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Objectives Subgroup analysis from two randomized trials showed a survival benefit for adjuvant chemoradiation (CRT) over radiation alone (RT) in patients with extracapsular spread (ECS) of involved lymph nodes and/or positive margins (PM) in resected head and neck cancer (HNSCC). However, results were not analyzed separately for patients with ECS or PM and were not stratified by tumor subsite/HPV status. We therefore sought to determine whether adjuvant CRT is associated with a survival benefit, separately among patients with ECS or PM and stratified by subsite/HPV status. Methods Using the National Cancer Database (NCDB), we identified 6948 patients diagnosed with HNSCC between 2010 and 13 who underwent surgical resection and had either ECS or PM. The impact of adjuvant therapy on OS from surgery was evaluated using Cox proportional hazards regression adjusting for clinical and demographic factors. Results Adjuvant CRT was associated with a significant survival benefit over RT alone among patients with ECS (aHR 0.83, 95%CI 0.71–0.97) but not among those with PM (aHR 0.89, 95%CI 0.77–1.04). In patients with HPV-negative tumors, CRT was associated with a benefit over RT alone in the setting of ECS (aHR 0.83, 95%CI 0.70–0.98) but not PM (aHR 0.91, 95%CI 0.78–1.06). However, in patients with HPV-positive oropharynx tumors, CRT was not associated with a benefit over RT in ECS (aHR 0.94, 95%CI 0.47–1.88) but appeared beneficial in PM (aHR 0.54, 95%CI 0.32–0.90). Conclusions CRT appears beneficial over RT in ECS among patients with HPV-negative tumors, and beneficial in PM among patients with HPV-positive tumors.

Background Surgery remains the mainstay of treatment for sinonasal melanoma, but it is often difficult to obtain clear, negative margins. Therefore, patients often receive adjuvant radiation therapy (RT), however its impact on overall survival (OS) is not well understood. Methods Patients with surgically resected sinonasal melanoma were identified from the National Cancer Data Base (NCDB, n = 696). Kaplan-Meier curves and parametric survival regression were used to analyze the impact of adjuvant RT on OS from surgery. Adjusted time ratios (aTRs) were computed, with values > 1 corresponding to improved survival. Results 399 (57.3%) patients received adjuvant RT. Those receiving RT tended to be younger but with more advanced disease and greater likelihood of positive margins, compared to those receiving no adjuvant therapy. Median survival was 25.0 months for those treated with surgery alone, compared to 28.3 months for those receiving adjuvant RT (log-rank P = 0.408). When adjusting for potential confounders, there was a trend towards greater survival with adjuvant RT (aTR 1.16, 95%CI 0.98–1.37). RT appeared beneficial in those with stage IVB disease (aTR 2.58, 95%CI 1.40–4.75) but not stage IVA (aTR 1.19, 95%CI 0.88–1.61) or III (aTR 0.85, 95%CI 0.65–1.13) disease. In contrast, there were no differences in impact of RT according to margin status (aTR 1.16 for both positive and negative margins). Conclusions Adjuvant therapy does not appear to provide a significant survival benefit in resected sinonasal melanomas regardless of margin status, except those with stage IVB disease. Practitioners should carefully consider the added benefit of adjuvant therapy in these patients.

Patient and tumor factors have been associated with rates for pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) for breast cancer, but variation in pCR rates across facilities has not been studied. This study used the National Cancer Data Base to identify women with clinical stages 1–3a breast cancer undergoing NAC from 2010 to 2013. Generalized estimation equation models were used to examine the relationship between facility characteristics and pCR rates, with adjustment for patient and tumor factors, while accounting for patient clustering at facilities. Analyses were stratified by tumor molecular subtype. Overall, 16,885 women underwent NAC, of whom 3130 (18.5%) were hormone receptor-positive (HR+) and human epidermal growth factor 2-positive (HER2+), 7045 (41.7%) were HR+HER2−, 1847 (10.9%) were HR−HER2+, and 4863 (28.8%) were HR−HER2−. Overall, 4002 of the patients (23.7%) achieved a pCR. The pCR rates were 29.5% for HR+HER2+, 10.8% for HR+HER2−, 45.3% for HR−HER2+, and 30.5% for HR−HER2− tumors. Multivariable analysis showed that pCR rates were significantly higher at high-volume facilities (>75th vs.

Objectives/Hypothesis A systematic review and meta-analysis of the literature was undertaken, examining the association between tobacco smoking and olfactory function in humans, utilizing PubMed and Web of Science (1970–2015) as data sources. Study Design Systematic literature review and meta-analysis. Methods This database review of studies of smoking and olfaction, with a focus on identifying high-quality studies (based on modified versions of the Newcastle-Ottawa Scale), used validated olfactory tests among the generally healthy population. Results We identified 11 studies meeting inclusion criteria. Of 10 cross-sectional studies, two were excluded from meta-analysis because the cohorts they studied were included in another article in the review. In meta-analysis, current smokers had substantially higher odds of olfactory dysfunction compared to never smokers (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.37–1.85). In contrast, former smokers were found to have no difference in risk of impaired olfaction compared to never smokers (OR = 1.05, 95% CI = 0.91–1.21). The single longitudinal study reviewed found a trend toward increased risk of olfactory decline over time in ever smokers; this trend was stronger in current as compared to former smokers. Conclusions Current smoking, but not former smoking, is associated with significantly increased risk of olfactory dysfunction, suggesting that the effects of smoking on olfaction may be reversible. Future studies that prospectively evaluate the impact of smoking cessation on improvement in olfactory function are warranted. Level of Evidence N/A. Laryngoscope, 2017

BACKGROUND Racial disparities in squamous cell carcinoma of the head and neck (HNSCC) negatively affect non-Hispanic black (NHB) patients. This study was aimed at understanding how treatment is prescribed and received across all HNSCC subsites. METHODS With the National Cancer Database, patients from 2004 to 2014 with surgically resectable HNSCCs, including tumors of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (LX), were studied. The treatment received was either upfront surgery or nonsurgical treatment. Treatment patterns were compared according to race and subsite, and how these differences changed over time was evaluated. RESULTS NHB patients were less likely than non-Hispanic white (NHW) patients to receive surgery across all subsites (relative risk [RR] for OC, 0.87; RR for OP, 0.75; RR for HP, 0.73; RR for LX, 0.87; all P values

Background: Olfactory dysfunction affects millions of people worldwide. This sensory impairment is associated with neurodegenerative disease and significantly decreased quality of life. Exposure to airborne pollutants has been implicated in olfactory decline, likely due to the anatomic susceptibility of the olfactory nerve to the environment. Historically, studies have focused on occupational exposures, but more recent studies have considered effects from exposure to ambient air pollutants. Objectives: To examine all relevant human data evaluating a link between ambient pollution exposure and olfaction and to review supporting animal data in order to examine potential mechanisms for pollution-associated olfactory loss. Methods: We identified and reviewed relevant articles from 1950 to 2015 using PubMed and Web of Science and focusing on human epidemiologic and pathophysiologic studies. Animal studies were included only to support pertinent data on humans. We reviewed findings from these studies evaluating a relationship between environmental pollutant exposure and olfactory function. Results: We identified and reviewed 17 articles, with 1 additional article added from a bibliography search, for a total of 18 human studies. There is evidence in human epidemiologic and pathologic studies that increased exposure to ambient air pollutants is associated with olfactory dysfunction. However, most studies have used proxies for pollution exposure in small samples of convenience. Human pathologic studies, with supporting animal work, have also shown that air pollution can contact the olfactory epithelium, translocate to the olfactory bulb, and migrate to the olfactory cortex. Pollutants can deposit at each location, causing direct damage and disruption of tissue morphology or inducing local inflammation and cellular stress responses. Conclusions: Ambient air pollution may impact human olfactory function. Additional studies are needed to examine air pollution–related olfactory impacts on the general population using measured pollution exposures and to link pollution exposure with olfactory dysfunction and related pathology. Citation: Ajmani GS, Suh HH, Pinto JM. 2016. Effects of ambient air pollution exposure on olfaction: a review. Environ Health Perspect 124:1683–1693; http://dx.doi.org/10.1289/EHP136

Background Little is known about the use of allergy and asthma medications in older adults. This study aimed to assess the prevalence of use of these medications in older adults and evaluate predictors of their use. Methods Cross-sectional study using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling, U.S. adults 57 to 85 years (n = 2976) collected in 2005–2006. We determined prevalence of medication use and used logistic regression to evaluate sociodemographic and health factors associated with their use. Results Overall prevalence of allergy medication usage was 8.4% (most commonly antihistamines), and prevalence of asthma medication usage was 8.0% (most commonly bronchodilators). Allergy medication use was significantly associated with history of asthma (odds ratio [OR] 2.37; 95% confidence interval [CI], 1.52 to 3.69), chronic obstructive pulmonary disease (COPD) (OR 2.35; 95% CI, 1.58 to 3.51), or nasal surgery (OR 1.97; 95% CI, 1.00 to 3.86). Older age was associated with decreased allergy medication use (per decade, OR 0.80; 95% CI, 0.66 to 0.98). Although increased education was associated with increased overall allergy medication use, it was associated with decreased use of allergy medications generally contraindicated in the elderly. In contrast, the only significant predictors of asthma medication use were history of asthma (OR 19.66; 95% CI, 3.18 to 121.70) or COPD (OR 4.25; 95% CI, 0.88 to 20.44). Conclusion Allergy and asthma medication use is prevalent among older adults and driven mostly by history of asthma or COPD. Additional sociodemographic factors predict allergy (but not asthma) medication use. Further studies are needed to evaluate efficacy of these drugs in the elderly.

Background Olfactory dysfunction has profound effects on quality of life, physical and social function, and mortality itself. Nitrogen dioxide (NO2) is a pervasive air pollutant that is associated with respiratory diseases. Given the olfactory nerve's anatomic exposure to airborne pollutants, we investigated the relationship between NO2 exposure and olfactory dysfunction. Methods The ability to identify odors was evaluated using a validated test in respondents from the National Social Life, Health, and Aging Project (NSHAP), a representative probability sample of home-dwelling, older U.S. adults age 57 to 85 years. Exposure to NO2 pollution was assessed using measurements obtained from the U.S. Environmental Protection Agency (EPA) Aerometric Information Retrieval System (AIRS) ambient monitoring site closest to each respondent's home. We tested the association between NO2 exposure and olfactory dysfunction using multivariate logistic regression. Results Among older adults in the United States, 22.6% had impaired olfactory function, defined as ≤3 correct (out of 5) on the odor identification test. Median NO2 exposure during the 365 days prior to the interview date was 14.7 ppb (interquartile range [IQR], 10.8 to 19.7 ppb). An IQR increase in NO2 exposure was associated with increased odds of olfactory dysfunction (OR, 1.35; 95% CI, 1.07 to 1.72), adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and season of the home interview (n = 1823). Conclusion We show for the first time that NO2 exposure is associated with olfactory dysfunction in older U.S. adults. These results suggest an important role for NO2 exposure on olfactory dysfunction, and, potentially, nasal disease more broadly.

BACKGROUND: Definitive surgery is recommended for oral cavity squamous cell carcinoma (SCC). The purpose of this study was to present our assessment of the disparities in treatment selection for oral cavity SCC. METHODS: Non-Hispanic white and non-Hispanic black patients with oral cavity SCC were identified in the National Cancer Database (NCDB). Regression models were used to estimate relative risk (RR) of receiving surgery and absolute difference between non-Hispanic white and non-Hispanic black patients. RESULTS: There were 82.3% of non-Hispanic white patients who received surgery, compared to 64.2% of non-Hispanic black patients (P < .001). The non-Hispanic black patients were less likely to receive surgery than non-Hispanic white patients (RR 0.87) with an absolute difference of 10.9%. The non-Hispanic black patients were significantly more likely to not be offered surgery (RR 1.42) and to refuse recommended surgery (RR 1.38) but not have a contraindication to surgery (RR 1.17). CONCLUSION: The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.

Surgical therapy for newly diagnosed breast cancer has changed over the past decade, but these trends have not been well documented in patients undergoing neoadjuvant therapy (NAC). In a retrospective cohort study of the National Cancer Database (NCDB), we selected 285,514 women with clinical stage I–III breast cancer who underwent NAC or adjuvant therapy (AC) from 2006 to 2014. Breast-conserving surgery (BCS), unilateral mastectomy (UM), and bilateral mastectomy (BM) rates were compared between patients undergoing NAC and AC. Of 285,514 women, 68,850 (24.1%) underwent NAC. Of NAC patients, 18,158 (26.4%) underwent BM and 27,349 (39.7%) BCS compared with 31,886 (14.7%) and 120,626 (55.7%) AC patients, respectively. From 2006 to 2014, BM increased from 16.1 to 28.8% (p

Objectives Very few studies have examined the quality of wedge resection in patients with non–small cell lung cancer. Using the National Cancer Database, we evaluated whether the quality of wedge resection affects overall survival in patients with early disease and how these outcomes compare with those of patients who receive stereotactic radiation. Methods We identified 14,328 patients with cT1 to T2, N0, M0 disease treated with wedge resection (n = 10,032) or stereotactic radiation (n = 4296) from 2005 to 2013 and developed a subsample of propensity-matched wedge and radiation patients. Wedge quality was grouped as high (negative margins, >5 nodes), average (negative margins, ≤5 nodes), and poor (positive margins). Overall survival was compared between patients who received wedge resection of different quality and those who received radiation, adjusting for demographic and clinical variables. Results Among patients who underwent wedge resection, 94.6% had negative margins, 44.3% had 0 nodes examined, 17.1% had >5 examined, and 3.0% were nodally upstaged; 16.7% received a high-quality wedge, which was associated with a lower risk of death compared with average-quality resection (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], 0.67-0.82). Compared with stereotactic radiation, wedge patients with negative margins had significantly reduced hazard of death (>5 nodes: aHR, 0.50; 95% CI, 0.43-0.58; ≤5 nodes: aHR, 0.65; 95% CI, 0.60-0.70). There was no significant survival difference between margin-positive wedge and radiation. Conclusions Lymph nodes examined and margins obtained are important quality metrics in wedge resection. A high-quality wedge appears to confer a significant survival advantage over lower-quality wedge and stereotactic radiation. A margin-positive wedge appears to offer no benefit compared with radiation.

International audience; Carbon nanotubes (CNTs) are rapidly influencing the development and applications of membrane technology for water treatment. Passage of CNTs through membrane pores is becoming a fundamental question to water industries, as the toxicity and environmental fate of waterborne CNTs are largely unknown. This study utilized CNTs and membranes with known properties to investigate the applicability of the Ferry-Renkin sieving equation to the rejection of CNTs by porous membranes. The results demonstrate that the hydrodynamic size of CNTs is more important than their physical dimensions for rejection. Moreover, the classical sieving equation provided reasonable predication of the experimental results. Important for water industries, current membranes used in drinking water treatment should be efficient barriers for waterborne CNTs leached from composite membranes or released from wastewater effluents. Further, process streams containing CNTs may be treated using membrane filtration for CNT recovery. However, micron-pore-size membranes used in previous studies for CNT-membrane fabrication may not be efficient in protecting CNT breakthrough. Since the hydrodynamic diameters of waterborne CNTs are usually above 150 nm, as a general rule of thumb, membranes with pore size smaller than 100 nm need to be used to ensure the safety of CNT membranes.

Carbon nanotubes (CNTs) were investigated for their capability and mechanisms to simultaneously remove colloidal natural organic matter (NOM) and humic substances from natural surface water. Static removal testing was conducted via adsorption experiments while dynamic removal was evaluated by layering CNTs onto substrate membranes and filtering natural water through the CNT-layered membranes. Analyses of treated water samples showed that removal of humic substances occurred via adsorption under both static and dynamic conditions. Removal of colloidal NOM occurred at a moderate level of 36–66% in static conditions, independent of the specific surface area (SSA) of CNTs. Dynamic removal of colloidal NOM increased from approximately 15% with the unmodified membrane to 80–100% with the CNT-modified membranes. Depth filtration played an important role in colloidal NOM removal. A comparison of the static and dynamic removal of humic substances showed that equilibrium static removal was higher than dynamic (p < 0.01), but there was also a significant linear relationship between static and dynamic removal (p < 0.05). Accounting for contact time of CNTs with NOM during filtration, it appeared that CNT mat structure was an important determinant of removal efficiencies for colloidal NOM and humic substances during CNT membrane filtration.

International audience; Small water systems that serve fewer than a few thousand persons are often less safe and less sustainable than large drinking water systems due to lack of suitable technologies. This ongoing research aims to develop a novel water treatment technology for small communities. By layering structured, functional carbon nanotubes (CNT) onto low pressure membranes (LPMs), composite membranes were prepared to remove different organic and inorganic contaminants from water, including heavy metals, viruses, natural organic matter, and organic micropollutants. The removal efficiencies varied from over 99.9% (for cadmium) to above 60% (for humic substances). A low-cost CNT formed an antifouling layer that removed membrane foulants by depth filtration, thereby extending the membrane filtration cycle over five-fold. When the CNTs were layered inside hollow fiber membranes, superb backwashable properties were observed, allowing the operation of CNT-modified membranes under full-scale treatment conditions. Moreover, a systematic study of CNT rejection by LPMs found that commercially available LPMs efficiently prevented CNT breakthrough, thus ensuring nanosafety of the treated water. By varying the composition and structure of functional CNT layers, energy-efficient composite membranes may be economically produced for designer water treatment systems and applied in small communities.

A systematic review and meta-analysis of the literature was undertaken, examining the association between tobacco smoking and olfactory function in humans, utilizing PubMed and Web of Science (1970-2015) as data sources.Systematic literature review and meta-analysis.This database review of studies of smoking and olfaction, with a focus on identifying high-quality studies (based on modified versions of the Newcastle-Ottawa Scale), used validated olfactory tests among the generally healthy population.We identified 11 studies meeting inclusion criteria. Of 10 cross-sectional studies, two were excluded from meta-analysis because the cohorts they studied were included in another article in the review. In meta-analysis, current smokers had substantially higher odds of olfactory dysfunction compared to never smokers (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.37-1.85). In contrast, former smokers were found to have no difference in risk of impaired olfaction compared to never smokers (OR = 1.05, 95% CI = 0.91-1.21). The single longitudinal study reviewed found a trend toward increased risk of olfactory decline over time in ever smokers; this trend was stronger in current as compared to former smokers.Current smoking, but not former smoking, is associated with significantly increased risk of olfactory dysfunction, suggesting that the effects of smoking on olfaction may be reversible. Future studies that prospectively evaluate the impact of smoking cessation on improvement in olfactory function are warranted.N/A. Laryngoscope, 127:1753-1761, 2017.

Objectives The olfactory nerve is anatomically susceptible to injury from pollution in inspired air, but there are no large-scale epidemiologic studies investigating this relationship. Methods Cross-sectional study using data from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling US adults age 57–85 years. Olfactory function was tested using a validated 5-item odor identification test (Sniffin' Sticks). Exposure to fine particulate matter (PM2.5) at each respondent's home was estimated as 1–12 month moving averages prior to olfactory assessment using validated spatio-temporal models. Results Olfactory dysfunction was significantly associated with PM2.5 exposures averaged over 3–12 months in urban-dwelling respondents. The strongest effect was for 6 month average exposure (per 1-IQR increase in PM2.5: OR 1.28, 95% CI 1.05, 1.55) adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and the season. Interestingly, the most deleterious effects were observed among the youngest respondents, 57–64 years old, and those living in the northeast and south. Conclusions We show for the first time that air pollution exposure is associated with poor olfaction among urban-living, older US adults.

Introduction: The olfactory nerve is anatomically susceptible to injury from pollution in inspired air. Fine particulate matter (PM2.5) exposure has been implicated in ecologic and pathologic studies of olfaction, but there are no large-scale epidemiological studies investigating this relationship. Methods: We performed a cross-sectional analysis of urban respondents from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling US adults age 57-85 years (n=2,210). Olfaction was tested using a validated 5-item Sniffin’ Sticks odor identification test, with dysfunction defined as ≤3 correct odorants identified. Exposure to PM2.5 at each respondent’s home was estimated as moving averages (1-12 months) prior to the date of olfactory assessment using validated spatio-temporal models. Odds ratios for olfactory dysfunction were computed using multivariate logistic regression, adjusting for potential confounders. Several effect modifiers of the PM2.5-olfaction relationship wer...

Olfactory dysfunction has profound effects on quality of life, physical and social function, and mortality itself. Nitrogen dioxide (NOThe ability to identify odors was evaluated using a validated test in respondents from the National Social Life, Health, and Aging Project (NSHAP), a representative probability sample of home-dwelling, older U.S. adults age 57 to 85 years. Exposure to NOAmong older adults in the United States, 22.6% had impaired olfactory function, defined as ≤3 correct (out of 5) on the odor identification test. Median NOWe show for the first time that NO

97 Background: Node positive disease (N+) is frequent (~40%) following neoadjuvant therapy (NAT) and esophagectomy, yet limited data exist regarding the efficacy of adjuvant chemotherapy (AC) in this setting. There are no randomized studies addressing this question and single-institution, retrospective studies have reported mixed findings. Methods: A retrospective analysis was conducted using the National Cancer Database. 2,258 N+ patients were identified who had received NAT (83.3% chemoradiation and 17.7% chemotherapy alone) followed by esophagectomy. Patients with either incomplete staging or treatment data were excluded, as were those who died within 90 days following esophagectomy. Multivariate logistic regression was used to test for differences in patient characteristics between those who did (AC+) or did not (AC-) receive AC. Overall survival (OS) after surgery, by AC status, was analyzed using Cox regression in a sample propensity matched on relevant demographic and clinical factors. Results: 433/2258 patients received AC (19.2%). Patients who received AC tended to be younger (OR 0.98 per 1-year increase, P = .03) and had a higher socioeconomic status (SES) (OR 1.47 for high vs. low SES, P = .01). Although there were no significant differences in comorbidity (P = .32), AC+ patients had significantly shorter hospital stays after surgery (OR 0.98 per 1-day increase, P = .03). Pathologic T classification was unrelated to the likelihood of receiving AC (P = .39), however patients with a higher pathologic N stage were more likely receive AC (OR 2.12 for pN3 vs. pN1, P < .001). Those receiving AC had demonstrably longer OS from the time of surgery than those who did not (HR 0.78, P = .004). Median OS for the entire cohort was 22.6 months, whereas the administration of AC was associated with an improvement in median OS of 6.2 months (26.3 vs. 20.1 months). Conclusions: This retrospective analysis indicates that AC is associated with a significant improvement in OS (median 6.2 months) in N+ patients following NAT and esophagectomy. Further studies are needed to clarify the optimal role of AC in this setting.

Precoagulation has been widely used by low pressure membrane filtration (LPMF) plants to reduce membrane fouling and increase natural organic matter (NOM) removal. Formation of aluminum and aluminum-NOM moieties plays a fundamental role in this important water treatment process. This study comprehensively investigated the mechanisms of aluminum-NOM species formation during precoagulation and their impacts on LPMF performance. The results show that, at low alum doses, e.g. 0.5 mg and 1.0 mg Al L −1 , humic substances (HS) and Al species (amorphous Al(OH) 3 , or Al(OH) 3(am) ) reacted to form small Al(OH) 3(am) -HS colloids. Increases in alum dose resulted in sequential transitions of the Al-HS moieties to larger particles and, eventually, precipitates. Compared to waters containing only naturally occurring organic colloids (OC) or HS, the coexistence of OC and HS facilitated the formation of Al-HS precipitates, thereby increasing the removal of HS by 7–15%, but the removal of OC was decreased by 3–20%. Interestingly, these transitions in Al-HS moieties did not affect membrane fouling. Both short-term and long-term filtration results demonstrate that OC, rather than the Al(OH) 3(am) -HS colloids, primarily caused membrane fouling. These findings highlight the dynamics of particulate Al-NOM formation during precoagulation and its relationship with membrane fouling, which can be utilized to optimize the operation of integrated precoagulation-LPMF systems on full-scale installations.

Background: Use of engineered nanoparticles (NPs) in consumer products is resulting in NPs in drinking water sources. Subsequent NP breakthrough into treated drinking water is a potential exposure route and human health threat. Objectives: In this study we investigated the breakthrough of common NPs—silver (Ag), titanium dioxide (TiO2), and zinc oxide (ZnO)—into finished drinking water following conventional and advanced treatment. Methods: NPs were spiked into five experimental waters: groundwater, surface water, synthetic freshwater, synthetic freshwater containing natural organic matter, and tertiary wastewater effluent. Bench-scale coagulation/flocculation/sedimentation simulated conventional treatment, and microfiltration (MF) and ultrafiltration (UF) simulated advanced treatment. We monitored breakthrough of NPs into treated water by turbidity removal and inductively coupled plasma–mass spectrometry (ICP-MS). Results: Conventional treatment resulted in 2–20%, 3–8%, and 48–99% of Ag, TiO2, and ZnO NPs, respectively, or their dissolved ions remaining in finished water. Breakthrough following MF was 1–45% for Ag, 0–44% for TiO2, and 36–83% for ZnO. With UF, NP breakthrough was 0–2%, 0–4%, and 2–96% for Ag, TiO2, and ZnO, respectively. Variability was dependent on NP stability, with less breakthrough of aggregated NPs compared with stable NPs and dissolved NP ions. Conclusions: Although a majority of aggregated or stable NPs were removed by simulated conventional and advanced treatment, NP metals were detectable in finished water. As environmental NP concentrations increase, we need to consider NPs as emerging drinking water contaminants and determine appropriate drinking water treatment processes to fully remove NPs in order to reduce their potential harmful health outcomes. Citation: Abbott Chalew TE, Ajmani GS, Huang H, Schwab KJ. 2013. Evaluating nanoparticle breakthrough during drinking water treatment. Environ Health Perspect 121:1161–1166; http://dx.doi.org/10.1289/ehp.1306574

Carbon nanotubes (CNTs) with different physiochemical properties were layered onto low pressure membranes and tested for antifouling properties using a natural surface water with high fouling potential. Membranes modified with the largest diameter pristine multi-walled CNTs (MWCNTs) were most effective in controlling membrane fouling, tripling the time it took for the membrane to become noticeably fouled at a CNT loading of 22 g/m(2). The differences in the structure of CNT layers were an important contributing factor for antifouling properties; scanning electron microscopy imaging showed that large diameter MWCNTs formed homogeneous porous layers across the membrane surface, while less effective, small diameter MWCNTs formed heterogeneous layers. Water quality analysis showed that CNT-membranes constructed with larger diameter CNTs were more effective at removing larger organic macromolecules responsible for fouling from feedwater compared to membranes made with smaller diameter CNTs. This reduced the concentration of foulants reaching the PVDF membrane and thus helped reduce membrane fouling. Beneficial for application, increased loadings of CNTs onto the membrane surface increased resistance to fouling while only slightly reducing the clean water permeability of the modified membranes. Overall, CNT layered membranes were shown to highly resist membrane fouling with potential applications in sustainable water treatment.