National Human Exposure Assessment Survey (NHEXAS): distributions and associations of lead, arsenic and volatile organic compounds in EPA region 5.

The National Human Exposure Assessment Survey (NHEXAS) Phase I field study conducted in EPA Region 5 provides extensive exposure data on approximately 250 study participants selected via probability sampling. Associated environmental media and biomarker (blood, urine) concentration data were also obtained to aid in the understanding of relationships of the exposures to both contaminant sources and doses. Distributional parameters for arsenic (As), lead (Pb), and four volatile organic compounds (VOCs)--benzene, chloroform, tetrachloroethylene, and trichloroethylene--were estimated for each of the relevant media using weighted data analysis techniques. Inter-media associations were investigated through correlation analysis, and longitudinal correlations and models were used to investigate longitudinal patterns. Solid food appeared to be a major contributor to urine As levels, while Pb levels in household (HH) dust, personal air, and beverages all were significantly associated with blood Pb levels. Relatively high (>0.50) longitudinal correlations were observed for tap water Pb and As, as compared to only moderate longitudinal correlations for the personal air VOCs.

When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220 000 cases.

BACKGROUND: Previous studies have suggested that there is an increase in cardiac events in the morning. Fewer data relate cardiac events to months of the year and season. METHODS AND RESULTS: We analyzed all monthly death certificate data from Los Angeles County, California, for death caused by coronary artery disease from 1985 through 1996 (n=222 265). The mean number of deaths was highest in December at 1808 and January at 1925; the lowest rates were in June, July, August, and September at 1402, 1424, 1418, and 1371, respectively. December and January had significantly higher rates than would be expected from a uniform distribution of monthly deaths (P=0.00001). The percent of yearly coronary deaths was defined by the quadratic U-shaped equation [percent=13.1198-1.5238(month)+0. 0952(month(2)), where January=1, February=2, etc]. When monthly deaths were plotted by year, there was a decrease from 1985 through 1996. Monthly mortality correlated inversely with temperature. During the months with the highest frequency of death (December, January), however, there was an increase in deaths that peaked around the holiday season and then fell, which could not be explained solely on the basis of the daily temperature change. CONCLUSIONS: Even in the mild climate of Los Angeles County, there are seasonal variations in the development of coronary artery death, with approximately 33% more deaths occurring in December and January than in June through September. Although cooler temperatures may play a role, other factors such as overindulgence or the stress of the holidays might also contribute to excess deaths during these peak times.

National human exposure assessment survey (NHEXAS): exploratory survey of exposure among population subgroups in EPA Region V.

The National Human Exposure Assessment Survey (NHEXAS) provides a rich database of exposure and environmental measurements for persons living in EPA Region V (Great Lakes). Demographics (e.g., gender, minority status, age, income, and year home built) between U.S. Census data and the overall Region V sample were compared and showed good agreement. This representative sample was used to conduct an exploratory investigation of selected subpopulations that might exhibit higher exposures, on average, to volatile organic chemicals (VOCs) such as benzene, chloroform, etc.; inspirable particles; and metals (e.g., lead, arsenic, etc.) than the general population in Region V. Means and medians were the metrics of comparison. Personal air exposures for p-dichlorobenzene were significantly higher in adults (> 21 years old) than in children (1-14 years old) (median: below detection limit vs. 0.87 microgram/m3, p = 0.0005), while a trend toward higher levels of arsenic exposure in children than adults was observed (median: 1.13 vs. 0.8 ng/m3, p = 0.083). A trend towards higher personal air exposure to lead for minorities vs. nonminorities was evident (median: 26 vs. 12 ng/m3, p = 0.066), but personal exposure to 1,1,1-trichloroethane tended to be higher in nonminorities (mean: 22 vs. 3.7 micrograms/m3, p = 0.081). Dietary exposure to arsenic from solid foods was significantly higher in adults than children (mean: 21 vs. 7.1 micrograms/kg, p = 0.0001; median: 10 vs. 5.6 micrograms/kg, p = < 0.001), and for cadmium it was higher for nonminorities than minorities (median: 18 vs. 15 micrograms/kg, p = 0.023). In contrast, the dietary intake for arsenic, which is based on body weight, was significantly higher in children than adults (mean: 1.72 vs 1.38 micrograms/kg-1 day-1, p = < 0.0001; median 1.02 vs. 0.83, p = < 0.0001). Dietary exposure to chromium in beverages tended to be higher in minorities than nonminorities (median: 16 vs. 13 micrograms/kg, p = 0.017). Lead levels in surface dust wipes tended to increase with the age of the home (mean: 128 micrograms/g in homes built since 1980 to 1075 micrograms/g in homes built before 1940; median: 93 to 236 micrograms/g, respectively). These findings were consistent with the observation that for persons living in older homes personal air exposures to lead are elevated compared to persons living in recently built homes (median: 12 ng/m3 in homes built since 1980, vs. 24 ng/m3 in homes built before 1940, p = 0.043).

Prospective validation of a composite end point in thrombolytic trials of acute myocardial infarction (TIMI 4 and 5). Thrombosis In Myocardial Infarction.

Although the use of composite end points in clinical trials has increased in recent years, few data are available on the validity of such an approach. In the Thrombolysis In Myocardial Infarction (TIMI) 4 and 5 trials, we set out to validate prospectively the nonfatal components of the "unsatisfactory outcome" end point. This end point consisted of the in-hospital occurrence or observation of new-onset severe congestive heart failure/shock, left ventricular ejection fraction <40% (or <30% for patients with prior myocardial infarction), reinfarction, reocclusion by sestamibi perfusion imaging, TIMI flow grade <2 at 90 minutes or 18 to 36 hours, intracranial hemorrhage, major spontaneous hemorrhage, or anaphylaxis. Among 576 patients in TIMI 4 and 5 with 1-year follow-up, a nonfatal unsatisfactory outcome end point was reached in hospital in 45% of patients. Compared with patients without such an end point, patients with an end point had a relative risk of 1-year mortality of 2.5 (95% confidence interval 1.4 to 5.6, p = 0.001). For individual components, new-onset severe congestive heart failure/shock had a relative risk of 4.6 (p = 0.001), left ventricular ejection fraction <40% had a relative risk of 3.5 (p = 0.006), recurrent myocardial infarction had a relative risk of 2.2 (p = 0.047), and TIMI flow grade <2 at 90 minutes had a relative risk of 2.2 (p = 0.005). Our findings show that these nonfatal in-hospital end points and the composite end point are associated with an increased risk of 1-year mortality and as such are valid predictive survival markers for use in clinical trials.

Particle Total Exposure Assessment Methodology (PTEAM) study: distributions of aerosol and elemental concentrations in personal, indoor, and outdoor air samples in a southern California community.

Particle concentrations were measured for a probability-based sample of 178 nonsmoking individuals aged 10 or older residing in Riverside, California, in the fall of 1990. Two 12-hr personal-exposure PM10 samples were obtained for each participant, along with fixed-location PM10 and PM2.5 indoor and outdoor air samples at their residences. The particle samples were also analyzed via X-ray fluorescence (XRF) to determine elemental concentrations for selected elements, including some toxic metals, crustal elements, and combustion- and industrial-source related elements. About 25% of the target population was estimated to have 24-hr personal exposures to PM10 that exceeded the national ambient air concentration standard of 150 micrograms/m3. The daytime personal exposure levels (median of 130 micrograms/m3) tended to exceed both indoor and outdoor levels by about 50%; nighttime personal exposure levels were lower and were only slightly higher than nighttime indoor levels. Several possible reasons for the elevated daytime personal PM10 levels (relative to indoor levels) are considered. Certain activities such as house cleaning and smoking were found to be associated with elevated personal exposure levels.

Temporal variability of benzene exposures for residents in several New Jersey homes with attached garages or tobacco smoke.

The U.S. Environmental Protection Agency's (EPA) previous TEAM studies of personal exposure to VOCs for 700 residents in several U.S. cities found that indoor air concentrations were often higher than outdoor levels. Several potential sources of benzene exposure were identified, including environmental tobacco smoke and materials or activities associated with attached garages. Indoor, personal, and outdoor monitoring was conducted at eleven New Jersey homes over multiple 12-hr monitoring periods. One study objective was to assess the impact of attached garages on human exposure to benzene and the variability of benzene exposure across time. Benzene was also measured in several homes inhabited by smokers and in homes without known combustion sources for comparative purposes. At homes with a garage or environmental tobacco smoke, mean indoor and personal benzene concentrations were two to five times higher than outdoor levels at all but one home. Mean personal exposures ranged from 8 to 31 micrograms/m3. Indoor/outdoor ratios were calculated and ranged from 0.8 to 11. Benzene levels in the four garages ranged from 3 to 196 micrograms/m3 and usually were higher than either indoor living areas or personal levels. Multi-zone air exchange rates were measured, and benzene source strengths in each zone were estimated. Garage source strength estimates for benzene ranged from 310 to 52,000 micrograms/h. The mass transfer of benzene from sources in the garage to home living areas was also large in three of the homes, ranging from 730 to 26,000 micrograms/h. Materials or activities in the garage were a source of benzene exposure for the residents in these three homes. Large temporal variations (factors of 2 to 30) were observed in indoor and personal benzene concentrations, indoor/outdoor ratios, and source strengths over the six or ten monitoring periods at each home. Changes in outdoor air benzene levels were an underlying factor in changing exposure levels, with indoor sources further elevating indoor air levels and personal exposures.

Effect of dry-cleaned clothes on tetrachloroethylene levels in indoor air, personal air, and breath for residents of several New Jersey homes.

Several volatile organic compounds, including tetrachloroethylene, have been found to be nearly ubiquitous in residential indoor environments during previous TEAM studies. Eleven homes in New Jersey were monitored over three or five days to examine the effect of bringing freshly dry-cleaned clothes into the home on indoor air levels and personal exposures to tetrachloroethylene. Indoor air, personal air, and breath concentrations were measured over multiple 12-hrs periods before and after dry-cleaned clothes were introduced into nine of the homes. No dry-cleaned clothes were introduced into the two remaining homes. Outdoor air tetrachloroethylene concentrations were measured at six of the eleven homes. Indoor/outdoor concentration ratios and source strengths were calculated at the six homes with outdoor measurements. Elevated indoor air levels and human exposures to tetrachloroethylene were measured at seven of the nine homes with dry-cleaned clothes. Indoor air concentrations reached 300 micrograms/m3 in one home and elevated indoor levels persisted for at least 48 hrs in all seven homes. Indoor/outdoor tetrachloroethylene concentration ratios exceeded 100 for the four homes with both dry-cleaned clothes and outdoor measurements. Maximum source strengths ranged from 16 to 69 mg/hr in these homes and did not directly correspond to the number of dry-cleaned garments brought into the home. Breath levels of tetrachloroethylene increased two to six-fold for participants living in seven homes with increased indoor air levels. Indoor air, personal air, and breath tetrachloroethylene concentrations were significantly related (0.05 level) to the number of garments introduced divided by the home volume.

Radon-222 levels in New York State homes.

Results are presented from a statewide survey that measured annual 222Rn concentrations in over 2000 single-family, owner-occupied homes in New York state. The participants were selected by a random-digit-dialing telephone interview approach developed by Mitofsky-Waksberg which allows inferences to be made from the sample to the statewide population. After completing a telephone questionnaire and agreeing to have their homes monitored, eligible households were mailed alpha-track detectors with instructions to place one detector in the main living area for 2 mo (during the winter heating season), a second in the main living area for 1 y, and a third in the basement (if applicable) for 1 y. The statewide median concentration for the heating-season, living-area readings was 31.6 Bq m-3, with a median of 24.0 Bq m-3 for the annual living-area readings and 51.8 for the annual basement readings. For the state, approximately 95% of the living-area concentrations and 86% of the basement concentrations were below 148 Bq m-3 (4 pCi L-1). In addition, only 1.4% of the readings in the basement were above 740 Bq m-3 (20 pCi L-1).