Updated Risk Assessment Research Articles

Updated Risk Assessment of Cannabidiol in Foods Based on Benchmark Dose–Response Modeling

Cannabidiol (CBD), a non-psychotropic main component of the Cannabis plant, has been approved as a drug in the European Union (EU) under the name “Epidyolex”. However, its approval process as a food ingredient under the Novel Food Regulation was paused by the European Food Safety Authority (EFSA) due to a lack of safety data. Nevertheless, there is a growing, unregulated market in which CBD is advertised with various health claims and dosage instructions. Of particular concern is its toxic effect on the liver and possible reproductive toxicity in humans. Studies suitable for calculating the benchmark dose were identified from the available data. Animal studies yielded a benchmark dose lower confidence limit (BMDL) of 43 mg/kg bw/day, which translates into a safe human dose of approximately 15 mg/day. Only the Lowest-Observed-Adverse-Effect Level (LOAEL) of 4.3 mg/kg bw/day could be identified from the human data. This updated risk assessment confirmed a health-based guidance value (HBGV) of 10 mg/day based on human LOAEL. Despite the existing data gaps, preliminary regulation appears advisable because the current form of the gray CBD market is unacceptable from the standpoint of consumer safety and protection.

Revisiting the risk of introduction of Japanese encephalitis virus (JEV) into the United States – An updated semi-quantitative risk assessment

Japanese encephalitis virus (JEV) is associated with encephalitis in humans and reproductive and neurological illness in pigs. JEV has expanded beyond its native distribution in southeast Asia, with identifications in Europe (2010) and Africa (2016), and most recently, its spread into mainland Australia (2021−2022). The introduction of JEV into the United States (US) is a public health risk, and could also impact animal health and the food supply. To efficiently and cost-effectively manage risk, a better understanding of how and where diseases will be introduced, transmitted, and spread is required. To achieve this objective, we updated our group's previous qualitative risk assessment using an established semi-quantitative risk assessment tool (MINTRISK) to compare the overall rate of introduction and risk, including impacts, of JEV in seven US regions. The rate of introduction from the current region of distribution was considered negligible for the Northeast, Midwest, Rocky Mountain, West, Alaska, and Hawaii regions. The South region was the only region with a pathway that had a non-negligible rate of introduction; infected mosquito eggs and larvae introduced via imported used tires (very low; 95% uncertainty interval (UI) = negligible to high). The overall risk estimate for the South was very high (95% UI = very low to very high). Based on this risk assessment, the South region should be prioritized for surveillance activities to ensure the early detection of JEV. The assumptions used in this risk assessment, due to the lack of information about the global movement of mosquitoes, number of feral pigs in the US, the role of non-ardeid wild birds in transmission, and the magnitude of the basic reproduction ratio of JEV in a novel region, need to be fully considered as these impact the estimated probability of establishment.

The estimated 10-year risk of first-onset cardiovascular disease in Swedish-born and non-Swedish-born primary healthcare patients

BackgroundSCORE2 has been introduced as an updated risk assessment tool for calculating the 10-year risk of first-onset cardiovascular disease (CVD). However, it does not account for ethnicity or socioeconomic status, known to affect CVD risk. This study investigated and compared SCORE2 estimates in Swedish-born and non-Swedish-born primary healthcare patients. The second aim was to examine if several risk factors could explain differences in CVD risk between the groups.MethodsThis was an observational, cross-sectional study. Data were obtained from the 4D Diabetes Project study, providing a total of 444 participants aged between 40 and 69 years. All participants had complete risk variable data necessary for the SCORE2 tool and no history of previous CVD. Descriptive analysis was conducted to compare distributions of risk factors between Swedes and immigrants and odds ratios of risk factors amongst these two groups in correlation to elevated CVD risk were calculated using logistic regression.ResultsSwedish-born patients showed a significantly higher risk of elevated CVD risk estimates (≥ 2.5% CVD risk increase for individuals < 50 years, respectively, ≥ 5% for individuals aged 51–69) than the non-Swedish-born population, even after adjustment for educational level (OR = 1.61, 95% CI 1.08–2.39). Weekly alcohol consumption implicated a risk of being classified as high risk of CVD risk, regardless of country of birth (OR = 1.93 CI 1.25-3.00). However, Swedes accounted for most of the alcohol consumption (62.6% vs. 19.6%). No other explanatory variable showed significance in association with elevated CVD risk.ConclusionsSwedish-born patients were found to be at higher risk of an increased 10-year CVD risk. The association of alcohol consumption with elevated CVD risk needs to be further studied in longitudinal studies in representative populations, notably among Sweden’s diverse ethnic groups.

An updated ecotoxicological evaluation and health risk assessment of metal contaminants in Perna viridis mussel harvested on March to August 2018 from Pasir Gudang Coastal Area, Malaysia

Perna viridis (P. viridis) is a significant protein source globally but is often contaminated by metals due to its filter-feeding behavior. Given that Kampung Pasir Puteh, Pasir Gudang (Johor) is Malaysia's primary P. viridis harvesting site and the last health risk assessment (2015) was incomplete, the metal contamination status remains uncertain. Graphite furnace-atomic absorption spectroscopy was employed to analyze metal contaminant concentrations in P. viridis samples collected from March to August 2018, as per Malaysian legal requirements. The R2 values varied between 0.9976 and 0.9980 for P. viridis mussels and between 0.9976 and 0.9999 for seawater. The recovery for P. viridis mussels and seawater ranged from 93.95% to 106.80% and 92.73–108.84%, respectively. Precision and accuracy for both intra and inter-day measurements ranged from 0.15% to 5.49% for P. viridis and 0.05–5.58% for seawater. The concentrations of metal contaminants in P. viridis varied significantly among the different months of sampling (p < 0.05). All P. viridis samples had higher concentration of arsenic (3.16–75.80 μg g−1) than that prescribed by the Malaysian law. Higher cadmium concentration was observed during July (2.12 μg g−1) and August (2.05 μg g−1) alone. With target hazard quotients and hazard indices > 1.0, the likelihood of negative health impacts from consuming these mussels cannot be ignored. TCR values for As and Cd exceeded USEPA standards, indicating a potential lifetime carcinogenic risk from continuous P. viridis consumption. Pb (21.20–49.28 µg L−1) in all surface seawater samples was invariably higher than the allowable limit for Class 2 water areas. Metal contaminant concentrations varied significantly between P. viridis and surface seawater (p < 0.05), implying inconsistent bioaccumulation due to pollution differences. Given the significance of P. viridis mussels, concerted scientific efforts are essential to devise effective metal contaminant removal methods.

Updated Estimates of Radiation Risk for Cancer and Cardiovascular Disease: Implications for Cardiology Practice.

This review aims to furnish an updated assessment of the societal healthcare load, including cancer and cardiovascular disease resulting from diagnostic radiologic operations. The previously projected additional cancer risk of 0.9% in a United States 2004 study referred to radiological conditions in 1996 with an X-ray exposure of 0.50 millisievert (mSv) per capita annually. Radiological exposure (radiology + nuclear medicine) has escalated to 2.29 mSv (2016) per capita per year. Low-dose exposures were previously assumed to have a lower biological impact, since they allow the DNA repair system to mitigate molecular damage. However, epidemiological data matured and disproved this assumption, as shown by updated cancer risk assessments derived from the World Health Organization 2013 and the German Institute of Radioprotection 2014 data. The risk of cardiovascular disease aligns within the same order of magnitude as cancer risk and compounds it, as shown by a comprehensive meta-analysis of 93 studies. The collective societal burden arising from the augmented risks of cancer and cardiovascular disease attributable to diagnostic radiology and nuclear medicine is higher than previously thought.

The Conflict between Regulatory Agencies over the 20,000-Fold Lowering of the Tolerable Daily Intake (TDI) for Bisphenol A (BPA) by the European Food Safety Authority (EFSA).

The European Food Safety Authority (EFSA) recommended lowering their estimated tolerable daily intake (TDI) for bisphenol A (BPA) 20,000-fold to . BPA is an extensively studied high production volume endocrine disrupting chemical (EDC) associated with a vast array of diseases. Prior risk assessments of BPA by EFSA as well as the US Food and Drug Administration (FDA) have relied on industry-funded studies conducted under good laboratory practice protocols (GLP) requiring guideline end points and detailed record keeping, while also claiming to examine (but rejecting) thousands of published findings by academic scientists. Guideline protocols initially formalized in the mid-twentieth century are still used by many regulatory agencies. EFSA used a 21st century approach in its reassessment of BPA and conducted a transparent, but time-limited, systematic review that included both guideline and academic research. The German Federal Institute for Risk Assessment (BfR) opposed EFSA's revision of the TDI for BPA. We identify the flaws in the assumptions that the German BfR, as well as the FDA, have used to justify maintaining the TDI for BPA at levels above what a vast amount of academic research shows to cause harm. We argue that regulatory agencies need to incorporate 21st century science into chemical hazard identifications using the CLARITY-BPA (Consortium Linking Academic and Regulatory Insights on BPA Toxicity) nonguideline academic studies in a collaborative government-academic program model. We strongly endorse EFSA's revised TDI for BPA and support the European Commission's (EC) apparent acceptance of this updated BPA risk assessment. We discuss challenges to current chemical risk assessment assumptions about EDCs that need to be addressed by regulatory agencies to, in our opinion, become truly protective of public health. Addressing these challenges will hopefully result in BPA, and eventually other structurally similar bisphenols (called regrettable substitutions) for which there are known adverse effects, being eliminated from all food-related and many other uses in the EU and elsewhere. https://doi.org/10.1289/EHP13812.

Enhancing laboratory biosafety management: a comprehensive strategy from theory to practice.

This study examines biosafety management practices in a psychiatric hospital's laboratory in China, focusing on how outdated information technology impacts the hospital's ability to respond to public health emergencies. The goal is to enhance the hospital's emergency response capabilities by updating risk assessments, biosafety manuals, and implementing a comprehensive quality management system alongside a specialized infection control system for significant respiratory diseases. We utilized an integrated research approach, expanding the scope of risk assessments, updating the biosafety manual according to the latest international standards, and implementing a quality management system. A specialized infection control system for significant respiratory diseases was introduced to improve emergency response capabilities. Updated risk assessments and a new biosafety manual have significantly improved the identification and management of biosafety threats. Implementing new quality management and infection control systems has enhanced response efficiency and operational standardization. The measures taken have strengthened the biosafety management and emergency response capabilities of the laboratory department, highlighting the importance of information technology in biosafety management and recommending similar strategies for other institutions.

Risk Assessment of Isoeugenol in Food Based on Benchmark Dose-Response Modeling.

Isoeugenol has recently been evaluated as possibly carcinogenic (Group 2B) by the WHO International Agency for Research on Cancer (IARC). In light of this evaluation, an updated risk assessment of this common food constituent was conducted using the benchmark dose (BMD) approach as recommended by the European Food Safety Authority (EFSA) for point of departure (POD) determination, as an alternative to the no observed adverse effect level (NOAEL). This approach was specifically chosen, as for the relevant neoplastic endpoints only lowest observed adverse effect level (LOAEL) values are available. The toxicological endpoint from the animal studies with the most conservative BMD lower confidence limit (BMDL) value was identified. Using the obtained BMDL value of 8 mg/kg body weight/day as POD, an acceptable daily intake (ADI) of 16 µg/kg body weight/day was obtained, which-despite being more conservative than previous approaches-is still clearly above the estimated daily exposure level to isoeugenol in the USA and in Europe. These results confirm a low risk of the estimated daily exposure levels of isoeugenol.

Diagnostic accuracy of updated risk assessment criteria and development of novel computational prediction models for patients with suspected choledocholithiasis.

There are risks of choledocholithiasis in symptomatic gallstones, and some surgeons have proposed the identification of choledocholithiasis before cholecystectomy. Our goal was to evaluate the diagnostic accuracy of the latest guidelines and create computational prediction models for the accurate prediction of choledocholithiasis. We retrospectively reviewed symptomatic gallstone patients hospitalized with suspected choledocholithiasis. The diagnostic performance of 2019 and 2010 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE) and 2019 guideline of the European Society of Gastrointestinal Endoscopy (ESGE) in different risks. Lastly, we developed novel prediction models based on the preoperative predictors. A total of 1199 patients were identified and 681 (56.8%) had concurrent choledocholithiasis and were included in the analysis. The specificity of the 2019 ASGE, 2010 ASGE, and 2019 ESGE high-risk criteria was 85.91%, 72.2%, and 88.42%, respectively, and their positive predictive values were 85.5%, 77.4%, and 87.3%, respectively. For Mid-risk patients who followed 2019 ASGE about 61.8% of them did not have CBD stones in our study. On the choice of surgical procedure, laparoscopic cholecystectomy + laparoscopic transcystic common bile duct exploration can be considered the optimal treatment choice for cholecysto-choledocholithiasis instead of Endoscopic Retrograde Cholangio-Pancreatography (ERCP). We build seven machine learning models and an AI diagnosis prediction model (ModelArts). The area under the receiver operating curve of the machine learning models was from 0.77 to 0.81. ModelArts AI model showed predictive accuracy of 0.97, recall of 0.97, precision of 0.971, and F1 score of 0.97, surpassing any other available methods. The 2019 ASGE guideline and 2019 ESGE guideline have demonstrated higher specificity and positive predictive value for high-risk criteria compared to the 2010 ASGE guideline. The excellent diagnostic performance of the new artificial intelligence prediction model may make it a better choice than traditional guidelines for managing patients with suspected choledocholithiasis in future.

Dynamics in Liver Stiffness Measurements Predict Outcomes in Advanced Chronic Liver Disease

Liver stiffness measurements (LSM) provide an opportunity to non-invasively monitor liver disease progression/regression. We aimed to determine the prognostic relevance of LSM-dynamics over time for liver-related events and death in patients with chronic liver disease. Patients with chronic liver disease undergoing ≥2 reliable LSM at least 180 days apart were included in this retrospective cohort study and stratified at baseline (BL) as non-advanced chronic liver disease (nonACLD, BL-LSM<10kPa), compensated ACLD (cACLD; BL-LSM≥10kPa) and decompensated ACLD (dACLD). Data on all consecutive LSM and clinical outcomes were collected. 2508 patients with 8561 reliable LSM (3 [IQR: 2-4] per patient) were included: 1647 (65.7%) nonACLD, 757 (30.2%) cACLD, and 104 (4.1%) dACLD. 7 nonACLD (0.4%) and 83 cACLD patients (10.9%) developed hepatic decompensation (median follow-up: 71 months). 20% increase in LSM at any time was associated with a ∼50% increased risk for hepatic decompensation (hazard ratio, HR: 1.58 [95%CI: 1.41-1.79], p<0.001) and liver-related death (HR: 1.45 [95%CI: 1.28-1.68], p<0.001) in cACLD patients. LSM-dynamics yielded a high accuracy to predict hepatic decompensation in the following 12 months (AUROC: 0.933). The performance of LSM-dynamics was numerically better than dynamics in FIB-4 (0.873), MELD (0.835), and single timepoint LSM (BL-LSM: 0.846; 2nd LSM: 0.880). Any LSM-decrease to <20kPa identified cACLD patients with a substantially lower risk of hepatic decompensation (HR: 0.13 [95%CI: 0.07-0.24]). If reliable, LSM also confers prognostic information in dACLD. Repeating LSM enables an individual and updated risk assessment for decompensation and liver-related mortality in ACLD.

Updated spatial distribution and health risk assessment of heavy metals in soils of the Yangtze River Basin, China

Supporting ecological protection and restoration has been at the heart of China’s ambitious Yangtze River conservation strategy. Knowledge of the current status of heavy metal distribution is important for planning remediation practices and allocation to waste treatment facilities. Through an extensive and systematic review of literatures, this study depicts the up-to-date spatial distribution and characteristics of typical heavy metals in soils of the Yangtze River Basin, China. A total of 7,694 geo-referenced records of heavy metal in soils of the Yangtze River Basin were compiled from the literatures published between 2000 and 2020. The results show the spatially-heterogeneous concentrations of Zn, Cu, Pb, Cr, Ni, As, Hg and Cd. The degree of heavy metal pollution was relatively higher in the middle reaches, while it was relatively lower in the upstream and downstream. According to the limits set by the state to ensure agricultural production and maintain human health, the average concentration of Cd greatly exceeded its limit. Overall, a certain number of heavily polluted areas were found to occur in regions with frequent human economic activities, posing potential health risks. The carcinogenic and non-carcinogenic risks of children are 1.4 times and 1.6 times higher than those of adults, respectively, and the heavy metal with the highest risk to human health was Cr. This study provides an important basis for the field of soil pollution prevention and control in the Yangtze River Basin. It updates the current understanding of the spatial pattern of major pollutants in a large ecologically protected region in China, which is conducive to the precise prevention and control of public health risks.

Safety and efficacy of a feed additive consisting of halofuginone hydrobromide (STENOROL®) for chickens for fattening and turkeys for fattening/reared for breeding (Huvepharma N.V.)

Following a request from the European Commission, EFSA was asked to deliver a new scientific opinion on the coccidiostat halofuginone hydrobromide (STENOROL®) when used as a feed additive for chickens for fattening and turkeys for fattening/reared for breeding. The Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) concludes that the safety for turkeys for fattening established in its previous opinion can be extended to turkeys for breeding up to 12 weeks of age. Based on the new data provided on the safety for consumer, environment and efficacy, the Panel updates its previous conclusions as follows: halofuginone hydrobromide is not genotoxic. Applying an uncertainty factor of 100 to the lowest no observed adverse effect level (NOAEL) of 0.03 mg/kg body weight (bw) per day, an acceptable daily intake (ADI) of 0.3 μg halofuginone/kg bw is established. The chronic exposure of consumers to residues of halofuginone would amount to 6-19% of the ADI after 3 days of withdrawal. Therefore, the Panel considers that the additive is safe for the consumer of tissues obtained from chickens for fattening and turkeys for fattening fed the additive at a maximum level of 3 mg/kg complete feed at a 3-day withdrawal time. For control purposes, the Panel recommends the setting of the following maximum residue limits (MRLs): liver, 50 μg/kg; kidney, 40 μg/kg; muscle, 3 μg/kg; skin/fat, 10 μg/kg wet tissue. Based on an updated environmental risk assessment, no concern for groundwater is expected. Halofuginone is unlikely to bioaccumulate and the risk of secondary poisoning is not likely to occur. No safety concerns are expected for terrestrial and aquatic environments. The additive has the potential to control coccidiosis in chickens for fattening and turkeys for fattening/reared for breeding up to 12 weeks of age at a minimum level of 2 mg/kg complete feed.

Gauging the Impact of Satellite &amp; Space Systems on Critical Infrastructure[CI]: Risk Management is Neither an Enigma nor a Mystery for CI Systems Security

Abstract This article summarizes many critical infrastructure vulnerability issues involving connectivity to space platforms and cyber systems. The article emphasizes the importance of rigorous updated risk assessment in these aeas and the urgent need to exercise all phases and aspects of infrastructufe failure, collapse or extended disruption.

Evaluation of the genotoxic potential of acrylamide: Arguments for the derivation of a tolerable daily intake (TDI value).

This opinion of the Senate Commission on Food Safety (SKLM) of the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) presents arguments for an updated risk assessment of diet-related exposure to acrylamide (AA), based on a critical review of scientific evidence relevant to low dose exposure. The SKLM arrives at the conclusion that as long as an appropriate exposure limit for AA is not exceeded, genotoxic effects resulting in carcinogenicity are unlikely to occur. Based on the totality of the evidence, the SKLM considers it scientifically justified to derive a tolerable daily intake (TDI) as a health-based guidance value.

What is needed to reduce the risk of anterior cruciate ligament injuries in children? – Hearing from experts

ObjectiveAnterior cruciate ligament (ACL) injuries are an emerging health problem in children. Acknowledging considerable gaps in knowledge, the aim of this study was to examine the current knowledge on childhood ACL injury, and to explore risk assessment and reduction strategies, with experts in the research community. DesignQualitative study; semi-structured expert interviews. MethodsInterviews with seven international, multidisciplinary academic experts were conducted from February until June 2022. A thematic analysis approach organized verbatim quotes into themes using Nvivo Software. ResultsGaps in knowledge on the actual injury mechanism, and influence of physical activity behaviours, constrain targeted risk assessment and reduction strategies in childhood ACL injuries. Strategies to examine and reduce the risk of ACL injury included: examining an athletes' whole-body performance, moving from constraint (e.g., squat) to less constraint (e.g., single-leg) tasks, making assessments into children's context, building a movement repertoire at young age, performing risk reduction programs, multiple sports, and prioritising rest. ConclusionResearch is urgently warranted on the actual injury mechanism, reasons for ACL injuries in children, and potential risk factors to update risk assessment and reduction strategies. Further, educating stakeholders on risk reduction strategies could be essential to address the increasing occurrence of childhood ACL injuries.

Surveillance and risk assessment for early detection of emerging infectious diseases in livestock.

Those who work in the area of surveillance and prevention of emerging infectious diseases (EIDs) face a challenge in accurately predicting where infection will occur and who (or what) it will affect. Establishing surveillance and control programmes for EIDs requires substantial and long-term commitment of resources that are limited in nature. This contrasts with the unquantifiable number of possible zoonotic and non-zoonotic infectious diseases that may emerge, even when the focus is restricted to diseases involving livestock. Such diseases may emerge from many combinations of, and changes in, host species, production systems, environments/habitats and pathogen types. Given these multiple elements, risk prioritisation frameworks should be used more widely to support decision-making and resource allocation for surveillance. In this paper, the authors use recent examples of EID events in livestock to review surveillance approaches for the early detection of EIDs, and highlight the need for surveillance programmes to be informed and prioritised by regularly updated risk assessment frameworks. They conclude by discussing some unmet needs in risk assessment practices for EIDs, and the need for improved coordination in global infectious disease surveillance.

Updated risk assessments for sudden cardiac death in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator.

Hypertrophic cardiomyopathy (HCM) is a genetic disease associated with a risk of malignant ventricular tachyarrhythmias and sudden cardiac death (SCD). Assessment of the SCD risk is crucial for its clinical management, and there has been considerable interest in developing risk stratification strategies. An implantable cardioverter-defibrillator (ICD) is a life-saving treatment for patients with HCM who are at a high-risk of ventricular tachyarrhythmias and SCD. However, a substantial number of ICD recipients experience adverse effects arising from inappropriate device therapy and implant-related complications. This has led to numerous investigations of the risk of SCD and the indications for ICD implantation. American guidelines were recently updated to include new risk markers, including left ventricular systolic dysfunction, apical aneurysm, and extensive late gadolinium enhancement, while European guidelines recommend individualized estimated 5-year SCD risk assessment models. Studies evaluating other risk factors for SCD in patients with HCM have also been published. Drawing on recent guidelines and publications on clinical risk factors, we focus this review on updated risk assessments for SCD with ICD therapy in patients with HCM.

Scientific statement on the maximum residue levels for potassium phosphonates.

The European Commission mandated EFSA to issue a scientific statement, in accordance with Article 31 of Regulation (EC) No 178/2002, providing an overview of the maximum residue levels for potassium phosphonates in different products. This statement should be based on the maximum residue levels recently proposed by EFSA in several Reasoned Opinions published between June 2021 and January 2022 and the maximum residue levels supported in preparation of an EU position at the 52nd Codex Committee on Pesticides Residues. EFSA prepared a scientific statement containing a summary of the maximum residue levels proposed, including a reference to the scientific output on which the recommendation for each product is based and a justification for the selected values when different ones were proposed by the different outputs. An updated consumer risk assessment, based on the consolidated list of MRLs for the enforcement of phosphonic acid residues, was calculated. No risk for consumers was identified.

PFAS in soil and groundwater following historical land application of biosolids

The land application of digested sewage sludge (biosolids) is widely employed across the globe. Studies show that biosolids contain significant amounts of inorganic and organic materials, as well as emerging pollutants, including per- and polyfluorinated alkyl substances (PFAS). With the wide range of pollutants commonly reported in biosolids, the potential risks associated with long-term land application operations are concerning. In this study, PFAS in surface soils, deeper soils into the vadose zone, and immediately-underlying groundwater was measured at an agricultural station with a long record of biosolids applications plus irrigation using treated wastewater. Twelve PFAS homologues were detected in every near surface soil sampled 0–30 cm depth below ground surface with multiple PFAS (especially short-chain) distributed through the soil profile. Average measured concentrations of PFAS in these soils suggest the soil burden PFOS>PFDA>PFOA for all substations sampled, independent of the historical loading rates and patterns of agricultural operations on those substations. Measured concentrations of PFOA and PFOS in the soil profile (0–90 cm) suggest these compounds have migrated to deeper soil depths (up to 9 m below the surface) with quantifiable concentrations in the soil and the immediate underlying groundwater located approximately 17 m below. Estimates of the total mass of PFAS in surface soils were effectively made using PFAS levels reported in sludges from the USEPA NSSS combined with long-term loading rates on record at the substations. With the land application of biosolids in the USA regulated by the USEPA, additional and updated risk assessments and surveys to include emerging pollutants such as PFAS are needed to protect public health and the environment.

Towards a toxic-free environment: perspectives for chemical risk assessment approaches.

Regulatory frameworks to control chemical exposure in general living and occupational environments have changed exposure scenarios towards a widely spread contamination at relatively low doses in developed countries. In such evolving context, some critical aspects should be considered to update risk assessment and management strategies. Risk assessment in low-dose chemical exposure scenarios should take advantage of: toxicological investigations on emerging substances of interest, like those recognised as endocrine disruptors or increasingly employed nanoscale materials; human biological monitoring studies aimed to identify innovative biomarkers for known chemical exposure; “omic” technologies useful to identify hazards of chemicals and their modes of action. For updated risk assessment models, suitable toxicological studies, analyses of dose-responses at low-concentrations, environmental and biological monitoring of exposure, together with exposome studies, and the proper definition of susceptible populations may all provide helpful contributions. These may guide defining preventive measures to control the exposure and develop safe and sustainable chemicals by design. Occupational medicine can offer know-how and instruments to understand and manage such evolution towards a toxic-free environment to protect the safety and health of the workforce and, in turn, that of the general population.