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Khoshakhlagh AH, Mohammadzadeh M, Ghobakhloo S, Cheng H, Gruszecka-Kosowska A, Knight J. Health risk assessment from inhalation exposure to indoor formaldehyde: A systematic review and meta-analysis. J Hazard Mater 2024; 471:134307. [PMID: 38678702 DOI: 10.1016/j.jhazmat.2024.134307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
This systematic review and meta-analysis investigated studies on formaldehyde (FA) inhalation exposure in indoor environments and related carcinogenic (CR) and non-carcinogenic (HQ) risk. Studies were obtained from Scopus, PubMed, Web of Science, Medline, and Embase databases without time limitation until November 21, 2023. Studies not meeting the criteria of Population, Exposure, Comparator, and Outcomes (PECO) were excluded. The 45 articles included belonged to the 5 types of sites: dwelling environments, educational centers, kindergartens, vehicle cabins, and other indoor environments. A meta-analysis determined the average effect size (ES) between indoor FA concentrations, CR, and HQ values in each type of indoor environment. FA concentrations ranged from 0.01 to 1620 μg/m3. The highest FA concentrations were stated in water pipe cafés and the lowest in residential environments. In more than 90% of the studies uncertain (1.00 ×10-6 1.00 ×10-4) due to FA inhalation exposure was reported and non-carcinogenic risk was stated acceptable. The meta-analysis revealed the highest CR values due to inhalation of indoor FA in high-income countries. As 90% of the time is spent indoors, it is crucial to adopt effective strategies to reduce FA concentrations, especially in kindergartens and schools, with regular monitoring of indoor air quality.
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Affiliation(s)
- Amir Hossein Khoshakhlagh
- Department of Occupational Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdiyeh Mohammadzadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Safiye Ghobakhloo
- Department of Environmental Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hefa Cheng
- MOE Key Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Agnieszka Gruszecka-Kosowska
- AGH University of Krakow, Faculty of Geology, Geophysics, and Environmental Protection, Department of Environmental Protection, Al. Mickiewicza 30, 30-059, Krakow, Poland
| | - Jasper Knight
- School of Geography, Archaeology & Environmental Studies, University of the Witwatersrand, Johannesburg 2050, South Africa
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Yen YC, Ku CH, Yao TC, Tsai HJ, Peng CY, Chen YC. Personal exposure to aldehydes and potential health risks among schoolchildren in the city. Environ Sci Pollut Res Int 2023; 30:101627-101636. [PMID: 37653197 DOI: 10.1007/s11356-023-29578-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
Schoolchildren are sensitive to airborne aldehyde exposures. The knowledge regarding inhalation exposure to aldehydes and the factors influencing exposure in schoolchildren is limited. This study aimed to assess the variability and potential health risks of exposure to aldehydes (including formaldehyde) in schoolchildren. The important factors affecting personal exposure to aldehydes were also explored. Forty schoolchildren were recruited from the urban and suburban areas of Taiwan for aldehyde samplings and questionnaire surveys. Personal and indoor home samples of aldehydes were collected simultaneously during warm and cold seasons. We also identified the potential variables associated with aldehyde exposure based on the participant's responses to the questionnaires using mixed-effects models. The dominant three abundant aldehydes identified in personal exposure samples were formaldehyde (geometric mean, GM = 12.2 µg/m3), acetaldehyde (GM = 5.53 µg/m3), and hexaldehyde (GM = 8.79 µg/m3), accounting for approximately 80% of the total selected aldehydes. Higher personal exposure to aldehydes was observed during the warm season. Moreover, the within-subject variance was predominant, accounting for 66.6 to > 99.9% of the total variance in exposure. Schoolchildren had a high probability of overexposure to formaldehyde and acrolein, which resulted in an incremental lifetime cancer risk of 1.59 × 10-4 (95th percentile = 4.64 × 10-4). Season, location, household refurbishment, and indoor ventilation variables were significantly associated with personal exposure to aldehydes. The results can improve our understanding of aldehyde exposure among schoolchildren to propose mitigation strategies. These findings may be applied to further epidemiological studies.
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Affiliation(s)
- Yu-Chuan Yen
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli, Taiwan
| | - Chun-Hung Ku
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli, Taiwan
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chiung-Yu Peng
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Yu-Cheng Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli, Taiwan.
- Department of Occupational Safety and Health, China Medical University, 91 Hsueh-Shih Road, Taichung, Taiwan.
- Department of Safety, Health and Environmental Engineering, National United University, No. 2, Lienda, Miaoli, 360302, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Pattavina F, Wachocka M, Tuti F, Boninti F, Santi R, Grossi R, Laurenti P. From hazard identification to risk assessment: The role of the prevention technician in the carcinogenic risk assessment for formaldehyde. Front Public Health 2023; 11:960921. [PMID: 37124772 PMCID: PMC10140350 DOI: 10.3389/fpubh.2023.960921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
The Prevention Technician in the Environment and Workplaces (PTEW) is a health professional who works in the identification, assessment, and management of risk in living and working places. The PTEW implements specific corrective actions at reducing exposure levels to chemicals such as formaldehyde. The aim of this report was to update the formaldehyde risk assessment document (RAD). The risk assessment process was divided into three steps as follows: (1) preliminary data collection, (2) an on-site visit to identify the use patterns and process, and (3) application of the algorithm to calculate the exposure levels of healthcare workers. In addition, with the introduction of closed-circuit systems, 23 devices were evaluated to identify possible airborne dispersion of formaldehyde. The algorithm was applied in 31 hospital units and the results allowed us to classify the staff in two levels of exposure for each hospital unit; healthcare workers were classified as "exposed" or "potentially exposed." Most of the HCWs are categorized as potentially exposed, and only workers working in laboratories are considered to be exposed. The results showed that devices must be used properly according to the user manual. To increase the level of worker safety, we have proposed to introduce closed-circuit safe handling systems and keeping the duration and intensity of exposure at the lowest possible levels according to the "ALARA" principle. The assignment of the Italian PTEW is to achieve excellence in the levels of health and safety of patients and hospital workers by pursuing a shared mission: improving the quality of public health.
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Affiliation(s)
- Fabio Pattavina
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Fabio Pattavina,
| | - Malgorzata Wachocka
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Federica Boninti
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Santi
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Grossi
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Laurenti
- Hygiene Hospital Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Soonklang N, Saowakon N. Evaluation of formaldehyde exposure among gross dissection after modified embalming solution and health assessment. Environ Sci Pollut Res Int 2022; 29:65642-65654. [PMID: 35488160 DOI: 10.1007/s11356-022-19704-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Mainly embalming fixative contains formaldehyde which is classified as a carcinogen. People who work with cadavers have been at higher risk of cancer after formaldehyde exposure. We have formulated a less-formalin fixative (contained 3.6% formaldehyde,23.8% ethanol, 15% glycerin, and 0.2% phenol in the water) for preserving cadavers. Therefore, the objective of the present study was to evaluate the level of atmospheric formaldehyde indoors and the breathing exposure of medical students during dissection classes. We also analyzed the pulmonary parameters and effects of formaldehyde. The levels of atmospheric formaldehyde indoors and personal breathing exposure were sampled during anatomy dissection classes (musculoskeletal system, respiratory system, and abdominopelvic organ system) using sorbent tubes with air sampling pumps. Samples were then analyzed using Gas Chromatography with Flame Ionization Detector (GC-FID). The mean level of formaldehyde indoor air among the three classes was 0.518 ± 0.156 ppm whereas the formaldehyde level in the personal breathing zone was 0.956±0.408 ppm, which exceeded the recommended exposure standards of international agencies, including NIOSH agency and PEL of Thailand legislation. The laboratory had high humidity, high room temperature, and poor air ventilation. There was a significant difference in FVC, FEV1, and PEF (p < 0.05) between the sexes of students. Comparison pulmonary parameters between students and instructors showed that all parameters of the pulmonary function test had no significant differences. General fatigue and burnings of eyes and nose associated with strong odor were the most common symptoms reported during the dissection classes. The modified embalming fixative was used less formalin with ethanol-glycerin mixture, and it was suitable for the study of medical students, with few side effects of respiratory problems. However, the modified exhaust ventilation with local table-exhaust ventilation and heating-ventilation-air conditioning system performance were urgent issues for reducing levels of formaldehyde indoor air in the dissection room.
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Affiliation(s)
- Nantawan Soonklang
- Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Naruwan Saowakon
- School of Preclinical Sciences, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, 30000, Thailand.
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Protano C, Buomprisco G, Cammalleri V, Pocino RN, Marotta D, Simonazzi S, Cardoni F, Petyx M, Iavicoli S, Vitali M. The Carcinogenic Effects of Formaldehyde Occupational Exposure: A Systematic Review. Cancers (Basel) 2021; 14:165. [PMID: 35008329 PMCID: PMC8749969 DOI: 10.3390/cancers14010165] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Formaldehyde, classified as a carcinogen in 2004, as of today is widely used in many work activities. From its classification, further studies were performed to evaluate its carcinogenicity. The aim of the systematic review is to update the evidence on occupational exposure to formaldehyde and cancer onset. METHODS The review, in accordance with the PRISMA statement, includes articles in English reporting original results of studies conducted on workers exposed to formaldehyde, considering all types of cancer, published from 1 January 2000 to 30 July 2021 and selected from the Pubmed and Scopus databases. The studies' quality was assessed by the Newcastle-Ottawa Scale. RESULTS A total of 21 articles were included, conducted in different European, American, and Asian countries. The most investigated occupational areas are those characterized by a deliberate use of formaldehyde. Some studies evaluated all types of cancer, whereas others focused on specific sites such as thyroid and respiratory, lymphohematopoietic, or central nervous systems. The results showed weak associations with lung cancer, nasopharyngeal cancer, leukemia, and non-Hodgkin's lymphoma. CONCLUSIONS The results demonstrate the need for further original studies carried out on representative samples of workers exposed to measured levels of FA. These studies should be designed to reduce the bias due to co-exposure to other carcinogens.
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Affiliation(s)
- Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (C.P.); (V.C.); (R.N.P.); (D.M.)
| | - Giuseppe Buomprisco
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (G.B.); (S.S.); (F.C.)
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (C.P.); (V.C.); (R.N.P.); (D.M.)
| | - Roberta Noemi Pocino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (C.P.); (V.C.); (R.N.P.); (D.M.)
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (C.P.); (V.C.); (R.N.P.); (D.M.)
| | - Stefano Simonazzi
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (G.B.); (S.S.); (F.C.)
| | - Francesca Cardoni
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (G.B.); (S.S.); (F.C.)
| | - Marta Petyx
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (M.P.); (S.I.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (M.P.); (S.I.)
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (C.P.); (V.C.); (R.N.P.); (D.M.)
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Bartoletti-Stella A, Gatta V, Mariani GA, Gobbi P, Falconi M, Manzoli L, Faenza I, Salucci S. Three-Dimensional Virtual Anatomy as a New Approach for Medical Student's Learning. Int J Environ Res Public Health 2021; 18:ijerph182413247. [PMID: 34948857 PMCID: PMC8702207 DOI: 10.3390/ijerph182413247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022]
Abstract
Most medical and health science schools adopt innovative tools to implement the teaching of anatomy to their undergraduate students. The increase in technological resources for educational purposes allows the use of virtual systems in the field of medicine, which can be considered decisive for improving anatomical knowledge, a requisite for safe and competent medical practice. Among these virtual tools, the Anatomage Table 7.0 represents, to date, a pivotal anatomical device for student education and training medical professionals. This review focuses attention on the potential of the Anatomage Table in the anatomical learning process and clinical practice by discussing these topics based on recent publication findings and describing their trends during the COVID-19 pandemic period. The reports documented a great interest in and a positive impact of the use of this technological table by medical students for teaching gross anatomy. Anatomage allows to describe, with accuracy and at high resolution, organ structure, vascularization, and innervation, as well as enables to familiarize with radiological images of real patients by improving knowledge in the radiological and surgical fields. Furthermore, its use can be considered strategic in a pandemic period, since it ensures, through an online platform, the continuation of anatomical and surgical training on dissecting cadavers.
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Affiliation(s)
- Anna Bartoletti-Stella
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy;
| | - Valentina Gatta
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
| | - Giulia Adalgisa Mariani
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
| | - Pietro Gobbi
- Department of Biomolecular Sciences (DiSB), Urbino University Carlo Bo, 61029 Urbino, Italy;
| | - Mirella Falconi
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
| | - Lucia Manzoli
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
| | - Irene Faenza
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
| | - Sara Salucci
- Cellular Signalling Laboratory, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy; (V.G.); (G.A.M.); (M.F.); (L.M.); (I.F.)
- Correspondence:
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Adamović D, Čepić Z, Adamović S, Stošić M, Obrovski B, Morača S, Vojinović Miloradov M. Occupational Exposure to Formaldehyde and Cancer Risk Assessment in an Anatomy Laboratory. Int J Environ Res Public Health 2021; 18:ijerph182111198. [PMID: 34769715 PMCID: PMC8583012 DOI: 10.3390/ijerph182111198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022]
Abstract
Dissecting a human cadaver is an irreplaceable practice in general training of medical students. Cadavers in anatomy laboratories are usually preserved in formalin, an embalming fluid whose basic component is formaldehyde (FA). The aim of this study is to assess the cancer risk of employees and students that are exposed to FA based on the results of three monitoring campaigns, as well as to suggest permanent solutions to the problem of FA exposure based on the results obtained. Three sampling campaigns of formaldehyde concentration in indoor environments were conducted at five different locations at the Anatomy Department of the Faculty of Medicine with the purpose of assessing permanent employees’ and medical faculty first year students’ exposure to FA. Indoor air was continuously sampled during 8 h of laboratory work and analyzed in accordance with the NIOSH Method 3500. Exceeding of the 8 h time-weighted average (8 h TWA) values recommended by Occupational Safety and Health Administration (OSHA) of 0.75 ppm was recorded in 37% of the samples during the three-month monitoring campaign. Cancer risk assessment levels for permanent employees were in the range from 6.43 × 10−3 to 8.77 × 10−4, while the cancer risk assessment levels for students ranged from 8.94 × 10−7 to 1.83 × 10−6. The results of the research show that cancer risk assessment for employees is several thousand times higher than the limit recommended by the EPA (10−6) and point to the importance of reducing exposure to formaldehyde through the reconstruction of the existing ventilation system, continual monitoring, the use of formaldehyde-free products, and plastination of anatomical specimens.
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Affiliation(s)
- Dragan Adamović
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Zoran Čepić
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
- Correspondence: ; Tel.: +381-64-200-4875
| | - Savka Adamović
- Department of Graphic Engineering and Design, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Milena Stošić
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Boris Obrovski
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
| | - Slobodan Morača
- Department of Industrial Engineering and Engineering Management, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Mirjana Vojinović Miloradov
- Department of Environmental Engineering and Occupational Safety and Health, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia; (D.A.); (M.S.); (B.O.); (M.V.M.)
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