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Binnington MJ, Curren MS, Chan HM, Wania F. Balancing the benefits and costs of traditional food substitution by indigenous Arctic women of childbearing age: Impacts on persistent organic pollutant, mercury, and nutrient intakes. Environ Int 2016; 94:554-566. [PMID: 27329691 DOI: 10.1016/j.envint.2016.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
For indigenous Arctic Canadians, traditional food consumption represents a key source of nutrients and environmental contaminants. Particularly, ingestion of marine mammal blubber and meat may lead to persistent organic pollutant levels and mercury intakes that exceed regulatory thresholds for sensitive populations. We investigated whether temporary adjustments to the consumption of traditional food derived from marine mammals appreciably impacted contaminant exposure and nutrient intakes among indigenous women of childbearing age. Such adjustments can be motivated by the desire to lower contaminant exposure or to increase nutrition, or by the diminishing availability of other traditional food sources. We combined the contaminant fate and transport model GloboPOP with the food chain bioaccumulation model ACC-Human Arctic to simulate polychlorinated biphenyl exposures in female 2007-08 Inuit Health Survey participants. We also calculated daily mercury and nutrient intake rates. Our results suggest that a temporary decrease in marine mammal consumption is largely ineffective at reducing exposure to polychlorinated biphenyls, because of their long elimination half-lives. In contrast, substitution of marine mammals was highly efficient at reducing mercury intake, but also appreciably lowered intakes of iron, manganese, selenium, and ω-3 polyunsaturated fatty acids. The impact of increasing intake of traditional food derived from marine mammals during childbearing age greatly depended on baseline consumption rates; replacement is ill-advised for those who already consume a lot of traditional food due to greater polychlorinated biphenyl and mercury exposures, while replacement was potentially beneficial for those with very limited marine mammal consumption due to increased nutrient intakes. Our calculations primarily suggest that considering baseline traditional food intake rates is critical to devising reproductive dietary adjustment strategies that maximize nutrient intake while minimizing environmental contaminant exposure.
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Affiliation(s)
- Matthew J Binnington
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Meredith S Curren
- Environmental Health Science and Research Bureau, Health Canada, 4908D - 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie-Curie Private, Ottawa, Ontario K1N 6N5, Canada
| | - Frank Wania
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada.
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Binnington MJ, Curren MS, Quinn CL, Armitage JM, Arnot JA, Chan HM, Wania F. Mechanistic polychlorinated biphenyl exposure modeling of mothers in the Canadian Arctic: the challenge of reliably establishing dietary composition. Environ Int 2016; 92-93:256-268. [PMID: 27115916 DOI: 10.1016/j.envint.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Traditional food (TF) consumption represents the main route of persistent organic pollutant (POP) exposure for indigenous Arctic Canadians. Ongoing dietary transitions away from TFs and toward imported foods (IFs) may contribute to decreasing POP exposures observed in these groups. METHODS To explore this issue, we combined the global fate and transport model GloboPOP and the human food chain bioaccumulation model ACC-Human Arctic to simulate polychlorinated biphenyl (PCB) exposure in two indigenous Arctic Canadian communities from the Inuvik region, Northwest Territories and Baffin region, Nunavut. Using dietary survey information from initial (1996-98) and follow-up (2005-07) biomonitoring campaigns in Inuvik and Baffin, we simulated PCB exposures (PCB-118, -138, -153, and -180) for each individual study participant and also whole study populations. RESULTS TF intake rates, particularly of marine mammals (MMs), were the most important predictors of modeled PCB exposure, while TF consumption did not associate consistently with measured PCB exposures. Further, reported mean TF intake increased from baseline to follow-up in both Inuvik (from 8 to 183gd(-1)) and Baffin (from 60 to 134gd(-1)), opposing both the expected dietary transition direction and the observed decrease in human PCB exposures in these communities (ΣPCB Inuvik: from 43 to 29ngglipid(-1), ΣPCB Baffin: from 213 to 82ngglipid(-1)). However dietary questionnaire data are frequently subject to numerous biases (e.g., recall, recency, confirmation), and thus casts doubt on the usefulness of these data. CONCLUSIONS Ultimately, our model's capability to reproduce historic PCB exposure data in these two groups was highly sensitive to TF intake, further underscoring the importance of accurate TF consumption reporting, and clarification of the role of dietary transitions in future POP biomonitoring of indigenous Arctic populations.
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Affiliation(s)
- Matthew J Binnington
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Meredith S Curren
- Environmental Health Science and Research Bureau, Health Canada, 4908D - 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9, Canada
| | - Cristina L Quinn
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - James M Armitage
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Jon A Arnot
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada; ARC Arnot Research & Consulting, 36 Sproat Avenue, Toronto, Ontario M4M 1W4, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie-Curie Private, Ottawa, Ontario K1N 6N5, Canada
| | - Frank Wania
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada.
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Curren MS, Liang CL, Davis K, Kandola K, Brewster J, Potyrala M, Chan HM. Assessing determinants of maternal blood concentrations for persistent organic pollutants and metals in the eastern and western Canadian Arctic. Sci Total Environ 2015; 527-528:150-158. [PMID: 25965033 DOI: 10.1016/j.scitotenv.2015.04.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
Aboriginal peoples in the Canadian Arctic are exposed to persistent organic pollutants (POPs) and metals mainly through their consumption of a traditional diet of wildlife items. Recent studies indicate that many human chemical levels have decreased in the north, likely due to a combination of reduced global chemical emissions, dietary shifts, and risk mitigation efforts by local health authorities. Body burdens for chemicals in mothers can be further offset by breastfeeding, parity, and other maternal characteristics. We have assessed the impact of several dietary and maternal covariates following a decade of awareness of the contaminant issue in northern Canada, by performing multiple stepwise linear regression analyses from blood concentrations and demographic variables for 176 mothers recruited from Nunavut and the Northwest Territories during the period 2005-2007. A significant aboriginal group effect was observed for the modeled chemicals, except for lead and cadmium, after adjusting for covariates. Further, blood concentrations for POPs and metals were significantly associated with at least one covariate of older age, fewer months spent breastfeeding, more frequent eating of traditional foods, or smoking during pregnancy. Cadmium had the highest explained variance (72.5%) from just two significant covariates (current smoking status and parity). Although Inuit participants from the Northwest Territories consumed more traditional foods in general, Inuit participants from coastal communities in Nunavut continued to demonstrate higher adjusted blood concentrations for POPs and metals examined here. While this is due in part to a higher prevalence of marine mammals in the eastern Arctic diet, it is possible that other aboriginal group effects unrelated to diet may also contribute to elevated chemical body burdens in Canadian Arctic populations.
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Affiliation(s)
- Meredith S Curren
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario, Canada.
| | - Chun Lei Liang
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 50 Columbine Driveway, Tunney's Pasture, Ottawa, Ontario, Canada.
| | - Karelyn Davis
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 50 Columbine Driveway, Tunney's Pasture, Ottawa, Ontario, Canada.
| | - Kami Kandola
- Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada.
| | | | | | - Hing Man Chan
- Center for Advanced Research in Environmental Genomics, University of Ottawa, 20 Marie-Curie, Ottawa, Ontario, Canada.
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Adlard B, Davis K, Liang CL, S Curren M, Rodríguez-Dozal S, Riojas-Rodríguez H, Hernández-Ávila M, Foster W, Needham L, Wong LY, Weber JP, Marro L, Leech T, Van Oostdam J. Persistent organic pollutants (POPs) and metals in primiparous women: a comparison from Canada and Mexico. Sci Total Environ 2014; 500-501:302-13. [PMID: 25233368 PMCID: PMC4825328 DOI: 10.1016/j.scitotenv.2014.08.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 07/30/2014] [Accepted: 08/21/2014] [Indexed: 05/09/2023]
Abstract
Under the North American Commission for Environmental Cooperation (CEC) and its Sound Management of Chemicals (SMOC) program, a tri-national human contaminant monitoring initiative was completed to provide baseline exposure information for several environmental contaminants in Canada, Mexico and the United States (U.S). Blood samples were collected from primiparous women in Canada and Mexico, and were analysed for a suite of environmental contaminants including polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene(p,p'-DDE),beta-hexachlorocyclohexane (β-HCH), mercury and lead. A multiple stepwise linear regression analysis was conducted using data from Canadian and Mexican primiparous mothers, adjusting for ethnicity group, age, pre-pregnancy BMI, years at current city and ever-smoking status. Concentrations of p,p'-DDE, β-HCH, and lead were found to be higher among Mexican participants; however, concentrations of most PCBs among Mexican participants were similar to Canadian primiparous women after adjusting for covariates. Concentrations of total mercury were generally higher among Mexican primiparous women although this difference was smaller as age increased. This initial dataset can be used to determine priorities for future activities and to track progress in the management of the selected chemicals, both domestically and on a broader cooperative basis within North America.
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Affiliation(s)
- Bryan Adlard
- Chemicals Surveillance Bureau, Health Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, ON, Canada K1A 0K9.
| | - Karelyn Davis
- Environmental Health Science and Research Bureau, Health Environments and Consumer Safety Branch, Health Canada, 50 Colombine Driveway, Tunney's Pasture, Ottawa, ON, Canada K1A 0K9.
| | - Chun Lei Liang
- Environmental Health Science and Research Bureau, Health Environments and Consumer Safety Branch, Health Canada, 50 Colombine Driveway, Tunney's Pasture, Ottawa, ON, Canada K1A 0K9.
| | - Meredith S Curren
- Chemicals Surveillance Bureau, Health Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, ON, Canada K1A 0K9.
| | - Sandra Rodríguez-Dozal
- Environmental Health Department, Center for Population Heath Research, National Institute of Public Health. Av. Universidad #655, CP 62100 Cuernavaca, Morelos, Mexico.
| | - Horacio Riojas-Rodríguez
- Environmental Health Department, Center for Population Heath Research, National Institute of Public Health. Av. Universidad #655, CP 62100 Cuernavaca, Morelos, Mexico.
| | - Mauricio Hernández-Ávila
- Office of the Director, National Institute of Public Health. Av. Universidad #655, CP 62100 Cuernavaca, Morelos, Mexico.
| | - Warren Foster
- Department of Obstetrics & Gynecology, McMaster University, 1200 Main Street West, Hamilton, ON, Canada L8N 3Z5.
| | - Larry Needham
- National Center of Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lee-Yang Wong
- National Center of Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jean-Philippe Weber
- Institut national de santé publique, 945 Avenue Wolfe, Québec, QC, Canada G1V 5B3.
| | - Leonora Marro
- Environmental Health Science and Research Bureau, Health Environments and Consumer Safety Branch, Health Canada, 50 Colombine Driveway, Tunney's Pasture, Ottawa, ON, Canada K1A 0K9.
| | - Tara Leech
- Chemicals Surveillance Bureau, Health Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, ON, Canada K1A 0K9.
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Curren MS, Davis K, Liang CL, Adlard B, Foster WG, Donaldson SG, Kandola K, Brewster J, Potyrala M, Van Oostdam J. Comparing plasma concentrations of persistent organic pollutants and metals in primiparous women from northern and southern Canada. Sci Total Environ 2014; 479-480:306-318. [PMID: 24576741 DOI: 10.1016/j.scitotenv.2014.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 05/28/2023]
Abstract
The exposure of Aboriginal peoples in the Canadian Arctic to persistent organic pollutants (POPs) and metals through the consumption of traditional food items is well recognized; however, less information is available for Canadian immigrants. The direct comparison of blood chemical concentrations for expectant primiparous women sampled in the Inuvik and Baffin regions of the Canadian Arctic, as well as Canadian- and foreign-born women from five southern Canadian centers (Halifax, Vancouver, Hamilton, Ottawa, and Calgary), provides relative exposure information for samples of northern and southern mothers in Canada. Based on our analyses, Canadian mothers are exposed to a similar suite of contaminants; however, Inuit first birth mothers residing in the Canadian Arctic had higher age-adjusted geometric mean concentrations for several legacy POPs regulated under the Stockholm Convention, along with lead and total mercury. Significant differences in exposure were observed for Inuit mothers from Baffin who tended to demonstrate higher blood concentrations of POPs and total mercury compared with Inuit mothers from Inuvik. Conversely, northern mothers showed a significantly lower age-adjusted geometric mean concentration for a polybrominated diphenyl ether (PBDE-153) compared to southern mothers. Furthermore, southern Canadian mothers born outside of Canada showed the highest individual concentrations measured in the study: 1700 μg/kg lipids for p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) and 990 μg/kg lipids for β-hexachlorocyclohexane (β-HCH). Data from Cycle 1 (2007-2009) of the nationally-representative Canadian Health Measures Survey (CHMS) places these results in a national biomonitoring context and affirms that foreign-born women of child-bearing age experience higher exposures to many POPs and metals than their Canadian-born counterparts in the general population.
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Affiliation(s)
- Meredith S Curren
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9, Canada.
| | - Karelyn Davis
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 50 Columbine Driveway, Tunney's Pasture, Ottawa, Ontario K1A 0K9, Canada.
| | - Chun Lei Liang
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 50 Columbine Driveway, Tunney's Pasture, Ottawa, Ontario K1A 0K9, Canada.
| | - Bryan Adlard
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9, Canada.
| | - Warren G Foster
- Department of Obstetrics & Gynecology, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Shawn G Donaldson
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9, Canada.
| | - Kami Kandola
- Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada.
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Curren MS, Davis K, Van Oostdam J. Sampling criteria for identifying human biomonitoring chemical differences in the Canadian Arctic. Int J Circumpolar Health 2014; 73:23467. [PMID: 24624369 PMCID: PMC3929119 DOI: 10.3402/ijch.v73.23467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/03/2014] [Indexed: 11/24/2022] Open
Abstract
Human biomonitoring studies in the Canadian Arctic have measured a wide range of metals and persistent organic pollutants in Aboriginal and non-Aboriginal mothers during two time periods in the Northwest Territories and Nunavut. This analysis provides preliminary estimates on sample sizes and sampling frequencies required to measure significant changes in maternal blood concentrations for PCB 153 and total mercury. For example, sample sizes of 35–40 mothers permit the detection of a 40% decrease in these chemical concentrations between two groups (e.g. communities or regions). Improvements in method sensitivity can be achieved by on-going sampling over multiple time periods (e.g. 4 or 5) in these regions, or increasing sample sizes.
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Affiliation(s)
- Meredith S Curren
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Karelyn Davis
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
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Donaldson SG, Curren MS, Adlard B, Provost J, Leech T, Tikhonov C, Feeley M, Tomlinson S, Shearer R. Future human health research directions for the Canadian Northern Contaminants Program. Int J Circumpolar Health 2013; 72:23049. [PMID: 24282784 PMCID: PMC3838971 DOI: 10.3402/ijch.v72i0.23049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/23/2013] [Indexed: 11/30/2022] Open
Abstract
Studies conducted in the mid-1980s and early 1990s demonstrated that persistent organic pollutants (POPs) and metals were reaching the Arctic ecosystem at unexpectedly high levels, many of which had no Arctic or Canadian sources. Epidemiological and toxicological studies in Canada and in other countries have found that these contaminants may pose a risk to human health. The objective of this paper is to provide the foundation for the discussion on future northern human health research under the Northern Contaminants Program (NCP) in Canada. This short discussion of human health priorities will help guide a path forward for future northern human health research in Canada to address on-going and new health concerns related to contaminants exposure in the Canadian Arctic.
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Affiliation(s)
- Shawn G Donaldson
- Chemicals Surveillance Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
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Curren MS, King JW. Ethanol-modified subcritical water extraction combined with solid-phase microextraction for determining atrazine in beef kidney. J Agric Food Chem 2001; 49:2175-2180. [PMID: 11368573 DOI: 10.1021/jf0014866] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The determination of the levels of pesticides in food products has prompted the development of sensitive and rapid methods of analysis that are solvent-free or utilize solvents that are benign to the environment and laboratory worker. In this study we have developed a novel extraction method that utilizes ethanol-modified subcritical water in combination with solid-phase microextraction (SPME) for the removal of atrazine from beef kidney. In situ sample cleanup was achieved using the technique of matrix solid-phase dispersion. A cross-linked polymer, XAD-7 HP, was utilized as a dispersing material for kidney samples. Subcritical water extractions were performed with a pressurized solvent extraction unit at 100 degrees C and 50 atm. Experimental parameters investigated were the volume of solvent and amount of modifier required for the complete extraction of atrazine and optimization of the extraction time. It was determined that 30% ethanol in water (v/v) is adequate for the complete extraction of atrazine. A Carbowax-divinylbenzene SPME fiber was used to sample the aqueous extracts. Analysis of the fiber contents was by ion-trap GC/MS utilizing the single ion mode. The total time of analysis for a single kidney sample is 90 min. The average percent recoveries from samples spiked to the concentrations of 2 and 0.2 microg/g were 104 and 111, respectively. The average relative standard deviations were 10 and 9, respectively. The method limit of detection for beef kidney spiked with atrazine was found to be 20 ng/g of sample.
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Affiliation(s)
- M S Curren
- National Center for Agricultural Utilization Research, USDA, Agricultural Research Service, 1815 North University Street, Peoria, Illinois 61604, USA.
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Abstract
Solubility measurements in pure and modified water serve as a basis for optimizing the subcritical water extraction of target analytes such as food contaminants. The solvent strength of the water is affected by both the system's temperature and the amount and type of cosolvent modifier that is added to the water, which causes a reduction in the dielectric constant of water. In the present work, the solubilities of the triazine pesticides atrazine, cyanazine, and simazine were measured in pure and modified water at temperatures ranging from 50 to 125 degrees C and at a pressure of 50 atm. The solubility data were obtained using a static solubility apparatus with on-line liquid chromatographic (LC) detection. By increasing the temperature of the water, the solubilities of the triazine pesticides increased approximately 3-fold in pure water for each 25 degrees C temperature increment. Cyanazine was 5 times more soluble than atrazine and an order of magnitude more soluble than simazine at 100 degrees C. The solubility of atrazine was also measured in ambient and hot water modified with ethanol and urea. At 100 degrees C, the solubility of atrazine is doubled when the water is modified with urea, and is increased over an order of magnitude when ethanol is used as modifier. The data, therefore, indicate that adding a cosolvent to water in addition to increasing the system temperature increases the solubilities of triazine pesticides in subcritical water. It was further determined that the solutes do not thermally degrade or hydrolyze at the temperatures reported in this study.
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Affiliation(s)
- M S Curren
- Food Quality and Safety Research, National Center for Agriclutural Utilization Research, ARS/USDA, Peoria, Illinois 61604, USA.
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