Workgroup report: Drinking-water nitrate and health--recent findings and research needs

Remediation of nitrate-contaminated water by solid-phase denitrification process-a review

The paper presents a compilation of various autotrophic and heterotrophic ways of solid-phase denitrification. It covers a complete understanding of various pathways followed during denitrification process. The paper gives a brief review on various governing factors on which the process depends. It focuses mainly on the solid-phase denitrification process, its applicability, efficiency, and disadvantages associated. It presents a critical review on various methodologies associated with denitrification process reported in past years. A comparative study has also been carried out to have a better understanding of advantages and disadvantages of a particular method. We summarize the various organic and inorganic substances and various techniques that have been used for enhancing denitrification process and suggest possible gaps in the research areas whi'ch are worthy of future research.

Future riverine nitrogen export to coastal regions in the United States: prospects for improving water quality

Nitrogen (N) fluxes generated by an increasing human population have the potential to increase coastal riverine N loading, with implications for areas already degraded by elevated nutrient loads. Here we examine contemporary (year 2005) and future (year 2030) loading of total dissolved N (TDN) in the continental United States using the Nutrient Export from WaterSheds model (NEWS2-TDN). Model-derived TDN estimates compared well with measured export of 29 catchments that represent 65% of land surface area for the continental United States (Nash-Sutcliffe efficiency = 0.83). Future output is based on scenarios that reflect future population growth and "business as usual" (BAU) and "ambitious" (AMB) approaches to nutrient management. Model-derived TDN export was 2.1 Tg N yr in 2005 and 2.2 and 1.6 Tg N yr in 2030 for the BAU and AMB scenarios, respectively. Depending on year and scenario, agriculture supplies 44 to 48% of coastal TDN, atmospheric N deposition supplies 14 to 17%, human sewage supplies 13 to 18%, and background sources supply 21 to 29%. The AMB scenario suggests that reducing nutrient loads to coastal areas will require aggressive actions, including a 25% improvement in agricultural nutrient use efficiency, a 20% reduction in N runoff from croplands, a 30% reduction in ammonia emissions from agriculture, and a 40% reduction in nitrogen oxide emissions from vehicles. Together, these aggressive actions could reduce year 2030 TDN export by 24% from 2005 levels, even with a 20% larger population.

[Nitrate concentrations in tap water in Spain]

OBJECTIVE

To determine nitrate concentrations in drinking water in a sample of Spanish cities.

MATERIAL AND METHODS

We used ion chromatography to analyze the nitrate concentrations of public drinking water in 108 Spanish municipalities with more than 50,000 inhabitants (supplying 21,290,707 potential individuals). The samples were collected between January and April 2012. The total number of samples tested was 324.

RESULTS

The median nitrate concentration was 3.47 mg/L (range: 0.38-66.76; interquartile range: 4.51). The water from 94% of the municipalities contained less than 15 mg/L. The concentration was higher than 25mg/L in only 3 municipalities and was greater than 50mg/L in one.

CONCLUSIONS

Nitrate levels in most public drinking water supplies in municipalities inhabited by almost half of the Spanish population are below 15 mg/L.

Nitrate in drinking water and bladder cancer risk in Spain

BACKGROUND

Nitrate is a widespread contaminant in drinking water and ingested nitrate under conditions resulting in endogenous nitrosation is suspected to be carcinogenic. However, the suggested association between nitrate in drinking water and bladder cancer remains inconsistent. We evaluated the long-term exposure to drinking water nitrate as a risk factor for bladder cancer, considering endogenous nitrosation modifiers and other covariables.

METHODS

We conducted a hospital-based case-control study of bladder cancer in Spain (1998-2001). Residential histories and water consumption information were ascertained through personal interviews. Historical nitrate levels (1940-2000) were estimated in study municipalities based on monitoring records and water source. Residential histories of study subjects were linked with nitrate estimates by year and municipality to calculate individual exposure from age 18 to recruitment. We calculated odds ratios (OR) and 95% confidence intervals (CI) for bladder cancer among 531 cases and 556 controls with reliable interviews and nitrate exposure information covering at least 70% of years from age 18 to interview.

RESULTS

Average residential levels ranged from 2.1mg/L to 12.0mg/L among regions. Adjusted OR (95%CI) for average residential levels relative to ≤ 5 mg/L were 1.2 (0.7-2.0) for >5-10mg/L and 1.1 (0.6-1.9) for >10mg/L. The OR for subjects with longest exposure duration (>20 years) to highest levels (>9.5mg/L) was 1.4 (0.9-2.3). Stratification by intake of vitamin C, vitamin E, meat, and gastric ulcer diagnosis did not modify these results. A non-significant negative association was found with waterborne ingested nitrate with an OR of 0.7 (0.4-1.0) for >8 vs. ≤ 4 mg/day. Adjustment for several covariables showed similar results to crude analyses.

CONCLUSION

Bladder cancer risk was inconsistently associated with chronic exposure to drinking water nitrate at levels below the current regulatory limit. Elevated risk is suggested only among subjects with longest exposure duration to the highest levels. No evidence of interaction with endogenous nitrosation modifiers was observed.

Spatial relationships among dairy farms, drinking water quality, and maternal-child health outcomes in the San Joaquin Valley

OBJECTIVE

Access to clean and affordable water is a significant public health issue globally, in the United States, and in California where land is heavily used for agriculture and dairy operations. The purpose of this study was to explore the geographic relationships among dairy farms, nitrate levels in drinking water, low birth weight, and socioeconomic data at the ZIP code level in the San Joaquin Valley.

DESIGN AND SAMPLE

This ecological study used a Geographic Information System (GIS) to explore and analyze secondary data.

MEASURES

A total of 211 ZIP codes were analyzed using spatial autocorrelation and regression analysis methods in ArcGIS version 10.1.

RESULTS

ZIP codes with dairies had a higher percentage of Hispanic births (p = .001). Spatial statistics revealed that ZIP codes with more dairy farms and a higher dairy cow density had higher levels of nitrate contamination. No correlation was detected between LBW and unsafe nitrate levels at the ZIP code level.

CONCLUSION

Further research examining communities that use private and small community wells in the San Joaquin Valley should be conducted. Birth data from smaller geographic areas should be used to continue exploring the relationship between birth outcomes and nitrate contamination in drinking water.

Impact of particle size and metal–support interaction on denitration behavior of well-defined Pt–Cu nanoparticles

Well-dispersed Pt–Cu nanoparticles with two average sizes were synthesized: small (≈1.6 nm) and large (≈4.8 nm), respectively.

Comparing and Optimizing Nitrate Adsorption from Aqueous Solution Using Fe/Pt Bimetallic Nanoparticles and Anion Exchange Resins

This research work was carried out for the removal of nitrate from raw water for a drinking water supply. Nitrate is a widespread ground water contaminant. Methodology employed in this study included adsorption on metal based nanoparticles and ion exchange using anionic resins. Fe/Pt bimetallic nanoparticles were prepared in the laboratory, by the reduction of their respective salts using sodium borohydride. Scanning electron microscope, X-ray diffraction, energy dispersive spectrometry, and X-ray florescence techniques were utilized for characterization of bimetallic Fe/Pt nanoparticles. Optimum dose, pH, temperature, and contact time were determined forNO3-removal through batch tests, both for metal based nanoparticles and anionic exchange resin. Adsorption data fitted well the Langmuir isotherm and conformed to the pseudofirst-order kinetic model. Results indicated 97% reduction in nitrate by 0.25 mg/L of Fe/Pt nanoparticles at pH 7 and 83% reduction in nitrate was observed using 0.50 mg/L anionic exchange resins at pH 4 and contact time of one hour. Overall, Fe/Pt bimetallic nanoparticles demonstrated greaterNO3-removal efficiency due to the small particle size, extremely large surface area (627 m2/g), and high adsorption capacity.

Long-term agroecosystem research in the central Mississippi river basin: hydrogeologic controls and crop management influence on nitrates in loess and fractured glacial till

Nitrogen from agriculture is known to be a primary source of groundwater NO-N. Research was conducted in a northeastern Missouri watershed to assess the impact of cropping systems on NO-N for a loess and fractured glacial till aquifer underlying claypan soils. Three cropped fields with 10 yr of similar management were each instrumented with 20 to 25 monitoring wells, 3 to 15 m in depth, in 1991 to 1992. Wells were sampled and analyzed for NO-N at least annually from 1991 to 2004. Initial NO-N concentrations were variable, ranging from undetectable to >24 mg L but averaged 7.0 mg L. Groundwater NO-N was significantly higher in Field 3, probably the result of concurrent applications of manure and N fertilizer before 1980. Overall changes in NO-N levels in Fields 1 and 2 were generally small; however, NO-N levels for Field 3 have decreased an average of 0.28 mg L yr. Excessive loading of N into the matrix of the glacial till may have had a long-term impact on NO-N for this field. Despite the presence of dissolved O in the aquifer, evidence of denitrification in some upper-landscape groundwater wells was found. The greatest decreases in NO-N concentration occurred as groundwater moved through an in-field tree line or through a riparian zone. While overall conclusions were complicated by the long-term impact of past management, the capacity of the till to buffer changes, hydrogeologic variability found among wells, and the activity of biological processes, we conclude that cropping practices during this study did not increase glacial till NO-N.

Determining Nitrate and Nitrite Content in Beverages, Fruits, Vegetables, and Stews Marketed in Arak, Iran

Background and Objectives. Presence of excessive nitrite and nitrate in foodstuff can have toxic and carcinogenic effects on humans. This study is aimed at measuring nitrate and nitrite in different foodstuffs available in Arak city market, Iran, in 2013. Methods. Totally 323 samples including stew (102 samples), beverage (116 samples), fruit (55 samples), and vegetables (50 samples) were randomly collected and analyzed according to official AOAC method 973 and ISO 6635 through spectrophotometric method. Results. Average concentration of nitrate and nitrite in the samples was 6.58-136.76, 1.52-38.22 mg kg(-1) or liter, respectively. Presence of nitrate and nitrite was confirmed in all samples. High levels of nitrate and nitrite were observed in celery and ghormeh stew; and lower level of nitrate and nitrite was found in traditionally produced vinegar, verjuice, and tomato. Conclusions. It was found that the mean values for nitrite in investigated products were higher than ADI levels of WHO.

Negative association between serum parathyroid hormone levels and urinary perchlorate, nitrate, and thiocyanate concentrations in U.S. adults: the National Health and Nutrition Examination Survey 2005-2006

OBJECTIVES

Perchlorate, nitrate, and thiocyanate are well-known inhibitors of the sodium-iodide symporter and may disrupt thyroid function. This exploratory study investigated the association among urinary perchlorate, nitrate, and thiocyanate concentrations and parathyroid hormone (PTH) levels in the general U.S. population.

METHODS

We analyzed data on 4265 adults (aged 20 years and older) from the National Health and Nutrition Examination Survey in 2005 through 2006 to evaluate the relationship among urinary perchlorate, nitrate, and thiocyanate concentration and PTH levels and the presence of hyperparathyroidism cross-sectionally.

RESULTS

The geometric means and 95% confidence interval (95% CI) concentrations of urinary perchlorate, nitrate, and thiocyanate were 3.38 (3.15-3.62), 40363 (37512-43431), and 1129 (1029-1239) ng/mL, respectively. After adjusting for confounding variables and sample weights, creatinine-corrected urinary perchlorate was negatively associated with serum PTH levels in women (P = 0.001), and creatinine-corrected urinary nitrate and thiocyanate were negatively associated with serum PTH levels in both sex groups (P = 0.001 and P<0.001 for men, P = 0.018 and P<0.001 for women, respectively). Similar results were obtained from sensitivity analyses performed for exposure variables unadjusted for creatinine with urinary creatinine added as a separate covariate. There was a negative relationship between hyperparathyroidism and urinary nitrate and thiocyanate [odds ratio (95% CI) = 0.77 (0.60-0.98) and 0.69 (0.61-0.79), respectively].

CONCLUSIONS

A higher urinary concentration of perchlorate, nitrate, and thiocyanate is associated with lower serum PTH levels. Future studies are needed to determine the pathophysiological background of the observation.

Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC), potential human carcinogens. We evaluated the association of nitrate and nitrite ingestion with postmenopausal ovarian cancer risk in the Iowa Women's Health Study. Among 28,555 postmenopausal women, we identified 315 incident epithelial ovarian cancers from 1986 to 2010. Dietary nitrate and nitrite intakes were assessed at baseline using food frequency questionnaire data. Drinking water source at home was obtained in a 1989 follow-up survey. Nitrate-nitrogen (NO3 -N) and total trihalomethane (TTHM) levels for Iowa public water utilities were linked to residences and average levels were computed based on each woman's duration at the residence. We computed multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression. We tested interactions of nitrate with TTHMs and dietary factors known to influence NOC formation. Ovarian cancer risk was 2.03 times higher (CI = 1.22-3.38, ptrend  = 0.003) in the highest quartile (≥2.98 mg/L) compared with the lowest quartile (≤0.47 mg/L; reference) of NO3 -N in public water, regardless of TTHM levels. Risk among private well users was also elevated (HR = 1.53, CI = 0.93-2.54) compared with the same reference group. Associations were stronger when vitamin C intake was <median (pinteraction  = 0.01 and 0.33 for private well and public supplies, respectively). Dietary nitrate was inversely associated with ovarian cancer risk (ptrend  = 0.02); whereas, dietary nitrite from processed meats was positively associated with the risk (ptrend  = 0.04). Our findings indicate that high nitrate levels in public drinking water and private well use may increase ovarian cancer risk among postmenopausal women.

Assessing bottled water nitrate concentrations to evaluate total drinking water nitrate exposure and risk of birth defects

Previous epidemiologic studies of maternal exposure to drinking water nitrate did not account for bottled water consumption. The objective of this National Birth Defects Prevention Study (NBDPS) (USA) analysis was to assess the impact of bottled water use on the relation between maternal exposure to drinking water nitrate and selected birth defects in infants born during 1997-2005. Prenatal residences of 1,410 mothers reporting exclusive bottled water use were geocoded and mapped; 326 bottled water samples were collected and analyzed using Environmental Protection Agency Method 300.0. Median bottled water nitrate concentrations were assigned by community; mothers' overall intake of nitrate in mg/day from drinking water was calculated. Odds ratios for neural tube defects, limb deficiencies, oral cleft defects, and heart defects were estimated using mixed-effects models for logistic regression. Odds ratios (95% CIs) for the highest exposure group in offspring of mothers reporting exclusive use of bottled water were: neural tube defects [1.42 (0.51, 3.99)], limb deficiencies [1.86 (0.51, 6.80)], oral clefts [1.43 (0.61, 3.31)], and heart defects [2.13, (0.87, 5.17)]. Bottled water nitrate had no appreciable impact on risk for birth defects in the NBDPS.

Curative vs. preventive management of nitrogen transfers in rural areas: lessons from the case of the Orgeval watershed (Seine River basin, France)

The Orgeval watershed (104 km(2)) is a long-term experimental observatory and research site, representative of rural areas with intensive cereal farming of the temperate world. Since the past few years, we have been carrying out several studies on nitrate source, transformation and transfer of both surface and groundwaters in relation with land use and agriculture practices in order to assess nitrate (NO3(-)) leaching, contamination of aquifers, denitrification processes and associated nitrous oxide (N2O) emissions. A synthesis of these studies is presented to establish a quantitative diagnosis of nitrate contamination and N2O emissions at the watershed scale. Taking this watershed as a practical example, we compare curative management measures, such as pond introduction, and preventive measures, namely conversion to organic farming practices, using model simulations. It is concluded that only preventive measures are able to reduce the NO3(-) contamination level without further increasing N2O emissions, a result providing new insights for future management bringing together water-agro-ecosystems.

Denitrification in a hypersaline lake-aquifer system (Pétrola Basin, Central Spain): the role of recent organic matter and Cretaceous organic rich sediments

Agricultural regions in semi-arid to arid climates with associated saline wetlands are one of the most vulnerable environments to nitrate pollution. The Pétrola Basin was declared vulnerable to NO3(-) pollution by the Regional Government in 1998, and the hypersaline lake was classified as a heavily modified body of water. The study assessed groundwater NO3(-) through the use of multi-isotopic tracers (δ(15)N, δ(34)S, δ(13)C, δ(18)O) coupled to hydrochemistry in the aquifer connected to the eutrophic lake. Hydrogeologically, the basin shows two main flow components: regional groundwater flow from recharge areas (Zone 1) to the lake (Zone 2), and a density-driven flow from surface water to the underlying aquifer (Zone 3). In Zones 1 and 2, δ(15)NNO3 and δ(18)ONO3 suggest that NO3(-) from slightly volatilized ammonium synthetic fertilizers is only partially denitrified. The natural attenuation of NO3(-) can occur by heterotrophic reactions. However, autotrophic reactions cannot be ruled out. In Zone 3, the freshwater-saltwater interface (down to 12-16 m below the ground surface) is a reactive zone for NO3(-) attenuation. Tritium data suggest that the absence of NO3(-) in the deepest zones of the aquifer under the lake can be attributed to a regional groundwater flow with long residence time. In hypersaline lakes the geometry of the density-driven flow can play an important role in the transport of chemical species that can be related to denitrification processes.

Nitrate variability in groundwater of North Carolina using monitoring and private well data models

Nitrate (NO3-) is a widespread contaminant of groundwater and surface water across the United States that has deleterious effects to human and ecological health. This study develops a model for predicting point-level groundwater NO3- at a state scale for monitoring wells and private wells of North Carolina. A land use regression (LUR) model selection procedure is developed for determining nonlinear model explanatory variables when they are known to be correlated. Bayesian Maximum Entropy (BME) is used to integrate the LUR model to create a LUR-BME model of spatial/temporal varying groundwater NO3- concentrations. LUR-BME results in a leave-one-out cross-validation r2 of 0.74 and 0.33 for monitoring and private wells, effectively predicting within spatial covariance ranges. Results show significant differences in the spatial distribution of groundwater NO3- contamination in monitoring versus private wells; high NO3- concentrations in the southeastern plains of North Carolina; and wastewater treatment residuals and swine confined animal feeding operations as local sources of NO3- in monitoring wells. Results are of interest to agencies that regulate drinking water sources or monitor health outcomes from ingestion of drinking water. Lastly, LUR-BME model estimates can be integrated into surface water models for more accurate management of nonpoint sources of nitrogen.

Nitrate attenuation potential of hypersaline lake sediments in central Spain: flow-through and batch experiments

Complex lacustrine systems, such as hypersaline lakes located in endorheic basins, are exposed to nitrate (NO3(-)) pollution. An excellent example of these lakes is the hypersaline lake located in the Pétrola basin (central Spain), where the lake acts as a sink for NO3(-) from agricultural activities and from sewage from the surrounding area. To better understand the role of the organic carbon (Corg) deposited in the bottom sediment in promoting denitrification, a four-stage flow-through experiment (FTR) and batch experiments using lake bottom sediment were performed. The chemical, multi-isotopic and kinetic characterization of the outflow showed that the intrinsic NO3(-) attenuation potential of the lake bottom sediment was able to remove 95% of the NO3(-) input over 296days under different flow conditions. The NO3(-) attenuation was mainly linked with denitrification but some dissimilatory nitrate reduction to ammonium was observed at early days favored by the high C/N ratio and salinity. Sulfate reduction could be neither confirmed nor discarded during the experiments because the sediment leaching masked the chemical and isotopic signatures of this reaction. The average nitrogen reduction rate (NRR) obtained was 1.25mmold(-1)kg(-1) and was independent of the flow rate employed. The amount of reactive Corg from the bottom sediment consumed during denitrification was 28.8mmol, representing approximately 10% of the total Corg of the sediment (1.2%). Denitrification was produced coupled with an increase in the isotopic composition of both δ(15)N and δ(18)O. The isotopic fractionations (ε of (15)N-NO3(-) and (18)O-NO3(-)) produced during denitrification were calculated using batch and vertical profile samples. The results were -14.7‰ for εN and -14.5‰ for εO.

Nitrate and periplasmic nitrate reductases

The nitrate anion is a simple, abundant and relatively stable species, yet plays a significant role in global cycling of nitrogen, global climate change, and human health. Although it has been known for quite some time that nitrate is an important species environmentally, recent studies have identified potential medical applications. In this respect the nitrate anion remains an enigmatic species that promises to offer exciting science in years to come. Many bacteria readily reduce nitrate to nitrite via nitrate reductases. Classified into three distinct types--periplasmic nitrate reductase (Nap), respiratory nitrate reductase (Nar) and assimilatory nitrate reductase (Nas), they are defined by their cellular location, operon organization and active site structure. Of these, Nap proteins are the focus of this review. Despite similarities in the catalytic and spectroscopic properties Nap from different Proteobacteria are phylogenetically distinct. This review has two major sections: in the first section, nitrate in the nitrogen cycle and human health, taxonomy of nitrate reductases, assimilatory and dissimilatory nitrate reduction, cellular locations of nitrate reductases, structural and redox chemistry are discussed. The second section focuses on the features of periplasmic nitrate reductase where the catalytic subunit of the Nap and its kinetic properties, auxiliary Nap proteins, operon structure and phylogenetic relationships are discussed.

Pharmacology and therapeutic role of inorganic nitrite and nitrate in vasodilatation

Nitrite has emerged as an important bioactive molecule that can be biotransformed to nitric oxide (NO) related metabolites in normoxia and reduced to NO under hypoxic and acidic conditions to exert vasodilatory effects and confer a variety of other benefits to the cardiovascular system. Abundant research is currently underway to understand the mechanisms involved and define the role of nitrite in health and disease. In this review we discuss the impact of nitrite and dietary nitrate on vascular function and the potential therapeutic role of nitrite in acute heart failure.

Zr(IV) loaded cross-linked chitosan beads with enhanced surface area for the removal of nitrate and phosphate

In this work, a new method namely silica dissolution method, has been adapted to increase the surface area of the cross-linked chitosan beads. Zr(IV) was loaded in the cross-linked chitosan beads in order to make it selective for the nitrate and phosphate anions from aqueous solutions. Zr(IV) loaded cross-linked chitosan beads prepared by normal method (ZrCB) and silica dissolution method (SD-ZrCB) were characterised using N2 adsorption/desorption studies, SEM, EDAX, XRD, FTIR, TGA, DTA and water regain property. The SD-ZrCB exhibited higher N2 adsorption, water regain property as well as anion adsorption capacity than ZrCB. Batch method was adapted for the adsorption studies. The nitrate and phosphate adsorbed SD-ZrCB was regenerated using 0.025M NaCl solution. There was not much drop in adsorption capacities up to 10th regeneration cycle. Freundlich adsorption isotherm was the best fit adsorption isotherm among Freundlich, Langmuir and Dubinin-Radushkevich (D-R) isotherms which have been used to fit the nitrate and phosphate adsorption data. Thermodynamic parameters such as ΔG°, ΔH° and ΔS° were calculated in order to understand the nature of adsorption process.

Developing a fuzzy neural network-based support vector regression (FNN-SVR) for regionalizing nitrate concentration in groundwater

The aim of this study is to develop a fuzzy neural network-based support vector regression model (FNN-SVR) for mapping crisp-input and fuzzy-output variables. In this model, an artificial neural network (ANN) estimator based on multilayer perceptron (MLP) is considered as the kernel function of the SVR, whereas asymmetric triangular fuzzy H-level sets are assumed for model parameters including weight and biases of the ANN model. A genetic algorithm (GA) with real coding is implemented to optimize the model parameters during the training phase. To evaluate the efficiency and applicability of the proposed model, it is applied for simulating and regionalizing nitrate concentration in Karaj Aquifer in Iran. The goodness-of-fit criteria indicate a better performance of the FNN-SVR compared to some benchmark models such as geostatistic techniques as well as traditional SVR models with linear, quadratic, polynomial, and Gaussian kernel functions for modeling nitrate concentrations in groundwater.

Modeling nitrate at domestic and public-supply well depths in the Central Valley, California

Aquifer vulnerability models were developed to map groundwater nitrate concentration at domestic and public-supply well depths in the Central Valley, California. We compared three modeling methods for ability to predict nitrate concentration >4 mg/L: logistic regression (LR), random forest classification (RFC), and random forest regression (RFR). All three models indicated processes of nitrogen fertilizer input at the land surface, transmission through coarse-textured, well-drained soils, and transport in the aquifer to the well screen. The total percent correct predictions were similar among the three models (69-82%), but RFR had greater sensitivity (84% for shallow wells and 51% for deep wells). The results suggest that RFR can better identify areas with high nitrate concentration but that LR and RFC may better describe bulk conditions in the aquifer. A unique aspect of the modeling approach was inclusion of outputs from previous, physically based hydrologic and textural models as predictor variables, which were important to the models. Vertical water fluxes in the aquifer and percent coarse material above the well screen were ranked moderately high-to-high in the RFR models, and the average vertical water flux during the irrigation season was highly significant (p < 0.0001) in logistic regression.

Nebraska's groundwater legacy: Nitrate contamination beneath irrigated cropland

A 31 year record of ∼44,000 nitrate analyses in ∼11,500 irrigation wells was utilized to depict the decadal expansion of groundwater nitrate contamination (N ≥ 10 mg/L) in the irrigated corn-growing areas of eastern and central Nebraska and analyze long-term nitrate concentration trends in 17 management areas (MAs) subject to N fertilizer and budgeting requirements. The 1.3 M contaminated hectares were characterized by irrigation method, soil drainage, and vadose zone thickness and lithology. The areal extent and growth of contaminated groundwater in two predominately sprinkler-irrigated areas was only ∼20% smaller beneath well-drained silt loams with thick clayey-silt unsaturated layers and unsaturated thicknesses >15 m (400,000 ha and 15,000 ha/yr) than beneath well and excessively well-drained soils with very sandy vadose zones (511,000 ha and 18,600 ha/yr). Much slower expansion (3700 ha/yr) occurred in the 220,000 contaminated hectares in the central Platte valley characterized by predominately gravity irrigation on thick, well-drained silt loams above a thin (∼5.3 m), sandy unsaturated zone. The only reversals in long-term concentration trends occurred in two MAs (120,500 ha) within this contaminated area. Concentrations declined 0.14 and 0.20 mg N/L/yr (p < 0.02) to ∼18.3 and 18.8 mg N/L, respectively, during >20 years of management. Average annual concentrations in 10 MAs are increasing (p < 0.05) and indicate that average nitrate concentrations in leachates below the root zone and groundwater concentrations have not yet reached steady state. While management practices likely have slowed increases in groundwater nitrate concentrations, irrigation and nutrient applications must be more effectively controlled to retain nitrate in the root zone.

Agriculture's Contribution to Nitrate Contamination of Californian Groundwater (1945-2005)

Nitrogen (N) use in intensive agriculture can degrade groundwater resources. However, considerable time lags between groundwater recharge and extraction complicate source attribution and remedial responses. We construct a historic N mass balance of two agricultural regions of California to understand trends and drivers of past and present N loading to groundwater (1945-2005). Changes in groundwater N loading result from historic changes in three factors: the extent of agriculture (cropland area and livestock herd increased 120 and 800%, respectively), the intensity of agriculture (synthetic and manure waste effluent N input rates increased by 525 and 1500%, respectively), and the efficiency of agriculture (crop and milk production per unit of N input increased by 25 and 19%, respectively). The net consequence has been a greater-than-order-of-magnitude increase in nitrate (NO) loading over the time period, with 163 Gg N yr now being leached to groundwater from approximately 1.3 million ha of farmland (not including alfalfa [ L.]). Meeting safe drinking water standards would require NO leaching reductions of over 70% from current levels through reductions in excess manure applications, which accounts for nearly half of all groundwater N loading, and through synthetic N management improvements. This represents a broad challenge given current economic and technical conditions of California farming if farm productivity is to be maintained. The findings illustrate the growing tension-characteristic of agricultural regions globally-between intensifying food, feed, fiber, and biofuel production and preserving clean water.

Clinical evidence demonstrating the utility of inorganic nitrate in cardiovascular health

The discovery of nitric oxide and its role in almost every facet of human biology opened a new avenue for treatment through manipulation of its canonical signaling and by attempts to augment endogenous nitric oxide generation through provision of substrate and co-factors to the endothelial nitric oxide synthase complex. This has been particularly so in the cardiovascular system and it is well recognized that there is reduced bioavailable nitric oxide in patients with both cardiovascular risk factors and manifest vascular disease. However, these attempts have failed to deliver the expected benefits of such an approach. Recently, an alternative pathway for nitric oxide synthesis has been elucidated that can produce authentic nitric oxide from the 1 electron reduction of inorganic nitrite. Furthermore, it has long been known that symbiotic, facultative, oral microflora can facilitate the reduction of inorganic nitrate, that is ingested in the average diet in millimolar amounts, to inorganic nitrite itself. Thus, there exists an alternative reductive pathway from nitrate, via nitrite as an intermediate, to nitric oxide that provides a novel pathway that may be amenable to therapeutic manipulation. As such, various research groups have explored the utility of manipulation of this nitrate-nitrite-nitric oxide pathway in situations in which nitric oxide is known to have a prominent role. Animal and early-phase human studies of both inorganic nitrite and nitrate supplementation have shown beneficial effects in blood pressure control, platelet function, vascular health and exercise capacity. This review considers in detail the pathways of inorganic nitrate bioactivation and the evidence of clinical utility to date on the cardiovascular system.

Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs

BACKGROUND

Safe drinking water is essential for well-being. Although microbiological contamination remains the largest cause of water-related morbidity and mortality globally, chemicals in water supplies may also cause disease, and evidence of the human health consequences is limited or lacking for many of them.

OBJECTIVES

We aimed to summarize the state of knowledge, identify gaps in understanding, and provide recommendations for epidemiological research relating to chemicals occurring in drinking water.

DISCUSSION

Assessing exposure and the health consequences of chemicals in drinking water is challenging. Exposures are typically at low concentrations, measurements in water are frequently insufficient, chemicals are present in mixtures, exposure periods are usually long, multiple exposure routes may be involved, and valid biomarkers reflecting the relevant exposure period are scarce. In addition, the magnitude of the relative risks tends to be small.

CONCLUSIONS

Research should include well-designed epidemiological studies covering regions with contrasting contaminant levels and sufficient sample size; comprehensive evaluation of contaminant occurrence in combination with bioassays integrating the effect of complex mixtures; sufficient numbers of measurements in water to evaluate geographical and temporal variability; detailed information on personal habits resulting in exposure (e.g., ingestion, showering, swimming, diet); collection of biological samples to measure relevant biomarkers; and advanced statistical models to estimate exposure and relative risks, considering methods to address measurement error. Last, the incorporation of molecular markers of early biological effects and genetic susceptibility is essential to understand the mechanisms of action. There is a particular knowledge gap and need to evaluate human exposure and the risks of a wide range of emerging contaminants.

CITATION

Villanueva CM, Kogevinas M, Cordier S, Templeton MR, Vermeulen R, Nuckols JR, Nieuwenhuijsen MJ, Levallois P. 2014. Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs. Environ Health Perspect 122:213–221; http://dx.doi.org/10.1289/ehp.1206229

Nitrogen inputs to a river course in a heavily impacted watershed: a combined hydrochemical and isotopic evaluation (Oglio River Basin, N Italy)

This study aims at evaluating sources and processes affecting NO₃(-) concentrations in the Oglio River. Five sampling campaigns considered the main watercourse, tributaries, point pollution sources, springs, and groundwater. Physico-chemical parameters, N forms, B, Sr(2+), stable isotopes (δ(2)HH₂O, δ(18)OH₂O, δ(15)NNO₃, δ(18)ONO₃, δ(11)B) and discharge were measured. Hydrological modelling was performed using mass balance and End Member Mixing Analysis equations. During the irrigation period, in the upstream reach, up to 90% of the natural river flow is diverted for irrigation and industrial purposes; excess water drained from agricultural fields is returned to river in the downstream reach. Results evidenced, in the middle reach, a large input of NO₃(-)-rich groundwater which could be quantified using hydrological modelling. Groundwater inputs are responsible for the sharp, tenfold increase in NO₃(-) in the river water, from 2.2-4.4 up to 33.5 mgL(-1), and are more evident in summer, when discharge is lower. Nevertheless, river water preserves its natural B isotopic composition, indicating that the two tracers do not have a common origin and are not co-migrant. In the lower plain, surface-groundwater interconnections and human disturbances in the water cycle favour the recycling of the compounds in the environment, and lead to a similarity in composition of the different water bodies (Oglio River, tributaries and groundwater). The long lasting agronomical practices have profoundly modified the surface-groundwater equilibrium and chemical characteristics, resulting in a highly buffered system. Infiltrating irrigation water leaches down NO₃(-) which is subsequently denitrified; when returned to the Oglio River, groundwater modifies the river water composition by dilution, in the case of NO₃(-), or by addition, for other constituents (e.g. Cl(-), B). The results of this study indicate that, in order to reduce the NO3(-) transport towards the Adriatic Sea, groundwater contamination should be addressed first, with expected long recovery times.

Heme-induced biomarkers associated with red meat promotion of colon cancer are not modulated by the intake of nitrite

Red and processed meat consumption is associated with the risk of colorectal cancer. Three hypotheses are proposed to explain this association, via heme-induced oxidation of fat, heterocyclic amines, or N-nitroso compounds. Rats have often been used to study these hypotheses, but the lack of enterosalivary cycle of nitrate in rats casts doubt on the relevance of this animal model to predict nitroso- and heme-associated human colon carcinogenesis. The present study was thus designed to clarify whether a nitrite intake that mimics the enterosalivary cycle can modulate heme-induced nitrosation and fat peroxidation. This study shows that, in contrast with the starting hypothesis, drinking water added with nitrite to mimic the salivary nitrite content did not change the effect of hemoglobin on biochemical markers linked to colon carcinogenesis, notably lipid peroxidation and cytotoxic activity in the colon of rat. However, ingested sodium nitrite increased fecal nitroso-compounds level, but their fecal concentration and their nature (iron-nitrosyl) would probably not be associated with an increased risk of cancer. We thus suggest that the rat model could be relevant for study the effect of red meat on colon carcinogenesis, in spite of the lack of nitrite in the saliva of rats.

Nitrogen budget in a lowland coastal area within the Po River basin (northern Italy): multiple evidences of equilibrium between sources and internal sinks

Detailed studies on pollutants genesis, path and transformation are needed in agricultural catchments facing coastal areas. Here, loss of nutrients should be minimized in order to protect valuable aquatic ecosystems from eutrophication phenomena. A soil system N budget was calculated for a lowland coastal area, the Po di Volano basin (Po River Delta, Northern Italy), characterized by extremely flat topography and fine soil texture and bordering a network of lagoon ecosystems. Main features of this area are the scarce relevance of livestock farming, the intense agriculture, mainly sustained by chemical fertilizers, and the developed network of artificial canals with long water residence time. Average nitrogen input exceeds output terms by ~60 kg N ha(-1) year(-1), a relatively small amount if compared to sub-basins of the same hydrological system. Analysis of dissolved inorganic nitrogen in groundwater suggests limited vertical loss and no accumulation of this element, while a nitrogen mass balance in surface waters indicates a net and significant removal within the watershed. Our data provide multiple evidences of efficient control of the nitrogen excess in this geographical area and we speculate that denitrification in soil and in the secondary drainage system performs this ecosystemic function. Additionally, the significant difference between nitrogen input and nitrogen output loads associated to the irrigation system, which is fed by the N-rich Po River, suggests that this basin metabolizes part of the nitrogen excess produced upstream. The traditionally absent livestock farming practices and consequent low use of manure as fertilizer pose the risk of excess soil mineralization and progressive loss of denitrification capacity in this area.

Nitrite signaling in pulmonary hypertension: mechanisms of bioactivation, signaling, and therapeutics

SIGNIFICANCE

Pulmonary arterial hypertension (PAH) is a disorder characterized by increased pulmonary vascular resistance and mean pulmonary artery pressure leading to impaired function of the right ventricle, reduced cardiac output, and death. An imbalance between vasoconstrictors and vasodilators plays an important role in the pathobiology of PAH.

RECENT ADVANCES

Nitric oxide (NO) is a potent vasodilator in the lung, whose bioavailability and signaling pathway are impaired in PAH. It is now appreciated that the oxidative product of NO metabolism, the inorganic anion nitrite (NO(2)(-)), functions as an intravascular endocrine reservoir of NO bioactivity that can be reduced back to NO under physiological and pathological hypoxia.

CRITICAL ISSUES

The conversion of nitrite to NO is controlled by coupled electron and proton transfer reactions between heme- and molybdenum-containing proteins, such as hemoglobin and xanthine oxidase, and by simple protonation and disproportionation, and possibly by catalyzed disproportionation. The two major sources of nitrite (and nitrate) are the endogenous L-arginine-NO pathway, by oxidation of NO, and the diet, with conversion of nitrate from diet into nitrite by oral commensal bacteria. In the current article, we review the enzymatic formation of nitrite and the available data regarding its use as a therapy for PAH and other cardiovascular diseases.

FUTURE DIRECTIONS

The successful efficacy demonstrated in several animal models and safety in early clinical trials suggest that nitrite may represent a promising new therapy for PAH.

Methemoglobinemia induced by vegetable intake in infants in northern Spain

BACKGROUND AND OBJECTIVE

Acquired methemoglobinemia (MHb) induced in infants by intake of vegetables is a condition uncommonly reported in the literature. The purpose of the present study was to study new vegetables involved and other epidemiological risk factors.

METHODS

Seventy-eight cases of diet-induced MHb seen in Pamplona from 1987 to 2010 are reported. Infant characteristics were collected, and a case-control study was conducted using as controls 78 age- and sex-matched infants selected at the same geographic area. Bivariate logistic regression analyses were performed to detect factors involved in MHb occurrence. Nitrate levels were tested in natural vegetables used to prepare purées.

RESULTS

A clear relation was found between MHb and use of borage (Borago officinalis) (OR 5.2; 95% CI 1.1-24.6) and maybe chard (Beta vulgaris var cicla) (OR 2.0; 95% CI 0.4-8.7), time from preparation to use (OR 17.4, 95% CI 3.5-86.3 if the purée had been prepared 24-48 hours before and OR 24.9, 95% CI 3.3-187.6 if prepared >48 hours before), and breast-feeding (OR 10.4; 95% CI 1.9-57.2). Tests confirmed that vegetables with the highest nitrate levels were borage (n = 15), with mean nitrate levels of 3968 mg/kg, and chard (n = 17), with mean levels of 2811 mg/kg.

CONCLUSIONS

The main associated factors were shown to be time from purée preparation to use (>24 hours), use of certain vegetables (borage and chard), and breast-feeding. Nitrate levels in both vegetables implicated as etiological factors in acquired MHb are high.

Temporal analysis of spring water data to assess nitrate inputs to groundwater in an agricultural area (Osona, NE Spain)

Non-point agricultural pollution is a major concern in groundwater management. To investigate nitrate input to the subsurface through groundwater recharge, thirteen natural springs were sampled. Discharge, electrical conductivity (EC), nitrate concentration, pH value and water temperature were monitored every two weeks from January 2010 till February 2011 at selected springs in the Osona region (NE Spain). Two extensive hydrochemical analyses were also conducted at the beginning and at the end of the survey. Springs are classified in four groups describing their hydrological response, based on discharge, EC and nitrate data. Geostatistical analysis provides an additional insight into the discharge and nitrate temporal pattern. Even though discharge and EC can be related to specific hydrogeological behaviours, nitrate content shows uniform values in most of the springs with only a minor influence from external factors such as rainfall events, fertilisation regimes and geological traits. Such evenness of outflow might be attributed to a homogenisation of the subsurface processes that determine nitrate infiltration after decades of intensive fertilisation using pig manure. Accumulated nitrate mass load and variograms confirm this result. Assuming that spring data are representative of nitrate leaching towards the underlying aquifer, nitrate content of infiltrating recharge in shallow aquifers should therefore show a steady value over time with only small fluctuations due to natural processes. Nevertheless, temporal fluctuations in nitrate content in aquifers could be also attributed to flow regime alterations due to human groundwater withdrawal.

Association of nitrate, nitrite, and total organic carbon (TOC) in drinking water and gastrointestinal disease

OBJECTIVE

We aimed to investigate the amounts of nitrate, nitrite, and total organic carbon (TOC) in two drinking water sources and their relationship with some gastrointestinal diseases.

METHODS

This cross-sectional study was conducted in 2012 in Iran. Two wells located in residential areas were selected for sampling and measuring the TOC, nitrate (NO3(-)), and nitrite (NO2(-)). This water is used for drinking as well as for industrial and agricultural consumption. Nitrate and nitrite concentrations of water samples were analyzed using DR 5000 spectrophotometer. The information of patients was collected from the records of the main referral hospital of the region for gastrointestinal diseases.

RESULTS

In both areas under study, the mean water nitrate and nitrite concentrations were higher in July than in other months. The mean TOC concentrations in areas 1 and 2 were 2.29 ± 0.012 and 2.03 ± 0.309, respectively. Pollutant concentration and gastrointestinal disease did not show any significant relationship (P > 0.05).

CONCLUSION

Although we did not document significant association of nitrite, nitrate, and TOC content of water with gastrointestinal diseases, it should be considered that such health hazards may develop over time, and the quality of water content should be controlled to prevent different diseases.

Drinking-water exposure to a mixture of nitrate and low-dose atrazine metabolites and small-for-gestational age (SGA) babies: a historic cohort study

BACKGROUND

Groundwater, surface water and drinking water are contaminated by nitrates and atrazine, an herbicide. They are present as a mixture in drinking water and with their endocrine-disrupting activity, they may alter fetal growth.

OBJECTIVES

To study an association between drinking-water atrazine metabolites/nitrate mixture exposure and small-for-gestational-age(SGA).

METHODS

A historic cohort study based on birth records and drinking-water nitrate and pesticide measurements in Deux-Sèvres (France) between 2005 and 2009 was carried out. Exposure to drinking-water atrazine metabolites/nitrate mixture was divided into 6 classes according to the presence or absence of atrazine metabolites and to terciles of nitrate concentrations in each trimester of pregnancy. Regression analysis of SGA by mixture exposure at second trimester was subsequently conducted.

RESULTS

We included 11,446 woman-neonate couples of whom 37.0% were exposed to pesticides, while 99.9% of the women were exposed to nitrates. Average nitrate concentration was from 0 to 63.30 mg/L. In the second trimester of pregnancy, the risk of SGA was different with mixture exposure when drinking-water atrazine metabolites, mainly 2 hydroxyatrazine and desethylatrazine, were present and nitrate dose exposure increased: compared to single first tercile of nitrate concentration exposure, single second tercile exposure OR was 1.74 CI 95% [1.10; 2.75] and atrazine metabolites presence in the third tercile of nitrate concentration exposure OR was 0.87 CI 95% [0.45;1.67].

CONCLUSIONS

It is possible that the association found at the second trimester of exposure with regard to birth weight may likewise be observed before birth, with regard to the estimated fetal weight, and that it might change in the event that the atrazine metabolites dose were higher or the nitrate dose lower. It would appear necessary to further explore the variability of effects.

Atrazine and nitrate in public drinking water supplies and non-hodgkin lymphoma in nebraska, USA

A secondary analysis of 1999-2002 Nebraska case-control data was conducted to assess the risk of non-Hodgkin lymphoma (NHL) associated with exposure to nitrate- and atrazine-contaminated drinking water. Water chemistry data were collected and weighted by well contribution and proximity of residence to water supply, followed by logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). We found no association between NHL risk and exposure to drinking water containing atrazine or nitrate alone. Risk associated with the interaction of nitrate and atrazine in drinking water was elevated (OR, 2.5; CI, 1.0-6.2). Risk of indolent B-cell lymphoma was higher than risk of aggressive B-cell lymphoma (indolent: OR, 3.5; CI, 1.0-11.6 vs. aggressive: OR, 1.9; CI, 0.6-5.58). This increased risk may be due to in vivo formation and subsequent metabolism of N-nitrosoatrazine. A larger study is warranted to confirm our findings.

Dietary intake of nitrate and nitrite and risk of renal cell carcinoma in the NIH-AARP Diet and Health Study

BACKGROUND

Nitrate and nitrite are present in many foods and are precursors of N-nitroso compounds, known animal carcinogens and potential human carcinogens. We prospectively investigated the association between nitrate and nitrite intake from dietary sources and risk of renal cell carcinoma (RCC) overall and clear cell and papillary histological subtypes in the NIH-AARP Diet and Health Study.

METHODS

Nitrate and nitrite intakes were estimated from a 124-item food frequency questionnaire. Over a mean follow-up of 9 years, we identified 1816 RCC cases (n=498, clear cell; n=115, papillary cell) among 491 841 participants. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Individuals in the highest quintile of nitrite intake from animal sources compared with those in the lowest quintile, had an increased risk of total RCC and clear cell subtype (HR=1.28, 95% CI, 1.10-1.49 and HR=1.68, 95% CI, 1.25-2.27, respectively). Nitrite from processed meats and other animal sources were associated with increased clear cell adenocarcinoma risk (HR=1.33, 95% CI, 1.01-1.76 and HR=1.78, 95% CI, 1.34-2.36, respectively). We found no association for nitrite intake from plant sources or nitrate intake overall.

CONCLUSION

Our findings suggest that nitrite from animal sources may increase the risk of RCC, particularly clear cell adenocarcinomas.

A Review of the Use of Organic Amendments and the Risk to Human Health

Historically, organic amendments—organic wastes—have been the main source of plant nutrients, especially N. Their use allows better management of often-finite resources to counter changes in soils that result from essential practices for crop production. Organic amendments provide macro- and micronutrients, including carbon for the restoration of soil physical and chemical properties. Challenges from the use of organic amendments arise from the presence of heavy metals and the inability to control the transformations required to convert the organic forms of N and P into the minerals available to crops, and particularly to minimize the losses of these nutrients in forms that may present a threat to human health. Animal manure and sewage biosolids, the organic amendments in greatest abundance, contain components that can be hazardous to human health, other animals and plants. Pathogens pose an immediate threat. Antibiotics, other pharmaceuticals and naturally produced hormones may pose a threat if they increase the number of zoonotic disease organisms that are resistant to multiple antimicrobial drugs or interfere with reproductive processes. Some approaches aimed at limiting N losses (e.g. covered liquid or slurry storage, rapid incorporation into the soil, timing applications to minimize delay before plant uptake) also tend to favor survival of pathogens. Risks to human health, through the food chain and drinking water, from the pathogens, antibiotics and hormonal substances that may be present in organic amendments can be reduced by treatment before land application, such as in the case of sewage biosolids. Other sources, such as livestock and poultry manures, are largely managed by ensuring that they are applied at the rate, time and place most appropriate to the crops and soils. A more holistic approach to management is required as intensification of agriculture increases.

Nitrate-nitrogen levels in rural drinking water: Is there an association with age-related macular degeneration?

We examined the association of nitrate-nitrogen exposure from rural private drinking water and incidence of age-related macular degeneration (AMD). All participants in the Beaver Dam Eye Study (53916 improvement plan code) completed a questionnaire and had an ocular examination including standardized, graded fundus photographs at five examinations. Only information from rural residents in that study are included in this report. Data from an environmental monitoring study with probabilistic-based agro-chemical sampling, including nitrate-nitrogen, of rural private drinking water were available. Incidence of early AMD was associated with elevated nitrate-nitrogen levels in rural private drinking water supply (10.0% for low, 19.2% for medium, and 26.1% for high nitrate-nitrogen level in the right eye). The odds ratios (ORs) were 1.77 (95% confidence interval [CI]: 1.12-2.78) for medium and 2.88 (95% CI: 1.59-5.23) for high nitrate-nitrogen level. Incidence of late AMD was increased for those with medium or high levels of nitrate-nitrogen compared to low levels (2.3% for low and 5.1% for the medium or high nitrate-nitrogen level, for the right eye). The OR for medium or high nitrate-nitrogen groups was 2.80 (95% CI: 1.07-7.31) compared to the low nitrate-nitrogen group.

Magnesium in drinking water modifies the association between nitrate ingestion and risk of death from esophageal cancer

The objective of this study was to explore whether magnesium (Mg) levels in drinking water modified the effects of nitrate on esophageal cancer risk occurrence. A matched cancer case-control study was used to investigate the relationship between the risk of death from esophageal cancer and exposure to nitrate in drinking water in Taiwan. All esophageal cancer deaths of Taiwan residents from 2006 through 2010 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N) and Mg in drinking water were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO(3)-N and Mg exposure via drinking water. Evidence of an interaction was noted between drinking water NO(3)-N and Mg intake. This is the first study to report effect modification by Mg intake originating from drinking water on an association between NO(3)-N exposure and increased risk mortality attributed to esophageal cancer.