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This article examines news and political mediations of security, race, and violence in the 2016 Pulse Nightclub shooting in an attempt to isolate how dominant institutions reaffirm and preserve the North American state's monopoly on violence and cultural preservation through the calculated balance of security in relation to tolerance of diversity. The event was predominantly mediated through security discourses of the “war on terror,” and this martial framing enabled the production of homonationalist rhetoric (drawing on Jasbir Puar's Terrorist Assemblages) that aimed to include previously excluded queer Latino/a populations within the American body politic. Focusing on news media reporting and political as well as activist responses to the shooting during the months of June–August 2016, the article shows how this process of homonationalist inclusion was not smooth. Memorialization and advocacy for the Pulse victims by dominant institutions is striated by colliding phobias (Islamo-, xeno-, and homo-) that interrupt a clear mode of nationalist address or point of identification in mediations of the shooting. Drawing on a knowledge base attentive to queer-of-color and Indigenous concerns, the article demonstrates how biopolitical and necropolitical value is extracted from communities exposed to intersecting violences with differential dividends distributed to queer Latino/a and Afro-Latino/a communities.

T cell receptor (TCR) repertoires are critical for antiviral immunity. Determining the TCR repertoire composition, diversity, and dynamics and how they change during viral infection can inform the molecular specificity of host responses to viruses such as SARS-CoV-2. To determine signatures associated with COVID-19 disease severity, here we perform a large-scale analysis of over 4.7 billion sequences across 2130 TCR repertoires from COVID-19 patients and healthy donors. TCR repertoire analyses from these data identify and characterize convergent COVID-19-associated CDR3 gene usages, specificity groups, and sequence patterns. Here we show that T cell clonal expansion is associated with the upregulation of T cell effector function, TCR signaling, NF-kB signaling, and interferon-gamma signaling pathways. We also demonstrate that machine learning approaches accurately predict COVID-19 infection based on TCR sequence features, with certain high-power models reaching near-perfect AUROC scores. These analyses provide a systems immunology view of T cell adaptive immune responses to COVID-19.

The COVID-19 crisis has had a significant impact on public libraries around the world. In Australia, almost all public libraries experienced some period of building closure, requiring libraries to adapt their services and delivery models. This article reports findings from a large-scale survey of public library managers in Australia, which was conducted in August 2020. In particular, it presents the results of a thematic analysis of the participants’ free-text responses to open questions asked as part of the survey. This analysis reveals important insights relating to responses to library closures, staffing issues, new and expanded services and programmes, relationships with parent bodies, and the role of public libraries during the crisis and beyond. While public libraries are perceived by managers to have been agile and adaptable, and to have utilised technology effectively, the findings clearly demonstrate the value to users of library buildings, with important consequences for understanding the role of public libraries.

Two studies in Pennsylvania aimed to determine whether community type and community socioeconomic deprivation (CSD) 1) modified associations between type 2 diabetes (hereinafter, diabetes) and COVID-19 hospitalization outcomes, and 2) influenced health care utilization among individuals with diabetes during the COVID-19 pandemic.The hospitalization study evaluated a retrospective cohort of patients hospitalized with COVID-19 through 2020 for COVID-19 outcomes: death, intensive care unit (ICU) admission, mechanical ventilation, elevated D-dimer, and elevated troponin level. We used adjusted logistic regression models, adding interaction terms to evaluate effect modification by community type (township, borough, or city census tract) and CSD. The utilization study included patients with diabetes and a clinical encounter between 2017 and 2020. Autoregressive integrated moving average time-series models evaluated changes in weekly rates of emergency department and outpatient visits, hemoglobin AIn the hospitalization study, of 2,751 patients hospitalized for COVID-19, 1,020 had diabetes, which was associated with ICU admission and elevated troponin. Associations did not differ by community type or CSD. In the utilization study, among 93,401 patients with diabetes, utilization measures decreased in March 2020. Utilization increased in July, and then began to stabilize or decline through the end of 2020. Changes in HbADiabetes was associated with selected outcomes among individuals hospitalized for COVID-19, but these did not differ by community features. Utilization trajectories among individuals with diabetes during the pandemic were influenced by community type and CSD and could be used to identify individuals at risk of gaps in diabetes care.

Background:Epigenetic dysregulation has been proposed as a key mechanism for arsenic-related cardiovascular disease (CVD). We evaluated differentially methylated positions (DMPs) as potential mediators on the association between arsenic and CVD.Methods:Blood DNA methylation was measured in 2321 participants (mean age 56.2, 58.6% women) of the Strong Heart Study, a prospective cohort of American Indians. Urinary arsenic species were measured using high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry. We identified DMPs that are potential mediators between arsenic and CVD. In a cross-species analysis, we compared those DMPs with differential liver DNA methylation following early-life arsenic exposure in the apoE knockout (apoE−/−) mouse model of atherosclerosis.Results:A total of 20 and 13 DMPs were potential mediators for CVD incidence and mortality, respectively, several of them annotated to genes related to diabetes. Eleven of these DMPs were similarly associated with incident CVD in 3 diverse prospective cohorts (Framingham Heart Study, Women’s Health Initiative, and Multi-Ethnic Study of Atherosclerosis). In the mouse model, differentially methylated regions in 20 of those genes and DMPs in 10 genes were associated with arsenic.Conclusions:Differential DNA methylation might be part of the biological link between arsenic and CVD. The gene functions suggest that diabetes might represent a relevant mechanism for arsenic-related cardiovascular risk in populations with a high burden of diabetes.

Inequitable access to neighborhood leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D) . We evaluated the LTPA environment as a potential mediating pathway through which the neighborhood socioeconomic environment (NSEE) affects T2D. We used harmonized measures and analytic approaches in three independent study samples in the Diabetes Location, Environmental Attributes, and Disparities Network: the national Veterans Administration Diabetes Risk (VADR) cohort, comprising electronic health records (EHR) of 4.1 million T2D-free veterans; Reasons for Geographic and Racial Differences in Stroke (REGARDS) , a national prospective cohort (n=11,2T2D-free) ; and a case-control study in the Geisinger EHR in Pennsylvania (15,888 T2D cases) . We measured NSEE with an index of census tract-level Census metrics (higher indicates disadvantage) . The LTPA environment was evaluated by PA facility density within street network buffers and population-weighted distance to parks. In models stratified by levels of community urbanicity, we estimated natural direct effects and indirect effects for each mediator. PA facility density mediated NSEE-T2D effects, but the magnitude and direction of the indirect effects differed by urbanicity and study sample. In rural communities, we found positive indirect effects via PA facility density (incidence rate difference [95% confidence interval] of NSEE quartile 4 vs. 1: 0.0[0.0038, 0.0099] in VADR; 1.53 [0.25, 3.05] in REGARDS) , representing a proportion mediated of 3% (VADR) and 51% (REGARDS) . We found small indirect effects for all other community types in VADR but none in the Geisinger sample. Distance to parks mediated NSEE-T2D effects only in VADR rural communities. Results suggest regional or population-specific differences in how and whether the LTPA environment mediates NSEE-T2D relations, which could support local T2D prevention efforts. Disclosure K.A. Moon: None. C.M. Nordberg: None. A. Zhu: Research Support; Amgen Inc. J. Uddin: None. P.M. Lopez: None. S.L. Orstad: None. M.D. Schwartz: None. V. Ryan: None. B.S. Schwartz: None. A.P. Carson: Research Support; Amgen Inc. D. Long: Research Support; Amgen Inc. J.R. Brown: None. G.S. Lovasi: None. S. Adhikari: Research Support; Johnson & Johnson. R. Kanchi: None. S. Avramovic: None. K.R. Siegel: None. M.N. Poulsen: None. Funding Centers for Disease Control (U01DP006293, Drexel University; U01DP006296, Geisinger-Johns Hopkins University; U01DP006299, New York University School of Medicine; U01DP006302, University of Alabama at Birmingham) .

Human‐mediated transport of species outside their natural range is a rapidly growing threat to biodiversity, particularly for island ecosystems that have evolved in isolation. The genetic structure underpinning island populations will largely determine their response to increased transport and thus help to inform biosecurity management. However, this information is severely lacking for some groups, such as the soil fauna. We therefore analysed the phylogeographic structure of an indigenous and an invasive springtail species (Collembola: Poduromorpha), each distributed across multiple remote sub‐Antarctic islands, where human activity is currently intensifying. For both species, we generated a genome‐wide SNP data set and additionally analysed all available COI barcodes. Genetic differentiation in the indigenous springtail Tullbergia bisetosa is substantial among (and, to a lesser degree, within) islands, reflecting low dispersal and historic population fragmentation, while COI patterns reveal ancestral signatures of postglacial recolonization. This pronounced geographic structure demonstrates the key role of allopatric divergence in shaping the region's diversity and highlights the vulnerability of indigenous populations to genetic homogenization via human transport. For the invasive species Hypogastrura viatica, nuclear genetic structure is much less apparent, particularly for islands linked by regular shipping, while diverged COI haplotypes indicate multiple independent introductions to each island. Thus, human transport has likely facilitated this species’ persistence since its initial colonization, through the ongoing introduction and inter‐island spread of genetic variation. These findings highlight the different evolutionary consequences of human transport for indigenous and invasive soil species. Crucially, both outcomes demonstrate the need for improved intraregional biosecurity among remote island systems, where the policy focus to date has been on external introductions.

With advancing global climate change, heat-related illnesses and injuries are anticipated to become more prevalent for humans and other species. Canine hyperthermia is already considered an important seasonal emergency. Studies have been performed on the risk factors for heat stroke in canine athletes and military working dogs; however there is limited knowledge on environmental risk factors for the average pet dog. This observational study explores variation in individually experienced environmental temperatures of pet dogs (N = 30) in rural and urban environments in central Alabama. Temperature data from dogs and their owners was collected using wearable personal thermometers. Demographic data on the dogs was collected using a brief survey instrument completed by their owners. Dogs included in the study varied in signalment, activity level, and home environment. Linear mixed effects regression models were used to analyze repeated measure temperature and heat index values from canine thermometers to explore the effect of environmental factors on the overall heat exposure risk of canine pets. Specifically, the heat exposures of dogs were modeled considering their owner's experienced temperatures, as well as neighborhood and local weather station measurements, to identify factors that contribute to the heat exposure of individual dogs, and therefore potentially contribute to heat stress in the average pet dog. Results show hourly averaged temperatures for dogs followed a diurnal pattern consistent with both owner and ambient temperature measurements, except for indoor dogs whose recordings remained stable throughout the day. Heat index calculations showed that owners, in general, had more hours categorized into the National Weather Station safe category compared to their dogs, and that indoor dogs had a greater proportion of hours categorized as safe compared to outdoor dogs. Our results suggest that the risk of the average pet dog to high environmental heat exposure may be greater than traditional measures indicate, emphasizing that more localized considerations of temperature are important when assessing a dog's environmental risk for heat-related injury or illness. National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01ES023029]; Virginia-Maryland College of Veterinary Medicine Summer Veterinary Student Research Program; Boehringer Ingelheim Veterinary Scholar programBoehringer Ingelheim Published version This work was supported by the National Institutes of Health [Grant number R01ES023029 (PI: JG)], the Virginia-Maryland College of Veterinary Medicine Summer Veterinary Student Research Program, and the Boehringer Ingelheim Veterinary Scholar program. These funding sources were not involved in study design, collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Background While there are known individual-level risk factors for kidney disease at time of type 2 diabetes diagnosis, little is known regarding the role of community context. We evaluated the association of community socioeconomic deprivation (CSD) and community type with estimated glomerular filtration rate (eGFR) when type 2 diabetes is diagnosed. Methods This was a retrospective cohort study of 13,144 adults with newly diagnosed type 2 diabetes in Pennsylvania. The outcome was the closest eGFR measurement within one year prior to and two weeks after type 2 diabetes diagnosis, calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) equation. We used adjusted multinomial regression models to estimate associations of CSD (quartile 1, least deprivation) and community type (township, borough, city) with eGFR and used adjusted generalized estimating equation models to evaluate whether community features were associated with the absence of diabetes screening in the years prior to type 2 diabetes diagnosis. Results Of the participants, 1279 (9.7%) had hyperfiltration and 1377 (10.5%) had reduced eGFR. Women were less likely to have hyperfiltration and more likely to have reduced eGFR. Black (versus White) race was positively associated with hyperfiltration when the eGFR calculation was corrected for race but inversely associated without the correction. Medical Assistance (ever versus never) was positively associated with reduced eGFR. Higher CSD and living in a city were each positively associated (odds ratio [95% confidence interval]) with reduced eGFR (CSD quartiles 3 and 4 versus quartile 1, 1.23 [1.04, 1.46], 1.32 [1.11, 1.58], respectively; city versus township, 1.38 [1.15, 1.65]). These features were also positively associated with the absence of a type 2 diabetes screening measure. Conclusions In a population-based sample, more than twenty percent had hyperfiltration or reduced eGFR at time of type 2 diabetes diagnosis. Individual- and community-level factors were associated with these outcomes., Highlights • Community factors are associated with kidney health at type 2 diabetes diagnosis. • Community factors are associated with type 2 diabetes screening. • Race and kidney health associations differ based on how kidney health is measured. • Men have greater risk of hyperfiltration at type 2 diabetes diagnosis. • Women have greater risk of reduced kidney function at type 2 diabetes diagnosis.

Significance The Antarctic environment is famously inhospitable to most terrestrial biodiversity, traditionally viewed as a driver of species extinction. Combining population- and species-level molecular data, we show that beetles on islands along the Antarctic Polar Front diversified in response to major climatic events over the last 50 Ma in surprising synchrony with the region’s marine organisms. Unique algae- and moss-feeding habits enabled beetles to capitalize on cooling conditions, which resulted in a decline in flowering plants—the typical hosts for beetles elsewhere. Antarctica’s cooling paleoclimate thus fostered the diversification of both terrestrial and marine life. Climatically driven evolutionary processes since the Miocene may underpin much of the region’s diversity, are still ongoing, and should be further investigated among Antarctic biota., Global cooling and glacial–interglacial cycles since Antarctica’s isolation have been responsible for the diversification of the region’s marine fauna. By contrast, these same Earth system processes are thought to have played little role terrestrially, other than driving widespread extinctions. Here, we show that on islands along the Antarctic Polar Front, paleoclimatic processes have been key to diversification of one of the world’s most geographically isolated and unique groups of herbivorous beetles—Ectemnorhinini weevils. Combining phylogenomic, phylogenetic, and phylogeographic approaches, we demonstrate that these weevils colonized the sub-Antarctic islands from Africa at least 50 Ma ago and repeatedly dispersed among them. As the climate cooled from the mid-Miocene, diversification of the beetles accelerated, resulting in two species-rich clades. One of these clades specialized to feed on cryptogams, typical of the polar habitats that came to prevail under Miocene conditions yet remarkable as a food source for any beetle. This clade’s most unusual representative is a marine weevil currently undergoing further speciation. The other clade retained the more common weevil habit of feeding on angiosperms, which likely survived glaciation in isolated refugia. Diversification of Ectemnorhinini weevils occurred in synchrony with many other Antarctic radiations, including penguins and notothenioid fishes, and coincided with major environmental changes. Our results thus indicate that geo-climatically driven diversification has progressed similarly for Antarctic marine and terrestrial organisms since the Miocene, potentially constituting a general biodiversity paradigm that should be sought broadly for the region’s taxa.

Funding was provided by the Royal Zoological Society of New South Wales (Ethel Mary Read Research Grant), the Centre for Biodiversity Analysis (Ignition Grant), the Sea World Research and Rescue Foundation Inc. (Grant Number SWR/4/2014), and the Australian Government (Australian Postgraduate Award).

Introduction: Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. Method: We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. Results: Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1- hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. Conclusion: Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees., This study was supported by the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health (#119187) with funding from the Bloomberg Initiative to Reduce Tobacco Use and the National Heart, Lung, and Blood Institute (1R01HL134149).

Lyme disease is the most common vector-borne disease in the United States. Electronic health record (EHR)-based research on Lyme disease is limited. We used Geisinger EHR data from 479,344 primary care patients in 38 Pennsylvania counties in 2006–2014 to compare EHR-based Lyme disease incidence rates to surveillance incidence rates, evaluate individual and community risk factors for incident Lyme disease, and to characterize the proportion of cases with diagnoses consistent with post-treatment Lyme disease syndrome in the EHR (PTLDSEHR). We primarily identified Lyme disease cases using diagnosis codes, serologic testing order codes, and medication orders but also completed subgroup analyses among those with positive serology and those with both diagnosis code and antibiotic treatment. We compared annual incidence rates from the EHR to surveillance by age, sex, and county. In case-control analyses, we compared cases to randomly selected controls (5:1) frequency-matched on year, age, and sex. We identified 9657 cases of Lyme disease, including 1791 cases with positive serology and 4992 cases with both diagnosis code and antibiotic treatment. Annual incidence rates in the EHR were 4.25–7.43 times higher than surveillance. In adjusted analyses, white non-Hispanic race/ethnicity (vs. black, Hispanic, or other) was associated with higher odds of Lyme disease (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.73–2.44). Medical Assistance insurance use (always vs. never; OR: 0.77, 95% CI: 0.68–0.88), and higher community-level socioeconomic deprivation (quartile 4 vs. 1 OR: 0.50 (95% CI: 0.42–0.59) were associated with lower odds of Lyme disease. Within 4–52 weeks after Lyme disease diagnosis, 20.8% (n = 735) of cases with a diagnosis code and treatment had a diagnosis of malaise or fatigue, pain, or cognitive difficulties not present in the past 26 weeks. These results highlight the utility of EHR data for epidemiologic research on Lyme disease for case-finding, surveillance, risk factor evaluation, and characterization of PTLDS using EHR data.

Evaluation of geographic disparities in type 2 diabetes (T2D) onset requires multidimensional approaches at a relevant spatial scale to characterize community types and features that could influence this health outcome. Using Geisinger electronic health records (2008–2016), we conducted a nested case-control study of new onset T2D in a 37-county area of Pennsylvania. The study included 15,888 incident T2D cases and 79,435 controls without diabetes, frequency-matched 1:5 on age, sex, and year of diagnosis or encounter. We characterized patients’ residential census tracts by four dimensions of social determinants of health (SDOH) and into a 7-category SDOH census tract typology previously generated for the entire United States by dimension reduction techniques. Finally, because the SDOH census tract typology classified 83% of the study region’s census tracts into two heterogeneous categories, termed rural affordable-like and suburban affluent-like, to further delineate geographies relevant to T2D, we subdivided these two typology categories by administrative community types (U.S. Census Bureau minor civil divisions of township, borough, city). We used generalized estimating equations to examine associations of 1) four SDOH indexes, 2) SDOH census tract typology, and 3) modified typology, with odds of new onset T2D, controlling for individual-level confounding variables. Two SDOH dimensions, higher socioeconomic advantage and higher mobility (tracts with fewer seniors and disabled adults) were independently associated with lower odds of T2D. Compared to rural affordable-like as the reference group, residence in tracts categorized as extreme poverty (odds ratio [95% confidence interval] = 1.11 [1.02, 1.21]) or multilingual working (1.07 [1.03, 1.23]) were associated with higher odds of new onset T2D. Suburban affluent-like was associated with lower odds of T2D (0.92 [0.87, 0.97]). With the modified typology, the strongest association (1.37 [1.15, 1.63]) was observed in cities in the suburban affluent-like category (vs. rural affordable-like–township), followed by cities in the rural affordable-like category (1.20 [1.05, 1.36]). We conclude that in evaluating geographic disparities in T2D onset, it is beneficial to conduct simultaneous evaluation of SDOH in multiple dimensions. Associations with the modified typology showed the importance of incorporating governmentally, behaviorally, and experientially relevant community definitions when evaluating geographic health disparities.

Background Addressing the modifiable health behaviors of cancer survivors is important in rural communities that are disproportionately impacted by cancer (eg, those in Central Appalachia). However, such efforts are limited, and existing interventions may not meet the needs of rural communities. Objective This study describes the development and proof-of-concept testing of weSurvive, a behavioral intervention for rural Appalachian cancer survivors. Methods The Obesity-Related Behavioral Intervention Trials (ORBIT) model, a systematic model for designing behavioral interventions, informed the study design. An advisory team (n=10) of community stakeholders and researchers engaged in a participatory process to identify desirable features for interventions targeting rural cancer survivors. The resulting multimodal, 13-week weSurvive intervention was delivered to 12 participants across the two cohorts. Intervention components included in-person group classes and group and individualized telehealth calls. Indicators reflecting five feasibility domains (acceptability, demand, practicality, implementation, and limited efficacy) were measured using concurrent mixed methods. Pre-post changes and effect sizes were assessed for limited efficacy data. Descriptive statistics and content analysis were used to summarize data for other domains. Results Participants reported high program satisfaction (acceptability). Indicators of demand included enrollment of cancer survivors with various cancer types and attrition (1/12, 8%), recruitment (12/41, 30%), and attendance (median 62%) rates. Dietary (7/12, 59%) and physical activity (PA; 10/12, 83%) behaviors were the most frequently chosen behavioral targets. However, the findings indicate that participants did not fully engage in action planning activities, including setting specific goals. Implementation indicators showed 100% researcher fidelity to delivery and retention protocols, whereas practicality indicators highlighted participation barriers. Pre-post changes in limited efficacy outcomes regarding cancer-specific beliefs and knowledge and behavior-specific self-efficacy, intentions, and behaviors were in desired directions and demonstrated small and moderate effect sizes. Regarding dietary and PA behaviors, effect sizes for fruit and vegetable intake, snacks, dietary fat, and minutes of moderate-to-vigorous activity were small (Cohen d=0.00 to 0.32), whereas the effect sizes for change in PA were small to medium (Cohen d=0.22 to 0.45). Conclusions weSurvive has the potential to be a feasible intervention for rural Appalachian cancer survivors. It will be refined and further tested based on the study findings, which also provide recommendations for other behavioral interventions targeting rural cancer survivors. Recommendations included adding additional recruitment and engagement strategies to increase demand and practicality as well as increasing accountability and motivation for participant involvement in self-monitoring activities through the use of technology (eg, text messaging). Furthermore, this study highlights the importance of using a systematic model (eg, the ORBIT framework) and small-scale proof-of-concept studies when adapting or developing behavioral interventions, as doing so identifies the intervention’s potential for feasibility and areas that need improvement before time- and resource-intensive efficacy trials. This could support a more efficient translation into practice.

How weather affects tick development and behavior and human Lyme disease remains poorly understood. We evaluated relations of temperature and humidity during critical periods for the tick lifecycle with human Lyme disease. We used electronic health records from 479,344 primary care patients in 38 Pennsylvania counties in 2006-2014. Lyme disease cases (n = 9657) were frequency-matched (5:1) by year, age, and sex. Using daily weather data at ~4 km2 resolution, we created cumulative metrics hypothesized to promote (warm and humid) or inhibit (hot and dry) tick development or host-seeking during nymph development (March 1-May 31), nymph activity (May 1-July 30), and prior year larva activity (Aug 1-Sept 30). We estimated odds ratios (ORs) of Lyme disease by quartiles of each weather variable, adjusting for demographic, clinical, and other weather variables. Exposure-response patterns were observed for higher cumulative same-year temperature, humidity, and hot and dry days (nymph-relevant), and prior year hot and dry days (larva-relevant), with same-year hot and dry days showing the strongest association (4th vs. 1st quartile OR = 0.40; 95% confidence interval [CI] = 0.36, 0.43). Changing temperature and humidity could increase or decrease human Lyme disease risk.

ObjectivesTo evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.DesignNested case–control study within the open dynamic cohort of health system patients.SettingLarge, integrated health system in 37 counties in central and northeastern Pennsylvania, USA.Participants and analysisWe used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types.ResultsBorough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds.ConclusionsUrban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.

Analysis of ancient environmental DNA (eDNA) has revolutionized our ability to describe biological communities in space and time,1–3 by allowing for parallel sequencing of DNA from all trophic levels.4–8 However, because environmental samples contain sparse and fragmented data from multiple individuals, and often contain closely related species,9 the field of ancient eDNA has so far been limited to organellar genomes in its contribution to population and phylogenetic studies.5,6,10,11 This is in contrast to data from fossils12,13 where full-genome studies are routine, despite these being rare and their destruction for sequencing undesirable.14–16 Here, we report the retrieval of three low-coverage (0.03×) environmental genomes from American black bear (Ursus americanus) and a 0.04× environmental genome of the extinct giant short-faced bear (Arctodus simus) from cave sediment samples from northern Mexico dated to 16–14 thousand calibrated years before present (cal kyr BP), which we contextualize with a new high-coverage (26×) and two lower-coverage giant short-faced bear genomes obtained from fossils recovered from Yukon Territory, Canada, which date to ∼22–50 cal kyr BP. We show that the Late Pleistocene black bear population in Mexico is ancestrally related to the present-day Eastern American black bear population, and that the extinct giant short-faced bears present in Mexico were deeply divergent from the earlier Beringian population. Our findings demonstrate the ability to separately analyze genomic-scale DNA sequences of closely related species co-preserved in environmental samples, which brings the use of ancient eDNA into the era of population genomics and phylogenetics.

Little is known about woolly mammoth (Mammuthus primigenius) mobility and range. Here we use high temporal resolution sequential analyses of strontium isotope ratios along an entire 1.7-meter-long tusk to reconstruct the movements of an Arctic woolly mammoth that lived 17,100 years ago, during the last ice age. We use an isotope-guided random walk approach to compare the tusk’s strontium and oxygen isotope profiles to isotopic maps. Our modeling reveals patterns of movement across a geographically extensive range during the animal’s ~28-year life span that varied with life stages. Maintenance of this level of mobility by megafaunal species such as mammoth would have been increasingly difficult as the ice age ended and the environment changed at high latitudes.

Advances in high throughput genomic approaches are enabling the accurate appraisal of movements of diverse species, previously considered intractable. The impact of long-distance dispersal and distribution changes on species interactions (such as host-parasite interactions) is of particular importance as attempts are made to project how ecosystems will shift under environmental change. The sub-Antarctic region, comprising isolated islands separated by hundreds to thousands of kilometres of open ocean, presents an ideal model system for studying long-distance dispersal, distribution, and ecosystem change. Here we used genomic methods to determine the extent of movement of penguin ticks (Ixodes uriae) among different host species, and among penguin colonies at small (within an island) and large (among islands separated by >6000 km) scales, in the sub-Antarctic region. Our results suggest that I. uriae ticks may be readily shared between distantly related penguin species with similar phenology, but indicate that – as inferred by previous research – ticks are less likely to be shared between flighted and non-flighted sea- birds. We also find evidence for small-scale movements of penguin ticks with their hosts, but no evidence for movements between islands separated by thousands of kilometers of open ocean. These inferred limitations to penguin tick movement could be the result of restricted host movements or the inability of penguin ticks to survive extended trips at sea. Our findings help elucidate parasite-host dynamics, with implications for host health and persistence in a region experiencing rapid environmental change.

Epidemiologic studies suggest that chronic exposure to arsenic is related to cardiovascular disease (CVD), but the pathophysiological link remains uncertain. We evaluated the association of chronic low-moderate arsenic exposure and arsenic metabolism with baseline difference and annual change in ECG measures (QT interval, JT interval, PR interval, QRS duration, and QT dispersion) using linear mixed models in the Strong Heart Study main cohort (N = 1174, median age 55 years) and family study (N = 1695 diabetes-free, median age 36 years). At baseline, arsenic exposure was measured as the sum of inorganic and methylated species in urine (ΣAs) and arsenic metabolism was measured as the relative percentage of arsenic species. Median ΣAs and Bazett heart rate-corrected QT interval (QTc) were 8.6 μg/g creatinine and 424 ms in the main cohort and 4.3 μg/g and 414 ms in the family study, respectively. In the main cohort, a comparison of the highest to lowest ΣAs quartile (14.4 vs.5.2 μg/g creatinine) was associated with a 5.3 (95% CI: 1.2, 9.5) ms higher mean baseline QTc interval but no difference in annual change in QTc interval. In the family study, a comparison of the highest to lowest quartile (7.1 vs.2.9 μg/g creatinine) was associated with a 3.2 (95% CI: 0.6, 5.7) ms higher baseline QTc interval and a 0.6 (95% CI: 0.04, 1.2) ms larger annual increase in QTc interval. Associations with JTc interval were similar but stronger in magnitude compared to QTc interval. Arsenic exposure was largely not associated with PR interval, QRS duration or QT dispersion. Similar to arsenic exposure, a pattern of lower %MMA and higher %DMA was associated with longer baseline QTc interval in both cohorts and with a larger annual change in QTc interval in the family study. Chronic low-moderate arsenic exposure and arsenic metabolism were associated with prolonged ventricular repolarization.

Parasite population structure can be used to infer fine-scale movement in host species. Many penguin species form large social colonies, and are highly philopatric, returning to the same nest or burrow, along the same route, after each trip to sea. Within a colony, however, the local abundance, physical similarity, and nocturnal habits of penguins hinder the observation of fine-scale movements. To determine the extent of movement and interaction of penguins within colonies, a genotyping by sequencing (GBS) approach was used to study the fine-scale structure of ticks—which depend on host movements for dispersal—exploiting the largest Little Penguin (Eudyptula novaehollandiae) colony in Australia (Phillip Island, Victoria). No barriers to tick gene flow were identified, and we infer that extensive penguin movement occurs throughout the colony. Our findings support the hypothesis that some penguin species are highly gregarious, socializing widely within colonies despite strong nest-site philopatry.

Lyme borreliosis (or Lyme Disease) is an emerging threat to human health in the Northern Hemisphere caused by tick-borne bacteria from the Borrelia burgdorferi sensu lato (Bbsl) complex. Seabirds are important reservoir hosts of some members of the Bbsl complex in the Northern Hemisphere, and some evidence suggests this may be true of penguins in the Southern Hemisphere. While the Bbsl complex has not been detected in Australia, a novel Borrelia species ('Candidatus Borrelia tachyglossi') was recently sequenced from native ticks (Ixodes holocyclus and Bothriocroton concolor) parasitising echidnas (Tachyglossus aculeatus), suggesting unidentified borreliae may be circulating amongst native wildlife and their ticks. In the present study, we investigated whether ticks parasitising little penguins (Eudyptula novaehollandiae) harbour native or introduced Borrelia bacteria. We chose this penguin species because it is heavily exploited by ticks during the breeding season, lives in close proximity to other potential reservoir hosts (including native wildlife and migratory seabirds), and is known to be infected with other tick-borne pathogens (Babesia). We screened over 230 penguin ticks (Ixodes spp.) from colonies in south-eastern Australia, and found no evidence of Borrelia DNA. The apparent absence or rarity of the bacterium in south-eastern Australia has important implications for identifying potential tick-borne pathogens in an understudied region.

BACKGROUND: Evidence evaluating the prospective association between low- to moderate-inorganic arsenic (iAs) exposure and cardiovascular disease in the general US population is limited. We evaluated the association between urinary arsenic concentrations in National Health and Nutrition Examination Survey (NHANES) 2003-2014 and heart disease mortality linked from the National Death Index through 2015. METHODS: We modeled iAs exposure as urinary total arsenic and dimethylarsinate among participants with low seafood intake, based on low arsenobetaine levels (N=4,990). We estimated multivariable adjusted hazard ratios (HRs) for heart disease mortality per interquartile range (IQR) increase in urinary arsenic levels using survey-weighted, Cox proportional hazards models, and evaluated flexible dose-response analyses using restricted quadratic spline models. We updated a previously published relative risk of coronary heart disease mortality from a dose-response meta-analysis per a doubling of water iAs (e.g., from 10 to 20 μg/L) with our results from NHANES 2003-2014, assuming all iAs exposure came from drinking water. RESULTS: A total of 77 fatal heart disease events occurred (median follow-up time 75 months). The adjusted HRs (95% CI) of heart disease mortality for an increase in urinary total arsenic and DMA corresponding to the interquartile range were 1.20 (0.83, 1.74) and 1.18 (0.68, 2.05), respectively. Restricted quadratic splines indicate a significant association between increasing urinary total arsenic and the HR of fatal heart disease for all participants at the lowest exposure levels

Extreme and remote environments provide useful settings to test ideas about the ecological and evolutionary drivers of biological diversity. In the sub-Antarctic, isolation by geographic, geological and glaciological processes has long been thought to underpin patterns in the region's terrestrial and marine diversity. Molecular studies using increasingly high-resolution data are, however, challenging this perspective, demonstrating that many taxa disperse among distant sub-Antarctic landmasses. Here, we reconsider connectivity in the sub-Antarctic region, identifying which taxa are relatively isolated, which are well connected, and the scales across which this connectivity occurs in both terrestrial and marine systems. Although many organisms show evidence of occasional long-distance, trans-oceanic dispersal, these events are often insufficient to maintain gene flow across the region. Species that do show evidence of connectivity across large distances include both active dispersers and more sedentary species. Overall, connectivity patterns in the sub-Antarctic at intra- and inter-island scales are highly complex, influenced by life-history traits and local dynamics such as relative dispersal capacity and propagule pressure, natal philopatry, feeding associations, the extent of human exploitation, past climate cycles, contemporary climate, and physical barriers to movement. An increasing use of molecular data – particularly genomic data sets that can reveal fine-scale patterns – and more effective international collaboration and communication that facilitates integration of data from across the sub-Antarctic, are providing fresh insights into the processes driving patterns of diversity in the region. These insights offer a platform for assessing the ways in which changing dispersal mechanisms, such as through increasing human activity and changes to wind and ocean circulation, may alter sub-Antarctic biodiversity patterns in the future.

Land use and forest fragmentation are thought to be major drivers of Lyme disease incidence and its geographic distribution. We examined the association between landscape composition and configuration and Lyme disease in a population-based case control study in the Geisinger health system in Pennsylvania. Lyme disease cases (n = 9657) were identified using a combination of diagnosis codes, laboratory codes, and antibiotic orders from electronic health records (EHRs). Controls (5:1) were randomly selected and frequency matched on year, age, and sex. We measured six landscape variables based on prior literature, derived from the National Land Cover Database and MODIS satellite imagery: greenness (normalized difference vegetation index), percent forest, percent herbaceous, forest edge density, percent forest-herbaceous edge, and mean forest patch size. We assigned landscape variables within two spatial contexts (community and ½-mile [805 m] Euclidian residential buffer). In models stratified by community type, landscape variables were modeled as tertiles and flexible splines and associations were adjusted for demographic and clinical covariates. In general, we observed positive associations between landscape metrics and Lyme disease, except for percent herbaceous, where associations differed by community type. For example, compared to the lowest tertile, individuals with highest tertile of greenness in residential buffers had higher odds of Lyme disease (odds ratio: 95% confidence interval [CI]) in townships (1.73: 1.55, 1.93), boroughs (1.70: 1.40, 2.07), and cities (3.71: 1.74, 7.92). Similarly, corresponding odds ratios (95% CI) for forest edge density were 1.34 (1.22, 1.47), 1.56 (1.33, 1.82), and 1.90 (1.13, 3.18). Associations were generally higher in residential buffers, compared to community, and in cities, compared to boroughs or townships. Our results reinforce the importance of peridomestic landscape in Lyme disease risk, particularly measures that reflect human interaction with tick habitat. Linkage of EHR data to public data on residential and community context may lead to new health system-based approaches for improving Lyme disease diagnosis, treatment, and prevention.

One of the most extreme examples of parasite adaptation comes from terrestrial ectoparasites exploiting marine hosts. Despite the ubiquity of such ectoparasitism and its ecological and evolutionary importance, investigations of the responses of ectoparasites to conditions encountered on their hosts are rare. In the case of penguins and their ticks, current understanding suggests that ticks freely parasitize their hosts on land but are incapable of surviving extended oceanic journeys. We examined this conjecture by assessing the physiological capacity of little penguin ticks to endure at-sea foraging and dispersal events of their hosts. Survival in penguins ticks was not significantly compromised by exposure to depths commonly associated with host dives (40 and 60 m), repeated seawater exposure relevant to the most common (30 s) and longest (120 s) recorded host dives, or extended (48 h) exposure to seawater. Mean (±SD) closed-phase durations in adult and nymphal ticks exhibiting discontinuous gas exchange (mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:mrowmml:mn339/mml:mnmml:mo±/mml:momml:mn237/mml:mn/mml:mrow/mml:mathandmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:mrowmml:mn240/mml:mnmml:mo±/mml:momml:mn295/mml:mn/mml:mrow/mml:maths, respectively) exceeded that of the maximum recorded host dive duration (120 s). Normoxic-anoxic-normoxic respirometry also confirmed spiracle closure. Mean metabolic rates (mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:mrowmml:mn0.354/mml:mnmml:mo±/mml:momml:mn0.220/mml:mn/mml:mrow/mml:mathandmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:mrowmml:mn4.853/mml:mnmml:mo±/mml:momml:mn4.930/mml:mn/mml:mrow/mml:mathμL/h at 25°C for unfed and fed adult females, respectively) were significantly influenced by temperature; optimal and LT

Objective The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. Methods In 2012–2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM 2.5 ) ( N =35), carbon monoxide (CO) ( N =23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) ( N =31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) ( N =43), and air nicotine ( N =46). Results Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) µg/m 3 for PM 2.5 , 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m 3 for p-PAHs, 1.0 (0.5, 1.9) ng/m 3 for NNK, and 5.3 (0.7, 14) µg/m 3 for nicotine. PM 2.5 , CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant. Conclusion High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.

Objective For many individuals with Lyme disease, prompt treatment leads to rapid resolution of infection. However, severe complications can occur if treatment is delayed. Our objective was to identify themes around belated diagnosis or treatment of Lyme disease using the General Model of Total Patient Delay (GMTPD). Design We conducted a qualitative interview study using indepth telephone interviews. Setting Participants were patients from a large, integrated health system in the state of Pennsylvania, USA. Participants There were 26 participants. Participants had to have a diagnosis of Lyme disease between 2014 and 2017 and a positive IgG western blot. We used a stratified purposeful sampling design to identify patients with and without late Lyme disease manifestations. To ensure variation in care experiences, we oversampled patients diagnosed outside of primary care. Outcome measures We asked participants about their experience from first Lyme disease symptoms to treatment. We applied an iterative coding process to identify key themes and then synthesised codes into higher order codes representing the GMTPD stages: appraisal delay (symptom to recognition of illness); illness delay (inferring illness to deciding to seek help); behavioural delay (deciding to seek help to the act of seeking help); scheduling delay (seeking help to attending an appointment); and treatment delay (attending appointment to treatment). Results Appraisal delay themes included symptom misattribution, intermittent symptoms and misperceptions about the necessity of a bull’s-eye rash. Health insurance status was a driver of illness and behavioural delays. Scheduling delay was not noted by participants, in part, because 10 of the 26 patients went to urgent care or emergency department settings. Misdiagnoses were more common in these settings, contributing to treatment delay. Conclusion Our study identified potentially modifiable risk factors for belated treatment. Targeting these risk factors may minimise time to treatment and reduce the occurrence of preventable complications.

Background Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

Background Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-moderate inorganic arsenic exposure with carotid arterial disease. Methods American Indians, 45–74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989–1991). Carotid artery ultrasound was performed in 1998–1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score). Results 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0 kg/m 2 , diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) µg/g creatinine. The mean CIMT was 0.75 mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09). Conclusions Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

Waterpipe smoking has been growing in popularity in the United States and worldwide. Most tobacco control regulations remain limited to cigarettes. Few studies have investigated waterpipe tobacco smoke exposures in a real world setting. We measured carbon monoxide (CO), particulate matter (PM)2.5, and airborne nicotine concentrations in seven waterpipe cafes in the greater Baltimore area. Area air samples were collected between two and five hours, with an average sampling duration of three hours. Waterpipe smoking behaviors were observed at each venue. Indoor air samplers for CO, PM2.5, and airborne nicotine were placed in the main seating area 1–2 m above the floor. Indoor airborne concentrations of PM2.5 and CO were markedly elevated in waterpipe cafes and exceeded concentrations that were observed in cigarette smoking bars. Air nicotine concentrations, although not as high as in venues that allow cigarette smoking, were markedly higher than in smoke-free bars and restaurants. Concentrations of PM approached occupational exposure limits and CO exceeded occupational exposure guidelines suggesting that worker protection measures need to be considered. This study adds to the literature indicating that both employees and patrons of waterpipe venues are at increased risk from complex exposures to secondhand waterpipe smoke.

The burden of diabetes is increasing globally. Identifying novel preventable risk factors is an urgent need. In 2011, the U.S. National Toxicological Program (NTP) conducted a workshop to evaluate the epidemiologic and experimental evidence on the relationship of environmental chemicals with obesity, diabetes, and metabolic syndrome. Although the evidence was insufficient to establish causality, the NTP workshop review identified an overall positive association between some environmental chemicals and diabetes. In the present systematic review, our objective was to summarize the epidemiological research published since the NTP workshop. We identified a total of 29 articles (7 on arsenic, 3 on cadmium, 2 on mercury, 11 on persistent organic pollutants, 3 on phthalates, and 4 on bisphenol A), including 7 prospective studies. Considering consistency, temporality, strength, dose-response relationship, and biological plausibility (confounding), we concluded that the evidence is suggestive but not sufficient for a relationship between arsenic and persistent organic pollutants and is insufficient for mercury, phthalates, and bisphenol A. For cadmium, the epidemiologic evidence does not seem to suggest an association with diabetes. Important research questions include the need for additional prospective studies and the evaluation of the dose-response relationship, the role of joint exposures, and effect modification with other comorbidities and genetic variants.

Background: To systematically investigate the role of arsenic metabolism in the development of cancer, cardiovascular disease, and diabetes-related outcomes. As a secondary objective, we characteri...

Introduction: Arsenic may be linked to atherosclerosis through inflammation. Few studies have examined the association between low-moderate arsenic (

Introduction: The etiology of arsenic-related cardiovascular disease is uncertain. A previous study of arsenic at high levels of arsenic in drinking water and QT interval found an association limit...