Publications by authors named "Matthew Jeronimo"

9 Publications

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Spatial and Temporal Variability in Antineoplastic Drug Surface Contamination in Cancer Care Centers in Alberta and Minnesota.

Ann Work Expo Health 2021 Apr 23. Epub 2021 Apr 23.

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

The health risks of exposure to antineoplastic drugs (ADs) are well established, and healthcare professionals can be exposed while caring for cancer patients receiving AD therapy. Studies conducted worldwide over the past two decades indicate continuing widespread surface contamination by ADs. No occupational exposure limits have been established for ADs, but concerns over exposures have led to the development of guidelines, such as United States Pharmacopeia (USP) General Chapter <800> Hazardous Drugs-Handling in Healthcare. While recommending regular surveillance for surface contamination by ADs these guidelines do not provide guidance on sampling strategies. Better characterization of spatial and temporal variability of multidrug contamination would help to inform such strategies. We conducted surface-wipe monitoring of nine cancer care centers in Alberta, Canada and Minnesota, USA, with each center sampled eight times over a 12-month period. Twenty surfaces from within pharmacy and drug administration areas were sampled, and 11 drugs were analyzed from each wipe sample. Exposure data were highly left-censored which restricted data analysis; we examined prevalence of samples above limit of detection (LOD), and used the 90th percentile of the exposure distribution as a measure of level of contamination. We collected 1984 wipe samples over a total of 75 sampling days resulting in 21 824 observations. Forty-five percent of wipe samples detected at least one drug above the LOD, but only three of the drugs had more than 10% of observations above the LOD: gemcitabine (GEM) (24%), cyclophosphamide (CP) (16%), and paclitaxel (13%). Of 741 wipe samples with at least one drug above LOD, 60% had a single drug above LOD, 19% had two drugs, and 21% had three drugs or more; the maximum number of drugs found above LOD on one wipe was 8. Surfaces in the compounding area of the pharmacy and in the patient area showed the highest prevalence of samples above the LOD, including the compounding work surface, drug fridge handle, clean room cart, passthrough tray, and hazardous drug room temperature storage, the IV pump keypad, patient washroom toilet handle, patient washroom door handle, nurses' storage shelf/tray, and patient side table. Over the course of the study, both 90th percentiles and prevalence above LOD varied without clear temporal patterns, although some centers appeared to show decreasing levels with time. Within centers, the degree of variability was high, with some centers showing changes of two to three orders of magnitude in the 90th percentile of drug concentrations month to month. A clear difference was observed between the six centers located in Alberta and the three in Minnesota, with Minnesota centers having substantially higher percentages of samples above the LOD for CP and GEM. Other factors that were associated with significant variability in exposures were drug compounding volume, size of center, number of patients seen, and age of the center. We hope that demonstrating variability associated with drug, surface, clinic-factors, and time will aid in a better understanding of the nature of AD contamination, and inform improved sampling strategies.
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http://dx.doi.org/10.1093/annweh/wxab013DOI Listing
April 2021

Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study.

Lancet Planet Health 2020 10;4(10):e451-e462

Eternal Heart Care Centre & Research Institute, Jaipur, India.

Background: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM and black carbon in rural communities with a wide range of cooking environments.

Methods: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM measurements were collected. Light absorbance (10m) of the PM filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period.

Findings: Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m [95% CI 43-48]), electricity (53 μg/m [47-60]), coal (68 μg/m [61-77]), charcoal (92 μg/m [58-146]), agricultural or crop waste (106 μg/m [91-125]), wood (109 μg/m [102-118]), animal dung (224 μg/m [197-254]), and shrubs or grass (276 μg/m [223-342]). Among households cooking primarily with wood, average PM concentrations varied ten-fold (range: 40-380 μg/m). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM personal exposures between women (67 μg/m [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women).

Interpretation: Using clean primary fuels substantially lowers kitchen PM concentrations. Importantly, average kitchen and personal PM measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m annual average), highlighting the need for comprehensive pollution mitigation strategies.

Funding: Canadian Institutes for Health Research, National Institutes of Health.
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http://dx.doi.org/10.1016/S2542-5196(20)30197-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591267PMC
October 2020

Lung function of primary cooks using LPG or biomass and the effect of particulate matter on airway epithelial barrier integrity.

Environ Res 2020 10 15;189:109888. Epub 2020 Jul 15.

Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States. Electronic address:

Background: Cooks exposed to biomass fuel experience increased risk of respiratory disease and mortality. We sought to characterize lung function and environmental exposures of primary cooking women using two fuel-types in southeastern India, as well as to investigate the effect of particulate matter (PM) from kitchens on human airway epithelial (HAE) cells in vitro.

Methods: We assessed pre- and post-bronchodilator lung function on 25 primary female cooks using wood biomass or liquified petroleum gas (LPG), and quantified exposures from 34 kitchens (PM, PM < 40 μm, black carbon, endotoxin, and PM metal and bacterial content). We then challenged HAE cells with PM, assessing its cytotoxicity to small-airway cells (A549) and its effect on: transepithelial conductance and macromolecule permeability (NuLi cells), and antimicrobial activity (using airway surface liquid, ASL, from primary HAE cells).

Results: Lung function was impaired in cooks using both fuel-types. 60% of participants in both fuel-types had respiratory restriction (post bronchodilator FEV/FVC>90). The remaining 40% in the LPG group had normal spirometry (post FEV/FVC = 80-90), while only 10% of participants in the biomass group had normal spirometry, and the remaining biomass cooks (30%) had respiratory obstruction (post FEV/FVC<80). Significant differences were found in environmental parameters, with biomass kitchens containing greater PM, black carbon, zirconium, arsenic, iron, vanadium, and endotoxin concentrations. LPG kitchens tended to have more bacteria (p = 0.14), and LPG kitchen PM had greater sulphur concentrations (p = 0.02). In vitro, PM induced cytotoxicity in HAE A549 cells in a dose-dependent manner, however the effect was minimal and there were no differences between fuel-types. PM from homes of participants with a restrictive physiology increased electrical conductance of NuLi HAE cells (p = 0.06) and decreased macromolar permeability (p ≤ 0.05), while PM from homes of those with respiratory obstruction tended to increase electrical conductance (p = 0.20) and permeability (p = 0.07). PM from homes of participants with normal spirometry did not affect conductance or permeability. PM from all homes tended to inhibit antimicrobial activity of primary HAE cell airway surface liquid (p = 0.06).

Conclusions: Biomass cooks had airway obstruction, and significantly greater concentrations of kitchen environmental contaminants than LPG kitchens. PM from homes of participants with respiratory restriction and obstruction altered airway cell barrier function, elucidating mechanisms potentially responsible for respiratory phenotypes observed in biomass cooks.
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http://dx.doi.org/10.1016/j.envres.2020.109888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525042PMC
October 2020

The application of novel field measurement and field evaluation protocols for assessing health care workers' exposure risk to antineoplastic drugs.

J Occup Environ Hyg 2020 09 2;17(9):373-382. Epub 2020 Jul 2.

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

Contamination of multiple antineoplastic drugs (ADs) on work surfaces presents an exposure concern for health care workers. Surface wipe sampling is a recognized method to evaluate the degree of contamination present. Our research team has previously reported on wipe sampling and analytical methods to simultaneously detect 10 commonly used ADs from a single wipe. Our objectives here were: to field test a protocol consisting of the wipe sampling method and an accompanying wipe sample collection tool kit and confirm this protocol can be effectively used by health care workers to assess drug contamination levels in their facilities; and, to confirm the potential for simultaneous exposure to multiple antineoplastic drugs. Three facilities within one health authority in British Columbia, Canada participated in this field study. In collaboration with the site health and safety advisors, up to 25 surfaces within each facility were considered for sampling. Collected wipe samples were analyzed using HPLC-MS/MS to quantify the 10 analyte, resulting in 750 potential analyses. Following the sampling, each of the three facilities' safety advisors provided feedback regarding the usability of the protocols. Among the 72 wipe samples actually collected (or 720 analyses conducted), detectable levels and simultaneous contamination of work surfaces of five of the 10 analytes were found at all three participating sites: 5-fluorouracil, cyclophosphamide, vincristine, paclitaxel, and methotrexate; (range < LoD to 33.0 ng/cm) with 5-fluorouracil having the highest concentration in every instance. Drug contamination was found on a variety of different work surfaces in pharmacies and patient care areas among all three sites. Users of the sampling protocols were generally satisfied with the wipe sample collection toolkit with some minor suggestions for improvement. Our findings support the hypothesis that health care workers may be simultaneously at risk of exposure to several ADs. Our toolkit was found to be user-friendly and manageable by those who were not experienced in collecting wipe samples to monitor contamination of ADs on the work surfaces in their facilities.
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http://dx.doi.org/10.1080/15459624.2020.1777296DOI Listing
September 2020

Analysis of black carbon on filters by image-based reflectance.

Atmos Environ (1994) 2020 Feb 20;223. Epub 2020 Jan 20.

School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, V6T1Z3, Canada.

Black carbon (BC) is an important contributor to global particulate matter emissions. BC is associated with adverse health effects, and an important short-lived climate pollutant. Here, we describe a low cost method of analysis that utilizes images of PTFE filters taken with a digital camera to estimate BC content on filters. This method is compared with two existing optical methods for analyzing BC (Smokestain Reflectance and Hybrid Integrating Plate and Sphere System) as well as the standard chemical analysis method for determining elemental carbon (Thermal-Optical Reflectance). In comparisons of aerosol generated under controlled conditions (using an inverted diffusion flame burner to cover a range of mass loading and reflectance levels) (N=12) and in field samples collected from residential solid fuel combustion in China and India (N=50), the image-based method was found to correlate well (normalized RMSE <10% for all comparisons) with existing methods. A correlational analysis of field samples between the optical methods and Fourier-transform infrared spectroscopy indicated that the same functional groups were predominantly responsible for light attenuation in each optical method. This method offers reduced equipment cost, rapid analysis time, and is available at no cost, which may facilitate more measurement of BC where PM mass concentrations are already measured, especially in low income countries or other sampling efforts with limited resources.
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http://dx.doi.org/10.1016/j.atmosenv.2020.117300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039653PMC
February 2020

Wipe Sampling Method and Evaluation of Environmental Variables for Assessing Surface Contamination of 10 Antineoplastic Drugs by Liquid Chromatography/Tandem Mass Spectrometry.

Ann Work Expo Health 2017 Oct;61(8):1003-1014

School of Occupational and Public Health, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3.

This paper describes a novel wipe sampling and high-performance liquid chromatography/tandem mass spectrometry (HPLC-MS/MS) method capable of simultaneously detecting 10 antineoplastic drugs (5-fluorouracil, oxaliplatin, methotrexate, vindesine, ifosfamide, cyclophosphamide, vincristine, vinblastine, docetaxel, and paclitaxel). The good overall recoveries and sensitivity values of this method along with the comparatively short run time (8 min) allows for its use in routine monitoring in health care facilities. The long-term behavior of the studied drugs on contaminated surfaces and the effect of surface roughness on drug recoveries were studied to gain insights about how these environmental variables influence the detection, cleaning, and occupational exposure of these drugs. Surfaces with higher roughness parameter (Ra) values (rougher) had the lowest recoveries while those with lower Ra (smoother) presented the highest recoveries. Long-term assessments evidence distinctive drug behaviors with oxaliplatin, vindesine, vincristine, and vinblastine being the less persistent drugs (~20% was recovered after 24 h) and docetaxel and paclitaxel the most persistent drugs with recoveries of 40% and 80% after 1 month. This information indicates the importance of collecting ancillary information about drug usage (throughput, timing, cleaning procedures, etc.) to interpret the results in the context of potential exposure. Finally, the method was successfully applied to evaluate trace surface contamination down to the single picogram per square centimeter in multiple work areas within three local health care centers on Vancouver Island, Canada.
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http://dx.doi.org/10.1093/annweh/wxx070DOI Listing
October 2017

Adult and child urinary 2,4-D in cities with and without cosmetic pesticide bylaws: a population-based cross-sectional pilot study.

J Expo Sci Environ Epidemiol 2017 09 17;27(5):484-490. Epub 2016 Aug 17.

University of Toronto and Public Health Ontario, Toronto, Ontario, Canada.

We evaluated 2,4-dichlorophenoxyacetic acid (2,4-D) exposure in four municipalities with and without cosmetic pesticide bylaws in British Columbia, Canada. We recruited a child (aged 1.5-5 years) and adult from 10 households in each city, who provided urine samples in May and June, 2009. No households had used pesticides for 7 days prior to sample collection. We quantified urinary 2,4-D using LC/MS/MS. Quantities of 2,4-D in urine were similar across cities and below biomonitoring equivalents corresponding to references doses in the United State of America and Canada. When adult's and children's urines were analyzed together in linear mixed-effects regression models, natural log urinary 2,4-D was significantly associated with having a diet of ⩾50% organic food (β=-0.6 (0.3) μg/l, P=0.05). Without natural log transformation, median concentration of urinary 2,4-D among those who ate ⩾50% organic food (n=12) was 1.4 μg/l versus 1.5 μg/l for others (n=59). Lack of a significant association (two-sided alpha=0.05) between pesticide bylaws and urinary 2,4-D might reflect small sample size, lack of recent acute exposure, or that 2,4-D exposure is primarily influenced by sources of exposure not addressed through bylaws. Food might be a route of exposure to 2,4-D, consistent with other studies. Future research will require larger sample sizes for sufficient statistical power.
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http://dx.doi.org/10.1038/jes.2016.44DOI Listing
September 2017

A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers.

Anal Bioanal Chem 2015 Sep 4;407(23):7083-92. Epub 2015 Jul 4.

School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z9, Canada,

An effective wipe sampling and LC-MS/MS method was developed to simultaneously analyze six commonly administered antineoplastic drugs in stainless steel surface. The analyzed drugs were methotrexate, paclitaxel, cyclophosphamide, 5-fluorouracil, vincristine, and oxaliplatin, a frequently prepared antineoplastic drug that has not been included among any of the published simultaneous detection methods. The established method was used to evaluate the recoveries of antineoplastic drugs on brand new and worn stainless steel surfaces by wiping the plates with a Whatman filter paper wetted with 0.5 mL of water/methanol (20:80) with 0.1% formic acid followed by LC-MS/MS before desorbing the filter with a water/methanol (50:50) solution. A significant decrease in the recovery of all evaluated drugs was found when worn plates were used. Additionally, the inter-personnel variability on drug recoveries during wiping procedures was evaluated. Significantly higher recoveries were achieved by the personnel with more training and experience versus personnel without prior experience. Finally, a laboratory stability test was developed to assess the degradation of the antineoplastic drugs during replicated shipping conditions. With the exception of vincristine sulfate which exhibited a significant (p < 0.05) degradation after 48 h, all evaluated drugs were stable during the first 24-48 h. However, after 144 h, an increase in the degradation of all evaluated drugs was observed, with oxaliplatin and 5-fluorouracil exhibiting the most degradation.
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http://dx.doi.org/10.1007/s00216-015-8868-yDOI Listing
September 2015

Portable chamber system for measuring chloroform fluxes from terrestrial environments--methodological challenges.

Environ Sci Technol 2013 Dec 21;47(24):14298-305. Epub 2013 Nov 21.

University of British Columbia , Vancouver, Canada.

This study describes a system designed to measure chloroform flux from terrestrial systems, providing a reliable first assessment of the spatial variability of flux over an area. The study takes into account that the variability of ambient air concentrations is unknown. It includes quality assurance procedures, sensitivity assessments, and testing of materials used to ensure that the flux equation used to extrapolate from concentrations to fluxes is sound and that the system does not act as a sink or a source of chloroform. The results show that many materials and components commonly used in sampling systems designed for CO2, CH4, and N2O emit chloroform and other volatile chlorinated compounds (VOCls) and are thus unsuitable in systems designed for studies of such compounds. To handle the above-mentioned challenges, we designed a system with a non-steady-state chamber and a closed-loop air-circulation unit returning scrubbed air to the chamber. Based on empirical observations, the concentration increase during a deployment was assumed to be linear. Four samples were collected consecutively and a line was fitted to the measured concentrations. The slope of the fitted line and the y-axis intercept were input variables in the equation used to transform concentration change data to flux estimates. The soundness of the flux equation and the underlying assumptions were tested and found to be reliable by comparing modeled and measured concentrations. Fluxes of chloroform in a forest clear-cut on the east coast of Vancouver Island, BC, during the year were found to vary from -130 to 620 ng m(-2) h(-1). The study shows that the method can reliably detect differences of approximately 50 ng m(-2) h(-1) in chloroform fluxes. The statistical power of the method is still comparatively strong down to differences of 35 ng m(-2) h(-1), but for smaller differences, the results should be interpreted with caution.
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http://dx.doi.org/10.1021/es403062cDOI Listing
December 2013