Urinary naphthalene and phenanthrene as biomarkers of occupational exposure to polycyclic aromatic hydrocarbons.

OBJECTIVES: The study investigated the utility of unmetabolised naphthalene (Nap) and phenanthrene (Phe) in urine as surrogates for exposures to mixtures of polycyclic aromatic hydrocarbons (PAHs). METHODS: The report included workers exposed to diesel exhausts (low PAH exposure level, n = 39) as well as those exposed to emissions from asphalt (medium PAH exposure level, n = 26) and coke ovens (high PAH exposure level, n = 28). Levels of Nap and Phe were measured in urine from each subject using head space-solid phase microextraction and gas chromatography-mass spectrometry. Published levels of airborne Nap, Phe and other PAHs in the coke-producing and aluminium industries were also investigated. RESULTS: In post-shift urine, the highest estimated geometric mean concentrations of Nap and Phe were observed in coke-oven workers (Nap: 2490 ng/l; Phe: 975 ng/l), followed by asphalt workers (Nap: 71.5 ng/l; Phe: 54.3 ng/l), and by diesel-exposed workers (Nap: 17.7 ng/l; Phe: 3.60 ng/l). After subtracting logged background levels of Nap and Phe from the logged post-shift levels of these PAHs in urine, the resulting values (referred to as ln(adjNap) and ln(adjPhe), respectively) were significantly correlated in each group of workers (0.71 < or = Pearson r < or = 0.89), suggesting a common exposure source in each case. Surprisingly, multiple linear regression analysis of ln(adjNap) on ln(adjPhe) showed no significant effect of the source of exposure (coke ovens, asphalt and diesel exhaust) and further suggested that the ratio of urinary Nap/Phe (in natural scale) decreased with increasing exposure levels. These results were corroborated with published data for airborne Nap and Phe in the coke-producing and aluminium industries. The published air measurements also indicated that Nap and Phe levels were proportional to the levels of all combined PAHs in those industries. CONCLUSION: Levels of Nap and Phe in urine reflect airborne exposures to these compounds and are promising surrogates for occupational exposures to PAH mixtures.

Likely Transiting Exocomets Detected By Kepler.

We present the first good evidence for exocomet transits of a host star in continuum light in data from the Kepler mission. The Kepler star in question, KIC 3542116, is of spectral type F2V and is quite bright at Kp = 10. The transits have a distinct asymmetric shape with a steeper ingress and slower egress that can be ascribed to objects with a trailing dust tail passing over the stellar disk. There are three deeper transits with depths of ≃ 0.1% that last for about a day, and three that are several times more shallow and of shorter duration. The transits were found via an exhaustive visual search of the entire Kepler photometric data set, which we describe in some detail. We review the methods we use to validate the Kepler data showing the comet transits, and rule out instrumental artefacts as sources of the signals. We fit the transits with a simple dust-tail model, and find that a transverse comet speed of ∼35-50 km s-1 and a minimum amount of dust present in the tail of ∼ 1016 g are required to explain the larger transits. For a dust replenishment time of ∼10 days, and a comet lifetime of only ∼300 days, this implies a total cometary mass of ≳ 3 × 1017 g, or about the mass of Halley's comet. We also discuss the number of comets and orbital geometry that would be necessary to explain the six transits detected over the four years of Kepler prime-field observations. Finally, we also report the discovery of a single comet-shaped transit in KIC 11084727 with very similar transit and host-star properties.

Predictors of occupational exposure to styrene and styrene-7,8-oxide in the reinforced plastics industry.

OBJECTIVE: To identify demographic and work related factors that predict blood levels of styrene and styrene-7,8-oxide (SO) in the fibreglass reinforced plastics (FRP) industry. METHODS: Personal breathing-zone air samples and whole blood samples were collected repeatedly from 328 reinforced plastics workers in the Unuted States between 1996 and 1999. Styrene and its major metabolite SO were measured in these samples. Multivariable linear regression analyses were applied to the subject-specific levels to explain the variation in exposure and biomarker levels. RESULTS: Exposure levels of styrene were approximately 500-fold higher than those of SO. Exposure levels of styrene and SO varied greatly among the types of products manufactured, with an 11-fold range of median air levels among categories for styrene and a 23-fold range for SO. Even after stratification by job title, median exposures of styrene and SO among laminators varied 14- and 31-fold across product categories. Furthermore, the relative proportions of exposures to styrene and SO varied among product categories. Multivariable regression analyses explained 70% and 63% of the variation in air levels of styrene and SO, respectively, and 72% and 34% of the variation in blood levels of styrene and SO, respectively. Overall, air levels of styrene and SO appear to have decreased substantially in this industry over the last 10-20 years in the US and were greatest among workers with the least seniority. CONCLUSIONS: As levels of styrene and SO in air and blood varied among product categories in the FRP industry, use of job title as a surrogate for exposure can introduce unpredictable measurement errors and can confound the relation between exposure and health outcomes in epidemiology studies. Also, inverse relations between the intensity of exposure to styrene and SO and years on the job suggest that younger workers with little seniority are typically exposed to higher levels of styrene and SO than their coworkers.

Comparison of protein adducts of benzene oxide and benzoquinone in the blood and bone marrow of rats and mice exposed to [14C/13C6]benzene.

Protein binding of hemoglobin (Hb) and bone marrow was used to compare in vivo reactions of 3 electrophilic metabolites of benzene, i.e., benzene oxide and 1,2- and 1,4-benzoquinone (1, 2-BQ and 1, 4-BQ), in F344 rats and B6C3F1 mice. Following a single p.o. administration of a mixture of [14C]- and [13C6]benzene between 50 and 400 mg/kg body weight, cysteine adducts of benzene oxide, 1,2-BQ, and 1,4-BQ were assayed, and the proportions of cysteine-bound adducts to total protein binding were estimated. Although dose-related production of each adduct was seen, large differences were observed between species and tissues. With rat Hb, benzene oxide adducts represented 27% of the total Hb binding and 73% of the cysteinyl binding, whereas quinone adducts represented relatively small proportions. However, with mouse Hb, the 1,4-BQ adducts accounted for 5.5% of the total Hb binding and 12.2% of the cysteinyl binding, while 1,2-BQ and benzene oxide each accounted for less than 3% of the total. In the bone marrow of both rats and mice, BQ adducts were more abundant than those of benzene oxide. However, adducts of 1,2-BQ predominated in rat marrow (9% of binding), whereas adducts of 1,4-BQ were more abundant in the mouse (21% of binding). The average blood concentrations of 1,4-BQ were estimated from the adduct levels and reaction-rate constants to be 2-5-fold higher in the mouse than in the rat. This work suggests that BQ binding is favored over that of benzene oxide in the bone marrow; however, high background levels of BQ adducts, observed with Hb and bone marrow proteins, suggest that any toxic effects of the quinones should only arise from high exposures to benzene.

An investigation of multiple biomarkers among workers exposed to styrene and styrene-7,8-oxide.

Investigations of cancer and cytogenetic damage among reinforced-plastics workers have produced contradictory results. In all studies, the focus has been on styrene rather than the carcinogen, styrene-7,8-oxide (SO), traces of which are generated during the manufacturing process. Because styrene is present at very high levels and is metabolized almost exclusively through SO, coexposures to SO have been discounted. This study investigated the relative contributions of airborne styrene and SO and of smoking toward several SO-specific biomarkers (DNA and albumin adducts) and sister chromatid exchanges in the blood of 48 reinforced-plastics workers. Among individual subjects, albumin and DNA adducts as well as sister chromatid exchanges were significantly correlated with styrene exposure. However, among the 20 subjects with measurements to both styrene and SO, albumin adducts were significantly correlated with exposure to SO but not to styrene. Finally, among the 10 job groups, surprisingly strong correlations (0.709 < or = r < or = 0.966) were found between all SO biomarkers and exposure to SO but not to styrene. Calculations suggest that SO was about 2000 times more effective than styrene in producing SO biomarkers. After accounting for the disparate exposures to the two chemicals, a typical worker received 71% of the systemic dose of SO via inhalation; nonetheless, 5 of the 20 subjects received the majority of the SO dose from styrene. Cigarette smoking increased levels of SO-albumin and SO-DNA adducts, suggesting that SO was a constituent of tobacco smoke. We conclude that inhalation of SO should be considered in any interventions to reduce health risks.

On the importance of exposure variability to the doses of volatile organic compounds.

The connection between occupational exposure to volatile organic compounds (VOCs) and the resulting internal doses is complicated by variability in air levels from day to day and by nonlinear kinetics of metabolism. We investigated long-term liver doses of VOCs and their metabolites using a physiologically based toxicokinetic model, to which 10,000 random 8-h exposures were inputted. Three carcinogenic VOCs were studied (i.e., benzene, perchloroethylene, and acrylonitrile); these compounds are all bioactivated in the liver and represent a wide range of an important toxicokinetic parameter Vmax/QL x KM. For each VOC, simulations were performed using mean air concentrations (muX) between 0.0003 and 1 mg/l (which covers both linear and saturated metabolism) and using coefficients of variation of exposure (CVX) between 0.23 and 2.18 (which includes most occupational settings). Two long-term measures of internal dose were examined, i.e., the area under the liver concentration-time curve (AUCL) and the area under the metabolic rate-time curve (AURC). Interestingly, both AUCL and AURC were linear functions of cumulative exposure (CE, mg x h/l air) even when metabolism was saturated and CVX was large. Yet, at a given CE, both AUCL and AURC were affected by CVX, with the magnitude of the effect increasing with Vmax/QL x KM (i.e., perchloroethylene < benzene < acrylonitrile). Nonetheless, the effects of CVX were typically only a few percent and should be of little consequence unless a VOC has large values of Vmax/QL x KM, muX,and CVX. We conclude that CE should be a sufficient predictor of the dose of either the parent chemical (VOC) or its metabolite in the liver, even when metabolism is nonlinear. We also observed that AUCL and AURC were sensitive to changes in values of model parameters in the high-variability scenarios, suggesting that (when CVX is large) the population variability of AUCL and AURC can be quite large at a fixed CE.

Air samples versus biomarkers for epidemiology.

BACKGROUND: It has been speculated on theoretical grounds that biomarkers are superior surrogates for chemical exposures to air samples in epidemiology studies. METHODS AND RESULTS: Biomarkers were classified according to their position in the exposure-disease continuum-that is, parent compound, reactive intermediate, stable metabolite, macromolecular adduct, or measure of cellular damage. Because airborne exposures and these different biomarkers are time series that vary within and between persons in a population, they are all prone to measurement error effects when used as surrogates for true chemical exposures. It was shown that the attenuation bias in the estimated slope characterising a log exposure-log disease relation should decrease as the within- to between-person variance ratio of a given set of air or biomarker measurements decreases. To gauge the magnitudes of these variance ratios, a database of 12,077 repeated observations was constructed from 127 datasets, including air and biological measurements from either occupational or environmental settings. The within- and between-person variance components (in log scale, after controlling for fixed effects of time) and the corresponding variance ratios for each set of air and biomarker measurements were estimated. It was shown that estimated variance ratios of biomarkers decreased in the order short term (residence time < or =2 days) > intermediate term (2 days < residence time < or =2 months) > long term biomarkers (residence time >2 months). Overall, biomarkers had smaller variance ratios than air measurements, particularly in environmental settings. This suggests that a typical biomarker would provide a less biasing surrogate for exposure than would a typical air measurement. CONCLUSION: Epidemiologists are encouraged to consider the magnitudes of variance ratios, along with other factors related to practicality and cost, in choosing among candidate surrogate measures of exposure.

Specific 5 alpha-dihydrotestosterone receptors in human gingiva.

The cytoplasm of normal human male and female gingiva contains a receptor capable of specifically binding 5 alpha-dihydrotestosterone (DHT). This binding has a high affinity for DHT (Kd, approximately 2.2 x 10-9 M) and a low capacity (approximately 190 fmol/mg protein). The binding is extremely heat sensitive and exhibits a pattern of competition similar to that obtained with DHT receptors from other target tissues. The demonstration of a specific DHT receptor in human gingiva provides the first direct biochemical evidence that this tissue may function as a target organ for androgens. There was no correlation between the Kd in normal tissue and gingival hyperplasia or between the Kd or number of binding sites and the age or sex of the patient. However, there sites and the age or sex of the patient. However, there was a significant difference (P less than 0.0005) between the amount of DHT-binding sites per mg protein in normal tissue as compared to gingival hyperplasia (drugs or pregnancy).

Specific estrogen receptors in human gingiva.

The cytoplasm of normal human male and female gingiva contains a receptor capable of specifically binding 17 beta-estradiol and moxestrol (R-2858) with high affinity (Kd = approximately 3.4 X 10(-10) M) and low capacity (4.5 fmol/mg protein). The binding is sensitive to heat (destroyed by warming to 37 C for 60 min), proteolytic enzymes (pronase, trypsin, and chymotrypsin), and exhibits a pattern of competition similar to that obtained with estrogen receptors from other target tissues. Nuclear uptake of [3H]estradiol was demonstrated by using a dry autoradiographic technique. Specific nuclear localization of [3H]estradiol was found predominantly in basal and spinous layers of gingival epithelium, stromal connective tissue cells (fibroblasts), and endothelial cells and pericytes of small blood vessels in the lamina propria. There was no difference between the Kd values in normal and diseased tissue or between the Kd values or number of binding sites and the age or sex of the patient. However, there was a difference between the amount of estrogen binding sites per mg protein in normal tissue compared to gingiva with dilantin hyperplasia. These results provide the first direct evidence that human gingiva may function as a target organ for estrogens.

Determination of albumin and hemoglobin adducts in workers exposed to styrene and styrene oxide.

Hemoglobin and albumin adducts of the carcinogen styrene-7,8-oxide (SO) were measured in 48 workers exposed to both styrene and SO in a boat manufacturing plant. Personal exposures to both substances were measured repeatedly over the course of 1 year (styrene:0.9-235 mg/m3 with a mean of 64.3 mg/m3 for 48 subjects; S0: 13.4-525 mu g/m3 with a mean of 159 mu g/m3 for 20 subjects). Cysteine and carboxylic acid adducts of SO with hemoglobin and albumin were assayed on one or more occasions for each subject. The proteins were subjected to base hydrolysis to release styrene glycol, representing carboxylic acid-bound SO, and were then treated with Raney nickel to release 1-phenylethanol and 2-phenylethanol, representing cysteine-bound SO. These three analytes were extracted, derivatized, and analyzed by gas chromatography-mass spectrometry. No evidence was found of any exposure-related increase in hemoglobin adducts. In contrast, albumin adducts were found to increase with exposures to either styrene or SO, the latter apparently being more important. This suggests that exposure to low levels of SO in the air may be important among workers in the reinforced plastics industry. Significant levels of SO adducts of albumin and hemoglobin were also detected in proteins obtained from persons without occupational exposure to styrene or to SO. This finding opens the possibility that SO is either a dietary or an environmental contaminant or is produced endogenously.

Protein adducts of 1,4-benzoquinone and benzene oxide among smokers and nonsmokers exposed to benzene in China.

Hemoglobin (Hb) and albumin (Alb) adducts of the benzene metabolites benzene oxide (BO) and 1,4-benzoquinone (1,4-BQ) were analyzed by gas chromatography-mass spectrometry in 43 exposed workers and 44 unexposed controls from Shanghai, China, as part of a larger cross-sectional study of benzene biomarkers. When subjects were divided into controls (n = 44) and workers exposed to 31 ppm (n = 22) of benzene, median 1,4-BQ-Alb adducts were 2110, 5850, and 13,800 pmol/g Alb, respectively (correlation with exposure: Spearman r = 0.762; P < 0.0001); median BO-Alb adducts were 106, 417, and 2400 pmol/g Alb, respectively (Spearman r = 0.877; P < 0.0001); and median BO-Hb adducts were 37.1, 50.5, and 136 pmol/g Hb, respectively (Spearman r = 0.757; P < 0.0001). To our knowledge, this is the first observation that adducts of 1,4-BQ are significantly correlated with benzene exposure. When compared on an individual basis, Alb adducts of 1,4-BQ and BO and Hb adducts of BO were highly correlated with each other and with urinary phenol and hydroquinone (P < 0.0001 for all of the comparisons). Although detectable in the assays, Hb adducts of 1,4-BQ and both Hb and Alb adducts of 1,2-BQ produced erratic results and are not reported. Interestingly, cigarette smoking increased Alb adducts of 1,4-BQ but not of BO, suggesting that benzene from cigarette smoke was not the primary contributor to the 1,4-BQ adducts.

Volatilization of mutagens from beef during cooking.

The process of cooking beef substances which are mutagenic in the Ames Salmonella/microsome bioassay [1,2]. In this study, the formation and disposition of basic mutagens produced by cooking beef at different temperatures were examined. Mutagenic activity increased exponentially with cooking temperature between 137 degrees C and 252 degrees C. However, the amount of mutagenic activity remaining in the meat was only 1--7% of that which was volatilized into the air. The ingested dose of mutagens may therefore be significantly influenced by factors which restrict the dissipation of mutagens from the container, as well as by cooking temperature. Inhalation of airborne mutagens from cooking, as an alternative route of exposure, should be investigated when considered in light of some epidemiological data showing an excess of lung and bladder cancer among cooks and kitchen workers.

Direct-acting mutagens in automobile exhaust.

Particulate matter in city air contains chemicals which are mutagenic in the Ames Salmonella typhimurium assay. In residential urban areas, the principal mutagens in air do not require liver enzymes to be activated. The source of these liver independent (direct-acting) mutagens may be automobile exhaust because (1) the mutagenic activities were correlated to the lead content or air, (2) the mutagens were found exhaust samples from automobiles and from an experimental CFR single-cylinder gasoline engine, and (3) these mutagens were not found in fuel or unused motor oil, but were found in used motor oil. The strain specificity and the fact that liver enzymes were not required for activation indicated that the exhaust and airborne mutagens were not unsubstituted polycyclic aromatic hydrocarbons (PAH), aromatic amines, alkylnitrosamines or aliphatic epoxides, peroxides and hydroepoxides. A number of nitro-substituted aromatic compounds are direct-acting mutagens in the Ames test, and it is possible that nitration of PAH in exhaust may form the compounds observed here. We synthesized 6-nitrobenzo [a] pyrene and found it to be a potent, direct-acting mutagen with activity comparable to that of benzo-[a] pyrene.

A lung retention model based on Michaelis-Menten-like kinetics.

A Michaelis-Menten (MM)-like kinetic model for pulmonary clearance and retention of insoluble dusts was developed and validated by comparing our predictions with experimental data from F344 rats. Published data from inhalation studies involving accumulation and elimination of photocopy test toner, antimony trioxide, carbon black, and diesel exhaust particles were investigated. Numerical integration techniques were used to solve mass balance relationships based upon dust retention in a single lung compartment and clearance via an MM-like kinetic process. The model fit most of the experimental data well. The parameters of MM-like clearance kinetics, which had been derived strictly from the elimination phase, accurately predicted dust retention during the elimination as well as accumulation phases. Furthermore, parameters estimated from one study could accurately predict retention of the same dust in other studies. Particle density and gender of the animals had no effect on the goodness of fit of model predictions. This study suggests that MM-like kinetics offer a reasonable description of particle clearance from the pulmonary region of the rat lung that is more parsimonious than existing particle-clearance models and therefore more suitable for use with small amounts of data.

Health aspects of the curing of synthetic rubbers.

A commonly used tread rubber formulation was cured in the laboratory under conditions simulating vulcanization in the Bag-O-Matic press. Volatile emissions were collected on charcoal and analyzed by combined GC-mass spectrometry. The compounds identified were either contaminants present in the raw material or reaction products. Some of these compounds were also identified in charcoal tube samples collected in the atmosphere of the industrial operations. Estimates based on the loss of weight of rubber during curing were used to predict airborne concentrations and compared to the concentrations actually found. The literature of the toxicity of raw materials and effluents was reviewed, and no acute or chronic toxicological effects would be anticipated. Information concerning potential carcinogenicity was not available and could not be evaluated.

Environmental and biological monitoring of benzene during self-service automobile refueling.

Although automobile refueling represents the major source of benzene exposure among the nonsmoking public, few data are available regarding such exposures and the associated uptake of benzene. We repeatedly measured benzene exposure and uptake (via benzene in exhaled breath) among 39 self-service customers using self-administered monitoring, a technique rarely used to obtain measurements from the general public (130 sets of measurements were obtained). Benzene exposures averaged 2.9 mg/m(3) (SD = 5.8 mg/m(3); median duration = 3 min) with a range of < 0.076-36 mg/m(3), and postexposure breath levels averaged 160 microg/m(3) (SD = 260 microg/m(3)) with a range of < 3.2-1,400 microg/m(3). Log-transformed exposures and breath levels were significantly correlated (r = 0.77, p < 0.0001). We used mixed-effects statistical models to gauge the relative influences of environmental and subject-specific factors on benzene exposure and breath levels and to investigate the importance of various covariates obtained by questionnaire. Model fitting yielded three significant predictors of benzene exposure, namely, fuel octane grade (p = 0.0011), duration of exposure (p = 0.0054), and season of the year (p = 0.032). Likewise, another model yielded three significant predictors of benzene concentration in breath, specifically, benzene exposure (p = 0.0001), preexposure breath concentration (p = 0.0008), and duration of exposure (p = 0.038). Variability in benzene concentrations was remarkable, with 95% of the estimated values falling within a 274-fold range, and was comprised entirely of the within-person component of variance (representing exposures of the same subject at different times of refueling). The corresponding range for benzene concentrations in breath was 41-fold and was comprised primarily of the within-person variance component (74% of the total variance). Our results indicate that environmental rather than interindividual differences are primarily responsible for benzene exposure and uptake during automobile refueling. The study also demonstrates that self-administered monitoring can be efficiently used to measure environmental exposures and biomarkers among the general public.

The use of protein adducts to investigate the disposition of reactive metabolites of benzene.

Benzene is metabolized to a number of electrophilic species that are capable of binding to both DNA and proteins. We used adducts of hemoglobin (Hb) and bone marrow proteins to study the disposition of three benzene and metabolites (benzene oxide [BO], 1,2-benzoquinone [1,2-BQ], and 1,4-benzoquinone [1,4-BQ]) in F344 rats and B6C3F1 mice following a single oral dosage of [13C6]benzene and/or [14C]benzene. Our assays focused upon cysteine adducts that accounted for 38 to 45% of protein binding to Hb and 63 to 81% of protein binding to bone marrow. Although both mice and rats showed dose-related increases in Hb and bone marrow protein adducts of BO and of the two benzoquinones, large intertissue and interspecies differences were noted, suggesting different preferences in metabolic pathways. The highest levels of adducts in mice were of 1,4-BQ (10-27% of all cysteine adducts), while in rats, BO adducts predominated in Hb (73% of all cysteine adducts) and 1,2-BQ adducts predominated in the bone marrow (14% of all cysteine adducts). High background levels of 1,2-BQ and 1,4-BQ adducts were also detected in both species, indicating that the toxic effects of quinone metabolites may only be important at high levels of benzene exposure.

The relationship between environmental monitoring and biological markers in exposure assessment.

The poor quality of traditional assessments of exposure has encouraged epidemiologists to explore biological monitoring in studies of chronic diseases. Yet, despite theoretical advantages, biomarkers have not been widely used in such applications. This article compares the general utility of a biomarker with that of the measurement of exposure per se. Points are illustrated with a longitudinal study of boat workers in which levels of styrene in the breathing zone and in exhaled air were compared to sister chromatid exchanges (SCEs) in peripheral lymphocytes. First, the linear relationship is explored between personal exposure and the levels of a biomarker in the cohort. A good fit to the straight-line relationship reflected by a correlation coefficient which is close to 1, such as observed with styrene in exhaled air (r2 = 0.83), suggests linear kinetics, that the appropriate route of exposure was measured by personal monitoring, small interindividual differences, adequate sample sizes, and a specific biomarker. However, a small correlation coefficient, as observed between SCEs and styrene exposure (r2 = 0.11), indicates that either kinetics were nonlinear or that more complex issues were involved with one or more of these factors. Second, environmental and biologic measurements are compared for use as independent variables in establishing a straight-line relationship between exposure and the health effect. If the ratio of the within-person to the between-person components of variance of the independent variable is large, then significant attenuation results when estimating the slope of the line.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of the glycophorin A human mutation assay to study workers exposed to styrene.

The glycophorin A (GPA) assay is a human mutation assay that is potentially useful for large epidemiological studies. The assay is rapid and requires a minimal amount of blood, which can be stored before analysis. The data presented here were collected from workers exposed to styrene in a boat manufacturing plant. This study was the first to apply the GPA assay to an occupationally exposed population. Subjects with a mean styrene exposure of 30 ppm had a higher frequency of GPA N phi variant cells than subjects with mean exposure of 1 ppm, but the subjects differed in respect to smoking and age distribution. Results indicate that the original 1-W-1 version of the assay may not be suitable for studies of small numbers of exposed subjects due to variability and artifacts. The newer BR6 version, however, has much lower variability and shows promise for use in the occupational setting.

The value of age and severity as predictors of costs in geriatric head trauma patients.

The costs of inpatient hospital care for treating head trauma were examined in 125 patients over the age of 50. Regression analysis indicated that injury severity, as measured by the admitting Glasgow Coma Scale, was a good predictor of hospital cost, while patient age was unrelated to cost. The regression relationship, however, was quadratic (not linear), indicating that least injured and severely injured patients cost less than moderately injured patients. These findings are in direct contrast with the commonly held belief that the elderly consume more hospital resources than younger patients. They suggest the need for a reexamination of the use of age in setting prospective reimbursement amounts in certain diagnoses, and in making resource allocation decisions relative to geriatric programming at the hospital level. Head trauma patients are costly because they are sick, not because they are old.