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Rothenberg SE. Invited Perspective: Linking the Intergenerational Impacts due to Mercury Exposure in Grassy Narrows First Nation, Canada. Environ Health Perspect 2023; 131:71301. [PMID: 37466318 PMCID: PMC10355146 DOI: 10.1289/ehp12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Sarah E Rothenberg
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Mergler D, Philibert A, Fillion M, Da Silva J. The Contribution across Three Generations of Mercury Exposure to Attempted Suicide among Children and Youth in Grassy Narrows First Nation, Canada: An Intergenerational Analysis. Environ Health Perspect 2023; 131:77001. [PMID: 37466317 PMCID: PMC10355150 DOI: 10.1289/ehp11301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND For 60 y, the people of Asubpeeschoseewagong Anishinabek (Grassy Narrows First Nation) have endured the effects of massive mercury (Hg) contamination of their river system, central to their traditions, culture, livelihood, and diet. In the years following the Hg discharge into the English-Wabigoon River system by a chloralkali plant in the early 1970s, there was a dramatic increase in youth suicides. Several authors attributed this increase solely to social disruption caused by the disaster. OBJECTIVE This research examined the possible contribution of Hg exposure across three generations on attempted suicides among today's children (5-11 y old) and youth (12-17 y old), using a matrilineal intergenerational paradigm. METHODS Information from the 2016-2017 Grassy Narrows Community Health Assessment (GN-CHA) survey was merged with Hg biomonitoring data from government surveillance programs (1970-1997). Data from 162 children/youth (5-17 years of age), whose mothers (n=80) had provided information on themselves, their parents, and children, were retained for analyses. Direct and indirect indicators of Hg exposure included a) grandfather had worked as a fishing guide, and b) mother's measured and estimated umbilical cord blood and childhood hair Hg and her fish consumption during pregnancy with this child. Structural equation modeling (SEM) was used to examine significant links from grandparents (G0) to mothers' exposure and mental health (G1) and children/youth (G2) risk for attempted suicide. RESULTS Mothers' (G1) median age was 33 y, 86.3% of grandmothers (G0) had lived in Grassy Narrows territory during their pregnancy, and 52.5% of grandfathers (G0) had worked as fishing guides. Sixty percent of children (G2) were <12 years of age. Mothers reported that among teenagers (G2: 12-17 years of age), 41.2% of girls and 10.7% of boys had ever attempted suicide. The SEM suggested two pathways that significantly linked grandparents (G0) to children's (G2) attempted suicides: a) through mothers' (G1) prenatal and childhood Hg exposure and psychological distress, and b) through maternal fish consumption during pregnancy (G1/G2), which is an important contributor to children's emotional state and behavior. DISCUSSION Despite minimal individual information on G0 and G1 past life experiences, the findings support the hypothesis that Hg exposure over three generations contributes to the mental health of today's children and youth. The prevalence of Grassy Narrows youth ever having attempted suicide is three times that of other First Nations in Canada. https://doi.org/10.1289/EHP11301.
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Affiliation(s)
- Donna Mergler
- Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Aline Philibert
- Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Myriam Fillion
- Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement, Université du Québec à Montréal, Montréal, Québec, Canada
- Département Science et Technologie, Université TÉLUQ, Montréal, Québec, Canada
| | - Judy Da Silva
- Grassy Narrows First Nation, Grassy Narrows, Ontario, Canada
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Tousignant B, Chatillon A, Philibert A, Da Silva J, Fillion M, Mergler D. Visual Characteristics of Adults with Long-Standing History of Dietary Exposure to Mercury in Grassy Narrows First Nation, Canada. Int J Environ Res Public Health 2023; 20:4827. [PMID: 36981736 PMCID: PMC10049103 DOI: 10.3390/ijerph20064827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Since the 1960s, Grassy Narrows First Nation (Ontario, Canada) has been exposed to methyl mercury (Hg) through fish consumption, resulting from industrial pollution of their territorial waters. This cross-sectional study describes the visual characteristics of adults with documented Hg exposure between 1970 and 1997. Oculo-visual examinations of 80 community members included visual acuity, automated visual fields, optical coherence tomography [OCT], color vision and contrast sensitivity. Median age was 57 years (IQR 51-63) and 55% of participants were women. Median visual acuity was 0.1 logMAR (Snellen 6/6.4; IQR 0-0.2). A total of 26% of participants presented a Visual Field Index inferior to 62%, and qualitative losses assessment showed concentric constriction (18%), end-stage concentric loss (18%), and complex defects (24%). On OCT, retinal nerve fiber layer scans showed 74% of participants within normal/green range. For color testing with the Hardy, Rand, and Rittler test, 40% presented at least one type of color defect, and with the Lanthony D-15 test, median color confusion index was 1.59 (IQR 1.33-1.96). Contrast sensitivity showed moderate loss for 83% of participants. These findings demonstrate important loss of visual field, color vision, and contrast sensitivity in older adults in a context of long-term exposure to Hg in Grassy Narrows First Nation.
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Affiliation(s)
- Benoit Tousignant
- School of Optometry, Université de Montréal, 3744 Jean-Brillant, Montreal, QC H3T 1P1, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada
| | - Annie Chatillon
- School of Optometry, Université de Montréal, 3744 Jean-Brillant, Montreal, QC H3T 1P1, Canada
| | - Aline Philibert
- Centre de Recherche Interdisciplinaire sur le Bien-être, la Santé, la Société et L’environnement (Cinbiose), Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada
| | - Judy Da Silva
- Grassy Narrows First Nation, General Delivery, Grassy Narrows, ON P0X 1B0, Canada
| | - Myriam Fillion
- Centre de Recherche Interdisciplinaire sur le Bien-être, la Santé, la Société et L’environnement (Cinbiose), Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada
- Département Science et Technologie, Université TÉLUQ, 5800, Rue Saint-Denis, Bureau 1105, Montréal, QC H2S 3L5, Canada
| | - Donna Mergler
- Centre de Recherche Interdisciplinaire sur le Bien-être, la Santé, la Société et L’environnement (Cinbiose), Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC H3C 3P8, Canada
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Guo X, Su W, Li N, Song Q, Wang H, Liang Q, Li Y, Lowe S, Bentley R, Zhou Z, Song EJ, Cheng C, Zhou Q, Sun C. Association of urinary or blood heavy metals and mortality from all causes, cardiovascular disease, and cancer in the general population: a systematic review and meta-analysis of cohort studies. Environ Sci Pollut Res Int 2022; 29:67483-67503. [PMID: 35917074 DOI: 10.1007/s11356-022-22353-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Amounting epidemiological evidence has shown detrimental effects of heavy metals on a wide range of diseases. However, the effect of heavy metal exposure on mortality in the general population remains unclear. The primary objective of this study was to clarify the associations between heavy metals and mortality from all causes, cardiovascular disease (CVD), and cancer based on prospective studies. We comprehensively searched Pubmed, Embase, and Web of Science electronic databases to identify studies published from their inception until 1 March 2022. Investigators identified inclusion criteria, extracted study characteristics, and assessed the methodological quality of included studies according to standardized guidelines. Meta-analysis was conducted if the effect estimates of the same outcome were reported in at least three studies. Finally, 42 original studies were identified. The results of meta-analysis showed that cadmium and lead exposure was significantly associated with mortality from all causes, CVD, and cancer in the general population. Moderate evidence suggested there was a link between arsenic exposure and mortality. The adverse effects of mercury and other heavy metals on mortality were inconclusive. Epidemiological evidence for the joint effect of heavy metal exposure on mortality was still indeterminate. In summary, our study provided compelling evidence that exposure to cadmium, lead, and arsenic were associated with mortality from all causes, CVD, and cancer, while the evidence on other heavy metals, for example mercury, was insignificant or indeterminate. Nevertheless, further prospective studies are warranted to explore the joint effects of multiple metal exposure on mortality.
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Affiliation(s)
- Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Qiwei Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China
| | - Yaru Li
- Internal Medicine, Swedish Hospital, 5140 N California Ave, Chicago, IL, 60625, USA
- College of Osteopathic Medicine, Des Moines University, 3200 Grand Ave, Des Moines, IA, 50312, USA
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, TAS, 7000, Australia
| | - Evelyn J Song
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Ce Cheng
- The University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ, 85724, USA
- Banner-University Medical Center South, 2800 E Ajo Way, Tucson, AZ, 85713, USA
| | - Qin Zhou
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA.
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Philibert A, Fillion M, Da Silva J, Lena TS, Mergler D. Past mercury exposure and current symptoms of nervous system dysfunction in adults of a First Nation community (Canada). Environ Health 2022; 21:34. [PMID: 35292021 PMCID: PMC8925187 DOI: 10.1186/s12940-022-00838-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/08/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND The watershed in Asubpeeschoseewagong Netum Anishinabek (Grassy Narrows First Nation) territory has been contaminated by mercury (Hg) since 1962, resulting in very high Hg concentrations in fish, central to the community's culture, traditions, economy and diet. Biomarkers of Hg exposure (umbilical cord blood and hair/blood samples), monitored between 1970 and 1997, decreased over time. A recent Grassy Narrows Community Health Assessment (GN-CHA) survey included current symptoms of nervous system dysfunction. The present study aimed to cluster self-reported symptoms and examine their associations with past Hg exposure. METHODS The GN-CHA included 391 adults. Symptom clustering used a two-step segmentation approach. Umbilical cord Hg and/or yearly measurements of equivalent hair Hg were available for 242 participants. Structural Equation Models (SEM) displayed the associations between Hg exposure and clusters, with Hg exposure modelled as a latent variable or in separate variables (prenatal, childhood and having had hair Hg ≥ 5 μg/g at least once over the sampling period). Longitudinal Mixed Effects Models (LMEM) served to examine past hair Hg with respect to clusters. RESULTS A total of 37 symptoms bonded into 6 clusters, representing Extrapyramidal impairment, Sensory impairment, Cranial nerve disturbances, Gross motor impairment, Neuro-cognitive deficits and Affect/Mood disorders. Median Hg concentrations were 5 μg/L (1-78.5) and 1.1 μg/g (0.2-16) for umbilical cord and childhood hair, respectively. More than one-third (36.6%) had hair Hg ≥ 5 μg/g at least once. In SEM, latent Hg was directly associated with Extrapyramidal and Sensory impairment, Cranial nerve disturbances and Affect/Mood disorders. Direct associations were observed for prenatal exposure with Affect/Mood disorders, for childhood exposure with Extrapyramidal impairment and Cranial nerve disturbances, and for hair Hg ≥ 5 μg/g with Extrapyramidal and Sensory impairment. For all clusters, a further association between past Hg exposure and symptom clusters was mediated by diagnosed nervous system disorders. LMEM showed higher past hair Hg among those with higher scores for all clusters, except Affect/Mood disorders. CONCLUSION Our findings provide evidence that in this First Nation community, past Hg exposure from fish consumption was associated with later-life clusters of coexisting symptoms of nervous system dysfunction.
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Affiliation(s)
- Aline Philibert
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada
| | - Myriam Fillion
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada
- Département Science et Technologie, Université TÉLUQ, 5800 Saint Denis St, Montréal, Québec, H2S 3L4, Canada
| | - Judy Da Silva
- Grassy Narrows First Nation, General Delivery, P0X 1B0, Grassy Narrows, Ontario, Canada
| | | | - Donna Mergler
- Université du Québec à Montréal, Centre de recherche interdisciplinaire sur le bien-être, la santé, la société et l'environnement (Cinbiose), CP 8888, Succ. Centreville, Montréal, Québec, H3C 3P8, Canada.
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Dack K, Fell M, Taylor CM, Havdahl A, Lewis SJ. Prenatal Mercury Exposure and Neurodevelopment up to the Age of 5 Years: A Systematic Review. Int J Environ Res Public Health 2022; 19:ijerph19041976. [PMID: 35206164 PMCID: PMC8871549 DOI: 10.3390/ijerph19041976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Neurodevelopmental delays can interfere with children’s engagement with the world and further development, and may have negative consequences into adulthood. Mercury is highly toxic and may negatively influence neurodevelopment because it can freely cross the placenta and accumulate in the fetal brain. We searched four publication databases (Embase, PsycINFO, PubMed/MEDLINE, Scopus) for studies examining the relationship between early life mercury exposure and scores on neurodevelopmental performance measures in children aged 0 to 5 years old. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Thirty-two prospective studies were included in the review. Neurodevelopmental performance was measured using 23 different scales, most commonly the Bayley Scales of Infant and Toddler Development (BSID). In most cases, the evidence for an association between mercury and neurodevelopment was weak. There did not appear to be exceptions for particular childhood ages, outcome scales, or mercury levels. The small number of results to the contrary were more likely to be studies which did not meet our high-quality criteria, and could be a consequence of multiple testing, selection bias, or incomplete confounder adjustment. Based on current evidence, dietary mercury exposure during pregnancy is unlikely to be a risk factor for low neurodevelopmental functioning in early childhood.
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Affiliation(s)
- Kyle Dack
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1TH, UK
- Correspondence:
| | - Matthew Fell
- Cleft Collective, University of Bristol, Bristol BS8 1TH, UK;
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK;
| | - Alexandra Havdahl
- Department of Mental Disorders, Norwegian Institute of Public Health, 0213 Oslo, Norway;
- Nic Waals Institute, Lovisenberg Diaconal Hospital, 0853 Oslo, Norway
| | - Sarah J. Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK;
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Joshee L, Kiefer A, Seney C, Matta KE, Orr SE, Bridges CC. Prophylactic supplementation with selenium alters disposition of mercury in aged rats. Exp Gerontol 2021; 149:111289. [PMID: 33741456 DOI: 10.1016/j.exger.2021.111289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/23/2022]
Abstract
Mercury (Hg) is a prevalent environmental toxicant to which older individuals are particularly susceptible. Selenium (Se) has been used as an antidote following exposure to Hg. However, little is known about the effect of prophylactic supplementation with Se on the handling of Hg. The current study was designed to test the hypothesis that oral pre-treatment with Se alters the corporal disposition of Hg and reduces the risk of Hg-induced toxicity. Young and aged rats were gavaged for 10 days with sodium selenite or saline. On day 11, rats were injected intravenously with 0.5 μmol HgCl2·kg-1·2 mL-1 normal saline. After 24 h, rats were euthanized and organs and tissues were harvested for determination of Hg content. Accumulation of Hg in the kidney was reduced significantly by pre-treatment with Se in both young and aged rats. In the renal cortex, the magnitude of the reduction was greater in aged rats than in young rats but in the outer stripe of the outer medulla, the magnitude of the reduction was similar between groups of rats. Urinary excretion of Hg was also reduced in rats pre-treated with Se. In contrast, the hepatic and hematologic burden of Hg increased in rats pre-treated with Se. Fecal excretion of Hg was decreased significantly by pre-treatment with Se in young rats but not in aged rats. These data suggest that prophylactic supplementation with Se alters the corporal disposition of Hg in a way that may reduce Hg-induced toxicity in target organs.
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Martin JW. Revisiting old lessons from classic literature on persistent global pollutants : This article belongs to Ambio's 50th Anniversary Collection. Theme: Environmental contaminants. Ambio 2021; 50:534-538. [PMID: 33464461 PMCID: PMC7814521 DOI: 10.1007/s13280-020-01413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 05/06/2023]
Abstract
Looking back 50 years at classic literature was a reminder of inspiring discoveries and clever theories that were formative to the field of environmental chemistry, but also of the irreparable costs that persistent global pollutants have had on ecosystems and human society. In my view, these three papers have greatly impacted contemporary science and influenced development of policies that have limited the spread of hazardous contaminants. At the same time, a sobering reality is that reversing decades of past pollution has proven impossible in our lifetime, and global trends are dire for both legacy and emerging contaminants. Lessons in these papers are clear to most environmental scientists, but I argue have not resulted in adequate investment in infrastructure or manpower to enable systematic unbiased searching for pollutants as proposed by Sören Jensen in 1972. Acknowledging that the costs of new global contaminants will be too high, we must incentivize safer chemicals and their sustainable use, increase international exchange of lists of chemicals in commerce, and coordinate international efforts in nontarget screening to identify new contaminants before they circulate the world.
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Affiliation(s)
- Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Science, Stockholm University, 106 91, Stockholm, Sweden.
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Rudd JW, Kelly CA, Sellers P, Flett RJ, Townsend BE. Why the English–Wabigoon river system is still polluted by mercury 57 years after its contamination. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Between 1962 and 1969, 10 tonnes of mercury were discharged from a chlor-alkali plant in Dryden, Ontario, to the English–Wabigoon River. Present-day fish mercury concentrations are amongst the highest recorded in Canada. In 2017, the Grassy Narrows Science Team found no evidence of ongoing discharges from the plant site to the river water, even though large quantities of mercury remain at the site. Instead, our data suggest that ongoing erosion of high mercury particles by the river, as it meanders through contaminated floodplains, is responsible for present-day transport of mercury to Clay Lake and to Ball Lake, located 154 km downstream. In Clay Lake, surface sediment total mercury concentrations and inflow water concentrations are still about 15 times above background (86 km downstream), and in Ball Lake mercury concentrations in sediments appeared to be still increasing. The remobilization of legacy inorganic mercury from riverbank erosion between Dryden and Clay Lake stimulates methyl mercury production there, in Clay Lake, and in Ball Lake. The large quantities of methyl mercury produced between Dryden and Clay Lake are mostly dissolved in water and are swept downstream, elevating concentrations in water and biota throughout the system. Several options for remediating the ongoing contamination are discussed.
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Affiliation(s)
- John W.M. Rudd
- R & K Research Inc., Salt Spring Island, BC V8K 2J3, Canada
| | - Carol A. Kelly
- R & K Research Inc., Salt Spring Island, BC V8K 2J3, Canada
| | - Patricia Sellers
- Biology Department, University of North Carolina at Pembroke, Pembroke, NC 28372, United States
| | - Robert J. Flett
- Flett Research Ltd., 440 Desalaberry Ave., Winnipeg, MB R2L 0Y7, Canada
| | - Bruce E. Townsend
- BEAT Environmental Inc., 23 Dunraven Ave., Winnipeg, MB R2M 0H3, Canada
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