1
|
Olsson A, Bouaoun L, Schüz J, Vermeulen R, Behrens T, Ge C, Kromhout H, Siemiatycki J, Gustavsson P, Boffetta P, Kendzia B, Radoi L, Barul C, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Migliore E, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Schejbalova M, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Straif K, Brüning T, Vlaanderen J, Peters S. Lung Cancer Risks Associated with Occupational Exposure to Pairs of Five Lung Carcinogens: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:17005. [PMID: 38236172 PMCID: PMC10795675 DOI: 10.1289/ehp13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND While much research has been done to identify individual workplace lung carcinogens, little is known about joint effects on risk when workers are exposed to multiple agents. OBJECTIVES We investigated the pairwise joint effects of occupational exposures to asbestos, respirable crystalline silica, metals (i.e., nickel, chromium-VI), and polycyclic aromatic hydrocarbons (PAH) on lung cancer risk, overall and by major histologic subtype, while accounting for cigarette smoking. METHODS In the international 14-center SYNERGY project, occupational exposures were assigned to 16,901 lung cancer cases and 20,965 control subjects using a quantitative job-exposure matrix (SYN-JEM). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for ever vs. never exposure using logistic regression models stratified by sex and adjusted for study center, age, and smoking habits. Joint effects among pairs of agents were assessed on multiplicative and additive scales, the latter by calculating the relative excess risk due to interaction (RERI). RESULTS All pairwise joint effects of lung carcinogens in men were associated with an increased risk of lung cancer. However, asbestos/metals and metals/PAH resulted in less than additive effects; while the chromium-VI/silica pair showed marginally synergistic effect in relation to adenocarcinoma (RERI: 0.24; CI: 0.02, 0.46; p = 0.05). In women, several pairwise joint effects were observed for small cell lung cancer including exposure to PAH/silica (OR = 5.12; CI: 1.77, 8.48), and to asbestos/silica (OR = 4.32; CI: 1.35, 7.29), where exposure to PAH/silica resulted in a synergistic effect (RERI: 3.45; CI: 0.10, 6.8). DISCUSSION Small or no deviation from additive or multiplicative effects was observed, but co-exposure to the selected lung carcinogens resulted generally in higher risk than exposure to individual agents, highlighting the importance to reduce and control exposure to carcinogens in workplaces and the general environment. https://doi.org/10.1289/EHP13380.
Collapse
Affiliation(s)
- Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Liacine Bouaoun
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Loredana Radoi
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, University Paris-Saclay, University Paris Cité, Villejuif, France
| | - Christine Barul
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Neil E. Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Centre of Oncology, Moscow, Russia
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John R. McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Miriam Schejbalova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | | | - Eleonora Fabianova
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
2
|
Paulo MS, Symanzik C, Ádam B, Gobba F, Kezic S, van der Molen HF, Peters CE, Rocholl M, Tenkate T, John SM, Loney T, Modenese A, Wittlich M. Risk of cutaneous squamous cell carcinoma due to occupational exposure to solar ultraviolet radiation: Protocol for a systematic review and meta-analysis. PLoS One 2023; 18:e0282664. [PMID: 36867594 PMCID: PMC9983864 DOI: 10.1371/journal.pone.0282664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
Solar ultraviolet radiation (UVR) is the most significant occupational carcinogenic exposure in terms of the number of workers exposed (i.e., outdoor workers). Consequently, solar UVR-induced skin cancers are among the most common forms of occupational malignancies that are potentially expected globally. This systematic review is registered in PROSPERO (CRD42021295221) and aims to assess the risk of cutaneous squamous cell carcinoma (cSCC) associated to occupational solar UVR exposure. Systematic searches will be performed in three electronic literature databases (PubMed/Medline, EMBASE, and Scopus). Further references will be retrieved by a manual search (e.g., in grey literature databases, internet search engines, and organizational websites). We will include cohort studies and case-control studies. Risk of Bias assessment will be conducted separately for case-control and cohort studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used for the certainty of assessment. In case quantitative pooling is not feasible, a narrative synthesis of results will be performed.
Collapse
Affiliation(s)
- Marília Silva Paulo
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Cara Symanzik
- Department of Dermatology, Environmental Medicine, and Health Theory, Osnabrück University, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Balázs Ádam
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Sanja Kezic
- Amsterdam UMC, Department of Occupational and Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk F. van der Molen
- Amsterdam UMC, Department of Occupational and Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Cheryl E. Peters
- BC Centre for Disease Control, Vancouver, Canada
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine, and Health Theory, Osnabrück University, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Thomas Tenkate
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine, and Health Theory, Osnabrück University, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Marc Wittlich
- Institute for Occupational Safety and Health of the German Social Accidents Insurance (IFA), Sankt Augustin, Germany
| |
Collapse
|
3
|
Photoprotection in occupational dermatology. Photochem Photobiol Sci 2023:10.1007/s43630-023-00385-6. [PMID: 36853496 DOI: 10.1007/s43630-023-00385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Skin cancer has become a substantial matter of public health and in the workplace, accounting for a significant share of all reported occupational diseases. The most important external factor in the development of skin cancer is exposure to solar ultraviolet radiation. Outdoor workers have already been identified as a high-risk category. The need for interventions to improve the sun protection behavior of outdoor workers has recently been understood. Outdoor workers' risk perceptions and attitudes toward sun protection methods are likely to influence practical sun protection behavior at work, and despite the fact that many workers have expressed interest in improving their sun protection behavior, outdoor workers' unique needs are still neglected. Occupational dermatology is predicted to become more concerned with photoprotection in the decades ahead. Preventive action against the rapidly increasing number skin cancer cases is in great demand around the globe. In terms of preventive measures, the full range of available options should be used as needed to address the current difficulties in a goal-oriented way. This will almost certainly only be achievable if preventative efforts on a collective and individual level are successfully paired with support from policymakers to inspire long-term change.
Collapse
|
4
|
Symanzik C, John SM. Sun protection and occupation: Current developments and perspectives for prevention of occupational skin cancer. Front Public Health 2022; 10:1110158. [PMID: 36620257 PMCID: PMC9816330 DOI: 10.3389/fpubh.2022.1110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
A substantial proportion of all reported occupational illnesses are constituted by skin cancer, making this disease a serious public health issue. Solar ultra-violet radiation (UVR) exposure is the most significant external factor in the development of skin cancer, for which the broad occupational category of outdoor workers has already been identified as high-risk group. Sun protection by deploying adequate technical, organizational, and person-related measures has to be understood as a functional aspect of workplace safety. To prevent skin cancers brought on by-typically cumulative-solar UVR exposure, outdoor workers must considerably lower their occupationally acquired solar UVR doses. Estimating cumulative sun exposure in outdoor workers requires consideration of the level of solar UVR exposure, the tasks to be done in the sun, and the employees' solar UVR preventive measures. Recent studies have highlighted the necessity for measures to enhance outdoor workers' sun protection behavior. In the coming decades, occupational dermatology is expected to pay increasing attention to sun protection at work. Also, the field of dermato-oncology will likely be concerned with sky-rocketing incidences of occupational skin cancers. The complete range of available alternatives should be utilized in terms of preventive actions, which seems pivotal to handle the present and future challenges in a purposeful manner. This will almost definitely only be possible if politicians' support is effectively combined with communal and individual preventive actions in order to spur long-term transformation.
Collapse
Affiliation(s)
- Cara Symanzik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Osnabrück University, Osnabrück, Germany,Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education (IGB), Faculty of Human Sciences, Osnabrück University, Osnabrück, Germany,*Correspondence: Cara Symanzik ✉
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Osnabrück University, Osnabrück, Germany,Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education (IGB), Faculty of Human Sciences, Osnabrück University, Osnabrück, Germany
| |
Collapse
|
5
|
Van Poppel H, Battisti NML, Lawler M, Kolarova T, Daly J, Rizvi K, Greene R, Buyens G, Oliver K, Price R, Osmanovic N, Venegoni E. European Cancer Organisation's Inequalities Network: Putting Cancer Inequalities on the European Policy Map. JCO Glob Oncol 2022; 8:e2200233. [PMID: 36252165 PMCID: PMC9812450 DOI: 10.1200/go.22.00233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hendrik Van Poppel
- European Association of Urology, Arnhem, the Netherlands,Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicolò Matteo Luca Battisti
- International Society of Geriatric Oncology, Châtelaine, Switzerland,The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mark Lawler
- Queens University Belfast, Belfast, Northern Ireland
| | | | | | | | - Robert Greene
- HungerNdThirst Foundation, Amsterdam, the Netherlands
| | | | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth Surrey, UK
| | | | | | - Enea Venegoni
- European Cancer Organisation, Brussels, Belgium,Enea Venegoni, Rue de la Science 41, 1000, Brussels, B-1040, Belgium; e-mail:
| |
Collapse
|
6
|
Sauvé JF, Emili A, Mater G. Application of Pattern Mining Methods to Assess Exposures to Multiple Airborne Chemical Agents in Two Large Occupational Exposure Databases from France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031746. [PMID: 35162769 PMCID: PMC8835122 DOI: 10.3390/ijerph19031746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/10/2022]
Abstract
Surveys of the French working population estimate that approximately 15% of all workers may be exposed to at least three different chemical agents, but the most prevalent coexposure situations and their associated health risks remain relatively understudied. To characterize occupational coexposure situations in France, we extracted personal measurement data from COLCHIC and SCOLA, two large administrative occupation exposure databases. We selected 118 chemical agents that had ≥100 measurements with detected concentrations over the period 2010-2019, including 31 carcinogens (IARC groups 1, 2A, and 2B). We grouped measurements by work situations (WS, combination of sector, occupation, task, and year). We characterized the mixtures across WS using frequent itemset mining and association rules mining. The 275,213 measurements extracted came from 32,670 WS and encompassing 4692 unique mixtures. Workers in 32% of all WS were exposed to ≥2 agents (median 3 agents/WS) and 13% of all WS contained ≥2 carcinogens (median 2 carcinogens/WS). The most frequent coexposures were ethylbenzene-xylene (1550 WS), quartz-cristobalite (1417 WS), and toluene-xylene (1305 WS). Prevalent combinations of carcinogens also included hexavalent chromium-lead (368 WS) and benzene-ethylbenzene (314 WS). Wood dust (6% of WS exposed to at least one other agent) and asbestos (8%) had the least amount of WS coexposed with other agents. Tasks with the highest proportions of coexposure to carcinogens include electric arc welding (37% of WS with coexposure), polymerization and distillation (34%), and construction drilling and excavating (34%). Overall, the coexposure to multiple chemical agents, including carcinogens, was highly prevalent in the databases, and should be taken into account when assessing exposure risks in the workplace.
Collapse
|
7
|
Modenese A, Loney T, Rocholl M, Symanzik C, Gobba F, John SM, Straif K, Silva Paulo M. Protocol for a Systematic Review on the Effectiveness of Interventions to Reduce Exposure to Occupational Solar UltraViolet Radiation (UVR) Among Outdoor Workers. Front Public Health 2021; 9:756566. [PMID: 34858932 PMCID: PMC8632259 DOI: 10.3389/fpubh.2021.756566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Solar UltraViolet Radiation (UVR) is considered the most relevant occupational carcinogenic exposure in terms of the number of workers exposed (i.e., outdoor workers) and UVR-induced skin cancers are among the most frequent types of occupational cancers worldwide. This review aims to collect and evaluate all the available preventive interventions conducted on outdoor workers to reduce their solar UVR related risk, with the final purpose of reducing the burden of occupational skin cancers for outdoor workers. Methods: We will search the following databases for peer-reviewed original research published: MEDLINE (through PubMed), Scopus, and EMBASE. We will include only interventional studies, both randomized and non-randomized, with an adequate comparison group, therefore excluding cross-sectional studies, as well as case-reports/series, reviews, and letters/comments. The systematic review will adhere to the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines for reporting systematic reviews. After the literature search, studies to be included will be independently reviewed by two Authors, first based on title and abstract, then based on the full text, according to the inclusion criteria. Conflicts will be solved by a third Author. Two authors will independently extract the required data from included studies and perform quality assessment according to the relevant domain for Risk of Bias assessment proposed by the Cochrane collaboration group. In case of sufficient homogeneity of interventions and outcomes evaluated, results from subgroups of studies will be pooled together in a meta-analysis. Discussion: Following the principles for the evaluation of interventions for cancer prevention established by the International Agency for Research on Cancer, this systematic review will investigate the effectiveness of the interventions, and consequently it will provide reliable indications for the actual reduction of skin cancer incidence in outdoor workers.
Collapse
Affiliation(s)
- Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Kurt Straif
- Instituto Salud Global (ISGlobal), Barcelona, Spain.,Department of Biology, Boston College, Chestnut Hill, MA, United States
| | - Marilia Silva Paulo
- Institute of Public Health - College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| |
Collapse
|