Inclusion of Drinking Water Source and Testing Questions into Electronic Medical Records: Advancing Environmental Medicine and Public Health Outreach in New Jersey.

Chronic arsenic exposure is associated with adverse health outcomes, and early life exposure is particularly damaging. Households with pregnant people and young children drinking from unregulated wells in arsenic-prevalent regions are therefore a public health priority for outreach and intervention. A partnership between Columbia University, New Jersey government partners, and Hunterdon Healthcare has informed Hunterdon County residents of the risks faced from drinking arsenic-contaminated water and offered free well testing through a practice-based water test kit distribution and an online patient portal outreach. Encouraged by those successes, Hunterdon Healthcare incorporated questions about drinking water source and arsenic testing history into the electronic medical record (EMR) template used by most primary care practices in Hunterdon County. The new EMR fields allow for additional targeting of risk-based outreach and water test kit distribution, offering promising new opportunities for public health and environmental medicine outreach, surveillance, and research.

Prediction of personal exposure to PM2.5 in mother-child pairs in rural Ghana.

BACKGROUND: Air pollution epidemiological studies usually rely on estimates of long-term exposure to air pollutants, which are difficult to ascertain. This problem is accentuated in settings where sources of personal exposure differ from those of ambient concentrations, including household air pollution environments where cooking is an important source. OBJECTIVE: The objective of this study was to assess the feasibility of estimating usual exposure to PM2.5 based on short-term measurements. METHODS: We leveraged three types of short-term measurements from a cohort of mother-child pairs in 26 communities in rural Ghana: (A) personal exposure to PM2.5 in mothers and age four children, ambient PM2.5 concentrations (B) at the community level, and (C) at a central site. Baseline models were linear mixed models with a random intercept for community or for participant. Lowest root-mean-square-error (RMSE) was used to select the best-performing model. RESULTS: We analyzed 240 community-days and 251 participant-days of PM2.5. Medians (IQR) of PM2.5 were 19.5 (36.5) µg/m3 for the central site, 28.7 (41.5) µg/m3 for the communities, 70.6 (56.9) µg/m3 for mothers, and 80.9 (74.1) µg/m3 for children. The ICCs (95% CI) for community ambient and personal exposure were 0.30 (0.17, 0.47) and 0.74 (0.65, 0.81) respectively. The sources of variability differed during the Harmattan season. Children's daily exposure was best predicted by models that used community ambient compared to mother's exposure as a predictor (log-scale RMSE: 0.165 vs 0.325). CONCLUSION: Our results support the feasibility of predicting usual personal exposure to PM2.5 using short-term measurements in settings where household air pollution is an important source of exposure. Our results also suggest that mother's exposure may not be the best proxy for child's exposure at age four.

Recommended Sampling Intervals for Arsenic in Private Wells.

Geogenic arsenic in drinking water is a worldwide problem. For private well owners, testing (e.g., private or government laboratory) is the main method to determine arsenic concentration. However, the temporal variability of arsenic concentrations is not well characterized and it is not clear how often private wells should be tested. To answer this question, three datasets, two new and one publicly available, with temporal arsenic data were utilized: 6370 private wells from New Jersey tested at least twice since 2002, 2174 wells from the USGS NAWQA database, and 391 private wells sampled 14 years apart from Bangladesh. Two arsenic drinking water standards are used for the analysis: 10 µg/L, the WHO guideline and EPA standard or maximum contaminant level (MCL) and 5 µg/L, the New Jersey MCL. A rate of change was determined for each well and these rates were used to predict the temporal change in arsenic for a range of initial arsenic concentrations below an MCL. For each MCL and initial concentration, the probability of exceeding an MCL over time was predicted. Results show that to limit a person to below a 5% chance of drinking water above an MCL, wells that are ½ an MCL and above should be tested every year and wells below ½ an MCL should be tested every 5 years. These results indicate that one test result below an MCL is inadequate to ensure long-term compliance. Future recommendations should account for temporal variability when creating drinking water standards and guidance for private well owners.

Leveraging Health Care Communication Channels for Environmental Health Outreach in New Jersey.

Households with pregnancies and young children are a priority group for outreach on private well water screening due to the widespread occurrence and toxicity of common groundwater contaminants such as arsenic. Given the trusted role of health care providers as communicators of health risk, Columbia University investigators and New Jersey government partners collaborated with Hunterdon Healthcare to offer free well testing to residents of Hunterdon County, a hot spot for naturally occurring arsenic in New Jersey. Through practice-based test kit distribution and online patient portal messages, supported by a public multimedia campaign, we tested 433 private wells and alerted 50 families about elevated arsenic found in their drinking water. These health care-facilitated outreach strategies allowed for targeting based on geographic and demographic risk and suggested opportunities to better leverage communication channels, such as incorporating questions on home water source into the electronic medical record.

Developing home-disinfection and filtration efficiency improvement methods for N95 respirators and surgical facial masks: stretching supplies and better protection during the ongoing COVID-19 Pandemic.

The U.S. CDC announced on 04/03/2020 that all citizens should wear face coverings when in public, potentially increasing demand for medical face masks from the public and exacerbating mask shortages for Covid-19 response staff. One solution is reuse after disinfection for the general public. Prior studies have shown that heating for 30 mins at 70°C or above effectively kills SARS, including SARS-CoV-2, and Influenza viruses on masks. Black carbon (BC) particles generated from a kerosene-lamp were used as a proxy for Coronavirus aerosols to test mask performance after disinfection given overlapping size distributions. We determined filtration efficiency (FE) measurements by comparing BC values on both sides of the respirators or masks (Moldex N95 and 3M N95 respirators, HSI surgical masks) placed under vacuum on mannequins. To obtain the maximum FE, each mask type was first measured while taped or modified to tightly fit a mannequin's face when new and after each heating cycle. No reduction in average FE was observed even after 10 disinfection cycles, with FE statistically greater than 95% for N95 respirators and 70% for surgical masks. In sharp contrast, the FE of all medical masks with no additional sealing decreased to ~ 40%, confirming the effectiveness of facial masks relies upon a tight fit. For solving this issue, we designed a method for making individualized custom nose clips to hold a mask tightly to face; FE of 3M N95 respirators and surgical masks remained above 95% and 80%, respectively. Surprisingly, the FE of three homemade thick cloth coverings (in normal use) were 55%. Though more work is still needed, this result supports the public announcements that the public could wear cloth coverings instead of N95 respirators or surgical masks in low-risk environments. When worn with a customized nose clip, N95 respirators and surgical masks have higher FE than the CDC design for cloth coverings.

Predicting Indoor Concentrations of Black Carbon in Residential Environments.

Black carbon (BC) is a descriptive term that refers to light-absorbing particulate matter (PM) produced by incomplete combustion and is often used as a surrogate for traffic-related air pollution. Exposure to BC has been linked to adverse health effects. Penetration of ambient BC is typically the primary source of indoor BC in the developed world. Other sources of indoor BC include biomass and kerosene stoves, lit candles, and charring food during cooking. Home characteristics can influence the levels of indoor BC. As people spend most of their time indoors, human exposure to BC can be associated to a large extent with indoor environments. At the same time, due to the cost of environmental monitoring, it is often not feasible to directly measure BC inside multiple individual homes in large-scale population-based studies. Thus, a predictive model for indoor BC is needed to support risk assessment in public health. In this study, home characteristics and occupant activities that potentially modify indoor levels of BC were documented in 23 homes, and indoor and outdoor BC concentrations were measured twice. The homes were located in the Cincinnati-Kentucky-Indiana tristate region and measurements occurred from September 2015 through August 2017. A linear mixed-effect model was developed to predict BC concentration in residential environments. The measured outdoor BC concentrations and the documented home characteristics were utilized as predictors of indoor BC concentrations. After the model was developed, a leave-one-out cross-validation algorithm was deployed to assess the predictive accuracy of the output. The following home characteristics and occupant activities significantly modified the concentration of indoor BC: outdoor BC, lit candles and electrostatic or high efficiency particulate air (HEPA) filters in heating, ventilation and air conditioning (HVAC) systems. Predicted indoor BC concentrations explained 78% of the variability in the measured indoor BC concentrations. The data show that outdoor BC combined with home characteristics can be used to predict indoor BC levels with reasonable accuracy.

Personal Fine Particulate Matter Constituents, Increased Systemic Inflammation, and the Role of DNA Hypomethylation.

Limited evidence is available on the effects of various fine particulate matter (PM2.5) components on inflammatory cytokines and DNA methylation. We examined whether 16 PM2.5 components are associated with changes in four blood biomarkers, that is, tumor necrosis factor-α (TNF-α), soluble cluster of differentiation 40 ligand (sCD40L), soluble intercellular adhesion molecule-1 (sICAM-1), and fibrinogen, as well as their corresponding DNA methylation levels in a panel of 36 healthy college students in Shanghai, China. We used linear mixed-effect models to evaluate the associations, with controls of potential confounders. We further conducted mediation analysis to evaluate the potential mediation effects of components on inflammatory markers through change in DNA methylation. We observed that several components were consistently associated with TNF-α and fibrinogen as well as their DNA hypomethylation. For example, an interquartile range increase in personal exposure to PM2.5-lead (Pb) was associated with 65.20% (95% CI: 37.07, 99.10) increase in TNF-α and 2.66 (95% CI: 37.07, 99.10) decrease in TNF-α methylation, 30.51% (95% CI: 0.72, 69.11) increase in fibrinogen and 1.25 (95% CI: 0.67, 1.83) decrease in F3 methylation. PM2.5 components were significantly associated with sICAM-1 methylation but not with sICAM-1 protein. DNA methylation mediated 19.89%-41.75% of the elevation in TNF-α expression by various PM2.5 constituents. Our findings provide clues that personal PM2.5 constituents exposure may contribute to increased systemic inflammation through DNA hypomethylation.

Assessment of exposure to air pollution in children: Determining whether wearing a personal monitor affects physical activity.

Personal air pollution monitoring in research studies should not interfere with usual patterns of behavior and bias results. In an urban pediatric cohort study we tested whether wearing an air monitor impacted activity time based on continuous watch-based accelerometry. The majority (71%) reported that activity while wearing the monitor mimicked normal activity. Correspondingly, variation in activity while wearing versus not wearing the monitor did not differ greatly from baseline variation in activity (P = 0.84).

Indoor air quality in green-renovated vs. non-green low-income homes of children living in a temperate region of US (Ohio).

Green eco-friendly housing includes approaches to reduce indoor air pollutant sources and to increase energy efficiency. Although sealing/tightening buildings can save energy and reduce the penetration of outdoor pollutants, an adverse outcome can be increased buildup of pollutants with indoor sources. The objective of this study was to determine the differences in the indoor air quality (IAQ) between green and non-green homes in low-income housing complexes. In one housing complex, apartments were renovated using green principles (n=28). Home visits were conducted immediately after the renovation, and subsequently at 6 months and at 12 months following the renovation. Of these homes, eight homes had pre-renovation home visits; this allowed pre- and post-renovation comparisons within the same homes. Parallel visits were conducted in non-green (control) apartments (n=14) in a nearby low-income housing complex. The IAQ assessments included PM2.5, black carbon, ultrafine particles, sulfur, total volatile organic compounds (VOCs), formaldehyde, and air exchange rate. Data were analyzed using linear mixed-effects models. None of the indoor pollutant concentrations were significantly different between green and non-green homes. However, we found differences when comparing the concentrations before and after renovation. Measured immediately after renovation, indoor black carbon concentrations were significantly lower averaging 682 ng/m(3) in post-renovation vs. 2364 ng/m(3) in pre-renovation home visits (p=0.01). In contrast, formaldehyde concentrations were significantly higher in post-renovated (0.03 ppm) than in pre-renovated homes (0.01 ppm) (p=0.004). Questionnaire data showed that opening of windows occurred less frequently in homes immediately post-renovation compared to pre-renovation; this factor likely affected the levels of indoor black carbon (from outdoor sources) and formaldehyde (from indoor sources) more than the renovation status itself. To reduce IAQ problems and potentially improve health, careful selection of indoor building materials and ensuring sufficient ventilation are important for green building designs.

A Systematic Review of Innate Immunomodulatory Effects of Household Air Pollution Secondary to the Burning of Biomass Fuels.

BACKGROUND: Household air pollution (HAP)-associated acute lower respiratory infections cause 455,000 deaths and a loss of 39.1 million disability-adjusted life years annually. The immunomodulatory mechanisms of HAP are poorly understood. OBJECTIVES: The aim of this study was to conduct a systematic review of all studies examining the mechanisms underlying the relationship between HAP secondary to solid fuel exposure and acute lower respiratory tract infection to evaluate current available evidence, identify gaps in knowledge, and propose future research priorities. METHODS: We conducted and report on studies in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In all, 133 articles were fully reviewed and main characteristics were detailed, namely study design and outcome, including in vivo versus in vitro and pollutants analyzed. Thirty-six studies were included in a nonexhaustive review of the innate immune system effects of ambient air pollution, traffic-related air pollution, or wood smoke exposure of developed country origin. Seventeen studies investigated the effects of HAP-associated solid fuel (biomass or coal smoke) exposure on airway inflammation and innate immune system function. RESULTS: Particulate matter may modulate the innate immune system and increase susceptibility to infection through a) alveolar macrophage-driven inflammation, recruitment of neutrophils, and disruption of barrier defenses; b) alterations in alveolar macrophage phagocytosis and intracellular killing; and c) increased susceptibility to infection via upregulation of receptors involved in pathogen invasion. CONCLUSIONS: HAP secondary to the burning of biomass fuels alters innate immunity, predisposing children to acute lower respiratory tract infections. Data from biomass exposure in developing countries are scarce. Further study is needed to define the inflammatory response, alterations in phagocytic function, and upregulation of receptors important in bacterial and viral binding. These studies have important public health implications and may lead to the design of interventions to improve the health of billions of people daily.

Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial.

BACKGROUND: Household air pollution exposure is a major health risk, but validated interventions remain elusive. METHODS/DESIGN: The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves. DISCUSSION: Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries. TRIAL REGISTRATION: The trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .

Use of X-ray absorption spectroscopy to speciate manganese in airborne particulate matter from five counties across the United States.

The purpose of this study is to characterize manganese oxidation states and speciation in airborne particulate matter (PM) and describe how these potentially important determinants of PM toxicity vary by location. Ambient PM samples were collected from five counties across the US using a high volume sequential cyclone system that collects PM in dry bulk form segregated into "coarse" and "fine" size fractions. The fine fraction was analyzed for this study. Analyses included total Mn using ICP-MS and characterization of oxidation states and speciation using X-ray absorption spectroscopy (XAS). XAS spectra of all samples and ten standard compounds of Mn were obtained at the National Synchrotron Light Source. XAS data was analyzed using Linear Combination Fitting (LCF). Results of the LCF analysis describe differences in composition between samples. Mn(II) acetate and Mn(II) oxide are present in all samples, while Mn(II) carbonate and Mn(IV) oxide are absent. To the best of our knowledge, this is the first paper to characterize Mn composition of ambient PM and examine differences between urban sites in the US. Differences in oxidation state and composition indicate regional variations in sources and atmospheric chemistry that may help explain differences in health effects identified in epidemiological studies.

Air toxics exposure from vehicle emissions at a U.S. border crossing: Buffalo Peace Bridge Study.

The Peace Bridge in Buffalo, New York, which spans the Niagara River at the east end of Lake Erie, is one of the busiest U.S. border crossings. The Peace Bridge plaza on the U.S. side is a complex of roads, customs inspection areas, passport control areas, and duty-free shops. On average 5000 heavy-duty diesel trucks and 20,000 passenger cars traverse the border daily, making the plaza area a potential "hot spot" for emissions from mobile sources. In a series of winter and summer field campaigns, we measured air pollutants, including many compounds considered by the U.S. Environmental Protection Agency (EPA*) as mobile-source air toxics (MSATs), at three fixed sampling sites: on the shore of Lake Erie, approximately 500 m upwind (under predominant wind conditions) of the Peace Bridge plaza; immediately downwind of (adjacent to) the plaza; and 500 m farther downwind, into the community of west Buffalo. Pollutants sampled were particulate matter (PM) < or = 10 microm (PM10) and < or = 2.5 microm (PM2.5) in aerodynamic diameter, elemental carbon (EC), 28 elements, 25 volatile organic compounds (VOCs) including 3 carbonyls, 52 polycyclic aromatic hydrocarbons (PAHs), and 29 nitrogenated polycyclic aromatic hydrocarbons (NPAHs). Spatial patterns of counts of ultrafine particles (UFPs, particles < 0.1 microm in aerodynamic diameter) and of particle-bound PAH (pPAH) concentrations were assessed by mobile monitoring in the neighborhood adjacent to the Peace Bridge plaza using portable instruments and Global Positioning System (GPS) tracking. The study was designed to assess differences in upwind and downwind concentrations of MSATs, in areas near the Peace Bridge plaza on the U.S. side of the border. The Buffalo Peace Bridge Study featured good access to monitoring locations proximate to the plaza and in the community, which are downwind with the dominant winds from the direction of Lake Erie and southern Ontario. Samples from the lakeside Great Lakes Center (GLC), which is upwind of the plaza with dominant winds, were used to characterize contaminants in regional air masses. On-site meteorologic measurements and hourly truck and car counts were used to assess the role of traffic on UFP counts and pPAH concentrations. The array of parallel and perpendicular residential streets adjacent to the plaza provided a grid on which to plot the spatial patterns of UFP counts and pPAH concentrations to determine the extent to which traffic emissions from the Peace Bridge plaza might extend into the neighboring community. For lake-wind conditions (southwest to northwest) 12-hour integrated daytime samples showed clear evidence that vehicle-related emissions at the Peace Bridge plaza were responsible for elevated downwind concentrations of PM2.5, EC, and benzene, toluene, ethylbenzene, and xylenes (BTEX), as well as 1,3-butadiene and styrene. The chlorinated VOCs and aldehydes were not differentially higher at the downwind site. Several metals (aluminum, calcium, iron, copper, and antimony) were two times higher at the site adjacent to the plaza as they were at the upwind GLC site on lake-wind sampling days. Other metals (beryllium, sodium, magnesium, potassium, titanium, manganese, cobalt, strontium, tin, cesium, and lanthanum) showed significant increases downwind as well. Sulfur, arsenic, selenium, and a few other elements appeared to be markers for regional transport as their upwind and downwind concentrations were correlated, with ratios near unity. Using positive matrix factorization (PMF), we identified the sources for PAHs at the three fixed sampling sites as regional, diesel, general vehicle, and asphalt volatilization. Diesel exhaust at the Peace Bridge plaza accounted for approximately 30% of the PAHs. The NPAH sources were identified as nitrate (NO3) radical reactions, diesel, and mixed sources. Diesel exhaust at the Peace Bridge plaza accounted for 18% of the NPAHs. Further evidence for the impact of the Peace Bridge plaza on local air quality was found when the differences in 10-minute average UFP counts and pPAH concentrations were calculated between pairs of sites and displayed by wind direction. With winds from approximately 160 degrees through 220 degrees, UFP counts adjacent to the plaza were 10,000 to 20,000 particles/cm3 higher than those upwind of the plaza. A similar pattern was displayed for pPAH concentrations adjacent to the plaza, which were between 10 and 20 ng/m3 higher than those at the upwind GLC site. Regression models showed better correlation with traffic variables for pPAHs than for UFPs. For pPAHs, truck counts and car counts had significant positive correlations, with similar magnitudes for the effects of trucks and cars, despite lower truck counts. Examining all traffic variables, including traffic counts and counts divided by wind speed, the multivariate regression analysis had an adjusted coefficient of determination (R2) of 0.34 for pPAHs, with all terms significant at P < 0.002. Study staff members traversed established routes in the neighborhood while carrying instruments to record continuous UFP and pPAH values. They also carried a GPS, which was used to provide location-specific time-stamped data. Analyses using a geographic information system (GIS) demonstrated that emissions at the Peace Bridge plaza, at times, affected ambient air quality over several blocks (a few hundred meters). Under lake-wind conditions, overall spatial patterns in UFP and pPAH levels were similar for summer and winter and for morning and afternoon sampling sessions. The Buffalo Peace Bridge Study demonstrated that a concentration of motor vehicles resulted in elevated levels of mobile-source-related emissions downwind, to distances of 300 m to 600 m. The study provides a unique data set to assess interrelationships among MSATs and to ascertain the impact of heavy-duty diesel vehicles on air quality.

Asbestos exposures to truck drivers during World Trade Center cleanup operations.

This article presents results of asbestos air sampling conducted to assess the exposure to truck drivers working at the World Trade Center site. Sampling consisted of a combination of area and personal monitoring of 49 truck drivers and included optical and electron microscopic analyses. Three sampling periods were conducted: October 1-7, 2001, October 17-26, 2001, and April 13-23, 2002. Area sample locations were selected to estimate airborne concentrations around the perimeter of the site, on top of the pile, and in the pit. Air samples were collected using a 50-mm conductive cowl and a 25-mm mixed cellulose ester filter at flow rates ranging from 0.5-2 L/min. Samples were analyzed using a combination of phase contrast microscopy (PCM) NIOSH method 7400, transmission electron microscopy (TEM) NIOSH method 7402, and the direct method specified under the Asbestos Hazardous Emergency Response Act. Sample times and flow rates were adjusted to prevent overloading while maximizing sample volume. Personal sampling results suggest that asbestos fiber exposures to truck drivers at the site were low. Exposures based on TEM results generally ranged from less than detectable to 0.1 structures per cubic centimeter (s/cm(3)). TEM-based results further indicate that the majority of asbestos fibers were chrysotile and less than 5 microm in length. PCM-based estimates were generally higher than the TEM results. This is likely due to the counting of nonasbestos fibers. This conclusion is supported by the NIOSH 7402 TEM results, which did not detect asbestos fibers longer than 5 micro m. Area sample results were generally less than the personal results (except for the sample collected on top of the rubble pile) and decreased over the course of the cleanup. Our results show low airborne asbestos concentrations and a predominance of short fibers. Given these low concentrations, evidence of short fibers, and the short duration of the exposure (less than 10 months to complete the cleanup), it is likely that truck drivers working at the site are not at an increased risk for asbestos-related disease.