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RATIONALE: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. OBJECTIVES: As part of the Household Air Pollution Intervention Network (HAPIN) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced and a road network analysis was performed. MEASUREMENTS AND MAIN RESULTS: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately-resourced facility was 41±19 minutes in J-GUA, 99±64 minutes in P-PER, 40±19 minutes in K-RWA, and 31±19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all p

BackgroundPopulation growth which has resulted in a need for increased crop yields to sustain food security, in addition to the effects of climate change, have led to the widespread use of chemical pesticides. The indiscriminate use of pesticides has in turn led to contamination of the environment, food commodities and bioaccumulation in human tissues, particularly in agrarian regions of India including the northern state of Haryana.MethodsWe conducted a pilot screening study to investigate the presence of organochlorine, organophosphate, and pyrethroid pesticides in breastmilk samples (n = 75) from Haryana, India. Pesticide analyses were conducted using gas chromatography mass spectrometry (GC-MS) for OC and OP pesticides and GC-electron capture detector for pyrethroids. The study was complemented by a qualitative evaluation of maternal and community perceptions, knowledge, attitudes and practices associated with pesticide use and risk of exposure (n = 30 in-depth interviews;n = 9 focus group discussions).ResultsAnalysis of breastmilk showed the presence ofp,p’-dichlorodiphenyltrichloroethane (DDT) andp,p’-dichlorodiphenyldichloroethylene (DDE) in 4% (range: Our qualitative findings showed that community members commonly held perceptions of pesticides as medicines and poison but acknowledged their widespread use to ensure crop yields. Given the gendered engagement in farming in this setting, lactating women in study communities do not directly handle chemical pesticides, thus lowering risk of inhalation and dermal exposure.ConclusionsIn our small sample, breastmilk pesticide concentrations were low and did not pose a risk to infants. Based on the persistent nature of many organic pollutants and reported widespread use, we recommend more comprehensive and longitudinal investigation of upstream pesticide contamination in the food supply and exposures among mothers and children.Trial registrationCTRI/2017/01/007636, Date Registered: 06/01/2017.CTRI website:http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=17249&EncHid=&modid=&compid=%27,%2717249det%27

SummaryBackgroundCountries continue to debate the need for decontamination of cold-chain food packaging to reduce possible SARS-CoV-2 fomite transmission among workers. While laboratory-based studies demonstrate persistence of SARS-CoV-2 on surfaces, the likelihood of fomite-mediated transmission under real-life conditions is uncertain.MethodsUsing a quantitative risk assessment model, we simulated in a frozen food packaging facility 1) SARS-CoV-2 fomite-mediated infection risks following worker exposure to contaminated plastic packaging; and 2) reductions in these risks attributed to masking, handwashing, and vaccination.FindingsIn a representative facility with no specific interventions, SARS-CoV-2 infection risk to a susceptible worker from contact with contaminated packaging was 2·8 × 10−3per 1h-period (95%CI: 6·9 × 10−6, 2·4 × 10−2). Implementation of standard infection control measures, handwashing and masks (9·4 × 10−6risk per 1h-period, 95%CI: 2·3 × 10−8, 8·1 × 10−5), substantially reduced risk (99·7%). Vaccination of the susceptible worker (two doses Pfizer/Moderna, vaccine effectiveness: 86-99%) combined with handwashing and masking reduced risk to less than 1·0 × 10−6. Simulating increased infectiousness/transmissibility of new variants (2-, 10-fold viral shedding) among a fully vaccinated workforce, handwashing and masks continued to mitigate risk (2·0 × 10−6-1·1 × 10−5risk per 1h-period). Decontamination of packaging in addition to these interventions reduced infection risks to below the 1·0 × 10−6risk threshold.InterpretationFomite-mediated SARS-CoV-2 infection risks were very low under cold-chain conditions. Handwashing and masking provide significant protection to workers, especially when paired with vaccination.FundingU.S. Department of Agriculture

Background Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method We conducted ethnographic research, including direct observation ( n = 36), in-depth ( n = 18), and semistructured ( n = 6) interviews, and 24 focus group discussions ( n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.

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 1,435 metabolic features significantly associated with at least one phthalate metabolite during early and late pregnancy (p

Background Measurements of urinary dialkyl phosphate (DAP) metabolites are often used to characterize exposures to organophosphate (OP) insecticides; however, some challenges to using urinary DAP metabolites as an exposure measure exist. OP insecticides have short biological half-lives with measurement in a single urine sample typically only reflecting recent exposure within the last few days. Because of the field staff and participant burden of longitudinal sample collection and the high cost of multiple measurements, typically only one or two urine samples have been used to evaluate OP insecticide exposure during pregnancy, which is unlikely to capture an accurate picture of prenatal exposure. Methods We recruited pregnant farmworker women in Chom Thong and Fang, two districts of Chiang Mai province in northern Thailand (N = 330) into the Study of Asian Women and their Offspring’s Development and Environmental Exposures (SAWASDEE) from 2017 to 2019. We collected up to 6 serial urine samples per participant during gestation and composited the samples to represent early, mid, and late pregnancy. We measured concentrations of urinary DAP metabolites in the composited urine samples and evaluated the within- and between-participant variability of these levels. We also investigated predictors of OP insecticide exposure. Results DAP metabolite concentrations in serial composite samples were weakly to moderately correlated. Spearman correlations indicated that composite urine samples were more highly correlated in Fang participants than in Chom Thong participants. The within-person variances (0.064–0.65) exceeded the between-person variances for DETP, DEP, ∑DEAP, DMP, DMTP, ∑DMAP, ∑DAP. The intraclass correlations (ICCs) for the volume-based individual metabolite levels (ng/mL) ranged from 0.10 to 0.66. For ∑DEAP, ∑DMAP, and ∑DAP the ICCs were, 0.47, 0.17, 0.45 respectively. We observed significant differences between participants from Fang compared to those from Chom Thong both in demographic and exposure characteristics. Spearman correlations of composite samples from Fang participants ranged from 0.55 to 0.66 for the ∑DEAP metabolite concentrations in Fang indicating moderate correlation between pregnancy periods. The ICCs were higher for samples from Fang participants, which drove the overall ICCs. Conclusions Collecting multiple (∼6) urine samples during pregnancy rather than just 1 or 2 improved our ability to accurately assess exposure during the prenatal period. By compositing the samples, we were able to still obtain trimester-specific information on exposure while keeping the analytic costs and laboratory burden low. This analysis also helped to inform how to best conduct future analyses within the SAWASDEE study. We observed two different exposure profiles in participants in which the concentrations and variability in data were highly linked to the residential location of the participants.

The SARS-CoV-2 global pandemic poses significant health risks to workers who are essential to maintaining the food supply chain. Using a quantitative risk assessment model, this study characterized the impact of risk reduction strategies for controlling SARS-CoV-2 transmission (droplet, aerosol, fomite-mediated) among front-line workers in a representative enclosed food manufacturing facility. We simulated: 1) individual and cumulative SARS-CoV-2 infection risks from close contact (droplet and aerosols at 1-3m), aerosol, and fomite-mediated exposures to a susceptible worker following exposure to an infected worker during an 8h-shift; and 2) the relative reduction in SARS-CoV-2 infection risk attributed to infection control interventions (physical distancing, mask use, ventilation, surface disinfection, hand hygiene). Without mitigation measures, the SARS-CoV-2 infection risk was largest for close contact (droplet and aerosol) at 1m (0.96, 95%CI: 0.67–1.0). In comparison, risk associated with fomite (0.26, 95%CI: 0.10–0.56) or aerosol exposure alone (0.05, 95%CI: 0.01–0.13) at 1m distance was substantially lower (73-95%). At 1m, droplet transmission predominated over aerosol and fomite-mediated transmission, however, this changed by 3m, with aerosols comprising the majority of the exposure dose. Increasing physical distancing reduced risk by 84% (1 to 2m) and 91% (1 to 3m). Universal mask use reduced infection risk by 52-88%, depending on mask type. Increasing ventilation (from 0.1 to 2-8 air changes/hour) resulted in risk reductions of 14-54% (1m) and 55-85% (2m). Combining these strategies, together with handwashing and surface disinfection, resulted in Significance StatementUsing mathematical modeling, we find that workers in enclosed food manufacturing facilities are at higher risk of SARS-CoV-2 infection from close contact transmission (exposure to large droplets and small aerosol particles) than fomite transmission. Thus, strategies protecting workers should prioritize close contact transmission pathways, such as physical distancing, universal mask use, and room air changes, with surface disinfection (reducing fomite transmission) and handwashing of secondary importance. Our work supports current international (EU-OSHA), domestic (FDA, OSHA), and food industry-standard guidance for managing COVID-19 transmission in essential workers in the food manufacturing sector. Although our model was designed for an indoor food manufacturing setting, it can be readily adapted to other indoor environments and infectious respiratory pathogens.

s 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.

Mycotoxins are carcinogenic secondary metabolites of fungi that have been linked to infant growth faltering. In this study, we quantified co-occurring mycotoxins in breast milk and food samples from Haryana, India, and characterized determinants of exposure. Deterministic risk assessment was conducted for mothers and infants. We examined levels of eight mycotoxins (Aflatoxin B1 , B2 , G1 , G2 , M1 , M2 ; Ochratoxin A, B) in 100 breast milk samples (infants 2-4 months) using ultra-high-performance liquid chromatography tandem mass spectrometry. Aflatoxin B1 (AFB1 ), fumonisin B1 (FB1 ) and deoxynivalenol (DON) were detected in several food items (n = 298) using enzyme-linked immunosorbent assays. We report novel data on the presence of mycotoxins in breast milk samples from India. Whereas breast milk concentrations (AFM1 median: 13.7; range: 3.9-1200 ng/L) remain low, AFM1 was detected above regulatory limits in 27% of animal milk samples. Additionally, 41% of infants were above provisional maximum tolerable daily intake (PMTDI) limits for AFM1 due to consumption of breast milk (mean: 3.04, range: 0.26-80.7 ng kg-1 bw day-1 ). Maternal consumption of breads (p < 0.05) was associated with breast milk AFM1 exposure. AFB1 (μg/kg) was detected in dried red chilies (15.7; 0-302.3), flour (3.13; 0-214.9), groundnuts (0; 0-249.1), maize (56.0; 0-836.7), pearl millet (1.85; 0-160.2), rice (0; 0-195.6), wheat (1.9; 0-196.0) and sorghum (0; 0-63.5). FB1 (mg/kg) was detected in maize (0; 0-61.4), pearl millet (0; 0-35.4) and sorghum (0.95; 0-33.2). DON was not detected in food samples. Mothers in our study exceeded PMTDI recommendations for AFB1 due to consumption of rice and flour (mean: 75.81; range: 35.2-318.2 ng kg-1 bw day-1 ). Our findings show the presence of Aflatoxin B1 and M1 at various levels of the food chain and in breast milk, with estimated intakes exceeding PMTDI recommendations. Aflatoxins are known carcinogens and have also been linked to stunting in children. Their presence across the food system and in breast milk is concerning, thus warranting further research to replicate and expand on our findings and to understand implications for maternal and child health.

Cold plasma is emerging as a novel food processing technology, with demonstrated efficacies for microbial inactivation and residual chemical dissipation of food products. Given the technology’s multimodal action it has the potential to reduce allergens in foods, however data on the efficacy and mechanisms of action are sparse. This study investigates the efficacy of cold plasma on major peanut allergens (Ara h 1 and Ara h 2). For this purpose, dry, whole peanut (WP) and defatted peanut flour (DPF) were subjected to an atmospheric air discharge using a pin to plate cold plasma reactor for different treatment durations. With increases in plasma exposure, SDS-PAGE analysis revealed reduced protein solubility of the major peanut allergens. Alterations in allergenicity and structure of Ara h 1 and Ara h 2 were examined using ELISA and circular dichroism (CD) spectroscopy. Competitive ELISA with proteins purified from plasma treated WP or DPF revealed reduced antigenicity for both Ara h 1 and Ara h 2. The highest reduction in antigenicity was 65% for Ara h 1 and 66% Ara h 2 when purified from DPF. Results from CD spectroscopy analysis of purified proteins strongly suggests the reduction in antigenicity is due to modifications in the secondary structure of the allergens induced by plasma reactive species. Cold plasma is effective at reducing peanut protein solubility and causes changes in allergen structure leading to reduced antigenicity.

Background The C8 Science Panel was composed of three epidemiologists charged with studying the possible health effects of PFOA in a highly exposed population in the mid-Ohio Valley. The Panel determined in 2012 there was a ‘probable link’ (i.e., more probable than not based on the weight of the available scientific evidence) between PFOA and high cholesterol, thyroid disease, kidney and testicular cancer, pregnancy-induced hypertension, and ulcerative colitis. Objective Here, former C8 Science Panel members and collaborators comment on the PFOA literature regarding thyroid disorders, cancer, immune and auto-immune disorders, liver disease, hypercholesterolemia, reproductive outcomes, neurotoxicity, and kidney disease. We also discuss developments regarding fate and transport, and pharmacokinetic models, and discuss causality assessment in cross-sectional associations among low-exposed populations. Discussion For cancer, the epidemiologic evidence remains supportive but not definitive for kidney and testicular cancers. There is consistent evidence of a positive association between PFOA and cholesterol, but no evidence of an association with heart disease. There is evidence for an association with ulcerative colitis, but not for other auto-immune diseases. There is good evidence that PFOA is associated with immune response, but uneven evidence for an association with infectious disease. The evidence for an association between PFOA and thyroid and kidney disease is suggestive but uneven. There is evidence of an association with liver enzymes, but not with liver disease. There is little evidence of an association with neurotoxicity. Suggested reductions in birthweight may be due to reverse causality and/or confounding. Fate and transport models and pharmacokinetic models remain central to estimating past exposure for new cohorts, but are difficult to develop without good historical data on emissions of PFOA into the environment. Conclusion Overall, the epidemiologic evidence remains limited. For a few outcomes there has been some replication of our earlier findings. More longitudinal research is needed in large populations with large exposure contrasts. Additional cross-sectional studies of low exposed populations may be less informative.

The Household Air Pollution Intervention Network trial is a multi-country study on the effects of a liquefied petroleum gas (LPG) stove and fuel distribution intervention on women's and children's health. There is limited data on exposure reductions achieved by switching from solid to clean cooking fuels in rural settings across multiple countries. As formative research in 2017, we recruited pregnant women and characterized the impact of the intervention on personal exposures and kitchen levels of fine particulate matter (PM2.5) in Guatemala, India, and Rwanda. Forty pregnant women were enrolled in each site. We measured cooking area concentrations of and personal exposures to PM2.5 for 24 or 48 h using gravimetric-based PM2.5 samplers at baseline and two follow-ups over two months after delivery of an LPG cookstove and free fuel supply. Mixed models were used to estimate PM2.5 reductions. Median kitchen PM2.5 concentrations were 296 μg/m3 at baseline (interquartile range, IQR: 158–507), 24 μg/m3 at first follow-up (IQR: 18–37), and 23 μg/m3 at second follow-up (IQR: 14–37). Median personal exposures to PM2.5 were 134 μg/m3 at baseline (IQR: 71–224), 35 μg/m3 at first follow-up (IQR: 23–51), and 32 μg/m3 at second follow-up (IQR: 23–47). Overall, the LPG intervention was associated with a 92% (95% confidence interval (CI): 90–94%) reduction in kitchen PM2.5 concentrations and a 74% (95% CI: 70–79%) reduction in personal PM2.5 exposures. Results were similar for each site. Conclusions The intervention was associated with substantial reductions in kitchen and personal PM2.5 overall and in all sites. Results suggest LPG interventions in these rural settings may lower exposures to the WHO annual interim target-1 of 35 μg/m3. The range of exposure contrasts falls on steep sections of estimated exposure-response curves for birthweight, blood pressure, and acute lower respiratory infections, implying potentially important health benefits when transitioning from solid fuels to LPG., Highlights • There was high uptake of an LPG stove and fuel intervention in 3 rural settings. • The LPG intervention was associated with a 92% reduction in kitchen PM2.5 levels. • The intervention was associated with a 74% reduction in personal exposure to PM2.5 • Maternal PM2.5 exposure was reduced to the WHO annual interim target-1 of 35 μg/m3. • Results from 3 countries indicate switching to clean fuel could improve health., Capsule summary: LPG stove and fuel intervention can reduce kitchen area and personal PM2.5 exposure levels in a pilot study of clean cookstove intervention trial. This strongly suggests switching to clean cook can improve health.

Background: Biomarkers of exposure, susceptibility, and effect are fundamental for understanding environmental exposures, mechanistic pathways of effect, and monitoring early adverse outcomes. To date, no study has comprehensively evaluated a large suite and variety of biomarkers in household air pollution (HAP) studies in concert with exposure and outcome data. The Household Air Pollution Intervention Network (HAPIN) trial is a liquified petroleum gas (LPG) fuel/stove randomized intervention trial enrolling 800 pregnant women in each of four countries (i.e., Peru, Guatemala, Rwanda, and India). Their offspring will be followed from birth through 12 months of age to evaluate the role of pre- and postnatal exposure to HAP from biomass burning cookstoves in the control arm and LPG stoves in the intervention arm on growth and respiratory outcomes. In addition, up to 200 older adult women per site are being recruited in the same households to evaluate indicators of cardiopulmonary, metabolic, and cancer outcomes. Objectives: Here we describe the rationale and ultimate design of a comprehensive biomarker plan to enable us to explore more fully how exposure is related to disease outcome. Methods: HAPIN enrollment and data collection began in May 2018 and will continue through August 2021. As a part of data collection, dried blood spot (DBS) and urine samples are being collected three times during pregnancy in pregnant women and older adult women. DBS are collected at birth for the child. DBS and urine samples are being collected from the older adult women and children three times throughout the child’s first year of life. Exposure biomarkers that will be longitudinally measured in all participants include urinary hydroxy-polycyclic aromatic hydrocarbons, volatile organic chemical metabolites, metals/metalloids, levoglucosan, and cotinine. Biomarkers of effect, including inflammation, endothelial and oxidative stress biomarkers, lung cancer markers, and other clinically relevant measures will be analyzed in urine, DBS, or blood products from the older adult women. Similarly, genomic/epigenetic markers, microbiome, and metabolomics will be measured in older adult women samples. Discussion: Our study design will yield a wealth of biomarker data to evaluate, in great detail, the link between exposures and health outcomes. In addition, our design is comprehensive and innovative by including cutting-edge measures such as metabolomics and epigenetics. https://doi.org/10.1289/EHP5751

Summary Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

Exposure to tobacco smoke during pregnancy has been associated with a series of adverse reproductive outcomes; however, the underlying molecular mechanisms are not well-established. We conducted an untargeted metabolome-wide association study to identify the metabolic perturbations and molecular mechanisms underlying the association between cotinine, a widely used biomarker of tobacco exposure, and adverse birth outcomes. We collected early and late pregnancy urine samples for cotinine measurement and serum samples for high-resolution metabolomics (HRM) profiling from 105 pregnant women from the Atlanta African American Maternal-Child cohort (2014–2016). Maternal metabolome perturbations mediating prenatal tobacco smoke exposure and adverse birth outcomes were assessed by an untargeted HRM workflow using generalized linear models, followed by pathway enrichment analysis and chemical annotation, with a meet-in-the-middle approach. The median maternal urinary cotinine concentrations were 5.93 μg/g creatinine and 3.69 μg/g creatinine in early and late pregnancy, respectively. In total, 16,481 and 13,043 metabolic features were identified in serum samples at each visit from positive and negative electrospray ionization modes, respectively. Twelve metabolic pathways were found to be associated with both cotinine concentrations and adverse birth outcomes during early and late pregnancy, including tryptophan, histidine, urea cycle, arginine, and proline metabolism. We confirmed 47 metabolites associated with cotinine levels, preterm birth, and shorter gestational age, including glutamate, serine, choline, and taurine, which are closely involved in endogenous inflammation, vascular reactivity, and lipid peroxidation processes. The metabolic perturbations associated with cotinine levels were related to inflammation, oxidative stress, placental vascularization, and insulin action, which could contribute to shorter gestations. The findings will support the further understanding of potential internal responses in association with tobacco smoke exposures, especially among African American women who are disproportionately exposed to high tobacco smoke and experience higher rates of adverse birth outcomes.

Background Prenatal exposures to per- and polyfluoroalkyl substances (PFAS) have been linked to reduced fetal growth. However, the detailed molecular mechanisms remain largely unknown. This study aims to investigate biological pathways and intermediate biomarkers underlying the association between serum PFAS and fetal growth using high-resolution metabolomics in a cohort of pregnant African American women in the Atlanta area, Georgia. Methods Serum perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) measurements and untargeted serum metabolomics profiling were conducted in 313 pregnant African American women at 8–14 weeks gestation. Multiple linear regression models were applied to assess the associations of PFAS with birth weight and small-for-gestational age (SGA) birth. A high-resolution metabolomics workflow including metabolome-wide association study, pathway enrichment analysis, and chemical annotation and confirmation with a meet-in-the-middle approach was performed to characterize the biological pathways and intermediate biomarkers of the PFAS-fetal growth relationship. Results Each log2-unit increase in serum PFNA concentration was significantly associated with higher odds of SGA birth (OR = 1.32, 95% CI 1.07, 1.63); similar but borderline significant associations were found in PFOA (OR = 1.20, 95% CI 0.94, 1.49) with SGA. Among 25,516 metabolic features extracted from the serum samples, we successfully annotated and confirmed 10 overlapping metabolites associated with both PFAS and fetal growth endpoints, including glycine, taurine, uric acid, ferulic acid, 2-hexyl-3-phenyl-2-propenal, unsaturated fatty acid C18:1, androgenic hormone conjugate, parent bile acid, and bile acid-glycine conjugate. Also, we identified 21 overlapping metabolic pathways from pathway enrichment analyses. These overlapping metabolites and pathways were closely related to amino acid, lipid and fatty acid, bile acid, and androgenic hormone metabolism perturbations. Conclusion In this cohort of pregnant African American women, higher serum concentrations of PFOA and PFNA were associated with reduced fetal growth. Perturbations of biological pathways involved in amino acid, lipid and fatty acid, bile acid, and androgenic hormone metabolism were associated with PFAS exposures and reduced fetal growth, and uric acid was shown to be a potential intermediate biomarker. Our results provide opportunities for future studies to develop early detection and intervention for PFAS-induced fetal growth restriction.

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.

Widespread polybrominated biphenyls (PBBs) contamination occurred in Michigan from 1973 to 1974, when PBBs were accidentally substituted for a nutritional supplement in livestock feed. People who lived in the state were exposed to PBBs via several routes including ingestion, inhalation and skin absorption. PBBs sequestered in lipid-rich matrices such as adipose tissue, are slowly eliminated after entering the human body, and can also be transferred from a mother to her offspring through the placenta and breastfeeding. Due to the long biological half-lives of PBBs, as well as concerns from the exposed community, biomonitoring measurements were conducted from 2012 to 2015. Because of their similar structures, serum PBBs, polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs) were all measured 40 years after the PBB contamination incident (N = 862). The serum PBB-153 levels among the original highly-exposed groups (i.e., chemical workers, the family of chemical workers, and individuals who lived on or received food from the contaminated farms) remains significantly higher than other Michigan residents. Several predictors such as sampling age, sex, and smoking status were significantly associated with the serum levels of some persistent organic pollutants (POPs). Higher average values and also wider ranges of serum POP levels were found in this study compared to the National Health and Nutrition Examination Survey (NHANES), with the most substantial difference in serum PBB-153. This was true for all groups of Michigan residents including those who were not part of the above-described highly-exposed groups. Moreover, the people born after the contamination incident began also have higher serum PBB-153 levels when compared with more recent NHANES data (2010–2014), which suggests potential intergenerational exposure and/or continued environmental exposure following the contamination period. Keywords: Polybrominated biphenyls (PBBs), Polychlorinated biphenyls (PCBs), Polybrominated diphenyl ethers (PBDEs), Persistent organic pollutants (POPs), Michigan PBB Registry, Biomonitoring

OBJECTIVES: Animal milk can be contaminated with mycotoxins (secondary metabolites of fungi) through poor quality feed and may be a source of human exposure. Our objective was to develop and optimize a method to detect biologically relevant concentrations of 8 mycotoxins (Aflatoxins B1, B2, G1, G2, M1, M2; Ochratoxins A, B) in animal milk. METHODS: We used ultra-high performance liquid chromatography/tandem mass spectrometry using selected reaction monitoring (UHPLC/MS-SRM) to quantify mycotoxins in animal milk samples (total N = 38; n = 10 each from cow and commercial milk and n = 9 from buffalo and goat) from the southern Indian states of Karnataka and Tamil Nadu. Method development was conducted and stable isotope dilution employed, using AFB1-D3 for aflatoxins and OTA-D5 for ochratoxins. We validated the method and examined matrix effects, freeze-thaw and auto-sampler stability. Our dynamic ranges from quantification were between 7.8–5000 pg/mL. RESULTS: Among samples collected from Southern India, 8 of 10 cow [median 103.35 pg/mL; n = 3 > 500 pg/mL]; 0 of 9 buffalo and 10 of 10 commercial [median: 151.5 pg/mL], milk samples were above the LOQ. AFM2 was also seen in samples from both regions, but in lower quantities when compared to AFM1 [median (north): 25.8 pg/mL; median (south): 70.95 pg/mL]. All except 3 samples were below the LOQ (31.3 pg/mL) for OTA, however we detected a sodium adduct of OTA above LOQ, across samples. We found [Na-OTA] in goat milk [median: 5.9 ng/mL] > buffalo [median: 2.2 ng/mL] > commercial [median: 2.04 ng/mL] > cow [median: 0.8 ng/mL]. Other mycotoxins were seen in concentrations close to or below LOQ. We did not identify significant stability issues. CONCLUSIONS: We developed a highly sensitive method with biologically relevant dynamic ranges for detection of mycotoxins in milk samples. We found AFM1, AFM2, and Na-OTA in milk samples from Southern India. Further studies with larger sample sizes are warranted to establish the extent of mycotoxin contamination in milk. FUNDING SOURCES: Funded by University Research Committee, Emory University and International Society for Research in Human Milk and Lactation.

The objective of this study was to investigate the effects of cold atmospheric plasma on the antigenicity of protein Ara h 1. Dry, defatted peanut flour (DPF), whole peanut (WP) were subjected to cold atmospheric plasma at voltage of 80 kV for different treatment durations (0, 15, 30, 45 and 60 min). The allergen samples were analyzed using SDS-PAGE, immunoblot and competitive ELISA. Furthermore, the secondary structure was examined using circular dichroism. SDS-PAGE results revealed no change in the protein intensity bands corresponding to Ara h 1 for both DPF and WP. Competitive ELISA of samples showed a reduction in antigenicity up to 43% for DPF and 9.3% for WP. Circular dichroism studies revealed modifications in secondary structure induced by plasma reactive species. Industrial relevance Cold plasma has emerged as a novel processing technique. This study provides evidence for reduction of antigenicity of Ara h1 in peanuts using cold plasma. This study also demonstrated the plasma-induced changes in protein structure at high treatment duration. The work described in this research is relevant to the processing of cereal grains and legumes wherein allergenicity is a major concern. This results provide the basis for possible industrial implementation.

Pulse grains were identified as a key resource for food innovation during the International Year of the Pulse (IYP), 2016. Pulse flour offers a sustainable source of plant protein for innovation in protein enriched cereal based foods. Fava-bean (Vicia faba), green- and yellow-pea (Pisum sativum) flour were analysed for proximate composition, minerals, amino acids, phenolic content, phytic acid and trypsin inhibitory activity. Fava-bean flour had the highest protein content (28 g/100 g), while green-pea flour had the highest total dietary fibre content (15 g/100 g). All three flours contained essential amino acids in adequate quantity, highlighting them as a source of good quality protein for in the formulation of protein-enriched foods. Fava-bean flour had significantly higher phenolic content and antioxidant activity than pea flours (387 mg GAE/100 g and 250 mg AAE/100 g respectively). Pulse flour contained high levels of potassium and zinc, while fava-bean flour was also high in iron. Phytic acid ranged from 543 to 889 mg/100 g; the lowest of which was observed in green-pea flour. Green-pea flour also exhibited the lowest trypsin inhibition (3.7 TIU/mg). Results demonstrate the significant potential of pulse flour to enhance the nutritional value of cereal based foods which is not possible with wheat flour alone.

Commercial carrot and tomato juices (final concentration: 90 % juice, v/v) were added with a phenolic extract from apple peels consisting mostly of flavan-3-ols (>50 %), flavonol glycosides and dihydrochalcones in order to enhance their antioxidant capacity. The antioxidant contribution of the added extract to the capacity of the hydrophilic and lipophilic components of the juices was measured as ascorbic acid equivalents with ferric reducing–antioxidant power and radical scavenging capacity against DPPH˙ assays, and as inhibition against lipid peroxidation using an emulsified lipid in an oven test. Results showed that the addition of apple peel flavonoids at concentrations equal to or above 160 mg gallic acid equivalents (GAE)/L as total phenolics in the juices led to significantly higher (p

The use of pesticides for crop production has grown in developing nations, especially in Thailand. As a result, agricultural workers are exposed to higher concentrations of organophosphate and pyre...

Biomonitoring has been widely used to assess environmental exposure, and spot urine is commonly studied due to its easy sample collection. The variability of urine dilution has been crucial for ass...

Since urinary insecticide metabolites are commonly used as biomarkers of exposure, it is important that we quantify whether insecticides degrade in food and beverages in order to better perform risk assessment. This study was designed to quantify degradation of organophosphorus and pyrethroid insecticides in beverages. Purified water, white grape juice, orange juice, and red wine were fortified with 500 ng/mL diazinon, malathion, chlorpyrifos, permethrin, cyfluthrin, cypermethrin, and deltamethrin, and aliquots were extracted several times over a 15-day storage period at 2.5 °C. Overall, statistically significant loss of at least one insecticide was observed in each matrix, and at least five out of seven insecticides demonstrated a statistically significant loss in all matrices except orange juice. An investigation of an alternative mechanism of insecticide loss-adsorption onto the glass surface of the storage jars-was carried out, which indicated that this mechanism of loss is insignificant. Results of this work suggest that insecticides degrade in these beverages, and this degradation may lead to pre-existing insecticide degradates in the beverages, suggesting that caution should be exercised when using urinary insecticide metabolites to assess exposure and risk.

The present paper reports on the use of phenolic extracts from olive mill wastewater (OMW) in model olive oil-in-water (O/W) emulsions to study their effect on their physical and chemical stability. Spray-dried OMW polyphenols were added to a model 20% olive O/W emulsion stabilized with whey protein isolate (WPI) and xanthan gum, in phosphate buffer solution at pH 7. The emulsions were characterised under accelerated storage conditions (40 °C) up to 30 days. Physical stability was evaluated by analysing the creaming rate, mean particle size distribution and mean droplet size, viscosity and rheological properties, while chemical stability was assessed through the measurement of primary and secondary oxidation products. The rheological behaviour and creaming stability of the emulsions were dramatically improved by using xanthan gum, whereas the concentration of WPI and the addition of encapsulated OMW phenolics did not result in a significant improvement of physical stability. The formation of oxidation products was higher when higher concentrations of encapsulated polyphenols were used, indicating a possible binding with the WPI added in the system as a natural emulsifier. This paper might help in solving the issue of using the olive mill wastewater from olive processing in formulating functional food products with high antioxidant activity and improved health properties.

The objectives of this study are to characterize New Mexico residents’ primary drinking water sources, consumption, and filter use by demographic characteristics, and to compare the 30-day prevalence of self-reported acute gastrointestinal illness (AGI) by water sources. We analyzed data on 6,600 adults surveyed in the 2007 New Mexico Behavioral Risk Factor Surveillance System. We estimated population frequencies and evaluated associations using chi-square tests and weighted multivariable logistic regression modeling. Over half (55 %) of individuals used public water as their primary drinking water source, 18 % used private wells, and 27 % used bottled water. Overall, 43 % of residents said they filtered their home tap water, which did not differ significantly by source. Compared to public water users, private well users had key demographic differences, including age, marital status, race, and education. The overall 30-day prevalence of AGI was 15 %. In models adjusted for demographic characteristics and health status indicators, individuals using well water had a non-significantly decreased odds of reporting AGI and seeking medical attention for AGI (odds ratio (OR) 0.83, 95 % CI 0.65–1.06 and OR 0.85, 95 % CI 0.41–1.80). This baseline measure suggests private well users are not uniformly distributed throughout the New Mexico population. This information is useful when planning educational outreach to targeted populations. Our cross-sectional analyses did not reveal significant associations between primary drinking water source and AGI. Future epidemiologic studies including children and measuring the duration of exposure and water quality are needed to fully understand the health impacts of drinking untreated or undertreated water.

A solid phase extraction method was developed to isolate four insecticide degradates from baby food that were measured subsequently using high-performance liquid chromatography–tandem mass spectrometry. The degradates [parent insecticide] measured were malathion dicarboxylic acid [malathion], 3,5,6-trichloro-2-pyridinol [chlorpyrifos, chlorpyrifos methyl] (TCPy), cis/trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid [permethrin, cypermethrin, cyfluthrin], and 3-phenoxybenzoic acid [general pyrethroid]. All degradates produced recoveries between 80 and 120% except TCPy in fruit (122% recovery), and all relative standard deviations were

The objective of this study was to investigate the efficacy of delactosed whey permeate (DWP) treatment on the physico-chemical, microbial and antioxidant compounds of tomatoes stored at 15 °C for 21 days compared with traditional chlorine treatment. Fresh tomatoes were treated with 3 ml/100 ml DWP or 120 mg/l chlorine solutions and packed in perforated polypropylene bags. The results showed that DWP treatment significantly reduced the number of total aerobic counts (∼1.62 log cfu/g) and yeast and moulds (∼1.66 log cfu/g) of tomatoes compared to chlorine during storage. Moreover, the tomatoes treated by DWP remained firmer (22%) than the control fruits and maintained significantly (p

This study was designed to observe the production of degradates of two organophosphorus insecticides and one pyrethroid insecticide in beverages. Purified water, white grape juice, apple juice, and red grape juice were fortified with 500 ng/g malathion, chlorpyrifos, and permethrin, and aliquots were extracted for malathion dicarboxylic acid (MDA), 3,5,6-trichloro-2-pyridinol (TCPy), and 3-phenoxybenzoic acid (3-PBA) several times over a 15 day period of being stored in the dark at 2.5 °C. Overall, first-order kinetics were observed for production of MDA, and statistically significant production of TCPy was also observed. Statistically significant production of 3-phenoxybenzoic acid was not observed. Results indicate that insecticides degrade in food and beverages, and this degradation may lead to preexisting insecticide metabolites in the beverages. Therefore, it is suggested that caution should be exercised when using urinary insecticide metabolites to assess exposure and risk.

Summary The aim of this study was to investigate the effect of delactosed whey permeate (DWP) treatment on antioxidant and physicochemical properties of strawberries. Fresh strawberries treated with 3% DWP were analysed for different quality, nutritional and microbiological markers during 10 days of storage at 5 °C. The results showed that DWP treatment significantly reduced incidences of decay (70%) and numbers of total aerobic counts (∼1.4 Log10 CFU g−1) and yeast and moulds (∼1.8 Log10 CFU g−1). DWP treatment also inhibited the loss of firmness (15%) and maintained significantly (P ≤ 0.05) higher levels of vitamin C, total phenols and antioxidant activity of strawberries. Sensory scores confirmed that the DWP-treated strawberries retained a good appearance and overall quality. The aroma and colour attributes were not reduced during storage. These results suggest that DWP treatment has potential to extend the shelf-life and maintain the quality of strawberries during storage.

Research Retrospective Exposure Estimation and Predicted versus Observed Serum Perfluorooctanoic Acid Concentrations for Participants in the C8 Health Project Hyeong-Moo Shin, 1 Veronica M. Vieira, 2 P. Barry Ryan, 3 Kyle Steenland, 3 and Scott M. Bartell 4 1 School of Social Ecology, University of California, Irvine, California, USA; 2 Department of Environmental Health, Boston University, Boston, Massachusetts, USA; 3 Department of Environmental Health, Emory University, Atlanta, Georgia, USA; 4 Program in Public Health, Department of Statistics, and Department of Epidemiology, University of California, Irvine, California, USA B ackground : People living or working in eastern Ohio and western West Virginia have been exposed to perfluorooctanoic acid (PFOA) released by DuPont Washington Works facilities. O bjectives : Our objective was to estimate historical PFOA exposures and serum concentrations experienced by 45,276 non-occupationally exposed participants in the C8 Health Project who con- sented to share their residential histories and a 2005–2006 serum PFOA measurement. M ethods : We estimated annual PFOA exposure rates for each individual based on predicted cali- brated water concentrations and predicted air concentrations using an environmental fate and trans- port model, individual residential histories, and maps of public water supply networks. We coupled individual exposure estimates with a one-compartment absorption, distribution, metabolism, and excretion (ADME) model to estimate time-dependent serum concentrations. R esults : For all participants (n = 45,276), predicted and observed median serum concentrations in 2005–2006 are 14.2 and 24.3 ppb, respectively [Spearman’s rank correlation coefficient (r s ) = 0.67]. For participants who provided daily public well water consumption rate and who had the same resi- dence and workplace in one of six municipal water districts for 5 years before the serum sample (n = 1,074), predicted and observed median serum concentrations in 2005–2006 are 32.2 and 40.0 ppb, respectively (r s = 0.82). C onclusions : Serum PFOA concentrations predicted by linked exposure and ADME models cor- related well with observed 2005–2006 human serum concentrations for C8 Health Project partici- pants. These individualized retrospective exposure and serum estimates are being used in a variety of epidemiologic studies being conducted in this region. K ey words : exposure, perfluorooctanoic acid, pharmacokinetics, serum. Environ Health Perspect 119:1760–1765 (2011). http://dx.doi.org/10.1289/ehp.1103729 [Online 3 August 2011] Perfluorooctanoic acid (PFOA, or C8) is one of the two most studied and prevalent world- wide perfluorinated compounds, along with perfluorooctane sulfonate (PFOS). PFOA has been used in the manufacture of Teflon® and other fluoropolymers. The primary sources of PFOA to the environment are direct emissions from the manufacturing facilities to air and water, indirect emissions from landfill leaching to groundwater, and farther long-range trans- port via ocean current and atmospheric disper- sion (McMurdo et al. 2008; Shin et al. 2011). Effluent from wastewater treatment plants may also contribute to PFOA contamination in the general environment (Loganathan et al. 2007; Sinclair and Kannan 2006). In spite of the voluntary phase-out on the use of PFOA by major manufacturing companies, the detec- tion of PFOA in wastewater influent indicates it has been released from consumer products made of this chemical (Loganathan et al. 2007). When products that contain PFOA are used indoors, it accumulates indoors, espe- cially in house dust (Strynar and Lindstrom 2008). Other potential sources of PFOA for human intake are assumed to be food and beverages, which are either primarily contami- nated or secondarily contaminated by food packaging materials (Begley et al. 2005). In the United States, PFOA was detected in the serum of most people with a median of 4 ppb in 2003–2004, 2005–2006, and 2007–2008 [National Health and Nutrition Examination Survey (NHANES) 2011]. Although there have been some animal studies of the toxic effects of PFOA (Abdellatif et al. 1991; Andersen et al. 2008; Kennedy et al. 2004; Lau et al. 2006, 2007; Luebker et al. 2005; Nilsson et al. 1991), the health effects in human subjects are still largely unknown (Steenland et al. 2010). Three longi- tudinal studies reported half-life estimates for PFOA in human serum: a) a median of 3.5 years from a study of 28 retired workers with 5 years of follow-up (Olsen et al. 2007); b) a median of 2.3 years from a study of 200 peo- ple who were exposed to contaminated public water, after 1 year of follow-up (Bartell et al. 2010); and c) a geometric mean of 3.3 years from 138 participants (45 children, 46 moth- ers, and 47 men) in a German study who were also exposed via drinking water, after 2 years of follow-up (Brede et al. 2010). Drinking water in the Mid-Ohio Valley has been presumably contaminated with PFOA released from the DuPont Washington Works facilities near Parkersburg, West Virginia, since 1951. PFOA emissions steadily increased as production of PFOA- related products increased over time, peak- ing in 1999 and then sharply decreasing after control strategies were implemented (DuPont volume 2008). PFOA emitted from the stacks was transported according to prevailing wind directions and settled to the ground surface by wet or dry deposition. Deposited PFOA infil- trated through the unsaturated zone, a region between the land surface and groundwater aquifer, with precipitation, and it eventually reached the saturated groundwater aquifer. PFOA released into the Ohio River contami- nated the groundwater aquifer that interacts with the river (Shin et al. 2011). We recently developed a more sophisti- cated multicompartment environmental fate and transport model to estimate retrospec- tive year-by-year PFOA concentrations in air, groundwater, and six public water supplies involved in the C8 Health Project, a cross- sectional study conducted from 2005 to 2006 (Shin et al. 2011). In this study, we linked retrospective air and water concentration predictions from the Shin et al. (2011) model to individual residen- tial histories for 45,276 participants from the C8 Health Project, predicting year-by-year PFOA exposures based on their individual residential histories and likely water sources. We then linked these individual annual expo- sure estimates to an absorption, distribution, metabolism, and excretion (ADME) model to predict annual PFOA serum concentra- tions for each individual, and compared those predicted serum concentrations to observed 2005–2006 serum measurements. Address correspondence to H.-M. Shin, University of California, Davis, One Shields Avenue, MS1-C, Davis, CA 95616 USA. Telephone: (949) 648-1614. Fax: (949) 824-9863. E-mail: hmshin@ucdavis.edu Supplemental Material is available online (http:// dx.doi.org/10.1289/ehp.1103729). We thank T. Fletcher and D. Mondal, who gener- ously provided data for the maternal–infant transfer component of the pharmacokinetic model. This research was funded by the C8 Class Action Settlement Agreement (Circuit Court of Wood County, WV) between DuPont and plaintiffs, which resulted from releases into drinking water of the chemical perfluorooctanoic acid (PFOA, or C8). Funds are administered by an agency that reports to the court. Our work and conclusions are indepen- dent of either party to the lawsuit. Funding was also provided by the Research and Education in Green Materials Program at University of California, Irvine (award UC-44157). The findings and conclusions in this paper are those of the authors. The authors declare they have no actual or potential competing financial interests. Received 25 March 2011; accepted 3 August 2011. 119 | number 12 | December 2011 • Environmental Health Perspectives

Prior studies have measured elevated ambient concentrations of hazardous metals in Beijing, attributable to coal combustion. The 2008 Olympic Games led to an intense investment in air pollution controls at the major power plants in the region, accounting for 30% of coal combustion in Beijing. Recently Chinese coal beds have been characterized in the World Coal Quality Index, facilitating the development of trace metal emission factors for Beijing coals. This study quantifies the relative value of the power plant air pollution controls in terms of public health risk from chronic exposure to trace metals. Ambient concentrations from power plants were estimated using an atmospheric dispersion model (CALPUFF), outlining spatial and temporal variations. The following toxic, refractory metals were evaluated for health risk using the USEPA Integrated Risk Information System: antimony, arsenic, beryllium, cadmium, chromium, cobalt, copper, lead, manganese, nickel, and selenium. Stringent use of power plant air pollution controls significantly reduces population risk, averting a cancer risk of 1 in 5,000. However, other sources of coal combustion, such as industrial and household uses, are more relevant to public health than power plant emissions. Coal washing has potential to reduce the hazard from these diffuse sources and avert a greater number of potential cancer cases.

The present study optimised the accelerated solvent extraction (ASE) conditions (Dionex ASE® 200, USA) to maximise the antioxidant capacity of the extracts from three spices of Lamiaceae family; rosemary, oregano and marjoram. Optimised conditions with regard to extraction temperature (66–129 °C) and solvent concentration (32–88% methanol) were identified using response surface methodology (RSM). For all three spices results showed that 129 °C was the optimum temperature in order to obtain extracts with high antioxidant activity. Optimal methanol concentrations with respect to the antioxidant activity of rosemary and marjoram extracts were 56% and 57% respectively. Oregano showed a different response to the effect of methanol concentration and was optimally extracted at 33%. The antioxidant activity yields of the optimal ASE extracts were significantly (p < 0.05) higher than solid/liquid extracts. The predicted models were highly significant (p < 0.05) for both total phenol (TP) and ferric reducing antioxidant property (FRAP) values in all the spices with high regression coefficients (R2) ranging from 0.952 to 0.999.

The present study investigated the changes in total phenols (TP), rosmarinic acid content and antioxidant capacity of six Lamiaceae herbs (rosemary, oregano, marjoram, sage, basil and thyme) after three drying treatments (air-, freeze- and vacuum oven-drying) stored for 60 days at −20 °C and compared to fresh samples. Ferric reducing antioxidant property (FRAP) and oxygen radical absorbance capacity (ORAC) were used as markers for antioxidant capacity. Air-dried samples had significantly (p

Green tea extract (GT) was evaluated as a preservative treatment for fresh-cut lettuce. Different quality markers, e.g. respiration, browning, ascorbic acid and carotenoid content were evaluated. GT concentration (0.25, 0.5 and 1 g 100 mL − 1 ) and temperature (20 °C and 50 °C) were tested. Optimal GT treatment (0.25 g 100 mL − 1 at 20 °C) was compared with chlorine (120 ppm at 20 °C). High GT concentrations (0.5 g 100 mL − 1 and 1.0 g 100 mL − 1 ) maintained better prevent ascorbic acid and carotenoid loss than 0.25 g 100 mL − 1 GT and chlorine. GT increased browning of samples, probably due to the content of polyphenols of the treatment; the use of heat-shock reduced this negative effect. GT and heat-shock combined also showed negative effects, reducing the antioxidant content (ascorbic acid and carotenoids). No significant differences were observed between chlorine and optimal GT (0.25 g 100 mL − 1 at 20 °C) in browning appearance and sensory properties. GT better kept the antioxidant activity of the samples than chlorine. Industrial relevance An alternative treatment for minimally processed Iceberg lettuce is tested, based on its antioxidant capacity. Minimally processed industry is constantly looking for new treatments to avoid the use of chlorine which is a standard at the moment.

The objectives of this study were to evaluate the antimicrobial activity of plant essential oils (EOs) against foodborne pathogens and key spoilage bacteria pertinent to ready-to-eat vegetables and to screen the selected EOs for sensory acceptability. The EOs basil, caraway, fennel, lemon balm, marjoram, nutmeg, oregano, parsley, rosemary, sage, and thyme were evaluated. The bacteria evaluated were Listeria spp., Staphylococcus aureus, Lactobacillus spp., Bacillus cereus, Salmonella, Enterobacter spp., Escherichia coli, and Pseudomonas spp. Quantitative antimicrobial analyses were performed using an absorbance-based microplate assay. Efficacy was compared using MIC, the half maximum inhibitory concentration, and the increase in lag phase. Generally, gram-positive bacteria were more sensitive to EOs than were gram-negative bacteria, and Listeria monocytogenes strains were among the most sensitive. Of the spoilage organisms, Pseudomonas spp. were the most resistant. Oregano and thyme EOs had the highest activity against all the tested bacteria. Marjoram and basil EOs had selectively high activity against B. cereus, Enterobacter aerogenes, E. coli, and Salmonella, and lemon balm and sage EOs had adequate activity against L. monocytogenes and S. aureus. Within bacterial species, EO efficacy was dependent on strain and in some cases the origin of the strain. On a carrot model product, basil, lemon balm, marjoram, oregano, and thyme EOs were deemed organoleptically acceptable, but only oregano and marjoram EOs were deemed acceptable for lettuce. Selected EOs may be useful as natural and safe additives for promoting the safety and quality of ready-to-eat vegetables.

Understanding and quantifying outdoor and indoor sources of human exposure are essential but often not adequately addressed in health effect studies for air pollution. Air pollution epidemiology, risk assessment, health tracking, and accountability assessments are examples of health effect studies that require but often lack adequate exposure information. Recent advances in exposure modeling along with better information on time-activity and exposure factor data provide us with unique opportunities to improve the assignment of exposures for both future and ongoing studies linking air pollution to health impacts. In September 2006, scientists from the US Environmental Protection Agency and the Centers for Disease Control and Prevention along with scientists from the academic community and state health departments convened a symposium on air pollution exposure and health to identify, evaluate, and improve current approaches for linking air pollution exposures to disease. This manuscript presents the key issues, challenges, and recommendations identified by the exposure working group, who used case studies of particulate matter, ozone, and toxic air-pollutant exposure to evaluate health effects for air pollution. One of the overarching lessons of this workshop is that obtaining better exposure information for these different health effect studies requires both goal setting for what is needed and mapping out the transition pathway from current capabilities for meeting these goals. Meeting our long-term goals requires definition of incremental steps that provide useful information for the interim and move us toward our long-term goals. Another overarching theme among the three different pollutants and the different health study approaches is the need for integration among alternate exposure-assessment approaches. For example, different groups may advocate exposure indicators, biomonitoring, mapping methods (GIS), modeling, environmental media monitoring, and/or personal exposure modeling. However, emerging research reveals that the greatest progress comes from integration among two or more of these efforts.

BACKGROUND: 3-Phenoxybenzoic acid (3PBA), a pyrethroid metabolite, was detected in 75% of urine samples analyzed for pesticides in the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2002. NHANES also includes 24-hr diet data and information on household pesticide use, activities, occupation, demographics, and other exposure factors. OBJECTIVES: The objective of our study was to explore the relative importance of diet versus nondiet predictors in explaining variability in urinary 3PBA. A secondary objective was to explore whether the NHANES data could be used to identify particular foods driving 3PBA levels. METHODS: We divided subjects into child (6-10 years of age), teen (11-18 years), and adult (>= 19 years) age groups and restricted our analyses to subjects in the morning sampling session who fasted for >= 8 hr beforehand. Regression modeling consisted of several model-building steps and a final Tobit regression on the left-censored log 3PBA measurements. We also conducted bootstrap analyses to evaluate the stability of the regression parameters. RESULTS: Reported household pesticide use was not significantly associated with urinary 3PBA in any age group. Diet was significant for all three groups, and certain foods appeared to contribute more than others. Among adults, tobacco use was positively associated with 3PBA (p = 0.0326), and positive associations were suggested with the number of cytochrome p450-inhibiting medications taken (p = 0.0652) and minutes spent gardening (p = 0.0613) in the past month. CONCLUSIONS: Although exploratory, our findings underline the importance of collecting accurate data on household pesticide use and dietary intake when evaluating pyrethroid exposure-biomarker relationships.

In Baguio City, Philippines, a mountainous city of 252,386 people where 61% of motor vehicles use diesel fuel, ambient particulate matter2.5 microm (PM(2.5)) and10 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-value0.05) 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.

The use of calcium lactate solutions has been shown to be a healthy alternative to chlorine washing in order to maintain the shelf-life of fresh-cut products. The aim of this research was to analyse the effects of calcium lactate (15 g L−1) treatment at 25 °C and 50 °C (heat-shock) on the textural properties of sliced carrots and to compare those with the chlorine treatment (120 mg L−1) widely used in industry. Several direct and indirect markers of textural changes in carrots during storage were used: Instron textural analysis, Cryo-SEM and optical microscopic, sensory analysis, pectin methylesterase (PME) activity, calcium content and water activity. Samples treated with calcium lactate maintained texture significantly (p < 0.05) better than samples treated with chlorine throughout storage. Calcium lactate treatment produced a reduction in the water activity in sliced carrots and a higher firmness (Instron analysis) than chlorine treatment. In addition, combined use of heat-shock and calcium lactate treatment increased PME activity significantly when compared to the other treatments, results that were confirmed by sensory analysis. Cryo-SEM analyses showed that combined heat-shock and calcium lactate treatment was more effective in maintaining the turgor of cortex tissue cells and reduced the extent of lignification at cutting-edge areas. The use of calcium lactate combined with heat-shock is a promising washing method for fresh-cut carrots in order to preserve their texture and improve their nutritional value, avoiding the use of chlorine washing.

The U.S. Environmental Protection Agency (EPA) defines cumulative risk as the combined risks from aggregate exposure to multiple stressors (U.S. EPA 2003), and cumulative risk assessment as an analysis, characterization, and possible quantification of these risks. In this and companion papers (Callahan and Sexton 2007), we explore approaches for assessing the effects of stressors from multiple sources (Menzie et al. 2007), the effects of differential vulnerability in populations and individuals (deFur et al. 2007), and the effects associated with differential exposure (Sexton and Hattis 2007). This article provides an evaluation of whether and how biomonitoring data can inform cumulative risk assessment. We examined the potential for human and ecosystem biomarkers to help us understand cumulative health risks from the interactions between environmental exposures and host susceptibility factors. We used case studies to address the question “Can biomarkers enable us to understand and quantify better the population burden of disease and health effects attributable to environmental exposures? Further, we present examples from the current literature on the availability and uses of biomarkers to explore two other questions: Under what circumstances can biomarkers be used to disaggregate disease burden into specific risk factors? For example, when and how can biomarkers be linked to specific diseases, and can a specific biomarker or set of biomarkers be useful for mapping disease to exposure? When and how can biomarkers be used to infer the source and magnitude of exposure among a set of competing sources and pathways? Specific health outcomes potentially may come from numerous differing exposures. The problem of trying to infer which exposures lead to these outcomes is not simple. The first of these two questions focuses on assessing multiple risk factors that may lead to health outcomes, whereas the latter question centers on disaggregating cumulative exposures into their component parts. In this article, we use the term “disaggregation” to address both of these issues, namely, risk factors leading to a health outcome and exposures leading to a health outcome. These are difficult problems that are only now receiving attention in the scientific community. Biomarkers may offer improved understanding of the pathway between the causative agents, as indicated by exposure measures, and the health outcome. There are many challenges and limitations. What are the public health implications of widespread low-level population exposures that can now be inferred from biological or ecologic measurements? Disaggregating the health effects and understanding the health risk from these exposures will require new perspectives on the environmental health paradigm. Ideally, biomonitoring will become a foundation of an environmental public health tracking system that includes identification of environmental sources, exposures, and related population health outcomes (Barr et al. 2005a). Combining biomonitoring results with population health surveillance offers opportunities for understanding the relationship between cumulative exposures and population, community, and individual risk.

The gradient of socioeconomic position (SEP) on health may be explained partly by a combination of increased contaminant exposures and greater susceptibility to their effects. Air pollution, for instance, may be higher near major roadways, power plants, and industrial sites, where property values are lower and lower-income populations reside (Graves 1988). Increased life stress among lower-SEP populations has also been proposed as a primary pathway through which SEP affects health (Gee and Payne-Sturges 2004; Morello-Frosch and Shenassa 2006). Because of this potential spatial covariance across exposures, and because stress and pollution may influence common physiologic pathways (i.e., oxidative stress) and health outcomes (i.e., respiratory disease), stronger methods are needed to disentangle their effects and investigate synergies (Gee and Payne-Sturges 2004; O’Neill et al. 2003; Weiss and Bellinger 2006). The environmental justice literature has documented significant disproportionate contaminant exposures in minority and lower-SEP communities (Brulle and Pellow 2006), and the resultant influence on asthma exacerbation patterns (Maantay 2007). However, fewer studies have considered disproportionate susceptibility among lower-SEP populations. Exposure to violence (ETV) has been conceptualized as a chronic urban stressor, potentially elevated in communities where pollution is higher. Chronic stress effects of episodic violence are grounded in trauma theory (e.g., post-traumatic stress), detailed elsewhere (Wright 2006). Episodic violence, post-traumatic stress (Augustyn et al. 2002; Overstreet and Braun 2000), and hyper-vigilance (Gordon and Riger 1991)—more prevalent in lower-SEP urban communities (Sampson et al. 1997)—may negatively influence health though physiologic alterations, including immune dysregulation, and behavioral pathways. Many urban caregivers, for example, restrict children’s behavior, keeping them indoors due to fear of violence (Levy et al. 2004; Wright et al. 2004b), making children more sedentary, increasing indoor exposures, and decreasing spatial autonomy that is important to development (Katz 1991). Chronic stress has been linked to asthma exacerbations in cross-sectional (Oh et al. 2004) and prospective (Sandberg et al. 2004) population studies. Other evidence suggests a role for stress in the onset of asthma (Wright et al. 2002, 2004a). Chronic stress may influence hypothalamic–pituitary–adrenal (HPA) axis and cortisol dysregulation (Hellhammer et al. 1997; Ockenfels et al. 1995), glucocorticoid resistance (Miller et al. 2002), sympathetic–adrenal–medullary (SAM) activation, catecholamine production (Glaser and Kiecolt-Glaser 2005), immune mediator function, inflammation (Umetsu et al. 2002), and cytokine production (Chen et al. 2003; Wright et al. 2004a). Stress and pollution affect some common physiologic systems, facilitating synergistic effects; for example, psychological stress (Epel et al. 2004) and ozone (Fugisawa 2005) both affect oxidative stress pathways. Few studies have examined the influence of stress on pollution susceptibility, though some findings suggest differential susceptibility by SEP, possibly mediated by life stress (Morello-Frosch and Shenassa 2006). Time-series studies indicate effect modification of short-term pollution exposures by SEP (Jerrett et al. 2004; Lin et al. 2004; Martins et al. 2004), though others found no significant modification (Zanobetti and Schwartz 2000). Fewer studies have considered long-term exposures, though some indicate greater associations between long-term air pollution and mortality among less-educated adults (Hoek et al. 2002; Krewski et al. 2000). In urban settings, traffic-related air pollution may be elevated along with ETV, and previous studies have linked traffic-related air pollution to asthma exacerbation and respiratory outcomes. In the United States and Europe, children living or attending school near truck routes and highways show increased asthma and allergy symptoms (Brauer et al. 2002), hospitalizations (Edwards et al. 1994; Lin et al. 2002), allergic rhinitis (Duhme et al. 1996), and reduced lung function (Brunekreef et al. 1997). Traffic-related pollutants have also been associated with asthma development (Gordian et al. 2006; Zmirou et al. 2004). Incorporating traffic-related air pollution into large-scale epidemiologic studies requires models linking traffic and ambient concentrations. Relationships between traffic and health have been examined using several different traffic indicators, with no consensus on which indictors best capture variability in traffic-related pollution or health outcomes in different settings. Prior studies have successfully extrapolated traffic exposures from sampling homes to larger cohorts using predictive land-use regression (LUR) models (Brauer et al. 2002; Brunekreef et al. 1997). LUR shows strong predictive power for intraurban nitrogen dioxide variability (Hochadel et al. 2006; Sahsuvaroglu and Jerrett 2004), using traffic and land use characteristics (i.e., population density, major sources). In this study, we explore the hypothesis that a chronic stressor (here, lifetime ETV) predicts stronger associations between traffic-related air pollution exposure and childhood asthma development. We employ data from the Maternal-Infant Smoking Study of East Boston (MISSEB), a community-based prospective pregnancy cohort examining asthma, respiratory, and cognitive development. Questionnaires were administered detailing violence exposures (both witnessing and victimization) and avoidance behaviors (staying in at night, avoiding certain areas, keeping children indoors). Because the MIS-SEB did not examine air pollution, we used geographic information systems (GIS) and LUR at the neighborhood scale to retrospectively estimate pollution exposures, using monthly NO2 data collected over 18 years in the surrounding neighborhoods.

The science of exposure assessment is relatively new and evolving rapidly with the advancement of sophisticated methods for specific measurements at the picogram per gram level or lower in a variety of environmental and biologic matrices. Without this measurement capability, environmental health studies rely on questionnaires or other indirect means as the primary method to assess individual exposures. Although we use indirect methods, they are seldom used as stand-alone tools. Analyses of environmental and biologic samples have allowed us to get more precise data on exposure pathways, from sources to concentrations, to routes, to exposure, to doses. They also often allow a better estimation of the absorbed dose and its relation to potential adverse health outcomes in individuals and in populations. Here, we make note of various environmental agents and how best to assess exposure to them in the National Children's Study--a longitudinal epidemiologic study of children's health. Criteria for the analytical method of choice are discussed with particular emphasis on the need for long-term quality control and quality assurance measures.

A number of emergency department studies have corroborated findings from mortality and hospital admission studies regarding an association of ambient air pollution and respiratory outcomes. More refined assessment has been limited by study size and available air quality data.Measurements of 5 pollutants (particulate matter [PM10], ozone, nitrogen dioxide [NO2], carbon monoxide [CO], and sulfur dioxide [SO2]) were available for the entire study period (1 January 1993 to 31 August 2000); detailed measurements of particulate matter were available for 25 months. We obtained data on 4 million emergency department visits from 31 hospitals in Atlanta. Visits for asthma, chronic obstructive pulmonary disease, upper respiratory infection, and pneumonia were assessed in relation to air pollutants using Poisson generalized estimating equations.In single-pollutant models examining 3-day moving averages of pollutants (lags 0, 1, and 2): standard deviation increases of ozone, NO2, CO, and PM10 were associated with 1-3% increases in URI visits; a 2 microg/m increase of PM2.5 organic carbon was associated with a 3% increase in pneumonia visits; and standard deviation increases of NO2 and CO were associated with 2-3% increases in chronic obstructive pulmonary disease visits. Positive associations persisted beyond 3 days for several of the outcomes, and over a week for asthma.The results of this study contribute to the evidence of an association of several correlated gaseous and particulate pollutants, including ozone, NO2, CO, PM, and organic carbon, with specific respiratory conditions.

Background Despite evidence supporting an association between ambient air pollutants and cardiovascular disease (CVD), the roles of the physicochemical components of particulate matter (PM) and copollutants are not fully understood. This time-series study examined the relation between ambient air pollution and cardiovascular conditions using ambient air quality data and emergency department visit data in Atlanta, Georgia, from January 1, 1993, to August 31, 2000. Methods Outcome data on 4,407,535 emergency department visits were compiled from 31 hospitals in Atlanta. The air quality data included measurements of criteria pollutants for the entire study period, as well as detailed measurements of mass concentrations for the fine and coarse fractions of PM and several physical and chemical characteristics of PM for the final 25 months of the study. Emergency department visits for CVD and for cardiovascular subgroups were assessed in relation to daily measures of air pollutants using Poisson generalized linear models controlling for long-term temporal trends and meteorologic conditions with cubic splines. Results Using an a priori 3-day moving average in single-pollutant models, CVD visits were associated with NO2, CO, PM2.5, organic carbon, elemental carbon, and oxygenated hydrocarbons. Secondary analyses suggested that these associations tended to be strongest with same-day pollution levels. Conclusions These findings provide evidence for an association between CVD visits and several correlated pollutants, including gases, PM2.5, and PM2.5 components.

Substantial evidence supports an association of particulate matter (PM) with cardiorespiratory illnesses, but little is known regarding characteristics of PM that might contribute to this association and the mechanisms of action. The Atlanta superstation sponsored by the Electric Power Research Institute as part of the Aerosol Research and Inhalation Epidemiology Study (ARIES) study is monitoring chemical composition of ambient particles by size fraction, as well as a comprehensive suite of other pollutants, at a site in downtown Atlanta during the 25-month period, August 1, 1998-August 31, 2000. Our investigative team is making use of this unique resource in several morbidity studies, called the "Study of Particulates and Health in Atlanta (SOPHIA)". The study includes the following components: (1) a time series investigation of emergency department (ED) visits for the period during which the superstation is operating; (2) a time series investigation of ED visits during the 5 years prior to implementation of the superstation; and (3) a study of arrhythmic events in patients equipped with automatic implantable cardioverter defibrillators (AICDs) for the period January 1, 1993-August 31, 2000. Thirty-three of 39 Atlanta area EDs are participating in the ED studies, comprising over a million annual ED visits. In this paper, we present initial analyses of data from 18 of the 33 participating EDs. The preliminary data set includes 1,662,713 ED visits during the pre-superstation time period and 559,480 visits during the superstation time period. Visits for four case groupings--asthma, chronic obstructive pulmonary disease (COPD), dysrhythmia, and all cardiovascular diseases (CVDs) combined--have been assessed relative to daily air quality indices, controlling for long-term temporal trends and meteorologic variables, using general linear models, generalized estimating equations and generalized additive models. Single-pollutant models predicting case visitation rates using moving averages of 0-, 1-, and 2-day lagged air quality variables were run. For the pre-superstation period, PM10 (24-h), ozone (8-h), SO2 (1-h), NO2 (1-h) and CO (1-h) were studied. For the first 12 months of superstation operation, the following air quality variables of a priori interest were available: ozone (8-h), NO2 (1-h), SO2 (1-h), CO (1-h), and 24-h measurements of PM10, coarse PM (PM 2.5-10 microm), PM2.5, polar VOCs, 10-100 nm particulate count and surface area, and in the PM2.5 fraction: sulfates, acidity, water-soluble metals, organic matter (OM), and elemental carbon (EC). During the pre-superstation time period, statistically significant, positive associations were observed for adult asthma with ozone, and for COPD with ozone, NO2 and PM10. During the superstation time period, the following statistically significant, positive associations were observed: dysrhythmia with CO, coarse PM, and PM2.5 EC; and all CVDs with CO, PM2.5 EC and PM2.5 OM. While covariation of many of the air quality indices limits the informativeness of this analysis, the study provides one of the first assessments of PM components in relation to ED visits.