The effect of age on the relative risk of lung cancer mortality in a cohort of chromium production workers.

BACKGROUND: Hexavalent chromium has been found to increase the risk of lung cancer in occupational studies. It has been suggested that the relative risk of lung cancer may vary by age. METHODS: The cohort examined is the Baltimore cohort of chromium production workers. The effect of age on the lung cancer risk from hexavalent chromium exposure was examined using a conditional Poisson regression modeling approach of Richardson and Langholz (R&L) and Cox models with interaction terms of age and cumulative hexavalent chromium exposure. RESULTS: The inclusion of multiple age groups in the R&L approach suggests the existence of an age effect that is also supported by a Cox proportional hazard analysis. The hazard ratio in Cox models with age-cumulative exposure interaction terms was significantly elevated for the youngest age group and significantly decreased for the oldest age group. CONCLUSIONS: Our analyses are consistent with the observation that younger chromium production workers have a greater lung cancer risk than older workers.

A systematic review of the association between pleural plaques and changes in lung function.

OBJECTIVES: To conduct a systematic review of changes in lung function in relation to presence of pleural plaques in asbestos-exposed populations. METHODS: Database searches of PubMed and Web of Science were supplemented by review of papers' reference lists and journals' tables of contents. Methodological features (eg, consideration of potential confounding by smoking) of identified articles were reviewed by ≥ two reviewers. Meta-analyses of 20 studies estimated a summary effect of the decrements in per cent predicted (%pred) forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) associated with presence of pleural plaques. RESULTS: Among asbestos-exposed workers, the presence of pleural plaques was associated with statistically significant decrements in FVC (4.09%pred, 95% CI 2.31 to 5.86) and FEV1 (1.99%pred, 95% CI 0.22 to 3.77). Effects of similar magnitude were seen when stratifying by imaging type (X-ray or high-resolution CT) and when excluding studies with potential methodological limitations. Undetected asbestosis was considered as an unlikely explanation of the observed decrements. Several studies provided evidence of an association between size of pleural plaques and degree of pulmonary decrease, and presence of pleural plaques and increased rate or degree of pulmonary impairment. CONCLUSIONS: The presence of pleural plaques is associated with a small, but statistically significant mean difference in FVC and FEV1 in comparison to asbestos-exposed individuals without plaques or other abnormalities. From a public health perspective, small group mean decrements in lung function coupled with an increased rate of decline in lung function of the exposed population may be consequential.

Nonparametric Bayesian methods for benchmark dose estimation.

The article proposes and investigates the performance of two Bayesian nonparametric estimation procedures in the context of benchmark dose estimation in toxicological animal experiments. The methodology is illustrated using several existing animal dose-response data sets and is compared with traditional parametric methods available in standard benchmark dose estimation software (BMDS), as well as with a published model-averaging approach and a frequentist nonparametric approach. These comparisons together with simulation studies suggest that the nonparametric methods provide a lot of flexibility in terms of model fit and can be a very useful tool in benchmark dose estimation studies, especially when standard parametric models fail to fit to the data adequately.

Total Blood Mercury Predicts Methylmercury Exposure in Fish and Shellfish Consumers.

Many studies evaluating methylmercury (MeHg) toxicity rely on whole blood total mercury (THg) measurements to estimate MeHg exposure. However, whole blood THg includes other forms of mercury (Hg), such as inorganic Hg, which have different exposure sources and toxicological effects than MeHg. Therefore, estimating the whole blood MeHg/THg ratio is critical to predicting MeHg exposure and, subsequently, efforts to establish an exposure-response relationship for use in risk assessment. A large, representative dataset (National Health and Nutrition Examination Survey (NHANES) 2011-2016) was used to determine the whole blood MeHg/THg ratio among (a) self-reported fish and shellfish consumers, ≥ 15 years of age (the "full adult" population (N = 5268 training dataset; N = 2336 test dataset)) and (b) female fish and shellfish consumers, 15-44 years of age (the "women of reproductive age" population (N = 1285 training dataset; N = 560 test dataset)). Unadjusted and adjusted linear and spline models with direct measurements for both THg and MeHg were evaluated. The mean whole blood MeHg/THg ratio was 0.75 (95% confidence interval (CI): 0.74, 0.75). This ratio was significantly higher among those with higher THg concentrations. All models exhibited excellent fit (adjusted R2 from 0.957 to 0.982). Performance was slightly improved in spline versus linear models. For the full adult population and women of reproductive age, the unadjusted spline model predicted whole blood MeHg concentrations of 5.65 µg/L and 5.55 µg/L, respectively, when the THg concentration was 5.80 µg/L. These results suggest that whole blood THg is a good predictor of whole blood MeHg among fish and shellfish consumers.

Approaches to cancer assessment in EPA's Integrated Risk Information System.

The U.S. Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program develops assessments of health effects that may result from chronic exposure to chemicals in the environment. The IRIS database contains more than 540 assessments. When supported by available data, IRIS assessments provide quantitative analyses of carcinogenic effects. Since publication of EPA's 2005 Guidelines for Carcinogen Risk Assessment, IRIS cancer assessments have implemented new approaches recommended in these guidelines and expanded the use of complex scientific methods to perform quantitative dose-response assessments. Two case studies of the application of the mode of action framework from the 2005 Cancer Guidelines are presented in this paper. The first is a case study of 1,2,3-trichloropropane, as an example of a chemical with a mutagenic mode of carcinogenic action thus warranting the application of age-dependent adjustment factors for early-life exposure; the second is a case study of ethylene glycol monobutyl ether, as an example of a chemical with a carcinogenic action consistent with a nonlinear extrapolation approach. The use of physiologically based pharmacokinetic (PBPK) modeling to quantify interindividual variability and account for human parameter uncertainty as part of a quantitative cancer assessment is illustrated using a case study involving probabilistic PBPK modeling for dichloromethane. We also discuss statistical issues in assessing trends and model fit for tumor dose-response data, analysis of the combined risk from multiple types of tumors, and application of life-table methods for using human data to derive cancer risk estimates. These issues reflect the complexity and challenges faced in assessing the carcinogenic risks from exposure to environmental chemicals, and provide a view of the current trends in IRIS carcinogenicity risk assessment.

Seafood, wine, rice, vegetables, and other food items associated with mercury biomarkers among seafood and non-seafood consumers: NHANES 2011-2012.

Fish/seafood consumption is a source of mercury; other dietary sources are not well described. This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) 2011-2012 data. Participants self-reported consuming fish/seafood (N = 5427) or not (N = 1770) within the past 30 days. Whole blood total mercury (THg), methylmercury (MeHg), and urinary mercury (UHg) were determined. Diet was assessed using 24 h recall. Adjusted regression models predicted mercury biomarker concentrations with recent food consumption, while controlling for age, sex, education, and race/ethnicity. Geometric mean THg was 0.89 µg/L (95% confidence interval (CI): 0.78, 1.02) (seafood consumers) and 0.31 µg/L (95% CI: 0.28, 0.34) (non-seafood consumers); MeHg and UHg concentrations follow similar patterns. In adjusted regressions among seafood consumers, significant associations were observed between mercury biomarkers with multiple foods, including fish/seafood, wine, rice, vegetables/vegetable oil, liquor, and beans/nuts/soy. Among non-seafood consumers, higher THg was significantly associated with mixed rice dishes, vegetables/vegetable oil, liquor, and approached statistical significance with wine (p < 0.10); higher MeHg was significantly associated with wine and higher UHg was significantly associated with mixed rice dishes. Fish/seafood consumption is the strongest dietary predictor of mercury biomarker concentrations; however, consumption of wine, rice, vegetables/vegetable oil, or liquor may also contribute, especially among non-seafood consumers.

Parameters of a dose-response model are on the boundary: what happens with BMDL?

It is well known that, under appropriate regularity conditions, the asymptotic distribution for the likelihood ratio statistic is chi(2). This result is used in EPA's benchmark dose software to obtain a lower confidence bound (BMDL) for the benchmark dose (BMD) by the profile likelihood method. Recently, based on work by Self and Liang, it has been demonstrated that the asymptotic distribution of the likelihood ratio remains the same if some of the regularity conditions are violated, that is, when true values of some nuisance parameters are on the boundary. That is often the situation for BMD analysis of cancer bioassay data. In this article, we study by simulation the coverage of one- and two-sided confidence intervals for BMD when some of the model parameters have true values on the boundary of a parameter space. Fortunately, because two-sided confidence intervals (size 1-2alpha) have coverage close to the nominal level when there are 50 animals in each group, the coverage of nominal 1-alpha one-sided intervals is bounded between roughly 1-2alpha and 1. In many of the simulation scenarios with a nominal one-sided confidence level of 95%, that is, alpha= 0.05, coverage of the BMDL was close to 1, but for some scenarios coverage was close to 90%, both for a group size of 50 animals and asymptotically (group size 100,000). Another important observation is that when the true parameter is below the boundary, as with the shape parameter of a log-logistic model, the coverage of BMDL in a constrained model (a case of model misspecification not uncommon in BMDS analyses) may be very small and even approach 0 asymptotically. We also discuss that whenever profile likelihood is used for one-sided tests, the Self and Liang methodology is needed to derive the correct asymptotic distribution.

Influence of exposure assessment and parameterization on exposure response. Aspects of epidemiologic cohort analysis using the Libby Amphibole asbestos worker cohort.

Recent meta-analyses of occupational epidemiology studies identified two important exposure data quality factors in predicting summary effect measures for asbestos-associated lung cancer mortality risk: sufficiency of job history data and percent coverage of work history by measured exposures. The objective was to evaluate different exposure parameterizations suggested in the asbestos literature using the Libby, MT asbestos worker cohort and to evaluate influences of exposure measurement error caused by historically estimated exposure data on lung cancer risks. Focusing on workers hired after 1959, when job histories were well-known and occupational exposures were predominantly based on measured exposures (85% coverage), we found that cumulative exposure alone, and with allowance of exponential decay, fit lung cancer mortality data similarly. Residence-time-weighted metrics did not fit well. Compared with previous analyses based on the whole cohort of Libby workers hired after 1935, when job histories were less well-known and exposures less frequently measured (47% coverage), our analyses based on higher quality exposure data yielded an effect size as much as 3.6 times higher. Future occupational cohort studies should continue to refine retrospective exposure assessment methods, consider multiple exposure metrics, and explore new methods of maintaining statistical power while minimizing exposure measurement error.

Intraoperative infrared imaging of brain tumors.

OBJECT: Although clinical imaging defines the anatomical relationship between a brain tumor and the surrounding brain and neurological deficits indicate the neurophysiological consequences of the tumor, the effect of a brain tumor on vascular physiology is less clear. METHODS: An infrared camera was used to measure the temperature of the cortical surface before, during, and after removal of a mass in 34 patients (primary brain tumor in 21 patients, brain metastases in 10 and falx meningioma, cavernous angioma, and radiation necrosis-astrocytosis in one patient each). To establish the magnitude of the effect on blood flow induced by the tumor, the images were compared with those from a group of six patients who underwent temporal lobectomy for epilepsy. In four cases a cerebral artery was temporarily occluded during the course of the surgery and infrared emissions from the cortex before and after occlusion were compared to establish the relationship of local temperature to regional blood flow. Discrete temperature gradients were associated with surgically verified lesions in all cases. Depending on the type of tumor, the cortex overlying the tumor was either colder or warmer than the surrounding cortex. Spatial reorganization of thermal gradients was observed after tumor resection. Temperature gradients of the cortex in patients with tumors exceeded those measured in the cortex of patients who underwent epilepsy surgery. CONCLUSIONS: Brain tumors induce changes in cerebral blood flow (CBF) in the cortex, which can be made visible by performing infrared imaging during cranial surgery. A reduction in CBF beyond the tumor margin improves after removal of the lesion.

Human health effects of tetrachloroethylene: key findings and scientific issues.

BACKGROUND: The U.S. Environmental Protection Agency (EPA) completed a toxicological review of tetrachloroethylene (perchloroethylene, PCE) in February 2012 in support of the Integrated Risk Information System (IRIS). OBJECTIVES: We reviewed key findings and scientific issues regarding the human health effects of PCE described in the U.S. EPA's Toxicological Review of Tetrachloroethylene (Perchloroethylene). METHODS: The updated assessment of PCE synthesized and characterized a substantial database of epidemiological, experimental animal, and mechanistic studies. Key scientific issues were addressed through modeling of PCE toxicokinetics, synthesis of evidence from neurological studies, and analyses of toxicokinetic, mechanistic, and other factors (tumor latency, severity, and background rate) in interpreting experimental animal cancer findings. Considerations in evaluating epidemiological studies included the quality (e.g., specificity) of the exposure assessment methods and other essential design features, and the potential for alternative explanations for observed associations (e.g., bias or confounding). DISCUSSION: Toxicokinetic modeling aided in characterizing the complex metabolism and multiple metabolites that contribute to PCE toxicity. The exposure assessment approach-a key evaluation factor for epidemiological studies of bladder cancer, non-Hodgkin lymphoma, and multiple myeloma-provided suggestive evidence of carcinogenicity. Bioassay data provided conclusive evidence of carcinogenicity in experimental animals. Neurotoxicity was identified as a sensitive noncancer health effect, occurring at low exposures: a conclusion supported by multiple studies. Evidence was integrated from human, experimental animal, and mechanistic data sets in assessing adverse health effects of PCE. CONCLUSIONS: PCE is likely to be carcinogenic to humans. Neurotoxicity is a sensitive adverse health effect of PCE.

Low levels of exposure to libby amphibole asbestos and localized pleural thickening.

OBJECTIVE: To explore the relationship between low levels of exposure to Libby amphibole asbestos (LAA) and pleural abnormalities, specifically localized pleural thickening (LPT). METHODS: Three studies presenting the risks associated with quantitative LAA exposure estimates were reviewed, paying particular attention to lower exposure ranges. RESULTS: Studies reviewed were conducted among workers exposed to LAA at mining and milling operations in Libby, Montana, at a vermiculite processing facility in Marysville, Ohio, and community residents exposed to LAA from a vermiculite processing facility in Minneapolis, Minnesota. Pleural abnormalities were evaluated using radiographs. Despite differences in study populations and design, each study found that cumulative inhalation LAA exposure was associated with increased risk of LPT even at low levels of exposure. CONCLUSIONS: Inhalation exposure to LAA is associated with increased risk of LPT even at the lowest levels of exposure in each study.

Localized pleural thickening: smoking and exposure to Libby vermiculite.

There is limited research on the combined effects of smoking and asbestos exposure on risk of localized pleural thickening (LPT). This analysis uses data from the Marysville cohort of workers occupationally exposed to Libby amphibole asbestos (LAA). Workers were interviewed to obtain work and health history, including ever/never smoking and chest X-rays. Cumulative exposure estimates were developed on the basis of fiber measurements from the plant and work history. Benchmark concentration (BMC) methodology was used to evaluate the exposure-response relationship for exposure to LAA and a 10% increased risk of LPT, considering potential confounders and statistical model forms. There were 12 LPT cases among 118 workers in the selected study population. The mean exposure was 0.42 (SD=0.77) fibers/cc-year, and the prevalence of smoking history was 75.0% among cases and 51.9% among non-cases. When controlling for LAA exposure, smoking history was of borderline statistical significance (P-value=0.099), and its inclusion improved model fit, as measured by Akaike's Information Criterion. A comparison of BMC estimates was made to gauge the potential effect of smoking status. The BMC was 0.36 fibers/cc-year, overall. The BMC for non-smokers was approximately three times as high (1.02 fibers/cc-year) as that for the full cohort, whereas the BMC for smokers was about 1/2 that of the full cohort (0.17 fibers/cc-year).

Physiologically based pharmacokinetic model use in risk assessment--Why being published is not enough.

A panel of experts in physiologically based pharmacokinetic (PBPK) modeling and relevant quantitative methods was convened to describe and discuss model evaluation criteria, issues, and choices that arise in model application and computational tools for improving model quality for use in human health risk assessments (HHRAs). Although publication of a PBPK model in a peer-reviewed journal is a mark of good science, subsequent evaluation of published models and the supporting computer code is necessary for their consideration for use in HHRAs. Standardized model evaluation criteria and a thorough and efficient review process can reduce the number of review and revision iterations and hence the time needed to prepare a model for application. Efficient and consistent review also allows for rapid identification of needed model modifications to address HHRA-specific issues. This manuscript reports on the workshop where a process and criteria that were created for PBPK model review were discussed along with other issues related to model review and application in HHRA. Other issues include (1) model code availability, portability, and validity; (2) probabilistic (e.g., population-based) PBPK models and critical choices in parameter values to fully characterize population variability; and (3) approaches to integrating PBPK model outputs with other HHRA tools, including benchmark dose modeling. Two specific case study examples are provided to illustrate challenges that were encountered during the review and application process. By considering the frequent challenges encountered in the review and application of PBPK models during the model development phase, scientists may be better able to prepare their models for use in HHRAs.

Towards quantitative uncertainty assessment for cancer risks: central estimates and probability distributions of risk in dose-response modeling.

Regulatory agencies and the scientific community have been engaged in a long-term effort to strengthen health risk assessment procedures. Recently the momentum of this effort has accelerated to increasing biological information for a variety of toxic compounds and emphasis on the policy goal of broader characterization of scientific uncertainty (in contrast to providing only a single risk estimate). For example, the OMB Regulatory Analysis Guidelines [OMB, 2003. Office of Management and Budget. Circular A-4. Available from: ] suggest that a formal quantitative uncertainty analysis be performed for economic assessments in support of major regulatory analyses, a process that can utilize both expected values and probability distributions for risk estimates. Some efforts have been made in the past to provide probability distributions of risk estimates. In this article, we examine a procedure for constructing probability distributions and expected values of risk estimates using a Bayesian framework. This approach has the advantage of mathematical soundness and computational feasibility, given the Markov chain Monte Carlo software tools that are available today. Importantly, the Bayesian framework can serve as a unifying platform for uncertainty analysis in cancer risk assessment. This paper provides some initial applications of Bayesian methods in quantitative analysis of uncertainty in cancer risk assessment, including implementation with cancer dose-response data sets for two chemicals. The Bayesian expected risk calculations provide an approach to generating a central estimate of risk that does not have the instability problems that have often limited utility of MLE risk estimates.

Age-dependent changes in the ability to encode a novel elementary motor memory.

In healthy individuals, motor training elicits cortical plasticity that encodes the kinematic details of the practiced movements and is thought to underlie recovery of function after stroke. The influence of age on this form of plasticity is incompletely understood. We studied 55 healthy subjects and identified a substantial decrease in training-dependent plasticity as a function of age in the absence of differences in training kinematics. These results suggest that the ability of the healthy aging motor cortex to reorganize in response to training decreases with age.

Enhancing encoding of a motor memory in the primary motor cortex by cortical stimulation.

Motor training results in encoding of motor memories, a form of use-dependent plasticity. Here we tested the hypothesis that transcranial magnetic stimulation (TMS) synchronously applied to a motor cortex engaged in a motor training task could enhance this plastic process. Healthy volunteers were studied in four sessions: training consisting of performance of directionally specific voluntary thumb movements (Train alone), training with TMS delivered during the execution of the training movement in a strictly temporal relationship to the motor cortex contralateral (Train+TMS synchronous(contra)) and ipsilateral (Train+TMS synchronous(ipsi)) to the training hand, and training with TMS delivered asynchronous to the training movement to the motor cortex contralateral to the training hand (Train+TMS asynchronous(contra)). Train alone, Train+TMS synchronous(contra), and Train+TMS asynchronous(contra) but not Train+TMS synchronous(ipsi) elicited a clear motor memory. The longevity of the encoded memory was significantly enhanced by Train+TMS synchronous(contra) when compared with Train alone and Train+TMS asynchronous(contra). Therefore use-dependent encoding of a motor memory can be enhanced by synchronous Hebbian stimulation of the motor cortex that drives the training task and reduced by stimulation of the homologous ipsilateral motor cortex, a result relevant for studies of cognitive and physical rehabilitation.

Modulation of use-dependent plasticity by d-amphetamine.

Use-dependent plasticity, thought to contribute to functional recovery after brain injury, is elicited by motor training. The purpose of this study was to determine if administration of d-amphetamine facilitates the effects of motor training on use-dependent plasticity. Healthy human volunteers underwent a training period of voluntary thumb movements under the effects of placebo or d-amphetamine in different sessions in a randomized double-blind, counterbalanced design. Previous work in a drug-naive condition showed that such training causes changes in the direction of thumb movements evoked by transcranial magnetic stimulation and in transcranial magnetic stimulation-evoked electromyographic responses. The endpoint measure of the study was the magnitude of training-induced changes in transcranial magnetic stimulation-evoked kinematic and electromyographic responses in the d-amphetamine and in the placebo conditions. Motor training resulted in increased magnitude, faster development and longer lasting duration of use-dependent plasticity under d-amphetamine compared to the placebo session. These results document a facilitatory effect of d-amphetamine on use-dependent plasticity, a possible mechanism mediating the beneficial effect of this drug on functional recovery after cortical lesions.