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Background: Prenatal exposure to persistent organic pollutants (POPs) has been linked to adverse pregnancy outcomes. Existing disparities in exposure across populations highlight the need for identifying modifiable risk factors. Here, we investigated the determinants of serum levels of polybrominated diphenyl ethers (PBDEs) and organochlorine pesticides (OCPs) in pregnant African American women (N = 54)., Methods: Concentrations of 2,2'4,4'-tetrabromodiphenyl ether (BDE-47), 2,2',4,4',5-pentabromodiphenyl ethe (BDE-99), 2,2',4,4',6-pentabromodiphenyl ether (BDE-100), hexachlorobenzene (HCB), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) were measured in first trimester maternal serum from a subset of women enrolled in the Atlanta African American Maternal Child Cohort. Home characteristics, cleaning behaviors, diet, and demographic information were collected via survey questionnaires. Associations between individual determinants and individual PBDE and OCP concentrations were assessed using linear regression., Results: Pregnant women who frequently ate red meat, cheese, milk, or yogurt had elevated levels of HCB and p,p'-DDE compared to those who ate these products less frequently (e.g., red meat: β=0.21; 95% CI=-0.07, 0.48 for p,p'-DDE), while pregnant women who reported living in apartments, homes ≥10 years old, or had couches ≥5 years old, had increased levels of PBDEs compared to reference groups. Pregnant women who vacuumed and cleaned their home more frequently showed decreased levels of PBDEs relative to reference groups (e.g., vacuuming: BDE-100 β= -0.81, 95% CI= -1.55, -0.06)., Conclusions: Our results illustrate modifiable determinants of PBDE and OCP exposures in pregnant women and emphasize the potential to reduce the body burden of these POPs both directly, by changing diet, residence, or home furnishings, and indirectly through cleaning methods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Per- and polyfluoroalkyl substances (PFAS) are fluorinated organic compounds used in a variety of consumer products and industrial applications that persist in the environment, bioaccumulate in biological tissues, and can have adverse effects on human health, especially in vulnerable populations. In this study, we focused on PFAS exposures in residents of senior care facilities. To investigate relationships between indoor, personal, and internal PFAS exposures, we analyzed 19 PFAS in matched samples of dust collected from the residents' bedrooms, and wristbands and serum collected from the residents. The median ∑PFAS concentrations (the sum of all PFAS detected in the samples) measured in dust, wristbands, and serum were 120 ng/g, 0.05 ng/g, and 4.0 ng/mL, respectively. The most abundant compounds in serum were linear- and branched-perfluorooctane sulfonic acid (L-PFOS and B-PFOS, respectively) at medians of 1.7 ng/mL and 0.83 ng/mL, respectively, followed by the linear perfluorooctanoic acid (L-PFOA) found at a median concentration of 0.59 ng/mL. Overall, these three PFAS comprised 80 % of the serum ∑PFAS concentrations. A similar pattern was observed in dust with L-PFOS and L-PFOA found as the most abundant PFAS (median concentrations of 13 and 7.8 ng/g, respectively), with the overall contribution of 50 % to the ∑PFAS concentration. Only L-PFOA was found in wristbands at a median concentration of 0.02 ng/g. Significant correlations were found between the concentrations of several PFAS in dust and serum, and in dust and wristbands, suggesting that the indoor environment could be a significant contributor to the personal and internal PFAS exposures in seniors. Our findings demonstrate that residents of assisted living facilities are widely exposed to PFAS, with several PFAS found in blood of each study participant and in the assisted living environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The immune system undergoes unique adaptations during pregnancy and is particularly sensitive to environmental chemicals, such as phthalates, which are associated with acute and chronic inflammatory medical conditions. However, current knowledge of how phthalate exposures are associated with systemic inflammation in pregnant people is limited by cross-sectional study designs and single chemical models. Our objective was to estimate the association between repeated measures of prenatal phthalate exposures, examined individually and collectively, and a panel of clinical inflammatory biomarkers., Methods: In the Atlanta African American Maternal-Child Cohort, biospecimens were collected at mean 11 and 26 weeks gestation (N = 126). Concentrations of eight urinary phthalate metabolites and five serum inflammatory biomarkers, including CRP, IFN-γ, IL-6, IL-10, and TNF-α, were measured. Linear mixed effect regression and quantile g-computation models were used to estimate the associations for single phthalates and their exposure mixture, respectively., Results: Participants who self-reported any use of alcohol, tobacco, or marijuana in the month prior to pregnancy had increased MEP, MBP, MiBP, and CRP, relative to those with no substance use. IFN-γ was elevated in response to MECPP (% change = 17.35, 95 % confidence interval [CI] = 0.32, 32.27), MEHHP (% change = 12.75, 95 % CI = 2.22, 24.36), MEOHP (% change = 11.63, 95 % CI = 1.21, 23.12), and their parent phthalate, ΣDEHP (% change = 15.03, 95 % CI = 0.28, 31.94). The phthalate mixture was also associated with an increase in IFN-γ (% change = 15.03, 95 % CI = 6.18, 24.61)., Conclusions: Our findings suggest DEHP metabolites induce systemic inflammation during pregnancy. The pro-inflammatory cytokine IFN-γ may play an important role in the relationship between prenatal phthalate exposures and adverse pregnancy outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Consumer products are common sources of exposure for phthalates and bisphenol A (BPA), which disrupt the endocrine system. Psychosocial stressors have been shown to amplify the toxic effects of endocrine disruptors but, information is limited among African Americans (AAs), who experience the highest rates of adverse pregnancy outcomes and are often exposed to the highest levels of chemical and non-chemical stressors. We examined the association between an exposure mixture of phthalate metabolites, BPA, and psychosocial stressors with gestational age at delivery and birthweight for gestational age z-scores in pregnant AA women., Study Design: Participants were enrolled in the Atlanta African American Maternal-Child Cohort (N = 247). Concentrations of eight phthalate metabolites and BPA were measured in urine samples collected at up to two timepoints during pregnancy (8-14 weeks gestation and 20-32 weeks gestation) and were averaged. Psychosocial stressors were measured using self-reported, validated questionnaires that assessed experiences of discrimination, gendered racial stress, depression, and anxiety. Linear regression was used to estimate individual associations between stress exposures (chemical and psychosocial) and birth outcomes. We leveraged quantile g-computation was used to examine joint effects of chemical and stress exposures on gestational age at delivery (in weeks) and birthweight for gestational age z-scores., Results: A simultaneous increase in all phthalate metabolites and BPA was associated with a moderate reduction in birthweight z-scores (mean change per quartile increase = -0.22, 95% CI = -0.45, 0.0). The association between our exposure mixture and birthweight z-scores became stronger when including psychosocial stressors as additional exposures (mean change per quantile increase = -0.35, 95% CI = -0.61, -0.08). Overall, we found null associations between exposure to chemical and non-chemical stressors with gestational age at delivery., Conclusions: In a prospective cohort of AA mother-newborn dyads, we observed that increased prenatal exposure to phthalates, BPA, and psychosocial stressors were associated with adverse pregnancy outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: African Americans (AAs) experience high rates of adverse pregnancy outcomes relative to Whites. Differential in utero exposure to environmental chemicals and psychosocial stressors may explain some of the observed health disparities, as exposures to per- and polyfluoroalkyl substances (PFAS) and experiences of discrimination have been linked to adverse birth outcomes. Few studies have examined chemicals and non-chemical stressors together as an exposure mixture, which may better reflect real-life exposure patterns. Here, we adapted methods designed for the analysis of exposure mixtures to examine joint effects of PFAS and psychosocial stress on birth outcomes among AAs., Methods: 348 participants from the Atlanta African American Maternal-Child cohort were included in this study. Four PFAS were measured in first trimester serum samples. Self-report questionnaires were administered during the first trimester and were used to assess psychosocial stress (perceived stress, depression, anxiety, gendered racial stress). Quantile g-computation and Bayesian kernel machine regression (BKMR) were used to estimate the joint effects between PFAS and psychosocial stressors on gestational age at delivery and birthweight for gestational age z-scores. All models were adjusted for maternal education, maternal age, parity, and any alcohol, tobacco and marijuana use., Results: Our analytic sample included a socioeconomically diverse group of pregnant women, with 79 % receiving public health insurance. In quantile g-computation models, a simultaneous one-quartile increase in all PFAS, perceived stress, depression, anxiety, and gendered racial stress was associated with a reduction in birthweight z-scores (mean %change per quartile increase = -0.24, 95 % confidence interval = -0.43, -0.06). BKMR similarly showed that increasing all exposures in the mixture was associated with a modest decrease in birthweight z-scores, but not a reduced length of gestation., Discussion: Using methods designed for analyzing exposure mixtures, we found that a simultaneous increase in in utero PFAS and psychosocial stressors was associated with reduced birthweight for gestational age z-scores., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Organophosphate (OP) insecticides, including chlorpyrifos, have been linked with numerous harmful health effects on maternal and child health. Limited data are available on the biological mechanisms and endogenous pathways underlying the toxicity of chlorpyrifos exposures on pregnancy and birth outcomes. In this study, we measured a urinary chlorpyrifos metabolite and used high-resolution metabolomics (HRM) to identify biological perturbations associated with chlorpyrifos exposure among pregnant women in Thailand, who are disparately exposed to high levels of OP insecticides., Methods: This study included 50 participants from the Study of Asian Women and their Offspring's Development and Environmental Exposures (SAWASDEE). We used liquid chromatography-high resolution mass spectrometry to conduct metabolic profiling on first trimester serum samples collected from participants to evaluate metabolic perturbations in relation to chlorpyrifos exposures. We measured 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of chlorpyrifos and chlorpyrifos-methyl, in first trimester urine samples to assess the levels of exposures. Following an untargeted metabolome-wide association study workflow, we used generalized linear models, pathway enrichment analyses, and chemical annotation to identify significant metabolites and pathways associated with urinary TCPy levels., Results: In the 50 SAWASDEE participants, the median urinary TCPy level was 4.36 μg TCPy/g creatinine. In total, 691 unique metabolic features were found significantly associated with TCPy levels (p < 0.05) after controlling for confounding factors. Pathway analysis of metabolic features associated with TCPy indicated perturbations in 24 metabolic pathways, most closely linked to the production of reactive oxygen species and cellular damage. These pathways include tryptophan metabolism, fatty acid oxidation and peroxisome metabolism, cytochromes P450 metabolism, glutathione metabolism, and vitamin B3 metabolism. We confirmed the chemical identities of 25 metabolites associated with TCPy levels, including glutathione, cystine, arachidic acid, itaconate, and nicotinamide adenine dinucleotide., Discussion: The metabolic perturbations associated with TCPy levels were related to oxidative stress, cellular damage and repair, and systemic inflammation, which could ultimately contribute to health outcomes, including neurodevelopmental deficits in the child. These findings support the future development of sensitive biomarkers to investigate the metabolic underpinnings related to pesticide exposure during pregnancy and to understand its link to adverse outcomes in children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Phenotype algorithms are central to performing analyses using observational data. These algorithms translate the clinical idea of a health condition into an executable set of rules allowing for queries of data elements from a database. PheValuator, a software package in the Observational Health Data Sciences and Informatics (OHDSI) tool stack, provides a method to assess the performance characteristics of these algorithms, namely, sensitivity, specificity, and positive and negative predictive value. It uses machine learning to develop predictive models for determining a probabilistic gold standard of subjects for assessment of cases and non-cases of health conditions. PheValuator was developed to complement or even replace the traditional approach of algorithm validation, i.e., by expert assessment of subject records through chart review. Results in our first PheValuator paper suggest a systematic underestimation of the PPV compared to previous results using chart review. In this paper we evaluate modifications made to the method designed to improve its performance., Methods: The major changes to PheValuator included allowing all diagnostic conditions, clinical observations, drug prescriptions, and laboratory measurements to be included as predictors within the modeling process whereas in the prior version there were significant restrictions on the included predictors. We also have allowed for the inclusion of the temporal relationships of the predictors in the model. To evaluate the performance of the new method, we compared the results from the new and original methods against results found from the literature using traditional validation of algorithms for 19 phenotypes. We performed these tests using data from five commercial databases., Results: In the assessment aggregating all phenotype algorithms, the median difference between the PheValuator estimate and the gold standard estimate for PPV was reduced from -21 (IQR -34, -3) in Version 1.0 to 4 (IQR -3, 15) using Version 2.0. We found a median difference in specificity of 3 (IQR 1, 4.25) for Version 1.0 and 3 (IQR 1, 4) for Version 2.0. The median difference between the two versions of PheValuator and the gold standard for estimates of sensitivity was reduced from -39 (-51, -20) to -16 (-34, -6)., Conclusion: PheValuator 2.0 produces estimates for the performance characteristics for phenotype algorithms that are significantly closer to estimates from traditional validation through chart review compared to version 1.0. With this tool in researcher's toolkits, methods, such as quantitative bias analysis, may now be used to improve the reliability and reproducibility of research studies using observational data., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Phthalates have been linked with numerous harmful health effects. Limited data are available on the molecular mechanism underlying phthalate toxicity on human health. In this study, we measured urinary phthalate metabolites and used high-resolution metabolomics (HRM) to identify biological perturbations associated with phthalate exposures among pregnant African American (AA) women, who are disproportionately exposed to high phthalates levels., Methods: We used untargeted HRM profiling to characterize serum samples collected during early (8-14 weeks gestation) and late (24-30 weeks gestation) pregnancy from 73 participants from the Atlanta AA Maternal-Child cohort. We measured eight urinary phthalate metabolites in early and late pregnancy, including Monoethyl phthalate (MEP), Mono(2-ethlyhexyl) phthalate (MEHP), and Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), to assess maternal exposures to phthalates. Metabolite and metabolic pathway perturbation were evaluated using an untargeted HRM workflow., Results: Geometric mean creatinine-adjusted levels of urinary MEP, MEHP, and MEHHP were 67.3, 1.4, and 4.1 μg/g creatinine, respectively, with MEP and MEHP higher than the mean levels of non-Hispanic blacks in the general US population (2015-2016). There were 73 and 1435 metabolic features significantly associated with at least one phthalate metabolite during early and late pregnancy (p < 0.005), respectively. Pathway enrichment analysis revealed perturbations in four inflammation- and oxidative-stress-related pathways associated with phthalate metabolite levels during both early and late pregnancy, including glycerophospholipid, urea cycle, arginine, and tyrosine metabolism. We confirmed 10 metabolites with level-1 evidence, which are associated with urinary phthalates, including thyroxine and thiamine, which were negatively associated with MEP, as well as tyramine and phenethylamine, which were positively associated with MEHP and MEHHP., Conclusion: Our results demonstrated that urinary phthalate levels were associated with perturbations in biological pathways connected with inflammation, oxidative stress, and endocrine disruption. The findings support future targeted investigations on molecular mechanisms underlying the impact of maternal phthalates exposure on adverse health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduced in the 1950s, acetaminophen is one of the most widely used antipyretics and analgesics worldwide. In 1999, the International Agency for Research on Cancer (IARC) reviewed the epidemiologic studies of acetaminophen and the data were judged to be "inadequate" to conclude that it is carcinogenic. In 2019 the California Office of Environmental Health Hazard Assessment initiated a review process on the carcinogenic hazard potential of acetaminophen. To inform this review process, the authors performed a comprehensive literature search and identified 136 epidemiologic studies, which for most cancer types suggest no alteration in risk associated with acetaminophen use. For 3 cancer types, renal cell, liver, and some forms of lymphohematopoietic, some studies suggest an increased risk; however, multiple factors unique to acetaminophen need to be considered to determine if these results are real and clinically meaningful. The objective of this publication is to analyze the results of these epidemiologic studies using a framework that accounts for the inherent challenge of evaluating acetaminophen, including, broad population-wide use in multiple disease states, challenges with exposure measurement, protopathic bias, channeling bias, and recall bias. When evaluated using this framework, the data do not support a causal association between acetaminophen use and cancer., (Copyright © 2021 Consumer Healthcare Products Association. Published by Elsevier Inc. All rights reserved.)

Vitamin D has been linked to various physiological functions in pregnant women and their fetuses. Previous studies have suggested that some per- and polyfluoroalkyl substances (PFAS) may alter serum vitamin D concentrations. However, no study has investigated the relationship between PFAS and vitamin D in pregnant women. This study aims to evaluate the associations of serum PFAS with serum total and free 25-hydroxyvitamin D (25(OH)D) during pregnancy in a cohort of African American women in Atlanta, GA. Blood samples from 442 participants were collected in early pregnancy (8-14 weeks of gestation) for PFAS and 25(OH)D measurements, and additional samples were collected in late pregnancy (24-30 weeks) for the second 25(OH)D measurements. We fit multivariable linear regressions and weighted quantile sum (WQS) regressions to estimate the associations of individual PFAS and their mixtures with 25(OH)D concentrations. We found mostly positive associations of total 25(OH)D with PFHxS (perfluorohexane sulfonic acid), PFOS (perfluorooctane sulfonic acid), PFDA (perfluorodecanoic acid), and NMeFOSAA (N-methyl perfluorooctane sulfonamido acetic acid), and negative associations with PFPeA (perfluoropentanoic acid). For free 25(OH)D, positive associations were observed with PFHxS, PFOS, PFOA (perfluorooctanoic acid), and PFDA, and a negative association with PFPeA among the women with male fetuses in the models using 25(OH)D measured in late pregnancy. In mixture models, a quartile increase in WQS index was associated with 2.88 ng/mL (95%CI 1.14-4.59) and 5.68 ng/mL (95%CI 3.31-8.04) increases in total 25(OH)D measured in the early and late pregnancy, respectively. NMeFOSAA, PFDA, and PFOS contributed the most to the overall effects among the eight PFAS. No association was found between free 25(OH)D and the PFAS mixture. These results suggest that PFAS may affect vitamin D biomarker concentrations in pregnant African American women, and some of the associations were modified by fetal sex., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Evidence-Based Medicine (EBM) encourages clinicians to seek the most reputable evidence. The quality of evidence is organized in a hierarchy in which randomized controlled trials (RCTs) are regarded as least biased. However, RCTs are plagued by poor generalizability, impeding the translation of clinical research to practice. Though the presence of poor external validity is known, the factors that contribute to poor generalizability have not been summarized and placed in a framework. We propose a new population-oriented conceptual framework to facilitate consistent and comprehensive evaluation of generalizability, replicability, and assessment of RCT study quality., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Exposure to per- and polyfluoroalkyl substances (PFAS) has been associated with adverse health outcomes, especially when exposure occurs within sensitive time windows such as the pre- and post-natal periods and early childhood. However, few studies have focused on PFAS exposure distribution and predictors in pregnant women, especially among African American women. We quantified serum concentrations of the four most common PFAS collected in all 453 participants and an additional 10 PFAS in 356 participants who were pregnant African American women enrolled from 2014 to 2018 in Atlanta, Georgia, and investigated the sociodemographic predictors of exposure. Additional home environment and behavior predictors were also examined in 130 participants. Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) were detected in >95% of the samples with PFOS having the highest concentrations (geometric mean (GM) 2.03 ng/mL). N-Methyl perfluorooctane sulfonamido acetic acid (NMeFOSAA), perfluoropentanoic acid (PFPeA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were found in 40-50% of the samples, whereas the detection frequencies for the other six PFAS were below 15%. When compared to National Health and Nutrition Examination Survey (NHANES) participants matching sex, race, and age with this study, our results showed similar concentrations of most PFAS, but higher concentrations of PFHxS (GM 0.99 ng/mL in this study; 0.63 and 0.4 ng/mL in NHANES, 2014-2015 and 2016-2017 cycles). A decline in concentrations over the study period was found for most PFAS but not PFPeA. In adjusted models, education, sampling year, parity, BMI, tobacco and marijuana use, age of house, drinking water source, and cosmetic use were significantly associated with serum PFAS concentrations. Our study reports the first PFAS exposure data among pregnant African American women in the Atlanta area, Georgia. The identified predictors will facilitate the setting of research priorities and enable development of exposure mitigation strategies., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Many observational studies explore the association between acetaminophen and cancer, but known limitations such as vulnerability to channeling, protopathic bias, and uncontrolled confounding hamper the interpretability of results. To help understand the potential magnitude of bias, we identify key design choices in these observational studies and specify 10 study design variants that represent different combinations of these design choices. We evaluate these variants by applying them to 37 negative controls - outcome presumed not to be caused by acetaminophen - as well as 4 cancer outcomes in the Clinical Practice Research Datalink (CPRD) database. The estimated odds and hazards ratios for the negative controls show substantial bias in the evaluated design variants, with far fewer of the 95% confidence intervals containing 1 than the nominal 95% expected for negative controls. The effect-size estimates for the cancer outcomes are comparable to those observed for the negative controls. A comparison of exposed and unexposed reveals many differences at baseline for which most studies do not correct. We observe that the design choices made in many of the published observational studies can lead to substantial bias. Thus, caution in the interpretation of published studies of acetaminophen and cancer is recommended., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice., Methods: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested., Findings: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes., Interpretation: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers., Funding: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: Smoking status is poorly record in US claims data. IBM MarketScan Commercial is a claims database that can be linked to an additional health risk assessment with self-reported smoking status for a subset of 1,966,174 patients. We investigate whether this subset could be used to learn a smoking status phenotype model generalizable to all US claims data that calculates the probability of being a current smoker., Methods: 251,643 (12.8%) had self-reported their smoking status as 'current smoker'. A regularized logistic regression model, the Current Risk of Smoking Status (CROSS), was trained using the subset of patients with self-reported smoking status. CROSS considered 53,027 candidate covariates including demographics and conditions/drugs/measurements/procedures/observations recorded in the prior 365 days, The CROSS phenotype model was validated across multiple other claims data., Results: The internal validation showed the CROSS model achieved an area under the receiver operating characteristic curve (AUC) of 0.76 and the calibration plots indicated it was well calibrated. The external validation across three US claims databases obtained AUCs ranging between 0.82 and 0.87 showing the model appears to be transportable across Claims data., Conclusion: CROSS predicts current smoking status based on the claims records in the prior year. CROSS can be readily implemented to any US insurance claims mapped to the OMOP common data model and will be a useful way to impute smoking status when conducting epidemiology studies where smoking is a known confounder but smoking status is not recorded. CROSS is available from https://github.com/OHDSI/StudyProtocolSandbox/tree/master/SmokingModel., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The primary approach for defining disease in observational healthcare databases is to construct phenotype algorithms (PAs), rule-based heuristics predicated on the presence, absence, and temporal logic of clinical observations. However, a complete evaluation of PAs, i.e., determining sensitivity, specificity, and positive predictive value (PPV), is rarely performed. In this study, we propose a tool (PheValuator) to efficiently estimate a complete PA evaluation., Methods: We used 4 administrative claims datasets: OptumInsight's de-identified Clinformatics™ Datamart (Eden Prairie,MN); IBM MarketScan Multi-State Medicaid); IBM MarketScan Medicare Supplemental Beneficiaries; and IBM MarketScan Commercial Claims and Encounters from 2000 to 2017. Using PheValuator involves (1) creating a diagnostic predictive model for the phenotype, (2) applying the model to a large set of randomly selected subjects, and (3) comparing each subject's predicted probability for the phenotype to inclusion/exclusion in PAs. We used the predictions as a 'probabilistic gold standard' measure to classify positive/negative cases. We examined 4 phenotypes: myocardial infarction, cerebral infarction, chronic kidney disease, and atrial fibrillation. We examined several PAs for each phenotype including 1-time (1X) occurrence of the diagnosis code in the subject's record and 1-time occurrence of the diagnosis in an inpatient setting with the diagnosis code as the primary reason for admission (1X-IP-1stPos)., Results: Across phenotypes, the 1X PA showed the highest sensitivity/lowest PPV among all PAs. 1X-IP-1stPos yielded the highest PPV/lowest sensitivity. Specificity was very high across algorithms. We found similar results between algorithms across datasets., Conclusion: PheValuator appears to show promise as a tool to estimate PA performance characteristics., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We developed a robust analytical method for quantification of malondialdehyde (MDA) in exhaled breath condensate (EBC) via derivatization with 2,4-dinitrophenylhydrazine (DNPH). The target MDA-DNPH hydrazone was separated by ultra-performance liquid chromatography using two reversed-phase analytical columns (C 18 and phenyl-hexyl) inter-connected via a two-position, six-port switching valve to a single-quadrupole mass spectrometer. The target derivative was analyzed under positive electrospray ionization using single ion monitoring mode (m/z = 235 for the target derivative, and m/z = 237 for its labeled isotopic analog). This pseudo two-dimensional chromatographic separation provided optimum separation conditions for the target derivative resulting in the limit of detection of 0.58 nM in EBC sample (or 36.2 pmol on-column amount), which is comparable to those reported previously using different techniques, including tandem mass spectrometry. Based on the calibration solutions, the method had a linear quantification range of 1.0-200 nM (r2 = 0.998). The method showed good relative recoveries (92.2-102.0%) and acceptable precisions (3.6-12.2% for inter-day precision, and 4.3-12.4% for intra-day precision for two quality control levels, prepared from 5 nM and 25 nM solutions). The derivative was found to be stable at room temperature for 48 h or during analysis. The method was used to analyze 205 exhaled breath condensate samples collected from individuals from a healthy population of student athletes. MDA was detected in approximately 95% of these samples, with concentrations ranging from 1.16 to 149.63 nM. The median concentration was 6.82 nM, (IQR 4.08-9.88). These data demonstrate that our method can be successfully used to measure MDA in population studies., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: Drug safety researchers seek to know the degree of certainty with which a particular drug is associated with an adverse drug reaction. There are different sources of information used in pharmacovigilance to identify, evaluate, and disseminate medical product safety evidence including spontaneous reports, published peer-reviewed literature, and product labels. Automated data processing and classification using these evidence sources can greatly reduce the manual curation currently required to develop reference sets of positive and negative controls (i.e. drugs that cause adverse drug events and those that do not) to be used in drug safety research., Methods: In this paper we explore a method for automatically aggregating disparate sources of information together into a single repository, developing a predictive model to classify drug-adverse event relationships, and applying those predictions to a real world problem of identifying negative controls for statistical method calibration., Results: Our results showed high predictive accuracy for the models combining all available evidence, with an area under the receiver-operator curve of ⩾0.92 when tested on three manually generated lists of drugs and conditions that are known to either have or not have an association with an adverse drug event., Conclusions: Results from a pilot implementation of the method suggests that it is feasible to develop a scalable alternative to the time-and-resource-intensive, manual curation exercise previously applied to develop reference sets of positive and negative controls to be used in drug safety research., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The design of randomized controlled clinical studies can greatly benefit from iterative assessments of population representativeness of eligibility criteria. We propose a multi-trait metric - GIST 2.0 that can compute the a priori generalizability based on the population representativeness of a clinical study by explicitly modeling the dependencies among all eligibility criteria. We evaluate this metric on twenty clinical studies of two diseases and analyze how a study's eligibility criteria affect its generalizability (collectively and individually). We statistically analyze the effects of trial setting, trait selection and trait summarizing technique on GIST 2.0. Finally we provide theoretical as well as empirical validations for the expected properties of GIST 2.0., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Organophosphate (OP) pesticides are widely used for crop protection in many countries including Thailand. Aside from causing environmental contamination, they affect human health especially by over-stimulating of the neurotransmission system. OP pesticides, as with other non-persistent pesticides, degrade quickly in the environment as well as are metabolized quite rapidly in humans. Assessing human exposures to these compounds requires analytical methods that are sensitive, robust, and most importantly, suitable for specific laboratory settings. The aim of this study was to develop and validate an analytical method for measuring 11 OP pesticide residues in human plasma and breast milk. Analytes in both plasma and breast milk samples were extracted with acetone and methylene chloride, cleaned-up using aminopropyl solid phase extraction cartridges, and analyzed by gas chromatography with flame photometric detection. The optimized method exhibited good linearity, with the coefficients of determination of 0.996-0.999 and <7% error about the slope. Extraction recoveries from spiked plasma and breast milk samples at low and medium concentrations (0.8-5.0 and 1.6-10ngmL(-1), respectively) ranged from 59.4% (ethion) to 94.0% (chlorpyrifos). Intra-batch and inter-batch precisions ranged from 2.3-18.9% and 5.8-19.5%, respectively. Method detection limits of plasma and breast milk ranged from 0.18-1.36 and 0.09-2.66ngmL(-1), respectively. We analyzed 63 plasma and 30 breastmilk samples collected from farmworkers in Chiang Mai Province to determine the suitability of this method for occupational exposure assessment. Of the 11 pesticides measured, seven were detected in plasma samples and five were detected in breast milk samples. Mass spectrometry was used to confirm results. Overall, this method is rapid and reliable. It offers the laboratories with limited access to mass spectrometry a capacity to investigate levels OP pesticides in plasma and breastmilk in those occupationally exposed for health risk assessment., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Benzene is a known occupational carcinogen associated with increased risk of hematologic cancers, but the relationships between quantity of passive benzene exposure through residential proximity to toxic release sites, duration of exposure, lag time from exposure to cancer development, and lymphoma risk remain unclear., Methods: We collected release data through the Environmental Protection Agency's Toxics Release Inventory (TRI) from 1989 to 2003, which included location of benzene release sites, years when release occurred, and amount of release. We also collected data on incident cases of non-Hodgkin lymphoma (NHL) from the Georgia Comprehensive Cancer Registry (GCCR) for the years 1999-2008. We constructed distance-decay surrogate exposure metrics and Poisson and negative binomial regression models of NHL incidence to quantify associations between passive exposure to benzene and NHL risk and examined the impact of amount, duration of exposure, and lag time on cancer development. Akaike's information criteria (AIC) were used to determine the scaling factors for benzene dispersion and exposure periods that best predicted NHL risk., Results: Using a range of scaling factors and exposure periods, we found that increased levels of passive benzene exposure were associated with higher risk of NHL. The best fitting model, with a scaling factor of 4 kilometers (km) and exposure period of 1989-1993, showed that higher exposure levels were associated with increased NHL risk (Level 4 (1.1-160kilograms (kg)) vs. Level 1: risk ratio 1.56 [1.44-1.68], Level 5 (>160kg) vs. Level 1: 1.60 [1.48-1.74])., Conclusions: Higher levels of passive benzene exposure are associated with increased NHL risk across various lag periods. Additional epidemiological studies are needed to refine these models and better quantify the expected total passive benzene exposure in areas surrounding release sites., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Prenatal organophosphate (OP) pesticide exposure has been reported to be associated with adverse birth outcomes and neurodevelopment. However, the mechanisms of toxicity of OP pesticides on human fetal development have not yet been elucidated. Our pilot study birth cohort, the Study of Asian Women and Offspring's Development and Environmental Exposures (SAWASDEE cohort) aimed to evaluate environmental chemical exposures and their relation to birth outcomes and infant neurodevelopment in 52 pregnant farmworkers in Fang district, Chiang Mai province, Thailand. A large array of data was collected multiple times during pregnancy including approximately monthly urine samples for evaluation of pesticide exposure, three blood samples for pesticide-related enzyme measurements and questionnaire data. This study investigated the changes in maternal acetylcholinesterase (AChE) and paraoxonase 1 (PON1) activities and their relation to urinary diakylphosphates (DAPs), class-related metabolites of OP pesticides, during pregnancy. Maternal AChE, butyrylcholinesterase (BChE) and PON1 activities were measured three times during pregnancy and urinary DAP concentrations were measured, on average, 8 times from enrollment during pregnancy until delivery. Among the individuals in the group with low maternal PON1 activity (n=23), newborn head circumference was negatively correlated with log10 maternal ∑DEAP and ∑DAP at enrollment (gestational age=12±3 weeks; β=-1.0 cm, p=0.03 and β=-1.8 cm, p<0.01, respectively) and at 32 weeks pregnancy (β=-1.1cm, p=0.04 and β=-2.6 cm, p=0.01, respectively). Furthermore, among these mothers, newborn birthweight was also negatively associated with log10 maternal ∑DEAP and ∑DAP at enrollment (β=-219.7 g, p=0.05 and β=-371.3g, p=0.02, respectively). Associations between maternal DAP levels and newborn outcomes were not observed in the group of participants with high maternal PON1 activity. Our results support previous findings from US birth cohort studies. This is the first study to report the associations between prenatal OP pesticide exposure and birth outcomes in Thailand., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The aim of this study was to develop an analytical method for the quantification of organochlorine (OC), organophosphate (OP), carbamate, and pyrethroid insecticide residues in cow milk, human milk, and baby formula. A total of 25 compounds were included in this method. Sample extraction procedures combined liquid-liquid extraction, freezing-lipid filtration, dispersive primary-secondary amine cleanup, and solid-phase extraction together for effective extraction and elimination of matrix interferences. Target compounds were analyzed using gas chromatography with electron impact ionization-tandem mass spectrometry (GC-EI-MS/MS) in the multiple reaction monitoring (MRM) mode. Average extraction recoveries obtained from cow milk samples fortified at two different concentrations (10 ng/mL and 25 ng/mL), ranged from 34% to 102%, with recoveries for the majority of target compounds falling between 60% and 80%. Similar ranges were found for formula fortified at 25 ng/mL. The estimated limits of detection for most target analytes were in the low pg/mL level (range 3-1600 pg/mL). The accuracies and precisions were within the range of 80-120% and less than 15%, respectively. This method was tested for its viability by analyzing 10 human milk samples collected from anonymous donors, 10 cow milk samples and 10 baby formula samples purchased from local grocery stores in the United States. Hexachlorobenzene, p,p-dicofol, o,p-DDE, p,p-DDE, and chlorpyrifos were found in all samples analyzed. We found detectable levels of permethrin, cyfluthrin, and fenvalerate in some of the cow milk samples but not in human milk or baby formula samples. Some of the pesticides, such as azinphos-methyl, heptachlor epoxide, and the pesticide synergist piperonyl butoxide, were detected in some of the cow milk and human milk samples but not in baby formula samples., (Copyright © 2014. Published by Elsevier B.V.)

Large electronic databases of health care information, such as administrative claims and electronic health records, are available and are being used in a number of public health settings, including drug safety surveillance. However, because of a lack of standardization, clinical terminologies may differ across databases. With the aid of existing resources and expert coders, we have developed mapping tables to convert ICD-9-CM diagnosis codes used in some existing databases to SNOMED-CT and MedDRA. In addition, previously developed definitions for specific health outcomes of interest were mapped to the same standardized vocabularies. We evaluated how vocabulary mapping affected (1) the retention of clinical data from two test databases, (2) the semantic space of outcome definitions, (3) the prevalence of each outcome in the test databases, and (4) the reliability of analytic methods designed to detect drug-outcome associations in the test databases. Although vocabulary mapping affected the semantic space of some outcome definitions, as well as the prevalence of some outcomes in the test databases, it had only minor effects on the analysis of drug-outcome associations. Furthermore, both SNOMED-CT and MedDRA were viable for use as standardized vocabularies in systems designed to perform active medical product surveillance using disparate sources of observational data., (Copyright © 2012 Elsevier Inc. All rights reserved.)

As an agricultural country and one of the world's major food exporters, Thailand relies heavily on the use of pesticides to protect crops and increase yields. During the past decade, the Kingdom of Thailand has experienced an approximate four-fold increase in pesticide use. This increase presents a challenge for the Royal Thai Government in effectively managing and controlling pesticide use based upon the current policies and legal infrastructure. We have reviewed several key components for managing agricultural pesticides in Thailand. One of the main obstacles to effective pesticide regulation in Thailand is the lack of a consolidated, uniform system designed specifically for pesticide management. This deficit has weakened the enforcement of existing regulations, resulting in misuse/overuse of pesticides, and consequently, increased environmental contamination and human exposure. This article provides a systematic review of how agricultural pesticides are regulated in Thailand. In addition, we provide our perspectives on the current state of pesticide management, the potential health effects of widespread, largely uncontrolled use of pesticides on the Thai people and ways to improve pesticide management in Thailand.

Melamine and cyanuric acid have been implicated as adulterants in baby formula in China and pet foods in North America. In China, the effect of melamine or melamine-cyanuric acid adulteration lead to kidney stone development and acute renal failure in thousands of Chinese infants. A selective and sensitive analytical method was developed to measure melamine in human urine in order to evaluate the extent of potential health implications resulting from the consumption of these types of adulterated products in the general US population. This method involves extracting melamine from human urine using cation-exchange solid-phase extraction, chromatographically separating it from its urinary matrix co-extractants on a silica-based, strong-cation exchange analytical column using high performance liquid chromatography, and analysis using positive mode electrospray ionization tandem mass spectrometry. Quantification was performed using modified, matrix-based isotope dilution calibration covering the concentration range of 0.50-100 ng/mL. The limit of detection, calculated using replicates of blank and low level spiked samples, was 0.66 ng/mL and the relative standard deviations were between 6.89 and 14.9%. The relative recovery of melamine was 101-106%. This method was tested for viability by analyzing samples collected from the general US population. Melamine was detected in 76% of the samples tested, with a geometric mean of 2.37 ng/mL, indicating that this method is suitable for reliably detecting background exposures to melamine or other chemicals from which it can be derived., (Copyright © 2012 Elsevier B.V. All rights reserved.)

In Baguio City, Philippines, a mountainous city of 252,386 people where 61% of motor vehicles use diesel fuel, ambient particulate matter <2.5 microm (PM(2.5)) and <10 microm (PM(10)) in aerodynamic diameter and carbon monoxide (CO) were measured at 30 street-level locations for 15 min apiece during the early morning (4:50-6:30 am), morning rush hour (6:30-9:10 am) and afternoon rush hour (3:40-5:40 pm) in December 2004. Environmental observations (e.g. traffic-related variables, building/roadway designs, wind speed and direction, etc.) at each location were noted during each monitoring event. Multiple regression models were formulated to determine which pollution sources and environmental factors significantly affect ground-level PM(2.5), PM(10) and CO concentrations. The models showed statistically significant relationships between traffic and early morning particulate air pollution [(PM(2.5)p=0.021) and PM(10) (p=0.048)], traffic and morning rush hour CO (p=0.048), traffic and afternoon rush hour CO (p=0.034) and wind and early morning CO (p=0.044). The mean early morning, street-level PM(2.5) (110+/-8 microg/m3; mean+/-1 standard error) was not significantly different (p-value>0.05) from either rush hour PM(2.5) concentration (morning=98+/-7 microg/m3; afternoon=107+/-5 microg/m3) due to nocturnal inversions in spite of a 100% increase in automotive density during rush hours. Early morning street-level CO (3.0+/-1.7 ppm) differed from morning rush hour (4.1+/-2.3 ppm) (p=0.039) and afternoon rush hour (4.5+/-2.2 ppm) (p=0.007). Additionally, PM(2.5), PM(10), CO, nitrogen dioxide (NO2) and select volatile organic compounds were continuously measured at a downtown, third-story monitoring station along a busy roadway for 11 days. Twenty-four-hour average ambient concentrations were: PM(2.5)=72.9+/-21 microg/m3; CO=2.61+/-0.6 ppm; NO2=27.7+/-1.6 ppb; benzene=8.4+/-1.4 microg/m3; ethylbenzene=4.6+/-2.0 microg/m3; p-xylene=4.4+/-1.9 microg/m3; m-xylene=10.2+/-4.4 microg/m3; o-xylene=7.5+/-3.2 microg/m3. The multiple regression models suggest that traffic and wind in Baguio City, Philippines significantly affect street-level pollution concentrations. Ambient PM(2.5) levels measured are above USEPA daily (65 microg/m3) and Filipino/USEPA annual standards (15 microg/m3) with concentrations of a magnitude rarely seen in most countries except in areas where local topography plays a significant role in air pollution entrapment. The elevated pollution concentrations present and the diesel-rich nature of motor vehicle emissions are important pertaining to human exposure and health information and as such warrant public health concern.

Four-day composite solid food and beverage duplicate plates and 1-L samples of drinking water were collected from a stratified random sample of 80 individuals as part of the National Human Exposure Assessment Survey in Maryland. The media were obtained from each participant in up to six equally spaced sampling cycles over a year and analyzed for copper by inductively coupled plasma mass spectrometry. Copper concentrations (microg/kg) and consumption rates (kg/d) of solid food, beverage and drinking water were used to derive average daily aggregate oral intake of copper (microg/d). The mean aggregate copper intake of 263 measurements obtained from 68 people was 923.2 +/- 685.6 microg/d (mean +/- SD). Intake through solid food accounted for the majority of aggregate daily intake of copper contributing 87% on average. According to results from mixed model analysis of variance procedures, the mean log-transformed average daily copper intake in each medium except beverage exhibited significant (P < 0.05) variability among sampling cycles. Between-person variability accounted for 50% of the total variance in aggregate copper intake. As measured by the coefficient of variation, distributions of copper intake consisting of one observation per individual were more variable than the distribution consisting of the long-term average intake for each person. These results suggest that estimates of the fraction of a population at risk from chronic copper deficiency or excess copper intake can be overestimated if based upon short-term measures of copper intake. In addition, these results indicate that longitudinal information is required for accurate assessment of aggregate oral intake of copper for an individual.

Teenagers represent a unique population in which to evaluate lead exposure. A self-administered questionnaire was developed to evaluate the current and historic lead exposures of teenagers. This work evaluates the exposure questionnaire for both its ability to predict lead exposure and the accuracy of the teenage respondents. Subjects received the survey at school and were instructed to get assistance from their parents in questionnaire completion. Environmental samples (dust, soil, and water) were collected from 30 suburban Boston homes to evaluate the questionnaire's predictiveness. To evaluate the accuracy of subjects' responses, independent information about housing was obtained. The questionnaire was effective in identifying predictors of dust and soil lead levels, but not for water lead levels. Fine dust lead loading (< 150 microns) varied significantly among the six housing age categories (pre-1940, 1940-1949, 1950-1959, 1960-1969, 1970-1979, and > 1979) and traffic levels. Fine dust lead concentrations varied significantly with decade of housing construction. Mean soil lead levels varied significantly among housing age categories, traffic levels, and exterior construction materials. For the important predictors, there was excellent agreement between the teenagers' self-report and confirmatory information. For housing age categories, the observed agreement was 69%; for traffic level, the observed agreement was 88%. These results illustrate that questionnaires continue to be useful in evaluating home lead levels even in suburban homes and that teenagers are accurate respondents.