Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence

Mendell, Mark J.; Mirer, Anna G.; Cheung, Kerry; Tong, My; Douwes, Jeroen

doi:10.1289/ehp.1002410

Title: Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence

Journal Article · Wed Jun 01 00:00:00 EDT 2011 · Environmental Health Perspectives

DOI:https://doi.org/10.1289/ehp.1002410· OSTI ID:1627104

Mendell, Mark J. ^[1]; Mirer, Anna G. ^[2]; Cheung, Kerry ^[3]; Tong, My ^[4]; Douwes, Jeroen ^[3]

California Dept. of Public Health, Richmond, CA (United States); Lawrence Berkeley National Laboratory (LBNL), Berkeley, CA (United States)
University of Wisconsin, Madison, WI (United States)
Massey University, Wellington (New Zealand)
California Dept. of Public Health, Richmond, CA (United States)

Many studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured microbiologic factors have received little review. We conducted an updated, comprehensive review on these topics. We reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects. We evaluated evidence for causation or association between qualitative/ subjective assessments of dampness or mold (considered together) and specific health outcomes. We separately considered evidence for associations between specific quantitative measurements of microbiologic factors and each health outcome. Evidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children. Suggestive evidence was available for only a few specific measured microbiologic factors and was in part equivocal, suggesting both adverse and protective associations with health. Evident dampness or mold had consistent positive associations with multiple allergic and respiratory effects. Measured microbiologic agents in dust had limited suggestive associations, including both positive and negative associations for some agents. Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.

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Research Organization:: Lawrence Berkeley National Laboratory (LBNL), Berkeley, CA (United States)

Sponsoring Organization:: USDOE Office of Science (SC)

Grant/Contract Number:: AC02-05CH11231

OSTI ID:: 1627104

Journal Information:: Environmental Health Perspectives, Vol. 119, Issue 6; ISSN 0091-6765

Publisher:: National Institute of Environmental Health SciencesCopyright Statement

Country of Publication:: United States

Language:: English

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Investigation of inflammatory and allergic responses to common mold species: Results from in vitro experiments, from a mouse model of asthma, and from a group of asthmatic patients Vincent, M.; Percier, P.; De Prins, S. Indoor Air, Vol. 27, Issue 5 https://doi.org/10.1111/ina.12385	journal	April 2017
Formaldehyde levels in FEMA-supplied travel trailers, park models, and mobile homes in Louisiana and Mississippi Murphy, M. W.; Lando, J. F.; Kieszak, S. M. Indoor Air, Vol. 23, Issue 2 https://doi.org/10.1111/j.1600-0668.2012.00800.x	journal	August 2012
Psychosocial Problems, Indoor Air-Related Symptoms, and Perceived Indoor Air Quality among Students in Schools without Indoor Air Problems: A Longitudinal Study Finell, Eerika; Tolvanen, Asko; Pekkanen, Juha International Journal of Environmental Research and Public Health, Vol. 15, Issue 7 https://doi.org/10.3390/ijerph15071497	journal	July 2018
Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: A cross-sectional study Ahlroth Pind, C.; Gunnbjörnsdottír, M.; Bjerg, A. Clinical & Experimental Allergy, Vol. 47, Issue 11 https://doi.org/10.1111/cea.12976	journal	August 2017
Neighborhood Material Deprivation Is Associated with Childhood Asthma Development: Analysis of Prospective Administrative Data Simons, Elinor; Dell, Sharon D.; Moineddin, Rahim Canadian Respiratory Journal, Vol. 2019 https://doi.org/10.1155/2019/6808206	journal	May 2019
Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort Valkonen, M.; Täubel, M.; Pekkanen, J. Indoor Air, Vol. 28, Issue 1 https://doi.org/10.1111/ina.12427	journal	October 2017
Crawling-induced floor dust resuspension affects the microbiota of the infant breathing zone Hyytiäinen, Heidi K.; Jayaprakash, Balamuralikrishna; Kirjavainen, Pirkka V. Microbiome, Vol. 6, Issue 1 https://doi.org/10.1186/s40168-018-0405-8	journal	February 2018
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Microbiology of the built environment Gilbert, Jack A.; Stephens, Brent Nature Reviews Microbiology, Vol. 16, Issue 11 https://doi.org/10.1038/s41579-018-0065-5	journal	August 2018
Infectious Disease in Relation to Climate Change in the Arab World Saad-Hussein, Amal Handbook of Healthcare in the Arab World https://doi.org/10.1007/978-3-030-36811-1_135	book	January 2021
The Role of Home Environments in Allergic Disease Kennedy, Kevin; Allenbrand, Ryan; Bowles, Eric Clinical Reviews in Allergy & Immunology, Vol. 57, Issue 3 https://doi.org/10.1007/s12016-018-8724-x	journal	January 2019
Moving towards a Robust Definition for a “Healthy” Indoor Microbiome Dannemiller, Karen C. mSystems, Vol. 4, Issue 3 https://doi.org/10.1128/msystems.00074-19	journal	May 2019
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Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II Norbäck, D.; Zock, J. -P.; Plana, E. Indoor Air, Vol. 27, Issue 5 https://doi.org/10.1111/ina.12375	journal	March 2017
Performance of Two Fluorescence-Based Real-Time Bioaerosol Detectors: BioScout vs. UVAPS Saari, S.; Reponen, T.; Keskinen, J. Taylor & Francis https://doi.org/10.6084/m9.figshare.942509	text	January 2014
Penicillium expansum strain isolated from indoor building material was able to grow on gypsum board and emitted guttation droplets containing chaetoglobosins and communesins A, B and D Salo, M. J.; Marik, T.; Mikkola, R. Journal of Applied Microbiology, Vol. 127, Issue 4 https://doi.org/10.1111/jam.14369	journal	July 2019
HEALTH ² : A Holistic Environmental Assessment Lay Tool for Home Health Hostland, C.; Sadiq, R.; Lovegrove, G. Canadian Journal of Civil Engineering, Vol. 42, Issue 4 https://doi.org/10.1139/cjce-2014-0228	journal	April 2015
Microbial and Metabolic Succession on Common Building Materials Under High Humidity Conditions Lax, Simon; Cardona, Cesar; Zhao, Dan Nature Communications https://doi.org/10.1101/444521	journal	October 2018
Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort Valkonen, Maria; Täubel, M.; Pekkanen, J. Wiley https://doi.org/10.5451/unibas-ep58388	text	January 2018
Degradation of phthalate esters in floor dust at elevated relative humidity Bope, Ashleigh; Haines, Sarah R.; Hegarty, Bridget Environmental Science: Processes & Impacts, Vol. 21, Issue 8 https://doi.org/10.1039/c9em00050j	journal	January 2019
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Indoor dampness and mould health effects - ongoing questions on microbial exposures and allergic versus nonallergic mechanisms Cox-Ganser, J. M. Clinical & Experimental Allergy, Vol. 45, Issue 10 https://doi.org/10.1111/cea.12601	journal	September 2015
Exploring Secondary Metabolite Profiles of Stachybotrys spp. by LC-MS/MS Jagels, Annika; Lindemann, Viktoria; Ulrich, Sebastian Toxins, Vol. 11, Issue 3 https://doi.org/10.3390/toxins11030133	journal	February 2019
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Marine bisindole alkaloid 2,2-bis(6-bromo-3-indolyl)ethylamine to control and prevent fungal growth on building material: a potential antifungal agent Campana, Raffaella; Sisti, Maurizio; Sabatini, Luigia Applied Microbiology and Biotechnology, Vol. 103, Issue 14 https://doi.org/10.1007/s00253-019-09895-9	journal	May 2019
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Infectious Disease in Relation to Climate Change in the Arab World Saad-Hussein, Amal Handbook of Healthcare in the Arab World https://doi.org/10.1007/978-3-319-74365-3_135-1	book	January 2019
Domestic exposure to volatile organic compounds in relation to asthma and allergy in children and adults Tagiyeva, Nara; Sheikh, Aziz Expert Review of Clinical Immunology, Vol. 10, Issue 12 https://doi.org/10.1586/1744666x.2014.972943	journal	November 2014
Indoor environment in children’s dwellings in Dalian and Beijing, China Lv, Yang; Wang, Zhimeng; Zhao, Tongke Science and Technology for the Built Environment, Vol. 25, Issue 4 https://doi.org/10.1080/23744731.2018.1533337	journal	January 2019
Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM) Wiesmüller, Gerhard A.; Heinzow, Birger; Aurbach, Ute Allergo Journal International, Vol. 26, Issue 5 https://doi.org/10.1007/s40629-017-0013-3	journal	February 2017
Pro-Inflammatory Responses in Human Bronchial Epithelial Cells Induced by Spores and Hyphal Fragments of Common Damp Indoor Molds Øya, Elisabeth; Becher, Rune; Ekeren, Leni International Journal of Environmental Research and Public Health, Vol. 16, Issue 6 https://doi.org/10.3390/ijerph16061085	journal	March 2019
Indoor mould exposure, asthma and rhinitis: findings from systematic reviews and recent longitudinal studies Caillaud, Denis; Leynaert, Benedicte; Keirsbulck, Marion European Respiratory Review, Vol. 27, Issue 148 https://doi.org/10.1183/16000617.0137-2017	journal	May 2018
Housing as a Determinant of Tongan Children’s Health: Innovative Methodology Using Wearable Cameras Robinson, Andrew; Hulme-Moir, Sarah; Puloka, Viliami International Journal of Environmental Research and Public Health, Vol. 14, Issue 10 https://doi.org/10.3390/ijerph14101170	journal	October 2017
Transmission of Airborne Bacteria across Built Environments and Its Measurement Standards: A Review Fujiyoshi, So; Tanaka, Daisuke; Maruyama, Fumito Frontiers in Microbiology, Vol. 8 https://doi.org/10.3389/fmicb.2017.02336	journal	November 2017
Short-term effect of outdoor mould spore exposure on prescribed allergy medication sales in Central France Caillaud, D.; Cheriaux, M.; Martin, S. Clinical & Experimental Allergy, Vol. 48, Issue 7 https://doi.org/10.1111/cea.13160	journal	May 2018
Microbial Bioaerosols in the Occupational Environment: Exposure, Detection, and Disease Reponen, Tiina; Green, Brett James Patty's Toxicology https://doi.org/10.1002/0471435139.tox019.pub2	book	January 2012
Fungal and bacterial growth in floor dust at elevated relative humidity levels Dannemiller, K. C.; Weschler, C. J.; Peccia, J. Indoor Air, Vol. 27, Issue 2 https://doi.org/10.1111/ina.12313	journal	July 2016
The challenge for microbial measurements in buildings Mendell, Mark J.; Adams, Rachel I. Indoor Air, Vol. 29, Issue 4 https://doi.org/10.1111/ina.12550	journal	June 2019
Residential water-soluble organic gases: chemical characterization of a substantial contributor to indoor exposures Duncan, Sara M.; Sexton, Kenneth; Collins, Leonard Environmental Science: Processes & Impacts, Vol. 21, Issue 8 https://doi.org/10.1039/c9em00105k	journal	January 2019
Microwave detection and quantification of water hidden in and on building materials: implications for healthy buildings and microbiome studies Horsley, Andrew; Thaler, David S. BMC Infectious Diseases, Vol. 19, Issue 1 https://doi.org/10.1186/s12879-019-3720-1	journal	January 2019
Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population Anderson, G. Brooke; Dominici, Francesca; Wang, Yun American Journal of Respiratory and Critical Care Medicine, Vol. 187, Issue 10 https://doi.org/10.1164/rccm.201211-1969oc	journal	May 2013
Impacts of indoor surface finishes on bacterial viability Hu, Jinglin; Ben Maamar, Sarah; Glawe, Adam J. Indoor Air, Vol. 29, Issue 4 https://doi.org/10.1111/ina.12558	journal	May 2019
Performance of Two Fluorescence-Based Real-Time Bioaerosol Detectors: BioScout vs. UVAPS Saari, S.; Reponen, T.; Keskinen, J. Taylor & Francis https://doi.org/10.6084/m9.figshare.942509.v1	text	January 2014
The Combined Effect of Poor Perceived Indoor Environmental Quality and Psychosocial Stressors on Long-Term Sickness Absence in the Workplace: A Follow-Up Study Finell, Eerika; Nätti, Jouko International Journal of Environmental Research and Public Health, Vol. 16, Issue 24 https://doi.org/10.3390/ijerph16244997	journal	December 2019
Embracing microbes in exposure science Nazaroff, William W. Journal of Exposure Science & Environmental Epidemiology, Vol. 29, Issue 1 https://doi.org/10.1038/s41370-018-0075-4	journal	September 2018
Risk factors for non-atopic asthma/wheeze in children and adolescents: a systematic review Strina, Agostino; Barreto, Mauricio L.; Cooper, Philip J. Emerging Themes in Epidemiology, Vol. 11, Issue 1 https://doi.org/10.1186/1742-7622-11-5	journal	June 2014
Evidence base for a housing warrant of fitness Telfar-Barnard, Lucy; Bennett, Julie; Robinson, Andrew SAGE Open Medicine, Vol. 7 https://doi.org/10.1177/2050312119843028	journal	January 2019
Internet of Things for Sustainable Human Health Salam, Abdul Internet of Things https://doi.org/10.1007/978-3-030-35291-2_7	book	December 2019
Expert clinician’s perspectives on environmental medicine and toxicant assessment in clinical practice Bijlsma, Nicole; Cohen, Marc Maurice Environmental Health and Preventive Medicine, Vol. 23, Issue 1 https://doi.org/10.1186/s12199-018-0709-0	journal	May 2018
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Measured moisture in buildings and adverse health effects: A review Mendell, M. J.; Macher, J. M.; Kumagai, K. Indoor Air, Vol. 28, Issue 4 https://doi.org/10.1111/ina.12464	journal	May 2018
Impact of occupational exposures on exacerbation of asthma: a population-based asthma cohort study Kim, Jeong-Lim; Henneberger, Paul K.; Lohman, Susanna BMC Pulmonary Medicine, Vol. 16, Issue 1 https://doi.org/10.1186/s12890-016-0306-1	journal	November 2016
An emerging paradox: Toward a better understanding of the potential benefits and adversity of microbe exposures in the indoor environment Mensah-Attipoe, J.; Täubel, M.; Hernandez, M. Indoor Air, Vol. 27, Issue 1 https://doi.org/10.1111/ina.12344	journal	December 2016
Evaluating the associations of race, ethnicity, and food allergens in the development of childhood asthma: Re-analysis of publicly available retrospective cross-sectional cohort data Abdalhuk, Musheer; Jordan, Angel; Wagimin, Roghan F1000Research, Vol. 7 https://doi.org/10.12688/f1000research.15831.1	journal	January 2018
Farmworker Housing in the United States and Its Impact on Health Quandt, Sara A.; Brooke, Carol; Fagan, Kathleen NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, Vol. 25, Issue 3 https://doi.org/10.1177/1048291115601053	journal	August 2015
Observation‐based metrics for residential dampness and mold with dose–response relationships to health: A review Mendell, M. J.; Kumagai, K. Indoor Air, Vol. 27, Issue 3 https://doi.org/10.1111/ina.12342	journal	October 2016
Association between greenhouse working exposure and bronchial asthma: A pilot, cross-sectional survey of 5,420 greenhouse farmers from northeast China Liu, Shuo; Wolters, Paul J.; Zhang, Yibing Taylor & Francis https://doi.org/10.6084/m9.figshare.7792514	text	January 2019
How home ventilation rates affect health: A literature review Fisk, W. J. Indoor Air, Vol. 28, Issue 4 https://doi.org/10.1111/ina.12469	journal	May 2018
Indoor fungi: companions and contaminants Nevalainen, A.; Täubel, M.; Hyvärinen, A. Indoor Air, Vol. 25, Issue 2 https://doi.org/10.1111/ina.12182	journal	January 2015
Microbial secondary metabolites in homes in association with moisture damage and asthma Kirjavainen, P. V.; Täubel, M.; Karvonen, A. M. Indoor Air, Vol. 26, Issue 3 https://doi.org/10.1111/ina.12213	journal	June 2015
Pseudoscience, snake oil, and indoor air quality Morrison, Glenn Indoor Air, Vol. 28, Issue 3 https://doi.org/10.1111/ina.12455	journal	April 2018
Parental worry about indoor air quality and student symptom reporting in primary schools with or without indoor air quality problems Nissilä, Juho‐Jooel; Savelieva, Kateryna; Lampi, Jussi Indoor Air, Vol. 29, Issue 5 https://doi.org/10.1111/ina.12574	journal	June 2019
Viruses in the Built Environment (VIBE) meeting report Prussin, Aaron J.; Belser, Jessica A.; Bischoff, Werner Microbiome, Vol. 8, Issue 1 https://doi.org/10.1186/s40168-019-0777-4	journal	January 2020
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Radon and moisture impacts from interventions integrated with housing energy retrofits Francisco, Paul W.; Gloss, Stacy; Wilson, Jonathan Indoor Air, Vol. 30, Issue 1 https://doi.org/10.1111/ina.12616	journal	October 2019
Home is where the health is: what indoor environment quality delivers a “healthy” home? Ade, Rochelle; Rehm, Michael Pacific Rim Property Research Journal, Vol. 26, Issue 1 https://doi.org/10.1080/14445921.2019.1707949	journal	December 2019
Gene expression of indoor fungal communities under damp building conditions: Implications for human health Hegarty, B.; Dannemiller, K. C.; Peccia, J. Indoor Air, Vol. 28, Issue 4 https://doi.org/10.1111/ina.12459	journal	April 2018
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Assessment of Indoor Air Quality and Hygrothermal Conditions of Boarders During Autumn, Winter and Spring in Two of Estonian Straw-Bale Houses Raamets, Jane; Ruus, Aime; Ivask, Mari Springer Proceedings in Energy https://doi.org/10.1007/978-3-030-00662-4_68	book	December 2018
Fungi and Atopy Barnes, Charles Clinical Reviews in Allergy & Immunology, Vol. 57, Issue 3 https://doi.org/10.1007/s12016-019-08750-z	journal	July 2019
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A Citizen-Science Study Documents Environmental Exposures and Asthma Prevalence in Two Communities Eiffert, Samantha; Noibi, Yomi; Vesper, Stephen Journal of Environmental and Public Health, Vol. 2016 https://doi.org/10.1155/2016/1962901	journal	January 2016
Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US Mudarri, David H. Journal of Environmental and Public Health, Vol. 2016 https://doi.org/10.1155/2016/2386596	journal	January 2016
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Association of Mechanical Ventilation and Flue Use in Heaters With Asthma Symptoms in Japanese Schoolchildren: A Cross-Sectional Study in Sapporo, Japan Cong, Shi; Araki, Atsuko; Ukawa, Shigekazu Journal of Epidemiology, Vol. 24, Issue 3 https://doi.org/10.2188/jea.je20130135	journal	January 2014
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Eosinophils in Fungus-Associated Allergic Pulmonary Disease Ghosh, Sumit; Hoselton, Scott A.; Dorsam, Glenn P. Frontiers in Pharmacology, Vol. 4 https://doi.org/10.3389/fphar.2013.00008	journal	January 2013
Bronchitis and Its Associated Risk Factors in First Nations Children Karunanayake, Chandima; Rennie, Donna; Ramsden, Vivian Children, Vol. 4, Issue 12 https://doi.org/10.3390/children4120103	journal	November 2017
The Built Environment—A Missing “Cause of the Causes” of Non-Communicable Diseases Walls, Kelvin; Boulic, Mikael; Boddy, John International Journal of Environmental Research and Public Health, Vol. 13, Issue 10 https://doi.org/10.3390/ijerph13100956	journal	September 2016
Dampness and Moisture Problems in Norwegian Homes Becher, Rune; Høie, Anja Hortemo; Bakke, Jan Vilhelm International Journal of Environmental Research and Public Health, Vol. 14, Issue 10 https://doi.org/10.3390/ijerph14101241	journal	October 2017
Using Twitter to Explore (un)Healthy Housing: Learning from the #Characterbuildings Campaign in New Zealand Chisholm, Elinor; O’Sullivan, Kimberley International Journal of Environmental Research and Public Health, Vol. 14, Issue 11 https://doi.org/10.3390/ijerph14111424	journal	November 2017
The Interactive Roles of Lipopolysaccharides and dsRNA/Viruses on Respiratory Epithelial Cells and Dendritic Cells in Allergic Respiratory Disorders: The Hygiene Hypothesis Lin, Tsang-Hsiung; Su, Hsing-Hao; Kang, Hong-Yo International Journal of Molecular Sciences, Vol. 18, Issue 10 https://doi.org/10.3390/ijms18102219	journal	October 2017
Does Spore Count Matter in Fungal Allergy?: The Role of Allergenic Fungal Species Lin, Wan-Rou; Chen, Yi-Hsing; Lee, Mey-Fann Allergy, Asthma & Immunology Research, Vol. 8, Issue 5 https://doi.org/10.4168/aair.2016.8.5.404	journal	January 2016
Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan Zubairi, Ali Bin Sarwar; Azam, Iqbal; Awan, Safia Asia Pacific Allergy, Vol. 4, Issue 2 https://doi.org/10.5415/apallergy.2014.4.2.91	journal	April 2014

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Conference · Sat Sep 10 00:00:00 EDT 2005 · OSTI ID:1627104

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