text:
Goin' Coastal - Canton
- Address:
125 W Main St
Canton, GA 30114Neighborhood:
- Cuisine:
SeafoodPrice: $30 and under
Goin' Coastal - Canton
- Dining Style: Casual Dining
- Website: http://goincoastalseafood.com/
- Phone: (770) 479-3737
- Hours of Operation:
Lunch: Monday - Friday: 11:30am - 4:00pm; Dinner: Monday - Friday: 4:30pm - 9:00pm, Saturday: 5:00pm - 10:00pm
- Payment Options: AMEX,Diners Club,Discover,JCB,MasterCard,Visa
- Cuisine: Seafood, Southern
- Executive Chef: Zach Kell
- Dress Code: Casual Dress
- Accepts Walk-Ins: Yes
- Additional Details: Banquet/Private Rooms, Bar Dining, Bar/Lounge, Beer, Chef's Table, Counter Seating, Farm to Table, Full Bar, Gluten-free Menu, Non-Smoking Area, Non-Smoking Restaurant, Personal wines welcome, Personal wines welcome (corkage fee applies), Private Room, Smoking Area, Takeout, Wheelchair Access, Wine, Wine Bar
A word from Goin' Coastal - Canton
Jezebel Magazine - #35 of the TOP 100 restaurants in AtlantaContinued
Highest Ranking Seafood Restaurant in the TOP 100
Atlanta Magazine - Highest ranked seafood restaurant in Atlanta
Yelp - 4 Star Rating
GOIN" COASTAL is a sustainable seafood joint. We feature only the highest quality seafood from sources, either fished or farmed that can exist over the long term without compromising species' survival or the health of the ecosystem. So why does this matter?
1. With over 75% of the world fisheries either fully fished or over fished, we believe the choices we make will help to enhance the seafood marketplace for all consumers.
2. Sustainable fishing practices are not only environmentally responsible they yield the highest quality seafood.
Thank you for supporting the sustainable seafood movement by GOIN COASTAL. Now, stop surfing the web and come eat some great seafood!
Highest Ranking Seafood Restaurant in the TOP 100
Atlanta Magazine - Highest ranked seafood restaurant in Atlanta
Yelp - 4 Star Rating
GOIN" COASTAL is a sustainable seafood joint. We feature only the highest quality seafood from sources, either fished or farmed that can exist over the long term without compromising species' survival or the health of the ecosystem. So why does this matter?
1. With over 75% of the world fisheries either fully fished or over fished, we believe the choices we make will help to enhance the seafood marketplace for all consumers.
2. Sustainable fishing practices are not only environmentally responsible they yield the highest quality seafood.
Thank you for supporting the sustainable seafood movement by GOIN COASTAL. Now, stop surfing the web and come eat some great seafood!
Foodspotting photosSee all photos
Awards voted by OpenTable diners
- Diners' Choice WinnerBest Overall
- Diners' Choice WinnerBest Ambiance
- Diners' Choice WinnerBest Food
Goin' Coastal - Canton - Best Restaurants in Canton ›
Goin' Coastal - Canton reviews from OpenTable diners
82 reviews since July 31, 2014
- Food4.7Service4.6
- Ambiance4.4Noise LevelModerate
neighborhood gem (60)special occasion (48)fit for foodies (46)romantic (21)notable wine list (19)good for groups (18)great for lunch (17)hot spot (15)vibrant bar scene (13)great for brunch (6)late-night find (5)kid-friendly (4)scenic view (3)great for outdoor dining (1)Show More
- Wonderful food and servicepdflowersVIPDined on 11/22/2014Another evening with wonderful food and service. As many times as I go to this restaurant, I never tire of it. Thanks for the wine recommendation, Zach. It was perfect.Special Features:I would recommend this to a friend.
- 1st time at this restaurant, will NOT be the last!jbrew33Dined on 11/21/2014This place was SO good! The location, the ambiance, the service, EVERYTHING about it was top notch! We went for my birthday and the only thing I regret is not saving enough room to have dessert! Would recommend this place to anyone!Special Features:
- Outstanding again...OpenTable Diner Since 2008Dined on 11/19/2014The bacon wrapped monkfish was terrific. The Thursday night oyster special was outstanding as usual.Special Features:I would recommend this to a friend.
- Wonderful evening. Even had UGA game on TV!OpenTable Diner Since 2014Dined on 11/15/2014Excellent menu. Lobster Pot Pie, Raw oysters, She Crab soup for starters were superb. Mahi & Grouper as good as any we have had. Apple cheesecake & peanut butter pie for dessert..yummy.Special Features:I would recommend this to a friend.
- Great Food!OpenTable Diner Since 2014Dined on 11/8/2014This is our second time eating at Goin' Coastal, we brought another couple with us and they were very pleased with the service and food. Love having such a unique restaurant in our backyard, so much better than all the chain places around Canton.Special Features:
- Always a good experience!Msudawg67Dined on 11/7/2014Goin' Coastal is our favorite Date Night restaurant. Never a bad meal and always great service. We highly recommend Goin' Coastal to our friends.Special Features:
- Perfect! As always!NCG147Dined on 11/4/2014Great food, perfectly prepared and served by true professionals. The seafood, always fresh offering a variety of options, difficult to choose from.Special Features:
- jburdDined on 11/3/2014lobster special served cool--but tasted good any way / the bacon flavor of gravy on the chicken--too heavy, almost tasted greasy--chicken was good / wine selection good / think prices are too highSpecial Features:
- Great SpotCouplaFoodiesDined on 11/3/2014We eat at Goin' Coastal at least once a month (typically on Monday, for $20 lobster night). We have never had anything short of an excellent meal. The food is outstanding and the wait staff is second to none. I highly recommend it to anyone who loves great seafood.Special Features:
- Seafood here always great!overpricedDined on 10/24/2014Food here is really good. Have been three or four times. I keep coming back. Although Canton is a drive the food is worth it. We shared the shrimp and crab dip. Awesome! I had the seafood bowl without oysters ( not a fan). Loved it! My friend had the trout and said it was fabulous! Would definitely go again.Special Features:I would recommend this to a friend.
- A+SaxonDined on 10/24/2014Goin' Coastal is always great & never disappoints!Special Features:
- Great spotLocalyokelDined on 10/22/2014Always great! Great food choices and bar drinks! Reservations are adviced.Special Features:
- Consistent qualityBeeHungryDined on 10/17/2014We've been here many times & it is consistently excellent seafood, & service! I particularly like that you pair your fish with your choice of preparation. Staff is attentive & overall you just can't go wrong when Goin Coastal!Special Features:I would recommend this to a friend.
- greatJohnDined on 10/15/2014Food & service was great. Got there around 6 so they had plenty of Oysters. Sometimes they run out.Special Features:I would recommend this to a friend.
- A little disappointedamylee225Dined on 10/10/2014We have always had wonderful food at Goin' Coastal, but our latest visit was a bit of a disappointment. While the restaurant wasn't very busy for a Friday night, our main entrees took a long time to get to our table. We had long finished our appetizers (lobster bisque; still good!) and salads. My husband ordered a 1&1/2 lb. lobster, but when it arrived, it was much smaller than it should have been, and there was very little meat. I had ordered the crablegs, and while there were certainly a lot of them, they were not seasoned in any way and actually seemed a bit overcooked. We will be willing to give it another try based on our history there, but this was not a good meal.
- Reliable venueOpenTable Diner Since 2014Dined on 9/29/2014We have used this venue for groups and for small parties, every visit there is continued good food and good service. Easy pick for reliability.
- OpenTable Diner Since 2014Dined on 9/27/2014Fish was fresh and excellent. Food presentation was eye appealing.Special Features:I would recommend this to a friend.
- Awesome find in Canton, GAFoodieOnTheProwlVIPDined on 9/24/2014I wasn't expecting this place to be so tasty! The drinks, the food, the bacon infused butter! It was absolutely mouth watering. The service was wonderful and who can argue with desserts made by the owner's mother… seriously! Can't wait to go back. We had the shrimp and crab dip (creamy, rich) and the lobster bisque (great update to a classic with lots of complex flavor). I had one of the fish specials made with arctic char that night - couldn't have been more perfect. Husband had the low country shrimp boil - they make their own seafood seasoning and the hints of cinnamon and nutmeg (maybe) were surprising and wonderful.Special Features:I would recommend this to a friend.
- Excellent in every way !!!HappyGrandmaGADined on 9/24/2014We have been here several times and everything has always been excellent! Food, service, quality, appetizers - - all consistent. Even though some dishes are a bit pricey, we know that we will be thrilled with the food so it is well worth going here. I also like that the family-style salad is still served as part of the meal whereas other restaurants have taken that away.Special Features:
- Great fresh foodbeehappyDined on 9/10/2014Great place, food is always fresh, great service, beautiful historic building, been there 3 times and plan on going more!Special Features:
- Never DisappointedCouplaFoodiesDined on 9/8/2014We are regulars at Goin' Coastal in Canton. I've never had a meal that was less than great, and the wait staff is awesome. It is the perfect mix of ambiance and fine dining.Special Features:
- GeorgieDined on 9/6/2014We totally enjoyed our dining experience at "Goin' Coastal" and will definitely return.Special Features:
- woodyDined on 9/6/2014The seafood was exquisite -- really excellent in all respects. The casual ambiance and energetic noise level conceals a really first-rate kitchen.Special Features:
- EnjoyableHungryInCantonDined on 9/5/2014Our second visit to Goin Coastal and both experiences were consistent. I was impressed to see New Bedford scallops, Wahoo, and other regional seafood that are fairly uncommon in most Atlanta restaurants. Between the 4 of us we had Grouper, Surf and Turf with Scallops, Lobster, and salad and She Crab Bisque. Bisque was delicious; very light and extremely tasty; a definite must. Steak got a great rating from my husband and the scallops were nicely done, although I could not detect the signature sweetness of New Bedford scallops. Grouper got rave reviews & my lobster was good. Service was friendly and efficient. Good cocktails, wine not a generous pour. Not 5 stars but an oasis in the culinary desert of Canton & we will return.Special Features:
- OpenTable Diner Since 2008VIPDined on 9/3/2014Great, as always. This is a very reliable spot in Canton!
- SHRSRDined on 8/29/2014Excellent ambience, good service, and great food. It was a most enjoyable experience.Special Features:I would recommend this to a friend.
- Great food!georgiakatDined on 8/25/2014We were surprised to find so many people at this restaurant in Canton on a Monday night, most of the streets in town were deserted! This seemed like a good sign to us. The bartender Josh was our server, and he checked on us many times during our visit, and made sure we had all we needed. The food was delicious, we had the shrimp and grits, and the stuffed rainbow trout. The chef has an excellent palate, the flavors were well balanced. Pricing gets into the $20s and $30s per entree, but that's the cost of high quality seafood these days. I would recommend this restaurant to friends.Special Features:I would recommend this to a friend.
- Canton, GA RecommendedOnTheHuntDined on 8/23/2014This was our 1st visit to Goin Coastal. You WILL get a great meal and service. Ordered the Amberjack and Grouper and received very generous portions well prepared. Started with Shrimp and Crab and Cheese appetizer, tasty! Cheese Grits - Very good. Entrée had a little hiccup with one entrée but handled quickly and professionally. Will go again when in area.Special Features:I would recommend this to a friend.
- DowntownDudeVIPDined on 8/23/2014Zach, Josh and crew are always spot-on. Great food, great service, one of the best joints for dinner in north metro! Keep it up!Special Features:
- Great food !HappyGrandmaGADined on 8/20/2014Happy experience, delicious food & appetizers, excellent waitress, had a very nice time with friends. The waitress turned off the fan since it was making it cold. There were not a lot of people this night and usually it is crowded so the noise level was not too bad.Special Features:I would recommend this to a friend.
- Wonderful Dinner ExperienceOpenTable Diner Since 2011Dined on 8/19/2014I went to Goin' Coastal for my dad's 66th birthday, and the whole experience was just wonderful. My dad is a man who is hard to please, but he thought the food was one of the best he's had. Friendly service, nice ambiance, and spectacular food are the reasons why I will go back to Goin' Coastal.Special Features:
- Wonderful!JamieDined on 8/16/2014Went with my husband on our date night, it was perfect! Service, food and atmosphere where all top notch! It is expensive, but for a special night out, it's worth every penny!Special Features:I would recommend this to a friend.
- GreatOpenTable Diner Since 2011VIPDined on 8/15/2014Nice restaurant. Consistently good food. However, this time service was unusually slow.Special Features:I would recommend this to a friend.
- Outstanding Sea BasspdflowersVIPDined on 8/14/2014the featured special--chilean sea bass with corn maque choux, lady peas, and bacon jam--was outstanding. As was the tuna carpaccio that we had as our appetizer. Service, as always, was excellent at our favorite seafood restaurant. I really like the recent changes to the menu.Special Features:I would recommend this to a friend.
- Wonderful food, ok service.Luv2DineDined on 8/2/2014We had a reservation for 8:30, but we didn't get seated until 9pm. This was disappointing. The food was amazing, but again, our service once seated was just mediocre. We had to ask more than once for drink refills. We've dined here before and have never had an issue. Guess it was just an off night. We're big fans of the restaurant overall. We will gladly return. Wonderful food!!Special Features:I would recommend this to a friend.
- Wonderful food and service!KimLewDined on 8/2/2014I have dined here two times now. Both times, had the same server. She is excellent and so is the food.Special Features:
- HarryDined on 8/1/2014Food was very good. Service was very good and helpful.Special Features:
- The following 333 reviews are from the Goin' Coastal - Canton reviews archive.
- Loved it!CantondinersDined on 7/29/2014My wife and I dined at Goin' Coastal for our 41st wedding anniversary. We loved it! Great food, excellent service in a warm setting. Food was outstanding from the mussel marinara appetizer to the family style salad that was chock full of veggies and topped with homemade dressing to our yummy entrees: lobster Mac & Cheese and Shrimp & Grits. Yum! Can't wait to come back!Special Features:I would recommend this to a friend.
- Happy guestLocalyokelDined on 7/29/2014We had some clients from out of town. They were very please with our dining selection.Special Features:
- Outstanding...againHungryJackDined on 7/28/2014Goin Coastal has quickly become my favorite place to eat. Unbelievable food and service with the small town charm of downtown Canton. I would give a 6th star were it available.Special Features:I would recommend this to a friend.


text:
* required fields
Secretary Chu has detailed President Barack Obama's $27.2 billion fiscal year 2013 budget request for the Energy Department. Requests focus on job creation, clean energy, national security, and innovation.
The United States is competing in a global race for the clean energy jobs of the future," says Secretary Chu. "The choice we face as a nation is simple: do we want the clean energy technologies of tomorrow to be invented in America by American innovators, made by American workers and sold around the world, or do we want to concede those jobs to our competitors? We can and must compete for those jobs. This budget request includes responsible investments in an American economy that is built to last."
Efficient, clean energy sources have been of continual interest to building owners and facility managers as new technologies pave the way toward greener, more affordable options. The FY 2013 budget includes a plethora of items seeking to explore energy use. The President's FY 2013 budget request for the department of energy:
Invests in cross-cutting research to lead in the research, development, deployment and production of clean energy technologies;
Promotes efforts to make solar power affordable for all Americans by reducing the cost of solar energy by 75% and making it cost competitive without subsidies by the end of the decade;
Continues the Obama Administration's efforts to reduce our dependence on oil by one-third by 2025;
Supports groundbreaking basic science, research and innovation to solve our energy challenges and ensure that the United States remains at the forefront of science and technology;
Strengthens national security by reducing nuclear dangers and maintaining a safe, secure and effective nuclear deterrent; and
Advances responsible environmental management by cleaning up the legacy from the Manhattan Project and the Cold War.
Other relevant highlights of the 2013 budget include:
$60 million to perform critical research on energy storage systems and devise new approaches for battery storage;
$770 million for nuclear energy, including $65 million for cost-shared awards to support first-of-a-kind small modular reactors and $60 million for nuclear waste R&D that aligns with the recommendations of the Blue Ribbon Commission on America's Nuclear Future;
$276 million for research and development of advanced fossil fuel power systems and carbon capture, utilization and storage technologies to allow for the continued use of our abundant domestic coal resources while reducing greenhouse gas emissions;
$350 million for the Advanced Research Projects Agency-Energy (ARPA-E) to continue support for promising early-stage research projects that could deliver game-changing clean energy technologies;
$120 million to support the Energy Frontier Research Centers and $140 million for the five existing Energy Innovation Hubs and to establish a new hub to focus on grid systems and the tie between transmission and distribution systems;
$11.5 billion to protect Americans by maintaining U.S. nuclear deterrence capabilities, reducing nuclear dangers in an increasingly unstable and unpredictable world, and providing for the Navy's nuclear propulsion needs; and
$2.5 billion to support NNSA's Defense Nuclear Nonproliferation program, which plays a critical role in completing the President's goal of securing all vulnerable nuclear material around the world in four years.
Visit our website today to learn about the design flexibility of a Morton building and the endless possibilities of partnering with our designBUILD team.
Wood construction is both cost and energy efficient. Check out Morton Buildings and our designBUILD team online today to discover all the benefits of post-frame construction.
When choosing a metal-clad building for your next construction project, consider Morton Buildings, Inc., and their designBUILD team, we'll make your dream a reality.
We Can Help You Reduce Energy by 30%
Our mission is to help our customers manage their buildings' energy costs, improve reliability, and enhance performance while having a positive impact on the environment. CLICK HERE to find out how.
More executives choosing alternatives to LEED.
EPA challenge to increase diversion rates for the holidays.
Framework allows users a better look at roofing's environmental impact.
Study finds paper towel dispensers carry far fewer germs.
Tool will help manage information during power outages.
Requirements include energy, IEQ, and sustainability updates.
Group of 17 properties earn energy efficiency designation.
Water conservation efforts see results.
Study shows sustainable investments weather the winter.
Standard focuses on occupant health.
EPA says cleanup will cost hundreds of thousands of dollars.
Methane will be used as a fuel source.
ASTM to target roofing material diversion rates.
ORNL scientists look to the future of renewable energy integration.
Lawsuits unlikely to convince polluters to change opposition to legislative reform.
Green building investment jumps in 2013.
Study shows difference between reported and measured occupant behavior
Report shows energy modeling as key to improving building performance
Report shows healthy features and practices yield results.
USGBC announces two more years to prepare for LEED v4.
Spot Coolers commercial portable heating & cooling. Nationwide Emergency service 24/7. Your source for portable air conditioning rentals and sales.
Need portable cooling for data centers, offices & more? Atlas Sales & Rentals is on call 24/7 from locations nationwide. Fast service, competitive prices.
FARO is the world's most trusted source for 3D measurement, imaging and realization technology. The company develops and markets computer-aided measurement and imaging devices and software. Technology from FARO permits high-precision 3D measurement, imaging and comparison of parts within production and quality assurance processes. The Focus3D X 330 Laser Scanner is the perfect tool for 3D documentation of as-built conditions for new builds, renovations and historical preservation. The Focus3D X 330 can scan objects up to 330 meters away and in direct sunlight. With its integrated GPS receiver, the laser scanner is able to correlate individual scans in post-processing making it ideal for architectural, construction, engineering and surveying based applications. http://www.faro.com/focus
Red Hawk: A comprehensive range of contemporary fire and security solutions. One that's just right for your business. That's the power of experience. www.redhawkus.com
The BUILDINGS brand serves commercial building owners and facilities management professionals for commercial real estate. BUILDINGS brand offers its audience of commercial building owners and facilities management professionals information on the development, construction, modernization, management and operations of commercial buildings as well as the products and services needed to support such commercial buildings and facilities management. With the information we offer, we help facilities management professionals make smarter decisions for commercial buildings.
BUILDINGS delivers relevant and timely information that equips commercial building owners and facilities management professionals with the knowledge and support they need to solve critical issues; energy management, lowering operating costs, new products for commercial buildings, security, and much more.
BUILDINGS provides facilities management professionals commercial buildings tips and trends trough online webinar events (BuildingsVIP), monthly newsletters, whitepapers and case studies.
In addition to content, BUILDINGS features a comprehensive list of products and services and is your link to the companies that provide these valuable facilities management and commercial buildings resources.
You also have the opportunity to maintain your commercial buildings certifications with BUILDINGS. Continuing Education Units are available with approved content from BOMI.
©Copyright 2014 Stamats Communications, Inc. All rights reserved / BUILDINGS

subset: commoncrawl


text:
Stardom: The A-List Answers for iPhone - iPodHome / iPhone - iPod /
Game Questions & Answers (Q&A) service lets you ask questions about video games for game consoles or PC games. So ask your Stardom: The A-List question for iPhone - iPod and get answers from real gamers or answer questions and share your insights and experience with the rest of the gaming community.
- Developer: Glu Games Inc.
- Publisher: Glu Games Inc.
- Genre: Adventure General
- Release Date: Dec 14, 2011
- ESRB: Not Set
Question & Answers
Relationship levels
I'm an a list now, i'm surprised how fast the fan increases when u film a big movie.. Bt anyway, i'm a couple with this guy, just wondering what is the next relationship level? Engaged? Is there a married or something? Pls reply!
Answer from: SoccerStardom22
There is no marriage, yet... The next one after couple is engaged, hope this helps! Good luck!
Answer from: emmashen
If it can be married and moved into a house, that would be better.
Answer from: Layla
I know I kept having to be engaged and tere was now where else to go a d so I did new projects and he broke up with me
Answer from: jd
Engaged is the highest level, I maxxed out the dating achievement with one of the girls I was in a couple with and I got a star and we are engaged but we were since we had 500 points together I think so nothing changed at the max amount (which is around 1200 I think ? ) If pple break up with you just call them to be a co-star when you do your next project and it will say you won't get professional points for working with them but say call them anyway, and as soon as they are there you can check your contacts and you will see that you are automatically a couple again and no longer broken up :-)
Answer from: Bigcol
My relationship is at 1249 out of 1250... I'm engaged but can't seem to get that last point.. Is it possible
Answer from: Allycat
@bigcol: I have the same problem and its a tad bit irritating :(
Answer from: Shelly belly
I'm engaged but I wish it got up to marriage!
Answer from: Nicole
It has marriage now and you can choose between Las Vegas or a Tahiti wedding. I am not sure what comes after marriage though as the relationship needs to be 5000 at that point to even know what's next.
Unanswered Questions
From: Tori
Posted on: 07-01-2014
From: Zoe
Posted on: 06-06-2014
From: Anbl
Posted on: 05-25-2014
From: Margarita
Posted on: 06-26-2013
Stardom: The A-List - Review Gameplay
- Aug 21, 2014, Views: 175
Stardom: The A-List - Gameplay Gameplay
- Aug 21, 2014, Views: 71
Stardom: The A-List - Glu Trailer
- Aug 21, 2014, Views: 77
Stardom: The A-List - Let's Play Trailer
- Aug 21, 2014, Views: 66
- Monster League Racing, (iPhone-iPod)
- Houseki Hiroi: Okane Mochi, (iPhone-iPod)
- What Happy Bird Left, (iPhone-iPod)
- Drunken Monkey, (iPhone-iPod)
- Bistro, (iPhone-iPod)
- ``Action Bike Stunt Rider, (iPhone-iPod)
- `` Airborne Legends Racer 3D `` - Use Your Mad Skill Racing To Get The Coins On The Epic Road, (iPhone-iPod)
- Wild Ski, (iPhone-iPod)
- White Tiles Frozen Edition, (iPhone-iPod)
- Volcano Fireball Rain - Water Cannon Shooting Defense Game Paid, (iPhone-iPod)
- Virtual Families 2: Our Dream House, (iPhone-iPod)
- Angry Birds Transformers, (iPhone-iPod)
- The Secret Society: Hidden Mystery, (iPhone-iPod)
- Kim Kardashian: Hollywood, (iPhone-iPod)
- WordBrain, (iPhone-iPod)
- The Sims: FreePlay, (iPhone-iPod)
- The Simpsons: Tapped Out, (iPhone-iPod)
- Episode: Choose Your Story, (iPhone-iPod)
- My Singing Monsters, (iPhone-iPod)
- Card Wars - Adventure Time, (iPhone-iPod)
- Kim Kardashian: Hollywood - Gameplay, (iPhone-iPod)
- Episode: Choose Your Story - Gameplay, (iPhone-iPod)
- How To Train Your Dragon 2 - Ready To Fly Trailer, (Wii)
- The Settlers - Kingdoms Of Anteria - Announcement Trailer, (PC)
- Entwined - Quick Look Trailer, (PS3)
- Blue Estate - Official Launch Trailer, (PS4)
- Goat Commando 3D Simulator - Gameplay, (iPhone-iPod)
- Munin - Official Launch Trailer, (iPad)


text:
The national exposure registry: history and lessons learned.
The National Exposure Registry (NER) was created as a comprehensive group of data repositories that sought, over time, to relate specific environmental chemical exposures to registrants' health conditions. The NER's primary goal was to facilitate epidemiologic research by establishing multiple databases (subregistries) that contained demographic, environmental, and health information on large populations exposed to selected chemicals. The databases created by the NER were intended to provide information that would generate appropriate hypotheses for future activities, such as epidemiologic studies.
This article reviews the decisions and events that led to the formation of the NER. It cites the history, operations, accomplishments of the NER, and the les sons that can be learned from this enterprise. The lessons learned will, hopefully, serve as a guide for more meaningful and useful data collection and interpretation for all future exposure registries.
Formation of the National Exposure Registry
Legislative Background
In the late 1970s and early 1980s, public concern was increasing about the potential impact of human exposures to hazardous substances from waste sites and chemical spills on the health of communities (Harris, 1983; Levine, 1983). The 1978 Love Canal Love Canal, section of Niagara Falls, N.Y., that formerly contained a canal that was used as chemical disposal site. In the 1940s and 50s the empty canal was used by a chemical and plastics company to dump nearly 20,000 tons (c. , New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , incident of soil contamination Soil contamination is the presence of man-made chemicals or other alteration in the natural soil environment. This type of contamination typically arises from the rupture of underground storage tanks, application of pesticides, percolation of contaminated surface water to with over 200 hazardous substances; the 1983 Times Beach, Missouri Times Beach, Missouri was a small town of 2,240 residents in St. Louis County, Missouri, 17 miles (27 km) southwest of St. Louis and 2 mi (3 km) east of Eureka, Missouri. The town was completely evacuated in the mid-1980s due to a dioxin scare that made national headlines. , dioxin dioxin
Aromatic compound, any of a group of contaminants produced in making herbicides (e.g., Agent Orange), disinfectants, and other agents. Their basic chemical structure consists of two benzene rings connected by a pair of oxygen atoms; when substituents on the rings are soil contamination; and the 1984 Battle Creek, Michigan "Battle Creek" redirects here. For other uses, see Battle Creek (disambiguation).
Battle Creek is a city in the U.S. state of Michigan, in northwest Calhoun County. , trichloroethylene trichloroethylene /tri·chlo·ro·eth·y·lene/ (-eth´i-len) a clear, mobile liquid used as an industrial solvent; formerly used as an inhalant anesthetic.
n. (TCE TCE
TCE Environment A volatile chlorinated hydrocarbon that boils at 88ºC and is highly soluble–1000 ppm in water, with various industrial uses Toxicity Peripheral neuropathy, carcinogenic. ) well water contamination were seminal events in the American public's perception of hazardous waste Hazardous waste
Any solid, liquid, or gaseous waste materials that, if improperly managed or disposed of, may pose substantial hazards to human health and the environment. Every industrial country in the world has had problems with managing hazardous wastes. sites as a major environmental hazard. In response to these and related concerns, Congress passed the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA CERCLA Comprehensive Environmental Response, Compensation, and Liability Act (aka SuperFund) ). This law provided for liability, compensation, cleanup, and emergency response for hazardous substances released into the environment and the cleanup of inactive hazardous waste disposal sites. This legislation also created the Agency for Toxic Substances and Disease Registry The United States Agency for Toxic Substances and Disease Registry, (ATSDR) is an agency for the U.S. Department of Health and Human Services that is directed by a congressional mandate to perform specific functions concerning the effect on public health of hazardous (ATSDR ATSDR Agency for Toxic Substances & Disease Registry ). Congress created ATSDR to specifically address the potential public health problems associated with environmental exposures to hazardous substances from waste sites and chemical spills. ATSDR was given two mandates relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc registries. They were first, to establish and maintain a national registry of persons exposed to hazardous substances, and second, to establish and maintain a national registry of persons with serious diseases or illnesses resulting from these exposures.
In April 1981, a subcommittee of the U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS (DHHS DHHS Department of Health & Human Services (US government)
DHHS Dana Hills High School (Dana Point, California)
DHHS Deaf and Hard of Hearing Services
DHHS Deaf and Hard of Hearing Services ) Committee to Coordinate Environmental and Related Programs (CCERF) released a report on the use of longterm registries for health follow-up of populations exposed to toxic hazards. This report outlined several conditions necessary to establish and operate such exposure registries, e.g., a scientifically acceptable and feasible rationale; sustained institutional commitments for funding, analysis, and reporting; ethical constraints in recruiting and following such populations; and the kinds of information that needed to be collected. Two years later, in 1983, DHHS published in the Federal Register a statement of organization, functions, and delegations of authority for ATSDR (The Public Health and Welfare Chapter 103--Comprehensive Environmental Response, Compensation, and Liability Subchapter I--Hazardous Substances Releases, Liability, and Compensation, 1983).
FIGURE 1 Goals and Objectives of the National Exposure Registry Primary Goals: To fill data gaps for long-term-health effects, defined as persistent adverse health outcomes, lasting more than one year, which may be manifested at any point in time. Those health outcomes will be focused on medically confirmed diagnoses potentially related to exposures to hazardous substances and their mixtures. Goal 1: To facilitate epidemiologic or health studies. Objective 1.1: To create data files that will be of value in research related to verifying what are thought to be known adverse health outcomes (hypothesis testing). Objective 1.2: To create data files that will be of value in research related to identifying previously unknown, undetermined adverse health outcomes should they exist (hypothesis generating). Goal 2: To facilitate state and federal health surveillance programs by enabling the identification and tracking of participants in the programs and by maintaining information on the participants. Objective 2.1: To create data files that can be used for follow-up surveillance activities if needed. Goal 3: To provide information that can be used to assess the burden of the effects of an exposure or health outcome on a population. Objective 3.1: To provide, to appropriate health officials, health information necessary for any contingency planning (such as information on appropriate screening plans, available diagnostic or therapeutic facilities, and educational materials for health care providers and the general public). Objective 3.2: To provide appropriate officials with environmental information necessary for any contingency plans to reduce exposures to hazardous substances. Supplemental Goals: To provide service and to be of direct benefit to the registrants, in keeping with the dictates of a public health agency. Goal 4: Working with state and local health officials, to provide exposed persons with current relevant information about the hazardous substances to which they have been exposed. Objective 4.1: To provide important toxicologic and epidemiologic findings that become available. Objective 4.2: To provide medical information that encourages registrants to seek medical attention, if needed. Goal 5: To enable local, state, or federal health officials to notify registrants rapidly of the adverse health effects of an exposure, preventative measures, or therapeutic advances that were not understood or known when the registry was established. Objective 5.1: To continue to provide state-of-the-art scientific information related to the exposure(s). Objective 5.2: To promptly provide new information on screening, diagnostic, or therapeutic activities related to the exposure(s). Blue text indicates process not achieved in practice.
In 1984, a document was produced titled, Criteria and Methods for Establishing and Maintaining Exposure and Outcome Registries for Environmental Public Health Problems (Center for Environmental Health, 1984) that proposed criteria for the establishment of nonoccupational environmental disease and exposure registries to be established under CERCLA. It also presented discussions of the strengths and limitations of exposure and disease registries. The top priorities for ATSDR registries, as stated in this document, were as follows:
(1) Persons exposed outside the workplace to
A. persistent, measurable levels of hazardous agents in which animal studies or other evidence predicts significant adverse effects in humans; or
B. hazardous agents for which current methods exist to prevent an adverse outcome; or
(2) Persons with outcomes of interest where measurements of exposure to hazardous agents are available.
Of the two original CERCLA mandates published in 1980, the second one relating to the establishment and maintenance of a national registry of persons with serious diseases or illnesses was deferred in order to first concentrate resources on the establishment of an exposure registry. This second mandate was, in fact, never acted upon. Therefore, this review is concerned with only the first mandate--the formation of a national registry of persons exposed to hazardous substances--the NER. An additional mandate was created by the Superfund Amendments and Reauthorization Act of 1986 (SARA Sara or Sarah, in the Bible, wife of Abraham and mother of Isaac. With Rebekah, Rachel, and Leah, she was one of the four Hebrew matriarchs. Her name was originally Sarai [Heb.,=princess]. ), which stated that the agency must consider establishing a registry as a follow-up action to a health assessment when a potentially significant risk to human health is indicated. Two exposure registries, the World Trade Center Health Registry and the Tremolite tremolite: see amphibole. Asbestos Registry, were recently established by ATSDR, but neither was created in response to the SARA mandate and neither is part of the NER. They will, therefore, not be discussed in this review.
Defining the NER
The stated goals and objectives of the NER are shown in Figure 1. The purpose of the NER was to assess and evaluate the potential relationships between environmental exposure and adverse health effects for an exposed population, particularly the relationship between chronic health effects and long-term, low-level chemical exposures. Of particular concern when considering environmental health issues is the lack of information about the effects of low-level exposures of long duration on general populations (versus worker populations), such as those typically surrounding hazardous waste sites. Registries can be a valuable tool for assembling the information necessary to address the potential health outcomes of these types of exposures.
The NER's primary goal was to facilitate epidemiologic research by establishing multiple databases (subregistries) that contain demographic, environmental, and health information on large populations exposed to selected chemicals. The processes for establishing, maintaining, and terminating a registry are shown in Figure 2.
It is important to differentiate between an exposure registry and an outcome registry. An exposure registry, such as the NER, is a registry in which people with particular exposure histories are followed forward from a period of exposure to determine whether they develop one or more adverse health outcomes. An outcome registry is a registry in which people with particular health outcomes, such as a specific disease, are studied backward in time from the date of their first such outcome, or onset, or diagnosis, to determine whether they may have been exposed to a hazardous agent of interest.
When the NER was launched, an exposure registry was a relatively new approach, in contrast to the more established disease or outcome registries, e.g., cancer registries. The purpose and function of an exposure registry has been defined as follows (Schulte & Kaye, 1988):
1. Delineation of the population at risk.
2. Follow-up of a cohort to ascertain exposure-disease associations.
3. Follow-up of a cohort to ensure the institution of appropriate primary and secondary prevention and medical surveillance.
4. Follow-up of a cohort to allow for appropriate social, legal, and economic support.
5. Demonstrate societal concern for the cohort and provide a base for political action relevant to the exposure.
6. Notify a cohort of an exposure, preventive measures, or therapeutic advances, which were not understood or known at the time that the registry was established.
Establishing an NER Subregistry
Subregistries were established for dioxin in 1988, TCE in 1989, benzene benzene (bĕn`zēn, bĕnzēn`), colorless, flammable, toxic liquid with a pleasant aromatic odor. It boils at 80.1°C; and solidifies at 5.5°C;. Benzene is a hydrocarbon, with formula C6H6. in 1991, and trichloroethane tri·chlo·ro·eth·ane
Either of two colorless, nonflammable, isomeric compounds, C2H3Cl3, having a sweet odor, used as solvents for adhesives, pesticides, and lubricants, and in industrial cleaning solutions. (TCA TCA
1. trichloroacetic acid.
2. tricarboxylic acid cycle (Krebs cycle).
TCA Tricyclic antidepressant, see there ) in 1992. The establish ment of an NER subregistry required several well-defined steps. They were (1) primary contaminants selection, (2) site selection, (3) population selection, (4) data collection, and (5) file creation and maintenance. Detailed descriptions of these steps are described elsewhere (Agency for Toxic Substances and Disease Registry [ATSDR], 1988, 1994; Burg, 1989; Burg & Gist, 1995, 1997; Gist & Burg, 1995; Gist, Burg, & Radtke, 1994).
Health Findings
ATSDR compared the NER data for people exposed to the hazardous substance to data for people in the U.S. who were not exposed to the hazardous substance. The comparison group for the NER subregistries was drawn from the National Health Interview Survey (NHIS NHIS National Health Interview Survey
NHIS New Hampshire International Speedway
NHIS National Health Insurance Scheme (Ghana)
NHIS National Health Insurance System ). Five health conditions were reported in excess in each subregistry in at least one data collection period for some group of registrants. They were (1) anemia and other blood disorders blood disorders,
n.pl hematologic dyscrasias that affect the component cells and plasma elements of the blood. They are generally divided into two broad groups: those in which an increase in bulk occurs (e.g. , diagnosed in the past year; (2) all cancers, diagnosed in the past year; (3) skin rashes, eczema eczema (ĕk`səmə), acute or chronic skin disease characterized by redness, itching, serum-filled blisters, crusting, and scaling. , or other skin allergies, diagnosed in the past year; (4) urinary tract disorders, including prostate trouble, diagnosed in the past year; and (5) stroke, ever diagnosed. Table 1 shows the health effects reported in excess when compared with national data (baseline or follow-up).
It is important to note that despite the many health effects observed to be in excess when compared with national norms, NER staff believe that the excess reporting of these health conditions might be explained by several factors including methodological differences in data analysis and reliance on self-reported, nonverified data. They further believe that these results do not identify relationships between the registrants' reported adverse health effects and their exposure to the chemicals studied in the four subregistries: TCE, benzene, dioxin, and TCA.
Design Issues
Many questions arise when designing an exposure registry. What constitutes adequate exposure measurement? How can exposed persons be adequately differentiated from nonexposed persons? What group could serve as a comparison group so that the disease experience of the exposed group can be evaluated? For how long should the group be followed? These questions can become quite technical, but often, even the most basic questions are the hardest to resolve. At least four important issues were never satisfactorily resolved in the design of the NER. They were adequacy of exposure measures, unverified self-reporting, appropriate control groups, and the use of biomarkers.
Inadequacy of Exposure Measures
The most important design deficiency of the NER was its inability to adequately assess exposure. Yet accurate exposure assessment is central to the utility of any exposure registry and is critical in establishing an association for health outcomes to a particular chemical of interest.
It is generally accepted that the four primary characteristics for the determination of exposure are (1) the nature of the agent, (2) the intensity of exposure, (3) the duration of exposure, and (4) the frequency of exposure. In the NER, the inability to measure the intensity, duration, and frequency of exposure to the chemicals of interest has been the most critical limiting factor A factor or condition that, either temporarily or permanently, impedes mission accomplishment. Illustrative examples are transportation network deficiencies, lack of in-place facilities, malpositioned forces or materiel, extreme climatic conditions, distance, transit or overflight rights, in its design. In the TCE subregistry, for example, the exposure assessment was limited to the measurements obtained at the time of the U.S. Environmental Protection Agency (U.S. EPA EPA eicosapentaenoic acid.
eicosapentaenoic acid
n.pr See acid, eicosapentaenoic.
n. ) investigations and was usually based on a single measurement from a well. The probable day-to-day and seasonal fluctuation of TCE levels in well water also makes a single measurement questionable. A more adequate exposure assessment would have documented the level of TCE in a registrant's well; the routes of exposure, e.g., ingestion ingestion /in·ges·tion/ (-chun) the taking of food, drugs, etc., into the body by mouth.
1. The act of taking food and drink into the body by the mouth.
2. or showering; and the frequency and duration of exposure. These measurements would be the most important variables in quantifying an individual's exposure to TCE.
An accurate exposure history is also important in the identification of any other major sources of exposure to the chemical in question, notably occupational exposure. Asking for a full occupational profile would have been difficult, but it might have been helpful to have added a question to ascertain whether the individuals worked in the industry responsible for the contamination, in addition to living in the neighborhood.
Another concern in exposure assessment is the issue of multiple contaminants. Many sites have other chemicals present in addition to the chemical of concern. To address the possible roles of other contaminants, registrants might have been grouped as (a) persons exposed to specific chemicals, (b) persons exposed to chemically related compounds, or (c) persons exposed to chemicals known to produce similar effects by in vitro or animal data. Such a grouping might have improved the prediction of specific health outcomes of interest.
In order to deal with the problem of inadequate or erroneous exposure measurements, future exposure registries should use as extensive a battery of exposure measurements as possible. Multiple environmental measurements would improve the accuracy of assessment and direct human exposure measurements should be used whenever possible. The initial NER questionnaires should have had questions to assess the likely extent of exposure by route, duration, and any other relevant factors. In addition, the questionnaires should have included questions that addressed other possible risk factors for the health outcomes that may be associated with the chemical of interest, such as medication use, lifestyle choices, heredity heredity, transmission from generation to generation through the process of reproduction in plants and animals of factors which cause the offspring to resemble their parents. That like begets like has been a maxim since ancient times. , and exposure to other chemicals.
Appropriate Control Groups
It should be noted that a subregistry of unexposed persons was not routinely created for a given site concurrently with the subregistry of exposed persons. The basis for this decision was that at most sites an appropriate control group could not be identified at the time the exposure subregistry was created. The hypothesis to be tested either may not have been known or defined well enough to enable the identification of a valid control population at that time. An example of an inappropriate control group might be a control subregistry of older persons when the adverse outcome is later identified as a birth defect. In some instances where subregistries might be combined for research purposes, an existing source of national statistics may have sufficed. At some sites, an exception to not creating a control subregistry could have been made (e.g., where extensive information is known about the exposure and the expected outcome of this exposure). For most sites, however, the identification of an appropriate comparison group was considered part of the future research activity.
The comparison group for the NER subregistries was drawn from the National Health Interview Survey (NHIS). Both NER and NHIS are self-reported and nonmedically verified data collections. The validity of comparisons between the subregistry populations and the NHIS was dependent on comparability between the two populations and between the data collection instruments. Comparability between the two instruments may have been compromised since some of the questions had been phrased differently in the two surveys. In addition, comparisons might have been misleading if the subregistry population was more likely to be aware of and to report health conditions because of their exposure or because of being in the registry. "Dose response" was another issue. It was not known whether health outcomes occurred more frequently in groups with the highest exposure because the available data did not provide gradients of exposure based on duration, routes, frequency, and intensity. An issue of potential variation in exposure from site to site also arose, creating potential problems of comparability within exposed populations. All of these issues brought into question the adequacy of the control populations for the NER subregistries.
Unverified Self-Reporting
The validity of self-reported data was an important issue in the design of the NER. Verification of reported outcomes with medical records could improve the quality of health information; however, verification was not part of the NER design. Verification adds expense and is relatively difficult to interpret unless an appropriate control group is available. Inherent shortcomings of verification are also present--not contacting the correct medical provider, faulty memory of where and when a diagnosis was made, problems in getting old records, and accessibility to records of a retired physician.
Issue of Biomarkers
Biological markers, or biomarkers, are cellular, biochemical, or molecular measures that are obtained from biological media such as human tissues, cell, or fluids and are indicative of exposure to environmental chemicals. In addition to indicating exposure, biomarkers can also signal events in biologic systems indicative of susceptibility or effect. Biological markers of exposure have been used to study environmental contaminants such as lead levels in blood, teeth, and hair from the inhalation inhalation /in·ha·la·tion/ (in?hah-la´shun)
1. the drawing of air or other substances into the lungs.inhala´tional
2. the drawing of an aerosolized drug into the lungs with the breath.
3. and ingestion of lead. Unfortunately, markers of exposure currently exist for only a small number of hazardous substances.
Lessons Learned
Lessons can be learned from both the strengths and the weaknesses of the NER experience. Some parts of the NER were well conceived, whereas other parts were not. Substantial thought and documentation went into creating the parameters for primary contaminant contaminant /con·tam·i·nant/ (kon-tam´in-int) something that causes contamination.
something that causes contamination. selection, site selection, population selection, and data collection. Less thought and documentation went into defining methods to measure adequately exposure to the chemicals of interest. This was the key missing element and the Achilles heel Achilles heel
a small but fatal weakness [Achilles in Greek mythology was killed by an arrow in his unprotected heel]
Achilles heel n → talón m de Aquiles of the NER program. Questions about the adequacy of self-reporting and the absence of biomarkers cast doubts about the program's design. Another weakness of the NER program was that it did not adequately focus on minority and ethnic populations that are disproportionately impacted by exposure to the chemicals in question. Also, there were inadequate efforts directed to the scientific and public health communities to get their participation in follow-up studies based on NER's findings.
An abundance of excess health outcomes existed for each of the chemical entities studied. Five health conditions were reported in excess for the dioxin, TCE, benzene, and TCA subregistries during at least one data collection period among some group of registrants. Additional health conditions were reported in excess for some, but not all, of the subregistries during at least one data collection period among some group of registrants (Table 1). Many of the excess health outcomes are backed up by biologically plausible hypotheses gained from occupational medicine, clinical studies, and laboratory studies. Yet, despite the many health effects observed to be in excess when compared with national norms, NER staff believed that the excess reporting of these health conditions might be explained by methodological differences in data analysis and reliance on self-reported nonverified data. The NER staff further believed that these results do not identify relationships between the registrants' reported adverse health effects and their exposure to the chemicals studied in the four subregistries. Other risk factors for disease such as heredity, lifestyle factors (such as smoking), medication use, and exposure to other chemicals were not taken into account in the subregistries and may be responsible for observed disease.
The positive lessons learned from the NER experience have been the progenitor pro·gen·i·tor
1. A direct ancestor.
2. An originator of a line of descent.
ancestor, including parent.
progenitor cell
stem cells. for the design of two recent exposure registries, the World Trade Center Health Registry and the Tremolite Asbestos Registry. Both of these exposure registries combine well-documented exposure information with personal health information. They are considerably simpler than the NER. In the case of the World Trade Center Health Registry, exposure was limited to one time and place and the public had a much greater awareness of that event than of the NER. In the case of the Tremolite Asbestos Registry, only one substance is of concern.
Creating and maintaining an exposure registry is a more difficult challenge than creating and maintaining an outcome registry, such as a cancer registry A cancer registry is a systematic collection of data about cancer and tumor diseases. The data is collected by Cancer Registrars. Cancer Registrars capture a complete summary of patient history, diagnosis, treatment, and status for every cancer patient in the United States, and . The former looks prospectively, whereas the latter looks retrospectively. Hindsight is generally more accurate than foresight. In addition, expectations may have been set too high for the NER. These notions were expressed two decades ago by Dr. Vernon Houk, thendirector, Center for Environmental Health, Centers for Disease Control, when he addressed a workshop that was held in Atlanta about the proposal to establish the NER (ATSDR, 1987):
Registries cannot be used to give quick, conclusive answers to the many questions that people ask about the effects of toxic chemical exposures to their health, the health of their families, or the health of their future children. Even the most active and aggressively pursued studies using registries may require decades to produce meaningful results. It is also true that even when the results of long-term studies are made available, the findings are likely to be hotly debated by scientists with honestly different points of view. Other important limitations of registries are the infeasibility due to mobility of the population, privacy, ethics, and the inability to detect conditions with a low attack rate after exposure. Even cost must be considered. I point out these inherent limitations to registries to call your attention to the fact that expectations for registries being used as tools to answer in the near future the questions before us today may be unrealistically high.
In addition to the inherent limitations of exposure registries cited by Dr. Houk, the flawed design and methodologies of the NER resulted in data that could not be used to reliably answer questions about the relationships between registrants' exposures and adverse health outcomes that would lead to hypothesis-generated health studies.
The NER was one of the most comprehensive data repositories tracking specific en vironmental chemical exposures and registrants' health conditions over time. The methods developed by NER for primary contaminant selection, site selection, population selection, and data collection are worthy of emulation. The methods used to compare registrant An individual or organization that signs up (registers) for a training class or service. See domain name registrar. health data trends to national trends have evolved and improved over time. The lack of adequate individual exposure measures has been the most limiting factor in the NER design. Other design issues of the NER that has limited the utility of the results are the competency of selfreport health outcomes, the lack of an adequate control population, and the absence of biomarkers. The NER experience will, hopefully, contribute to more meaningful and useful data collection for all future exposure registries.
Agency for Toxic Substances and Disease Registry. (1987, March). Public workshop on a national registry of persons exposed to toxic substances. Atlanta: U.S. Department of Health and Human Services, Public Health Service.
Agency for Toxic Substances and Disease Registry. (1988). Policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental for establishing a national registry of persons exposed to hazardous substances. Atlanta: U.S. Department of Health and Human Services, Public Health Service.
Agency for Toxic Substances and Disease Registry. (1994). National Exposure Registry trichloroethylene (TCE) subregistry baseline technical report (Revised) (NTIS NTIS - National Technical Information Service Publication No. PB95-154589). Atlanta: Author & U.S. Department of Health and Human Services, Public Health Service.
Burg, J.R. (1989). Policies and procedures for establishing the National Exposure Registry. Journal of the American College of Toxicology toxicology, study of poisons, or toxins, from the standpoint of detection, isolation, identification, and determination of their effects on the human body. Toxicology may be considered the branch of pharmacology devoted to the study of the poisonous effects of drugs. , 8(5), 949-954.
Burg, J.R., & Gist, G.L. (1995). The National Exposure Registry: Procedures for establishing a registry of persons environmentally exposed to hazardous substances. Toxicology and Industrial Health, 11(2), 231-248.
Burg, J.R., & Gist, G.L. (1997). The potential impact on women from environmental exposures. Journal of Women's Health Women's Health Definition
Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. , 6(2), 159-161.
Center for Environmental Health. (1984). Criteria and methods for establishing and maintaining exposure and outcome registries for environmental public health problems. Atlanta: Agency for Toxic Substances and Disease Registry.
Comprehensive Environmental Response, Compensation, and Liability Act, 42 U.S.C. [section] 9601-9657 (1980).
Gist, G.L., & Burg, J.R. (1995). Methodology for selecting substances for the National Exposure Registry. Journal of Exposure Analysis and Environmental Epidemiology, 5(2), 197-208.
Gist, G.L., Burg, J.R., & Radtke, T.M. (1994). The site selection process for the National Exposure Registry. Journal of Environmental Health, 56(6), 7-12.
Harris, J.S. (1983). Toxic waste toxic waste is waste material, often in chemical form, that can cause death or injury to living creatures. It usually is the product of industry or commerce, but comes also from residential use, agriculture, the military, medical facilities, radioactive sources, and uproar: A community history. Journal of Public Health Policy 4(2), 181-201.
Levine, A. (1983). Psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.
Involving aspects of both social and psychological behavior. impact of toxic waste dumps. Environmental Health Perspectives, 48, 15-17.
The Public Health and Welfare Chapter 103--Comprehensive Environmental Response, Compensation, and Liability Subchapter I--Hazardous Substances Releases, Liability, and Compensation, 42 U.S.C. [section] 9604 (1983).
Schulte, P.A., & Kaye, W.E. (1988). Exposure registries. Archives of Environmental Health, 43(2), 155-161.
Myron G. Schultz, MD, FACP FACP Fellow of the American College of Physicians.
1. Fellow of the American College of Physicians
2. Fellow of the American College of Prosthodontists
James H. Sapp II, MS
Caroline D. Cusack, MSPH MSPH Mailman School of Public Health (Columbia Universty, New York City)
MSPH Master of Science in Public Health
MSPH Mrs. Potato Head (toy)
Jennifer M. Fink fink Slang
1. A contemptible person.
2. An informer.
3. A hired strikebreaker.
intr.v. finked, fink·ing, finks
1. To inform against another person. , MPH, cHES
Corresponding Author: Myron G. Schultz, Senior Medical Officer, Division of Health Studies, NCEH/ATSDR, Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. , 4770 Buford Highway NE, MS F-57, Atlanta, GA 30341. E-mail: email@example.com.
TABLE 1 Health Effects Reported in Excess Compared With National Data TCE Registry Anemia Cancer Skin rashes Urinary tract disorders Stroke Diabetes Liver disease Kidney disease Hearing impairment Speech impairment Benzene Registry Anemia Cancer Skin rashes Urinary tract disorders Stroke Diabetes Liver disease Kidney disease Respiratory allergies Arthritis GI ulcers Dioxin Registry Anemia Cancer Skin rashes Urinary tract disorders Stroke TCA Registry Anemia Cancer Skin rashes Urinary tract disorders Stroke Diabetes Liver disease Respiratory allergies
Reader Opinion
|Printer friendly Cite/link Email Feedback
|Title Annotation:
|Schultz, Myron G.; Sapp, James H., II; Cusack, Caroline D.; Fink, Jennifer M.
|Journal of Environmental Health
|Feb 27, 2010
|Previous Article:
|General public health considerations for responding to animal hoarding cases.
|Next Article:
|The intern, or: a tale of the economy.


text:
Back to Previous Page
The Boss 302 returns to the road after 42 years.
Shaking Hands With The Devil
In this video the Flex picks off a modded Mustang GT.
Make Your "Five-Oh" Go Faster and Smoother
If you love Ford performance, this is the place for you!
We put together some of our favorite articles about the Ford Mustang!
King of the Road
A Race Car For The Streets
Born on California's highways, the Mustang SSP offered police a high-performance alternative.
How to get up-close and personal to find the finest Ford Mustang you can afford.
A visual guide to telling one vintage Pony Car from its model-year stable mates.
Mustang's third body style emerges.
A visual feast for Mustang lovers.
A Real Jekyll & Hyde Ride
Upgrading a 1966 Mustang's Baer system from two-piston PBR caliper to six-piston Baer caliper.
Daytona Speedway was a fitting corral for these ponies.
Tulsa Raceway Park thundered with Ford power!
Carving corners with Ford power!
Walking around the paddock at Hallett Motor Racing Circuit
The Ultimate Ford Family Reunion
Fords invade downtown Tulsa's Brady Arts District
Walking around Tulsa Raceway Park
The capstone of a great event.
Families, fun and Mustangs at Myrtle Beach.
'Mustang Alley,' the 'Stone Soup Boss 5.0' and more make the 18th Woodward Dream Cruise a Ford-ified success
Records fell with the gavel in Gainesville, Georgia.
Fast, loud and flashy, just like Las Vegas!
AutoTrader Classics checks out what is new...and old!
AutoTrader.com Employees Show Off Their Rides!
Steel may be real, but this plastic is fantastic.
Not your usual David & Goliath story.
More photos from the Mitty!
Check out Bryan's latest project on Cafe Racer TV.
Sometimes the little things can make all the difference.
New car plus old styling equals retro cool!
Long flowing running boards, stunning metalwork, and dripping with style.
A shortened Mustang? One-off customs? A mid-engine Corvette? Just what were they thinking!?
It isn't very often that an attraction exceeds expectations by leaps and bounds, but the NASCAR Hall of Fame does so at every turn.
It takes a special woman to be a car guy's mother.
These rigs haul more style than cargo.
These rods are keeping true to their roots.
Open wheel rodding at its finest!
What better way to see a car show...than from a car!
Check out our grab bag of cool cars.
AutoTrader Classics Editor Brian Medford tells you why you should respect the 4-door.
World's favorite pony car celebrates its golden jubilee in Charlotte, North Carolina.
Sometimes an auction is also a car show.
This year there was a bumper crop of great trucks.
These high-dollar machines are right at home in Las Vegas.
provided by
by Brian Medford
More from Author
Watch as a Cobra Jet lines up with a Super Cobra Jet!
Please select a field.
From Customs, Chevys, Fords to the Classics, these magazines provide the latest cutting edge information to fuel your passion.
All Magazines
Required Information
How likely would you be to recommend this site to a friend or colleague?


text:
Now Casting
Cutthroat Kitchen Seasons 8 & 9
How far are you willing to go for a chance of winning 25,000? If you have what it takes to cook delicious dishes for an upcoming season, APPLY NOW!
La Voz Kids
The world's most exciting singing competition is back for KIDS! Does your child have what it takes to be the next Shakira or Prince Royce? Can they sing in Spanish and English? If so, click HERE now!


text:
Outfitting fans since 1999.
Main Content
Order as many items as you like with our $4.99 flat rate shipping.
This item ships within one business day.
Order as many items as you like with our $4.99 flat rate shipping.
Need it faster?
Your little angel has already shown enormous interest in the L.A. Dodgers. She's clearly on her way to Dodgers superfandom in no time! This adorable Take the Crown set from Majestic features pink "Cutest Little Dodgers Fan" lettering and princess tiara graphics with a team logo on the shirt. It comes with a cute pink tutu, so everyone will know your little Los Angeles fan is the princess of Dodgers fanatics her age!
- 100% Cotton shirt
- 100% Polyester skirt
- Elastic waist on skirt
- Imported
- Officially licensed MLB product
- Screen printed graphics
- Tagless collar on shirt
- Tool lining on skirt
Shop early for holidays and birthdays with our 365 Day No-Hassle Return Policy! Because we stand behind the quality of our products, you can return any item in original condition for up to a full year from the purchase date. We want you and your gift recipients to love what you ordered, but if not, we make returns easy for you.
Fans Also Bought:
Special event items are produced by manufacturers only after the outcome of a game or event. These are advanced sale items and will ship immediately after they are received in our warehouse.
Manufacturer direct items are shipped directly from the manufacturer. These items are not available for international or expedited shipping.
Customized items can be personalized with options such as your name, your favorite number, and/or designs. Some options may be limited by league rules.


text:
- Home
- Latest News
- About Us
- Membership
- Advocacy
- Media
- Events
- Surveys & Reports
- Contact Us
Every two years, NSBA brings together our members at the NSBA Small Business Congress to discuss pertinent issues for small business and vote on the top priority issues for the upcoming session of Congress.
NSBA's 2015 Small Business Congress in Phoenix, Arizona Feb. 19-20, 2015. This event will be held in coordination with our regional affiliate, the Arizona Small Business Association, giving attendees a unique opportunity to network and discuss best practices for business growth and engagement, as well as discuss the key policy issues facing small business today.
The event culminates in lively discussions to craft and then vote on the top priorities for NSBA for the upcoming session of Congress.
Registration will be open soon – stay tuned to www.NSBA.biz for details.


text:
Thanksgiving is celebrated every year on the fourth Thursday of November. The month of November comes in autumn, the main season for harvesting crops. Thanksgiving is an autumn harvest festival like those found in many cultures. It is viewed as the most traditional of all American holidays. More
Also in the news, India-Pakistan tensions remain at a major South Asia conference in Kathmandu, Nepal; Hong Kong police arrest student leaders and clear streets around Mong Kok; The Revolutionary Armed Forces (FARC) of Colombia frees two soldiers to restart peace talks with the government. More
Thousands of people have been killed in the fighting in the Central African Republic, and many have been forced from their homes. Among the victims are children whose parents died or have gone missing. For these boys and girls, joining an armed group is one of the only ways to find protection. More
In 2012, people spent $700 million on agri-tourism in the United States, a large increase from five years earlier. Fun on the farm is in full swing across the United States, as many farms host festivals and other activities to attract tourists. VOA visited Montpelier Farms in Maryland. More
The story sounds like a work of fiction: An American filmmaker takes to the road on a motorcycle. He and his video camera travel around the Arab world. He ended up fighting with Libyan rebels opposed to Gadhafi and made a movie. The movie won the top documentary prize at Tribeca. More
Many people these days are going as far as South Africa to get their version of perfection. People from across Africa and the world come for so-called "surgery safaris." There are no animals to see on these safaris. The visitors instead look for smaller stomachs, firmer bottoms or perhaps new eye. More
An American grand jury ruling has resulted in new violence in the city of Ferguson, Missouri. The jurors decided not to charge a white police officer who shot and killed an unarmed African American teenager last August. The decision was announced Monday -- more than three months after the shooting. More
Due to rising sea level, farmers are increasingly unable to use fields close to the sea. A farmer in the Netherlands is growing small, but healthy and tasty crops in a mixture of fresh and salt water. Farmers in Pakistan may soon be growing Dutch potatoes in areas affected by rising sea waters. More
On November 19, 1863, President Abraham Lincoln said no one would remember his speech at a battlefield cemetery in Gettysburg, Pennsylvania. But Lincoln's Gettysburg Address remains one of the most important speeches in U.S. history. | The Making of a Nation More
Access provides two years of free English classes to needy young people around the world. One of the largest Access programs is in Indonesia --with about 1,000 students. To find out if there will be an Access class near you, contact the U.S. Embassy in your home country. More
Question 0/ 0
Monday, November 24, 1800 UTC: Jonathan Evans talks about driving
Tuesday, November 25, 2000 UTC: Caty and Ashley "bundle up" for some wintry phrasal verbs
Wednesday, November 26, 1400 UTC: Dr. Jill talks about the importance of setting goals for language learning.
To participate, send a Skype contact request to VOALearningEnglish


text:
Opposition to Mail-In Primary
Posted: 03/11/2008 - Opponents include Obama campaign.
Posted: 03/11/2008 - Opponents include Obama campaign.
Updated: 03/12/2008 - Michigan regulators approve 911 surcharges on cell phones.
Updated: 03/12/2008 - Probation and community service is the punishment for the 911 operator who didn't take a boy's call for help seriously.
Updated: 03/11/2008 - The 1999 New Year's Eve fire at Ag Hall may have fallen off the front page, but it was never off the radar of MSU Police.
Updated: 03/11/2008 - Manpower survey shows that 33 percent of companies in Lansing will hire more employees from April to June, as well as 43 percent of companies in Jackson.
Updated: 03/11/2008 - She faces up to ten years in prison if convicted
Updated: 03/12/2008 - Four people charged with the 1999 New Years Eve fire at Ag Hall on MSU campus.
Posted: 03/11/2008 - Michigan's six NBC affiliates will carry Gov. Granholm's town hall meeting.
Updated: 03/11/2008 - The state will close a female prison in suburban Detroit.
Posted: 03/11/2008 - Senate plan would boost funding for auto battery technology.
Updated: 03/11/2008 - Cox: Electricity legislation would bring large rate increase.
Updated: 03/12/2008 - Fed announces further steps to ease credit crunch.
Updated: 03/11/2008 - Wheatfield Township official arrested Tuesday morning.
Posted: 03/10/2008 - High priced oil poses a threat to Northwest Airlines.
Posted: 03/10/2008 - Detroit mayor Kwame Kilpatrick prepares to deliver his State of the City address amidst allegations of scandal.
Updated: 03/11/2008 - Parents are raising doubts and questions about a reconstitution plan for the Lansing School District's three high schools.
Posted: 03/10/2008 - Reports of a potential deal on the horizon between Comcast and Big Ten Network is music to MSU and UM fans' ears.
Updated: 03/11/2008 - Insiders say look for a deal to be in place before the start of the 2008 football season.
Posted: 03/10/2008 - The city scales back its plans for the development, and in the process, cools tempers in a fight over eminent domain.
Posted: 03/10/2008 - Has forced GM to close all or part of 28 plants.
Posted: 03/10/2008 - People who have been adopted would have more access to their health history under terms of a new bill in the works at the state capitol.
Posted: 03/10/2008 - LCC chooses Brent Knight from Cicero, Illinois.
Updated: 03/10/2008 - The Department of Planning and Neighborhood Development will update it's master plan in 18 months, and the city wants the community to be part of the process.
Updated: 03/10/2008 - U of M will enhance wheelchair accessibility at the Big House
Posted: 03/10/2008 - Defense attorney for Ingham County Circuit Judge Beverley Nettles-Nickerson says investigating judge "cherry-picked" evidence.


text:
Property to let in Castlebeck Drive, Sheffield S2
£450 pcm (£104 pw)
Woodrove Close, Woodthorpe, Sheffield S13Terraced house to rent - 2 bedrooms
A well proportioned two bedroomed terrace. Situated in this popular and convenient residential area with local shops, schools, public transport and easy access to the city centre and motorway network. Furnished More details
Note: Distances are straight line measurements
- Darnall (1.2 miles)
- Sheffield (2.1 miles)
Marketed by Blundells - Crystal Peaks, S20. Call 0114 287 0669£500 pcm (£115 pw)
Castledale Grove, Sheffield S2Semi-detached house to rent - 3 bedrooms
An internal inspection is recommended on this newly refurbished three bedroomed semi detached property that is situated close to all local amenities. Off road parking, central heating, double glazing More details
Note: Distances are straight line measurements
- Darnall (1.0 mile)
- Sheffield (2.1 miles)
Marketed by JMC Estate Agents Limited, S12. Call 0114 446 0130


text:
Designer wear is Tasmiyah, a brand is not very old. Clothing made from finest fabrics and exquisite detailing offers. It offers a wide range of outfits, casuals to formals. It is still in the early stages of establishment and Pakistan fashion industry is still in its brand.
However, her beautiful outfits, soon will be able to gain popularity among women in Pakistan believe that. Tasmiyah multi-brand designer wear outfits Tehxeeb, Lahore are available in various stores. Outfits are available, Pakistan and abroad.
Incoming search terms:
- beautiful designer dresses
- beautiful dress designs pakistani
- tena durrani 2014
- beautiful pakistani designer dresses
- Teena durani
- tehxeeb lahore collection 2014
- tasmiyaha disgnr wear
- tasmiyah designer collection for wear
- pakistani dress designers in lahore
- latest designer outfits for women


text:
You're leaving Wedding Paper Divas to see the Deal of the Day at our parent site, Tiny Prints.
You won't be able to dismiss this by usual means (escape or click button), but you can close it programatically based on user choices or actions.
"We used the enclosure cards to provide information about accommodations and our wedding website. I was initially concerned about getting all of the information on the card but it fit perfectly. The design team adjusted things to ensure it looked great. I appreciated the easy process!"
"I used this card as an invitation to the rehearsal dinner that was taking place at the same venue (Bed and Breakfast) where the guest would be staying over for either the rehearsal dinner and wedding or just coming in for the wedding. This was a subtle invitation that did not take away from the wedding invitation but was a beautiful complement!"
"These enclosure cards look beautiful and are great quality. They went perfectly with the Starry Blooms wedding invitations that I ordered."
"On whole the invitation came to me looking beautiful and I have compliments on how the general appearance. When I called up customer service with inquiries they were most helpful and very knowledgeable with the product. I received all parts of the invitation in a timely fashion, and the designers did a wonderful job with the special request I made for design changes."
"Our designer helped us with our response cards and invitations but did BY FAR the most work on the enclosure cards. She let us do front and back, organized everything so perfectly, and suggested different ways for us to lay everything out. I couldn't be more appreciative or happy with how they came out!"


text: North Penn Softball team weight lifting workout View full-size image < previous next > Is this photo a winner? "just wanted to send a copy of photo with the back line and their faces. thanks again" - North Penn High School Softball (Jan 16, 2014) Share this photo on: Twitter Facebook Pinterest Similar Photos: k12 athletics | k-12 athletics | weight lifting | workout Feeling inspired? Visit the CustomInk Design Lab to start your own group order. Design Your Own


text:
death metal underground
The Ultimate Death Metal Resource
Death Metal Search Engine
Show Posts
This section allows you to view all posts made by this member. Note that you can only see posts made in areas you currently have access to.
Messages - death metal black metal
Metal / Re: The Atheist reissues are finally coming!« on: January 04, 2006, 01:46:50 PM »
Picked it up and bought it, or just picked it up?
Any word on the quality of "remaster" for these reissues?
Any word on the quality of "remaster" for these reissues?
Metal / Re: 1917: Mexican Melodic Black Metal« on: January 04, 2006, 01:45:04 PM »
Transmetal needs to do a "greatest hits."
Auzhia and Xibalba got mentioned in another thread.
I still listen frequently to Cenotaph's first album.
Auzhia and Xibalba got mentioned in another thread.
I still listen frequently to Cenotaph's first album.
Metal / Re: Averse Sefira - Plagabraha from new album« on: January 04, 2006, 01:44:09 PM »
All distros have sold out of this album again. Really fucked up my Christmas shopping!
Metal / Re: Xibalba« on: January 04, 2006, 01:43:17 PM »
Good album; it and Auzhia's first should not be forgotten.
Metal / Re: Eyes of Ligeia« on: January 04, 2006, 01:42:28 PM »
One of the few doom bands with "concept," much as Celtic Frost had.
Metal / Re: Top Ten Moron Metal of 2005« on: January 04, 2006, 01:41:59 PM »
Thread Staleness Indicator: 89%
Metal / Future of metal? (Yes/No)« on: January 04, 2006, 01:41:12 PM »
So we've seen punk wipe away the pompous, overblown dinosaur rock of the 70's; we've seen the grunge backlash against the hairspray cock rock of the 80's...
Good summary - to that point.
Black metal was a revolution against all rock music.
Next, metal's going to have more singing, and get progressive in the way Morbid Angel and Slayer were (e.g. not Opeth). I think it's going to expand lyrically to be further like the English Romantic poets. I don't think it's going to get anti-Nationalists, or leftist/rightist like the boring punk bands.
Emo is doomed, indie is doomed, and black metal and death metal will hybridize.
After the Chinese invade, it'll be harder to get CDs out, so quality will go up too!
Metal / Re: Thrash metal« on: January 02, 2006, 08:44:26 PM »
Most people consider D.R.I., C.O.C. and stuff to be Crossover.
History is written by the winners I guess, and the media won in this case, as far as I can see, but who really fucking cares?
Thrash refers to the act of skating, which was part of the culture.
When you study a culture, you name it appropriately
Unless you want to call ancient Germans "congoids" and refer to modern African-Americans as "klansmen," language means a lot.
Metal / Re: Tom G Warrior on Amazon.com« on: January 01, 2006, 07:01:52 PM »
Sad. Half of them are kissing his ass, and half insulting him. He should crapflood his own board.
Metal / Re: Post-2000 albums« on: January 01, 2006, 06:59:24 PM »
Because I'm an asshole, I might just mention that the CD cover there is not an official release, thus is not endorsed by the artists, and that one might think it's cool simply because it's a dead dude. My experience suggests that black metal is intolerant of fatalism, at least, the pre-1997/1999 variant is
Metal / Re: Death Metal Sound« on: January 01, 2006, 06:58:02 PM »
In my opinion, which is non-technical, the way to make distortion is to blast the shit out of everything, put some reverb on it, and then EQ it back into sanity. You might accomplish this with a noise gate or other limiter, depending on your setup. For the Swedish death metal sound, use two DMX86 (whatever) pedals in series. Most people now seem to use digital units, which may technically be as good as everything else but sometimes seem less chaotic.
Metal / Re: Post-2000 albums« on: January 01, 2006, 05:33:31 AM »
I really enjoy Tara's riffs but IMO, Barathrum is their best.
Tara's very heavy metal, and like most of their later stuff, spotty. Great riffs are followed by cliches, and many songs go nowhere. Hence, I agree re: Barathrum VITRIOL.
Metal / Re: Thrash metal« on: January 01, 2006, 05:32:40 AM »
Now can anyone anwser how speed and thrash got mixed up? Because most everyone makes the mistake.
"Thrash" is a more marketable term than "speed." More unique word with extreme connotations = sales.
Metal / Re: The Future of Metal« on: January 01, 2006, 05:15:01 AM »
Music is a language. There will always be poems that need writing, books, etc - at some times more than others.
Metal is far from exhausted, in theory. In practice? Gimme a break. It's a wall of total shit with a handful of exceptions, most of which are far closer to "good" than "great."
Metal is far from exhausted, in theory. In practice? Gimme a break. It's a wall of total shit with a handful of exceptions, most of which are far closer to "good" than "great."
Metal / Re: Tom G Warrior on Amazon.com« on: December 31, 2005, 08:20:47 PM »
And if anyone's wondering where Oliver Amberg, the loser rockstar guitarist who helped produce the abomination known as "Cold Lake," went...


text:
- Publisher: Battlefront.com
- Release Date: Apr 28, 2006
- Critic Score
- Most active
- Publication
- Most clicked
An excellent war game. Blitzkrieg fixes almost all of the problems the first game had (a small Africa etc). The AI could still be better, though. [May 2006]
An effective, old school strategy game of properly strategic proportions. [Oct 2006, p.70]
While the abstract approach to combat might appeal to some gamers, we found ourselves wanting a little more information about how the game resolved combats. Beyond that, the overall presentation is dry even by wargame standards with some notable shortcomings in terms of the interface and the visuals.
Strategic Command 2 is best for someone entirely new to war gaming who is looking to get a feel for the genre. However, like training wheels on a bike it will soon outlive its purpose.
User Score
Generally favorable reviews- based on 6 Ratings
User score distribution:
Positive: 3 out of 3
Mixed: 0 out of 3
Negative: 0 out of 3
DanRowdJul 31, 2008This Is a reincarnattion of one of the greated turned based wargames of all time - Panzer General. Those who give it a low score are probably to young to remember what a superb wargame is really was when it came out many years ago. Many ciritic now seek flashy graphic and audio and spurn anything that does not have it.
If you liked Panzer General and miss not bing able to play it on modern operating systems like XP and Vista, this game is for you. I am glad to see someone has brought Panzer General back!… Full Review »
BioWizardAug 17, 2006I am addicted! Tries to remain historically accurate. Human vs Human games are the best. Of course, AI is weak but it cannot be otherwise which such an intricate great game!… Full Review »
DavidB.May 15, 2006Good, sophisticated, flexible game. Fun to play. AI is very weak. A few minor bugs which will probably be fixed in a patch.