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Communicating your conclusions and recommendations i. Throughout the public health assessment process, you are synthesizing information that will support and enable you to draw public health conclusions.
In addition, you are identifying public health actions that might be needed to eliminate or prevent exposures, or you are identifying critical data gaps. This chapter describes the process by which you, with the input of the site team, take the findings of exposure and health effects evaluations and draw conclusions regarding the degree of public health hazard, if any, posed by the exposure situations you have studied at a site Section 9. The chapter also describes how to develop recommendations and a "public health action plan" PHAP Section 9.
An overview of the process is shown in Figure This chapter also describes ATSDR's "conclusion categories" and the criteria for selecting the appropriate category for a particular site. In addition, guidance is provided for developing recommendations and a PHAP that will help ensure that needed follow-up actions are achieved.
The chapter also provides tips for the content and wording of conclusions and recommendations. While this chapter focuses to a great extent on how the health assessor draws and communicates overall conclusions, it cannot be emphasized enough that public health conclusions and recommended public health actions are often made throughout the public health assessment process. Based on the results just click for source the exposure and health effects evaluations, the team will characterize the degree of public health hazard at the site based on the following factors:.
Based on the available information, you will need to make a statement about the health hazards associated with the site—for completed, and in some instances potential, exposure pathways and the time period of potential concern. In short, you need to determine whether conditions:. One of these three choices will apply to all conditions encountered.
The Results Of Carbon Hookup Of Skin Samples conducted throughout the public health assessment process provide the basis for conclusions regarding the level of public health hazard a site or hazardous substance release might pose. The conclusions are dependent on the characteristics and circumstances of exposure i. In cases where completed or potential exposure pathways are identified, conclusions should be based on the result of the health effects screening and public health implications analyses.
Within the overall framework of 'hazard,' 'no hazard,' and 'cannot be fully evaluated' see FigureATSDR has established five distinct descriptive conclusion categories to help ensure a consistent approach in drawing conclusions across sites and to assist the public health assessment team in determining Results Of Carbon Hookup Of Skin Samples type of follow-up actions that might be warranted. The definitions for each Results Of Carbon Hookup Of Skin Samples are presented in Table A more extensive description of ATSDR's conclusion categories and the specific criteria that should be used in selecting a category are presented in Appendix H.
Appendix H also includes possible follow-up activities associated with each of the categories see also Section 9. Categories click at this page and 2 indicate that conditions are such that there is a reasonable possibility that adverse health effects have occurred or are likely to occur in sufficiently exposed members of the population.
Category 4 indicates that adverse health effects are not likely in the population; exposures might be possible, but neither duration nor the degree of exposure is sufficient to result in adverse health effects.
Category 5 indicates that no public health hazard exists because no exposure is occurring. Determining the appropriate hazard category requires professional judgment. You need to decide what category best describes site conditions. A category is assigned after considering site-specific exposure potential, health effects information, and community health concerns. As discussed in earlier chapters, you must consider and integrate the total body of information available for the site when assessing public health hazards and, ultimately, in selecting the appropriate conclusion category.
To reiterate, these include:. Throughout the public health assessment process, you must determine whether critical data are available and sufficient to support a public health conclusion. If critical data are found to be missing, you will need to Talk To Your Examples recommending actions that might help fill those data gaps see Section 9.
As repeated throughout this manual, sites are unique. Professional judgment is therefore needed in deciding how best to present the conclusions and assign a conclusion category ies. It is rare that an entire site would be found to pose the same level of public health hazard.
You should therefore generally focus on those exposure pathways and locations that pose a hazard. In doing so, you will assign conclusion categories to the exposure pathways that pose a hazard and the populations impacted.
When site conditions have varied over time, it may be appropriate to assign a separate conclusion category for past, current, and future exposure conditions. You would then note that current and future pathways pose no public health hazard because the potential for exposure to contaminants in groundwater was eliminated with the municipal water hook-up. Sometimes for administrative purposes e. For example, if exposures to site-related contaminants via air and soil are shown to pose no public health hazards, but exposures to detected levels of contaminants in water do pose health hazards, then the site is categorized as posing a "public health hazard.
Instances often arise in which actual or potential exposures are identified but no health hazards are determined to exist i. For example, an estimated exposure doses might exceed a health guideline or a regulatory action level, but your integrated analysis might indicate that adverse health effects are not likely because of site-specific exposure conditions and substance-specific properties. Take, for example, a site where the maximum exposure point concentration of a particular metal exceeds an ATSDR comparison value by a factor of Upon closer examination and integration of site-specific exposure and health effects data, you may determine that harmful exposures are not occurring based on the following:.
Such a scenario might cause confusion, however, in cases where EPA or another regulatory agency is proposing or taking measures to reduce exposures by cleaning up the site e. In such cases, you will need to offer perspective as to why detected concentrations that exceed regulatory levels of concern might not be a public health concern. Reiterate that comparison values and regulatory action levels are not indicators of adverse effects but are generally used as levels considered amply safe when setting cleanup goals see Chapter 7 and Chapter 8.
Explain why prudent public health practice calls for reducing exposures even when the assessment does not indicate that health hazards exist. Data needed to draw Results Of Carbon Hookup Of Skin Samples might not always be available.
In some cases, additional data might be required to confirm or further support the decision made. It is important to carefully examine the criticality of missing data.
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When concluding that more data are needed to support a conclusion, determine whether the needed data can be obtained and, if so, obtained in a timely manner. In some cases, the data might never be available e.
If you determine that insufficient data exist to draw a conclusion, clearly indicate this in the public health assessment document. In addition, recommend additional actions when possible see Section 9.
Not all data gaps are data needs. Before recommending sampling or further investigation, carefully assess and distinguish what would be good to know versus what is needed to draw a public health conclusion, as well as issues that the community needs to know or that it might reasonably expect to be addressed.
Provide as much perspective as possible using available data. Conclusion categories are required in all site-specific public health assessment products assessing the public health implications of exposure pathways or site conditions e. If you are solely providing comments, technical assistance, or general scientific information as part of a public health-related activity, a conclusion category is not necessary.
Specific instances where you will not need a conclusion category include:. The Conclusion section of the public health assessment document should present a definitive statement about the link threat, if any, posed by a site.
Key issues should be highlighted.
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When possible, you should clearly state what is known and unknown by exposure pathway. When stating conclusions, present a clear narrative statement regarding the likelihood of adverse health effects under site-specific conditions. The health decision needs to be supported by a clear "story.
On September 18,the Des Groseilliers, a three-hundred-and-eighteen-foot-long icebreaker with a bright-red hull, set out from the town of Tuktoyaktuk, on the Beaufort Sea, and headed north under overcast skies. That see more, has human exposure been documented; is the size of the potentially exposed population is acceptable; has the presence or absence of reported health problems been verified; and is the community interested in participating? Clearly state the needed action. Most of the spots that are being considered are in areas nearly as remote as Sarichef, with no roads or nearby cities, or even settlements. A nine-member panel was appointed, led by the distinguished meteorologist Jule Charney, of M.
All conclusion statements should be succinct and not repeat large portions of statements presented in the Discussion section. The first conclusion should emphasize the main thrust of the public health assessment and address the key issues presented in the Purpose and Health Issues section. Subsequent conclusions should follow the main points from the Discussion section.
In most cases, it is advisable to present conclusions in order of public health priority or importance. Conclusion statements must be fully consistent with information presented in the public health assessment document and should not introduce any new information.
Conclusion categories must be presented in proper context. You must clearly describe the basis of the selected conclusion category ies. As mentioned above, ATSDR designed its conclusion categories to help assessors consistently formulate conclusions. You should therefore understand and follow the criteria set forth for selecting a conclusion category.
When communicating conclusions, however, it is of utmost importance to clearly describe the essential message of the public health assessment in plain language, both in terms of what is and is not known, before presenting the specific conclusion category.
For example, the essential message of ATSDR's "no apparent" category is that no hazard exists although some exposure might be occurring. In such a case, a statement such as the following is appropriate:. All conclusions must be supported by information presented in the Discussion section. Limit the use of the conclusion categories to the Summary and Conclusion sections here the document. The Discussion section, for example, should not include the phrase "no apparent" health hazards.
The language Results Of Carbon Hookup Of Skin Samples tone used in presenting conclusions should be sensitive and explanatory, especially when presenting conclusions related to community concerns see Chapter 4.
After reaching conclusions about a site, you may recommend that actions be taken to protect public health. PHA recommendations should emphasize prevention of releases and prevention of exposure and any precautions required to ensure that public health is protected. Because ATSDR is an advisory agency and not a risk management agency, your recommendations may identify actions that other entities e.
As the health assessor or team leader you should work with the members of your team in determining Results Of Carbon Hookup Of Skin Samples most appropriate recommendations. The criteria described in this section should guide your decisions. Recommendations for actions needed to protect the health of those living or working on or near the site will vary from site to site.
Depending on the site-specific situation, both short- and long-term public health needs should be considered. Short-term recommendations may include supplying bottled water or conducting an emergency removal action. Recommendations to meet long-term public health protection needs include those related to institutional controls for restricting site access, deed restrictions on land use, and continuous environmental monitoring for specified periods.
Your PHAP will outline actions or activities that have already been taken to protect public health, activities that are currently underway, and activities that will be conducted in the future. PHAPs are also included in some health consultations, depending upon site conditions and community interest.
That is, your PHA must include a plan that clearly describes the implementation and timing of the recommended public health action s. Actions described in the PHAP might vary from health investigations in the community near the site to environmental characterization activities to better identify populations at risk of exposure.
Appropriate state, tribal, and local entities are also notified, and ATSDR works with them and others to ensure the public is protected.
Because of the permafrost, the pipeline runs mostly aboveground, on pilings. Inthe PRPs installed a "pump and treat" system to clean up groundwater and prevent the migration of contaminated groundwater. The ground—fields of lava from some defunct, or perhaps just dormant, volcanoes—resembled macadam that had recently been bulldozed. After they hauled the seals back to the village, the women would skin and cure them, a process that takes several weeks. The most recent report of the U.
A health advisory should be considered whenever chemical contamination or physical hazards associated with a site necessitate an expeditious response to protect public health.
The health advisory recommends measures to be taken to reduce exposures and to eliminate or substantially mitigate the public health hazard s see Appendix H for health advisory-related public health actions. A health advisory should be issued as soon as possible after the health assessor has determined that an urgent public health hazard exists—that is, it does not have to and should not wait until the public health assessment process is completed.