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Index A American Conference of Governmental Industrial Hygienists (ACGIH), Acetylglucosamine polymer fibrils, 68 102103, 272, 274, 288, 301 ACGIH. See American Conference of guidance from, 296n Governmental Industrial Hygienists American Housing Survey, 316 Acremonium, 57 American Industrial Hygiene Association Actinomycetes, 145 (AIHA), 275, 284, 287, 296, Acute idiopathic pulmonary hemorrhage in 298 infants (AIPHI), 11, 241242, 333 American Lung Association, 320n AFS. See Allergic fungal rhinosinusitis American Red Cross (ARC), 272 AIHA. See American Industrial Hygiene American Society for Testing and Materials Association (ASTM) methods, 294 AIPHI. See Acute idiopathic pulmonary American Society of Heating, Refrigerating hemorrhage in infants and Air-Conditioning Engineers Air filtration methods, for assessing (ASHRAE), 273 microorganisms, 101 ventilation standard, 297 Airborne bacteria, concentrations in indoor American Thoracic Society, 320n air, 111 Analytic bias, 2223 Airborne fungal concentrations in confounding bias, 22 residences, in relation to building information bias, 22 dampness characteristics, 6065 response bias, 23 Airflow obstruction, 211212 reverse causality bias, 22 Allergens, isolated from fungi, 67. See also selection bias, 22 specific allergenic fungi Animals and animal cells Allergens of microbial origin, 6768 experiments on mucous membrane Allergic fungal rhinosinusitis (AFS), 210 irritation and inflammation, 136 Alternaria, 57, 216, 225, 231, 236 respiratory effects in, 139146 A. alternata, 55, 58, 211, 230, 316 ARC. See American Red Cross 343

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344 INDEX ASHRAE. See American Society of Heating, bacterial genera isolated from moldy Refrigerating and Air-Conditioning building materials, 66 Engineers on building materials, 5965 Aspergillus, 57, 66, 70, 128, 134, 157, 161 concentrations in the environment, 162, 189, 214, 216, 225, 235236, 110111, 112 247, 291 fungal genera found in infested A. alutaceus, 169 building materials, 64 A. clavatus, 162 fungi and other microorganisms A. flavus, 57, 71, 169 associated with dampness or mold A. fumigatus, 57, 71, 148150, 163, 230 growth in buildings, 65 A. niger, 5758 genera isolated from moldy building A. ochraceous, 145, 169 materials, 66 A. penicilloides, 57 in outdoor and indoor air, 5659 A. versicolor, 54, 57, 71, 135, 154 BALF. See Bronchoalveolar lavage fluid 155, 217 Barriers Assessment of epidemiologic evidence, 2325 to the adoption of dampness Assessment of microorganisms, 101103 prevention and reduction measures, culture-based methods, 101102 313314 exposure, 101103 to prevention, 5254 nonculture methods, 102103 Beck Depression Inventory, 247 Assessment of public health approaches to BHR. See Bronchial hyperresponsiveness damp indoor environments, 315 Bioaerosols: Assessment and Control, 317 274 Association. See Categories of association/ Bioavailability and route of exposure, 126 evidence 133 Asthma, 215231 experimental data, 130133 in Clearing the Air, 219 inhaled spores deposited in respirable definition of disorder, 215 (alveolar) area of lung, 129 exacerbation of, 218226 issues that affect bioavailability, 126 other asthma issues, 216217 130 role of sensitization, 215216 some mycotoxins and the symptoms in asthmatic people and microorganisms that produce them, exposure to damp indoor 127 environment, 220224 spore-deposition coefficients of mold Asthma development, 226231 genera in indoor environments, and exposure to damp indoor 129 environments, 228229 Biologic gradient (dose-response ASTM. See American Society for Testing relationship), 24 and Materials methods Biologic plausibility and coherence, 24 Atopic dermatitis, 245 Biomarkers, 109 Aureobasidium, 57 Boroscopes, 291 Bronchial hyperresponsiveness (BHR), 212 Bronchoalveolar lavage fluid (BALF), 136, B 144 Building materials, and microbial growth, (13)-glucans, concentrations in the 7273 environment, 113114 Buildings Bacillus spp., 59, 67, 71, 134 characteristics of, 5152 Bacteria collecting histories of, 287288 airborne fungal concentrations in as microbial habitats, 5455 residences in relation to building dampness characteristics, 6065

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INDEX 345 C CMHC. See Canadian Mortgage and Housing Corporation Calcium chloride test, 295 Collaboration, regarding public health California Occupational Safety and Health approaches to damp indoor Standards Board, 318 environments, 326327 California Verbal Learning Test (CVLT), Collecting histories of building and 247 occupants, 287288 Canadian Mortgage and Housing Colony-forming units (CFUs), 102 Corporation (CMHC), 272 Commercial buildings, in the United States, Cancers, 250251 1 Candida, 134, 216 Committee on Curriculum Development in C. albicans, 148, 156, 194 Environmental Medicine, 325 Capillary electrophoresis, 104 Comparison, of seven mold-remediation Carcinogenesis, 166170 guidance documents, 276285 Carcinogenic effects, of mycotoxins, 167 Components of microbial agents, 6572 168 allergens of microbial origin, 6768 Categories of association/evidence, 8, 2627 gaps in building microbiology science, inadequate or insufficient evidence to 71 determine whether an association microbial volatile organic compounds, exists, 811, 27 69 limited or suggestive evidence of an spores and cells of bacteria, 67 association, 811, 27 spores and fragments of fungi, 66 sufficient evidence of a causal structural components of fungi and relationship, 811, 26 bacteria, 6869 sufficient evidence of an association, toxic products of microbial secondary 811, 26 metabolism, 6971 CDC. See Centers for Disease Control and Computed tomographic (CT) scans, 188 Prevention Concentrations in the environment, 110 Cell-culture cytotoxicity testing, 104 114 Centers for Disease Control and Prevention airborne bacteria in indoor air, 111 (CDC), 2, 11, 15, 17, 240, 328329 (13)-glucans, 113114 CFUs. See Colony-forming units bacteria, 110111 Chaetomium, 66, 71 bacterial types found in different Characterizing Moisture Damaged indoor environments, 112 Buildings--Environmental and endotoxins, 111113 Biological Monitoring, 284 fungi, 110 Chronic obstructive pulmonary disease respiratory health related to indoor (COPD), 211, 213215 endotoxin exposure, 112113 Cladding, 34 Condensation and high humidity, 3944 Cladosporium, 57, 134, 200, 216, 219, moisture in heating, ventilating, and 225, 230231, 236 air-conditioning systems, 4244 C. cladosporioides, 54, 58, 140141, occupants as sources of moisture, 41 143145 42 C. herbarum, 230 Confidence intervals, 2122 C. sphaerospermum, 54, 58 Confounding, 23 Clearing the Air: Asthma and Indoor Air Confounding bias, 22 Exposures, 19, 56, 68, 184185, Connecticut Public Act 03-220, 317, 319 215216, 218219, 226227, 301, Conservation techniques, 298n 314, 321 Consistency, of association, 24 development of asthma in, 227 Construction moisture, 38

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346 INDEX Containment, establishing appropriate, fatigue and related symptoms and 295297 exposure to, 248249 Control of Moisture Problems Affecting nausea and related symptoms and Biological Indoor Air Quality, 274 exposure to, 246 COPD. See Chronic obstructive pulmonary skin problems and exposure to, 244 disease upper respiratory tract symptoms and Coprinus, 57 exposure to, 190192 Corynebacterium, 59 wheeze and exposure to, 203207 Cough, 194201 Dampness definitions and associated and exposure to damp indoor environmental assessments, 4, 106 environments, 195199 108 CT. See Computed tomographic scans Dampness-related problems not associated Culture-based methods of assessing with biologic sources, 7374 microorganisms, 101102 Decontaminating or removing damaged air filtration methods, 101 materials as appropriate, 298299 impactor methods, 101 Definitions of exposure assessment terms, liquid impinger methods, 101 9194 Cunninghamella, 57 dose, 94 Curvularia, 57 exposure, 9192 Cuyahoga County (Ohio) Department of exposure mechanisms, 9293 Development, 323 Demonstration projects, public-health- CVLT. See California Verbal Learning Test oriented, 321323 Dermal toxicity, 166 Development of asthma, 226231 D in Clearing the Air, 227 and exposure to damp indoor Damp buildings, 45, 2989 environment, 228229 dampness-related problems not DMSO, 133 associated with biologic sources, Dose, 94 7374 defined, 94 duration, 51 effective, 94 findings, 7677 internal, 94 location, 5051 Drechslera, 57 microorganisms occurring in indoor Duration, of dampness in buildings, 51 spaces and on building materials, Dyspnea, and exposure to damp indoor 5673 environments, 208, 209 moisture definitions, 3031 moisture dynamics and how buildings get wet, 3244 E from moisture to microbial growth, 5456 Economic and other incentives, in public prevalence, 4449 health approaches to damp indoor recommendations, 77 environments, 319320 research needs, 7778 Eczema, 245 risk factors for moisture problems, 51 Education, regarding public health 54 approaches to damp indoor severity, 4950 environments, 324326 Damp indoor environments Effective dose, 94 asthma development and exposure to, Electromagnetic fields (EMFs), 289 228229 Eliminating moisture sources, and drying cough and exposure to, 195199 the materials, 297298 dyspnea and exposure to, 209

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INDEX 347 ELISA. See Enzyme-linked immunosorbent Evidence. See Categories of association/ assays evidence Emergency actions, to stop water intrusion, Experimental data, on bioavailability and taking if needed, 286 route of exposure, 130133 EMFs. See Electromagnetic fields Experimental methods, to assess the Endotoxin units (EUs), 111 pulmonary effects of fungi, 334 Endotoxins, 68 Exposure, defined, 9192 concentrations in the environment, Exposure assessment, 67, 90124 111113 assessing bioallergens, 104 Environmental tobacco smoke (ETS), 12, assessing microbial constituents, 103 184, 201, 214, 227, 229, 242243 104 Enzyme-linked immunosorbent assays assessing microorganisms, 101103 (ELISA), 104, 109 concentrations in the environment, Epidemiologic evidence, 1728 110114 and categories of association, 2627 definitions, 9194 considerations in assessing the strength evaluation of exposure data, of, 2325 114115 evaluating, 2125 findings, 115116 intent and goals of the study, 1719 indirect exposure-assessment methods, research approach, 1921 104110 summarizing conclusions regarding, 26 recommendations, 115116 Epioccum, 57, 225 research needs, 115116 EPSs. See Extracellular polysaccharides sampling strategies, 94101 Equilibrium relative humidity (ERH), 31, Exposure mechanisms, defined, 9293 54, 7273 Exposure surrogates, 91 test, 295 Extracellular polysaccharides (EPSs), 91 ERH. See Equilibrium relative humidity ETS. See Environmental tobacco smoke Eurotium spp., 54 F EUs. See Endotoxin units Evaluation Fans, HEPA-filtered, 299 Fatigue and related symptoms, 245246 of the evidence of toxic effects of fungi and bacteria, 126 and exposure to damp indoor of exposure data, 114115 environments, 248249 Federal Emergency Management Agency of health effects, 186189 of whether the space has been (FEMA), 272, 324 successfully remediated, 299300 FEMA. See Federal Emergency Management Agency Evaluation criteria, 2325 biologic gradient (dose-response FEV. See Forced expiratory volume relationship), 24 Findings about dampness in buildings, 7677 biologic plausibility and coherence, 24 consistency of association, 24 about exposure assessment, 115116 strength of association, 2324 regarding prevention and remediation of damp indoor environments, temporally correct association, 24 Evaluation of the epidemiologic evidence, 304305 2125 regarding public health response, 327 328 conclusions regarding epidemiologic evidence, 2627 regarding the toxic effects of fungi and considerations in assessing the strength bacteria, 170171 First National Environmental Health Survey of epidemiologic evidence, 2325 methodologic considerations, 2123 of Child Care Centers, 316

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348 INDEX FISH. See Fluorescent in situ hybridization H Flavobacterium, 59 Fluorescent in situ hybridization (FISH), 102 Harvard Six Cities Study, 313 Forced expiratory volume (FEV), 96 Health complaints and disorders, 243252. Forced vital capacity (FVC), 211n See also Human health effects Fungal contamination, ascertaining extent associated with damp indoor and location of, 288292 environments Fungal Contamination in Buildings: A cancers, 250251 Guide to Recognition and fatigue, 245246 Management, 274 gastrointestinal tract, 245 Fungal genera, found in infested building nausea and related symptoms and materials, 64 exposure to damp indoor Fungi environments, 246 associated with dampness or mold neuropsychiatric symptoms, 247250 growth in buildings, 65 reproductive effects, 251 on building materials, 5965 rheumatologic and other immune concentrations in the environment, diseases, 251252 110 sick building syndrome, 250 in outdoor and indoor air, 5659 skin, 243245 Fusarium, 57, 71, 131, 164, 235 Healthy Homes Initiative, 323324, 326 FVC. See Forced vital capacity Healthy persons, respiratory infections in, 236237 Heating, ventilation, and air conditioning G (HVAC) systems, 5, 4244, 7578, 273, 275, 296297 Ganoderma, 57 Hemosiderosis, 238243 GAO. See General Accounting Office HEPA. See High-efficiency particulate air Gas chromatography (GC), 104 High-efficiency particulate air (HEPA), Gas chromatography-mass spectrometry 272273 (GCMS), 103104 filtering in a fan, 299 Gastrointestinal tract, 245 filtering in a vacuum, 298 GC. See Gas chromatography High-performance liquid chromatography GCMS. See Gas chromatography-mass (HPLC), 104 spectrometry Histories of buildings and occupants, General Accounting Office (GAO), 48 collecting, 287288 Geotrichum, 57 History of "toxic mold," 334 Gliotoxin, 163 Housing Global Initiative for Chronic Obstructive public health response, 312313 Lung Disease (GOLD), 213 in the United States, 1 GOLD. See Global Initiative for Chronic HP. See Hypersensitivity pneumonitis Obstructive Lung Disease HPLC. See High-performance liquid Grooved Pegboard Test, 247 chromatography Guidelines Human health effects associated with damp from the EPA, 274, 299, 324 indoor environments, 910, 183 for prevention of dampness-related 269 problems, 320321 evaluating health effects, 186189 Guidelines for the Assessment of other health complaints and disorders, Bioaerosols in the Indoor 243252 Environment, 272, 274 recommendations, 254255 research needs, 254255

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INDEX 349 respiratory symptoms, 189208 Indoor air quality (IAQ), 48 respiratory tract disorders, 208243 Indoor Air Quality Tools for Schools Humans and human cells, respiratory effects Program, 317 in, 146150 Indoor Allergens, 56, 68, 184 Humidifier fever, 233 Indoor Climate Work Environment HVAC. See Heating, ventilation, and air questionnaire, 287 conditioning systems Indoor:outdoor (I/O) concentration ratios, Hyalodendron, 57 59 Hypersensitivity pneumonitis (HP), 231233 Inflammatory responses to bacteria and fungi in mice, 137138 Information bias, 22 I Information gathering, 1920 Inhalation fevers, 233234 I/O. See Indoor:outdoor concentration humidifier fever, 233 ratios organic dust toxic syndrome (ODTS), IAQ. See Indoor air quality 233 IARC. See International Agency for Inhaled spores, deposited in respirable Research on Cancer (alveolar) area of lung, 129 Identification of the vulnerable population, Institute of Inspection, Cleaning, and extent of contamination, and Restoration Certification, 274n moisture dynamic, 287295 Institute of Medicine (IOM), 17, 19, 56, ascertaining extent and location of 184, 215, 302, 314 fungal contamination, 288292 Committee on Curriculum collecting histories of building and Development in Environmental occupants, 287288 Medicine, 325 identifying moisture dynamic, 293295 Internal dose, 94 Idiopathic pulmonary hemosiderosis. See International Agency for Research on Acute idiopathic pulmonary Cancer (IARC), 26, 169 hemorrhage in infants 2000 International Residential Code, 53 Illinois Department of Health, 323 International Society of Indoor Air Quality Immune-compromised persons, respiratory (ISIAQ), 274275, 299, 301 infections in, 235236 IOM. See Institute of Medicine Immunotoxicity, 150157 ISIAQ. See International Society of Indoor immunoactive mycotoxins and effects, Air Quality 152153 Impactor methods, for assessing microorganisms, 101 J In vitro experiments, on mucous membrane irritation and inflammation, 134 Judgment, role of, 21 135 Inadequate or insufficient evidence to determine whether or not an L association exists, 27 Indirect exposure-assessment methods, 104 LAL. See Limulus amebocyte lysate Leptosphaeria, 57 110 biomarkers, 109 Light, 55n dampness definitions and associated Limited or suggestive evidence of an association definition, 27 environmental assessments, 4, 106 108 Limiting conditions, for fungal growth on predictive exposure models, 109110 building materials, 335 Limiting moisture sources, and drying the signs and measurements of dampness, moisture, or mold, 104109 materials, 297298

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350 INDEX Limulus amebocyte lysate (LAL), 91, 103, fungi and bacteria in outdoor and 114 indoor air, 5659 L. polyphemus, 103 fungi and bacteria on building Lipopolysaccharides (LPSs), 103 materials, 5965 Liquid impinger methods, for assessing MM-040-EA Indoor Climate Work microorganisms, 101 Environment questionnaire, 287 LOAELs. See Lowest-observed-adverse- Moisture effect levels buildings as microbial habitats, 5455 Location, of dampness in buildings, 5051 definitions, 3031 Lower respiratory tract (LRT) effects, 194 determinants of microbial growth 208 indoors, 5556 cough, 194201 in heating, ventilating, and air shortness of breath (dyspnea), 208 conditioning systems, 4244 wheeze, 201208 role in microbial growth, 5456 Lowest-observed-adverse-effect levels Moisture content (MC), 3031, 73 (LOAELs), 126 Moisture dynamics in buildings LPSs. See Lipopolysaccharides condensation and high humidity, 39 LRT. See Lower respiratory tract effects 44 construction moisture, 38 how buildings get wet, 3244 M plumbing and wet rooms, 3738 rainwater and groundwater, 3337 MC. See Moisture content Moisture meters, 289 Memnoniella echinata, 128, 146147, 149 Mold and moisture control activities at Methodologic considerations, 2123 HUD, 333 analytic bias, 2223 Mold-remediation guidance documents, confounding, 23 comparison of, 276285 uncertainty and confidence, 2122 Mold Remediation in Schools and Microbial agents, components of, 6572 Commercial Buildings, 274 Microbial growth indoors, determinants of, Monitoring, of public health approaches to 5556 damp indoor environments, 315 Microbial volatile organic compounds 317 (MVOCs), 5, 66, 69, 90, 165 Morbidity and Mortality Weekly Report, Microbiology science, gaps in building, 71 233 Micrococcus, 59 Mucor plumbeus, 55 M. luteus, 134 Mucous membrane irritation and "Microenvironmental model" approach, inflammation, 133136 9798 animal experiments, 136 Microorganism constituents, 6 in vitro experiments, 134135 allergens, 6 Mucous membrane irritation syndrome, (13)-glucans, 6, 66, 237 212213 endotoxins, 6 MVOCs. See Microbial volatile organic fungal extracellular polysaccharides, 6 compounds fungal spores, 6 Mycobacterium obvis, 154 Microorganisms occurring in indoor spaces M. scrofulaceum, 135 and on building materials, 5673 M. terrae, 135136, 217 associated with dampness or mold Mycotoxins, and the microorganisms that growth in buildings, 65 produce them, 127 building materials and microbial growth, 7273 components of microbial agents, 65 72

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INDEX 351 N P National Cooperative Inner-City Asthma Paecilomyces, 57 Study, 323 Paralysis-inducing neurotoxins, 162 National Health and Nutrition Examination PCR. See Polymerase chain reaction Survey (NHANES II), 313 technologies National Institute for Occupational Safety Peak expiratory flow (PEF), 96, 211 and Health, 48 PEF. See Peak expiratory flow National Survey of Lead and Allergens in Penicillium, 57, 66, 7071, 128, 145, 157, Housing (NSLAH), 316 161162, 200, 216, 225, 230231, Nausea and related symptoms, and 236, 291 exposure to damp indoor P. aurentiogriseum, 149150, 169 environments, 246 P. bravicompactum, 54 Neuropsychiatric symptoms, 247250 P. chrysogenum, 149, 230, 292, 297 Neurospora, 57 P. citreo-viride, 162 Neurotoxic effects of indoor molds and P. crustosum, 162 bacteria, 157164 P. cyclopium, 169 gliotoxin, 163 P. expansum, 149 ochratoxin, 162163 P. glabrum, 149 paralysis-inducing neurotoxins, 162 P. simplicissimum, 162 tremorgenic toxins, 161162 P. spinulosum, 135136, 217 trichothecenes, 163164 P. verruculosum var. cyclopium, 162, Neurotoxic mycotoxins and effects, 158 169 161 P. viridicatum, 149, 169 New York City Department of Health Peptidoglycans, 6869 (NYCDOH), 273275, 287, 299, Personal vs area sampling, 9798 324 Phenylspirodrimanes, 147 NHANES II. See National Health and Planning remediation activities, 295301 Nutrition Examination Survey decontaminating or removing damaged NOAELS. See No-observed-adverse-effect materials as appropriate, 298299 levels eliminating or limiting moisture No-observed-adverse-effect levels sources and drying the materials, (NOAELs), 126, 145 297298 Nocardiopsis, 71 establishing appropriate containment Nonculture methods, for assessing and worker and occupant microorganisms, 102103 protection, 295297 North American Air Duct Cleaners evaluating whether the space has been Association, 296 successfully remediated, 299300 NSLAH. See National Survey of Lead and reassembling the space to prevent Allergens in Housing recurrence by controlling moisture NYCDOH. See New York City Department and nutrients, 301 of Health Plumbing and wet rooms, 3738 Polymerase chain reaction (PCR) technologies, 103 O Polyvinyl chloride (PVC) materials, 7374 Potential for water and moisture sources Occupants of buildings leading to excessive indoor collecting histories of, 287288 dampness, 3 as sources of moisture, 4142 Predictive exposure models, 109110 Ochratoxin, 162163 Prevalence, 4449 ODTS. See Organic dust toxic syndrome of dampness in buildings, 4449 Organic dust toxic syndrome (ODTS), 233

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352 INDEX of reported housing water leaks, 47 R of signs of building dampness, 4546 Prevention and remediation of damp indoor Rainwater and groundwater, 3337 environments, 1213, 270310 Reactivity issues, 94 effects of air and surface cleaning and Reassembling the space to prevent ventilation, 301304 recurrence by controlling moisture findings, 304305 and nutrients, 301 prevention, 270271 Recommendations, 1112 public health response, 1416 about dampness in buildings, 77 published guidance for mold about exposure assessment, 115116 remediation, 271284 regarding human health effects recommendations, 305 associated with damp indoor research needs, 305306 environments, 254255 tasks involved in remediation, regarding prevention and remediation 284301 of damp indoor environments, 305 Pseudomonas, 59, 134, 234 regarding public health response, 328 P. fluorescens, 134 329 Public health approaches to damp indoor regarding the toxic effects of fungi and environments, 314327 bacteria, 170171 assessment and monitoring, 315317 Regrowth of mold after remediation, 299 collaboration, 326327 300 economic and other incentives, 319320 Regulations, building codes, and building- education and training, 324326 related contracts, modification of, guidelines for prevention of dampness- 318 related problems, 320321 Relative humidity (RH), 31, 3940, 5152, modification of regulations, building 5455, 7274, 286, 294 codes, and building-related Remediation activities, 284301, 334 contracts, 318 decontaminating or removing damaged public-health-oriented research and materials as appropriate, 298299 demonstration, 321323 eliminating or limiting moisture Public health response, 1416, 311332 sources and drying the materials, barriers to the adoption of dampness 297298 prevention and reduction measures, establishing appropriate containment 313314 and worker and occupant findings, 327328 protection, 295297 public health and housing, 312313 evaluating whether the space has been public health approaches to damp successfully remediated, 299300 indoor environments, 314327 identifying the vulnerable population, recommendations, 328329 extent of contamination, and research needs, 328329 moisture dynamic, 287295 Publication bias, 2021 reassembling the space to prevent Published guidance for mold remediation, recurrence by controlling moisture 271284 and nutrients, 301 comparison of seven mold-remediation taking emergency actions to stop water guidance documents, 276285 intrusion if needed, 286 Pulmonary hemorrhage, 238243 Repairing Your Flooded Home, 272 in infants, 146149 Report of the Microbial Growth Task PVC. See Polyvinyl chloride materials Force, 274 Reported prevalence of signs of building dampness, 4546 Reproductive effects, 251

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INDEX 353 RER. See Rough endoplasmic reticulum pulmonary hemorrhage or Research approach to epidemiologic hemosiderosis, 238243 evidence, 1921 respiratory infections, 235238 information gathering, 1920 sinusitis, 208211 publication bias, 2021 Response bias, 23 role of judgment, 21 Reverse causality bias, 22 Research needs RH. See Relative humidity concerning dampness in buildings, 77 Rheumatologic and other immune diseases, 78 251252 in exposure assessment, 115116 Rhinocladiella, 57 public-health-oriented, 321323 Risk factors for moisture problems, 5154 regarding human health effects barriers to prevention, 5254 associated with damp indoor building characteristics, 5152 environments, 254255 Risk-relevant exposure metric, 91 regarding prevention and remediation Rough endoplasmic reticulum (RER), 144 of damp indoor environments, 305306 regarding public health response, 328 S 329 Saccharomyces, 57, 216 regarding the toxic effects of fungi and bacteria, 170171 Salmonella, 154 Respiratory cells and tissues, 136150 Sampling strategies, 94101 personal vs area sampling, 9798 animals and animal cells, 139146 effects of indoor molds and bacteria, settled dust vs airborne measurements, 136150 9497 when, where, and how often to humans and human cells, 146150 inflammatory and toxic responses to sample, 98101 bacteria and fungi in mice, 137138 San Diego Neuropsychological Test Battery, 247 pulmonary hemorrhage in infants, 146149 SBS. See Sick building syndrome Respiratory health, related to indoor Scanning electron microscopy (SEM), 102 Seattle-King County Healthy Homes endotoxin exposure, 112113 Respiratory infections, 235238 Project, 322 in immune-compromised persons, 235 Selection bias, 22 SEM. See Scanning electron microscopy 236 in otherwise-healthy persons, 236237 Sensory irritation, 164165 Respiratory symptoms, 189208 Settled dust vs airborne measurements, 94 97 lower respiratory tract (LRT) effects, 194208 Severity, of dampness in buildings, 4950 upper respiratory tract (URT) effects, Shortness of breath (dyspnea), 208 dyspnea and exposure to damp indoor 189194 Respiratory tract disorders, 208243 environment, 209 airflow obstruction, 211212 Sick building syndrome (SBS), 250 Signs and measurements of dampness, asthma, 215231 chronic obstructive pulmonary disease moisture, or mold, 104109 (COPD), 211, 213215 Sinusitis, 208211 Skin, 243245 hypersensitivity pneumonitis (HP), 231233 problems with, and exposure to damp inhalation fevers, 233234 indoor environments, 244 Smart Growth in America, 5354 mucous membrane irritation syndrome, 212213 Spore-deposition coefficients of mold genera in indoor environments, 129

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354 INDEX Spore-trap samples, 291 Toxic effects of indoor molds and bacteria, Spores 133170 and cells of bacteria, 67 carcinogenesis, 166170 and fragments of fungi, 66 carcinogenic effects of mycotoxins, Stachybotrys, 66, 132, 134135, 241242 167168 S. alternans, 70 dermal toxicity, 166 S. atra, 55, 70, 139140, 166, 239, immunoactive mycotoxins and effects, 273 152153 S. chartarum, 11, 17, 58, 70, 109, 128, immunotoxicity, 150157 135, 140149, 166, 170, 188, 239 mucous membrane irritation and 241, 247 inflammation, 133136 Staphylococcus, 134 neurotoxic effects, 157164 Stockholm Indoor Environment respiratory effects, 136150 Questionnaire, 287 sensory irritation, 164165 Strength of association, 2324 toxic responses to bacteria and fungi in Streptomyces, 59, 67, 71, 134 mice, 137138 S. annlatus, 134135, 252 Toxic products of microbial secondary S. californicus, 71n, 130, 134136, metabolism, 6971 217 Training, regarding public health Structural components of fungi and approaches to damp indoor bacteria, 6869 environments, 324326 acetylglucosamine polymer fibrils, 68 Tremorgenic toxins, 161162 endotoxins, 68 Trichoderma, 57, 71 peptidoglycans, 6869 T. viride, 127, 145, 153, 160, 162 Sufficient evidence Trichophyton, 216 of an association definition, 26 Trichosporon cutaneum, 232 of a causal relationship definition, 26 Trichothecene mycotoxins, 109, 131, 147, 155, 164 Trichothecenes, 163164 T Tritirachium, 57 Tasks involved in remediation, 284301 identifying the vulnerable population, U extent of contamination, and moisture dynamic, 287295 Ulocladium consortiale, 55 planning remediation activities, 295 Ultraviolet germicidal irradiation (UVGI), 44 301 Uncertainty, statistical characterization of, taking emergency actions to stop water 2122 intrusion if needed, 286 Upper respiratory tract (URT) effects, 189 Temporally correct association, 24 194 Thermophilic actinomycetes, 186 symptoms, and exposure to damp Thin-layer chromatography, 104 indoor environment, 190192 Toxic effects of fungi and bacteria, 78, URT. See Upper respiratory tract effects 125182 U.S. Census American Housing Survey, 44 bioavailability and route of exposure, U.S. Department of Agriculture (USDA), 126133 272, 324 considerations in evaluating the U.S. Department of Housing and Urban evidence, 126 Development (HUD), 15, 323, defined, 139n 328 findings, 170171 Healthy Homes Initiative, 323324, recommendations, 170171 326 research needs, 170171

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INDEX 355 U.S. Environmental Protection Agency Workshop topics, 333335 (EPA) acute idiopathic pulmonary guidelines, 274, 299, 324 hemorrhage in infants, 333 Indoor Air Quality Tools for Schools clinical issues, 334 Program, 317 EPA mold-related activities, 333 mold-related activities, 333 epidemiology of indoor damp spaces, U.S. Pharmacopoeia, 111n 334 U.S. Toxic Mold Safety and Protection Act experimental methods to assess the of 2003, 317n pulmonary effects of fungi, 334 UVGI. See Ultraviolet germicidal irradiation history and measurement of "toxic mold," 334 investigation and remediation of damp V indoor spaces, 334 limiting conditions for fungal growth Vacuum cleaner, HEPA-filtered, 298 on building materials, 335 Vapor-emission tests, 295 mold and moisture control activities at VOCs. See Volatile organic compounds HUD, 333 Volatile organic compounds (VOCs), 5, 66, mold-related research activities in 69, 90, 94, 165, 187 Finland, 333 toxicology, 335 toxigenic fungi as significant W environmental health threats, 333 Wallemia sebi, 54 Wheeze, 201208 and exposure to damp indoor Z environments, 203207 Zygomycetes, 231, 236 Worker and occupant protection, establishing appropriate, 295297

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