Melissa A. Mcdiarmid, Md, Mph
University of Maryland Medical Center
United States of America
Research activities in the Division of Occupational and Environmental Medicine continue to provide opportunities for both productive scholarship as well as prevention practice in the community. A major project, which I lead, involves the on-going surveillance of Gulf War and OIF veterans who were victims of "friendly fire" involving depleted uranium (DU) weapons. These veterans possess multiple fragments of DU in their soft tissues, which are not easily accessed surgically. These retained fragments are oxidizing in-situ and therefore raise the patient's systemic body burden of uranium. While only weakly radioactive, the uranium toxicity of concern is primarily from the heavy metal chemical hazard it poses. Our clinical investigations focus on the early detection of sentinel effects of this uranium burden on the health of these veterans. A related project has focused on methods development to allow the assessment of uranium burden and sentinel health effects via mail. As the only center for DU surveillance worldwide, we receive requests for urine uranium testing from veterans nationally and internationally. Expertise developed from this project has been applied to offer other biologic monitoring services to wounded Veterans that measure the body burden of toxic metals found in improvised explosive devices (IEDs). These results are then applied to guide clinical patient management. Clinical toxicology applications of my work focus on the surveillance of healthcare workers exposed to chemical hazards in the course of their work. Of special interest is the risk of health harm to workers from preparing and administering anti-cancer chemotherapy. These drugs are well known for their acute and chronic toxicity in treated patients, but they also impose a risk to workers, most notably adverse reproductive outcomes and possibly cancer. We are engaged in several projects to enhance the safety practices used to handle these clinically important drugs. I am also a member of the Population Science Program within the University of Maryland Marlene and Stewart Greenebaum Cancer Center Program in Oncology. Population Science researchers collaborate with investigators throughout the University of Maryland System to identify determinants of cancer etiology and survivorship, characterize cancer-related health behaviors, and translate basic discoveries into behavioral cancer prevention and control interventions. My research interests are in occupational and environmental determinants of cancer, second malignancy development in chemotherapy treated patients, the cancer risk of oncology workers and chemotherapy safety. In 2009 our Division was named a Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Center in Occupational Health. In this role our staff provides technical expertise and content knowledge in support of the WHO Global Plan of Action on Workers Health with an emphasis on the healthcare sector including assistance with the Ebola response. My clinical practice involves the assessment and management of patients who are occupationally or environmentally exposed to toxic substances. We also design and provide OSHA-mandated surveillance programs for high-risk workers. Ultimately, we promote prevention to our patients, our students and the wider public.
Occupational medicine, clinical toxicology, healthcare hazards, global workers' health, exposure assessment
McDiarmid, MA, Gaitens, JM, Hines, S, Breyer, R, Engelhardt, SM, Oliver, M, Gucer, P, Kane, R, Cernich, A, Kaup, B, Hoover, D, Gaspari, AA, Liu, J, Harberts, E, Brown, L, Centeno, JA, Gray, PJ, Hanna, X, Squibb, KS. The gulf war depleted uranium cohort at 20: Bioassay results and novel approaches to fragment surveillance. Health Physics 2013 140(4):347-361.
McDiarmid, MA, Albertini, RJ, Tucker, ID, Vacek, PM, Carter, EW, Bakhmutsky, MV, Oliver, MS, Engelhardt, SM, Squibb, KS. Measures of genotoxicity in Gulf war I veterans exposed to depleted uranium. Environ Molecular Mut, 2011;52(7):569-581.
McDiarmid, MA.,Oliver, MS, Roth, TS, Rogers B, Escalante, C. Chromosome 5 and 7 Abnormalities in Oncology Personnel Handling Anticancer Drugs. JOEM. 20l0;52(10):1028-1034.