Estimation of incidence and social cost of colon cancer due to nitrate in drinking water in the EU: a tentative cost-benefit assessment

The Burden of Plastic Surgery Related Disease in Canada: A Perspective Based on the 2019 Global Burden of Disease Study

Purpose: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, inform policy, and generate support for research funding. Methods and Patients: Data on the burden of disease (ie, prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years [DALYs]), were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in Canadian dollars was calculated based on prior studies. Data are presented as either rates (per 100 000) or counts with the associated uncertainty interval. Results: In 2019, plastic surgery related conditions in Canada had an overall age-standardized DALY rate of 556 per 100 000 [463-664]. Of these conditions, breast cancer was responsible for approximately 50% of the overall burden of disease, with an age-standardized DALY rate of 268 per 100 000 [244-294] followed by squamous cell carcinoma (66 per 100 000 [45-94]) and thermal burns (61 per 100 000 [46-82]). Age-standardized incidence rates were highest for cellulitis (2654 per 100 000 [2502-2812]). Breast cancer had the highest age-standardized cost of care of all plastic surgery related diseases, at $5.1 billion, approximately half of the total age-standardized cost of $10.6 billion for included plastic surgery diseases. Conclusion: Plastic and reconstructive surgery related diseases, particularly breast cancer, thermal burns, and malignant melanoma, are responsible for a high burden of disease and significant cost to the Canadian healthcare system. These results will help guide national healthcare policy and should provide support to directing funding and research efforts toward impactful diseases facing the Canadian healthcare system.

Participatory modelling of scenarios to restore nitrogen cycles in a nutrient-saturated area

This paper aims to find socially acceptable solutions of circularity as measure to reduce nitrogen (N) losses and prevent environmental damage by combining participatory modelling and scenario Substance Flow Analyses (SFA). A local perspective was taken on the agro-food-waste system in the animal production-dominated German district Cleves. Three scenarios were programmed as Monte Carlo simulation of SFA with stakeholder input regarding crop allocation, livestock composition, livestock reduction, and manure allocation following the elimination of feed imports. The three scenarios either utilized the unaltered stakeholder input (PS), altered crop allocation to satisfy the demand for feed (CBS), or adjusted the livestock numbers to match the locally available feed (LBS). In the reference year (2020) agricultural losses amounted to 68 kg N year-1 ha-1 agricultural land and 116 kg N in feed was imported year-1 ha-1 agricultural land. In the PS feed import elimination led to deficits in feed availability. The LBS showed the biggest reduction of agricultural N losses and improved N use efficiency (+6 %), however agricultural losses were still high (50 kg N year-1 ha-1 agricultural land). The results show a limited effect of feed import elimination on N losses if no further measures are taken, such as reduced consumption of animal-based products. Further, the study shows that it is important to improve stakeholders' knowledge about approaches to circular agro-food-waste systems. The discrepancy between stakeholder visions and N circularity provide policy makers with the recommendation to improve stakeholders' visions of a circular agro-food-waste system.

Health-economic valuation of lowering nitrate standards in drinking water related to colorectal cancer in Denmark

Nitrate in drinking water is a contaminant which can affect human health and has been associated with an increased risk of, amongst other diseases, colorectal cancer. Based on epidemiologic data from Denmark on the association between drinking water nitrate and colorectal cancer, the health and economic consequences of lowering the standard of nitrate in drinking water from 50 mg/L to 9.25 mg/L and 3.87 mg/L, respectively are analyzed. The drinking water nitrate attributable number of cases was estimated using the risk in the exposed and unexposed population based on current nationwide exposure distributions. The analysis shows that a lower limit of 9.25 mg/L would decrease the annual number of colorectal cancer cases by 72 (95 % confidence interval: 34-114) and by an additional 55 (95 % CI: 10-100) for a stricter limit of 3.87 mg/L. The resulting avoided health-related costs are $179 million per year for the 9.25 mg/L nitrate limit and another $138 million per year for a further reduction to 3.87 mg/L nitrate. The new requirements would incur costs linked to either i) changes in land use management, ii) well reallocation or iii) use of treatment technologies. The additional costs are estimated to $0.03-1.84 per m3 abstracted water from public water companies, which together with costs for owners of private wells, will result in an average additional cost of $9 and $6 million per year for the two levels. The economic health benefits are higher than the costs for both limits with net gains of $170 million (9.25 mg/L) and additionally $132 million (3.87 mg/L) a year. Even in a worst-case scenario (lowest health-related benefits and highest mitigation costs), there is a likely economic gain for society from lowering the limit to 9.25 mg/L, but this might not be the case for the lower limit of 3.87 mg/L.

Managing nitrogen in maize production for societal gain

Highly productive agriculture is essential to feed humanity, but agricultural practices often harm human health and the environment. Using a nitrogen (N) mass-balance model to account for N inputs and losses to the environment, along with empirical based models of yield response, we estimate the potential gains to society from improvements in nitrogen management that could reduce health and environmental costs from maize grown in the US Midwest. We find that the monetized health and environmental costs to society of current maize nitrogen management practices are six times larger than the profits earned by farmers. Air emissions of ammonia from application of synthetic fertilizer and manure are the largest source of pollution costs. We show that it is possible to reduce these costs by 85% ($21.6 billion per year, 2020$) while simultaneously increasing farmer profits. These gains come from (i) managing fertilizer ammonia emissions by changing the mix of fertilizer and manure applied, (ii) improving production efficiency by reducing fertilization rates, and (iii) halting maize production on land where health and environmental costs exceed farmer profits, namely on low-productivity land and locations in which emissions are especially harmful. Reducing ammonia emissions from changing fertilizer types-in (i)-reduces health and environmental costs by 46% ($11.7 billion). Reducing fertilization rates-in (ii)-limits nitrous oxide emissions, further reducing health and environmental costs by $9.5 billion, and halting production on 16% of maize-growing land in the Midwest-in (iii)-reduces costs by an additional $0.4 billion.

Explaining vegetarian and vegan dietary behavior among U.S. and Dutch samples applying a reasoned action approach

The present research applied the framework of the Reasoned Action Approach (RAA) to investigate intention formation of adopting vegetarian and vegan diets among U.S. and Dutch samples. First, a belief elicitation study was carried out to determine salient beliefs regarding both dietary behaviors. The U.S. sample (N = 59) together provided a total of 551 beliefs (298 vegetarian, 253 vegan) and the Dutch sample (N = 30) 294 beliefs (171 vegetarian, 123 vegan). Second, a regression study determined which reasoned action variables—Attitude, Perceived Norm and Perceived Control—explained Intention to adopt a vegetarian or a vegan diet for two separate samples. For both samples RAA-variables explained Intention relatively well (i.e., between 30 and 43% of the variance). For U.S. participants (N = 204), Instrumental and Experiential Attitude were significant predictors of their Intention to have a vegetarian or a vegan diet. For Dutch participants (N = 345), Instrumental and Experiential Attitude and Descriptive Norm predicted Intention to adopt a vegetarian diet. For adopting a vegan diet, Experiential Attitude was the only predicting variable for the Dutch sample. Almost all salient beliefs collected in the belief elicitation study significantly correlated with Intention to adopt diet, regardless of which RAA-variable they belonged to. Based on our findings, we critically evaluate the use of RAA in explaining behavioral Intentions, especially for behavior with a strong social component. Moreover, we show the importance of—the often not employed—belief elicitation phase and as such, discourage using only a regression approach. From a societal perspective, we argue that there is a strong need for interventions if one wants to encourage behavior change in the field of vegetarianism and veganism as—amongst others—average Intention scores were very low. In addition, we show that while the U.S. and Dutch samples, sharing Western norms and values, often overlapped, they also differed in subtle—yet potentially important—ways when it comes to motivations and cognitions with regard to vegetarian and vegan dietary behavior. Hence, interventions may have to include different content in order to be effective for these seemingly similar target groups and target behaviors.

Prenatal nitrate exposure from diet and drinking water and timing of puberty in sons and daughters: A nationwide cohort study

BACKGROUND

In Western countries, age at pubertal development has declined during the last century in girls, and probably also in boys. No studies have investigated whether nitrate, a widespread environmental exposure with teratogenic and hormone disrupting properties, might affect timing of puberty.

OBJECTIVES

We investigated if prenatal exposure to nitrate from drinking water and diet was associated with timing of puberty.

METHODS

This cohort study included 15,819 children born from 2000 to 2003 within the Danish National Birth Cohort. Self-reported information on current status of various pubertal milestones was provided every six months by a questionnaire from 11 years of age until 18 years or full maturity, whichever came first. Maternal nitrate intake from diet (mg/day) was derived from a mid-pregnancy food frequency questionnaire and individual level nitrate exposure from drinking water (mg/L) was derived using measurements from Danish public waterworks. Adjusted average differences in months in age at attaining several pubertal milestones as well as the average age difference in age at attaining all the milestones were estimated separately for diet and water using a regression model for interval-censored data. C- and E-vitamin, red meat and processed meat intake were explored as potential effect modifiers in sub-analyses.

RESULTS

No strong associations were observed between prenatal exposure to nitrate and timing of puberty in children. However, sons born of mothers with a nitrate concentration in drinking water at their residential address of > 25 mg/L (half of the World Health Organisation (WHO) guideline value) compared with ≤ 1 mg/L showed a tendency towards earlier age at pubertal development with an average age difference of -1.2 months (95 % confidence interval,-3.0;0.6) for all the pubertal milestones combined.

DISCUSSION

Studies including more highly exposed children are needed before the current WHO drinking water guideline value for nitrate can be considered safe concerning pubertal development.

Association between nitrate concentration in drinking water and rate of colorectal cancer: a case study in northwestern Iran

Nitrate, as a major pollutant of drinking water, is associated with colorectal cancer (CRC) and serves as an environmental health concern, especially in the districts with unregulated agriculture. In this case study in northwestern Iran, we used two databases of nitrate concentration (1999-2013) and age-standardized incidence rate (ASR) for CRC (2002-2012) from 19 counties of East Azerbaijan province. The trend and correlation between nitrate and ASR was investigated. Inverse distance weighted technique was used to spatially interpolate the maps. Expectedly, drinking water nitrate has increased throughout the province (8-20.5 mg/L) as well as the ASR for CRC of men (from 2.07 to 18.05 mg/L) and women (from 1.57 to 10.94 mg/L). While ASR for CRC of men was positively correlated to nitrate (Pearson's r = 0.624, p-value = 0.040), no statistically significant correlation was found between nitrate and ASR for women's CRC (Pearson's r = 0.289, p-value = 0.351). According to our findings, the incidence of CRC was not higher for those residing in the regions with higher nitrate, suggesting that risk factors such as genetic predisposition and diet that were not taken into account could be determinants of this pattern. However, even a small increase in CRC rate due to water nitrate could translate into a large public health concern. The incremental pattern observed in nitrate levels of different counties over the years gives the health policymakers a better perspective of the problem and how the control of water nitrate level as a CRC risk factor might contribute to the prevention of CRC.

Nitrate in Drinking Water and Time to Pregnancy or Medically Assisted Reproduction in Women and Men: A Nationwide Cohort Study in the Danish National Birth Cohort

Purpose

No studies have investigated if drinking water nitrate affects human fecundity. Experimental studies point at detrimental effects on fetal development and on female and male reproduction. This cohort study aimed to explore if female and male preconception and long-term exposure to nitrate in drinking water was associated with fecundability measured as time to pregnancy (TTP) or use of medically assisted reproduction (MAR) treatment.

Methods

The study population consisted of pregnant women recruited in their first trimester in 1996–2002 to the Danish National Birth Cohort. Preconception drinking-water nitrate exposure was estimated for the pregnant women (89,109 pregnancies), and long-term drinking water nitrate exposure was estimated from adolescence to conception for the pregnant women (77,474 pregnancies) and their male partners (62,000 pregnancies) by linkage to the national drinking water quality-monitoring database Jupiter. Difference in risk of TTP >12 months or use of MAR treatment between five exposure categories and log-transformed continuous models of preconception and long-term nitrate in drinking water were estimated. Binominal regression models for risk ratios (RR) were adjusted for age, occupation, education, population density, and lifestyle factors.

Results

Nitrate in drinking water (median preconception exposure: 1.9 mg/L; median long-term exposure: 3.3 mg/L) was not associated with TTP >12 months or use of MAR treatment, neither in the categorical nor in the continuous models.

Conclusion

We found no association between preconception or long-term exposure to drinking water nitrate and fecundability.

Nitrate contamination in drinking water and colorectal cancer: Exposure assessment and estimated health burden in New Zealand

BACKGROUND

Epidemiological evidence in multiple jurisdictions has shown an association between nitrate exposure in drinking water and an increased risk of colorectal cancer (CRC).

OBJECTIVE

We aimed to review the extent of nitrate contamination in New Zealand drinking water and estimate the health and financial burden of nitrate-attributable CRC.

METHODS

We collated data on nitrate concentrations in drinking water for an estimated 85% of the New Zealand population (∼4 million people) who were on registered supplies. We estimated nitrate levels for the remaining population (∼600,000 people) based on samples from 371 unregistered (private) supplies. We used the effective rate ratio from previous epidemiological studies to estimate CRC cases and deaths attributable to nitrate in drinking water.

RESULTS

Three-quarters of New Zealanders are on water supplies with less than 1 mg/L NO₃-N. The population weighted average for nitrate exposure for people on registered supplies was 0.49 mg/L NO₃-N with 1.91% (95%CI 0.49, 3.30) of CRC cases attributable to nitrates. This correlates to 49.7 cases per year (95%CI 14.9, 101.5) at a cost of 21.3 million USD (95% 6.4, 43.5 million USD). When combining registered and unregistered supplies, we estimated 3.26% (95%CI 0.84, 5.57) of CRC cases were attributable to nitrates, resulting in 100 cases (95%CI 25.7, 171.3) and 41 deaths (95%CI 10.5, 69.7) at a cost of 43.2 million USD (95%CI 10.9, 73.4).

CONCLUSION

A substantial minority of New Zealanders are exposed to high or unknown levels of nitrates in their drinking water. Given the international epidemiological studies showing an association between cancer and nitrate ingestion from drinking water, this exposure may cause an important burden of preventable CRC cases, deaths, and economic costs. We consider there is sufficient evidence to justify a review of drinking water standards. Protecting public health adds to the strong environmental arguments to improve water management in New Zealand.

Reconciling regional nitrogen boundaries with global food security

While nitrogen inputs are crucial to agricultural production, excess nitrogen contributes to serious ecosystem damage and water pollution. Here, we investigate this trade-off using an integrated modelling framework. We quantify how different nitrogen mitigation options contribute to reconciling food security and compliance with regional nitrogen surplus boundaries. We find that even when respecting regional nitrogen surplus boundaries, hunger could be substantially alleviated with 590 million fewer people at risk of hunger from 2010 to 2050, if all nitrogen mitigation options were mobilized simultaneously. Our scenario experiments indicate that when introducing regional N targets, supply-side measures such as the nitrogen use efficiency improvement are more important than demand-side efforts for food security. International trade plays a key role in sustaining global food security under nitrogen boundary constraints if only a limited set of mitigation options is deployed. Policies that respect regional nitrogen surplus boundaries would yield a substantial reduction in non-CO₂ GHG emissions of 2.3 GtCO₂e yr^-1 in 2050, which indicates a necessity for policy coordination.

Governance and groundwater modelling: Hints to boost the implementation of the EU Nitrate Directive. The Lombardy Plain case, N Italy

The EU Nitrate Directive has been ruling for almost 30 years, nevertheless nitrate concentration in the Lombardy Plain did not decrease. Together with failures of management implementation, a possible cause for such field observations is that management actions were taken without adequately considering the actual hydrogeological dynamics. To consider this aspect, the paper presents a groundwater flow and transport numerical model of a specific area of the Lombardy Plain. The aim of this model is to demonstrate how modelling, as a management tool, can be useful in the governance process. The groundwater model, using well-known MODFLOW-MT3D codes, is based on existing hydrogeological information, while a nitrogen mass balance has been performed at municipal scale to determine the agricultural N surplus to the subsurface. The model adequately reproduces head levels and nitrate concentrations in observation wells for a 10-year simulation period, showing that 4.5% of the N annual input remains stored in the system. The model indicates the efficiency of rivers and springs to export N out from the system at an estimated rate of 77.5% of the annual N inputs. Back to governance, the model shows that management data at municipal level (e.g. irrigation rates, groundwater withdrawal, N net recharge) provide a satisfactory scale for successfully reproducing nitrate evolution. Hence those variables that can be object of debate during a governance process can be treated as input data to the numerical model. Therefore, backcasting exercises can be conducted to check whether the model outcome fits with the expected results of specific management actions. The model highlights how the N mass balance evolves, providing clues on which factors can be managed to reduce nitrate concentrations and meet the Directive's requirements. Numerical groundwater models, as an option to address water management issues, ultimately contribute to solve the information and capacity governance gaps.

Health and economic impact of nitrate pollution in drinking water: a Wisconsin case study

Nitrate contamination of drinking water, common in agricultural areas, increases the risk of certain cancers and impacts fetal development during pregnancy. Building on previously published methodology, this study evaluates nitrate-attributable disease cases and adverse birth outcomes as well as their economic costs for Wisconsin, USA. Nitrate is the most common contaminant in groundwater in Wisconsin. Two-thirds of the state's residents use groundwater as the primary source of drinking water. Here, we analyze nitrate exposure from drinking water in Wisconsin based on nitrate test results for community water systems for the period of 2010-2017 and a novel methodology for estimating nitrate exposure for the 28% of state's residents who use private wells. We estimate that annually, 111-298 combined cases of colorectal, ovarian, thyroid, bladder, and kidney cancer in Wisconsin may be due to nitrate contamination of drinking water. Each year, up to 137-149 cases of very low birth weight, 72-79 cases of very preterm birth, and two cases of neural tube defects could be due to nitrate exposure from drinking water. The direct medical cost estimates for all nitrate-attributable adverse health outcomes range between $23 and $80 million annually. Simulating targeted reductions in the counties with the highest current drinking water nitrate concentrations resulted in similar reductions in adverse health outcomes as statewide reduction efforts, up to nitrate reductions of 20%. Time trend analysis suggests that groundwater nitrate concentrations are overall increasing. Thus, nitrate contamination of water supplies in Wisconsin is a public health problem that needs to be addressed.

Association between Drinking Water Nitrate and Adverse Reproductive Outcomes: A Systematic PRISMA Review

One in six couples experience fertility problems. Environmental factors may affect reproductive health; however, evidence is lacking regarding drinking water nitrates and outcomes of male and female fertility. The aim of this study was to investigate if exposure to nitrates in drinking water is associated with adverse reproductive outcomes in humans, and animals of fertile age. We conducted a systematic literature search and included case-control studies, cohort studies, and randomized control trials reporting on the association between drinking water nitrate exposure of men, women, or animals and adverse reproductive outcomes, specified as: Semen quality parameters, time to pregnancy (TTP), pregnancy rates, assisted reproductive technologies (ART), and spontaneous abortion. Findings were reported in a narrative synthesis. A total of 12 studies were included. The only human study included reported a decrease in spontaneous abortion at any detectable nitrate level. Overall, the 11 included animal studies support a potential negative effect on semen quality parameters but report equivocal results on TTP and number of offspring produced, and higher risk of spontaneous abortion. In conclusion, animal studies indicate possible effects on semen quality parameters and spontaneous abortion. However, with a few studies, including some with methodological limitations and small sample sizes, caution must be applied when interpreting these results.

Exposure-based assessment and economic valuation of adverse birth outcomes and cancer risk due to nitrate in United States drinking water

BACKGROUND

Nitrate ingestion from drinking water has been associated with an increased risk of adverse birth outcomes as well as elevated risk of colorectal cancer and several other cancers. Yet, to date, no studies have attempted to quantify the health and economic impacts due to nitrate in drinking water in the United States.

METHODS

This study presents a first-of-its-kind comprehensive assessment of nitrate exposure from drinking water for the entire United States population. This exposure assessment serves as the basis for our analysis of the annual nitrate-attributable disease cases in the United States and the associated economic losses due to medical costs and lost productivity. Additionally, through a meta-analysis of studies on drinking water nitrate and colorectal cancer, we examine the exposure-response relationship for nitrate and cancer risk.

RESULTS

On the basis of national nitrate occurrence data and relative risk ratios reported in the epidemiology literature, we calculated that annually, 2939 cases of very low birth weight, 1725 cases of very preterm birth, and 41 cases of neural tube defects could be related to nitrate exposure from drinking water. For cancer risk, combining nitrate-specific risk estimates for colorectal, ovarian, thyroid, kidney, and bladder cancers results in a range of 2300 to 12,594 annual nitrate-attributable cancer cases (mean: 6537 estimated cases). For medical expenditures alone, this burden of cancer corresponds to an annual economic cost of 250 million to 1.5 billion U.S. dollars, together with a potential 1.3 to 6.5 billion dollar impact due to lost productivity. With the meta-analysis of eight studies of drinking water nitrate and colorectal cancer, we observed a statistically significant positive association for nitrate exposure and colorectal cancer risk and calculated a one-in-one million cancer risk level of 0.14 mg/L nitrate in drinking water.

CONCLUSION

Health and economic analyses presented here suggest that lowering exposure to nitrate in drinking water could bring economic benefits by alleviating the impacts of nitrate-associated diseases.

Nitrate trends in groundwater of the Campania region (southern Italy)

The Environmental Protection Agency of the Campania region in Italy (ARPAC) manages a groundwater quality monitoring network. For almost all the polluted waters, the key parameter driving the classification is the concentration of nitrate; hence, the Campania region, in coherence with the EU regulations, outlined the vulnerable areas and undertook remediation policies. The best groundwater quality is recorded for carbonate aquifers of the Apennine chain; on the contrary, the Tyrrhenian coastal plains are affected by severe contamination, with a locally very contaminated groundwater of the shallow and also the deeper aquifers. The study is especially focused on a large coastal plain of Campania region, where nitrate concentration sometimes exceeds 200 mg/L. The study, based on almost 200 sampling points for the whole region during the period 2003-2015 (approx two samples per year), verified the effectiveness of the groundwater monitoring network, the present distribution of nitrate in groundwater, and the evolution of nitrate trends at different scales: regional, groundwater body, and single well, using spatial and time series statistical approaches. Significant variations in contamination evolution within the study area have been observed and the correlation with land use has been highlighted.

Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.

Assessing the Social and Environmental Costs of Institution Nitrogen Footprints

This article estimates the damage costs associated with the institutional nitrogen (N) footprint and explores how this information could be used to create more sustainable institutions. Potential damages associated with the release of nitrogen oxides (NOx), ammonia (NH₃), and nitrous oxide (N₂O) to air and release of nitrogen to water were estimated using existing values and a cost per unit of nitrogen approach. These damage cost values were then applied to two universities. Annual potential damage costs to human health, agriculture, and natural ecosystems associated with the N footprint of institutions were $11.0 million (2014) at the University of Virginia (UVA) and $3.04 million at the University of New Hampshire (UNH). Costs associated with the release of nitrogen oxides to human health, in particular the use of coal-derived energy, were the largest component of damage at UVA. At UNH the energy N footprint is much lower because of a landfill cogeneration source, and thus the majority of damages were associated with food production. Annual damages associated with release of nitrogen from food production were very similar at the two universities ($1.80 million vs. $1.66 million at UVA and UNH, respectively). These damages also have implications for the extent and scale at which the damages are felt. For example, impacts to human health from energy and transportation are generally larger near the power plants and roads, while impacts from food production can be distant from the campus. Making this information available to institutions and communities can improve their understanding of the damages associated with the different nitrogen forms and sources, and inform decisions about nitrogen reduction strategies.

Reducing Nitrogen Pollution while Decreasing Farmers' Costs and Increasing Fertilizer Industry Profits

Nitrogen (N) pollution is emerging as one of the most important environmental issues of the 21st Century, contributing to air and water pollution, climate change, and stratospheric ozone depletion. With agriculture being the dominant source, we tested whether it is possible to reduce agricultural N pollution in a way that benefits the environment, reduces farmers' costs, and increases fertilizer industry profitability, thereby creating a "sweet spot" for decision-makers that could significantly increase the viability of improved N management initiatives. Although studies of the economic impacts of improved N management have begun to take into account farmers and the environment, this is the first study to consider the fertilizer industry. Our "sweet spot" hypothesis is evaluated via a cost-benefit analysis of moderate and ambitious N use efficiency targets in U.S. and China corn sectors over the period 2015-2035. We use a blend of publicly available crop and energy price projections, original time-series modeling, and expert elicitation. The results present a mixed picture: although the potential for a "sweet spot" exists in both countries, it is more likely that one occurs in China due to the currently extensive overapplication of fertilizer, which creates a greater potential for farmers and the fertilizer industry to gain economically from improved N management. Nevertheless, the environmental benefits of improving N management consistently dwarf the economic impacts on farmers and the fertilizer industry in both countries, suggesting that viable policy options could include incentives to farmers and the fertilizer industry to increase their support for N management policies.

Health Impact Assessment and Evaluation of a Clinical Waste Management Policy for Cameroon

Health impact assessment (HIA) was carried out to evaluate development of a clinical waste management policy for Cameroon. Fifteen stakeholders of different portfolios within the health sector were selected during a HIA initiating study trip to the Northwest region of Cameroon. Questionnaires were then developed and emailed to the stakeholders. The stakeholders identified cross-contamination, environmental pollution, physical injuries and poor waste management sites as potential risk factors that can be associated with poor clinical waste management. They recommended strong economic and political capital as a prerequisite for the development and implementation of a successful clinical waste policy. Local impacts on health, according to the stakeholders, should be prioritized in deciding any treatment and disposal option. The whole HIA process run through 2008-2010.

Enzymology and ecology of the nitrogen cycle

The nitrogen cycle describes the processes through which nitrogen is converted between its various chemical forms. These transformations involve both biological and abiotic redox processes. The principal processes involved in the nitrogen cycle are nitrogen fixation, nitrification, nitrate assimilation, respiratory reduction of nitrate to ammonia, anaerobic ammonia oxidation (anammox) and denitrification. All of these are carried out by micro-organisms, including bacteria, archaea and some specialized fungi. In the present article, we provide a brief introduction to both the biochemical and ecological aspects of these processes and consider how human activity over the last 100 years has changed the historic balance of the global nitrogen cycle.