive Healthcare Group, Benson, AZ, 1988-present; Medical Director and Board Chairman, Benson Ambulance Service, Benson, AZ, 1990-present

Other Information: Published several articles

Disclosure Statement: Cholestyramine

SPEECH TITLE: “Mold, Mycotoxins & Public Health: a Clinicians Perspective”

The speaker has provided the information below.

1.) Goals and objectives: To help clinical practitioners recognize and treat systemic illnesses associated with mixed molds and mycotoxins

2.) Outline of talk/abstract: A descriptive epidemiologic survey of the results of clinical evaluations of 250 patients exposed to mixed, toxigenic, structural molds and mycotoxins will be presented

3.) Conclusion of what is to be learned: How to evaluate and manage mycotoxicosis

4.) References: Bibliography provided with handouts.

Mold, Mycotoxins, and Public Health

Michael R. Gray, M.D., Robert C. Crago, Ph.D., Kaye Kilburn, M.D.

Clinical evaluations of 250 patients compiled from 1994-2003, are presented in a clinically based descriptive epidemiologic study with results compared to unexposed controls, general reference ranges, and national databases for multiple parameters measured. Abnormalities of immune function, pulmonary function, and neurocognitive function and impairment, are presented confirming that exposure to mixed toxigenic structural filamentous, terrestrial molds (e.g., Stachybotrys sp., asperigillius/Penicillium sps., Fusarium, etc), and their associated mixed mycotoxins (eg., aflatoxin, rubrotoxin, sterigmatocystin, vomitoxin, tremulotoxin, zearalanone, trycothecenes, T-2 toxin, etc.) collectively induce mycotoxicosis, a clinical syndrome resulting from infectious and toxic neuroimmunopathophysiologic effects. Key features include: immune toxicity with hyper activation and simultaneous suppression, small airways obstruction and reactivity, and neurological toxicity involving multiple neurophysiologic processes (e.g., balance, visual perception, peripheral vision, simple and choice reaction time, blink reflex, etc.).

21st ANNUAL INTERNATIONAL SYMPOSIUM

ON MAN & HIS ENVIRONMENT

SCHEDULE

Friday, June 20, 2003

7:00 a.m. Breakfast with Drucker Labs, Michelangelo Room

8:00 a.m. ANNOUNCEMENTS/MODERATOR: Sherry A. Rogers, M.D.

8:05 Eugene A. Shinn, U.S. Research Geologist, Geological Survey, St. Petersburg, FL: “Update: Transoceanic Soil Dust Transport and Medical Implications”

8:25 Q & A

8:35 Lester Friedlander, B.A., D.V.M., Wyalusing, PA: “Molds and Mycotoxins in the Food Chain”

8:55 Q& A

9:05 Katherine Warsco, Ph.D., Department of Interior Design, East Carolina University, Greenville, NC: “Interior Design for a Mold-Free Environment”

9:25 Q & A

9:35 Aristo Vojdani, Ph.D., M.T., Director, Immunosciences Laboratories, Inc., Beverly Hills, CA: “Immunotoxicology of Molds and Mycotoxins”

9:55 Q & A

10:05 BREAK WITH EXHIBITORS

10:30 Bruce Small, Director of Envirodesic Certification Program, Georgetown, Ontario, Canada: “Prescription for Preventing Mold and for Mold Remediation”

10:50 Q & A

11:00 Martha Stark, M.D., Department of Psychiatry, Harvard Medical School, Boston, MA: “Mysterious Mental Illnesses, Pernicious Poisons”

11:20 Q & A

11:30 John H. Boyles, Jr., M.D., Dayton Ear, Nose & Throat Surgeons Inc., Centerville, OH: “Diagnosis & Treatment of Inhalant and Mold Allergy”

11:50 Q & A

12:00n OPEN LUNCH

MODERATOR: Kaye H. Kilburn, M.D.

1:00 p.m. David C. Straus, Ph.D., Department of Microbiology, Texas Tech University Health Science Center, Lubbock, TX: “The Role of Fungi in Sick Building Syndrome”

1:20 Q & A

1:30 Tapani Tuomi, Laboratory Chief, Finnish Institute of Occupational Health, Helsinki, Finland: “Mycotoxins in Cigarettes and in Tobacco Smoke”

1:50 Q & A

2:00 Mohamed B. Abou-Donia, Ph.D., Duke University Medical Center, Durham, NC: “Acute Exposure to Sarin Increases Blood Brain Barrier Permeability & Induces Neuropathological Changes in the Rat Brain: Dose Response Relationship”

2:20 Q & A

2:30 Sherry A. Rogers, M.D., Medical Director, Northeast Center for Environmental Medicine, Author, Syracuse, N.Y.: “Rescuing the Heart as Toxic Target Organ”

2:50 Q & A

3:00 BREAK WITH EXHIBITORS

3:30 Bruce Jarvis, Ph.D., Department of Chemistry & Biochemistry, University of Maryland, College Park, MD: “History and Toxicology of Mycotoxicoses”

3:50 Q & A

4:00 David C. Straus, Ph.D., Department of Microbiology, Texas Tech University Health Science Center, Lubbock, TX: “Recent Research in Sick Building Syndrome”

4:20 Q & A

4:30 William J. Rea, M.D., Director, Environmental Health Center B Dallas, Dallas, TX: “Treatment of Mold & Mycotoxin Exposure”

4:50 Q & A

5:00 Panel Discussion: “How and when to remodel a moldy building” Donald P. Dennis, M.D., Larry Foster, Professor Tang G. Lee, AAA, David C. Straus, Ph.D., Bruce Small, and Tapani Tuomi

6:00 RECEPTION WITH THE EXHIBITORS

FRIDAY, JUNE 20, 2003

ABSTRACTS

AND

HANDOUTS

Abstract Information & Notes

Lester C. Friedlander, B.A., D.V.M. Date of talk: Friday, June 20, 2003, 8:35am

P.O. Box 534 Phone: 570/746-3072

Wyalusing, PA 18853 Fax: 570/746-1386

E-mail: [email protected]

Undergraduate School Attended: Northland College, Ashland, WI

Araneta University Foundation, College of Veterinary Medicine, Metro Manila, Philippines

Major and date of Graduation: BA, 1971: DVM,1979

Board Certifications: None

Current Faculty Appointments: None

Current Job Description: Independent Researcher, Consultant

Other Information: Chronic Wasting Disease Workshop – Veterinary Professional C.E. UNIV. of Minnesota, College of Veterinary Medicine. Co-Authored: Accumulation 0f 2.8 Dihydroxyadenine in Bovine Liver, Kidneys, and Lymph Nodes. Journal of Veterinary Pathology 28:99-109(1991)

Disclosure Statement: None

SPEECH TITLE: “Molds and Mycotoxins in the Food Chain”

The speaker has provided the information below.

1.) Goals and objectives: To inform and educate health professionals that there are molds and mycotoxins in the foods we eat. Furthermore to explain and list the symptoms of mycotoxins in both humans and animals

2.) Outline of talk/abstract: Please refer to page 2

3.) Conclusion of what is to be learned: There are many mycotoxins in our environments with similar symptoms in humans

4.) References:

1. Black, Kevin. “Aflatoxins in Corn” (Dec. 1996): 2 pag. Online. Internet. 20, Feb. 1997

2. Cheeke, Peter R., Lee R. Shull. ed. Natural Toxicants in Feeds and Poisonous Plants. Westport: AVI Publishing 1985.

3. Hascheck, Wanda M. “Selected Mycotoxins Affecting Animal and Human Health”: Academic Press 2002

4. GIPSA, Technical Services Division: “ Grain Fungal Diseases & Mycotoxin Reference” USDA 2003

5. http://vm.cfsan.fda.gov/~frf/iupac.html

http://www.btny.purdue.edu/NC129/

http://pasture.ecn.purdue.edu/~grainlab/

http://www.ces.ncsu.edu/drought/dro-29.html

http://www.aces.edu/department/grain/ANR767.htm

http://www.ianr.unl.edu/pubs/pesticides/g790.htm

http://www.ipm.iastate.edu/ipm/icm/1998/1-19-1998/btdiscon.html

http://www.scisoc.org/feature/Btcorn/Top.html

Molds and Mycotoxins in the Food Chain

Lester Friedlander, B.A., D.V.M.

1.) Goals and objectives:

To inform and educate health professionals that there are molds and mycotoxins in the foods we eat. Furthermore, to explain and list the symptoms of mycotoxins in both humans and animals.

2.) Outline of talk/abstract:

I. Introduction

A. Condensed History of Mycotoxicology (Early 1960’s to Present)

II. Classification of Mycotoxins

A. Aflatoxins

B. Trichothecenes

C. Fumonisins

D. Zearalenone

E. Ochratoxin A

F. Ergot Alkaloids

III. How We Consume Mycotoxins

A. How mycotoxins get into your Food

1. Growth

2. Storage

3. Transportation

B. Mycotoxins Carried by Animals

1. General Carriers

2. Species Specific

3. Rarities

IV. Conclusion

A. Current Mycotoxin Standards

B. High risk areas

Abstract Information & Notes

Katherine Warsco, Ph.D. Date of talk: Friday, June 20, 2003, 9:05am

East Carolina University Phone: 252/328-6929

152 Rivers Building, ECU Fax: 252/328-4276

Greenville, NC 27834 E-mail: [email protected]

Medical School Attended: NA (Ph.D. College of Human Ecology, Michigan State University)

Major and date of Graduation: Family and Child Ecology, 1988

Residency: NA (Doctoral Internship – Energy Information Administration, US Department of Energy, Washington D.C.)

Current Faculty Appointments: Interior Design Program, School of Human Environmental Sciences, East Carolina University, Greenville, NC

Current Job Description: Chair, Department of Apparel Merchandising and Interior Design, School of Human Environmental Sciences, East Carolina University, Greenville, NC

Other Information: Founder of Environmental Quality in Interiors Network, Interior Design Educators Council

Disclosure Statement: None

SPEECH TITLE: “Interior Design For A Mold-Free Environment”

The speaker has provided the information below.

1.) Goals and objectives: This speech will provide an overview of current thinking within the professional community of interior design with regards to methods of proactive environmental design. Objectives include identifying current >best practices= advice of a general and conceptual nature for the types of mold problems experienced in many homes, schools and office facilities. Current thinking is based on a comparison of philosophical positions of the interior design community evident among practitioners and educators of interior design and agricultural experiment station cooperative extension specialists.

2.) Outline of talk/abstract: Presented here are proactive approaches to achieving mold-free building interiors along with strategies for mold remediation in building interiors resulting from water leakage, condensation, or flooding. Interior design decisions impact prevalence of moisture and nutrient matter through space planning and specification of interior finishes, fabrics, furnishings, and equipment. Also, covered are current efforts in the development of certification programs to rate building materials and interior products. This speech concludes with trade-offs between >best practices= advice and other considerations regarding up-front building costs, building maintenance and operation, and building occupant comfort, health and well-being.

3.) Conclusion of what is to be learned: Interior design practice and education contribute to the prevention and remediation of mold growth in indoor environments. The literature points to a need for interior designers to be educated from a perspective of eco-materialism that links indoor material choices to building occupant health.

4.) References: See attached

Interior Design For A Mold-Free Environment

Katherine Warsco, Ph.D.

East Carolina University

Goals and objectives

This speech will provide an overview of current thinking within the professional community of interior design with regards to methods of proactive environmental design. Objectives include identifying current ‘best practices’ advice of a general and conceptual nature for the types of mold problems experienced in many homes, schools and office facilities. Current thinking is based on a comparison of philosophical positions of the interior design community evident among practitioners and educators of interior design and agricultural experiment station cooperative extension specialists.

Presented here are proactive approaches to achieving mold-free building interiors along with strategies for mold remediation for moisture intrusion due to water leakage, condensation, and flooding. The US Environmental Protection Agency and East Carolina University supported the development of an environmental education curriculum. A design competition and teacher’s supplement were developed to assist educators and students of interior design to explore linkages between microclimate, architectural shell, interior space plan, mechanical systems, materials specification, indoor air quality, and environmental illness. Excerpts from student submissions to this competition, shown in this presentation serve to illustrate interior design for a mold-free environment.

Proactive Approach

Interior design decisions impact prevalence of moisture and nutrient matter that support microbial growth through space planning of the building interior and specification of interior finishes, furnishings, fabrics, and equipment. Strategies for removing, isolating, and diluting moisture and nutrient matter in the building interior follow two schools of thought; they typically either focus on the natural environment (i.e., healthy planet), or they focus on the interaction of the building and the building occupant (i.e., healthy people). Architectural and engineering ventilation strategies illustrate these approaches. A ‘healthy planet’ design approach might use a negative pressurized architectural shell that maximizes airflow through interior breathing zones. Benefits to the planet include reduced fossil fuel consumption for heating, ventilating and air conditioning. A ‘healthy people’ design approach might use a positive pressurized architectural shell that balances and filters airflow within interior breathing zones. Although ventilation strategies are largely within the domains of architecture and engineering, Interior design decisions intertwine with those of allied building fields to impact the ultimate success of these approaches to address mold-free design.

Ventilation (dilution) strategies are addressed through space planning and design of mechanical systems.

a. Arranging fenestration and interior partitions to facilitate natural ventilation will dry moisture-laden areas and exhaust indoor contaminants.

b. Arranging air inlets and air outlets to facilitate cross-ventilation will dry moisture-laden stored items and exhaust indoor contaminants.

c. Specifying fans will exhaust moisture-laden air prevalent in rooms such as kitchens, bathrooms, hobby rooms, and utility rooms.

d. Specifying air-to-air exchanger units can be used to filter incoming air for interior living spaces and to exhaust contaminants at their source.

The arrangement of interior spatial volumes in conjunction with openings in the architectural shell of a building can impact moisture intrusion and dissipation.

Maximizing day lighting and solar gain in the interior will retard microbial growth.
Planning for adequate space to ensure airflow around furnishings will dry moisture-laden areas.
Providing transitional zones such as vestibules, air lock entries, mudrooms, or breezeways to shed contaminants from outer garments and footwear reduces airborne contaminants entering living areas.

The specification of interior products contributes to prevalence of moisture and nutrient matter within the breathing zones of buildings. Specification of products includes interior finishes, fabrics, furnishings & equipment.

Specifying porous wall coverings on perimeter interior walls will allow surfaces with temperature differences to ‘breathe.’
Specifying wall materials so that permeability increases from exterior cladding to interior finish will allow moisture within the wall cavity to dissipate.
Specifying non-porous finishes for interior walls with low temperature difference between rooms can avoid entrapment of moisture and organic materials due to activities of the building occupant.
Specifying nonporous, continuous work surfaces will avoid entrapment of moisture and organic materials.
Specifying non-fleecy interior surfaces and designing built-in furniture reduces surface-to-volume ratio for collection of dust and the sink effect of VOCs.
Specifying non-fleecy fabrics and designing built-in window treatments reduces surface-to-volume ratio for collection of dust and sink effect of VOCs.
Specifying finishes and fabrics that easily can be cleaned (laundered or wiped clean) will prevent build up of contaminants.
Specifying non-cellulose materials such as ceramic, glass, and metal decreases hospitable habitats for microbial growth.
Specifying open storage containers will allow stored items to ‘breathe’.
Specifying upholstery with open construction allows for air movement and dissipation of body heat.

Reactive Approach

Strategies to minimize exposure to contaminants in indoor air as a result of moisture intrusion focus on their removal, isolation, and dilution. These strategies are a response to flooding and damage control for water leakage and condensation.

Drying contaminated materials with daylight and air and exposing contaminated materials to ultraviolet light will kill mold.
Depressurizing the building through exhaust fans and natural ventilation will dry wet materials.
Elevating the building to facilitate airflow in the crawl space will retard microbial growth.
Encapsulating fungi embedded in organic materials will prevent their exposure to interior breathing zones.
Cleaning, drying, sealing, and maintaining the building will prevent damage from water intrusion and microbial growth.
Pressurizing the interior with central air systems can prevent infiltration of ambient pollutants and dormant spores within cavities of the architectural shell.
Drying, cleaning, and disinfecting nonporous interior products will kill mold and remove dormant fungal spores.
Disposing of porous interior products such as bedding, upholstery, thermoplastics draperies, softwoods, and paper products will remove interiors furnishings and accessories with embedded mold.
Seeking restoration specialists to remove mold and dormant fungal spores from porous products can preserve valuable belongings.

Caveats to ‘best practices’ advice

Important trade-offs should be factored into design decisions between ‘best practices’ advice and other considerations regarding upfront building costs, building maintenance and operation, and building occupant comfort, health and well-being. These considerations are relevant to ventilation strategies and specification of interior products.

Procedures for operating mechanical systems, designing passive convection systems, and tightening the architectural shell to address reductions in energy consumption can be counterproductive to occupant health.

Strategies to address energy efficiency can result in high relative humidity for indoor air conducive to growth of molds (e.g., cycling air with no cooling or heating on weekends; bringing in unfiltered ambient air in humid climates via passive convection).
Negative air pressure fans used to exhaust moisture also can draw dormant spores out of crawl spaces and wall cavities into interior breathing zones.
Negative air pressure caused by inadequate ventilation in tightly sealed buildings may cause back drafts from combustion appliances and equipment, releasing pollutants into indoor air.

Decisions regarding the selection of interior products can be counterproductive to occupant health with regards to building occupants with heightened sensitivities to noise pollution, allergens and toxins.

Acoustics - specifying non-fleecy surfaces may increase transmission of unwanted sounds.
Chemical sensitivity - using chemicals for cleaning and in finishes that retard microbial growth (e.g., fungicides, bleach, and desiccants) may trigger allergic or toxic response.
Maintenance - interior finishes specified in office and hotel facilities for their ease of maintenance often have a low permeability rating. Inability of exterior wall cavities to ‘breathe’ can result in condensation and growth of mold.

Certification Programs & Consultancies

Certification programs and consultancies have emerged in the fields of building sciences and industrial hygiene. Current efforts in the development of certification programs to rate building materials and interior products include the following:

a. Leadership in Energy and Environmental Design (LEED) program is a voluntary certification program that analyzes content of building materials in new facilities (US Green Building Council, 2002; Mendler, 2002). Beginning with exterior materials, the program is currently focusing on interior materials for commercial buildings and eventually will develop a materials rating system for remodeling of old buildings. Criteria of this program include recycled content, energy efficiency, and VOC emissions.

b. Air Quality Sciences, Inc. has a Greenguard certification program that rates building materials according to biologicals and toxins (Air Quality Sciences, Inc., 2002).

c. Industrial Hygiene association regulates a mold remediation certification program that has been developed along the lines of asbestos removal and radon mitigation (American Industrial Hygiene Association’s EMLAP Program).

d. McDonough Braungart Design Chemistry (MBDC) and Environmental Protection Encouragement Agency (EPEA) provide consulting services on chemical composition of interior products from the perspective of ‘cradle-to-cradle’ impact on the natural environment and wellness of building occupants (McDonough, 2003).

The Interior Design Community

Interior design practice and education contribute to the prevention and remediation of mold growth in indoor environments. The literature points to three prevailing philosophical perspectives with regards to interior design practice that influences approaches to achieving a mold-free environment.

A traditional materialist philosophy, Indicative of mainstream interior design practice values materials for their appearance, durability, and availability (Nielson & Taylor, 2002). Designers subscribing to this philosophy have focused on client considerations to the exclusion of ecological considerations of protecting and preserving the natural environment. If economy is a consideration, the expectation is that designing with ecologically sensitive products will increase the cost for completion of the project (Beecher and Davies, 2002). Historically, knowledge underlying interior design decisions has been held by an elite group and applied on behalf of an elite clientele.

An eco-materialism philosophy, indicative of a growing interest in the green design movement and sustainable design movement values materials for their environmental sensitivity over availability, convenience, or appearance (Beecher and Davies, 2002). This philosophy embraces an ecology-centered approach that expands traditional measures of building performance (e.g., cost per square feet, minimum standards for air quality) to include issues of building occupant comfort, satisfaction, and overall well-being. Health factors affecting material selections would include VOC emissions and susceptibility to allergens and toxins. Long-term environmental impact would be considered in tandem with upfront building costs (Moussatche, King, and Rogers, 2002). Knowledge based on the science of product quality can effect changes to the way interior products are manufactured, the composition of interior products, and the specification of products by the interior designer (McDonough, 2003).

A Human ecology (Home Economics) philosophy, indicative of a cooperative extension approach to design values materials for their durability and for wise use of natural resources within a tradition of supporting health and wellness in the family. This philosophy embraces a holistic approach to design decisions that includes considerations of the environment and human needs (e.g., University of Florida, University of Minnesota, Kansas State University). Knowledge based on science and best practices developed by federal and state government (e.g., programs addressing disaster relief for flooding) is translated to a layman’s language to empower the consumer.

Conclusions - Toward a Hybrid Model of Benign Design

The professional community of design education and practice could benefit from the development of a design model that reflects a merger of values indicative of an aesthetic tradition (beautiful design), a science of product quality evolving from the environmental movement (contaminant-free design), and the cooperative extension tradition of empowering individuals and families (user-driven design). Needed to support this model is a more comprehensive metrics to evaluate building performance inclusive of measures of improved occupant health and well-being and life-cycle analyses of interior products that provide measures of long-term impact to the natural environment.

References

AERIAS. (2002a). Carpet, a Haven for Unwanted Guests. AERIAS. Available: http://www.aerias.org/sitemap.htm [2002, October 11].

AERIAS. (2002b). Ceiling Materials and Problems Associated with Indoor Air. AERIAS. Available: http://www.aerias.org/sitemap.htm [2002, October 11].

AERIAS. (2002c). Healthy ("Green") Workplaces: The Economical Choice. AERIAS [2002, October 11].

AERIAS. (2002d). Indoor Air Problems Associated with Different Types of Flooring. AERIAS. Available: http://www.aerias.org/sitemap.htm [2002, October 11].

AERIAS. (2002e). Overview of Furniture in the Indoor Environment. AERIAS. Available: http://www.aerias.org/sitemap.htm [2002, October 11].

AERIAS. (2002f). Overview of IAQ Problems in Homes and Apartments. AERIAS. Available: http://www.aerias.org/home_overview.htm [2002, October 11].

AERIAS. (2002g). Prevention of Indoor Air Quality (IAQ) Problems in the Home. AERIAS. Available: http://www.aerias.org/home_prevention.htm [2002, October 11].

Air Quality Sciences, I. (2002). Greenguard Registry: The World's Leading Guide to Healthy Indoor Products and Materials. Air Quality Sciences, Inc. [2002, October 11].

American Red Cross, & Agency, F. E. M. (1992, 2001). Repairing Your Flooded Home, [Guidance Document]. American Red Cross

Federal Emergency Management Agency. Available: http://www.redcross.org/pubs/dspubs/cdelist.html [2002, November 11].

Coleman, C. (1999). Life-cycle design: Leaving future generations a legacy. Perspective (Spring/Summer), 27-28, 30.

Dickson, A. W., & White, A. C. (1994). The Polsky Forum: The Creation of a vision for the interior design profession in the year 2010. Journal of Interior Design, 20(2), 3-11.

Durst, C. S. (2000a). Assessing the Future of Green Design. Perspective: Journal of the International Interior Design Association (Fall/Winter 2000), 30-33.

Durst, C. S. (2000b). Dateline: Design. Perspective: Journal of the International Interior Design Association (Fall/Winter 2000), 9-12.

Foundation Interior Design Education Research. (2001). FIDER Professional Standards 2000 (Standards and Guidelines Document). Grand Rapids, MI: Foundation of Interior Design Education Research.

Gates, G. S., & Yousri, K. A. (1996). Strategic Planning for Interior Design Education: Effective Development in Conditions of Resource Decline. Journal of Interior Design, 22(1), 45-50.

Guerin, D. A. (1992). Issues facing interior design education in the twenty-first century. Journal of Interior Design Education and Research, 17(2), 9-16.

Hasell, M. J., & Scott, S. C. (1996). Interior Design Visionaries' Explorations of Emerging Trends. Journal of Interior Design, 22(2), 1-14.

Heerwagen, J. H. (2000). Design Research. Perspective: Journal of the International Interior Design Association (Winter/Spring 2000), 50-53.

McDonough, W. & Braungart, M. Redefining Green: A New Definition of Quality Empowers the Next Wave of Design. Perspective: Journal of the International Interior Design Association (Spring 2003), 20-25.

Mendler, S. (2002). LEED: A Roadmap for Added Value. Perspective: Journal of the International Interior Design Association (Winter 2002), 42-49.

Miller, J. W. (2002). Green Home Building. Perspective: Journal of the International Interior Design Association (Fall 2003), 22-27.

Minnesota Department of Commerce. (2001, November 7, 2002). Home Moisture. Minnesota Department of Commerce - Energy Information Center [2002, November 11].

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Minnesota Department of Commerce. (2002b, June 24, 2002). Indoor Ventilation, [Home Energy Guide]. Minnesota Department of Commerce - Energy Information Center. Available: http://www.commerce.state.mn.us/pages/Energy/InfoCenter/energyGuides.htm [2002, November 11].

Minnesota Department of Commerce. (2002c, June 24, 2002). New Homes, [Home Energy Guide]. Minnesota Department of Commerce - Energy Information Center. Available: http://www.commerce.state.mn.us/pages/Energy/InfoCenter/EnergyGuides.htm [2002, November 13].

Minnesota Department of Health. (2001, November 7, 2002). Recommended Best Practices for Mold Investigations in Minnesota Schools, [Guidance Document]. Minnesota Department of Health - Indoor Air Unit. Available: http:/www.health.state.mn.us/divs/eh/indoorair/mold/index.html [2002, November 11, 2002].

Nielson, K., & Taylor, D. (2002). Interiors: An Introduction. Boston: McGraw Hill.

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Abstract Information & Notes

Aristo Vojdani, P.H.D., M.T. Date of talk: Friday, June 20, 2003, 9:35am

Immunosciences Lab., Inc. Phone: 301/657-1077

8693 Wilshire Blvd., Suite 200 Fax: 310/657-1053

Beverly Hills, CA 90211 E-mail: [email protected]

Medical School Attended: Bar-Ilan University Ramat-Gan Israel

Major and date of Graduation: Immunology 1976

Residency: University of California Los Angeles 1979-2001

Board Certifications: Laboratory Medicine

Current Faculty Appointments: A Clinical Professor UCLA Dept. Neurobiology

Current Job Description: Research in the field of Neuroimmunology at Immunosciences Lab. And at UCLA School of Medicine

Disclosure Statement: Part owner of Immunosciences Lab. Inc., and have financial interest in the company.

SPEECH TITLE: “Immunotoxicology of Molds and Mycotoxins”

The speaker has provided the information below.

1.) Goals and objectives: To understand the impacts of molds and mycotoxins on the human immune system

2.) Outline of talk/abstract: 1. Sign and symptoms of patients exposed to toxigenic molds in water-damaged building. 2. Detection of mucosal immune response to molds. 3. Detection of cellular and humoral immune responses to molds and mycotoxins. 4. Neurotoxicity induction by molds and mycotoxins.

3.) Conclusion of what is to be learned: A. Exposure to toxigenic molds and mycotoxins can induce type 1 to type 4 allergic reactions. B. Allergy evaluation by skin test or in vitro tests for detection of IgE mediated allergies are not enough for detection of molds induced toxicity. C. Prolonged and intense exposure to molds and mycotoxins is associated with disorders of mucosal, cellular and humoral immune system.

4.) References:

1. Vojdani et al., Antibodies Against Molds and Mycotoxins after Exposure to Toxigenic Fungi in a Water Damaged Building (submitted)

2. Mahfoud R., et al., The Mycotoxin Patulin Alters the Barrier Function of the Intestinal Epithelium: Mechanism of Action of the Toxin and Protective Effect of Glutathione. Toxicology and Applied Pharmacology 181:209, 2002

Abstract Information & Notes

Bruce Small Date of talk: Friday, June 20, 2003, 10:30am

Small & Rubin Ltd. Phone: 905/702-8615

100 Rexway Drive Fax: 905/873-6260

Georgetown, Ontario L7G 1R5 E-mail: [email protected]

Canada

Medical School Attended: University of Toronto, Engineering Science, B.A.Sc., Southern Illinois University, Physics and Design, M.S. 1975

Current Job Description: Director of the Enviorodesic Certification Program, a private sector initiative to identify and foster the development of building materials and other products that will lead to healthier indoor environments.

Other Information: Executive Director of Technology and Health Foundation, a Canadian charity focused on environmental health.

Disclosure Statement: Icynene Inc. and Cogent Environmental Solutions

SPEECH TITLE: “Prescription for Preventing Mold and for Mold Remediation”

The speaker has provided the information below.

1.) Goals and objectives: To outline common causes of mold growth and regrowth in buildings. To outline primary means of preventing mold growth and regrowth in buildings.

2.) Outline of talk/abstract: Existing building and maintenance practices predispose many buildings to mold growth. Current mold remediation methods and building reconstruction practices may also lead to mold regrowth. Environmental physicians are in a unique position to specify effective building science principles to promote mold-free buildings and more effective remediation. When designed, built and maintained with sufficient thought and care, there is no reason for buildings to go moldy.

3.) Conclusion of what is to be learned: Proper use of rain screens, air barriers, and vapor barriers can alleviate some of the primary causes of building envelope moisture penetration and mold growth. Timely maintenance is also paramount. Homeowners, school boards and building managers armed with this knowledge are in a better position to avoid occupant mold exposures. Physicians can play a role by advocating the use of good building science to prevent mold growth.

4.) References: To be included in presentation notes.

Useful web sites on building science for avoiding mold growth:

http://www.aiha.org/GovernmentAffairs-PR/html/prmoldsources.htm

http://www.cdc.gov/nceh/airpollution/mold/moldfacts.htm

http://www.epa.gov/iaq/molds/

http://www.buildingscience.com/housesthatwork/default.htm

http://www.buildingscience.com/resources/mold/default.htm

http://www.envirodesic.com/sfl/HomeEnergyArticle.pdf

Abstract Information & Notes

Martha Stark, M.D. Date of talk: Friday, June 20, 2003, 11:00am

3 Ripley St. Phone: 617/244-7188

Newton Centre, MA 02459-2209 E-mail: [email protected]

Medical School Attended: Harvard Medical School

Major and date of Graduation: M.D., 1974

Residency: Adult Psychiatry Residency - The Cambridge Hospital/Cambridge, MA

Child Psychiatry Fellowship - Massachusetts Mental Health Center/Boston, MA

Board Certifications: None (Board-Eligible in Adult and Child/Adolescent Psychiatry)

Current Faculty Appointments: Faculty: Harvard Medical School; Boston Psychoanalytic Institute; Massachusetts Institute for Psychoanalysis; Center for Psychoanalytic Studies, Massachusetts General Hospital; Department of Continuing Education, Massachusetts Mental Health Center; Continuing Education Program, Massachusetts School of Professional Psychology; and Program of Continuing Education, Smith College School for Social Work.

Current Job Description: Private practice of psychiatry/psychoanalysis; various faculty appointments and teaching responsibilities; teaching/supervising analyst at several local psychoanalytic institutes; speaking engagements at training institutes around the country; completing fourth book and at work on fifth book

Other Information: Author of four books

Disclosure Statement: none

SPEECH TITLE: “Mysterious Mental Illnesses, Pernicious Poisons”

The speaker has provided the information below.

1.) Goals and objectives:

a. To understand that mycotoxins have the power both to intoxicate and to poison

b. To appreciate all the mysterious ways in which mycotoxins can affect the mind (and the brain)

2.) Outline of talk/abstract: Mycotoxins have figured more prominently in human affairs than most would have suspected B in both good ways and bad. They have been used since earliest times as mind-altering hallucinogens and, as such, have promoted psychedelic/mystical experiences. Furthermore, evidence suggests that these poisons have also been responsible for “bewitching” people (as Happened, for example, in Salem, Massachusetts, during the 17^th century). Particularly virulent strains have been known to cause bizarre physical ailments, mystifying mental disorders, and, in some instances, a slow steady decline into deathBwhich is why some mycologically savvy mystery writers have recognized that some mycotoxins are perfect murder weapons! Finally, mycotoxins are now understood to have been responsible for wiping out whole groups of people who had the misfortune of consuming foods contaminated with mold (as happened, for example, during the Irish potato famine).

3.) Conclusion of what is to be learned:

a. To develop a healthy respect for mycotoxins and their potency

b. To recognize that patients with certain mysterious mental illnesses (patients once described as simply "mad" or "deranged") are actually suffering from poisoning by mycotoxins

4.) References:

Hudler, G.W. (2000). Magical Mushrooms, Mischievous Molds. Princeton, NJ: Princeton University Press. Princeton and Oxford: Princeton University Press

Matossian, M.K. (1989). Poisons of the Past: Molds, Epidemics, and History. New Haven and London: Yale University Press.

Schaechter, E. (1998). In the Company of Mushrooms: A Biologist=s Tale. Cambridge, MA: Harvard University Press.

MYSTERIOUS MENTAL ILLNESSES, PERNICIOUS POISONS

Martha Stark. M.D. -- Harvard Medical School

Harvard Health Letter (January 2003) – “The Truth About Mold”

“Most experts say there's more fear than fact to 'toxic mold.’”

neither mental illness nor mental health can be meaningfully understood without reference to the brain and the nervous system

our minds do not exist in a vacuum, they are linked to the chemistry of the brain

molds can have a negative effect on human health in three ways:

1. as pathogens (whereby they take up residence either in or on the body of those whose immune systems are compromised)

result: infectious symptoms

2. as allergens (whereby they provoke either immediate or delayed hypersensitivity reactions in those who are sensitized to molds)

result: allergic symptoms

3. as toxins (whereby they poison otherwise healthy individuals)

result: toxic symptoms

neurotoxic symptoms when the brain is involved

moisture + warmth ---> germination of the spore

balloon-like protuberances (hyphae) that exude powerfully toxic digestive enzymes, which systematically break down whatever they can find to feed upon

the hyphae then take back in what's left of the ravaged substrate, where it is further degraded in order to nourish the mold's relentless growth

what happens when mycotoxins come into contact with the brain?

although we have yet to understand the exact mechanism of action whereby mold toxins affect how we feel, think, and act, there is much that we can learn about both mental illness and mental health by studying the impact of various mycotoxins on the brain and, more particularly, on brain neurotransmitters and their receptors

in fact, mycotoxins have been found to bear a striking resemblance to specific neurotransmitters in the brain--especially serotonin

in other words, mycotoxins are in a prime position to compete with serotonin for (re-)uptake at various postsynaptic 5-HT (5-hydroxytryptamine) receptor sites

in essence, mycotoxins appear to affect the central nervous system at the level of the synapse

Claviceps purpurea - a perniciously poisonous mold that produces a variety of mycotoxins known as ergot alkaloids

ingestion of products made from ergot-infected rye (like bread) --->

ergot poisoning, a disease that is thought to have affected the physical and mental health of people throughout much of the Middle Ages

gangrenous ergotism involves an ergot alkaloid that can be such a powerful vasoconstrictor that it can restrict entirely the flow of blood to body parts, particularly the extremities

convulsive, hallucinogenic ergotism involves an ergot alkaloid that has a more direct effect on the brain

symptoms range from (1) vomiting, diarrhea, and general lethargy; to (2) a sensation of ants crawling on the skin (formication), twitching, and grotesque distortion of limbs; to (3) vivid hallucinations and seizures similar to those associated with epilepsy

the mental effects of ergot poisoning are said to be unremittingly unpleasant: fright, outright panic, and an inability to maintain a sense of distance in the face of such strange experiences

the historian Mary Matossian (in her book Poisons of the Past) has hypothesized that “bewitched” people in central Europe between the 16th and 19th centuries were actually exhibiting symptoms of ergot poisoning (both gangrenous and convulsive)

furthermore, the women (and men) in Salem, Massachusetts, accused in 1692 of being witches (and wizards) either were themselves afflicted with ergotism or, interestingly, were wrongly accused by others who had become paranoid and delusional because they were afflicted with ergotism

from earliest times, mycotoxins have been implicated as the cause of several major human epidemics

but, from earliest times, mycotoxins have also been found to produce mind-altering, consciousness-enhancing, mind-expanding, bewitching, intoxicating, inebriating, psychedelic, hallucinogenic experiences that have afforded the user much pleasure

many of the most respected Greek philosophers--like Plato and Socrates--were inspired to formulate some of their greatest thoughts when they were under the influence of certain “magical mushrooms” (and their mycotoxins)

hallucinogenic mushrooms (also known as 'shrooms) are still in use today as recreational drugs

chemical analyses of 'shrooms have determined that they contain psilocybin and psilocin, psychoactive substances that closely resemble serotonin (the "feel good" hormone)--which lends further credence to the hypothesis that all the major plant hallucinogens contain substances similar in chemical composition to psychoactive chemicals within the brain

1938 - birth of the psychedelic age

a young German chemist, Dr. Albert Hofmann, began experimenting with lysergic acid, the chemical backbone of the ergot alkaloids

five years later, he was able to synthesize lysergic acid diethylamide--LSD

Dr. Hofmann described his first unintentional use of LSD as a "not unpleasant intoxicated-like condition" involving “interesting imagery” that lasted for several hours

“...all objects appeared in unpleasant, constantly changing colors, the predominant shades being sickly green and blue. When I closed my eyes, an unending series of colorful, very realistic, and fantastic images surged in upon me. A remarkable feature was the manner in which all acoustic perceptions (e.g., the noise of a passing car) were transformed into optical effects, every sound invoking a corresponding colored hallucination constantly changing in shape and color like pictures in a kaleidoscope. At about one o'clock I fell asleep and awoke the next morning feeling perfectly well.”

Hofmann noted that some of the more bizarre symptoms he endured on subsequent “trips” were remarkably similar to those accompany schizophrenia

amongst other things, schizophrenics frequently speak of having out-of-body experiences and “interpret” sights and sounds in distinctly idiosyncratic ways--much as he had when he was “tripping”

Hofmann's experience certainly lent support to the hypothesis that certain mental illnesses, initially presumed to be purely psychic in nature, might actually have a biochemical cause

but actually long before Dr. Hofmann's discovery of LSD, Indians in southern Mexico had discovered these same mushrooms growing in the wild--intoxicating mushrooms that proved to be hallucinogenic when ingested

the visions so produced were thought to be divinely inspired and capable of leading to spiritual enlightenment

in the 1950s, Gordon Wasson spent time in Mexico studying the effects of these inebriating mushrooms

“The sacred mushrooms of Mexico seize hold of you with irresistible power. They lead to a temporary schizophrenia in which your body lies heavy as lead on the mat ... while your soul flies off to the ends of the world and indeed to other planes of existence.”

“I experienced hallucinations...visions of palaces, gardens, seascapes, and mountains... With the speed of thought, you are translated wherever you desire to be, and you are there, a disembodied eye, poised in space, seeing but not seen, invisible, incorporeal. ...All of <your> senses are equally affected, and the human organism as a whole is lifted to a place of intense experience. A drink of water ... is transformed, leaving you breathless with wonder and delight. The emotions and intellect are similarly stepped up. Your whole being is aquiver with life.”

“What is happening to you seems freighted with significance, beside which the humdrum events of every day are trivial. All these things you see with an immediacy of vision that leads you to say to yourself: 'Now I am seeing for the first time, seeing direct without the intervention of mortal eyes.’”

and in 1960, at the Center for Research in Personality at Harvard University, Dr. Timothy Leary (with his colleague Dr. Richard Alpert) was doing his own experimenting with magical mushrooms

“I was whirled through an experience which could be described ... as above all and without question the deepest religious experience of my life.”

more generally, it would seem that magical mushrooms (and their mycotoxins) are appealing in large part because they transport the user into other realms where knowledge is intuitive, non-linear, dynamic, rather than reasoned, linear, ordered

intense experiences of vivid colors and abstract patterns alternate with visions of mystical union, cosmic connectedness, and transcendence of the usual boundaries of time and place

later still, none other than the CIA began its own experimentation with the hallucinogenic drugs produced by magical mushrooms

they were searching for a mind-control agent that would allow them more effectively to interrogate suspected spies, preferably without the spy's knowledge of this interrogation

but the magical mushrooms were found to have many untoward and some potentially lethal side effects

so by the late 1960s, early 1970s, all scientific experimentation (whether in the laboratories of academic institutions or governmental agencies) had ground to a halt

the psychoactive ingredients in magical mushrooms appear to alter a person's state of consciousness, affecting how she feels, thinks, and acts

overall, her senses are heightened, her feelings are exaggerated, and her perceptions are intensified

emotional changes may occur suddenly, dramatically, unpredictably

the distinction between past, present, and future may become blurred

cognitive impairment may take the form of fluctuating attention, a short attention span, memory loss, word finding difficulties

there is often a profusion of vague ideas and a preoccupation with philosophical and existential issues--but because of impaired judgment and illogical thought processes, the person may imagine that she has “discovered” new truths when, in fact, she is creating “word salads” (akin to those produced by schizophrenics) that usually do not stand up to the light of day

as noted earlier, although the exact mode of action of mycotoxins in the brain has not yet been established, presumably both LSD and psilocybin are psychoactive chemicals that alter how we feel, think, and act by disrupting the action of the neurotransmitter serotonin--a monoamine chemical messenger known to play a major role in the regulation of mood, energy, appetite, libido, sleep, and cognitive functioning

many of the effects of LSD are through serotonin-mediated pathways (particularly those involving the dorsal raphe nucleus, which lies along the midline of the brainstem and projects to most parts of the brain, including the cerebral cortex and the limbic system)

the hallucinogenic effects of LSD have mainly been attributed to the interaction of this drug with the serotonergic system, but it seems more likely that there are complex interactions of LSD with dopaminergic and noradrenergic target sites as well

studies suggest that LSD not only penetrates the blood-brain barrier but slips slyly into the transmission site inside the nerve cells themselves

it can mimic serotonin to the point where the brain thinks it is serotonin and consequently shoots it across the synaptic cleft

when LSD reaches the other side, it is accepted by the serotonin receptor sites (particularly the 5-HT2A receptor sites)--but now the jig is up, because the LSD cannot carry the message any further

in essence, the LSD blocks or "antagonizes" the normal activity of the serotonergic relay system

instead, the electrical impulse (the action potential) generated by the LSD at the receptor site is redirected more or less randomly down either new or less familiar pathways--pathways that may not have been highly conditioned, pathways that may not have been frequently traveled

it could be said that consciousness is “redirected” to unimprinted areas of the cortex, thus the variety of "interpretations" of sensations, emotions, and perceptions that accompany hallucinogenic experiences

in fact, sensory perceptions may blend in a phenomenon known as synesthesia, a cross-circuiting of brain information in which a person sees sound, smells color, or hears motion--evidence that there is a problem with sensory integration

in sum, the work of Hofmann and other researchers who have devoted their lives to studying mycotoxins points not to a separation but to an association between the brain and the mind

more specifically, biochemical events that take place in the brain with respect to neurotransmitters and their receptors are the physical correlates of psychic experiences that take place in the mind with respect to how a person feels, thinks, and acts

indeed, the mind does not exist in a vacuum; it is linked to the biochemistry of the brain

References:

Cook, Robin (1994). Acceptable Risk. New York: Berkley Books.

Grafton, Sue (1992). “I” is for Innocent. New York: Fawcett Crest.

Greene, Graham (1978). The Human Factor. New York: Simon and Schuster.

Harvard Health Letter - Volume 28 - Number 3 - January 2003.

Hudler, George W. (1998). Magical Mushrooms, Mischievous Molds. Princeton, NJ: Princeton University Press.

Kavaler, Lucy (1965). Mushrooms, Molds, and Miracles. New York: A Signet Book.

Masters, Robert, & Houston, Jean (2000). The Varieties of Psychedelic Experience. Rochester, VT: Park Street Press.

Matossian, Mary K. (1989). Poisons of the Past. New Haven: Yale University

Press.

Ramachandran, Vilayanur, & Hubbard, Edward. Hearing Colors, Tasting Shapes.

In Scientific American, May 2003.

Restak, Richard M. (1994). Receptors. New York: Bantam.

Schaechter, Elio (1997). In the Company of Mushrooms. Cambridge, MA:

Harvard University Press.

Stahl, Stephen M. (2000). Essential Psychopharmacology, 2nd edition. London: Cambridge University Press.

Abstract Information & Notes

John H. Boyles, M.D. Date of talk: Friday, June 20, 2003, 11:30am

Dayton Ear, Nose & Throat Surgeons Inc. Phone: 937/434-0555

7076 Corporate Way Fax: 937/434-7413

Centerville, OH 45459 E-mail: N/A

Medical School Attended: Northwestern University Medical School, Chicago, Illinois

Major and date of Graduation: M.D., 1960

Internship: Latter-Day Saints Hospital, Salt Lake City, Utah; Northwestern University Medical School, Chicago, Illinois (1964-1967)

Board Certifications: American Board of Otolaryngology and American Board of Environmental Medicine

Current Faculty Appointments: Assistant Clinical Professor, Wright State Medical School

Current Job Description: Private Practice - Dayton Ear, Nose and Throat Surgeons, Inc.

Other Information: Published several articles

Disclosure Statement: None

SPEECH TITLE: “Diagnosis & Treatment of Inhalant and Mold Allergy”

The speaker has provided the information below.

1.) Goals and objectives: How to properly diagnose and treat mold sensitivities through allergic desensitization using SET and traditional build-up therapy.

2.) Outline of talk/abstract: Practitioners must know the prevalent molds in their geographic location, and be able to test the individual sensitivity for each mold. In addition, they should be able to test and properly treat TOE sensitivity.

3.) Conclusion of what is to be learned: Treatment of mold sensitivity is extremely important in an allergic patient, and must be controlled before one goes on to testing of food and chemical sensitivity.

4.) References:

Diagnosis & Treatment of Inhalant and Mold Allergy

John H. Boyles, Jr., M.D.

For centuries, we have known that mold exposure and infestation is injurious to human health. In this presentation, we want to emphasize the importance of recognizing fungus infections, and treating them effectively. This includes the controversial concept of Candidiasis. We also seek to explain the importance of fungus allergy, and how to diagnose and treat it.

We will also show the importance of fungal contamination of buildings, how it relates to human health, and how it may be eradicated.

Abstract Information & Notes

David C. Straus, Ph.D. Date of talk: Friday, June 20, 2003, 1:00pm

Texas Tech University Phone: 806/743-2523

Department of Microbiology Fax: 806/743-2334

Texas Tech University Health Sciences Center E-mail: [email protected]

Lubbock, TX 79430

Graduate School Attended: Loyola University of Chicago

Major and date of Graduation: Microbiology - May 1974

Current Faculty Appointments: Professor of Microbiology & Immunology

Current Job Description: Teaching and Research

Other Information: Member Sigma Xi, American Society for Microbiology, American Academy of Microbiology

Disclosure Statement: Assured IAQ7 of Dallas, TX

SPEECH TITLE: “The Role of Fungi in Sick Building Syndrome”

The speaker has provided the information below.

1.) Goals and objectives: To educate the audience on how fungi produce the phenomenon known as sick building syndrome

2.) Outline of talk/abstract: I will describe what organisms are important in sick building syndrome and how they produce the associated symptoms.

3.) Conclusion of what is to be learned: Fungi cause health problems inside buildings by the production of spores and mycotoxins

4.) References: Cooley et al. 1998. Correlation between the prevalence of certain fungi and sick building syndrome. Occup. Environ. Med 55:579-584. McGrath et al. 1999. Continually measured fungal profiles in Sick Building Syndrome. Curr. Microbiol. 38:33-36.

The Role of Fungi in Sick Building Syndrome

By David C. Straus, Ph.D.

Professor of Microbiology and Immunology

Texas Tech University

Health Sciences Center

Lubbock, Texas 79430

Man has known about the consequences of having mold (a form of fungi) grow inside his buildings for over 3,300 years. Verses in the Old Testament of the Bible (Leviticus 14:33-45) describe how mold infested houses should not be occupied, and could potentially lead to the destruction of the house. Therefore, it should not be surprising that mold-infestation of our buildings still remains a problem. What is different now than in the time of Leviticus, is we now know what the problematic fungi are and we know what products they produce that we should be concerned with.

Sick Building Syndrome (SBS) is a lay term, which is characterized by a constellation of symptoms. These symptoms include itchy eyes, congestion, scratchy throat, nausea, headaches, fatigue, and decreased attention span. This phenomenon was first described in 1982 and published in 1984 (1). It literally means that there is something inside a particular building that can make people sick. It does not usually refer to a bacterial pneumonia like Legionairre’s Disease that can be a consequence of being in a building with a certain bacterium in the air conditioning system. Legionairre’s Disease is caused by the bacterium Legionella pneumophila and is an actual infection. In this case, when the person leaves the building, the organism leaves with him. In the case of SBS, the fungi (for the most part) stay inside the building. However, we do know that fungal spores travel with us on and in our clothing (2).

We are constantly breathing microorganisms, both inside and outside, and the immune system of a healthy individual normally has no problem clearing the lungs of these living particles. However, immunocompromised individuals (like those with Acquired Immunodeficiency Syndrome or AIDS) are at an increased risk of a fungal pneumonia due to the inhalation of living fungal spores. Fungi can cause human disease by at least four different mechanisms. They are 1) allergic rhinitis (hay fever), 2) hypersensitivity pneumonitis (which is due to the sensitization and recurrent exposure to inhaled fungal spores), 3) toxicity (certain fungi produce toxic substances called mycotoxins), and 4) infection. The latter is not usually an important part of SBS, but the possibility exists for it to occur.

We get into trouble with fungi or mold when we allow them to grow inside our homes, schools, or commercial buildings. Fungi essentially need four things to grow: food, water, oxygen, and the appropriate temperature. If water enters a building where it should not be and cellulose containing building structures becomes wet, mold can use the building material as a food source. Fungi particularly like the paper on sheetrock, ceiling tiles and pressed particleboard. They use these materials as a food source because they are made of cellulose, which is the most abundant organic material on the planet. It is the job of fungi to break down organic material. So we should not be surprised when they begin to grow in our wet buildings. In fact, we should be surprised if it did not happen.

We recently published several studies where we examined the role of mold on building materials, in animals, and in SBS. The first study was a two-year investigation of 48 U.S. public schools (3). In that study we showed that spores of Penicillium species and the presence of Stachybotrys species inside schools correlated with the prevalence of SBS, and when these organisms were removed, and the conditions that allowed them to grow in the first place were remediated, the SBS-associated symptoms were significantly reduced.

In another study (4), examining a contaminated hotel in the Southwestern United States, we showed that even though the outside fungal profile is continually changing, the indoor fungal profile in a “sick building” tends to remain unchanged. Because it appeared from the above studies that the inhalation of Penicillium chrysogenum spores played a role in SBS, we undertook studies to determine the consequences of long-term intranasal instillation of Penicillium chrysogenum spores in a mouse model. We discovered that when mice inhale Penicillium chrysogenum spores, the spores remain viable for up to 36 hours in the lungs of these animals (5). We later found that the long-term inhalation of viable (but not nonviable) Penicillium chrysogenum spores induced type 2 T-helper cell mediated (Th2) inflammatory responses such as an increase in total and spore specific serum IgE and IgG₁, together with bronchial alveolar lavage fluid levels of interleukins 4 and 5 and peripheral and airway eosinophilia, which are mediators of allergic reactions (6). Finally, in an effort to elucidate ways to prevent fungal mediated SBS, we evaluated fungal growth on cellulose-containing and inorganic ceiling tile (7). We showed that inorganic ceiling tile did not support the growth of Cladosporium, Penicillium and Stachybotrys while the cellulose-containing ceiling tile did. These results demonstrate that it will be possible to develop mold-resistant building materials and possibly decrease the occurrence of SBS.

What then are the health effects of exposure to mold inside our buildings? We believe that Penicillium and Stachybotrys are two of the most important genera in SBS and we believe that these two organisms affect people in different ways. Other workers have shown that Penicillium species spores were good potentiators of asthma (8). As stated above, we have shown that the long-term inhalation of viable Penicillium chrysogenum spores by mice results in an inflammatory reaction in their lungs (6). As regards Stachybotrys exposures, we believe that the reported health effects are due to the mycotoxins and its role in SBS is probably due to the production of these compounds. However, much more work needs to be done in this area before this can be conclusively shown. Some of the most potent mycotoxins produced by Stachybotrys chartarum are called trichothecenes. They are potent inhibitors of protein synthesis (9). The symptoms most commonly reported by individuals who have been exposed to S. chartarum include loss of balance, hair loss, hearing loss, mucosal bleeding, rashes, and vomiting (personal communications). The above symptoms are consistent with those observed when trichothecene mycotoxins were injected intravenously (0.077 mg/kg) daily for 5 days in patients with hepatic metastases. The well-known effect of the trichothecene mycotoxins on rapidly dividing cells was the impetus for their evaluation as antitumor drugs in the late 1970’s. The trichothecene examined in these studies was 4,15-Diacetoxyscripenol or DAS (anquidine) (10). DAS in these patients demonstrated no antitumor activity and was so toxic its use was discontinued. The signs and symptoms of toxicity reported by these patients were hair loss, vomiting, burning erythema, diarrhea, confusion, ataxia, fever, chills, and hypotension.

In conclusion it appears that fungi are important in SBS but the exact roles of their spores and mycotoxins remains to be elucidated. However, it appears quite clear that the inhalation of high concentrations of fungal spores is responsible for the respiratory complications (allergies, hypersensitivity pneumonitis and asthma) associated with SBS. A high number of peer-reviewed scientific publications are available to support this hypothesis (8, 11, 12, 13, 14, 15, 16, 17, 18). Although the data seem to indicate the importance of Penicillium and Stachybotrys species in this phenomenon, we believe that other fungi such as Chaetomium species (19), Alternaria species (8), Memnoniella species (9), and Aspergillus species (20) also play a role.

REFERENCE

1. Finnigan, M.S., Pickering, C.A.C., and Burge, P.S. (1984). The sick building syndrome: prevalence studies. British Medical Journal, 289,1573-1575.

2. Dart, B.L., and Obendorf, S.K. (2000) Retention of Aspergillus Niger spores on textiles. In Nelson, C.N. and N.W. Henry (ed). Performance of Protective Clothing: Issues and Priorities for the 21^st Century: Seventh Volume, ASTM STP 1386. American Society for Testing and Materials, West Conshohocken, PA, pg 251-268.

3. Cooley, J.D., Wong, W.C., Jumper, C.A., and Straus, D.C. (1998). Correlation between the prevalence of certain fungi and sick building syndrome. Occupational and Environmental Medicine, 55, 579-584.

4. McGrath, J.J., Wong, W.C., Cooley, J.D., and Straus, D.C. (1999). Continually measured fungal profiles in sick building syndrome. Current Microbiology, 38, 33-36.

5. Cooley, J.D., W.C. Wong, C.A. Jumper, and D.C. Straus. (1999). Cellular and humoral response in an animal model inhaling Penicillium chrysogenum spores. Proceedings of the Third International Conference on Bioaerosols, Fungi and Mycotoxins, pp 403-410.

6. Cooley, J.D., Wong, W.C., Jumper, C.A., Huston, J.C., Williams, H.J., Schwab, C.J., and Straus, D.C. (2000). An animal model for allergic penicilliosis induced by the intranasal instillation of viable Penicillium chrysogenum conidia. Thorax, 55, 489-496.

7. Karunasena, E., Markham, N., Brasel, T., Cooley, J.D., and Straus, D.C., (2000). Evaluation of fungal growth on cellulose-containing and inorganic ceiling tile. Mycopathologica 150: 91-95.

8. Licorish, K., Novey, H.S., Kozak, P., Firshter, R.D., and Wilson, A.F., (1985). Role of Alternaria and Penicillium spores in the pathogenesis of asthma. Journal of Allergy and Clinical Immunology, 76, 819-825.

9. Jarvis, B.B., Sorenson, W.G., Hintikka, E.L., Nikulin, M., Zhou, Y., Jiang, J., Wang, S., Hinkley, S., Etzel, R.A., and Dearborn, D. (1998), Study of toxin production by isolates of Stachybotrys chartarum and Memnoniella echinata isolated during a study of pulmonary hemosiderosis in infants. Applied and Environmental Microbiology, 64, 3620-3625.

10. Wannemacker, R.W., and Wiener, S.L. (1997). Trichothecene Mycotoxins. In Textbook of Military Medicine, Part I. Warfare, Weaponry, and the Casualty, Medical Aspects of Chemical and Biological Warfare, (eds). Zajtchuk, R, and Bellamy, R.F. Published by the Office of the Surgeon General, Chapter 34, pp 655-676.

11. Apostolakos, M.J., Rossmore, H., and Beckett, W.S. (2001). Hypersensitivity pneumonitis from ordinary residential exposures. Environmental Health Perspectives, 109, 979-981.

12. Jaakkola, M.S., Nordman, H., Piipari, R., Uitti, J., Laitinen, J., Karjalainen, A., Hahtola, P., and Jaakkola, J. (2002). Indoor dampness and molds and development of adult-onset asthma: A population-based incident case-control study. Environmental Health Perspectives, 110, 543-547.

13. Jacob, B., Ritz, B., Gehring, U., Koch, A., Bischof, W., Wichman, H.E., and Heinrich, J. (2002) Indoor exposure to molds and allergic sensitization. Environmental Health Perspectives, 110, 647-653.

14. Dales, R.E., Burnett, R., and Zwanenburg, H. (1991). Adverse health effects among adults exposed to home dampness and molds. American Review of Respiratory Disease, 143, 505-509.

15. Dhasmage, S., Bailey, M., Roven, J., Abeyawickrama, K., Cao, D., Guest, D., Rolland, J., Forbes, A., Thien, F., Abramsch, M., and Walters, E.H. (2002). Mouldy houses influence symptoms of asthma among atopic individuals. Clinical and Experimental Allergy, 32, 714-720.

16. Downs, S.H., Mitakakis, T.L., Marks, G.B., Car, N.G., Belousova, E.G., Leuppi, J.D., Xuah, W., Downie, J.R., Tobias, A., and Peat, J.K. (2001). Clinical importance of Alternaria exposure in children. Respiratory and Critical Care Medicine, 164, 455-459.

17. Fung, F., Tappen, D., and Wood, G. 2000. Alternaria-associated asthma. Applied Occupational and Environmental Hygiene, 150, 924-927.

18. Fergusson, R.J., Milne, L.J.R., and Crompton, G.K. (1984.) Penicillium allergic alveolitis: faculty installation of central heating. Thorax, 39, 294-298.

19. Abbott, S.P., Sigler, L., McAleer, R., McGough, D.A., Rinaldi, M.G., and Mizell, G. (1995). Fatal cerebral mycoses cause by the ascomycete Chaetomium strumarium. Journal of Clinical Microbiology, 33, 2692-2698.

20. Hodgson, M.J., Morey, P., Leung, W.Y., Morrow, L., Miller, D., Jarvis, B.B., Robbins, H., Halsey, J.F., and Storey, E. (1998). Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor. Journal for Environmental Medicine, 40, 241-249.

Abstract Information & Notes

Tapani Tuomi Date of talk: Friday, June 20, 2003, 1:30pm

Finnish Institute of Occupational Health (FIOH) Phone: 358-9-47472926

Arinatie 3 A Fax: 358-9-5061087

Helsinki, Finland FIN-00370 E-mail: [email protected]

School Attended: Helsinki University of Technology

Major and date of Graduation: DR, Chemical Engineering (Applied Microbiology), 1995

Current Faculty Appointments: Docent in Environmental Chemistry and Microbiology, Helsinki Univ. of Technology

Current Job Description: Laboratory Chief, Laboratory of Chemistry and Microbiology, Finnish Inst. Of Occupational Health, Helsinki, Finland

Disclosure Statement: None

SPEECH TITLE: “Mycotoxins in Cigarettes and in Tobacco Smoke”

The speaker has provided the information below.

1.) Goals and objectives: To present current literature on the mycotoxin content of tobacco products as well as research data on the carry-over of mycotoxins to mainstream and side stream tobacco smoke

2.) Outline of talk/abstract: The harvesting and production of tobacco products is vulnerable to contamination by mycotoxin producing fungi. There is evidence that tobacco products may contain aflatoxins and aflatoxins have been suggested to contribute to the cancer outcome of smokers. The talk will review current literature on the mycotoxin content of tobacco products. Potential exposure routes are discussed and research data presented on the mycotoxin content of cigarettes as well as data of an attempt to estimate the carry-over of mycotoxins to mainstream and side stream tobacco smoke.

3.) Conclusion of what is to be learned: Tobacco products are potential sources of mycotoxins - as are many other agricultural products. Tobacco stored in curing barns may become contaminated with aflatoxin and it is becoming recognized that aflatoxins should be monitored during the production of tobacco products. Recently, techniques have been developed to inhibit mycotoxin production in refined agricultural products, including tobacco. The talk examines the evidence for the carry-over of mycotoxins to mainstream and side stream smoke.

4.) References: Tuomi et al., 2001, Analyst, 126:1545-1550, El-Maghraby and Abdel_Sater, Zentralbl Mikrobiol, 1993, 148:253-64; Subbiah V., USPO, 1997, U.S. Patent 5,698,599; Georggiett et al., Rev Fac Cien Med Univ Nac Cordoba 2000, 57:95-107, Welty and Lucas, Appl Microbiol, 1969: 17:360-365

Mycotoxins in Cigarettes and in Tobacco Smoke

Tapani Tuomi

Cigarettes are natural products produced from the leaves of Nicotina tabacum. Before or after harvesting, tobacco leaves may become infected by common sapphrophytic and/or pathogenic fungi. Particularly fungi belonging to the following genus or genera, that have been established in different studies, on a variety of tobacco products, raise concern that tobacco products including cigarettes may contain mycotoxins: Aspergillus flavus, Aspergillus fumigatus, Fusarium spp. (F. solani, F. moniliforme and F oxysporum), Stachybotrys chartarum, Trichoderma viride^1,2,3. As of present, the aflatoxins B_1-2 and G_1-2, T-2 toxin and zearalenone have been found in cigarettes or in chewing tobacco^1,2,4. Mycotoxins have not, however, been detected in either side-stream or mainstream tobacco smoke. In one study, aflatoxins artificially added to cigarettes were upon smoking detected in the cigarette filter but not in tobacco smoke¹.

During the smoking of cigarettes, gas-phase temperatures reach 850°C at the core of the firecone⁵. Solid phase temperatures reach 800°C at the core and 900 or greater at the char line⁵. Core temperatures are high enough to carbonize the tobacco and produce an oxygen deficient region where smoke constituents are formed through reductive processes. Temperatures behind the char line drop rapidly to the range 200-400 °C within 2 mm of the char line, enabling steam distillation of tobacco components⁵. Some 1200 chemical components, including nicotine, n-parafines and terpenes are distilled into mainstream smoke in the region behind the char line⁵. Side stream smoke is produced mainly between puffs when the firecone temperatures are 200-300°C lower than during puffs, and the smoke is convectively driven in the reverse direction of airflow accompanying a puff⁵. This results in quantitative and qualitative differences of individual components between mainstream and side stream smoke. Side stream smoke is richer than mainstream smoke in cancerogenous nitrosamines and in tar, as well as in nicotine⁵. Environmental tobacco smoke is composed mainly of diluted side stream smoke, which as a result of emission and distribution into ambient air differs from side stream smoke in particle size and mass -distribution, as well as in the distribution of compounds between particle and gas -phases⁵.

As a result of these dynamic processes, resulting in the production of mainstream smoke inhaled by the smoker and environmental tobacco smoke inhaled both by the smoker and passive smokers, it is impossible to define the faith of mycotoxins potentially present in cigarettes without performing chemical analysis of side stream and mainstream smoke from native cigarettes and from cigarettes spiked with mycotoxins already present in native cigarettes. Such tests cannot, as of yet, be found in the literature. It is possible that aflatoxins or other toxins originally present in raw or stored tobacco are neutralized by ammoniation⁶. Different curing processes might also affect the distribution of mycotoxins potentially present in tobacco.

In conclusion, tobacco products are potential sources of mycotoxins - as are many other agricultural products. Tobacco stored in curing barns may become contaminated with aflatoxin produced by Aspergillus flavus as well as other mycotoxins, including fumitremorgins, produced by Aspergillus fumigatus. It is becoming recognized that mycotoxins should be monitored during the production of tobacco products. Recently, techniques have been developed to inhibit mycotoxin production in refined agricultural products, including tobacco. It has not been established as of yet, however, that mycotoxins are carried-over to mainstream and side stream smoke.

REFERENCES: ¹El-Maghraby and Abdel-Sater, Zentralbl Mikrobiol, 1993, 148: 253-64; ²Warke et al., J. Food Prot., 1999, 62: 678-686; 3Verweij et al., JAMA, 2000, 284: 2875; ³Welty and Lucas, App Micro, 1969, 17: 360-365; ⁴Georgiett et al., Rev Fac Cien Med Univ Nac Cordoba, 2000, 57: 95-107; ⁵Jenkins et al., Mainstream and side stream tobacco smoke, In The chemistry of environmental tobacco smoke: composition and measurement, M. Eisenberg, Ed, Lewis Publishers, Boca Raton, Florida, 2000, p. 49-75; ⁶Subbiah V., USPO, 1997, U.S. Patent 5,698,599.

Abstract Information & Notes

Mohamed B. Abou-Donia, Ph.D. Date of talk: Friday, June 20, 2003, 2:00pm

Duke University Medical Center

Laboratory of Neurotoxicology Phone: 919/684-2221

Dept. of Pharmacology and Cancer Biology Fax: 919/681-8224

Box 3813 E-mail: [email protected]

Durham, NC 27710

Medical School Attended: University of California, Berkeley, CA

Major and date of Graduation: Agricultural Chemistry, 1967

Residency: North Carolina

Board Certifications: American Board of Toxicology: Academy of Toxicological Sciences

Current Faculty Appointments: Professor of Pharmacology and Cancer biology

Current Job Description: Teaching Toxicology to medical and graduate students carrying out research.

Disclosure Statement:

SPEECH TITLE: “Acute Exposure to Sarin Increases Blood Brain Barrier Permeability and Induces Neuropathological Changes in the Rat Brain: Dose Response Relationship”

The speaker has provided the information below.

1.) Goals and objectives:

2.) Outline of talk/abstract:

3.) Conclusion of what is to be learned:

4.) References:

Treatment of Allergic Fungal Sinusitis by Decreasing the Environmental Air Fungal Load and Anti-Microbial Nasal Sprays Based on 14 Years Clinical Observation in 639 Patients

Donald P. Dennis, M.D., F.A.C.S.

Atlanta, Georgia

Treatment Strategy:

In September 1999 Mayo Clinic published an article that pegs 93% of all chronic sinusitis as being caused by mold. The most likely mechanism of formation of sinusitis is, a Type 2 Gell Coombs reaction. As mold is breathed into the nasal mucosa intact eosinophylls migrate through the mucosa and bind to IgG antibodies in the nasal mucus. The mold antibody complex binds to the mold and the eosinophyll lyses, releasing major basic protein, which pits the mucosa. These pits trap mucous so that the mucous cannot drain. The stagnant mucous gets infected which causes nasal polyps and thickening of the lining, which obstructs the outflow of mucous. The polyps cause more infection and the infection causes more polyps and then there is a viscous cycle, which perpetuates itself. This reaction is most likely a type 2 hypersensitivity reaction. All type 2-hypersensitivity reactions stop when the antigen (mold in this case) is removed. We knew from 20 years of clinical experience that when patients cleaned their environmental air their sinusitis improved. The air mold level required for health was discovered by testing the one hour gravity plate exposure inside each chronic sinusitis patient=s home and following them by endoscopic photographs as remediation of mold was done. Over 600 patients homes were tested for mold before and after mold remediation. It was discovered that a mold count of 0-4 colonies with a one-hour gravity plate exposure was required for the sinus mucosa to clear by endoscopic photography. Normal saline nasal irrigation with a combination of antifungal-antibacterial-anti-inflammatory nasal sprays were found to markedly improve mucosal recovery. A ASystemic Fungal Syndrome@ was observed in some patients consisting of memory loss, hearing loss, dizziness, arthritis, fibromyalgia, dermatitis, ataxia, muscle weakness, disorientation, and GI disturbance. These patients likely hypersensitivity mechanism was a Gell-Coombs Type 3 and 4 reactions. Many different ways of mold remediation and nasal sprays were tested and a protocol was developed that was easy for the patient to implement and cost effective. An effective environmental and nasal treatment protocol was developed. The environmental treatment consists of a HEPA air filter combined either with either botanical oil evaporation, or non-ozone ionization, with vent covers sprayed with botanical extract. Whole house fogging was also developed to bring the colony counts down to zero in 1 hour.

Attached are 3 photos.

Fig. 1 is an endoscopic photo showing the mold count in the patient=s room air before and after room air mold remediation with the endoscopic photographs showing the purulent infection clearing after the mold count drops to 4 colonies.

Fig. 2 shows the colony count dropping from TNTC to 0 in six days using the Wein 2500 room unit.

Fig. 3 shows the mold colony count going from TNTC to 0 in 1 hr. and 1 colony in 2 hrs.

Note

EPA "Introduction to Indoor air Quality: A Reference Manual" uses 50 CFU/m3 as a beginning concern and 10,000 as a problem amount using an Anderson sampler. The equivalents of Gravity feed to Anderson Sampler for 3 minutes @ 28.3 L/min are:

CFU Comparison

Gravity Fed

Anderson Sampler Range

Anderson avg.

40-400

345

1100-1200

1198

2100-2500

2401

3400-3500

3496

4800-5000

4913

6200-6300

6263

7500-7600

7531

8700-8900

8745

9900-10,100

9978

11,000-11,300

11,254

12,500-12,600

12,513

13,700-14,000

13,749

Therefore in reality the value for mold safe air using an Anderson sampler is 3400-3500 cfu (colony forming units).

Abstract Information & Notes

Geoffrey Hutton Date of talk: Saturday, June 21, 2003, 9:30am

Hutton & Rostron Environmental Investigations Phone: 011/44-1483-203221

Gomshall, Guildford Fax: 011/44-1483-202911

Surrey, UK GU5-9QA E-mail: [email protected]

Current Job Description: Partner in private, specialist architectural practice and Chairman of a firm of environmental; investigators

Other Information: Hutton & Rostron (H&R) is a firm of architects, health and legal professionals with scientific support specializing in building pathology. Investigation of building defects and loss prevention is an important part of its activities. Although maintenance is often reactive, a proactive policy is preferred and for this reason reliable and time-related data is acquired for diagnosis and warning

Disclosure Statement: None

SPEECH TITLE: “The Way We Build Now”

The speaker has provided the information below.

1.) Goals and objectives: To introduce the delegates to the nature of building construction, the materials and the consequences for the environment and health.

2.) Outline of talk/abstract: The background of construction as a fundamental activity to fill the many needs for shelter and working facilities, and the impact these have on the environment, disease and perceptions of health, fashion and the technology involved.

3.) Conclusion of what is to be learned: Intricacy of construction and engineering services may no necessarily be beneficial and the increasing use of products depending on volatile components for manufacturer or maintenance is a hazard.

4.) References: None

THE WAY WE BUILD NOW

Geoffrey H Hutton, ARIBA, DipArch (Dist)

Building design is a multi-factorial equation of thousands of unknowns and few knowns with interactions with health at every level, this has been resolved in the evolution of vernacular building, but not so successfully in conceptually based design

Birds are great builders. They exploit local resources in competition with others while optimizing the loads and traveling distance. They have to get the location and structure right; too high in the tree and the wind will destroy the nest and too low and a predator will get your eggs. Too strong or elaborate construction will take longer and waste otherwise valuable breeding or feeding time. The nest must be defensible, inconspicuous, protect the eggs from breakage, not harbor pests or support fungal growth, must retain sufficient heat for insulation, be well drained and ventilated. The initial owner may decide to clear out after a year and build a new hygienic model next season or invest in a family home to be refurbished each year or even to be a squatter. Every climate and context has residents and tourists who have solved their accommodation problems sufficiently well to have survived and prospered over many generations with no insurance. We have much to learn from the blind watchmaker

Man too has solved the problems of climate and context in the building methods and materials available to him either as a nomad or in a settled community with as much convenience and defense that could be afforded. The possible solutions, if not the result of self-help, were understood by the users and the technology was within the grasp of the individuals concerned and shared within the community. Differentiation between building functions was slight, the essentials of shelter and enclosure could be met by common methods for providing spanning, load bearing and enclosing structures relying on the inherent properties of the materials for weather resistance, load bearing and insulation or thermal capacity. The interior was modified by the combustion of the limited fuel available, which was of primary importance for cooking. Such buildings continued to serve satisfactorily for millennia and can still be found throughout the world providing the ultimate barrier to the environment after the primary barrier provided by clothing for the climate and season. The technology evolved incorporates the accumulated experience acquired for practical survival and prosperity in the conditions experienced over many generations. Such empirical knowledge includes such issues as ventilation, temperature and evaporation from surfaces with an elegance, which may not be perceived, and thus overlooked in analysis

Building from the earliest times has, of course, also served symbolic purposes demonstrating power, identity or spiritual values. These monumental characteristics are usually achieved either at some otherwise unjustified expense and inconvenience to the practical performance of the building, or they are ignored altogether

Unfortunately, the empirical has been overlaid by the monumental which is further complicated by the introduction of codes and standards which try to capture the multi-factorial performance of buildings by setting out criteria for aspects of structural strength, fire resistance, thermal characteristics, ventilation, lighting etc further defined by methods of test limited by the laboratory methods available. Such aspects of performance are inherent in the overall construction by evolutionary optimization. Important to both birds and man is the health of the occupants as fundamental to survival, whereas this is not of great significance in monumental buildings (which may well be tombs)

The gradual incorporation of imagery and construction from monumental building into the mainstream of the vernacular has led to the dominance of conceptual design over the utilitarian product of evolution and the local environment. Professions developed to match, each with a visual or engineering idea to promote, but without an overarching experience of the interactions between the diverse needs and performance required. In turn, they served building owners and users with less personal appreciation of the issues

Much of the performance required is now specific to particular components, which, in turn, are used in assemblies and bought as a catalogue items to achieve theoretically defined objectives. The performance of items may be known from tests, but the consequences for the whole assembly, and particularly at the interfaces, may not be fully understood, defined or even measurable. Further, the overall design may not be repeated or the result of experience acquired over many projects. Consequently, failures occur due to unanticipated effects or events, at changes of material or section, or in voids concealed from inspection

Historically, buildings were either heavyweight, usually masonry, or assembled from frames and infilling panels normally of timber. Each has advantages for particular climates and occupancies. The masonry building will have a smaller exposed surface area and a higher thermal capacity than the frame building, which will also contain more cavities. Current building is generally of frame and fill construction, even if faced with masonry, as modern construction tries to limit the activities on site. Typically, such buildings have suspended ceilings, raised floors and paneled or cavity wall constructions creating voids which are not easily accessible and can be contaminated and difficult to clean. Builders’ dirt and votive offerings are frequently found in such places, which also provide the accommodation for engineering plant and distribution services, pipes and ductwork

Since the early 19th century, the exploitation of fossil fuels has been the cheap and, for the time being, pervasive source of thermal process energy in the manufacture of products such as glass, metals, cement and bricks; and power for cutting, forming, handling and distribution of products. Fossil fuels now provide raw materials for plastics, fibers, dyes, paints and adhesives used in construction, building services, furniture, soft furnishing, household utensils and clothing, and a host of treatments in the form of cleaning agents, polishes, insecticides, and life-style support generally. The processes involved generate persistent wastes, and the products can have undesirable emissions and result in toxic waste. Most of all, fossil fuel has been used to power environmental services in buildings for heating, ventilation and air-conditioning without which (and lifts and escalators) much of the world would be virtually uninhabitable at the present densities. The management of such services is not precise and the fuel is still cheap and generally available. Consequently, there is little incentive to economize, thus environmental services consume some 60 per cent of all fuel. In historic terms, this relatively short-term cost-free resource has changed lifestyles to reduce the thermal importance of clothing, increase the size of individual spaces, reduce the need for natural light or ventilation, and medicated our surroundings. The availability of hot water, for the dispersal of activities, such as bathing, laundry and cooking results in higher levels of humidity. The engineering required to provide for such conditions, over that possible by the passive qualities of the building enclosure, becomes increasingly complex while occupying a large proportion of the available space and requires regular and diligent maintenance to achieve its theoretical performance

The environmental standards achievable by the use of engineering services inside buildings, particularly if sealed, subjects the external envelope to greater stresses in providing what has come to be regarded as the primary barrier to external conditions. It must now accommodate greater thermal movement, vapor pressure and rates of heat transfer, as well as continuing to offer weather resistance, and in some conditions condensation will occur within the structure

The nature of frame and fill buildings favors the use of space heating, rather than structural heating and high thermal capacity which results in slow adjustment to ambient conditions and can normally be expected to give comfort with lower air temperatures and thus less likely to suffer from condensation. Space heating (or cooling) depends on the processing of large volumes of air, much of which is re-circulated to economize in fuel. Such air carries the waste products of respiration and activities in the space, which must be processed, filtered and mixed with 'fresh' air for re-use. Such a system is liable to contamination and condensation at a number of points even if the filters are routinely changed and well maintained. Biological material will form part of the contaminants and with the appropriate humidity fungal growth can be anticipated

Depending on building use and standards of housekeeping, the various unobserved voids may become home to insects and other pests, which may be encouraged by the ambient conditions. They may be sustained by human litter and food droppings, and initiate further contamination and damage to structure and furnishings. Particular activities such as sleeping and cooking bring particular infestations such as house mites and cockroaches with consequences for health. Major destruction can result from fungi such as the wet and dry rots, and wood-boring insects all of which are indicators of poor environments and housekeeping

Very heavily serviced buildings such as hospitals could become hygienic liabilities; the continuing cost of maintenance and the difficulty of decontamination may make simpler disposable accommodation viable. Ultimately, the properties will be removed for reasons of fashion or return on investment and it seems reasonable that this should be foreseen as part of the brief. Contamination and hazards to health should be factors in this decision

Buildings of historic, technical, literary or national interest should be preserved. This helps understanding of how people lived and adapted to the climate and context in which they lived in the thousands of years before the profligate use of energy and how we may have to live again. These buildings often suffer from fungal decay and insect attack due to neglect, misuse, the introduction of modern heating, new materials and lifestyles; but rarely due to the work of the original builders. The fungal and insect infestations can almost invariably be dealt with by reversing the conditions causing decay and ensuring ventilation in future

Health must become of central concern in the equation

END

Hutton + Rostron Environmental Investigations Limited

Netley House, Gomshall, Surrey GU5 9QA

Tel 01483 203221 Fax 01483 202911 Email [email protected] Web: www.handr.co.uk

Abstract Information & Notes

William J. Meggs, M.D., Ph.D. Date of talk: Saturday, June 21, 2003, 10:30am

Brody School of Medicine

East Carolina University Phone: 252/744-2954

600 Moye Blvd., Room 4W54 Fax: 252/744-3589

Greenville, NC 27858 E-mail: [email protected]

Medical School Attended: University of Miami

Major and date of Graduation: M.D., 1979

Residency: University of Rochester

Board Certifications: Medical Toxicology, Allergy & Immunology, Internal Medicine, Emergency Medicine

Current Faculty Appointments: Professor & Chief of Toxicology

Current Job Description: Physician

Other Information: Author of "The Inflammation Cure" to be published in Sept. 2003. Editor of "Health & Safety in Agriculture, Forestry, & Fisheries." Author of numerous research articles and textbook chapters.

Disclosure Statement: None

SPEECH TITLE: “The Need for a National Environmental Medical Unit”

The speaker has provided the information below.

1.) Goals and objectives:

$ To know what an environmental control unit [environmental medical unit] is.

$ To know the history of Environmental Medical Units in this country and abroad.

$ To know the clinical and research uses of Environmental Medical Units.

$ To know the need for a National Environmental Medical Units for research studies.

2.) Outline of talk/abstract: The concept of an Environmental Control Unit [Environmental Medical Unit] was developed by Dr. Theron Randolph as a clinical tool to evaluate environmental factors such as air pollutants, natural and additive dietary elements, and water contaminants on specific disease processes. From 1966 to 1974,a number of EMUs were opened in this country and for the evaluation of environmental factors contributing to specific disease processes in individual patients. Though tens of thousands of patients were treated in these units with a high degree of patient and physician satisfaction, these units were abandoned due to economic and political factors, the changing healthcare environment, and the refusal of third party carriers to pay for this service. Environmental Medical Units are an important research tool to evaluation environmental factors in a number of syndromes and diseases. The Japanese have taken a leadership role in establishing EMUs for medical research, in particular in evaluating effects of sick building gases and volatile organic chemicals on cerebral function. The case for a national EMU in the United States is presented, and the use of such a unit to study environmental factors in specific diseases is discussed.

3.) Conclusion of what is to be learned: Environmental Medical Units have been very valuable as a clinical tool and will play a prominent role in environmental medicine research in the future. The United States should build a National Environmental Control Unit devoted to research in environmental medicine.

4.) References: Proceedings of the 2003 International Symposium on Indoor Air Pollution and Health Hazards. Tokyo, Japan. January 8 to 11, 2003.

Abstract Information & Notes

Allan D. Lieberman, M.D. Date of talk: Saturday, June 21, 2003, 11:00am

Center for Occupational & Environmental

Medicine, PA Phone: 843/572-1600

7510 Northforest Dr. Fax: 843/572-1795

North Charleston, SC 29420-4297 E-mail: [email protected]

Medical School Attended: Chicago Medical School

Major and date of Graduation: 1960

Residency: Children=s Memorial Hospital - Chicago

Board Certifications: Fellowship - American Academy of Environmental Medicine

American Board Environmental Medicine

Current Job Description: Medical Director of Center for Occupational & Environmental Medicine

Disclosure Statement: None

SPEECH TITLE: “Explosion of Mold Cases in Homes, Work Places and in Occupational Medical Practices”

The speaker has provided the information below.

1.) Goals and objectives: To explore the different questions of toxic mold exposures.

2.) Outline of talk/abstract: A clinical presentation of the effects and sequelae of 3 separate sick building exposures to mold.

3.) Conclusion of what is to be learned: Patterns of Reactivity to mold, their similarities, differences and their chronicity.

4.) References:

Explosion of Mold Cases in Homes, Workplaces and in Occupational Medical Practices

Allan D. Lieberman, M.D.

In practices all over the country, there has been an explosion of patients seeking help from alleged exposure to molds both in their homes and workplaces. The severity of their symptoms and the multi-system spectrum of their complaints demands that physicians seeing these patients become more knowledgeable about the serious health effects of mold exposure.

Yet, we are told in a position paper¹ published by the American College of Occupational and Environmental Medicine and peer reviewed by the Council on Scientific Affairs, that “mold growth indoors is undesirable but does not warrant the fear that is too often associated with it. A careful review of the science suggests that irrational fear of indoor mold threatens responsible public policy more than indoor mold threatens public health.”²

On what clinical evidence is this opinion based? Objective analysis requires you to believe in what you see and not see what you believe.

The case report is the gold standard in identifying the adverse effects of environmental exposures and it is the obligation of physicians to report these cases. This presentation will do just that, summarizing the findings in 48 cases of mold exposure.

The case reports presented derive from workers in a bank, industrial plants, teachers in schools, and people in their homes. All were knowingly exposed to molds that were professionally evaluated, identified, and quantified. Most exposures were long-term lasting weeks to months. Moisture was the universal cause precipitating the growth of the indoor mold. The mold species identified varied but the most common were:

Aspergillus

Penicillium

Cladosporium

Stachybotrys

Multiple systems were affected confirming the multi-system injury that mold exposure can produce. The spectrum of signs and symptoms in descending order of frequency included:

Muscle and/or joint pain 71%

Fatigue/weakness 70%

Neurocognitive dysfunction 67%

Sinusitis 65%

Headache 65%

Gastrointestinal problems 58%

Shortness of breath 54%

Anxiety/depression/irritability 54%

Vision problems 42%

Chest tightness 42%

Insomnia 40%

Dizziness 38%

Numbness and tingling 35%

Laryngitis/hoarseness 35%

Nausea 33%

Rashes 27%

Tremors 25%

Heart palpitations 21%

Bronchitis/pneumonia 21%

Nose bleeds 13%

Nasal Septal Perforation 2%

Mold and mycotoxin antibody titers:

23 out of 29 or 80% of patients tested showed positive antibodies to molds and mycotoxins.

Trichothecene 38%

Aspergillus 34%

Cladosporium 31%

Penicillium 28%

Stachybotrys 28%

Conclusions:

The findings of 48 cases of serious health effects from mold exposure suggests that mold is a significant cause of illness, impairment and disability.

References:

1. Hardin, B.D., Kelman, B.J., Saxon, A., ACOEM’s evidence based statement on the Adverse Health Effects Associated With Molds In The Indoor Environment. ACOEM’s report. Oct/Nov/Dec 2002.

2. Brunekreff, B., 1992. Damp Housing And Adult Respiratory Symptoms. Allergy 47:498-502.

3. Brunkreff, B., D.W. Dockery, F.E. Speizer, J.H. Ware, J.D. Spengler, and B.G. Ferris. 1989. Home Dampness And Respiratory Morbidity In Children. Am. Rev. Respir. Dis. 140: 1363-1367.

4. Dales, R.E., H. Zwanenburg, R. Burnett, and C.A. Franklin. 1991. Respiratory Health Effects Of Home Dampness And Molds Among Canadian Children. Am. J. Epidemiol. 134:196-203.

5. Packer, C.N., Stewart-Brown, and S.E. Fowle. 1994. Damp Housing And Adult Health: Results From A Lifestyle Study In Worcester, England. J. Epidemiol. Community Health 48:555-559.

6. Firhonen, I., A. Nevalainen, T. Husman, and J. Pekkanen. 1996. Home Dampness, Molds And Their Influence On Respiratory Infections And Symptoms In Adults In Finland. Eur. Respir. J. 9:2618-2622.

7. Platt, S.D., C.J. Martin, S.M. Hunt, and C.W. Lewis. 1989. Damp Housing, Mold Growth, And Symptomatic Health State. Br. Med. J. 298:1673-1678.

8. Engelhart, S. et al, Applied and Environmental Microbiology, August 2002, P. 3886-3890.

9. Bornchag, CG. et al. Indoor Air, 2001 June 1 (2): 71.

10. Beebe, Glenn. Toxic Carpet Three. 1971.

11. Andreissen, J.W., B. Brunekreff, and W. Roemer. 1998. Home Dampness And Respiratory Health Status In European Children. Clin. Exp. Allergy 28:1991-1200.

Abstract Information & Notes

Nancy A. Didriksen, Ph.D. Date of talk: Saturday, June 21, 2003, 11:30am

100 North Cottonwood Drive Phone: 972/889-9933

Ste. 106 Fax: 972/889-9935

Richardson, TX 75080 E-mail: N/A

Medical School Attended: University of North Texas

Major and date of Graduation: 1986 - Health Psychology/Behavioral Medicine

Residency: N/A

Current Faculty Appointments: Adjunct Professor of Psychology - University of North Texas

Current Job Description: Private Practice, primarily evaluating and treating patients with chemical/environmental sensitivity, Chronic Fatigue Immune Deficiency Syndrome, and Fibromyalgia.

Other Information: Internship - Environmental Control Unit, Northeast Community Hospital, Bedford, TX

Disclosure Statement: None

SPEECH TITLE: “Neurocognitive Deficits in Individuals Exposed to Toxigenic Molds”

The speaker has provided the information below.

1.) Goals and objectives: Describe the neurocognitive profiles of mold-exposed patients and implications of findings as to the neurotoxic properties of toxigenic fungi.

2.) Outline of talk/abstract: 1. General effects of neurotoxic exposure. 2. Description of the neurocognitive deficits observed in mold-exposed patients. 3. Caveats of data interpretation. 4. Implications of data for litigation and/or disability issues. 5. Implications for future research.

3.) Conclusion of what is to be learned: Extent and kind of neurocognitive dysfunction observed in patients exposed to toxigenic molds, implications for litigation and disability issues, and caveats regarding data interpretation.

4.) References:

Auger, P.L. (1994). Mycotoxins and Neurotoxicity. In Johanning, E. and Yang, C.S. (Eds.), Fungi and bacteria in indoor air environments (Proceedings of the International Conference, Saratoga Springs, New York). Eastern New York Occupational Health Program.

Mandell, M. (1976). Mold allergy as a major cause of bio-ecologic mental illness. In L. Dickey (Ed.), Clinical ecology (pp. 259-261). Springfield, Il: Charles C. Thomas.

Johanning, E. (Ed.). (2001). Bioaerosols, fungi and mycotoxins: Health effects, assessment, prevention and control. Albany, NY: Fungal Research Group (FRG), Inc. Boyd Printing Company, Inc.

Neurocognitive Deficits in Individuals Exposed to Toxigenic Molds

Nancy A. Didriksen, Ph.D.

Goals and Objectives:

1. Describe the neuropsychological test results of patients reporting primary exposures to toxigenic molds.

2. Describe the types of neurocognitive deficits found most frequently in mold-exposed individuals.

3. Discuss the physical, psychological, and neurocognitive symptoms endorsed most frequently on the checklists and whether the reported neurocognitive symptoms are consistent with neuropsychological findings.

4. Discuss confounding variables in data analysis and their importance in disability and litigation issues.

5. Implications for future research.

Relatively few studies are available regarding the neurocognitive deficits resulting from exposure to toxigenic molds. Dr. Marshall Mandell (1976) reported cerebral reactions including inability to concentrate and confusion during provocative testing with various mold extracts and reviewed the biological sources of antibiotics with proven neurotoxic properties. More recently, cognitive impairment associated with exposure to toxigenic fungi has been reported by Gordon, Johanning, and Haddad (2001). Auger, Pépin, Miller, Gareis, et. al. (2001) have reported chronic toxic encephalopathies apparently related to exposure to toxigenic fungi. Baldo, Ahmad, and Ruff (2002) have described the neuropsychological performance of patients following mold exposure with impairment observed in visuospatial learning and memory, verbal learning and psychomotor speed.

The neurocognitive data of 41 patients (mean age 47.95, mean educational level 15.32) reporting primary mold exposures were examined in the present study. Neuropsychological test batteries of varying comprehensiveness (including the Halstead-Reitan Neuropsychological Test Battery) were administered. Test results were compared with normative data. Deficits were found primarily on measures of executive functions, psychomotor problem-solving, and incidental memory. Scores on the Wechsler Memory Scale-III fell within normal limits, overall, with greatest impairment on measures of visual memory. Fifty-seven percent of patients demonstrated mild to moderate impairment, overall, on the Halstead-Reitan Battery. Forty-two percent demonstrated mild to severe impairment on the Comprehensive Neuropsychological Screen with an additional 17 percent scoring in a low-normal range. Scores on measures of specific neuropsychological abilities showed some impairment of sensory and motor functions. IQ scores fell generally within expected ranges, overall.

Physical Symptoms reported most frequently on the Physical Symptom Checklist included fatigue, low energy, headaches, difficulty remaining asleep, weakness, sinus discomfort, skin problems, decreased balance and coordination, mucus, difficulty falling asleep, and “sick all over.” Psychological symptoms most frequently reported on the Psychological Symptom Checklist included present performance inferior to prior performance or level of functioning, overwhelming exhaustion, fatigue, or weariness, “cloudy, foggy, spacey,” “This is not me,” difficulty getting started in the morning, worry about bodily dysfunction, tense, difficulty setting and reaching goals, inability to cope well with daily or other stressors, irritability, decreased libido, and feels like “insides are racing.” Frequently endorsed neurocognitive symptoms on the Neurocognitive Symptom Checklist included decreased immediate and short-term memory, decreased concentration, decreased attention, difficulty remembering the names of things or people, intellectual inefficiency, word-finding problems, decreased comprehension, decreased long-term memory, easily distracted, loses train of thought, and poorly organized.

Age, sex, and educational norms were utilized in addition to the standardization group norms to determine whether a decrement in functioning had occurred. Additionally, prior levels of educational and occupational performance were considered in the interpretation of test results, particularly important for disability determination. All patients to whom a malingering test had been administered scored within normal limits.

Many factors, including time elapsed from exposure to evaluation (0-67 months), duration of exposure (less than 1 month to 12 years), other environmental exposures/sensitivities, motivation of the individual, reactions to environmental incitants at the time of evaluation, head trauma and/or other neurological conditions, medications, metabolic disorders, and past or present drug and alcohol abuse were considered in the interpretation of individual test data and to determine whether the observed deficits were due primarily to mold exposure. These factors are particularly important for litigation issues.

Conclusions:

The neuropsychological test data of mold-exposed individuals present a pattern of deficits quite similar to those found in patients exposed to other neurotoxins including solvents, pesticides, and metals. Results suggest that the molds to which these patients were exposed have neurotoxic properties. Deficits do not appear as severe as those observed with other types of neurotoxic exposures. Possible explanations include (1) a greater awareness of physical discomfort alerting the individual to the toxic environment and decreasing the duration of exposure, (2) neurotoxic effects of molds are less severe, (3) small sample size, (4) sensitivity of tests administered, (5) individual susceptibility.

Further research is necessary to determine the neurotoxic effects of specific molds, types of individuals with greater susceptibility to neurotoxic effects, factors which appear to enhance susceptibility to adverse effects, and interventions, which promote healing after exposure. A larger database and collaboration among various healthcare providers are necessary.

References:

American Psychiatric Association (1990). Diagnostic and statistical manual of mental disorders (4th Ed.) (pp. 733-34). Washington, D.C: American Psychiatric Association.

Auger, P. L. (1994). Mycotoxins and neurotoxicity. In Johanning, E. and Yang, C. S. (Eds.), Fungi and bacteria in indoor air environments (Proceedings of the International Conference, Saratoga Springs, New York). Eastern New York Occupational Health Program.

Baldo, J.V., Ahmad, L. & Ruff, R. (2002). Neuropsychological performance of patients following mold exposure. Applied Neuropsychology, 9(4), 193-202.

Harrell, E.H., Butler, J.R., & Didriksen, N.A. (1986). Comprehensive neuropsychological screen. Unpublished assessment instrument. Health Psychology/Behavioral Medicine Associates, 100 N. Cottonwood Dr., Suite 106, Richardson, TX 75080.

Heaton, R. K., Grant, I. & Matthews, C. G. (1991). Comprehensive norms for an expanded Halstead-Reitan battery. Odessa, FL: Psychological Assessment Resources, Inc.

Jarvis, P.E. & Barth, J.T. (1994). The Halstead-Reitan neuropsychological battery: a guide to interpretation and clinical applications. Odessa, FL: Psychological Assessment Resources, Inc.

Johanning, E. (Ed.). (2001). Bioaerosols, fungi and mycotoxins: Health effects, assessment, prevention and control. Albany, NY: Fungal Research Group (FRG), Inc. Boyd Printing Company, Inc.

Lezak, M.D. (1995). Neuropsychological assessment (3rd Ed.) New York: Oxford.

Mandell, M. (1976). Mold allergy as a major cause of bio-ecologic mental illness. In L. Dickey (Ed.), Clinical ecology (pp. 259-261). Springfield, Il: Charles C. Thomas.

Reitan, R.M. & Wolfson, D. (1993, 2nd Ed.). The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation. Tucson, AZ: Neuropsychology Press.

The Psychological Corporation. (1997). WAIS-III WMS-III technical manual. San Antonio: The Psychological Corporation.

Wechsler, D. (1981). Wechsler adult intelligence scale - revised. New York: Psychological Corporation.

Abstract Information & Notes

Jean A. Monro, M.D. Date of talk: Saturday, June 21, 2003, 1:30pm

Breakspear Hospital Phone: 011442261333

Hertfordshire House Fax: 011442266388

Wood Lane, Paradise Estate E-mail: [email protected]

Hemel Hempstead, Herts, HP2 4FD

U.K.

Medical School Attended: London Hospital Medical College

Major and date of Graduation: Medicine MB, BS 1960

Current Job Description: Medical Director of Breakspear Hospital, Hemel Hempstead, UK

Disclosure Statement: None

SPEECH TITLE: “Treatment of Cancer with Mushroom Products”

The speaker has provided the information below.

1.) Goals and objectives: To provide information on the use of natural resources in the treatment of cancer. To highlight that these can be a protective measure through life.

2.) Outline of talk/abstract:

3.) Conclusion of what is to be learned: Prevention of disease and treatment can overlap. Mushroom products can be therapeutically beneficial in prevention. There are toxic mushroom products which have been used in chemotherapy.

4.) References:

4. Ikekawa T. Beneficial effects of edible and medicinal mushrooms on health care. Int J Med Mushrooms 2000;3:291-8.

5. Monro JA. Coriolus: the use of the medicinal mushroom Coriolus MRL as an immunotherapeutic agent in the treatment of patients with chronic fatigue syndrome. To be published 2003.

6. Smith JE, Rowan NJ, Sullivan R. Medicinal mushrooms; their therapeutic properties and current medical usage with special emphasis on cancer treatments. London: Cancer Research UK; 2002.

Dr. Jean A. Monro,

Breakspear Hospital,

Hemel Hempstead, U.K.

ABSTRACT

In the treatment of cancer, most treatments currently used are designed to be cytotoxic to the neoplastic cells. One of the most promising methods to be considered is an immunological method of control. No agent other than mushrooms can be used both for prevention and treatment. In both, mushroom species have the properties for immune modulation and prevention of disease, which certainly is not the case with those forms of treatment, which are cytotoxic. Some mushroom products have other medicinal purposes; for example antibiotics and ergot alkaloids, Penicillin, Griseofulvin and also of course some cytotoxic agents such as Cyclosporin which are fungus-derived.

However, mushroom-derived polysaccharides can modulate animal and human responses and inhibit tumour growth. They influence cells through cytotoxic macrophage activity, monocytes, neutrophils, natural killer cells, dendritic cells, and alter chemical messengers, cytokines, which trigger complement and acute phase responses such as the interleukins, interferons and colony-stimulating factors. Multi-cytokine inducers can induce gene expression of immunomodulatory cytokines and cytokine receptors. They can stimulate

T-cells with cell mediated cytotoxicity and B-cells with antibody production.

In Japan, Korea and China Phase I, II and III clinical trials have been performed and mushrooms are now used as adjuncts to chemotherapy. Some of the main important polysaccharide compounds that have undergone clinical trials include :

Lentinan from Lentinula edodes
Schizophyllum from Schizophyllum commune
PSK Krestin and PSP from Trametes versicolor
Grifon D from Grifola frondosa

Letinan and Schizophyllum are T-cell oriented immuno-potentiators and require a functional T-cell component for biological activity by way of increasing helper T-cell production, increased macrophage production leading to a stimulation of acute phase proteins and colony stimulating factors, which in turn affect proliferation of macrophages, neutrophils and lymphocytes and activation of the complement system.

PSK Krestin and PSP are potent immuno-stimulators with specific activity for T-cells and for antigen presenting cells such as monocytes and macrophages. Their biological activity is characterised by their ability to increase white blood cell counts, interferon gamma, interleukin 2 production and delayed hypersensitivity reactions.

Epidemiologically there have been large-scale studies of the effects of mushrooms. The anti-tumour activities of Basidiomycetes have been studied by the National Cancer Centre Research Institute of Japan since 1966. This has included an epidemiological investigation over 15 years from 1972 to 1986. 174,505 people were studied. A group of people in the Nagano Prefecture in Japan was examined and those farmers who were producing mushroom species Flammulina velutipes were compared with the rest of the population. The average cancer death rate of farmers was hugely different from those in the rest of the population. The cancer death rate in general was 160.1 per 100,000 and of the farmers 97.1 per 100,000. This edible mushroom is now popularly consumed as a functional food, particularly in the Nagano Prefecture.

In our own work we have shown that natural killer cell numbers can be doubled within two months of taking therapeutic doses of Coriolus which contains Krestin PSk and PSP. We have embarked on programs of assessment of treatment of patients with cancer with immune-modulating mushroom products.

Why do mushroom polysaccharides have such an amazing array of biopharmacological activities? Polysaccharides, unlike proteins and nucleic acids, contain repetitive structural features that are polymers of monosaccharide residues joined to each other by glycosidic linkage. These polysaccharides offer a high capacity for carrying biological information because of their increased potential for structural variability. The amino acids in proteins and the nucleotides in nucleic acids can only interconnect in one way, while the monosaccharide units in the polysaccharides can interconnect at several points to provide a wide range of branched molecules. The number of possible permutations from four different sugar monosaccharides could be up to 35,560, whereas four amino acids can only form 24 different permutations. This allows an enormous flexibility for regulatory mechanisms of cell interactions. The responses that changes in this highly branched structure can allow information transmission. Most of the matrix between cells is constructed of glycoproteins in a similar way and it is the matrix, which allows the transfer of information through the organism at an incredibly rapid rate, it is said at the speed of sound. The incorporation of biological structures which are proteoglycans throughout the matrix of the body can be likened to the equivalent of fungal structures. Biologically this can be said to be equivalent to the incorporation within cells of mitochondria which we know of from plant species. It could be that this biological role that we have for proteoglycans in our structures is being augmented and mimicked by the polysaccharide and proteoglycans from mushroom species.

Natural killer cells are increased in numbers by mushroom treatment. In my paper on Coriolus I quoted the work of Roitt who showed that “NK cells are thought to recognise structures on high molecular weight glycoproteins which appear on the surface of virally infected cells and which allow them to be differentiated from normal cells. This recognition probably occurs through lectin-like [i.e. carbohydrate binding] receptors on the NK cell surface which bring killer and target into close opposition.

Activation of the NK cell ensues and leads to polarisation of granules between nucleus and target within minutes and extra-cellular release of their contents into the space between the two cells, often utilising the cytolysin perforin.

NK cells kill by activating apoptosis.

In addition to perforin, the granules contain tumour necrosis factor β and a family of serine proteases termed granzymes, one of which, granzyme B, can function as an NK cytotoxic factor. Also fully ionised ATP which can cause apoptosis in many different cell types; the effectors themselves are resistant probably due to a lack of ATP receptors on their surface. These factors sequentially induce NK-mediated lysis.

A current view is that granzyme B kills by directly activating an endogenous family of ICE [IL-1β converting enzyme] proteases which subsequently degrade other molecules including the repair enzyme poly [ADP-ribose] polymerase. Chondroitin sulphate A, a protease-resistant highly negatively charged proteo-glycan, is present in the granules and may protect the NK cell from autolysis.

The various interferons augment NK cytotoxicity and since interferons are produced by virally infected cells, there is an integrated feedback defence system.

Virally infected cells can be killed by cytotoxic T-cells and ADCC

Viral antibodies can bring the NK cell very close to the target virally infected cell by forming a bridge and the NK cell being activated by the complexed antibody molecules is able to kill the virally infected cell by its extra-cellular mechanisms. This system, termed antibody-dependent cell-mediated cytotoxicity [ADCC], has been demonstrated in vitro.” Natural killer cells scavenge cancer cells similarly.

Conclusion

Of the 10 million new cancers diagnosed worldwide annually, 1.5 million are said to have been associated with infections, especially viruses, 3 million due to toxic exposure and 3 million due to dietary causes. The remainder have an unknown aetiology.

Mushrooms may be able to address virally induced cancers as well as those due to dietary and lifestyle causes.

References :

1. Ikekawa T. Beneficial effects of edible and medicinal mushrooms on health care. Int J Med Mushrooms 2000;3:291-8.

2. Monro JA. Coriolus: the use of the medicinal mushroom Coriolus MRL as an immunotherapeutic agent in the treatment of patients with chronic fatigue syndrome. To be published 2003.

3. Smith JE, Rowan NJ, Sullivan R. Medicinal mushrooms; their therapeutic properties and current medical usage with special emphasis on cancer treatments. London: Cancer Research UK; 2002.

Abstract Information & Notes

Larry Foster Date of talk: Saturday, June 21, 2003, 2:00pm

Enviro Cure Phone: 404/876-3680

1280 West Peachtree Street, Suite 1606 Fax: 404/685-0971

Atlanta, GA 30309 E-mail: N/A

Current Job Description: Senior Environmental Consultant

Other Information: Discovered that species of mold in the environment (indoors) were causative factors in human sickness including allergies, arthritis, asthma, headaches, learning disabilities, sinus infections, sleep apnea and more.

Disclosure Statement: None

SPEECH TITLE: “General Reasons and Causes of Sick Buildings that are a Result of Airborne Biohazards”

The speaker has provided the information below.

1.) Goals and objectives: To provide information to the Physician that is a necessity for an optimum diagnosis.

2.) Outline of talk/abstract:

I. How a Source of Disease Begins

II. How it Grows and Spreads

III. How it Enters the Human System and Causes Disease

3.) Conclusion of what is to be learned: A “New@ Broader view to Health Care (Treatment), viewing a “womb to the tomb@ approach.

4.) References:

E.P.A. Manual on Schools and Commercial Buildings

The Fungus Link by Doug Kaufmann

General Reasons and Causes of Sick Buildings that are a result of airborne biohazards.

Larry Foster

Enviro-CURE Services, Atlanta, Georgia

Do not buy a house (or building) that is in a gully, a food plain, or is downhill from the path of rainwater.

Do not by a house (or building) that has had water leaks that have not been corrected.

Do not by a house that has a flooded crawlspace, a sump pump (a great indications of previous water problems). (See A)

Do not buy a house that has had watermarked walls or ceilings. In just a short time the house can be overrun by visible colonies. (See A1)

Things to inspect (concerns) before you buy: Attic Area – Be sure that this area is not infested by birds, insects, rodents or varmints.

Check for visible signs of water intrusion. (See B)

If there is blown-in fibrous insulation, it will disintegrate and particulate. The minute fibers become airborne and can be visually observed on the topside of ductwork and beams and on the A.C. system. (See C) These particles are able to infiltrate (See D) into the living areas as they are sucked into the A.C. and circulated through the air ducts and into the living areas. (See E)

In many instances the attic openings that the ceiling (below) lights and ducting pass through in many cases are not properly caulked. (See F)

This can be a source of airborne fibers, molds, bacteria, animal and insect by products that will infiltrate into the bedrooms (below the attic) and appear to the homeowner as just acceptable “house dust.” (See G) It does not long before belongings are covered with mold and must be discarded. This “house dust” causes allergies, asthma, sleep apnea, snoring, rashes, congestion, infections and a long list of health complaints. (See H)

To avoid these problems when building a new home, use insulation wrapped in plastic to prevent long-term degradation or aerolization of any fibrous particulate. These products are readily available at Lowe’s and Home Depot Stores.

Attic A.C. systems are a source of contamination that not only sucks in fibers but minute mold and bacterial and insect fragments (feces) that locate in this dark rarely used area. (See I)

HVAC Systems (In General)

For some reason the architects and builders have not come up with the concept that people live in the houses they design and build.

They have taken no time at all to consider that the houses that they have completed are in fact contaminated boxes that ultimately will cause sickness and death.

Picture a tightly insulated building that has had water leaks or rain or high humidity during the building process. When that house (or building) is “boxed” in, the A.C. units are being used by the contractor, which are sucking in debris, mold, bacteria, etc. (See J)

The air is contaminated with sheetrock dust, fibers, cigarette smoke, chemicals and even food remnants left by laborers. The cabinets and carpets are off-gassing formaldehyde. (See K) All this is being circulated by a contaminated A.C. system.

You look out a window and it is raining. The roof begins to leak and the rainwater soaks the blown-in insulation. Insects and rodents find wet insulation ideal nesting areas. (See L)

The small fragments of fibers are settling through holes around the lighting fixtures and down between two-by-fours, down the light sockets, in the walls. (See M)

The rain subsides and a foul odor emanates from under the house. You walk around the house and find a small door that enters into a two or three-foot high dirt crawlspace (See N) that you can just about crawl around in and find it is muddy, foul smelling and there are no drains to alleviate any standing water (See O), which will infest the under floor beams and flooring.

And to make things worse the one air conditioner is located in this mud and the other one is in the damp attic along side the wet fiberglass insulation.

It is a wonder why the A.C. systems, which are designed fro our comfort and health, are always installed in the dirtiest, foulest, most contaminated locations in our homes. It is as if the homes were designed by the pharmaceutical companies. After living in a home of this description for less than one year, your children will be diagnosed as asthmatic. Someone will experience respiratory ailments, sleep apnea, and chronic illness and even worse your children’s life is being programmed with anti-biotic. Isn’t there something criminally wrong with this picture?

Humidifiers are helpful at times. They are a source of diseases at other times. When they are installed in the plenum of a furnace they are designed to spray water into the ducts. This will add moisture into the house and mold and bacteria into your lungs. (See P) The biohazards are spread by the air ducts (See P1) and eventually appear coming out of the air supply. (See P2)

Humidity (over 50%) is necessary for the growth and habitat for dust mites. If you can control your humidity levels to below 40%, dust mites cannot live in your environment. If you don’t the dust mites and their feces become airborne and can cause allergies and respiratory complaints and aid in the spread of diseases. They are one of the top allergens of note.

HEPA Vacuums (Not a Brand Name), a rating of 99.997 @ 0.3 microns, are very effective in reducing airborne particulates and germs that are causes of many allergies and diseases. An average vacuum cleaner produces more dust into the air than it picks up, it’s just that you can’t see it. Many times the large particles of dust are just pulverized by the vacuum and become minute microscopic airborne contaminants that may remain airborne for months.

People with allergies and those who are hypersensitive to dust and mold are safer in their homes if a HEPA or retrofitted HEPA is attached to your current vacuum cleaner.

Abstract Information & Notes

Theodore R. Simon, M.D. Date of talk: Saturday, June 21, 2003, 2:30pm

Functional Imaging of Texas, PA Phone: 214/528-2482

4429 Southern Avenue Fax: 972/566-4762

Dallas, TX 75202 E-mail: [email protected]

Medical School Attended: Yale University

Major and date of Graduation: M.D., 1975

Residency: Nuclear Medicine

Board Certifications: Nuclear Medicine

Current Job Description: Private Practice

Disclosure Statement: None

SPEECH TITLE: “Neurotoxicity: Mold Exposure versus All Causes”

The speaker has provided the information below.

1.) Goals and objectives: Demonstrate the utility of scintigraphy in diagnosing frequently encountered environmental illnesses.

2.) Outline of talk/abstract: Available nuclear medicine techniques will be shown as they relate to specific illnesses with particular emphasis on the brain.

3.) Conclusion of what is to be learned: Appropriate, cost-effective use of nuclear medicine procedures in environmental illnesses can be achieved using a systematic approach.

4.) References:

Neurotoxicity: Mold Exposure versus All Causes

Theodore R. Simon, M.D.

June 21, 2003

Goals and Objectives: We have developed an interest in neurotoxicity as demonstrated by single photon emission computed tomography using a tracer for glutathione function. Recently, we have attempted to focus this interest on patients with putative neurotoxicity from mold exposure. That focus will be explored and used as a basis for explaining the clinical utility of scintigraphy of the brain as a clinical tool for addressing the care of environmentally challenged patients.

The audience will learn how to determine whether this technique is appropriate in individual patients that may require management for environmental disease exposure.

Outline: We have performed single photon emission computed tomography (SPECT) with [technetium-99m]HMPaO on 30 patients taken from a sample of 153 consecutive patients who presented with neurotoxicity and a history of mold exposure. These data will be presented and compared with our normal sample and with previous patients who have been examined for neurotoxicity from all causes.

Our usual technique of early and late single photon emission computed tomography using a triple head SPECT gamma camera and an intravenous injection, under microprocessor control, of [technetium-99m]HMPaO showed at least one of the findings that we expect in neurotoxicity was present in every patient. These findings are: mismatch between the early and late phases, shunting of the tracer to the soft tissues, temporal lobe asymmetry, and a “salt and pepper pattern". The salt and pepper pattern is defined as multiple hot and cold foci distributed throughout the cortex without regard to lobar distribution.

The sample of thirty subjects to be presented was acquired between November 22, 2000 and December 5, 2002. It consisted of 20 (67%) females and 10 (33%) males aged 5 to 67 years (average±sem= 43.3±2.18). Overall, the population showed no severe cases with the neurotoxic pattern; 11(37%), moderate; 15(50%), mild; and 4(13%), without the pattern. This overall distribution differs from the usual population of clinically neurotoxic patients. Mold exposure was associated with an absence of the pattern to a severe degree and by a higher incidence of moderate disease. Other, more subtle, differences will be explained in the presentation.

Conclusions: Triple head single photon emission computed tomography of the brain could be a useful adjunct to the clinical management of patients with putative neurotoxic exposure from mold.

Los Angeles, CA

ON MAN & HIS ENVIRONMENT

THURSDAY, JUNE 19, 2003

ABSTRACTS

AND

HANDOUTS

Abstract Information & Notes

Teaching Design for Good Indoor Air Quality

Outline

Evaluation of Competition Submissions

Evaluation of Student Contributions to Teacher’s Supplement

Conclusions

References

SCHEDULE

Molds and Mycotoxins in the Food Chain

The arrangement of interior spatial volumes in conjunction with openings in the architectural shell of a building can impact moisture intrusion and dissipation.

The specification of interior products contributes to prevalence of moisture and nutrient matter within the breathing zones of buildings. Specification of products includes interior finishes, fabrics, furnishings & equipment.

Decisions regarding the selection of interior products can be counterproductive to occupant health with regards to building occupants with heightened sensitivities to noise pollution, allergens and toxins.

References

Professor of Microbiology and Immunology

Metairie, LA

References

Medical School Attended: Medical College of Georgia, Augusta, Georgia

Neurocognitive Deficits in Individuals Exposed to Toxigenic Molds

Enviro-CURE Services, Atlanta, Georgia

June 21, 2003

Medical School Attended: Medical College of Georgia, Augusta, Georgia

References