1
|
Toro-Román V, Robles-Gil MC, Muñoz D, Bartolomé I, Grijota FJ, Maynar-Mariño M. Sex differences in cadmium and lead concentrations in different biological matrices in athletes. Relationship with iron status. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 99:104107. [PMID: 36914057 DOI: 10.1016/j.etap.2023.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE The present study aimed to analyse sex differences in cadmium and lead concentrations in plasma, urine, platelets and erythrocytes and to relate these concentrations to biomarkers of iron status. METHODS A total of 138 soccer players divided according to sex: men (n = 68) and women (n = 70) participated in the present study. All participants resided in the city of Cáceres (Spain). Erythrocyte, haemoglobin, platelet, plateletcrit, ferritin and serum iron values were determined. Cadmium and lead concentrations were quantified by inductively coupled plasma mass spectrometry. RESULTS The women had lower haemoglobin, erythrocyte, ferritin and serum iron values (p < 0.01). Regarding cadmium, the women showed higher concentrations in plasma, erythrocytes and platelets (p < 0.05). As for lead, they also showed higher concentrations in plasma, relative values of erythrocytes and relative values of platelets (p < 0.05). Significant correlations were observed between cadmium and lead concentrations with biomarkers of iron status. CONCLUSIONS Cadmium and lead concentrations are different between sexes. Biological differences between sexes and iron status could influence cadmium and lead concentrations. Lower serum iron concentrations and markers of Fe status increase Cd and Pb concentrations. Ferritin and serum iron have been directly related to increased Cd and Pb excretion.
Collapse
Affiliation(s)
- Víctor Toro-Román
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain
| | - María C Robles-Gil
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain.
| | - Diego Muñoz
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain
| | - Ignacio Bartolomé
- Department of Sport Science, Faculty of Education, Pontifical University of Salamanca, C/Henry Collet, 52-70, 37007 Salamanca, Spain
| | - Francisco J Grijota
- Faculty of Life and Nature Sciences, University of Nebrija, Campus La Berzosa, Calle del Hostal, Hoyo de Manzanares, 28248 Madrid, Spain
| | - Marcos Maynar-Mariño
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain
| |
Collapse
|
2
|
Kim Y. μSex, pregnancy, and age-specific differences of blood manganese levels in relation to iron status; what does it mean? Toxicol Rep 2017; 5:28-30. [PMID: 29270364 PMCID: PMC5734794 DOI: 10.1016/j.toxrep.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 11/19/2017] [Accepted: 12/04/2017] [Indexed: 12/25/2022] Open
Abstract
The interaction of iron with manganese (Mn) is the major factor affecting blood Mn level in general population. Children and pregnant women had no adverse effects from blood Mn levels associated with adverse effects in adult workers. The differences between a physiological and a pathological hypermanganesemia complicate the dose-response relationship.
The objective of the present study was to evaluate sex, menopause, pregnancy, and age-specific differences of blood manganese (Mn) levels in relation to iron status, and to assess the toxicological implications of these relationships. Females of childbearing age have higher concentrations of blood Mn than males because women have lower concentrations of ferritin. Previous studies indicated significant increases in blood Mn levels throughout pregnancy, and that the geometric mean of blood Mn was significantly higher in premenopausal women than postmenopausal women. This may be due to the enhanced absorption of Mn because of upregulation of iron absorption, which is especially important during late pregnancy. Mn concentrations are highest in infancy, decreased with age up to adolescence, and did not change during adulthood. Thus, the relationship of iron with Mn may be the major factor affecting blood Mn levels according to menstrual stage, reproductive status, menopausal factors, and age. However, Mn absorbed via the gastrointestinal system seems to be less neurotoxic than inhaled or parenteral Mn, due to the tight enterohepatic homeostatic control of this essential element. Furthermore, children and pregnant women had no adverse health effects from blood levels of Mn that were associated with adverse effects in adult workers. In conclusion, the differences between a physiological and a pathological hypermanganesemia complicate interpretation of the dose-response relationship.
Collapse
|
3
|
Zheng Y, Flanagan SV. The Case for Universal Screening of Private Well Water Quality in the U.S. and Testing Requirements to Achieve It: Evidence from Arsenic. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:085002. [PMID: 28893720 PMCID: PMC5783670 DOI: 10.1289/ehp629] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/13/2016] [Accepted: 12/29/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND The 1974 Safe Drinking Water Act (SDWA) regulates >170,000 public water systems to protect health, but not >13 million private wells. State and local government requirements for private well water testing are rare and inconsistent; the responsibility to ensure water safety remains with individual households. Over the last two decades, geogenic arsenic has emerged as a significant public health concern due to high prevalence in many rural American communities. OBJECTIVES We build the case for universal screening of private well water quality around arsenic, the most toxic and widespread of common private water contaminants. We argue that achieving universal screening will require policy intervention, and that testing should be made easy, accessible, and in many cases free to all private well households in the United States, considering the invisible, tasteless, odorless, and thus silent nature of arsenic. DISCUSSION Our research has identified behavioral, situational and financial barriers to households managing their own well water safety, resulting in far from universal screening despite traditional public health outreach efforts. We observe significant socioeconomic disparities in arsenic testing and treatment when private water is unregulated. Testing requirements can be a partial answer to these challenges. CONCLUSIONS Universal screening, achieved through local testing requirements complemented by greater community engagement targeting biologically and socioeconomically vulnerable groups, would reduce population arsenic exposure greater than any promotional efforts to date. Universal screening of private well water will identify the dangers hidden in America's drinking water supply and redirect attention to ensure safe water among affected households. https://doi.org/10.1289/EHP629.
Collapse
Affiliation(s)
- Yan Zheng
- School of Environmental Science and Engineering, Southern University of Science and Technology , Shenzhen, China
- Lamont-Doherty Earth Observatory, Columbia University , Palisades, New York, USA
- City University of New York School of Public Health , New York, New York, USA
| | - Sara V Flanagan
- Lamont-Doherty Earth Observatory, Columbia University , Palisades, New York, USA
- City University of New York School of Public Health , New York, New York, USA
| |
Collapse
|
4
|
Kearney GD, Namulanda G, Qualters JR, Talbott EO. A decade of environmental public health tracking (2002-2012): progress and challenges. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21 Suppl 2:S23-35. [PMID: 25621442 PMCID: PMC5667361 DOI: 10.1097/phh.0000000000000181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. OBJECTIVE To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. DESIGN A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. MAIN OUTCOMES Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development. CONCLUSIONS Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.
Collapse
Affiliation(s)
- Gregory D Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville North Carolina (Dr Kearney); Division of Environmental Hazards & Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Namulanda and Dr Qualters); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Talbott)
| | | | | | | |
Collapse
|
5
|
Flanagan SV, Marvinney RG, Johnston RA, Yang Q, Zheng Y. Dissemination of well water arsenic results to homeowners in Central Maine: influences on mitigation behavior and continued risks for exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 505:1282-90. [PMID: 24726512 PMCID: PMC4192113 DOI: 10.1016/j.scitotenv.2014.03.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/01/2014] [Accepted: 03/06/2014] [Indexed: 04/13/2023]
Abstract
Private wells in the United States are unregulated for drinking water standards and are the homeowner's responsibility to test and treat. Testing for water quality parameters such as arsenic (As) is a crucial first step for homeowners to take protective actions. This study seeks to identify key behavioral factors influencing homeowners' decisions to take action after receiving well As test results. A January 2013 survey of central Maine households (n=386, 73% response) who were notified 3-7 years earlier that their well water contained As above 10 μg/L found that 43% of households report installing As treatment systems. Another 30% report taking other mitigation actions such as drinking bottled water because of the As, but the remaining 27% of households did not act. Well water As level appears to be a motivation for mitigation: 31% of households with well water level between 10 and 50 μg/L did not act, compared to 11% of households with well water >50 μg/L. The belief that the untreated water is not safe to drink (risk) and that reducing drinking water As would increase home value (instrumental attitude) were identified as significant predictors of mitigating As. Mitigating As exposure is associated with less worry about the As level (affective attitude), possibly because those acting to reduce exposure feel less worried about As. Use of a treatment system specifically was significantly predicted by confidence that one can maintain a treatment system, even if there are additional costs (self-efficacy). An assessment of As treatment systems used by 68 of these households with well water As >10 μg/L followed up within August-November 2013 found that 15% of treatment units failed to produce water below As 10 μg/L, suggesting that there are continued risks for exposure even after the decision is made to treat.
Collapse
Affiliation(s)
- Sara V Flanagan
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, United States; City University of New York Graduate Center and School of Public Health, 365 5th Ave, New York, NY 10016, United States
| | - Robert G Marvinney
- Maine Geological Survey, 93 State House Station, Augusta, ME 04333, United States
| | - Robert A Johnston
- Maine Geological Survey, 93 State House Station, Augusta, ME 04333, United States
| | - Qiang Yang
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, United States
| | - Yan Zheng
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, United States; School of Earth and Environmental Sciences, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367, United States; City University of New York Graduate Center and School of Public Health, 365 5th Ave, New York, NY 10016, United States.
| |
Collapse
|
6
|
Yang Q, Culbertson CW, Nielsen MG, Schalk CW, Johnson CD, Marvinney RG, Stute M, Zheng Y. Flow and sorption controls of groundwater arsenic in individual boreholes from bedrock aquifers in central Maine, USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 505:1291-307. [PMID: 24842411 PMCID: PMC4233206 DOI: 10.1016/j.scitotenv.2014.04.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 05/05/2023]
Abstract
To understand the hydrogeochemical processes regulating well water arsenic (As) evolution in fractured bedrock aquifers, three domestic wells with [As] up to 478 μg/L are investigated in central Maine. Geophysical logging reveals that fractures near the borehole bottom contribute 70-100% of flow. Borehole and fracture water samples from various depths show significant proportions of As (up to 69%) and Fe (93-99%) in particulates (>0.45 μm). These particulates and those settled after a 16-day batch experiment contain 560-13,000 mg/kg of As and 14-35% weight/weight of Fe. As/Fe ratios (2.5-20 mmol/mol) and As partitioning ratios (adsorbed/dissolved [As], 20,000-100,000 L/kg) suggest that As is sorbed onto amorphous hydrous ferric oxides. Newly drilled cores also show enrichment of As (up to 1300 mg/kg) sorbed onto secondary iron minerals on the fracture surfaces. Pumping at high flow rates induces large decreases in particulate As and Fe, a moderate increase in dissolved [As] and As(III)/As ratio, while little change in major ion chemistry. The δD and δ(18)O are similar for the borehole and fracture waters, suggesting a same source of recharge from atmospheric precipitation. Results support a conceptual model invoking flow and sorption controls on groundwater [As] in fractured bedrock aquifers whereby oxygen infiltration promotes the oxidation of As-bearing sulfides at shallower depths in the oxic portion of the flow path releasing As and Fe; followed by Fe oxidation to form Fe oxyhydroxide particulates, which are transported in fractures and sorb As along the flow path until intercepted by boreholes. In the anoxic portions of the flow path, reductive dissolution of As-sorbed iron particulates could re-mobilize As. For exposure assessment, we recommend sampling of groundwater without filtration to obtain total As concentration in groundwater.
Collapse
Affiliation(s)
- Qiang Yang
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, USA; School of Earth and Environmental Sciences, Queens College and Graduate Center, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367, USA
| | - Charles W Culbertson
- U.S. Geological Survey, Maine Water Science Center, 196 Whitten Road, Augusta, ME 04330, USA
| | - Martha G Nielsen
- U.S. Geological Survey, Maine Water Science Center, 196 Whitten Road, Augusta, ME 04330, USA
| | - Charles W Schalk
- U.S. Geological Survey, Maine Water Science Center, 196 Whitten Road, Augusta, ME 04330, USA
| | - Carole D Johnson
- U.S. Geological Survey, Branch of Geophysics, 11 Sherman Place, Unit 5015, University of Connecticut, Storrs, CT 06269, USA
| | | | - Martin Stute
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, USA
| | - Yan Zheng
- Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964, USA; School of Earth and Environmental Sciences, Queens College and Graduate Center, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
| |
Collapse
|
7
|
Hoet P, Roels HA. Significance and Usefulness of Biomarkers of Exposure to Manganese. MANGANESE IN HEALTH AND DISEASE 2014. [DOI: 10.1039/9781782622383-00355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Manganese (Mn) accomplishes functions essential to maintaining human health, but at the same time this trace element can be toxic at low levels of exposure and accurate estimation of internal exposure is needed. A biomarker of exposure to Mn is meaningful only if there is sufficient knowledge of the toxicokinetics determining its presence in a biological medium (e.g. whole blood, plasma, urine, hair, nail). Moreover, biological monitoring of exposure to Mn is useful only when the biomarker is sufficiently specific and sensitive to distinguish exposed from non-exposed subjects, when it is dose-related to the external exposure (current, recent, or time-integrated), and when it displays reasonable dose–effect/response relationships with the occurrence of adverse effects on the central nervous system, the critical target for Mn exposure. Human investigations in which biomarkers of Mn exposure meet all these criteria are hard to locate. Overall, the available studies report poor or no associations on an individual basis between external (Mn in air or drinking water) and internal (Mn in blood, urine, hair, or nail) Mn exposure indices. This may be to some extent explained by features inherent of the Mn metabolism (homeostatic control), the Mn biomarker's half-life with respect to the exposure window, and the variable nature of external exposure scenarios. Studies particularly dealing with Mn inhalation exposure, different or poorly described methodological approaches, or air sampling strategies may render direct comparison and interpretation of results a tedious task. Nevertheless, several studies report significant dose–effect associations between biomarkers of Mn exposure and subclinical deficits of psychomotor or neuropsychological test performances. Because directly associated with the site of toxic action and providing the magnetic resonance imaging is done no later than three months after Mn exposure ceased, the Mn T1 relaxation time is potentially the better biomarker of Mn exposure in a clinical context (e.g. after long-term parenteral nutrition, chronic liver failure, methcathinone drug abuse). Magnetic resonance imaging is, however, unpractical as a tool for biological monitoring of exposure to Mn in the occupational setting (inhalation) and in the general population (air, drinking water). In conclusion, it would be inappropriate to recommend, on the basis of the currently available evidence, a reliable well-validated biomarker of exposure to Mn, or to establish a health-based threshold value for subclinical neurotoxic effects.
Collapse
Affiliation(s)
- Perrine Hoet
- Université catholique de Louvain (UCL), Institut de Recherche Expérimentale et Clinique (IREC), Louvain Centre for Toxicology and Applied Pharmacology (LTAP) Bruxelles Belgium
| | - Harry A. Roels
- Université catholique de Louvain (UCL), Institut de Recherche Expérimentale et Clinique (IREC), Louvain Centre for Toxicology and Applied Pharmacology (LTAP) Bruxelles Belgium
| |
Collapse
|
8
|
Park S, Sim CS, Lee H, Kim Y. Blood manganese concentration is elevated in infants with iron deficiency. Biol Trace Elem Res 2013; 155:184-9. [PMID: 23955423 DOI: 10.1007/s12011-013-9782-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/06/2013] [Indexed: 01/25/2023]
Abstract
The present study was done to determine whether blood Mn concentration is elevated in iron-deficient infants. Thirty-one infants with iron deficiency and thirty-six control subjects (6-24 months of age) were tested for blood Mn concentration, complete blood counts, serum ferritin, and serum iron/transferring iron-binding capacity (Fe/TIBC). All the 31 iron-deficient infants were treated with iron supplement; however, 19 of them underwent blood Mn checkup again in compliance with follow-up schedule when their ferritin levels returned to the normal range. Iron therapies were done for 1-6 months (mean, 2.8; standard deviation, 1.6) using ferric hydroxide-polymaltose complex (6 mg/kg Fe(3+) daily). Infants with iron deficiency had a higher mean blood Mn concentration than controls (2.550 vs. 1.499 μg/dL, respectively). After iron therapy, the blood Mn levels of iron-deficient infants significantly decreased compared to their pre-therapy levels (2.045 vs. 2.971 μg/dL, respectively), and their hemoglobin and ferritin levels significantly increased. After adjustment for covariates (e.g., age and breast-feeding), multiple linear regression models showed that increased blood Mn levels were significantly associated with low serum ferritin and hemoglobin levels, whereas with Fe/TIBC there was only a tendency. Our results indicate that iron deficiency increases blood Mn levels in infants, presumably by increasing Mn absorption.
Collapse
Affiliation(s)
- Sangkyu Park
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | | |
Collapse
|
9
|
Sanders AP, Flood K, Chiang S, Herring AH, Wolf L, Fry RC. Towards prenatal biomonitoring in North Carolina: assessing arsenic, cadmium, mercury, and lead levels in pregnant women. PLoS One 2012; 7:e31354. [PMID: 22427803 PMCID: PMC3302877 DOI: 10.1371/journal.pone.0031354] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/06/2012] [Indexed: 01/02/2023] Open
Abstract
Exposure to toxic metals during the prenatal period carries the potential for adverse developmental effects to the fetus, yet such exposure remains largely unmonitored in the United States. The aim of this study was to assess maternal exposure to four toxic metals (arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb)) in a cohort of pregnant women in North Carolina. We analyzed blood samples submitted to the North Carolina Department of Health and Human Services for blood typing to assess toxic metal levels in pregnant women (n = 211) across six North Carolina counties. Whole blood metal concentrations were measured by inductively coupled plasma mass spectrometry. The association between maternal characteristics, including county of residence, age, and race, and metal exposure was analyzed using multiple linear regression analysis. A large fraction of the blood samples showed detectable levels for each of the four metals. Specifically, As (65.7%), Cd (57.3%), Hg (63.8%), and Pb (100%) were detected in blood samples. Moreover, compared with adult females participating in the Fourth National Report on Human Exposure to Environmental Chemicals and guidelines for pregnant women, some women in the sample population exceeded benchmark levels of Cd, Hg, and Pb. Evidence from this pilot study indicates that pregnant women in North Carolina are exposed to As, Cd, Hg, and Pb and suggests that factors related to maternal county of residence and race may impact maternal exposure levels. As increased levels of one or more of these metals in utero have been associated with detrimental developmental and reproductive outcomes, further study is clearly warranted to establish the impacts to newborns.
Collapse
Affiliation(s)
- Alison P. Sanders
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kaye Flood
- State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, United States of America
| | - Shu Chiang
- State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, United States of America
| | - Amy H. Herring
- Department of Biostatistics, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Leslie Wolf
- State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, United States of America
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| |
Collapse
|