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Environmental exposure assessment in European birth cohorts: results from the ENRIECO project
- Ulrike Gehring1Email author,
- Maribel Casas2, 3, 4,
- Bert Brunekreef1, 5,
- Anna Bergström6,
- Jens Peter Bonde7,
- Jérémie Botton2, 3, 4,
- Cecile Chévrier8,
- Sylvaine Cordier8,
- Joachim Heinrich9,
- Cynthia Hohmann10,
- Thomas Keil10,
- Jordi Sunyer2, 3, 4, 11,
- Christina G Tischer9,
- Gunnar Toft12,
- Magnus Wickman6,
- Martine Vrijheid2, 3, 4 and
- Mark Nieuwenhuijsen2, 3, 4
© Gehring et al.; licensee BioMed Central Ltd. 2013
Received: 29 June 2012
Accepted: 8 January 2013
Published: 23 January 2013
Environmental exposures during pregnancy and early life may have adverse health effects. Single birth cohort studies often lack statistical power to tease out such effects reliably. To improve the use of existing data and to facilitate collaboration among these studies, an inventory of the environmental exposure and health data in these studies was made as part of the ENRIECO (Environmental Health Risks in European Birth Cohorts) project. The focus with regard to exposure was on outdoor air pollution, water contamination, allergens and biological organisms, metals, pesticides, smoking and second hand tobacco smoke (SHS), persistent organic pollutants (POPs), noise, radiation, and occupational exposures. The review lists methods and data on environmental exposures in 37 European birth cohort studies. Most data is currently available for smoking and SHS (N=37 cohorts), occupational exposures (N=33), outdoor air pollution, and allergens and microbial agents (N=27). Exposure modeling is increasingly used for long-term air pollution exposure assessment; biomonitoring is used for assessment of exposure to metals, POPs and other chemicals; and environmental monitoring for house dust mite exposure assessment. Collaborative analyses with data from several birth cohorts have already been performed successfully for outdoor air pollution, water contamination, allergens, biological contaminants, molds, POPs and SHS. Key success factors for collaborative analyses are common definitions of main exposure and health variables. Our review emphasizes that such common definitions need ideally be arrived at in the study design phase. However, careful comparison of methods used in existing studies also offers excellent opportunities for collaborative analyses. Investigators can use this review to evaluate the potential for future collaborative analyses with respect to data availability and methods used in the different cohorts and to identify potential partners for a specific research question.
Environment Europe Exposure assessment Birth cohort ReviewIntroduction
Pregnancy and birth cohort studies provide the possibility of repeated measurements of health outcomes and exposures at different time points from pregnancy through childhood and adolescence into adulthood. Therefore, they present an ideal framework for the prospective study of the effects of environmental exposures on the health and development of children. Furthermore, they allow the study of temporal variability in exposure. If temporal variability is sufficient, the relevance of exposure at different time points (e.g. prenatal and postnatal) and the health impact associated with changes in exposure can be investigated, which may help to focus preventive actions.
Currently, many European birth cohort studies of children's environment-health relationships exist and provide evidence for relationships that can be used to develop strategies to reduce environmental exposures and to improve health. However, single studies often lack statistical power to lead to conclusive results on their own, in particular when health outcomes and/or exposures with low prevalence are studied. Combining data from different studies is a powerful remedy for this. Also, collaboration between birth cohorts enables us to replicate and corroborate or refute findings as well as to explore reasons for heterogeneity. Therefore, there is an urgent need to evaluate, and where possible combine, the existing data, methods and tools from European birth cohort studies in order to evaluate possible links between environmental exposures and health [1].
The assessment of exposure is a crucial element of the study of the potential adverse effects associated with exposure. Error in exposure measurements reduces the statistical power of a study [2] and the estimated effect is likely to be smaller than the true effect [3], both increasing the likelihood that real associations are not detected. Exposure can be assessed by means of direct approaches including biological and personal monitoring, by means of indirect approaches including environmental monitoring and modeling as well as the use of questionnaires and diaries or a combination thereof [4]. Exposure assessment by means of (repeated) individual environmental or biological monitoring, however, is costly and therefore usually not feasible in all participants of large cohort studies. This means that making informed decisions of what to measure in how many study subjects is crucial.
As part of the European Union funded Environmental Health Risks in European Birth Cohorts (ENRIECO) project, an inventory of the environmental exposure and health data in existing European birth cohort studies was made [5]. The objective of the present review is to analyze the environmental exposure assessment in the birth cohort studies in detail. The review covers established exposures (e.g. ambient air pollution, environmental tobacco smoke, allergens and biocontaminants, metals, persistent organic pollutants (POPs) and noise) as well as exposures that more recently became the focus of epidemiological research (e.g. electromagnetic fields, phthalates and phenols). The emphasis is on comparison of methods currently used in birth cohort studies leading to recommendations for improvement. We focus on methodological issues such as comparability, validity, (dis-)agreement between methods, ability to predict concentrations in earlier or later periods, and timing of exposure assessment that are relevant to several exposures rather than exposure-specific issues.
Participating cohorts and inventory
A detailed description of the cohorts included in the ENRIECO project has been published elsewhere [5]. In brief, cohorts were included in an inventory if they a) collected data on at least one of the following exposures: air pollution, water contamination, allergens and microbial agents, metals, pesticides, POPs, other chemical pollutants, noise, and radiations; b) started enrolment of mothers into the cohort during pregnancy or at birth; c) included in their protocol at least one follow-up point after birth with direct contact with mothers and children; d) included at least 200 mother-child pairs; and d) were based in a European country. Between March 1, 2009 and February 15, 2011 37 different European birth cohorts (counting the cohorts of the Faroes, the old and the new INMA cohorts as one cohort each) completed inventory questionnaires with detailed information on the study protocol, exposure and health outcome assessment [5]. A web-based searchable inventory database is now publically available on http://www.birthcohortsenrieco.net. The information provided by the inventory has been approved by the cohorts.
Evaluation of exposure information
The evaluation was divided in 11 exposure groups: outdoor air pollution, water contamination, allergens and microbial agents, metals, pesticides (including persistent pesticides), POPs, other chemical pollutants (e.g. phthalates and phenols), smoking and second hand tobacco smoke (SHS), noise, radiation and occupational exposures. The evaluations were conducted by experts from several fields relevant to the topic of this review, including environmental and occupational epidemiology, toxicology, public health, medical sciences (more specifically, pediatrics), sociology, psychology, and biostatistics. A full list of the names of the experts who participated in the different working groups is presented in Additional file 1: Table S1.
The aims of the evaluations were a) to describe the environmental exposure assessment in European birth cohort studies including methods used, timing and coverage (number of cohorts and number of subjects within cohorts with exposure information) of exposure assessment; b) to discuss the exposure assessments used in the birth cohort studies in terms of agreement between direct and indirect methods, timing and temporal variability of exposure measurements, exposure at non-residential addresses and time-activity patterns, c) to discuss the potential for collaborative analyses within the birth cohort studies including examples of successful collaborations; and d) to discuss areas of interest for future analyses including new data collection and new methods.
Exposure assessment methods currently used in European birth cohorts
Description of exposure assessment in the birth cohorts by exposure topic
Exposure topic | N * | Description |
Outdoor air pollution | 27 | ·Many cohorts assessed outdoor air pollution exposure (27 cohorts). |
·Air pollution modeling is becoming increasingly the method of choice: land-use regression modeling (18 cohorts) and dispersion modeling (10 cohorts). | ||
·Sixteen cohorts are currently participating in the collaborative EU-funded ESCAPE project that adds land-use regression modeling of nitrogen oxides, particulate matter, soot and particle composition to existing cohort studies using a standardized protocol. | ||
·Most cohorts currently have data on exposure during pregnancy and/or early life. | ||
Water contamination | 13 | ·Disinfection by-products were studied most. |
·Exposure assessment usually by means of a combination of questionnaires and individual measurements or routinely collected measurement data (8 cohorts). | ||
·Validation by means of biomonitoring in a small number of subjects (3 cohorts). | ||
·Most studies assessed exposure during pregnancy. | ||
Allergens & microbial agents | 27 | ·Exposure to cat and dog allergen was assessed by means of questionnaires in all cohorts and by means of measurements in house dust samples in 9 and 4 cohorts, respectively. |
·Mite allergen levels were measured in settled house dust samples in 10 cohorts. | ||
·Mold exposure was mainly assessed by means of questionnaires. | ||
·Exposure was assessed during infancy and/or early childhood in most studies. | ||
Metals | 20 | ·Most cohorts have analyzed the effects of low-level environmental exposure to mercury (Hg; 15 cohorts) and lead (Pb; 16 cohorts); little attention to other metals. |
·Exposure was mainly assessed by means of biomonitoring. Five cohorts used questionnaires, two of them in addition to biomonitoring, | ||
·There are well-standardized protocols for most of the metals. | ||
·Inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectroscopy (AAS) were used most. | ||
·Most measurements were performed in cord blood; other non-invasive matrices such as hair and urine are gaining attention. | ||
Pesticides a | 18 | ·Many studies assessed household use (16 cohorts); and occupational exposure (13 cohorts), fewer cohorts assessed dietary exposure (6 cohorts) or residence proximity to crops (2 cohorts). |
·Exposures via household use, occupational exposure and diet, were mainly assessed by means of questionnaires. | ||
Persistent organic pollutants | 19 | ·Exposure assessment by means of high performance liquid chromatography (HPLC) measurements in biological samples with adjustment for lipid content. |
·Variation between studies with regard to sampling medium, timing of sample collection and lipid adjustment. | ||
Most data available for polychlorinated biphenyl (PCB) and dichlorodiphenyltrichloroethane (DDT). | ||
Other chemical exposures b | 17 | ·Few cohorts have measured these contaminants (13 cohorts), but this is a rapidly developing field and more cohorts are planning to assess exposure to other chemicals (7 cohorts). |
·Exposure was mainly assessed by means of biomonitoring. | ||
There is heterogeneity with regard to the type of biological media used and the timing of the exposure measurement. | ||
Radiation | 12 | Ionizing radiation |
·Mainly assessed by questionnaire: maternal occupational exposures (3 cohorts), prenatal medical ionizing radiation exposures (6 cohorts); 2 cohorts currently plan to ask questions about medical radiation exposures in children. | ||
·1 cohort is planning to assess residential radon exposure using geographical methods. | ||
·No standardized questionnaires or protocols in this field. | ||
Ultraviolet (UV) | ||
·Only six cohorts are collecting UV-related data through questionnaire questions on sunburn in children, use of sun beds during pregnancy, and time spent outdoors. | ||
·None of the cohorts collect data on maternal and child skin type, sunscreen use, or clothing. | ||
·Standard questionnaires are not available. | ||
Non-ionizing radiation | ||
·Very few cohorts assess exposure to non-ionizing radiation: 2 cohorts include occupational electromagnetic field (EMF) exposure in their questionnaires, 2 cohorts assess extreme low frequency (ELF) exposure to overhead high-voltage power lines through geographical information from electricity companies, 2 cohorts include questions about mobile phone use of the mother during pregnancy and 4 on children's mobile phone use. | ||
·A few cohorts have started using base-station maps combined with information from home appliances and personal radio frequency (RF) exposimeters, in order to estimate whole body RF/ELF-EMF exposure. | ||
·There are no standardized or validated questionnaires, models or protocols in use at this moment. | ||
Smoking and second hand tobacco smoke | 37 | ·All cohorts have information about exposure during pregnancy and 29 cohorts in addition assessed exposure at different periods during infancy and childhood. |
Assessment mainly by questionnaire; cotinine measurements in biological samples (mainly urine) in 14 cohorts. | ||
Noise | 14 | ·All cohorts used questionnaire assessments, mainly about noise annoyance. |
·5 cohorts used noise propagation modeling or noise maps. | ||
·Traffic is the source of noise that has been studied most. | ||
·Most cohorts assessed exposure during pregnancy. | ||
Occupational exposures | 33 | ·All cohorts have information on maternal occupation and most cohorts (n=26) have information on paternal occupation for at least one point in time. |
·Data mainly collected by means of questionnaires (most often job title; sometimes checklist occupation or occupational exposures). | ||
·Coding of maternal job title (n=17) or use of Job Exposure Matrices (JEM) (n=8) planned/done in a number of studies. |
Coverage of different exposure assessment methods
Exposure data was generally available for the vast majority of the study participants if exposure was assessed by means of exposure modeling, questionnaires, routinely collected data or a combination thereof (see e.g. http://www.enrieco.org). Biomonitoring was sometimes performed in addition to other methods (e.g. for assessment of exposure to water contaminants, smoking and SHS exposure) usually in small subsets of the study population for validation purposes (Additional file 1: Tables S4 and S6). Also for other exposures such as metals, POPs, phthalates and phenols, where exposure assessment largely relied on biomonitoring, biomonitoring was often restricted to subsets of the cohorts due to the costs involved (Additional file 1: Table S6). Nevertheless, performing biomonitoring (and other exposure assessments that require large resources) in subsets of prospective cohort studies can still be very efficient, if for example the outcome of interest is rare and the subset has been selected according to a nested case–control design, which is superior to a conventional case–control design as it is less prone to recall and selection bias [8]. Moreover, the internal human dose can be estimated more efficiently and precisely by biomonitoring as compared to chemical analyses of different environmental matrices at different time points if exposure occurs through multiple pathways.
Comparison of direct and indirect methods
Questionnaires for the assessment of pet allergen and mold exposure as well as SHS exposure have been compared with environmental monitoring (e.g. house dust and air sampling) in a number of cohort studies that are part of ENRIECO, but also in other studies. Despite some misclassification, questionnaire reports were found to be an inexpensive and valid estimate of residential SHS exposure among preschool and school children [9–11]. Questionnaires were also found to be a valid method of assessing exposure to drinking water in pregnant women [12]. In contrast, questionnaire-reported cat and dog ownership is a relatively poor measure of pet allergen levels in house dust [13–16]. Similarly, it has been shown that questionnaire data cannot be used as a surrogate for measurements of specific microbial agents such as endotoxin, gram positive bacteria and mold components in house dust [17–19].
Timing of exposure assessment and time-activity patterns
Most exposures were mainly assessed during pregnancy and/or at birth. Exposure to outdoor air pollution has mainly been assessed for pregnancy and/or early life; exposure to allergens and biological contaminants was mainly assessed during infancy and early childhood (Additional file 1: Tables S2 and S3).
At present, repeated exposure assessments are available for a limited number of exposure topics (e.g. outdoor air pollution, allergens and microbial agents, smoking and SHS exposure, and phenols). Time-activity patterns, exposure at non-residential addresses and residential mobility are currently rarely included in the assessment.
Potential for collaborative analyses
Combined analyses have been successfully performed/are being performed within the framework of EU-collaborative projects such as GA2LEN (allergens [20]), TRAPCA (outdoor air pollution [21]), ESCAPE (outdoor air pollution [22, 23]), HIWATE (water contamination [24]) AIRALLERG (allergens, biological contaminants and indoor air pollution [25, 26]), and HITEA (indoor biological agents, http://www.hitea.eu/). In addition, for exposure to molds [27] second hand tobacco smoke [28], and POPs [6], combined analyses have been performed as part of case studies within the current ENRIECO project to explore the feasibility, potentials and difficulties of merging partly heterogeneous data from different European pregnancy and birth cohort studies. For ionizing, non-ionizing and UV radiation, as well as other chemical contaminants there is currently not sufficient data available in the cohorts for data pooling, but many measurements are ongoing and comparison studies may be feasible within the next few years.
Recommendations for future research
Recommendations for methods, evaluations of collaboration with existing data, and areas of interest for future work including new data/new methods by exposure topic
Exposure topic | Recommendations for methods | Collaboration with existing data | Areas of interest for future work |
Outdoor air pollution | ·Exposure modeling is currently the state-of the art method | ·Within the ESCAPE project, a standardized exposure assessment is being added to a number of birth cohort studies and will soon be linked to existing health data in these cohorts; pooled analyses will be performed for a number of health endpoints | ·Assessment of long-term exposure to ultrafine particles, which are currently not being assessed within cohort studies. |
·Few studies so far compared land-use regression models with dispersion models; results are inconsistent | |||
·Residential mobility, time-activity pattern, and exposure at non-residential addresses should be evaluated in exposure assessment | |||
·Assessment of long-term validity (i.e. stability) of land-use regression models which are based on one measurement campaign | |||
·There is currently little validation of modeled exposures against personal exposure measurements | |||
Water contamination | ·Best method for exposure assessment is to combine information of water-related behaviors obtained by questionnaire with newly or routinely collected water contaminant measurements | ·Further opportunity to study exposure to water pollutants in cohorts without water exposure assessment; routinely collected water pollutants are often available | ·Assessment of exposure to substances such as pharmaceuticals, Perfluorooctanesulfonic acid (PFOS)/Perfluorooctanoic Acid (PFOA), and (other) endocrine disrupters |
·Validation of questionnaires against biomonitoring since it has been conducted in only a few subjects | ·Consideration of source of water as an exposure indicator (ground water versus surface water) | ||
·Assessment of variability and measurement error of questionnaires by repeated assessments | ·Data pooling currently being done in the HIWATE project | ||
·Access to publicly collected data should be increased and European databases should be made available to researchers | |||
Allergens & microbial agents | ·Measurements in house dust or air samples are recommended | ·Meta-analyses in the framework of the GA2LEN (allergens) and AIRALLERG projects (allergens and biocontaminants) and ENRIECO case study on mold and dampness | ·Use of newly developed analysis techniques such as molecular methods or DNA fingerprinting |
·Use of questionnaires is inexpensive, but questionnaires were found to have a low sensitivity | |||
·Exposure at non-residential locations and timing of exposure should be taken into account | |||
Metals | ·Human biological monitoring is the state of the art method for estimation of total dose. | ·Data pooling and/or meta-analysis of the data available in the European birth cohorts can overcome this problem if conversion models can be developed to transfer between different biological media (hair, cord blood, urine, etc.). | ·Validation of questionnaire data against human biological monitoring is needed. |
·Inductively coupled plasma mass spectrometry (ICP-MS) is more sensitive and faster than Atomic absorption spectroscopy (AAS) | |||
·In general labs are using well standardized protocols. It is recommended to validate the analytical technique in each lab including a sample with known concentration of metal/s every X number of samples. This will be useful to validate both the pre-treatment and the analytic process. | |||
·Some studies compared Mercury levels in biological samples with fish/shellfish consumption assessed through validated food frequency questionnaires with encouraging results. More studies are needed to confirm these findings. For other metals, validation of other exposure assessment methods must be further explored. | |||
Pesticides | ·There are multiple pesticides and multiple pathways of exposure conducing to varying exposure assessment | ·Since few cohorts assessed exposure to pesticides there is a large scope of doing more work on pesticide exposure within the European birth cohorts, particularly by analyzing available biological samples | ·Include validation studies in exposure assessment |
·Biomonitoring hardly feasible for large cohorts, but recommended on sub-populations for validation purposes and identification of main exposure sources | ·Use of Geographic Information System (GIS) technologies with existing European data on soil occupancy and satellite imagings/maps of crops to assess bystander exposure due to agricultural activities | ·Assessment of time-activity pattern and exposure at non-residential locations | |
·There is a need for harmonization of exposure assessment by biomonitoring (choice of molecules of interest, biological matrices, sampling and storage conditions, chemical analyses controlled by international comparison programs, etc.) between studies | |||
·Validation of questionnaires needed | |||
·Inclusion of exposure at non-residential locations may improve exposure assessment | |||
Persistent organic pollutants | ·High-performance liquid chromatography (HPLC) derived methods are the state of the art for measurements of POPs | ·The possibility to perform a pooled or meta-analysis on the association between exposure to POPs and birth outcomes in the European birth cohorts have been evaluated within a case study that is part of ENRIECO and continued in CHICOS (http://www.chicosproject.eu). | ·There is high degree of variability between studies in study design including timing of sample collection and collection medium. Therefore additional data collection according to a standardized protocol may be needed, especially if the outcomes of interest are hypothesized to be related to exposure at specific time windows during fetal life or early childhood. |
·All analyzing laboratories should participate in inter-laboratory calibration tests. | ·Data pooling is possible for polychlorinated biphenyl (PCB), and dichlorodiphenyltrichloroethane (DDT). For other POPs there is little data or too much heterogeneity with regard to the sampling media or the timing of exposure assessment. | ||
·Especially for detecting POPs in low concentrations in small volumes equipment with a high sensitivity is needed. | ·Conversion factors needed to be developed to allow pooling of data. | ||
·The persistence of organochlorines makes sample degradation a lesser problem as for other more readily degradable compounds. However, it is recommended to store samples at −80°C at least, if measurements are planned to be performed after several years. | |||
Other chemical exposures (brominated flame retardants, perfluorinated compounds, phthalates and phenols) | Human biological monitoring is the state of the art method for estimation of total dose | There is currently little published data in the cohorts, but many measurements are ongoing and we recommend cohorts starting to work towards combined and comparison studies. | This is an emerging field and there is a rapidly growing expertise in the cohorts, which would benefit from continued communication and coordination. |
·For non-persistent exposures with very short half-lives (phthalates and phenols), we recommend repeated measurements as standard practice. | ·Conversion factors should be developed to transfer from concentrations in one medium/time point to another in order to compare/combine data from different cohorts. | ·Very little is known about the effects of postnatal exposure to emerging chemicals, and therefore we recommend further evaluation of these new chemicals in children. | |
·Issues of contamination from storage materials and lab equipment, and storage conditions are of great importance and need to be addressed in depth. We recommend to closely follow published recommendations on sampling collection and packing, storage, and analysis (see COPHES website: http://www.eu-hbm.info/cophes). | ·Active dialogue and partnership among the scientists representing the various disciplines would be essential for selecting new contaminants and setting prioritization for measurement in birth cohort studies. | ||
·It is recommended to conduct a European evaluation of inter- and intra-laboratory variability. | |||
·Validation of other exposure assessment methods such as questionnaires, occupational Job Exposure Matrices (JEMs), environmental measurements, and/or toxicokinetic models is needed | |||
Radiation | Ionizing radiation | ||
·Assessment of medical radiation exposures (X-ray, computer tomography (CT)-scan) by standardized questionnaires | ·Existing data are not sufficient for pooled studies. | ·Assessment of medical radiation exposure | |
·Assessment of occupational exposure by means of badge dose information or if not possible by questions on x-ray equipment and protective equipment used | ·Evaluation of link with other EUROPEAN cohorts of children exposed to CT scans | ||
·Assessment through job-exposure matrices difficult | |||
·ENRIECO has developed a set of core questions on sun exposure for different exposure-time windows that is recommended for use in cohort studies | ·Existing data are not sufficient for pooled studies | ·Inclusion of vitamin D and UV exposure related questions in cohort questionnaires. | |
Non-ionizing radiation | |||
·Use of core set of standardized questions to assess mobile and cordless phone use | ·Comparison studies with existing data comparing questionnaire data between cohorts | ·Integration of standardized questions on use of mobile phones to facilitate future combined analyses of non-cancer effects | |
·Validation of questionnaires using information of other types of studies | ·Collaborative efforts focusing on design of questions related to other RF-EMF sources (e.g. WiFi, new communication technologies, microwave ovens, baby phones) | ||
·Coordination between cohorts in developing validated exposure models for RF and ELF-EMF | |||
Smoking and second hand tobacco smoke | ·Questionnaires are most suitable method for larger epidemiological studies and for assessment of long-term exposure | ·Combined analyses on the effects of pre- and postnatal exposure to second hand tobacco smoke have been performed within a case study that is part of ENRIECO | ·Large studies with close monitoring of second-hand tobacco smoke exposure before conception, during trimesters of pregnancy and during the first year of life to disentangle the role of exposure during different periods |
·Relevance of the timing of the exposure (before conception; during pregnancy, infancy, childhood or later in life) is not clear. Large studies can enhance knowledge if exposure is assessed repeatedly during different time periods. | ·Specific questions recommended for the different exposure periods | ||
Noise | ·Objective measures should be in accordance with the European Union's Environmental Noise Directive (END) guidelines. | ·Few European cohorts currently have data from objective noise assessments that could be combined | ·Inclusion of objective and subjective exposure assessments |
·Noise propagation modeling is recommended for large studies. | ·Assessment of time-activity pattern | ||
·Questionnaire- assessments of noise annoyance should be performed in addition to objective measures; standard scales can be recommended. Information on non-residential exposure, time-activity pattern, and insulation of buildings, window opening behavior and the position of bedroom in relation to source of noise should be included in exposure assessment. | |||
Occupational exposures | ·A number of Job Exposure Matrices (JEMs) have been built in Europe covering different periods of time and different types of exposures. | ·Within the ENRIECO project, the possibility to perform pooled/meta-analyses of the association between adverse health outcomes and selected occupations of mothers and fathers during vulnerable periods has been explored; 14 cohorts are eligible for this analysis, 12 have already expressed their interest. A protocol for the analysis has been developed. | ·For an adequate data collection on occupational exposures job title is not sufficient. In addition, one should collect description of task, type of industry, number of hours per week, and if possible name of company, existence of biomonitoring data. Free text should be kept in the data base for additional details. |
·JEMs need to be validated against objective measures of exposure (work environment, biomarkers) | ·A good training of coders should be organized for harmonization of occupation coding | ||
·If JEMs are used, they should be country- and agent-specific since work environments differ between countries and time periods. | ·Standardized questionnaires for physical load should be published | ||
·To avoid any influence of birth outcome on the availability of occupational information and on its quality, we recommend that data should be collected before birth. This is mandatory when questionnaires on occupational exposures are used and optional for job title. | |||
·The period of interest is around conception and each trimester - or at least one trimester of pregnancy (depending on the health outcome studied) for mothers, and before conception for fathers. |
The inventory revealed that in the European birth cohort studies, rich and diverse data on environmental exposures exist. Several examples of successful collaborations were identified making use of exposure data obtained in several cohorts.
A number of methodological issues were identified as well. Often, indirect methods were used rather than measures of personal exposure. Temporal misalignment of exposure measurements relative to timing of health measurements was also identified, as was lack of information on time-activity patterns. All of these produce error in exposure measurements which may attenuate risk estimates and statistical power of a study and increases the likelihood that real associations are not detected [2]. The National Research Council ranked the different direct and indirect approaches of exposure assessment and considered personal exposure measurements as the best estimate of actual exposure [29]. Exposure assessment by means of (repeated) individual environmental or biological measurements, however, is costly and therefore usually not feasible in all participants of large cohort studies. Therefore, in many studies in this inventory, questionnaires were used to enquire about the exposure of interest, occasionally in combination with environmental measurements (water contamination).
Questionnaire reports were found to be an inexpensive and valid estimate of residential SHS exposure among preschool and school children [9–11], whereas questionnaire-reported cat and dog ownership is a relatively poor measure of pet allergen levels in house dust [13–16] and cannot be used as a surrogate for measurements of specific microbial agents in house dust [17–19]. House dust collection by study participants instead of fieldworkers can reduce the costs associated with the collection of dust samples for the assessment of allergen and biocontaminant exposure. Several methods have been described in the literature including nylon socks [30], electrostatic wipes [31, 32], and passive samplers [33]. For other exposures such as household use of pesticides and non-ionizing radiation, where exposure assessment also largely relies on questionnaires, such validation studies are still lacking. Also, for chemical exposures such as phthalates that are currently exclusively measured by biomonitoring, no validated questionnaires exist and predictors need to be identified [7].
Likewise, there is still little validation of modeled exposures (ambient air pollution) or surrogate variables (e.g. proximity to agricultural activities as a proxy for bystander exposure to pesticides) against individual environmental monitoring.
As the birth cohorts studies in this inventory were all funded locally, there was no initial harmonization of exposure assessment methods For example, different questionnaires were used in different cohorts; there were no standardized protocols for the collection and analysis of individual environmental samples and biomonitoring was done in different media such as breast milk, cord blood, placenta, serum and whole blood. Some exceptions include studies in which a standardized exposure assessment was part of a collaborative effort (e.g. TRAPCA (outdoor air pollution [21]), ESCAPE (outdoor air pollution [22, 23, 34]), HIWATE (water contamination [24]) AIRALLERG (allergens, biological contaminants and indoor air pollution [25, 26]), and HITEA (indoor biological agents, http://www.hitea.eu/). In the absence of such prior harmonization of methods, data can still be combined after careful examination of the communalities and differences between methods. Moreover, it should be noted that harmonization of exposure assessment is not straightforward and may not be beneficial in all cases as for example for many exposures there is no gold standard, and questionnaires may be based on wrong hypotheses. This is more a concern for emerging exposures (e.g. radiation) than for established exposures (e.g. SHS). Furthermore, the development of internationally accepted standards is a complicated and lengthy process and often standards hinder the development and introduction of new methods. Especially for the assessment of emerging exposures and for new exposure assessment methods diversity is desired as it allows the evaluation and comparison of different methods. For exposures that are (mainly) assessed by means of biomonitoring (i.e. metals, pesticides, POPs, and other chemical pollutants), the performance of inter-laboratory comparisons and either the harmonization of the exposure assessment with regard to the sampling medium or the development of conversion factors has been recommended to facilitate combined analyses (Table 2).
Individual assessment of exposures experienced by the study subjects in different micro-environments by means of personal or stationary monitoring alone will generally not be feasible in birth cohorts, as the study populations generally comprise several hundreds to thousands of subjects. Therefore, environmental exposure assessment in the European birth cohorts currently is often limited to residential exposure although many study participants regularly spend considerable amounts of their time outside their homes for instance at day care centers or schools. Consequently, little is known about the role of non-residential exposure and time-activity pattern in the association between these exposures and health. Some recent publications on the effects of ambient air pollution where exposure was estimated as a time-weighted average of several addresses where the participants spent considerable amounts of time indicated little differences between the estimated exposure at the home address only and the time-weighted average of residential and non-residential (i.e. work or school) exposure [35–37]. However, this needs further evaluation.
For many exposures, we presently know very little about the relevance of the timing of the exposure in addition to the level of exposure, and it is unclear whether exposure during a specific period when organs develop and are considered being more susceptible, is more important than later exposure (e.g. for congenital anomalies early pregnancy and birth weight mostly likely late pregnancy). The window of susceptibility for reproductive outcomes is most likely short (days, months, trimesters of pregnancy) and depends on the type of outcome [38]. For asthma and allergies it has been hypothesized that there is a "window of opportunity" early in life where the development of asthma and allergies is initiated by a variety of factors [39]. However, we cannot rule out that there are multiple windows of susceptibility during fetal development and (early) childhood. As an example, one of the case studies performed within the ENRIECO project demonstrated that SHS exposure during pregnancy and during the first year of life are independent risk factors for childhood wheeze and asthma [28].
Prospective birth cohort studies with repeated exposure and health outcome assessments offer a unique possibility to increase our knowledge with regard to the temporal variability of exposure and if variability is sufficient the relevance of exposure during different time periods. The need for repeated exposure assessments depends on the temporal variability and the toxicokinetics of the exposure of interest: if there is little variability, few repeated measures are needed; if there is a lot of variability many repeated measurements are needed. The number of measurements that can be performed in a cohort study, however, is limited, and therefore it will never be possible to continuously monitor exposure. Repeated exposure assessments, for part of the population if not possible for all study participants, however, can provide valuable information about the validity of a single exposure assessment for a longer period, i.e. its ability to predict concentrations in earlier of later periods. For example, land-use regression models that are currently used very often for assessments of long-term exposures to outdoor air pollution are based on one measurement campaign during which air pollution concentrations are measured at a number of locations. Few validation studies have been performed so far. Recently, it has been shown that land-use regression models were highly predictive of NO/NO2 concentrations measured 10 and 13 years apart in The Netherlands, and Rome, Italy [40, 41]. A high correlation has also been shown between measurements of POPs performed as much as 10 years apart [42]. Furthermore, there is some evidence that a single endotoxin [43–46], mite or cat allergen measurement [46, 47] is a valid estimate of exposure for longer time periods.
Collecting data before the occurrence of any adverse health event of interest is crucial when temporal variability of the exposure of interest is high or the presence of a certain disease or condition can result in changes in exposure (e.g. allergen avoidance in subjects with asthma and allergies). Furthermore, if exposure assessment relies on (parental) self-reporting a retrospective assessment may result in reporting bias or recall bias (e.g. due to increased awareness of certain exposures in diseased subjects). Nevertheless, also in prospective cohort studies, exposure assessment is sometimes done retrospectively, i.e. an exposure assessment is added to existing health data because time and money for exposure assessment at the beginning of a study are limited and often new exposures become of interest only after the study has been going on for some time. The storage of (part of) biological and environmental samples for later analyses as well as the use of historical data that has been routinely collected for other (e.g. monitoring) purposes can overcome the problems associated with retrospective exposure assessment. Another possibility included the use of GIS-based techniques and exposure modeling techniques, which are currently in particular, but not exclusively, used for air pollution exposure assessment. For example, within European birth cohort studies, GIS-based techniques have also being used for assessment of noise. Furthermore, outside European birth cohorts, GIS-based techniques have been used to assess pesticide exposures, e.g. [48, 49] and more recently exposure to radiofrequency electromagnetic fields [50].
Lessons from collaborative efforts so far have been that combining data from various cohorts requires careful consideration of the aims, protocols, data (comparability and availability of exposure, health and relevant confounder data), ethical issues, analyses and management, and it is time and labor intensive but potentially fruitful. As an example, a challenge of the case study on POPs [6] was the development of conversion factors to facilitate combined analyses with persistent organic pollutant measurements performed in different media. Collaborative studies performed within the EU-funded CHICOS project (http://www.chicosproject.eu) currently build on these experiences. Both, existing collaborative studies as well as our recommendations regarding future meta-analyses and/or pooled analyses within the European birth cohort studies, so far, were very much focused on the study of one exposure at a time. Possible interactions between different exposures are of course of major interest as environmental exposure is not limited to a single agent and basically all cohorts have data on multiple exposures. Limited statistical power of single cohort studies is a much bigger issue in the study of interactions between exposures than in one-agent-at-a-time studies, resulting in an even greater need for collaborative studies here.
Substantive questions in environmental health that could potentially be answered by future collaborative efforts include health effects of ultrafine particles in air; pharmaceuticals, PFOS/PFOA and other endocrine disruptors in drinking water [51]; and medical radiation exposure.
Improvement is needed of questionnaire instruments to assess water contamination, UV, non-ionizing radiation, second hand tobacco smoke, noise, and occupational exposures. Inter-laboratory comparisons are needed for methods to measure POPs and other chemicals through biomonitoring. Recommendations for future work include the use of new technologies such as GIS and satellite imaging for assessment of pesticide exposure and molecular methods or DNA fingerprinting for assessment of microbial exposures.
Lack of information on variables that are determinants of exposure and health outcomes can lead to confounding bias in epidemiological studies [8]. A discussion of relevant confounders for a wide range of exposure-health relationships is beyond the scope of this paper. However, there are two variables that may act as a confounders of many exposure health relationships and that we would like to mention here, namely socio-economic status (SES) and genetic predisposition. Socio-economic status has been shown to be an important determinant of several environmental exposures (e.g. air pollution and second-hand smoking) and susceptibilities (e.g. pre-existing health conditions, stress, behavior), which have been suggested to act together to influence the health response of groups classified by socioeconomic level [52–54]. Therefore information on SES has been collected in basically all existing cohorts. We strongly recommend to new cohorts to collect individual information on participants' SES (e.g. parental education, income or occupation) to assess potential confounding and modifications of exposure-health relationships by SES. Likewise, information on genetic predisposition is very important and should be collected as genetic predisposition may act as a confounder (e.g. allergen-avoidance of allergic parents [55]) or an effect modifier of the association of interest.
Concluding remarks
European birth cohorts are collecting a wealth of data on environmental exposures. Most data is currently available for outdoor air pollution, allergens and microbial agents, smoking and second hand tobacco-smoke, and occupational exposures. Collaborative analyses with data from several birth cohorts have been performed successfully for outdoor air pollution, water contamination, allergens, biological contaminants, molds, POPs and tobacco smoke exposure. This illustrates the large potential for collaborative analyses of other environmental health issues as well. Investigators can use this review to evaluate the potential for future collaborative analyses with respect to data availability and methods used in the different cohorts and to identify potential partners for a specific research question. The main reasons for collaboration between population studies are replication, studying heterogeneity, and increasing statistical power to study small relative risks, rare events and/or complex interactions. Apart from subject-matter specific recommendations, progress can only be achieved with further harmonization of methods, including those for environmental exposure assessment. The ENRIECO project shows the potential as well as the limitations to use data from existing, locally funded studies for this. Assuming that the majority of future studies will continue to be locally designed and funded, there is a need to periodically review methods for exposure assessment as they become available. Investigators and funding agencies can then make use of this information to choose methods.
Atomic absorption spectroscopy
Computer tomography
Environmental Noise Directive
Extreme low frequency
Electromagnetic field
Environmental Health Risks in European Birth Cohorts
Geographic Information System
High-Performance Liquid Chromatography
Inductively Coupled Plasma Mass Spectrometry
Job Exposure Matrix
Polychlorinated Biphenyl
Perfluorooctanoic Acid
Perfluorooctanesulfonic Acid
Persistent Organic Pollutant
Radio Frequency
Socio-Economic Status
Second Hand Smoke
We thank all other cohort researchers and technical staff who have helped with the completion of the questionnaires and all researchers who were involved in the evaluation of the exposure information.
This work was supported by ENRIECO (Environmental Health Risks in European Birth Cohorts), a project conducted within the European Union's 7th Framework Programme (Theme 6, Environment (Including Climate Change)) [Grant agreement number: 226285].
Authors' Affiliations
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Q. I recently had 100 new, hammered balusters sent out to be powder coated. These were forged steel balusters, single basket, 45 ¼ × 2 ¾ inches, weighing 3.83 lbs.
They each have a basket with a ring above it. I set a couple outside and noticed a slight orange color in the basket after one night of exposure to moisture.
Is there a remedy at this point that can be used to repair the rusty look? Can the powder coater redo the affected area? I asked an employee from the supplier and he said it was necessary to do a pre-treatment on the balusters with Simple Green or soap to remove any oils or film. He said that maybe the powder coater could remedy it. What is my best solution? Start over, meaning get all new balusters (expensive) and powder coat properly, or use alum L.K.
A. This is a complex question. Is there rust break-out due to a void or a light area in the coating? Is rust bleeding up through the film? You need to know the origin to know the solution. If it is a void or light spot, you could blast clean it and recoat the entire part and it should work as long as you get rid of all the rust. Be sure that all visible rust is gone and recoat the entire part. If the surface is rusted under the coating, you have to strip it off and recoat or make new balusters. If the surface is rusted under the coating, it will continue to spread and break down the coating.

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Comments (8)
Christopher Zeidel (6 years ago)
I recently watched Straight Time on Netflix streaming and I was not impressed. I thought it was confused. It starts out making you think that Hoffman was not such a bad guy and that he was the victim of a corrupt system. Eventually, Hoffman comes off as being truly evil and you all of a sudden start hating him and wishing he were back in prison. The film was never clear whether he was evil or not, or whether we should hate him or not. I was not sure what to think of his character. This uncertainty frustrated me.
Christopher, you inadvertently made Gene Siskel's point. You wouldn't allow the movie to tell its own story to you.
I wrote a research paper on Night Moves, and I would recommend it to any noir fan!
Jennifer Warren was ultra s*xy in Night Moves. I mean hot in a grown woman way, not like some of the kids that you normally see runniing around Hollywood.
Absolutely. In real life there's no such thing as categorically "evil" or "good" people (besides Adolf Hitler and Mother Teresa, perhaps), and the most interesting movie characters are the ones that acknowledge how complicated it is to be human.
gradepoint (5 years ago)
I saw the Sorcerer based on this review recently, and I have to admit I wasn't as impressed as Roger. Actually the Sorcerer is basically a remake of "Wages of Fear", which in my opinion is much better.
Soulo_Guero (12 months ago)
I understand Sorcerer was released one month after Star Wars. A formidable shadow was cast.
Comment on this video
6 years ago
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...of the 1970s. Roger picks The Sorcerer, Night Moves, and Images, and Gene picks The Late Show, Straight Time, and Mean Streets as movies that were critical successes, but box office flops....
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If you are NICET certified and in the process of upgrading to a higher level, beware. January 1, 2011 is the deadline for element testing. After this date if you are in the process of testing for a higher level you lose all of the elements for that level. Testing format will change to a pass/fail test starting January 1, 2011. Example, I am two (2) elements from NICET III and and nine (9) from level IV. I will be testing in July. If I do not pass my NICET IV I will have one more change before January 1, 2011. If I pass Level III but not level IV before the deadline I will lose all of the elements for level IV that I have passed and will have to take the pass/fail test next time I test. beware
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Photo Walk
Uploaded by SodScrap, May 07 2011 08:11 PM
- Owner:
- Uploaded: May 07 2011 08:11 PM
- Views: 329
- Category: National Scrapbook Day 2011
Such a fun photo walk with friends!
During our Midwest ScrapGirls get together, we enjoyed a photo walk at the Shoal Creek Living History Museum. It was a beautiful day! Those on the photo walk were Angie Briggs, Pat Barnes,
Cherie Thieleke,Sandi Carter, Theresa Reck, Rozanne Paxman and Me.
BMU_SSTools_MegaLift I Squared
ABR_SSDLO_Ser 5
CC always welcome
Oh, Conda! What great shots you got on your photo walk! Just beautiful - thanks so much for sharing them! I hope one of these days I can go on one of these meets - I would love to meet you-you are such a fun person! I really enjoyed seeing these!
These are great shots and I like the way you did your journaling. I've lived in KC area all my life and never gone to Shoal Creek. I must put that on my bucket list! Your page has inspired me to get up and go.
Wow! I wish I could have been there. Those photos are amazing.
Love this layout! The photos are fantastic to begin with, but I love the simple muted layout. Very nice!
Wowsa! Fabulous photos, and a great way to display them. Love the two fonts and how they contrast but work together.
I really love the fresh modern approach to this layout....another Beauty!!
Youve achieved a lovely balanced page here. Such interesting photos too.
You captured some lovely images that day Conda - I really like the beautiful simplicity of this page showcasing the images.


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Shop Now
Get directly in touch with GENTRY HOME
Request prices/quote
Request catalogues
Retailers list
Verona (VR) / Italy
GENTRY HOME S.r.l. Via Chioda, 78 37136 Verona (VR) | Italy Tel.: +39 045-8006917 Fax: +39 045-8020111
Collection ST. JAMES by GENTRY HOME
Toothbrush holder
Wall-mounted soap dish
Toilet roll holder
Ceramic toilet brush
Robe hook
Shower taps by GENTRY HOME
Classic style chrome-plated shower...
Thermostatic shower mixer


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Tropical Fish Keeping - Aquarium fish care and resources
- Beginner Planted Aquarium
- - Updating my planted sorority! (20g)
Updating my planted sorority! (20g) 3 Attachment(s) I've had a planted 20g running since August, but it's been in serious need of some re-scaping. Crypts growing like crazy in the foreground, anubias that are kinda lost in the leaves, a few swords, and some unknown shorter stemmed plants. Occupants of the tank: 6 female bettas (Amelia, River, Rose, Martha, Clara, and Idris) 4 gold panda mollies (yes, I know, tank too small, blah blah blah) 1 male ancistrus pleco (Jack Harkness) 1 three-line cory (uh huh, shoaling, I know) 1 panda cory (thinks it's a betta) 3 nerite snails Not here to talk about poor stocking choices. These are my survivors. Here to post updates of my tanks. Any plants removed from this tank will go into one of my 10g divided tanks. These pics are taken after removing a 6" tall crypt from the center of the front. |
4 Attachment(s) Soooo much better looking already! All I've done so far is move around the plants that were already in there, tied the anubias and some java ferns that I forgot was in there onto the mopani wood (added another piece of that, too), and rooted the wisteria that was floating at the top... |
New plants will have to wait until tomorrow. Life happened tonight... |
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Okay yeah. Definitely not the biggest fan of bagged teas, or the ones in the k-cups.
They're just much harder to manage because I'm very picky with how I like my tea.
It's good like every once in a while, but I just can't wait to go back to my flat so I can have my loose leaf :)


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Terms and Conditions
T1 to T4 at Kicking Horse from Le Beausoleil
Prices and Taxes:
Prices do not include taxes. Taxes are added to the bill at the time of check out. The current tax rate is 15.00%.
Le Beausoleil requires a valid credit card number to make a reservation. For bookings of more than one night or more than one room a 25% deposit may be required.
Balance of payment is due when you check in. Payment methods are Email Payment, Direct Debit, MasterCard, Visa or cash (Canadian Dollars)
1) If the cancellation is made seven days or more prior to the arrival date there is no penalty.
2) If the cancellation is made within seven days of the arrival date the total room cost will be charged to the credit card. Le Beausoleil will make every effort to re-rent the room and if successful the penalty will be refunded.
3) If the cancellation is made within 24 hours of the arrival date or you do not show up on the arrival date the total room cost will be charged to the credit card. There is NO REFUND.
4) Cancellations must be in writing, emails are acceptable. Le Beausoleil recommends you have travel insurance in case you have to cancel your visit.
Check In and Check Out Times:
Check In Time is between 4:30 PM and 9:30 PM Mountain Time. Early luggage drop-offs and late arrivals are allowed but please call to make arrangements.
Check Out Time is 10:00 AM Mountain Time. Late luggage pick-ups are allowed but please call to make arrangements.
Please note Golden is on Mountain Time (Calgary/Banff) and not Pacific Time (Vancouver/Revelstoke).
Le Beausoleil provides a healthy and hearty self-serve breakfast in the guest dining area from 7:30 AM to 9:30 AM.
Breakfast includes home made breads, bagels, granola and jams, seasonal fruit, a selection of hot and cold cereals, yogurt, juice, milk, tea and coffee.
If you have any food allergies please notify your hosts so they can accommodate you.
Loss or Damage to Property:
There is a $35.00 fee to replace lost room keys.
Le Beausoleil uses a new for old policy when replacing items that are damaged or stolen. The replacement cost of these items will be charged to the occupant's credit card. The card holder will receive an email advising them of the damage and cost of the items.
Le Beausoleil is the sole arbitrator when determining costs for damaged or stolen items.
Food and Beverages:
If you have any allergies please notify your hosts.
Cooking and food preparation is not allowed in the guest rooms or guest lounge/library.
The dining area is equipped with a microwave, refrigerator and dishwasher for guest use.
Glass containers are not allowed on the decks or in the hot tub. Please use plastic glasses or containers.
Hot Tub and Common Area:
The hot tub is open from 10:00 AM until 11:00 PM.
Children under the age of 16 using the hot tub must be accompanied by an adult.
The guest lounge/library is open from 7:00 AM until 11:00 PM. If watching TV before 9:00 AM or after 9:00 PM please respect the other guests by turning down the volume.
Smokng is not allowed inside Le Beausoleil. Please use the outdoor designated areas.
Le Beausoleil is "animal friendly" and accepts pets. The Purcell and Selkirk rooms are "pet friendly". There is an additional charge of $15.00 per night per pet.
If you are allergic to animals please note there is a Black Lab (Amos) in residence.
Owners are responsible for cleaning up after their pets................yes you scoop the poop!
The Disorderly Conduct Rules apply to pets as well as their owners.
Disorderly Conduct:
Disorderly conduct , disturbance of other guests or the breaking of any house rules will not be tolerated.
Guests will receive one verbal warning. If the disorderly conduct persists the guest or guests will be asked to leave.
There are no refunds for guests asked to leave for disorderly conduct.
Terms and Conditions Agreement
By making a reservation at Le Beausoleil Bed and Breakfast you are agreeing that you have read the Terms and Conditions and that you accept them.


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At First, They Thought It Was an Old Tire. When These Scientists Got Closer, They Couldn't Believe Their Eyes.
The Rainforest SiteWhen deep sea explorers see something they can't believe, you know it's a big deal.
Researchers with the Nautilus Live expedition — a live-streamed deep sea exploratory mission — nearly passed right over a rare specimen floating along the sea floor.
The creature was later identified as a siphonophore: a superorganism that's made up of a colony of smaller animals called zooids. You may remember the Portuguese Man-o-War, which is perhaps the most well-known type of siphonophore. Like jellyfish, these aquatic predators use their tentacles to capture prey. Of the 175 known species, some reach lengths of up to 40 meters.
Watch the rare footage here:


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SocialBro launches real-time Twitter analytics: Find out more about who's tweeting right now
- 6
Wouldn't it be great to be able to see which of your Twitter followers are around right now so you know who's likely to read your next tweet? Twitter analytics startup SocialBro has just rolled out an update that lets you do just that.
SocialBro is a free app available for Google Chrome and Adobe Air that allows you to get a broad overview of your Twitter community. We've written about it a number of times in the past (most recently when it integrated PeerIndex scores) and it's truly a useful tool. With the new real-time feature, you can see which of your followers are active, the number of active users per second, the languages your followers are tweeting in and the apps and clients that they're tweeting from.
Win a trip to Amsterdam!
We've teamed up with Product Hunt to offer you the chance to win an all expense paid trip to TNW Conference 2017!
It's not just your followers either, you can monitor a particular Twitter list or a search term – meaning that you could see a bit more about the people tweeting about a certain topic right now.
So, how does it work? SocialBro counts 'active' as someone who has tweeted in the past 5 minutes, although future versions will be configurable for a wider range of criteria.
The Spanish startup says that there are a number of use cases for the new feature:
- To see at a glance the real-time state of your community and to identify users who are online, to interact with them.
- If you have a multi-language account, the language chart helps you identify the best language to tweet in at any given time.
- If the users are mostly tweeting from apps like Foursquare or Instagram, for example, they probably are not aware of their timelines in that moment.
- You can monitor a specific group of users via a Twitter list.
- You also can monitor a hashtag or a key word to get an idea of how active they are.
The real-time analytics feature is currently limited to a maximum of 100 concurrent users, meaning that if you're monitoring a busy topic or a lot of your followers are active, you might not see them all. It should give you a good flavour of what they're up to though.
The video below gives you an idea of how it works, or you can dive right in to give it a try.
Read next: Google wants more lulz on Google+, begins rolling out image meme generator


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Yes, Sioux Falls Has a Leprechaun Door
Subscribe to KIKN-FM / Kickin' 100.5 on
Does Sioux Falls have a leprechaun door? This was asked of me this week in casual conversation. Now, I'm not a 'Ghost Hunter' but pour me a pint of Guinness and I'll investigate anything.
After said investigation, I'm proud to announce that yes, Sioux Falls, we have a magical leprechaun door.
It really didn't take much investigating. The door, although it is rather small, is in plain sight. Look no further than McNally's Irish Pub on Western Avenue. I was greeted by Nicki, who was more than accommodating to take the time and chat a little bit about the leprechaun door that graces the stained glass entryway of the pub.
It's always fun at around 1:00 am when someone asks 'how long has that door been there?' says, Nicki. "It's just a great conversation piece."
Nicki also points out that those who are truly Irish will point out that leprechauns are actually invisible. So wouldn't it stand to reason then, that the door would open and close on it's own every once in a while?
Well, if you have enough Jameson Irish Whiskey…maybe.
Visit them online to learn more about it's great atmosphere and drinks, promotions, and incredible food.


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The Broncos sent an undisclosed 2013 draft pick to Philadelphia on Monday for the defensive tackle whose trade to Cleveland for a 2012 fifth-round pick over the weekend was scuttled.
Bunkley reported to Cleveland but did not meet all the conditions of the trade and was reverted to the Eagles, who managed to find a new suitor in Denver.
All trades are contingent on players passing physicals. Bunkley had an elbow injury last season.
Eagles general manager Howie Roseman said Bunkley was surprised by the trade.
"I think that he enjoyed it a lot here and I think part of the reason was this all shocked him," Eagles general manager Howie Roseman said. "He was a first-round pick. I think he thought he'd be here for his whole career. I think he liked the kind of the energy that's going on here and he wanted to be a part of it."
Bunkley had six sacks in 76 games in Philadelphia. He became expendable when the Eagles signed former Packers defensive lineman Cullen Jenkins.
Bunkley was picked 14th overall in the first round of the 2006 draft out of Florida State. He was a three-year starter before sharing time last year in Philadelphia, where he had six sacks and 144 tackles in his five seasons.
Bunkley isn't the only former first-rounder the Broncos acquired Monday.
They also signed defensive end Derrick Harvey, a former Florida star whose production never matched his potential after the Jacksonville Jaguars selected the defensive MVP of the 2006 Bowl ChampionshipSeries title game with the eighth overall pick in 2009.
Harvey tallied eight sacks in three seasons with the Jaguars, where he posted 88 career tackles and started 32 of 47 games, playing both right and left defensive end. He started 26 straight games for the Jaguars before his benching midway through last season.
He'll be looking to jump-start his career as a backup in Denver, where the Broncos are returning to the 4-3 scheme with Elvis Dumervil and Robert Ayers as the starters and Von Miller, the second overall pick in the draft, rushing the passer from the outside linebacker spot.
The Broncos also re-signed unrestricted free agent Marcus Thomas, who has played in every game during his four years in Denver, and moved Mario Haggan back to linebacker Monday after moving him to defensive end for the first four days of training camp.
Defensive tackle is the Broncos' biggest area of concern, and it's a position they didn't address in the draft that was deep at that position. Nor did they jump into the bidding for the high-priced veterans during the frenzied opening days of free agency.
The Broncos also signed tight ends Daniel Fells and Dante Rosario. To make room, they waived safety Nick Polk, cornerback James Rogers and wide receiver Marshall Williams.


text:
PR Newswire
REDWOOD CITY, Calif., Nov. 3, 2016
REDWOOD CITY, Calif., Nov. 3, 2016 /PRNewswire/ -- Genomic Health, Inc. (Nasdaq: GHDX) today announced that Brad Cole, chief operating officer and chief financial officer, will present at the Credit Suisse 25th Annual Healthcare Conference in Scottsdale, Arizona on Tuesday, November 8, 2016 at 3:30 p.m. Mountain Time.
To access the live and subsequently archived webcast of the presentation, go to the Investor Relations section of the company's web site at http://investor.genomichealth.com. Please connect to the web site at least 15 minutes prior to the presentation to allow for any software download that may be necessary. An archived replay will be available for three months beginning 24 hours after the live presentation.
About Genomic Health
Genomic Health, Inc. (NASDAQ: GHDX) is the world's leading provider of genomic-based diagnostic tests that help optimize cancer care by addressing the overtreatment of the disease, one of the greatest issues in healthcare today. With its Oncotype IQ™ Genomic Intelligence Platform, the company is applying its world-class scientific and commercial expertise and infrastructure to lead the translation of clinical and genomic big data into actionable results for treatment planning throughout the cancer patient journey, from diagnosis to treatment selection and monitoring. The Oncotype IQ portfolio of genomic tests and services currently consists of the company's flagship line of Oncotype DX gene expression tests that have been used to guide treatment decisions for more than 700,000 cancer patients worldwide. Genomic Health is expanding its test portfolio to include additional liquid- and tissue-based tests, including the recently launched Oncotype SEQ® Liquid Select assay. The company is based in Redwood City, California, with international headquarters in Geneva, Switzerland. For more information, please visit, www.GenomicHealth.com and follow the company on Twitter: @GenomicHealth, Facebook, YouTube and LinkedIn.
This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and the other risks set forth in the company's filings with the Securities and Exchange Commission, including the risks set forth in the company's quarterly report on Form 10-Q for the quarter ended June 30, 2016. These forward-looking statements speak only as of the date hereof. Genomic Health disclaims any obligation to update these forward-looking statements.
NOTE: The Genomic Health logo, Oncotype, Oncotype DX, Recurrence Score, DCIS Score, Oncotype SEQ, and Oncotype IQ are trademarks or registered trademarks of Genomic Health, Inc. All other trademarks and service marks are the property of their respective owners.
Logo - http://photos.prnewswire.com/prnh/20130425/SF01493LOGO
To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/genomic-health-to-present-at-the-credit-suisse-25th-annual-healthcare-conference-300356553.html
SOURCE Genomic Health, Inc.
PR NewswireLast updated on: 03/11/2016


text:
Morning Buzz — October 4, 2010
Hat tip to Library Stuff: Audio Recordings of US History Fading Fast.
Google has announced a gallery of Android phones.
More Yahoo executives are leaving.
Here's a quick roundup of YouTube news.
Woo-hoo! It's a release candidate for Ubuntu 10.10!
The Internet Archive wraps up Banned Books Week.
From the W|A blog: Talk to Wolfram|Alpha in TeX.
I don't want Google search before I ask. The substituted searches now are bad enough…
The University of Maryland Eastern Shore yearbook collection has gone digital. Good morning, Internet…


text:
Mario Kart: Double Dash Cheats :
This cheat for Mario Kart: Double Dash [Game Cube] has been posted at 04 Oct 2010 by matty987 and is called "Mario Kart Double Dash Unlockables". If cheat is usable don't forgot thumbs up matty987 and share this with your freinds. And most important we have 10 other cheats for Mario Kart: Double Dash, look them as soon as possible!
Unlockable - Mario Kart Double Dash Unlockables
by matty987 Oct 04, 2010
Here are the unlockables for mario kart double dash
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Mario Kart: Double Dash Cheats: |
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text:
Conventional Infertility Treatment vs. Fast Track to IVF (FASTT)
- Full Text View
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- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Condition | Intervention |
Infertility |
Procedure: intrauterine insemination Procedure: infertility |
Study Type: | Interventional |
Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
Official Title: | Conventional Infertility Therapy vs. Fast Track to IVF |
- Determine the cost-effectiveness of fast track to IVF versus conventional infertility treatment by conducting a randomized clinical trial to compare success rates and costs, as well as the associated complications of treatment. [ Time Frame: at end of study ]
- Demographics and baseline variables will be collected, including: medical and reproductive history, age, education, income, race, nutritional history, smoking history, and clinical variables related to infertility diagnosis and treatment. [ Time Frame: at end of study ]
Enrollment: | 503 |
Study Start Date: | August 1999 |
Study Completion Date: | April 2006 |
Primary Completion Date: | August 2005 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
Active Comparator: I.
Conventional infertility therapy
Procedure: intrauterine insemination
An assisted reproduction technique which deposits washed sperm directly into the uterus, bypassing the cervix, and allowing the sperm to enter the fallopian tubes where fertilization normally occurs.
Other Names:
Procedure: infertility
This procedure involves stimulating the ovaries, retrieving released eggs, fertilizing the eggs, growing the embryos in a laboratory, and then implanting the embryos in the woman's uterus to develop naturally.
Other Name: assisted reproductive technologies
Active Comparator: II.
Fast track to in vitro fertilization therapy
Procedure: intrauterine insemination
An assisted reproduction technique which deposits washed sperm directly into the uterus, bypassing the cervix, and allowing the sperm to enter the fallopian tubes where fertilization normally occurs.
Other Names:
Procedure: infertility
This procedure involves stimulating the ovaries, retrieving released eggs, fertilizing the eggs, growing the embryos in a laboratory, and then implanting the embryos in the woman's uterus to develop naturally.
Other Name: assisted reproductive technologies
Detailed Description:
This is a randomized clinical trial to evaluate the efficacy, adverse events, and particularly cost and cost-effectiveness of two alternative infertility treatment strategies for patients who would otherwise be candidates for ovulation induction and IUI as their initial treatment. The two therapies compared are conventional treatment and fast track to IVF. Conventional therapy is a cost-conscious progressive treatment strategy that begins with the least invasive form of ovulation induction, clomiphene/IUI. It then progresses to FSH/IUI and, if pregnancy is not achieved, to IVF. The fast track to IVF strategy begins with clomiphene/IUI; if pregnancy does not result, these patients bypass FSH/IUI and move directly to IVF. We hypothesize that the fast track to IVF therapy results in a higher pregnancy rate, lower rates of medical complications during treatment, lower rates of pregnancy complications, and costs no more than conventional infertility treatment.
The trial has the following specific aims:
Aim 1: To compare the number of deliveries per initiated cycle, the proportion of women with a clinically recognized intrauterine pregnancy, and the time to clinical pregnancy between fast track to IVF and the conventional treatment arms of the clinical trial.
Aim 2: To compare the frequency of infertility treatment complications between the fast track to IVF arm and the conventional treatment arm.
Aim 3: To compare the occurrence of pregnancy complications between the fast track to IVF arm and the conventional treatment arm.
Aim 4: To evaluate the costs and cost effectiveness of the two alternative treatment strategies by comparing the direct and indirect medical costs between the fast track to IVF and conventional treatment arms of the clinical trial.
This is a collaborative study between Boston IVF, Harvard Vanguard Medical Associates, Harvard School of Public Health, Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan.
Total Enrollment: 503 Couples
Ages Eligible for Study: | 21 Years to 40 Years (Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Female partner age 21 up to 40th birthday, at the time of recruitment. Infertility is defined as failure to conceive a recognized pregnancy after one year (or 12 menstrual cycles) of unprotected intercourse.
- Male partner has a normal semen analysis with a sperm concentration of >15 million total motile sperm, >1% normal forms by strict criteria, or >5 million total motile sperm on IUI prep.
- Female patient has at least one ovary and at least one ipsilateral patent fallopian tube confirmed by HSG or laparoscopy; pelvic pathology amenable to operative laparoscopy (pelvis restored to functional). The open tube cannot have had a previous ectopic (tubal) pregnancy and the closed tube cannot be a hydrosalpinx (a tube that is blocked at the end and filled with fluid), unless a tubal ligation has been performed at the junction of the uterus and fallopian tube.
- Patients with surgically corrected stages I and II endometriosis will be included.
- Normal uterine cavity demonstrated by HSG, Sonohysterogram (SHG), or hysteroscopy; pathologies of uterine cavity amenable to operative hysteroscopy (cavity restored to normal and demonstrated by post operative study).
- Anovulatory patients who did not conceive after a minimum of three ovulatory cycles with any medications, not including gonadotropin therapy. Anovulatory patients unable to achieve ovulation at dosages up to 150 mg of clomiphene or standard dosages of other ovulation inducing medications (i.e. bromocriptine). Hypoestrogenic hypothalamic amenorrhea patients will qualify immediately for inclusion, prior to any gonadotropin therapy.
- Normal ovarian reserve demonstrated in all patients i.e., cycle day 3 FSH/E2 values of <15 mIU/mL and <100 pg/mL, respectively. Normal TSH and prolactin.
- Female body mass index ≤ 38.
Exclusion Criteria:
- Previous tubal reconstructive surgery in which the pelvis was not restored to functional.
- Unilateral or bilateral hydrosalpinx (a tube that is blocked at the end and filled with fluid) that has not had a tubal ligation performed at the junction of the uterus and fallopian tubes.
- A laparoscopy that demonstrated pelvic adhesions or endometriosis for which the pelvis could not be restored to normal by surgery or endometriosis was not ablated or excised. All patients with stages III and IV endometriosis.
- One or more prior ectopic pregnancies in which one or both tubes were rendered nonfunctional; two or more ectopic pregnancies, even if tubes are patent.
- Severe male factor (i.e.; semen analysis with a sperm concentration of <15 million total motile sperm, <1% normal forms by strict criteria, or <5 million total motile sperm on IUI prep). Couples using donor semen will be excluded.
- Previous treatment with IUI or IVF. Previous treatment of normal ovulation patients with gonadotropins.
- Inadequate ovarian reserve demonstrating FSH >15 mIU/mL or estradiol > 100 pg/mL.
- Patients requiring gamete intrafallopian tube transfer (GIFT), zygote intrafallopian tube transfer (ZIFT), or tubal embryo transfer (TET).
- Female body mass index > 38.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00260091
United States, Massachusetts | |
Harvard Vanguard Medical Associates | |
Boston, Massachusetts, United States, 02215 | |
Boston IVf | |
Brookline, Massachusetts, United States, 02446 | |
Harvard Vanguard Medical Associates | |
Burlington, Massachusetts, United States, 01803 | |
Boston IVF | |
Quincy, Massachusetts, United States, 02169 | |
Harvard Vanguard Medical Associates | |
Quincy, Massachusetts, United States, 02169 | |
Boston IVF | |
Waltham, Massachusetts, United States, 02451 | |
Harvard Vanguard Medical Associates | |
Wellesley, Massachusetts, United States, 02481 |
Principal Investigator: | Richard H. Reindollar, M.D. | Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire |
Study Director: | Marlene B. Goldman, Sc.D. | Dartmouth-Hitchcock Medical Center |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) |
ClinicalTrials.gov Identifier: | NCT00260091 History of Changes |
Other Study ID Numbers: |
1R01HD038561 ( US NIH Grant/Contract Award Number ) |
Study First Received: | November 29, 2005 |
Last Updated: | November 15, 2013 |
Keywords provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):
Infertility Advanced maternal age Pregnancy |
Reproductive health Fertility treatment Reproduction |
Additional relevant MeSH terms:
Infertility Genital Diseases, Male Genital Diseases, Female |
ClinicalTrials.gov processed this record on March 28, 2017