1
|
Checkoway H, Lees PSJ, Dell LD, Gentry PR, Mundt KA. Peak Exposures in Epidemiologic Studies and Cancer Risks: Considerations for Regulatory Risk Assessment. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2019; 39:1441-1464. [PMID: 30925210 PMCID: PMC6850123 DOI: 10.1111/risa.13294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 05/20/2023]
Abstract
We review approaches for characterizing "peak" exposures in epidemiologic studies and methods for incorporating peak exposure metrics in dose-response assessments that contribute to risk assessment. The focus was on potential etiologic relations between environmental chemical exposures and cancer risks. We searched the epidemiologic literature on environmental chemicals classified as carcinogens in which cancer risks were described in relation to "peak" exposures. These articles were evaluated to identify some of the challenges associated with defining and describing cancer risks in relation to peak exposures. We found that definitions of peak exposure varied considerably across studies. Of nine chemical agents included in our review of peak exposure, six had epidemiologic data used by the U.S. Environmental Protection Agency (US EPA) in dose-response assessments to derive inhalation unit risk values. These were benzene, formaldehyde, styrene, trichloroethylene, acrylonitrile, and ethylene oxide. All derived unit risks relied on cumulative exposure for dose-response estimation and none, to our knowledge, considered peak exposure metrics. This is not surprising, given the historical linear no-threshold default model (generally based on cumulative exposure) used in regulatory risk assessments. With newly proposed US EPA rule language, fuller consideration of alternative exposure and dose-response metrics will be supported. "Peak" exposure has not been consistently defined and rarely has been evaluated in epidemiologic studies of cancer risks. We recommend developing uniform definitions of "peak" exposure to facilitate fuller evaluation of dose response for environmental chemicals and cancer risks, especially where mechanistic understanding indicates that the dose response is unlikely linear and that short-term high-intensity exposures increase risk.
Collapse
Affiliation(s)
- Harvey Checkoway
- Department of Family Medicine & Public HealthSan Diego School of Medicine, University of CaliforniaLa JollaCAUSA
| | | | | | | | | |
Collapse
|
2
|
Fries M, Williams PRD, Ovesen J, Maier A. Airborne exposures associated with the typical use of an aerosol brake cleaner during vehicle repair work. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:531-540. [PMID: 29672233 DOI: 10.1080/15459624.2018.1467017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many petroleum-based products are used for degreasing and cleaning purposes during vehicle maintenance and repairs. Although prior studies have evaluated chemical exposures associated with this type of work, most of these have focused on gasoline and exhaust emissions, with few samples collected solely during the use of an aerosol cleaning product. In this case study, we assess the type of airborne exposures that would be expected from the typical use of an aerosol brake cleaner during vehicle repair work. Eight exposure scenarios were evaluated over a 2-day study in which the benzene content of the brake cleaner and potential for dilution ventilation and air flow varied. Both short-term (15 min) and task-based (≥1 hr) charcoal tube samples were collected in the breathing zone and adjacent work area and analyzed for total hydrocarbons (THCs), toluene, and benzene. The majority of personal (N = 48) and area (N = 47) samples had detectable levels of THC and toluene, but no detections of benzene were found. For the personal short-term samples, average airborne concentrations ranged from 3.1-61.5 ppm (13.8-217.5 mg/m3) for THC and 2.2-44.0 ppm (8.2-162.5 mg/m3) for toluene, depending on the scenario. Compared to the personal short-term samples, average concentrations were generally 2-3 times lower for the personal task-based samples and 2-5 times lower for the area short-term samples. The highest exposures occurred when the garage bay doors were closed, floor fan was turned off, or greatest amount of brake cleaner was used. These findings add to the limited dataset on this topic and can be used to bound or approximate worker or consumer exposures from use of aerosol cleaning products with similar compositions and use patterns.
Collapse
Affiliation(s)
- Michael Fries
- a Department of Environmental Health , University of Cincinnati , Cincinnati , Ohio
| | | | - Jerald Ovesen
- a Department of Environmental Health , University of Cincinnati , Cincinnati , Ohio
| | - Andrew Maier
- a Department of Environmental Health , University of Cincinnati , Cincinnati , Ohio
| |
Collapse
|
3
|
Zhang Z, Yan X, Gao F, Thai P, Wang H, Chen D, Zhou L, Gong D, Li Q, Morawska L, Wang B. Emission and health risk assessment of volatile organic compounds in various processes of a petroleum refinery in the Pearl River Delta, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 238:452-461. [PMID: 29587216 DOI: 10.1016/j.envpol.2018.03.054] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/12/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
The process-specific emission of volatile organic compounds (VOCs) from a petroleum refinery in the Pearl River Delta, China was monitored to assess the health risk from VOCs to workers of this refinery. Over 60 VOCs were detected in the air samples collected from various sites in the refining, basic chemical, and wastewater treatment areas of the refinery using gas chromatography-mass spectrometry/flame ionization detection. The health risks of VOCs to the refinery workers were assessed using US Environmental Protection Agency (US EPA) and American Conference of Governmental Industrial Hygienists (ACGIH) methods. Monte Carlo simulation and sensitivity analysis were implemented to assess the uncertainty of the health risk estimation. The emission results showed that C5-C6 alkanes, including 2-methylpentane (17.6%), 2,3-dimethylbutane (15.4%) and 3-methylpentane (7.7%), were the major VOCs in the refining area. p-Diethylbenzene (9.3%), 2-methylpentane (8.1%) and m-diethylbenzene (6.8%) were dominant in the basic chemical area, and 2-methylpentane (20.9%), 2,3-dimethylbutane (11.4%) and 3-methylpentane (6.5%) were the most abundant in the wastewater treatment area. For the non-cancer risk estimated using the US EPA method, the total hazard ratio in the basic chemical area was the highest (3.1 × 103), owing to the highest level of total concentration of VOCs. For the cancer risk, the total cancer risks were very high, ranging from 2.93 × 10-3 (in the wastewater treatment area) to 1.1 × 10-2 (in the basic chemical area), suggesting a definite risk. Using the ACGIH method, the total occupational exposure cancer risks of VOCs in the basic chemical area were the highest, being much higher than those of refining and wastewater treatment areas. Among the areas, the total occupational exposure risks in the basic chemical and refining areas were >1, which suggested a cancer threat to workers in these areas. Sensitivity analysis suggested that improving the accuracy of VOC concentrations themselves in future research would advance the health risk assessment.
Collapse
Affiliation(s)
- Zhijuan Zhang
- Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China; Guangdong Provincial Engineering Research Center for Online Source Apportionment System of Air Pollution, Guangzhou 510632, China
| | - Xiuying Yan
- Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China; Guangdong Provincial Engineering Research Center for Online Source Apportionment System of Air Pollution, Guangzhou 510632, China
| | - Feilong Gao
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China
| | - Phong Thai
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane QLD, 4001, Australia
| | - Hao Wang
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; JNU - QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China.
| | - Dan Chen
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China
| | - Lei Zhou
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China
| | - Daocheng Gong
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China
| | - Qinqin Li
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; Institute of Mass Spectrometer and Atmospheric Environment, Jinan University, Guangzhou 510632, China
| | - Lidia Morawska
- JNU - QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane QLD, 4001, Australia
| | - Boguang Wang
- Institute for Environment and Climate Research, Jinan University, Guangzhou 511443, China; JNU - QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China.
| |
Collapse
|
4
|
Turner MC, Mehlum IS. Greater coordination and harmonisation of European occupational cohorts is needed. Occup Environ Med 2018; 75:475-476. [PMID: 29735748 PMCID: PMC6035485 DOI: 10.1136/oemed-2017-104955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/17/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
5
|
Williams PRD, Mani A. Benzene Exposures and Risk Potential for Vehicle Mechanics from Gasoline and Petroleum-Derived Products. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2015; 18:371-399. [PMID: 26514691 DOI: 10.1080/10937404.2015.1088810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Benzene exposures among vehicle mechanics in the United States and abroad were characterized using available data from published and unpublished studies. In the United States, the time-weighted-average (TWA) airborne concentration of benzene for vehicle mechanics averaged 0.01-0.05 ppm since at least the late 1970s, with maximal TWA concentrations ranging from 0.03 to 0.38 ppm. Benzene exposures were notably lower in the summer than winter and in the Southwest compared to other geographic regions, but significantly higher during known gasoline-related tasks such as draining a gas tank or changing a fuel pump or fuel filter. Measured airborne concentrations of benzene were also generally greater for vehicle mechanics in other countries, likely due to the higher benzene content of gasoline and other factors. Short-term airborne concentrations of benzene frequently exceeded 1 ppm during gasoline-related tasks, but remained below 0.2 ppm for tasks involving other petroleum-derived products such as carburetor and brake cleaner or parts washer solvent. Application of a two-zone mathematical model using reasonable input values from the literature yielded predicted task-based benzene concentrations during gasoline and aerosol spray cleaner scenarios similar to those measured for vehicle mechanics during these types of tasks. When evaluated using appropriate biomarkers, dermal exposures were found to contribute little to total benzene exposures for this occupational group. Available data suggest that vehicle mechanics have not experienced significant exposures to benzene in the workplace, except perhaps during short-duration gasoline-related tasks, and full-shift benzene exposures have remained well below current and contemporaneous occupational exposure limits. These findings are consistent with epidemiology studies of vehicle mechanics, which have not demonstrated an increased risk of benzene-induced health effects in this cohort of workers. Data and information presented here may be used to assess past, current, or future exposures and risks to benzene for vehicle mechanics who may be exposed to gasoline or other petroleum-derived products.
Collapse
Affiliation(s)
| | - Ashutosh Mani
- b Department of Environmental Health , University of Cincinnati , Cincinnati , Ohio , USA
| |
Collapse
|
6
|
Glass DC, Wood E, Del Monaco A, Sim MR. Cohort Profile: Health Watch-a 30-year prospective cohort study of Australian petroleum industry workers. Int J Epidemiol 2015; 45:700-6. [PMID: 26157111 DOI: 10.1093/ije/dyv121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Deborah C Glass
- Monash University, Centre for Occupational and Environmental Health, Melbourne, VIC, Australia
| | - Elisa Wood
- Monash University, Centre for Occupational and Environmental Health, Melbourne, VIC, Australia
| | - Anthony Del Monaco
- Monash University, Centre for Occupational and Environmental Health, Melbourne, VIC, Australia
| | - Malcolm R Sim
- Monash University, Centre for Occupational and Environmental Health, Melbourne, VIC, Australia
| |
Collapse
|
7
|
Edokpolo B, Yu QJ, Connell D. Health risk characterization for exposure to benzene in service stations and petroleum refineries environments using human adverse response data. Toxicol Rep 2015; 2:917-927. [PMID: 28962430 PMCID: PMC5598410 DOI: 10.1016/j.toxrep.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/13/2023] Open
Abstract
Health risk characterization of exposure to benzene in service stations and petroleum refineries has been carried out in previous studies using guideline values set by various agencies. In this work, health risk was characterized with the exposure data as cumulative probability distribution (CPD) plots but using human epidemiological data. This was achieved by using lowest observable adverse effects levels (LOAEL) data plotted as cumulative probability lowest effects distribution (CPLED). The health risk due to benzene was characterized by using probabilistic methods of hazard quotient (HQ50/50 and HQ95/5), Monte-Carlo simulation (MCS) and overall risk probability (ORP). CPD relationships of adverse health effects relationships and exposure data were in terms of average daily dose (ADD) and lifetime average daily dose (LADD) for benzene. For service station environments HQ50/50 and HQ95/5 were in a range of 0.000071-0.055 and 0.0049-21, respectively. On the other hand, the risk estimated for petroleum refinery environments suggests higher risk with HQ50/50 and HQ95/5 values ranging from 0.0012 to 77 and 0.17 to 560, respectively. The results of Monte-Carlo risk probability (MRP) and ORP indicated that workers in petroleum refineries (MRP of 2.9-56% and ORP of 4.6-52% of the affected population) were at a higher risk of adverse health effects from exposure to benzene as compared to exposure to benzene in service station environments (MRP of 0.051 -3.4% and ORP of 0.35-2.7% affected population). The adverse effect risk probabilities estimated by using the Monte-Carlo simulation technique and the ORP method were found to be generally consistent.
Collapse
Affiliation(s)
- Benjamin Edokpolo
- Griffith School of Engineering, Griffith University, Nathan Campus, Brisbane 4111, QLD, Australia
| | - Qiming Jimmy Yu
- Griffith School of Engineering, Griffith University, Nathan Campus, Brisbane 4111, QLD, Australia
| | - Des Connell
- Griffith School of Environment, Griffith University, Nathan Campus, Brisbane 4111, QLD, Australia
| |
Collapse
|
8
|
Edokpolo B, Yu QJ, Connell D. Health risk assessment for exposure to benzene in petroleum refinery environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:595-610. [PMID: 25588154 PMCID: PMC4306881 DOI: 10.3390/ijerph120100595] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/06/2015] [Indexed: 01/29/2023]
Abstract
The health risk resulting from benzene exposure in petroleum refineries was calculated using data from the scientific literature from various countries throughout the world. The exposure data was collated into four scenarios from petroleum refinery environments and plotted as cumulative probability distributions (CPD) plots. Health risk was evaluated for each scenario using the Hazard Quotient (HQ) at 50% (CEXP50) and 95% (CEXP95) exposure levels. Benzene levels were estimated to pose a significant risk with HQ50 > 1 and HQ95 > 1 for workers exposed to benzene as base estimates for petroleum refinery workers (Scenario 1), petroleum refinery workers evaluated with personal samplers in Bulgarian refineries (Scenario 2B) and evaluated using air inside petroleum refineries in Bulgarian refineries (Scenario 3B). HQ50 < 1 were calculated for petroleum refinery workers with personal samplers in Italian refineries (Scenario 2A), air inside petroleum refineries (Scenario 3A) and air outside petroleum refineries (Scenario 4) in India and Taiwan indicating little possible adverse health effects. Also, HQ95 was < 1 for Scenario 4 however potential risk was evaluated for Scenarios 2A and 3A with HQ95 > 1. The excess Cancer risk (CR) for lifetime exposure to benzene for all the scenarios was evaluated using the Slope Factor and Overall Risk Probability (ORP) methods. The result suggests a potential cancer risk for exposure to benzene in all the scenarios. However, there is a higher cancer risk at 95% (CEXP95) for petroleum refinery workers (2B) with a CR of 48,000 per 106 and exposure to benzene in air inside petroleum refineries (3B) with a CR of 28,000 per 106.
Collapse
Affiliation(s)
- Benjamin Edokpolo
- Griffith School of Engineering, Griffith University, Nathan Campus, Brisbane, QLD 4111, Australia.
| | - Qiming Jimmy Yu
- Griffith School of Engineering, Griffith University, Nathan Campus, Brisbane, QLD 4111, Australia.
| | - Des Connell
- Griffith School of Environment, Griffith University, Nathan Campus, Brisbane, QLD 4111, Australia.
| |
Collapse
|
9
|
Glass DC, Schnatter AR, Tang G, Irons RD, Rushton L. Risk of myeloproliferative disease and chronic myeloid leukaemia following exposure to low-level benzene in a nested case–control study of petroleum workers. Occup Environ Med 2014; 71:266-74. [DOI: 10.1136/oemed-2013-101664] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
Schnatter AR, Glass DC, Tang G, Irons RD, Rushton L. Myelodysplastic syndrome and benzene exposure among petroleum workers: an international pooled analysis. J Natl Cancer Inst 2012; 104:1724-37. [PMID: 23111193 PMCID: PMC3502195 DOI: 10.1093/jnci/djs411] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Benzene at high concentrations is known to cause acute myeloid leukemia (AML), but its relationship with other lymphohematopoietic (LH) cancers remains uncertain, particularly at low concentrations. In this pooled analysis, we examined the risk of five LH cancers relative to lower levels of benzene exposure in petroleum workers. Methods We updated three nested case–control studies from Australia, Canada, and the United Kingdom with new incident LH cancers among petroleum distribution workers through December 31, 2006, and pooled 370 potential case subjects and 1587 matched LH cancer-free control subjects. Quantitative benzene exposure in parts per million (ppm) was blindly reconstructed using historical monitoring data, and exposure certainty was scored as high, medium, or low. Two hematopathologists assigned diagnoses and scored the certainty of diagnosis as high, medium, or low. Dose–response relationships were examined for five LH cancers, including the three most common leukemia cell-types (AML, chronic myeloid leukemia [CML], and chronic lymphoid leukemia [CLL]) and two myeloid tumors (myelodysplastic syndrome [MDS] and myeloproliferative disease [MPD]). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression, controlling for age, sex, and time period. Results Cumulative benzene exposure showed a monotonic dose–response relationship with MDS (highest vs lowest tertile, >2.93 vs ≤0.348 ppm-years, OR = 4.33, 95% CI = 1.31 to 14.3). For peak benezene exposures (>3 ppm), the risk of MDS was increased in high and medium certainty diagnoses (peak exposure vs no peak exposure, OR = 6.32, 95% CI = 1.32 to 30.2) and in workers having the highest exposure certainty (peak exposure vs no peak exposure, OR = 5.74, 95% CI = 1.05 to 31.2). There was little evidence of dose–response relationships for AML, CLL, CML, or MPD. Conclusions Relatively low-level exposure to benzene experienced by petroleum distribution workers was associated with an increased risk of MDS, but not AML, suggesting that MDS may be the more relevant health risk for lower exposures.
Collapse
Affiliation(s)
- A Robert Schnatter
- Occupational and Public Health Division, ExxonMobil Biomedical Sciences, Inc, 1545 US Highway 22 East, Annandale, NJ 08801-3059, USA.
| | | | | | | | | |
Collapse
|
11
|
Meek MEB, Klaunig JE. Proposed mode of action of benzene-induced leukemia: Interpreting available data and identifying critical data gaps for risk assessment. Chem Biol Interact 2010; 184:279-85. [PMID: 20153303 DOI: 10.1016/j.cbi.2010.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mode of action is defined as a series of key biological events leading to an observed toxicological effect (for example, metabolism to a toxic entity, cell death, regenerative repair and tumors). It contrasts with mechanism of action, which generally involves a detailed understanding of the molecular basis for an effect. A framework to consider the weight of evidence for hypothesized modes of action in animals and their relevance to humans, has been widely adopted and used by government agencies and international organizations. The framework, developed and refined through its application in case studies for principally non-DNA-reactive carcinogens, has more recently been extended to DNA-reactive carcinogens, non-cancer endpoints and different life stages. In addition to increasing transparency, use of the framework promotes consistency in decision-making concerning adequacy of weight of evidence, facilitates peer input and review and identifies critical research needs. The framework provides an effective tool to facilitate discussion between the research and risk assessment communities on critical data gaps, which if filled, would permit more refined estimates of risk. As a basis for additionally coordinating and focusing research on critical data gaps in a risk assessment context, five key events in the mode of action for benzene-induced leukemia are proposed: (1) benzene metabolism via Cytochrome P450, (2) the interaction of benzene metabolites with target cells in the bone marrow, (3) formation of initiated, mutated target cells, (4) selective proliferation of the mutated cells and (5) production of leukemia. These key events are considered in a framework analysis of human relevance as a basis to consider appropriate next steps in developing research strategies.
Collapse
Affiliation(s)
- M E Bette Meek
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, One Stewart Street, Suite 309, Ottawa, Ontario, Canada.
| | | |
Collapse
|