Systematic reviews: Separating fact from fiction

The volume of scientific literature continues to expand and decision-makers are faced with increasingly unmanageable volumes of evidence to assess. Systematic reviews (SRs) are powerful tools that aim to provide comprehensive, transparent, reproducible and updateable summaries of evidence. SR methods were developed, and have been employed, in healthcare for more than two decades, and they are now widely used across a broad range of topics, including environmental management and social interventions in crime and justice, education, international development, and social welfare. Despite these successes and the increasing acceptance of SR methods as a ‘gold standard’ in evidence-informed policy and practice, misconceptions still remain regarding their applicability. The aim of this article is to separate fact from fiction, addressing twelve common misconceptions that can influence the decision as to whether a SR is the most appropriate method for evidence synthesis for a given topic. Through examples, we illustrate the flexibility of SR methods and demonstrate their suitability for addressing issues on environmental health and chemical risk assessment.     

From comparative risk assessment to multi-criteria decision analysis and adaptive management: recent developments and applications

Environmental risk assessment and decision-making strategies over the last several decades have become increasingly more sophisticated, information-intensive, and complex, including such approaches as expert judgment, cost-benefit analysis, and toxicological risk assessment. One tool that has been used to support environmental decision-making is comparative risk assessment (CRA), but CRA lacks a structured method for arriving at an optimal project alternative. Multi-criteria decision analysis (MCDA) provides better-supported techniques for the comparison of project alternatives based on decision matrices, and it also provides structured methods for the incorporation of project stakeholders' opinions in the ranking of alternatives. We argue that the inherent uncertainty in our ability to predict ecosystem evolution and response to different management policies requires shifting from optimization-based management to an adaptive management paradigm. This paper brings together a multidisciplinary review of existing decision-making approaches at regulatory agencies in the United States and Europe and synthesizes state-of-the-art research in CRA, MCDA, and adaptive management methods applicable to environmental remediation and restoration projects. We propose a basic decision analytic framework that couples MCDA with adaptive management and its public participation and stakeholder value elicitation methods, and we demonstrate application of the framework to a realistic case study based on contaminated sediment management issues in the New York/New Jersey Harbor.     

An approach to comparative assessments of potential health risks from exposure to radionuclides and hazardous chemicals

The need to compare potential health risks to the public associated with different activities that can result in releases of hazardous substances to the environment is becoming increasingly important in decision-making. In making such comparisons, it is desirable to use equivalent indicators of potential health risks for radionuclides, chemical carcinogens, and noncarcinogenic hazardous chemicals. Current approaches to risk assessment that were developed for purposes of protecting human health do not provide equivalent indicators of potential risks from exposure to radionuclides and hazardous chemicals. Comparisons of environmental concentrations or calculated exposures or risks with standards for protection of public health also do not provide equivalent indicators of potential risks. We propose a simple approach to comparative risk assessments in which calculated exposures to any hazardous substances are expressed relative to no-observed-effect levels (NOELs) or, preferably, lower confidence limits of benchmark doses (BMDLs) in humans. This approach provides an equivalent, science-based indicator of the relative risks posed by different exposures to any hazardous substances.     

Risk communication and sustainability science: lessons from the field

Sustainability science aims to help societies across the globe address the increased environmental and health crises and risks that range from poverty to climate change to health pandemics. With the increased magnitude and frequency of these large-scale risks to different societies, scientists and institutions have increasingly recognized the need for improved communication and collaboration among researchers, governments, businesses, and communities. This article argues that risk communication has fundamentally important contributions to make to sustainability science’s mission to create use-inspired, “actionable science” that can lead to solutions. Risk communication research can advance the mission of sustainability science to engage a wide range of stakeholders. This kind of engagement is especially important in the context of addressing sustainability problems that are characterized by high levels of uncertainty and complexity. We introduce three core tenets of risk communication research that are fundamental to advancing sustainability science. Risk communication specifically offers an increased understanding of how system feedbacks, human perceptions, and levels of uncertainty influence the study and design of solutions within social ecological systems.     

Sea-Level Rise Risk Communication: Public Understanding,Risk Perception,and Attitudes about Information

We present the results of a study using a document-based evaluation method to better understand how residents in vulnerable coastal areas respond to risk communications about sea-level rise (SLR) and to determine whether communications localized for specific populations improve reception. Similar to climate change communication, SLR risk communication presents challenges involving complex science, uncertainty, invisibility, and politicization. To be comprehensible and persuasive, risk messages must be appropriately framed and visually compelling and must take into account risk perceptions and diverse viewpoints. Our approach involves assessing people's encounters with actual risk messages to determine their reactions and responses. Participants in this study had difficulty understanding information and expressed attitudes including fear, fatalism, skepticism, and loss. SLR risks were also perceived as both temporally and spatially distant, creating a challenge for communicators trying to convey a sense of urgency. We conclude by considering the implications of audience-focused research for SLR risk communication.     

Flood risk and climate change in the Rotterdam area,The Netherlands: enhancing citizen's climate risk perceptions and prevention responses despite skepticism

Effective communication about climate change and related risks is complicated by the polarization between “climate alarmists” and “skeptics.” This paper provides insights for the design of climate risk communication strategies by examining how the interplay between climate change and flood risk communication affects citizens’ risk perceptions and responses. The study is situated in a delta area with substantial geographic variations in the occurrence and potential impact of flood risk, which has led to initiatives to make the area more “climate proof.” We developed a research model that examines individual differences in processing information about climate change related flood risk, based on the postulate that individuals often make an implicit trade-off between motivation to know “what is real” and motivation to maintain prior beliefs. A field experiment, embedded in a survey (n = 1887), sought to test out how the participants responded to risk frames in which a story on flood was either or not combined with climate change information. The results show that it was possible to increase the participants’ local climate risk perception in combination with increased motivation for flood damage prevention, despite a certain level of climate change skepticism. A general implication of our study is that relevant and diagnostic information about local climate-related flood risks can stimulate citizens’ need to know “what’s real” and their willingness to take responsibility for preparedness.     

Causation in risk assessment and management: models, inference, biases, and a microbial risk-benefit case study

Causal inference of exposure-response relations from data is a challenging aspect of risk assessment with important implications for public and private risk management. Such inference, which is fundamentally empirical and based on exposure (or dose)-response models, seldom arises from a single set of data; rather, it requires integrating heterogeneous information from diverse sources and disciplines including epidemiology, toxicology, and cell and molecular biology. The causal aspects we discuss focus on these three aspects: drawing sound inferences about causal relations from one or more observational studies; addressing and resolving biases that can affect a single multivariate empirical exposure-response study; and applying the results from these considerations to the microbiological risk management of human health risks and benefits of a ban on antibiotic use in animals, in the context of banning enrofloxacin or macrolides, antibiotics used against bacterial illnesses in poultry, and the effects of such bans on changing the risk of human food-borne campylobacteriosis infections. The purposes of this paper are to describe novel causal methods for assessing empirical causation and inference; exemplify how to deal with biases that routinely arise in multivariate exposure- or dose-response modeling; and provide a simplified discussion of a case study of causal inference using microbial risk analysis as an example. The case study supports the conclusion that the human health benefits from a ban are unlikely to be greater than the excess human health risks that it could create, even when accounting for uncertainty. We conclude that quantitative causal analysis of risks is a preferable to qualitative assessments because it does not involve unjustified loss of information and is sound under the inferential use of risk results by management.     

Uncertainties in human health risk assessment of environmental contaminants: A review and perspective

Addressing uncertainties in human health risk assessment is a critical issue when evaluating the effects of contaminants on public health. A range of uncertainties exist through the source-to-outcome continuum, including exposure assessment, hazard and risk characterisation. While various strategies have been applied to characterising uncertainty, classical approaches largely rely on how to maximise the available resources. Expert judgement, defaults and tools for characterising quantitative uncertainty attempt to fill the gap between data and regulation requirements. The experiences of researching 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) illustrated uncertainty sources and how to maximise available information to determine uncertainties, and thereby provide an ‘adequate’ protection to contaminant exposure. As regulatory requirements and recurring issues increase, the assessment of complex scenarios involving a large number of chemicals requires more sophisticated tools. Recent advances in exposure and toxicology science provide a large data set for environmental contaminants and public health. In particular, biomonitoring information, in vitro data streams and computational toxicology are the crucial factors in the NexGen risk assessment, as well as uncertainties minimisation. Although in this review we cannot yet predict how the exposure science and modern toxicology will develop in the long-term, current techniques from emerging science can be integrated to improve decision-making.     

Assessing the human health impacts of exposure to disinfection by-products — A critical review of concepts and methods

Understanding the public health implications of chemical contamination of drinking water is important for societies and their decision-makers. The possible population health impacts associated with exposure to disinfection by-products (DBPs) are of particular interest due to their potential carcinogenicity and their widespread occurrence as a result of treatments employed to control waterborne infectious disease.We searched the literature for studies that have attempted quantitatively to assess population health impacts and health risks associated with exposure to DBPs in drinking water. We summarised and evaluated these assessments in terms of their objectives, methods, treatment of uncertainties, and interpretation and communication of results.In total we identified 40 studies matching our search criteria. The vast majority of studies presented estimates of generic cancer and non-cancer risks based on toxicological data and methods that were designed with regulatory, health-protective purposes in mind, and therefore presented imprecise and biased estimates of health impacts. Many studies insufficiently addressed the numerous challenges to DBP risk assessment, failing to evaluate the evidence for a causal relationship, not appropriately addressing the complex nature of DBP occurrence as a mixture of chemicals, not adequately characterising exposure in space and time, not defining specific health outcomes, not accounting for characteristics of target populations, and not balancing potential risks of DBPs against the health benefits related with drinking water disinfection. Uncertainties were often poorly explained or insufficiently accounted for, and important limitations of data and methods frequently not discussed. Grave conceptual and methodological limitations in study design, as well as erroneous use of available dose–response data, seriously impede the extent to which many of these assessments contribute to understanding the public health implications of exposure to DBPs. In some cases, assessment results may cause unwarranted alarm among the public and potentially lead to poor decisions being made in sourcing, treatment, and provision of drinking water. We recommend that the assessment of public health impacts of DBPs should be viewed as a means of answering real world policy questions relating to drinking water quality, including microbial contaminants; that they should be conducted using the most appropriate and up-to-date data and methods, and that associated uncertainties and limitations should be accounted for using quantitative methods where appropriate.     

Guidance on assessing the methodological and reporting quality of toxicologically relevant studies: A scoping review

Assessments of methodological and reporting quality are critical to adequately judging the credibility of a study's conclusions and to gauging its potential reproducibility. To aid those seeking to assess the methodological or reporting quality of studies relevant to toxicology, we conducted a scoping review of the available guidance with respect to four types of studies: in vivo and in vitro, (quantitative) structure-activity relationships ([Q]SARs), physico-chemical, and human observational studies. Our aims were to identify the available guidance in this diverse literature, briefly summarize each document, and distill the common elements of these documents for each study type. In general, we found considerable guidance for in vivo and human studies, but only one paper addressed in vitro studies exclusively. The guidance for (Q)SAR studies and physico-chemical studies was scant but authoritative. There was substantial overlap across guidance documents in the proposed criteria for both methodological and reporting quality. Some guidance documents address toxicology research directly, whereas others address preclinical research generally or clinical research and therefore may not be fully applicable to the toxicology context without some translation. Another challenge is the degree to which assessments of methodological quality in toxicology should focus on risk of bias – as in clinical medicine and healthcare – or be broadened to include other quality measures, such as confirming the identity of test substances prior to exposure. Our review is intended primarily for those in toxicology and risk assessment seeking an entry point into the extensive and diverse literature on methodological and reporting quality applicable to their work.     

Undisclosed chemicals — implications for risk assessment: A case study from the mining industry

Many of the chemicals used in industry can be hazardous to human health and the environment, and some formulations can have undisclosed ingredients and hazards, increasing the uncertainty of the risks posed by their use. The need for a better understanding of the extent of undisclosed information in chemicals arose from collecting data on the hazards and exposures of chemicals used in typical mining operations (copper, platinum and coal). Four main categories of undisclosed chemicals were defined (incomplete disclosure; chemicals with unspecific identities; relative quantities of ingredients not stated; and trade secret ingredients) by reviewing material safety data sheet (MSDS) omissions in previous studies. A significant number of chemicals (20% of 957 different chemicals) across the three sites had a range of undisclosed information, with majority of the chemicals (39%) having unspecific identities. The majority of undisclosed information was found in commercially available motor oils followed by cleaning products and mechanical maintenance products, as opposed to reagents critical to the main mining processes. All three types of chemicals had trade secrets, unspecific chemical identities and incomplete disclosures. These types of undisclosed information pose a hindrance to a full understanding of the hazards, which is made worse when combined with additional MSDS omissions such as acute toxicity endpoints (LD₅₀) and/or acute aquatic toxicity endpoints (LC₅₀), as well as inadequate hazard classifications of ingredients. The communication of the hazard information in the MSDSs varied according to the chemical type, the manufacturer and the regulations governing the MSDSs. Undisclosed information can undermine occupational health protection, compromise the safety of workers in industry, hinder risk assessment procedures and cause uncertainty about future health. It comes down to the duty of care that industries have towards their employees. With a wide range of chemicals increasingly used, there is a balance that needs to be reached between disclosure requirements, trade secret provisions and definitions of hazardous ingredients for market needs, and the information required to protect the health of their workers.     

Targeted analytical toxicology: Simultaneous determination of 17α-ethynylestradiol and the estrogen-induced vitellogenin biomarker

In most toxicological studies, chemical concentrations and its biological/molecular response (biomarker) levels are often quantified separately. We report a method, named as Targeted Analytical Toxicology (TAT), for the simultaneous determination of levels of chemicals and protein biomarkers in organisms by UPLC/ESI–MS/MS on the basis of targeted proteomics. The TAT method is successfully applied to detect the concentrations of 17α-ethynylestradiol (EE₂) and EE₂-induced vitellogenin (a biomarker for estrogens) in male zebrafish exposed to EE₂. It is expected for TAT to have broad application in toxicology, especially in environmental toxicology, due to its high sensitivity, accuracy, reproducibility, high throughput, and the savings of time, cost and labor.     

Molecular profiling--a tool for addressing emerging gaps in the comparative risk assessment of GMOs

Assessing the risks of genetically modified organisms (GMOs) is required by both international agreement and domestic legislation. Many view the use of the "omics" tools for profiling classes of molecules as useful in risk assessment, but no consensus has formed on the need or value of these techniques for assessing the risks of all GMOs. In this and many other cases, experts support case-by-case use of molecular profiling techniques for risk assessment. We review the latest research on the applicability and usefulness of molecular profiling techniques for GMO risk assessment. As more and more kinds of GMOs and traits are developed, broader use of molecular profiling in a risk assessment may be required to supplement the comparative approach to risk assessment. The literature-based discussions on the use of profiling appear to have settled on two findings: 1. profiling techniques are reliable and relevant, at least no less so than other techniques used in risk assessment; and 2. although not required routinely, regulators should be aware of when they are needed. The dismissal of routine molecular profiling may be confusing to regulators who then lack guidance on when molecular profiling might be worthwhile. Molecular profiling is an important way to increase confidence in risk assessments if the profiles are properly designed to address relevant risks and are applied at the correct stage of the assessment.     

Do nanoparticles present ecotoxicological risks for the health of the aquatic environment?

Nanotechnology is a major innovative scientific and economic growth area, which may present a variety of hazards for environmental and human health. The surface properties and very small size of nanoparticles and nanotubes provide surfaces that may bind and transport toxic chemical pollutants, as well as possibly being toxic in their own right by generating reactive radicals. There is a wealth of evidence for the harmful effects of nanoscale combustion-derived particulates (ultrafines), which when inhaled can cause a number of pulmonary pathologies in mammals and humans. However, release of manufactured nanoparticles into the aquatic environment is largely an unknown. This review addresses the possible hazards associated with nanomaterials and harmful effects that may result from exposure of aquatic animals to nanoparticles. Possible nanoparticle association with naturally occurring colloids and particles is considered together with how this could affect their bioavailability and uptake into cells and organisms. Uptake by endocytotic routes are identified as probable major mechanisms of entry into cells; potentially leading to various types of toxic cell injury. The higher level consequences for damage to animal health, ecological risk and possible food chain risks for humans are also considered based on known behaviours and toxicities for inhaled and ingested nanoparticles in the terrestrial environment. It is concluded that a precautionary approach is required with individual evaluation of new nanomaterials for risk to the health of the environment. Although current toxicity testing protocols should be generally applicable to identify harmful effects associated with nanoparticles, research into new methods is required to address the special properties of nanomaterials.     

ICT applications in the research into environmental sustainability: a user preferences approach

Whether information and communication technology (ICT) constitutes a threat or a cure to environment??s deterioration is controversially discussed. Empirical evidence on the impacts of ICT is rare, so that generalizable lessons can hardly be drawn. This study provides empirical results on the role of ICT in research for environmental sustainability, but instead of ascertaining the impact of ICT on environmental protection, we conduct an analysis of the use of ICT in sustainability research. We assess the preferences of experts in different thematic sustainability fields for applying ICT tools, and we investigate ways to improve the application of these tools in order to augment their returns with respect to environmental protection research. This analysis is based on a set of surveys that were administered to international experts to evaluate the importance of ICT in environmental sustainability research and the research demands in key environmental sectors, such as climate change, natural resources, energy and biodiversity. The methodological framework is built on the analysis of users?? preferences for future developments in ICT tools using stated preferences techniques. Overall results suggest that ICT tools need to be developed in specific contexts, taking into account users?? needs and expectations. Our analysis shows that the use of ICT in environmental research is of great importance in the scientific community, but it can also play a crucial role in the policy context.     

Which compounds contribute most to elevated airborne exposure and corresponding health risks in the Western Balkans?

A majority of ongoing monitoring of persistent organic pollutants (POPs) is currently focused on chemicals emphasized in the Stockholm Convention. Quantitative detection of other substances (especially those with numerous anthropogenic sources such as polyaromatic hydrocarbons (PAHs)) is, however, also needed since their concentrations are usually several orders of magnitude higher. A goal of this study was to determine how various groups of compounds contribute to total human health risks at the variety of sampling sites in the region of Western Balkan. Distribution of the risks between the gas and particulate phases was also addressed. Results showed that inhalation exposure to organochlorine pesticides (OCPs) does not represent a significant risk to humans, while polychlorinated biphenyls (PCBs) re-volatilized to the atmosphere from contaminated soils and buildings can pose a problem. PCB evaporation from primary sources (currently used PCB-filled transformers or non-adequate storage facilities) generally resulted in much higher atmospheric concentrations than evaporation from the secondary sources (soils at the sites of war destructions). A majority of the human health risks at the urban sites were associated with PAHs. Between 83 and 94% of the cumulative risk at such sites was assigned to chemicals sorbed to particles, and out of it, PAHs were responsible for 99%.     

Visitor Proficiency Profiling and Risk Communication at a National Park

While cognitive heuristics may produce successful, efficient outcomes, they can also introduce predictable biases that may be unavoidable even for seasoned experts. This study connects the concept of “professional intuition” to the practice of strategic communication, suggesting that people may rely on heuristics to profile an audience. These judgments, in turn, influence crafting of communication to meet the audiences’ assumed needs, the defining element of an audience-centered approach. Using interview and observational data, this study examines how national park staff use heuristic cues to evaluate visitors during face-to-face interactions. The assessments employees make, in turn, influence whether they encourage or discourage visitors from participating in inherently risky recreational activities. This visitor proficiency profiling, together with the strategic communication strategies employed, extends audience-centered communication to include both informal messages as well as individuals not necessarily trained as risk communicators. Both applied and theoretical implications of this research are considered.     

Modelling microbial health risk of wastewater reuse: A systems perspective

There is a widespread need for the use of quantitative microbial risk assessment (QMRA) to determine reclaimed water quality for specific uses, however neither faecal indicator levels nor pathogen concentrations alone are adequate for assessing exposure health risk. The aim of this study was to build a conceptual model representing factors contributing to the microbiological health risks of reusing water treated in maturation ponds. This paper describes the development of an unparameterised model that provides a visual representation of theoretical constructs and variables of interest. Information was collected from the peer-reviewed literature and through consultation with experts from regulatory authorities and academic disciplines. In this paper we explore how, considering microbial risk as a modular system, following the QMRA framework enables incorporation of the many factors influencing human exposure and dose response, to better characterise likely human health impacts. By using and expanding upon the QMRA framework we deliver new insights into this important field of environmental exposures. We present a conceptual model of health risk of microbial exposure which can be used for maturation ponds and, more importantly, as a generic tool to assess health risk in diverse wastewater reuse scenarios.     

Mechanistic aspects of organophosphorothionate toxicity in fish and humans

Metabolic transformation plays a major role in the mechanism of toxicity of organophosphorous (OP) pesticides. The modulation of their toxicity by oxonases and monooxygenases, alone or in combination, has been shown in mammals and fish. Very limited information exists for the identification of the metabolic factors relevant in the human toxicology of such chemicals. In this paper, we develop a simple algorithm, based on in vitro data, for the identification of fish species more susceptible to diazinon (D). Similar algorithms are likely to be applicable to other organophosphothionate (OPT) pesticides. We also report on preliminary studies on the OPT substrate specificity of human liver cytochromes P450 (CYPs): such information may be useful to understand the role of sulphoxidation in OPT toxicity to humans and to identify individuals with increased susceptibility to OPT toxicity. Studies of the mechanism of OPT toxicity may provide useful tools for a more detailed characterisation of these chemicals, with reference to the risk for the human population and to the impact on the fish species present in specific environments.