Kidney injury biomarkers and urinary creatinine variability in nominally healthy adults.

Environmental exposure diagnostics use creatinine concentrations in urine aliquots as the internal standard for dilution normalization of all other excreted metabolites when urinary excretion rate data are not available. This is a reasonable approach for healthy adults as creatinine is a human metabolite that is continually produced in skeletal muscles and presumably excreted in the urine at a stable rate. However, creatinine also serves as a biomarker for glomerular filtration rate (efficiency) of the kidneys, so undiagnosed kidney function impairment could affect this commonly applied dilution calculation. The United States Environmental Protection Agency (US EPA) has recently conducted a study that collected approximately 2600 urine samples from 50 healthy adults, aged 19-50 years old, in North Carolina in 2009-2011. Urinary ancillary data (creatinine concentration, total void volume, elapsed time between voids), and participant demographic data (race, gender, height, and body weight) were collected. A representative subset of 280 urine samples from 29 participants was assayed using a new kidney injury panel (KIP). In this article, we investigated the relationships of KIP biomarkers within and between subjects and also calculated their interactions with measured creatinine levels. The aims of this work were to document the analytical methods (procedures, sensitivity, stability, etc.), provide summary statistics for the KIP biomarkers in "healthy" adults without diagnosed disease (distribution, fold range, central tendency, variance), and to develop an understanding as to how urinary creatinine level varies with respect to the individual KIP proteins. Results show that new instrumentation and data reduction methods have sufficient sensitivity to measure KIP levels in nominally healthy urine samples, that linear regression between creatinine concentration and urinary excretion explains only about 68% of variability, that KIP markers are poorly correlated with creatinine (r(2) ∼ 0.34), and that statistical outliers of KIP markers are not random, but are clustered within certain subjects. In addition, we interpret these new adverse outcome pathways based in vivo biomarkers for their potential use as intermediary chemicals that may be diagnostic of kidney adverse outcomes to environmental exposure.

Post-operative elimination of sevoflurane anesthetic and hexafluoroisopropanol metabolite in exhaled breath: pharmacokinetic models for assessing liver function.

Sevoflurane (SEV), a commonly used anesthetic agent for invasive surgery, is directly eliminated via exhaled breath and indirectly by metabolic conversion to inorganic fluoride and hexafluoroisopropanol (HFIP), which is also eliminated in the breath. We studied the post-operative elimination of SEV and HFIP of six patients that had undergone a variety of surgeries lasting between 2.5 to 8.5 h using exhaled breath analysis. A classical three compartments pharmacokinetic model developed for the study of environmental contaminants was fitted to the breath data. We found that SEV kinetic behavior following surgery (for up to six days) is consistent across all subjects whereas the production and elimination of HFIP varies to some extent. We developed subject specific parameters for HFIP metabolism and interpreted the differences in the context of timing and dose of anesthesia, type of surgery, and specific host factors. We propose methods for assessing individual patient liver function using SEV as a probe molecule for assessing efficiency of liver metabolism to HFIP. This work is valuable not only for the clinical study of metabolism recovery, but potentially also for the study of the interaction of other manufactured and environmental compounds with human systems biology in controlled exposure and observational studies.

Cumulative exposure assessment for trace-level polycyclic aromatic hydrocarbons (PAHs) using human blood and plasma analysis.

Humans experience chronic cumulative trace-level exposure to mixtures of volatile, semi-volatile, and non-volatile polycyclic aromatic hydrocarbons (PAHs) present in the environment as by-products of combustion processes. Certain PAHs are known or suspected human carcinogens and so we have developed methodology for measuring their circulating (blood borne) concentrations as a tool to assess internal dose and health risk. We use liquid/liquid extraction and gas chromatography-mass spectrometry and present analytical parameters including dynamic range (0-250 ng/ml), linearity (>0.99 for all compounds), and instrument sensitivity (range 2-22 pg/ml) for a series of 22 PAHs representing 2-6-rings. The method is shown to be sufficiently sensitive for estimating PAHs baseline levels (typical median range from 1 to 1000 pg/ml) in groups of normal control subjects using 1-ml aliquots of human plasma but we note that some individuals have very low background concentrations for 5- and 6-ring compounds that fall below robust quantitation levels.

Application of novel method to measure endogenous VOCs in exhaled breath condensate before and after exposure to diesel exhaust.

Polar volatile organic compounds (PVOCs) such as aldehydes and alcohols are byproducts of normal human metabolism and thus are found in blood and exhaled breath. Perturbation of the normal patterns of such metabolites may reflect exposures to environmental stressors, disease state, and human activity. Presented herein is a specific methodology for assaying PVOC biomarkers in exhaled breath condensate (EBC) samples with application to a series of samples from a controlled chamber exposure to dilute diesel exhaust (DE) or to purified air. The collection/analysis method is based on condensation of normal (at rest) exhaled breaths for 10 min (resulting in 1-2 ml of liquid) with subsequent analyte adsorption onto Tenax cartridges followed by thermal desorption and analysis by gas chromatography/mass spectrometry (GC/MS). Analytical data have linearity of response (R(2)>0.98) across a range of 0-160 ng/ml with a detection limit ranging from 0.2 to 7 ng/ml depending on the compound. Statistical analyses of the results of the controlled exposure study indicate that metabolism, as reflected in simple breath-borne oxygenated species, is not affected by exposure to ambient airborne levels of DE. Linear mixed-effects models showed that PVOC biomarker levels are affected by gender and vary significantly among nominally healthy subjects. Differences among PVOCs analyzed in clinic air, purified chamber air, and chamber air containing dilute DE confirm that most of the compounds are likely of endogenous origin as the exogenous exposure levels did not perturb the EBC measurements.

Responses measured in the exhaled breath of human volunteers acutely exposed to ozone and diesel exhaust.

Exhaled breath collection is used to identify and monitor inflammatory or oxidative components in breath. Exhaled breath sample collection is noninvasive and would greatly benefit human pollutant exposure research. We demonstrate the efficacy of exhaled breath collection and analysis in two human exposure studies to ozone (O(3)) and diesel exhaust, respectively. O(3) study: we collected exhaled breath (gas phase) from healthy human volunteers (age 18-35 years, 12 subjects) immediately before and after exposure to filtered air or 0.4 ppm O(3) for 2 h with and without intermittent exercise. Six subjects received antioxidant supplementation for 2 weeks before their O(3) exposure, while the remaining six subjects received placebo treatments. We demonstrate increased amounts of non-polar carbonyls exhaled immediately post O(3) exposure. The O(3)-induced increase in exhaled carbonyl concentrations was attenuated in the group receiving antioxidants. Our data demonstrate that exhaled exposure biomarkers can be measured in the breath gas phase in humans exposed to O(3). Diesel study: we collected exhaled breath condensate (EBC; liquid phase) from healthy human volunteers (age 18-40 years; 10 subjects) immediately before, immediately after and 20 h post filtered air or diesel exhaust (106 ± 9 µg m(-3)) exposure. Clean air and diesel exposures were separated by 3 weeks to 6 months. We obtained reproducible intra-subject EBC volumes and total protein concentrations across our six collection time points. Diesel exposure did not affect either EBC volume or total protein concentrations. Our data demonstrated EBC volume and total protein reproducibility over several months. Volume and total protein concentration may serve as normalizing factors for other EBC constituents.

Exposure reconstruction for reducing uncertainty in risk assessment: example using MTBE biomarkers and a simple pharmacokinetic model.

Adverse health risks from environmental agents are generally related to average (long-term) exposures. Because a given individual's contact with a pollutant is highly variable and dependent on activity patterns, local sources and exposure pathways, simple 'snapshot' measurements of surrounding environmental media may not accurately assign the exposure level. Furthermore, susceptibility to adverse effects from contaminants is considered highly variable in the population so that even similar environmental exposure levels may result in differential health outcomes in different individuals. The use of biomarker measurements coupled to knowledge of rates of uptake, metabolism and elimination has been suggested as a remedy for reducing this type of uncertainty. To demonstrate the utility of such an approach, we invoke results from a series of controlled human exposure tests and classical first-order rate kinetic calculations to estimate how well spot measurements of methyl tertiary butyl ether and the primary metabolite, tertiary butyl alcohol, can be expected to predict different hypothetical scenarios of previous exposures. We found that blood and breath biomarker measurements give similar results and that the biological damping effect of the metabolite production gives more stable estimates of previous exposure. We also explore the value of a potential urinary biomarker, 2-hydroxyisobutyrate suggested in the literature. We find that individual biomarker measurements are a valuable tool in reconstruction of previous exposures and that a simple pharmacokinetic model can identify the time frames over which an exogenous chemical and the related chemical biomarker are useful. These techniques could be applied to broader ranges of environmental contaminants to assess cumulative exposure risks if ADME (Absorption, Distribution, Metabolization and Excretion) is understood and systemic biomarkers can be measured.

Evaluation of methyl tert-butyl ether (MTBE) as an interference on commercial breath-alcohol analyzers.

Anecdotal reports suggest that high environmental or occupational exposures to the fuel oxygenate methyl tert-butyl ether (MTBE) may result in breath concentrations that are sufficiently elevated to cause a false positive on commercial breath-alcohol analyzers. We evaluated this possibility in vitro by establishing a response curve for simulated breath containing MTBE in ethanol. Two types of breath-alcohol analyzers were evaluated. One analyzer's principle of operation involves in situ wet chemistry (oxidation of ethanol in a potassium dichromate solution) and absorption of visible light. The second instrument uses a combination of infrared absorption and an electrochemical sensor. Both types of instruments are currently used, although the former method represents older technology while the latter method represents newer technology.The percent blood alcohol response curve was evaluated over a breath concentration range thought to be relevant to high-level environmental or occupational exposure (0-361 microg/l). Results indicate that MTBE positively biases the response of the older technology Breathalyzer when evaluated as a single constituent or in combination with ethanol. We conclude that a false positive is possible on this instrument if the MTBE exposure is very high, recent with respect to testing, and occurs in combination with ethanol consumption. The interference can be identified on the older technology instrument by a time dependent post-reading increase in the instrument response that does not occur for ethanol alone. In contrast, the newer technology instrument using infrared and electrochemical detectors did not respond to MTBE at lower levels (0-36 microg/l), and at higher levels (>72 microg/l) the instrument indicated an "interference" or "error". For this instrument, a false positive does not occur even at high MTBE levels in the presence of ethanol.

Optimized determination of trace jet fuel volatile organic compounds in human blood using in-field liquid-liquid extraction with subsequent laboratory gas chromatographic-mass spectrometric analysis and on-column large-volume injection.

A practical and sensitive method to assess volatile organic compounds (VOCs) from JP-8 jet fuel in human whole blood was developed by modifying previously established liquid-liquid extraction procedures, optimizing extraction times, solvent volume, specific sample processing techniques, and a new on-column large-volume injection method for GC-MS analysis. With the optimized methods, the extraction efficiency was improved by 4.3 to 20.1 times and the detection sensitivity increased up to 660 times over the standard method. Typical detection limits in the parts-per-trillion (ppt) level range were achieved for all monitored JP-8 constituents; this is sufficient for assessing human fuels exposures at trace environmental levels as well as occupational exposure levels. The sample extractions are performed in the field and only solvent extracts need to be shipped to the laboratory. The method is implemented with standard biological laboratory equipment and a modest bench-top GC-MS system.

Real-time and integrated measurement of potential human exposure to particle-bound polycyclic aromatic hydrocarbons (PAHs) from aircraft exhaust.

We used real-time monitors and low-volume air samplers to measure the potential human exposure to airborne polycyclic aromatic hydrocarbon (PAH) concentrations during various flight-related and ground-support activities of C-130H aircraft at an Air National Guard base. We used three types of photoelectric aerosol sensors (PASs) to measure real-time concentrations of particle-bound PAHs in a break room, downwind from a C-130H aircraft during a four-engine run-up test, in a maintenance hangar, in a C-130H aircraft cargo bay during cargo-drop training, downwind from aerospace ground equipment (AGE), and in a C-130H aircraft cargo bay during engine running on/off (ERO) loading and backup exercises. Two low-volume air samplers were collocated with the real-time monitors for all monitoring events except those in the break room and during in-flight activities. Total PAH concentrations in the integrated-air samples followed a general trend: downwind from two AGE units > ERO-loading exercise > four-engine run-up test > maintenance hangar during taxi and takeoff > background measurements in maintenance hangar. Each PAH profile was dominated by naphthalene, the alkyl-substituted naphthalenes, and other PAHs expected to be in the vapor phase. We also found particle-bound PAHs, such as fluoranthene, pyrene, and benzo[a]pyrene in some of the sample extracts. During flight-related exercises, total PAH concentrations in the integrated-air samples were 10-25 times higher than those commonly found in ambient air. Real-time monitor mean responses generally followed the integrated-air sample trends. These monitors provided a semiquantitative temporal profile of ambient PAH concentrations and showed that PAH concentrations can fluctuate rapidly from a baseline level < 20 to > 4,000 ng/m(3) during flight-related activities. Small handheld models of the PAS monitors exhibited potential for assessing incidental personal exposure to particle-bound PAHs in engine exhaust and for serving as a real-time dosimeter to indicate when respiratory protection is advisable.

Personal exposure to JP-8 jet fuel vapors and exhaust at air force bases.

JP-8 jet fuel (similar to commercial/international jet A-1 fuel) is the standard military fuel for all types of vehicles, including the U.S. Air Force aircraft inventory. As such, JP-8 presents the most common chemical exposure in the Air Force, particularly for flight and ground crew personnel during preflight operations and for maintenance personnel performing routine tasks. Personal exposure at an Air Force base occurs through occupational exposure for personnel involved with fuel and aircraft handling and/or through incidental exposure, primarily through inhalation of ambient fuel vapors. Because JP-8 is less volatile than its predecessor fuel (JP-4), contact with liquid fuel on skin and clothing may result in prolonged exposure. The slowly evaporating JP-8 fuel tends to linger on exposed personnel during their interaction with their previously unexposed colleagues. To begin to assess the relative exposures, we made ambient air measurements and used recently developed methods for collecting exhaled breath in special containers. We then analyzed for certain volatile marker compounds for JP-8, as well as for some aromatic hydrocarbons (especially benzene) that are related to long-term health risks. Ambient samples were collected by using compact, battery-operated, personal whole-air samplers that have recently been developed as commercial products; breath samples were collected using our single-breath canister method that uses 1-L canisters fitted with valves and small disposable breathing tubes. We collected breath samples from various groups of Air Force personnel and found a demonstrable JP-8 exposure for all subjects, ranging from slight elevations as compared to a control cohort to > 100 [mutilpe] the control values. This work suggests that further studies should be performed on specific issues to obtain pertinent exposure data. The data can be applied to assessments of health outcomes and to recommendations for changes in the use of personal protective equipment that optimize risk reduction without undue impact on a mission.

Method for liquid-liquid extraction of blood surrogates for assessing human exposure to jet fuel.

A baseline method of liquid-liquid extraction for assessing human exposure to JP-8 jet fuel was established by extracting several representative compounds ranging from very volatile to semi-volatile organic compounds, including benzene, toluene, nonane, decane, undecane, tridecane, tetradecane and pentadecane, from PBS buffer. Some specific techniques for solvent selection, solvent evaporation, and GC analysis were developed to accommodate this wide range of constituents of JP-8. The application of the established method to the extraction and quantitative analysis of JP-8 from PBS and bovine plasma was demonstrated.

Sample timing and mathematical considerations for modeling breath elimination of volatile organic compounds.

Real-world exposure measurements are a necessary ingredient for subsequent detailed study of the risks from an environmental pollutant. For volatile organic compounds, researchers are applying exhaled breath analysis and the time dependence of concentrations as a noninvasive indicator of exposure, dose, and blood levels. To optimize the acquisition of such data, samples must be collected in a time frame suited to the needs of the mathematical model, within physical limitations of the equipment and subjects, and within logistical constraints. Additionally, one must consider the impact of measurement error on the eventual extraction of biologically and physiologically relevant parameters. Given a particular mathematical model for the elimination kinetics (in this case a very simple pharmacokinetic model based upon a multiterm exponential decay function that has been shown to fit real-world data extremely well), we investigated the effects on synthetic data caused by sample timing, random measurement error, and number of terms included in the model. This information generated a series of conditions for collecting samples and performing analyses dependent upon the eventual informational needs, and it provided an estimate of error associated with various choices and compromises. Though the work was geared specifically toward breath sampling, it is equally applicable to direct blood measurements in optimizing sampling strategy and improving the exposure assessment process.

Trichloroethene levels in human blood and exhaled breath from controlled inhalation exposure.

The organic constituents of exhaled human breath are representative of bloodborne concentrations through gas exchange in the blood/breath interface in the lungs. The presence of specific compounds can be an indicator of recent exposure or represent a biological response of the subject. For volatile organic compounds, sampling and analysis of breath is preferred to direct measurement from blood samples because breath collection is noninvasive, potentially infectious waste is avoided, the sample supply is essentially limitless, and the measurement of gas-phase analytes is much simpler in a gas matrix rather than in a complex biological tissue such as blood. However, to assess the distribution of a contaminant in the body requires a reasonable estimate of the blood level. We have investigated the use of noninvasive breath measurements as a surrogate for blood measurements for (high) occupational levels of trichloroethene in a controlled exposure experiment. Subjects were placed in an exposure chamber for 24 hr; they were exposed to 100 parts per million by volume trichloroethene for the initial 4 hr and to purified air for the remaining 20 hr. Matched breath and blood samples were collected periodically during the experiment. We modeled the resulting concentration data with respect to their time course and assessed the blood/breath relationship during the exposure (uptake) period and during the postexposure (elimination) period. Estimates for peak blood levels, compartmental distribution, and time constants were calculated from breath data and compared to direct blood measurements to assess the validity of the breath measurement methodology. Blood/breath partition coefficients were studied during both uptake and elimination. At equilibrium conditions at the end of the exposure, we could predict actual blood levels using breath elimination curve calculations and a literature value partition coefficient with a mean ratio of calculated:measured of 0.98 and standard error (SE) = 0.12 across all subjects. blood/breath comparisons at equilibrium resulted in calculated in vivo partition coefficients with a mean of 10.8 and SE = 0.60 across all subjects and experiments and 9.69 with SE = 0.93 for elimination-only experiments. We found that about 78% of trichloroethene entering the body during inhalation exposure is metabolized, stored, or excreted through routes other than exhalation.

Alveolar breath sampling and analysis to assess trihalomethane exposures during competitive swimming training.

Alveolar breath sampling was used to assess trihalomethane (THM) exposures encountered by collegiate swimmers during a typical 2-hr training period in an indoor natatorium. The breath samples were collected at regular intervals before, during, and for 3 hr after a moderately intense training workout. Integrated and grab whole-air samples were collected during the training period to help determine inhalation exposures, and pool water samples were collected to help assess dermal exposures. Resulting breath samples collected during the workout demonstrated a rapid uptake of two THMs (chloroform and bromodichloromethane), with chloroform concentrations exceeding the natatorium air levels within 8 min after the exposure began. Chloroform levels continued to rise steeply until they were more than two times the indoor levels, providing evidence that the dermal route of exposure was relatively rapid and ultimately more important than the inhalation route in this training scenario. Chloroform elimination after the exposure period was fitted to a three compartment model that allowed estimation of compartmental half-lives, resulting minimum bloodborne dose, and an approximation of the duration of elevated body burdens. We estimated the dermal exposure route to account for 80% of the blood chloroform concentration and the transdermal diffusion efficiency from the water to the blood to in excess of 2%. Bromodichloromethane elimination was fitted to a two compartment model which provided evidence of a small, but measurable, body burden of this THM resulting from vigorous swim training. These results suggest that trihalomethane exposures for competitive swimmers under prolonged, high-effort training are common and possibly higher than was previously thought and that the dermal exposure route is dominant. The exposures and potential risks associated with this common recreational activity should be more thoroughly investigated.

Exhaled human breath measurement method for assessing exposure to halogenated volatile organic compounds.

The organic constituents of exhaled human breath are representative of blood-borne concentrations through gas exchange in the blood/breath interface in the lungs. The presence of specific compounds can be an indicator of recent exposure or represent a biological response of the subject. For volatile organic compounds (VOCs), sampling and analysis of breath is preferred to direct measurement from blood samples because breath collection is noninvasive, potentially infectious waste is avoided, and the measurement of gas-phase analytes is much simpler in a gas matrix rather than in a complex biological tissue such as blood. To exploit these advantages, we have developed the "single breath canister" (SBC) technique, a simple direct collection method for individual alveolar breath samples, and adapted conventional gas chromatography-mass spectrometry analytical methods for trace-concentration VOC analysis. The focus of this paper is to describe briefly the techniques for making VOC measurements in breath, to present some specific applications for which these methods are relevant, and to demonstrate how to estimate exposure to example VOCs on the basis of breath elimination. We present data from three different exposure scenarios: (a) vinyl chloride and cis-1,2-dichloroethene from showering with contaminated water from a private well, (b) chloroform and bromodichloromethane from high-intensity swimming in chlorinated pool water, and (c) trichloroethene from a controlled exposure chamber experiment. In all cases, for all subjects, the experiment is the same: preexposure breath measurement, exposure to halogenated VOC, and a postexposure time-dependent series of breath measurements. Data are presented only to demonstrate the use of the method and how to interpret the analytical results.

A methodological approach for exposure assessment studies in residences using volatile organic compound-contaminated water.

This paper presents a methodological approach for assessing total exposures to volatile organic compounds (VOCs) in residences using contaminated water supplies. This approach is founded on assessment of ingestion, inhalation, and dermal exposures; both long-term (i.e., 12 to 24 hr) low-level exposures and short-term (i.e., approximately 10 min) high-level exposures are considered. The methodology is based on the collection of water samples to establish the identity of the contaminants, maximum source terms, and possible dermal and ingestion exposures; integrated whole-air samples are collected to assess long- and short-term inhalation exposures; whole-air grab samples are used to confirm peak and typical inhalation exposures; and alveolar breath samples are used to confirm exposures and to estimate contaminant concentrations in the blood of the test subjects. While we do not suggest that this methodology should supersede any current investigative approach, this material is primarily offered as a consolidated reference to the many people or organizations who might contemplate a study of this type. Application of this investigative protocol should provide detailed exposure assessment information, while it supplies critical real world data for risk assessment specialists, toxicologists, and modeling experts. Data from a recent field study assessing exposures to trichloroethylene are presented to illustrate the utility and some of the limitations of this strategy.

Alveolar breath sampling and analysis to assess exposures to methyl tertiary butyl ether (MTBE) during motor vehicle refueling.

Methyl tertiary butyl ether (MTBE) is added to gasoline (15% by volume) in many areas of the U.S. to help control carbon monoxide emissions from motor vehicles. In this study we present a sampling and analytical methodology that can be used to assess consumers' exposures to MTBE that may result from routine vehicle refueling operations. The method is based on the collection of alveolar breath samples using evacuated one-liter stainless steel canisters and analysis using a gas chromatograph-mass spectrometer equipped with a patented "valveless" cryogenic preconcentrator. To demonstrate the utility of this approach, a series of breath samples was collected from two individuals (the person pumping the fuel and a nearby observer) immediately before and for 64 min after a vehicle was refueled with premium grade gasoline. Results demonstrate low levels of MTBE in both subjects' breaths before refueling, and levels that increased by a factor of 35 to 100 after the exposure. Breath elimination models fitted to the post exposure measurements indicate that the half-life of MTBE in the first physiological compartment was between 1.3 and 2.9 min. Analysis of the resulting models suggests that breath elimination of MTBE during the 64 min monitoring period was approximately 115 micrograms for the refueling subject while it was only 30 micrograms for the nearby observer. This analysis also shows that the post exposure breath elimination of other gasoline constituents was consistent with previously published observations. These results demonstrate that this new methodology can be used effectively in studies designed to assess exposures to MTBE. The method can be used to objectively demonstrate recent exposures, the relative magnitude of an exposure, and the approximate duration of the resulting bloodborne dose. Once a blood/breath partition coefficient for MTBE has been firmly established, the bloodborne concentration of the absorbed material can be determined using these techniques as well.

Collection of a single alveolar exhaled breath for volatile organic compounds analysis.

Measurement of specific organic compounds in exhaled breath has been used as an indicator of recent exposure to pollutants or as an indicator of the health of an individual. A typical application involves the collection of multiple breaths onto a sorbent cartridge or into an evacuated canister with the use of a relatively complex sampling apparatus. A new method has been developed wherein a single exhaled breath is directly transferred from the mouth into an evacuated 1 l or 1.8 l stainless steel SUMMA canister. The single breath canister (SBC) method avoids the necessity for a complex sampling system requiring maintenance and cleaning and allows easy collection of samples. Additionally, it is possible to collect a rapid sequence of samples from a subject to establish the elimination curve subsequent to an exposure to specific volatile organic compounds with a theoretical resolution of adjacent breaths. The SBC method was compared to an accepted canister based sampling system to assure comparability and then used to demonstrate its utility by measuring the absorption and elimination of chloroform during and after exposure to chlorinated shower water.