TIME |
PRESENTATION TITLE |
EXPERT PANEL DISCUSSION POINTS |
SPEAKER(S) |
Day 1
8:10 a.m.–12:30 p.m. |
Lay the groundwork for the workshop, including welcome, purpose, goals, structure, general background on chemical and nonchemical stressors, and cardiovascular disease (CVD) causes and risk factors/buffers; discuss potential approaches for stressor identification and causality. |
| 7:50 a.m.–8:10 a.m. |
Registration |
| 8:10 a.m.–8:20 a.m. |
Welcome – The purpose of the workshop is to:
(1) identify and vet methods for integrating chemical and non-chemical stressors that could be presented in the Cumulative Risk Assessment (CRA) Guidelines for use by EPA;
(2) focus on human health and methods for stressor identification and causal analysis; and
(3) use a specific disease endpoint (i.e., CVD) to identify relevant stressors, illustrate methods and discuss their utility from the areas of the medical sciences, epidemiology, ecology, spatial analysis, chemical mixtures and toxicology. |
Ed Ohanian, Chair
EPA Risk Assessment Forum
Glenn Paulson,
EPA Science Advisor |
| 8:20 a.m.–8:50 a.m. |
Differences in Assessing Chemical vs. Non-Chemical Stressors: Addressing Chemical, Physical, Biological and Socio-Economic Factor Differences in Exposure, Health Effects, Dose-Response and Risk Analysis Approaches |
Rick Hertzberg,
Biomathematics Consulting |
8:50 a.m.–9:10 a.m. |
Epidemiological Approaches for CRA – Directed Acyclic Graphs |
Lucas Neas,
EPA/NHEERL |
| 9:10 a.m.–9:30 a.m. |
Epidemiological Approaches for CRA – Multilevel Modeling |
Sara Adar,
University of Michigan |
9:30 a.m–10:10 a.m. |
CVD Etiology: The Strength and Weight of Evidence of Known and Hypothesized Causes and Risk Factors, Including How These Relate to the Underlying Biology of CVD, and How Disparate Causes and Risk Factors Are Identified and Quantified. |
Jesus Araujo,
University of California,
Los Angeles (UCLA) |
| 10:10 a.m.–10:30 a.m. |
Break |
| 10:30 a.m.–10:50 a.m. |
A Conceptual Model for CRA Using CVD as an Example and the Role of Ecosystem Services as Pertaining to CVD |
Charlie Menzie,
Exponent |
| 10:50 a.m.–12:30 p.m. |
Expert Panel (and discussion with audience) |
Discussion of CVD stressor identification, causality and linkages with population characteristics and ecosystem services, building on the conceptual model(s) that were presented. Using CVD as an example:
- Given the risk factors identified earlier, how strong are the causal links between CVD and the identified chemical and non-chemical stressors. Would you make any changes to the conceptual model?
- What are the key sources of etiologic uncertainty in delineating components of the CVD causal pie?
- How can we identify contributions to CVD from socio-economic factors in a given community, especially those which may be just markers of other causal factors?
- What aspects of ecosystem services are important to identifying independent contributions toward or buffers against CVD risk for various stressors?
|
Lorenz Rhomberg
(Facilitator),
Gradient Corporation
Tom Luben,
EPA/NCEA
Laura Jackson,
EPA/NHEERL
June Dunnick,
NIH/NIEHS
Lucas Neas,
EPA/NHEERL
Jesus Araujo,
UCLA
Charlie Menzie,
Exponent
|
| 12:30 p.m.–1:30 p.m. |
Lunch |
Day 1
1:30 p.m.–5:30 p.m. |
Discussion of how to link and group stressors associated with CVD, use of exposure and toxicity data, and computer algorithms |
| 1:30 p.m.–2:00 p.m. |
Combining Stressors by Common Exposures and Toxicity or Health Effect |
Glenn Rice,
EPA/NCEA |
| 2:00 p.m.–2:25 p.m. |
The Use of Geographic Information Systems (GIS) Data, Spatial Data and National Databases for Multiple Stressors/Health Risks Assessment: Potentials and Pitfalls: How Are/Should Geospatial Data Be Used in Different Types of Assessment at Different Scales? How Can They Be Used to Identify Co-Occurrence of Stressors and Possible Interactions? |
Liem Tran,
University of Tennessee |
| 2:25 p.m.–2:55 p.m. |
Systematically Linking Environmental Factors to Disease States: Environment-Wide Association: Data-Driven Informatics Methods to Connect Environmental and Genetic Factors to Multiple Diseases and Phenotypes. Use of Manhattan Plots and Graphs for Visualization of Large-Dimensioned Data. (10 minutes for questions) |
Chirag Patel,
Stanford University,
(Remote) |
| 2:55 p.m.–3:15 p.m. |
Break
|
| 3:15 p.m.–5:20 p.m. |
Expert Panel (and discussion with audience) |
Discussion of assessment of multiple stressor “exposures” and toxicity, ways to form stressor groups, and use of GIS and other computer algorithms to inform stressor links and groupings. Using CVD as an example:
- How should different types of chemical and non-chemical stressors be identified, linked, grouped and characterized, including consideration of exposure and toxicity/health effects information?
- How can total disease burden (e.g., CVD) be measured—and identified causes partitioned—with available/new tools?
- What are the pros and cons of these approaches that map, group, link or diagram multiple stressors, including scientific and policy issues?
|
Lorenz Rhomberg (Facilitator),
Gradient Corporation
Dean Jones,
Emory University
Amanda Evans,
EPA Fellow
Jane Ellen Simmons, EPA/NHEERL
Tim Barzyk,
EPA/NERL
Deborah Cory-Slechta, University of Rochester
Jesus Araujo,
University of California, Los Angeles (UCLA)
Liem Tran,
University of Tennessee
Glenn Rice,
EPA/NCEA |
| 5:20 p.m.–5:30 p.m. |
Review of Agenda for Day 2 and Meeting Logistics |
Lorenz Rhomberg
(Facilitator),
Gradient Corporation |
Day 2
8:00 a.m.–12:00 p.m. |
Discussion of the CVD endpoint and how to analyze it in relation to combinations of stressors |
| 8:00 a.m.–8:35 a.m. |
Recap of Day 1: Discussion of Day 1 Presentations, Discussions and Conclusions |
Lorenz Rhomberg
(Facilitator),
Gradient Corporation
Workshop Leads |
| 8:35 a.m.–9:05 a.m. |
Adapting Chemical Mixture Risk Assessment Methods to Assess Chemical and Non-Chemical Stressor Combinations: Are There Chemical Mixtures Risk Assessment Methods Appropriate for Examining Risks Posed by Non-Chemical Stressors? |
Linda Teuschler,
EPA/NCEA |
| 9:05 a.m.–9:20 a.m. |
Multicity Epidemiologic Studies: What Information Could be Used in a Cumulative Risk Assessment? (An Example in Air Pollution-Related Mortality) |
Jason Sacks,
EPA/NCEA |
| 9:20 a.m.–9:40 a.m. |
Moving Toward a Characterization of Cumulative Risk: The Example of Local-Scale Health Impact Assessments of Air Pollution |
Neal Fann,
EPA/OAR |
| 9:40 a.m.–9:55 a.m. |
Break |
| 9:55 a.m.–11:50 a.m. |
Expert Panel (and discussion with audience) |
Discussion of different stressor group contributions to dose-response assessments and health risk characterization. Using CVD as an example:
- How can data on effect measure modification or on health effect associations from the epidemiological literature be extrapolated and applied to CRA efforts? For example, how should they be used to account for different susceptible populations (e.g., diabetics for CVD) that may be identified from the epidemiological literature?
- How should risk assessors take interactions into account, especially for non-chemical stressors, when focusing on environmental health risk assessment—for example, determining whether and how such interactions influence dose-response?
- Discuss the potential use of extending chemical mixtures risk assessment methods to incorporate nonchemical stressors, including the strengths and limitations of such applications.
- Characterize the strengths and limitations associated with these approaches.
|
Lorenz Rhomberg,
(Facilitator)
Gradient Corporation
Richard Hertzberg,
Biomathematics Consulting
Tom Webster,
Boston University
Deborah Cory-Slechta,
University of Rochester
Jane Ellen Simmons,
EPA/NHEERL
Moiz Mumtaz,
ATSDR
Jason Sacks,
EPA/NCEA
Linda Teuschler,
EPA/NCEA
Neal Fann,
EPA/OAR |
| 11:50 a.m.–12:50 p.m. |
Lunch |
Day 2
12:50 p.m.–3:00 p.m. |
Discussion of and recommendations regarding the methods to identify, group and analyze combinations of stressors |
| 12:50 p.m.–2:30 p.m. |
Expert Panel (and discussion with audience) |
Discussion to provide recommendations regarding the utility of the methods for CRA and the potential for methodological improvements. Specifically:
- Which methods are mature scientifically and most applicable for use in EPA’s CRA Guidelines at this point in time? How would EPA and other agencies use them? What are their strengths and limitations? If a little more work would improve them significantly, what would you recommend be done? Are there methods other than those addressed in this workshop that you would recommend that EPA and other agencies consider (please provide citations)? Consider:
- Methods for hazard identification/stressor identification and grouping
- Methods to map individual-level and aggregate-level exposures
- Methods to quantify “exposures” to multiple stressors
- Methods for estimation or characterization of disease incidence
- Methods for estimating dose-response and quantifying health risk associated with exposures to combined stressors
- The contributions to risk of the identified stressors can be categorized depending on their nature and function (e.g., causal factors, confounders, effect modifiers, intrinsic factors). How does knowing such information help us to scope CRAs and quantitatively estimate risk?
- The workshop focus has largely been focused on an effects-based approach to CRA. Which methods could be readily applicable for use in evaluating a stressor-based CRA?
|
Lorenz Rhomberg
(Facilitator),
Gradient Corporation
Liem Tran,
University of Tennessee
Linda Teuschler,
EPA/NCEA
Charlie Menzie,
Exponent
Tom Webster,
Boston University
Deborah Cory-Slechta,
University of Rochester
Richard Hertzberg,
Biomathematics Consulting
Lucas Neas,
EPA/NHEERL
Sara Adar,
University of Michigan |
| 2:30 p.m.–3:00 p.m. |
General Discussion: Next Steps and Research Needs
Adjournment |
