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Well water around the world can be contaminated with arsenic, a naturally occurring geological element that has been associated with myriad adverse health effects. Persons obtaining their drinking water from private wells are often responsible for well testing and water treatment. High levels of arsenic have been reported in well water-supplied areas of the United States. We quantified - in cases and dollars - the potential burden of disease associated with the ingestion of arsenic through private well drinking water supplies in the United States. To estimate cancer and cardiovascular disease burden, we developed a Monte Carlo model integrating three input streams: (1) regional concentrations of arsenic in drinking water wells across the United States; (2) dose-response relationships in the form of cancer slope factors and hazard ratios; and (3) economic cost estimates developed for morbidity endpoints using 'cost-of-illness' methods and for mortality using 'value per statistical life' estimates. Exposure to arsenic in drinking water from U.S. domestic wells is modeled to contribute 500 annual premature deaths from ischemic heart disease and 1,000 annual cancer cases (half of them fatal), monetized at $10.9 billion (2017 USD) annually. These considerable public health burden estimates can be compared with the burdens of other priority public health issues to assist in decision-making. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the effect of secukinumab, a monoclonal antibody that inhibits interleukin (IL)-17A, on number of new active brain magnetic resonance imaging (MRI) lesions in subjects with relapsing-remitting multiple sclerosis (MS). Subjects ( N = 73) were randomized 1:1 to secukinumab 10 mg/kg or placebo by intravenous infusion at weeks 0, 2, 4, 8, 12, 16, and 20. MRI scans were obtained within 30 days prior to randomization, on a monthly basis during the treatment period, and at study completion. The primary endpoint was the cumulative number of combined unique active lesions (CUAL) observed on brain MRI scans from week 4 to week 24. Compared with placebo, secukinumab non-significantly reduced the number of CUAL observed on 4-weekly MRI from week 4 to 24 (primary endpoint) by 49 % (95 % CI −10 to 77 %; P = 0.087) and significantly reduced the number of cumulative new gadolinium-enhancing T1 lesions by 67 % (31-84 %, P = 0.003). CUAL reductions were progressively greater from week 4 (1 %) to week 16 (49 %) and persisted until end-study (50 %). There were no serious adverse events; the adverse event rate was comparable to placebo (53 versus 49 %), although mild-to-moderate infection was somewhat more frequent (37 versus 23 %). This proof-of-concept study provides the first evidence that blocking IL-17A with an antibody may reduce MRI lesion activity in MS. Further studies are needed to confirm this finding and determine the magnitude of effect. [ABSTRACT FROM AUTHOR]

Kaliningrad Oblast of the Russian Federation has a unique position in the Baltic Sea Region due to its physiographic situation and, thereby, it plays an active role in geopolitical and economic processes that occur in the Baltic Sea Region. This, first of all, happens owing to its exclave position that causes to a great extent a necessity for close cross-border integration for the developing economy of the Oblast. The article considers new spatial forms of international economic integration (NSFIEI) contributing to the development of border regions; distinguishing of the border regions as international "development corridors" has been substantiated within the general region classification; the place of Kaliningrad Oblast regarding the level of economic development and maturity of external relations among the border regions of Russia has been shown; its role as an "international development corridor" of Russia and EU has also been viewed. The comparative method and the technique of economic geography classification have been applied. [ABSTRACT FROM AUTHOR]

Chronic low-level cadmium (Cd) exposure is linked to kidney and cardiovascular disease, fractures, and cancer. Diet and smoking are primary sources of exposure in the general population. We analyzed urinary Cd in NHANES 1999-2008 to determine whether levels declined significantly over the decade for US. children, teens, and adults (nonsmokers and smokers) and, if so, factors influencing the decline(s). For each subpopulation, we modeled log urinary Cd using variable-threshold censored multiple regression. Models included individual-level covariates (age, gender, BMI, income, race/ethnicity/country of origin, education, survey period), smoking, housing (home age, water source, filter use), and diet (supplement use; 24-h calorie, fat, protein, micronutrient, and Cd-containing food intakes), creatinine, and survey year variables. Geometric mean urinary Cd (ng/mL) declined 20-25% in these subpopulations, and the regressions showed statistically significant declines in later years for teens and adults. While certain covariates were significantly associated with Cd by subpopulation (creatinine; age; BMI; race/ethnicity/origin; education; smokers in the home; serum cotinine; 24-h fat, Mg, Fe intakes; use of dietary supplements), they did not help explain the declines. Instead, unidentified time-related factors appeared responsible. Despite the declines, millions of Americans remain potentially at risk of adverse outcomes associated with low-level Cd exposure. [ABSTRACT FROM AUTHOR]

Background Environmental biomonitoring data provide one way to examine race/ethnicity and incomerelated exposure disparity and identify potential environmental justice concerns. Methods We screened U.S. National Health and Nutrition Examination Survey (NHANES) 2001-2008 biomonitoring data for 228 chemicals for race/ethnicity and income-related disparity. We defined six subgroups by race/ethnicity-Mexican American, non-Hispanic black, non- Hispanic white-and income-Low Income: poverty income ratio (PIR) <2, High Income: PIR ⩾ 2. We assessed disparity by comparing the central tendency (geometric mean ratio [GMR]) of the biomonitoring concentration of each subgroup to that of the reference subgroup (non-Hispanic white/High Income), adjusting for multiple comparisons using the Holm-Bonferroni procedure. Results There were sufficient data to estimate at least one GMR for 108 chemicals; 37 had at least one GMR statistically different from one. There was evidence of potential environmental justice concern (GMR significantly >1) for 12 chemicals: cotinine; antimony; lead; thallium; 2,4- and 2,5-dichlorophenol; p,p'-dichlorodiphenyldichloroethylene; methyl and propyl paraben; and mono-ethyl, mono-isobutyl, and mono-n-butyl phthalate. There was also evidence of GMR significantly <1 for 25 chemicals (of which 17 were polychlorinated biphenyls). Conclusions Although many of our results were consistent with the U.S. literature, findings relevant to environmental justice were novel for dichlorophenols and some metals. [ABSTRACT FROM AUTHOR]

In this article the forms of cross-border and trans-border cooperation of semi-medium-sized towns of Kaliningrad region in the Baltic Sea Region are described, and presented the description of two European Union's instruments for international cooperation in the Baltic Sea Region. The short analysis of participation of semi-medium-sized towns of Kaliningrad region in projects of Programmes for trans-border and cross-border cooperation such as Interreg III B (Baltic Sea Region Neighbourhood Programme) and Interreg III A (Lithuania-Poland-Kaliningrad region of Russian Federation) is performed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lead (Pb) is a highly toxic pollutant. Evidence suggests it is associated with cardiovascular disease (CVD)-related mortality. OBJECTIVES: We present a rigorous approach for identifying concentration–response functions that relate adult Pb exposures to CVD mortality to inform a health impact model (HIM). We then use the model in a proof-of-concept example. METHODS: Building on previously conducted government literature reviews and a de novo supplemental literature review, we compiled and evaluated the available data on Pb and CVD mortality in humans. We applied a set of predefined selection criteria to identify studies that would be most useful in understanding the impact of Pb exposure on CVD mortality risk in adults. Once we identified the studies, we derived a HIM and used each study’s concentration–response function in a proof-of-concept example. RESULTS: Our literature search identified 15 studies for full-text review. Of those 15 studies, 4 fit our criteria for use in the HIM. Using population and CVD mortality rates for 40- to 80-y-olds in 2014, we estimated that 34,000–99,000 deaths have been avoided due to the lowering of blood Pb levels from 1999 to 2014. Based on these values we estimated that approximately 16%–46% of the decreased CVD-related death rate from 1999 to 2014 may be attributable to decreased blood Pb levels. CONCLUSION: Our results demonstrate that decreases in Pb exposure can result in large benefits for the adult population. We have provided a HIM that can be used in a variety of applications from burden-of-disease estimates to regulatory impact assessments and have demonstrated its sensitivity to the choice of concentration–response function. [ABSTRACT FROM AUTHOR]

The main objective is to verify whether it is possible to confirm differences in price policy not only in the division of chains according to the format of the shops but also in relation to Czech and foreign food and whether these findings can be clearly identified. The partial objective is to find the difference between Czech and foreign products in the context of chain approach according to other criteria such as price differences among products and among chains. There are eleven chains evaluated in the tables as well as 29 relevant food groups. The used underlying data is based on the data processed from the primary data obtained by the data collection in the retail chains. The average number of observations of one item, which is about 43 observations, of which 37 observations of Czech products and about 29 products with price. Only Lidl has a higher number of price observations from the total number of observations of foreign products. In the area of price policy evaluation (whether it is possible to confirm the differences not only in the division of the chains according to the format of the stores, but also in relation to Czech and foreign foods and identify clearly these findings), the difference is considered mainly according to the "low price" of food and it can be said that there are noticeable differences among the chains, which also confirm different approach to Czech and foreign food and differences according to the format of chain stores. This paper originated in the context of the exploratory study „Prices of selected Czech and foreign food products in retail chains in November 2016". The study was created for the needs of the Ministry of Agriculture of the Czech Republic. [ABSTRACT FROM AUTHOR]

In this paper we develop a modified production model to calculate changes in pollution abatement costs (PAC) when both data on bad outputs and information on the inputs assigned to pollution abatement activities are not available. To calculate the PAC of reducing bad output, we introduce a measure that captures variation in the abatement intensity of technologies used to reduce water discharges. We then decompose the change in PAC into three components to identify their relative contribution to changes in PAC: (1) changes in the level of inputs, (2) changes in pollution abatement intensity, and (3) technological change. We demonstrate how to calculate PAC and these three components using data from 1997 to 2007 on a sample of pulp mills required to comply with the effluent limits for dioxin set by the U.S. EPA's Cluster Rule. We find regulation-induced technological change is consistently associated with declining PAC, while both changes in inputs and abatement intensity are associated with increasing PAC. [ABSTRACT FROM AUTHOR]

Background: Approved botulinum toxin A products require reconstitution. AbobotulinumtoxinA solution for injection is a ready-to-use liquid formulation of abobotulinumtoxinA.Objectives: The objective of this study was to demonstrate the superior efficacy of abobotulinumtoxinA solution for injection to placebo and to test the noninferior efficacy of abobotulinumtoxinA solution for injection versus abobotulinumtoxinA (dry formulation) in cervical dystonia.Methods: This was a phase-3, multicenter, prospective, double-blind, randomized, active, and placebo-controlled study (N = 369). Patients with cervical dystonia were randomized (3:3:1) to abobotulinumtoxinA solution for injection 500 U, abobotulinumtoxinA 500 U, or placebo. Following the double-blind phase, patients received abobotulinumtoxinA solution for injection, open-label, for up to 4 cycles. The primary outcome was change from baseline at week 4 of the Toronto Western Spasmodic Torticollis Rating Scale total score. Secondary measures included change from baseline or cycle baseline in Toronto Western Spasmodic Torticollis Rating Scale scores.Results: At week 4, both products were superior to placebo (Toronto Western Spasmodic Torticollis Rating Scale total score least square mean decrease from baseline, abobotulinumtoxinA solution for injection 500 U -12.5, abobotulinumtoxinA 500 U -14.0, placebo -3.9; P < .0001 vs placebo). The noninferiority limit of 3 points in the Toronto Western Spasmodic Torticollis Rating Scale total score at week 4 was not met for abobotulinumtoxinA solution for injection versus abobotulinumtoxinA. Toronto Western Spasmodic Torticollis Rating Scale total score reductions were maintained for up to 4 cycles of abobotulinumtoxinA solution for injection open-label follow-up treatment. Safety profiles of abobotulinumtoxinA solution for injection and abobotulinumtoxinA were similar, with dysphagia and injection-site pain the most frequent drug-related adverse events.Conclusions: Although the predefined noninferiority criterion was not met, abobotulinumtoxinA solution for injection was similarly effective to freeze-dried abobotulinumtoxinA in reducing Toronto Western Spasmodic Torticollis Rating Scale total scores with a similar safety profile. AbobotulinumtoxinA solution for injection efficacy was maintained with chronic open-label treatment, and this novel formulation may add convenience as well as dosing accuracy to treatment with abobotulinumtoxinA. © 2016 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]