Review of the Department of Defense Enhanced Particulate Matter Surveillance Program Report

Committee for Review of the DOD’s Enhanced Particulate Matter Surveillance Program Report

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
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Committee for Review of the DOD’s Enhanced Particulate Matter Surveillance Program Report Board on Environmental Studies and Toxicology Division on Earth and Life Studies

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Insti- tute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract No. W81K04-06-D-0023 between the National Academy of Sciences and the U.S. Army. Any opinions, findings, conclusions, or rec- ommendations expressed in this publication are those of the authors and do not necessar- ily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-15413-0 International Standard Book Number-10: 0-309-15413-8 Additional copies of this report are available from The National Academies Press 500 Fifth Street, NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the re- sponsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the Na- tional Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE FOR REVIEW OF THE DOD’S ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM REPORT Members MARK J. UTELL (Chair), University of Rochester School of Medicine and Dentistry, NY JOHN R. BALMES, University of California School of Medicine, San Francisco MICHELLE L. BELL, Yale School of Forestry and Environmental Studies, New Haven, CT MARK S. GOLDBERG, McGill University, Montreal, Quebec, Canada PHILIP K. HOPKE, Clarkson University, Potsdam, NY PETROS KOUTRAKIS, Harvard School of Public Health, Boston, MA JACOB D. MCDONALD, Lovelace Respiratory Research Institute, Albuquerque, NM KENT E. PINKERTON, University of California, Davis BAILUS WALKER, JR., Howard University School of Medicine, Washington, DC ANTHONY S. WEXLER, University of California, Davis Staff HEIDI MURRAY-SMITH, Project Director EILEEN ABT, Senior Program Officer NORMAN GROSSBLATT, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Manager, Editorial Projects PANOLA GOLSON, Program Associate Sponsor U.S. ARMY v

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COMMITTEE ON TOXICOLOGY Members GARY P. CARLSON (Chair), Purdue University, West Lafayette, IN LAWRENCE S. BETTS, Eastern Virginia Medical School, Norfolk EDWARD C. BISHOP, HDR Engineering, Inc., Omaha, NE JAMES V. BRUCKNER, University of Georgia, Athens MARION F. EHRICH, Virginia Polytechnic Institute and State University, Blacksburg SIDNEY GREEN, Howard University, Washington, DC WILLIAM E. HALPERIN, UMDNJ–New Jersey Medical School, Newark MERYL H. KAROL, University of Pittsburgh, Pittsburgh, PA JAMES N. MCDOUGAL, Wright State University School of Medicine, Dayton, OH ROGER G. MCINTOSH, Science Applications International Corporation, Abingdon, MD JOYCE TSUJI, Exponent, Inc., Bellevue, WA GERALD N. WOGAN, Massachusetts Institute of Technology, Cambridge Staff RAYMOND A. WASSEL, Senior Program Officer for Environmental Studies SUSAN N.J. MARTEL, Senior Program Officer for Toxicology ELLEN K. MANTUS, Senior Program Officer for Risk Analysis EILEEN N. ABT, Senior Program Officer RUTH E. CROSSGROVE, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Manager, Editorial Projects TAMARA DAWSON, Program Associate vi

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1 Members ROGENE F. HENDERSON (Chair), Lovelace Respiratory Research Institute, Albuquerque, NM RAMON ALVAREZ, Environmental Defense Fund, Austin, TX  TINA BAHADORI, American Chemistry Council, Arlington, VA MICHAEL J. BRADLEY, M.J. Bradley & Associates, Concord, MA DALLAS BURTRAW, Resources for the Future, Washington, DC JAMES S. BUS, Dow Chemical Company, Midland, MI JONATHAN Z. CANNON, University of Virginia, Charlottesville GAIL CHARNLEY, HealthRisk Strategies, Washington, DC RUTH DEFRIES, Columbia University, New York, NY RICHARD A. DENISON, Environmental Defense Fund, Washington, DC H. CHRISTOPHER FREY, North Carolina State University, Raleigh J. PAUL GILMAN, Covanta Energy Corporation, Fairfield, NJ RICHARD M. GOLD, Holland & Knight, LLP, Washington, DC LYNN R. GOLDMAN, Johns Hopkins University, Baltimore, MD JUDITH A. GRAHAM (retired), Pittsboro, NC HOWARD HU, University of Michigan, Ann Arbor ROGER E. KASPERSON, Clark University, Worcester, MA TERRY L. MEDLEY, E.I. du Pont de Nemours & Company, Wilmington, DE JANA MILFORD, University of Colorado at Boulder, Boulder DANNY D. REIBLE, University of Texas, Austin JOSEPH V. RODRICKS, ENVIRON International Corporation, Arlington, VA ROBERT F. SAWYER, University of California, Berkeley KIMBERLY M. THOMPSON, Kid Risk, Inc., Newton, MA MARK J. UTELL, University of Rochester Medical Center, Rochester, NY Senior Staff JAMES J. REISA, Director DAVID J. POLICANSKY, Scholar RAYMOND A. WASSEL, Senior Program Officer for Environmental Studies SUSAN N.J. MARTEL, Senior Program Officer for Toxicology ELLEN K. MANTUS, Senior Program Officer for Risk Analysis EILEEN N. ABT, Senior Program Officer RUTH E. CROSSGROVE, Senior Editor MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center RADIAH ROSE, Manager, Editorial Projects 1 This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology. vii

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OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Toxicity-Pathway-Based Risk Assessment: Preparing for Paradigm Change (2010) The Use of Title 42 Authority at the U.S. Environmental Protection Agency (2010) Review of the Environmental Protection Agency’s Draft IRIS Assessment of Tetrachloroethylene (2010) Hidden Costs of Energy: Unpriced Consequences of Energy Production and Use (2009) Contaminated Water Supplies at Camp Lejeune—Assessing Potential Health Effects (2009) Review of the Federal Strategy for Nanotechnology-Related Environmental, Health, and Safety Research (2009) Science and Decisions: Advancing Risk Assessment (2009) Phthalates and Cumulative Risk Assessment: The Tasks Ahead (2008) Estimating Mortality Risk Reduction and Economic Benefits from Controlling Ozone Air Pollution (2008) Respiratory Diseases Research at NIOSH (2008) Evaluating Research Efficiency in the U.S. Environmental Protection Agency (2008) Hydrology, Ecology, and Fishes of the Klamath River Basin (2008) Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007) Models in Environmental Regulatory Decision Making (2007) Toxicity Testing in the Twenty-first Century: A Vision and a Strategy (2007) Sediment Dredging at Superfund Megasites: Assessing the Effectiveness (2007) Environmental Impacts of Wind-Energy Projects (2007) Scientific Review of the Proposed Risk Assessment Bulletin from the Office of Management and Budget (2007) Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues (2006) New Source Review for Stationary Sources of Air Pollution (2006) Human Biomonitoring for Environmental Chemicals (2006) Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006) Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) State and Federal Standards for Mobile-Source Emissions (2006) Superfund and Mining Megasites—Lessons from the Coeur d’Alene River Basin (2005) Health Implications of Perchlorate Ingestion (2005) Air Quality Management in the United States (2004) Endangered and Threatened Species of the Platte River (2004) Atlantic Salmon in Maine (2004) viii

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Endangered and Threatened Fishes in the Klamath River Basin (2004) Cumulative Environmental Effects of Alaska North Slope Oil and Gas Development (2003) Estimating the Public Health Benefits of Proposed Air Pollution Regulations (2002) Biosolids Applied to Land: Advancing Standards and Practices (2002) The Airliner Cabin Environment and Health of Passengers and Crew (2002) Arsenic in Drinking Water: 2001 Update (2001) Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001) Compensating for Wetland Losses Under the Clean Water Act (2001) A Risk-Management Strategy for PCB-Contaminated Sediments (2001) Acute Exposure Guideline Levels for Selected Airborne Chemicals (seven volumes, 2000-2009) Toxicological Effects of Methylmercury (2000) Strengthening Science at the U.S. Environmental Protection Agency (2000) Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) Ecological Indicators for the Nation (2000) Waste Incineration and Public Health (2000) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter (four volumes, 1998-2004) The National Research Council’s Committee on Toxicology: The First 50 Years (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (five volumes, 1989-1995) Science and Judgment in Risk Assessment (1994) Pesticides in the Diets of Infants and Children (1993) Dolphins and the Tuna Industry (1992) Science and the National Parks (1992) Human Exposure Assessment for Airborne Pollutants (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academies Press (800) 624-6242 or (202) 334-3313 www.nap.edu ix

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OTHER REPORTS OF THE COMMITTEE ON TOXICOLOGY Evaluation of the Health and Safety Risks of the New USAMRIID High- Containment Facilities at Fort Detrick, Maryland (2010) Combined Exposures to Hydrogen Cyanide and Carbon Monoxide in Army Operations: Final Report (2008) Managing Health Effects of Beryllium Exposure (2008) Review of Toxicologic and Radiologic Risks to Military Personnel from Exposures to Depleted Uranium (2008) Emergency and Continuous Exposure Guidance Levels for Selected Submarine Contaminants, Volume 1 (2007), Volume 2 (2008) Review of the Department of Defense Research Program on Low-Level Exposures to Chemical Warfare Agents (2005) Review of the Army’s Technical Guides on Assessing and Managing Chemical Hazards to Deployed Personnel (2004) Spacecraft Water Exposure Guidelines for Selected Contaminants, Volume 1 (2004), Volume 2 (2007), Volume 3 (2008) Toxicologic Assessment of Jet-Propulsion Fuel 8 (2003) Review of Submarine Escape Action Levels for Selected Chemicals (2002) Standing Operating Procedures for Developing Acute Exposure Guideline Levels for Hazardous Chemicals (2001) Evaluating Chemical and Other Agent Exposures for Reproductive and Developmental Toxicity (2001) Acute Exposure Guideline Levels for Selected Airborne Contaminants, Volume 1 (2000), Volume 2 (2002), Volume 3 (2003), Volume 4 (2004), Volume 5 (2007), Volume 6 (2008), Volume 7 (2009), Volume 8 (2009) Review of the U.S. Navy’s Human Health Risk Assessment of the Naval Air Facility at Atsugi, Japan (2000) Methods for Developing Spacecraft Water Exposure Guidelines (2000) Review of the U.S. Navy Environmental Health Center’s Health-Hazard Assessment Process (2000) Review of the U.S. Navy’s Exposure Standard for Manufactured Vitreous Fibers (2000) Re-Evaluation of Drinking-Water Guidelines for Diisopropyl Methylphosphonate (2000) Submarine Exposure Guidance Levels for Selected Hydrofluorocarbons: HFC-236fa, HFC-23, and HFC-404a (2000) Review of the U.S. Army’s Health Risk Assessments for Oral Exposure to Six Chemical-Warfare Agents (1999) Toxicity of Military Smokes and Obscurants, Volume 1(1997), Volume 2 (1999), Volume 3 (1999) Assessment of Exposure-Response Functions for Rocket-Emission Toxicants (1998) x

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Toxicity of Alternatives to Chlorofluorocarbons: HFC-134a and HCFC-123 (1996) Permissible Exposure Levels for Selected Military Fuel Vapors (1996) Spacecraft Maximum Allowable Concentrations for Selected Airborne Contaminants, Volume 1 (1994), Volume 2 (1996), Volume 3 (1996), Volume 4 (2000), Volume 5 (2008) xi

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Preface Soldiers deployed during the 1991 Persian Gulf War returned from de- ployment with complaints of persistent respiratory symptoms. Several studies have shown an association between deployment to the gulf region during the war and various respiratory outcomes. In an effort to understand and character- ize the environmental exposures of military personnel in the Middle East, the Department of Defense (DOD) initiated sampling of air, water, and soil at the beginning of military operations in Afghanistan in 2001 and Iraq in 2003. The most common ambient airborne pollutant measured was particulate matter, which has been shown to be associated with risks of premature mortality and morbidity. To address concerns about the ambient environment in the Middle East, DOD designed and implemented the Enhanced Particulate Matter Surveillance Program to characterize and quantify the particulate matter at 15 sites in the Central Command Area of Operations in the Middle East. In 2009, the U.S. Army asked the National Research Council to review a report on the program titled Final Report: Department of Defense Enhanced Particulate Matter Sur- veillance Program (EPMSP). The National Research Council’s Board on Envi- ronmental Studies and Toxicology convened the Committee for Review of the DOD’s Enhanced Particulate Matter Surveillance Program Report, which pro- duced the present document. The committee members had expertise in exposure assessment, analytic methods, inhalation toxicology, epidemiology, and occupa- tional health. In its review of the DOD EPMSP report, the committee was specifically asked to address the approaches to sampling and analysis, site-specific differ- ences in particulate-matter concentrations, and the potential acute and chronic health implications for deployed personnel based on the particle mass concentra- tion and chemical composition data presented. The committee’s review included consideration of epidemiologic investigations and health-surveillance informa- tion collected by the U.S. Army on deployed personnel presented to the commit- tee during its first meeting. The committee was also asked to make recommen- dations for reducing or better characterizing health risks and for improving epidemiologic investigations. xiii

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xiv Preface The present report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Robert Burr, Wa- satch Endocrinology and Diabetes Specialists; Judith C. Chow, Desert Research Institute; J. Timothy Dvonch, University of Michigan; John. M. Ondov, University of Maryland; Jonathan M. Samet, University of Southern California; Jeremy A. Sarnat, Emory University; Richard B. Schlesinger, Pace University; and Paul J. Villeneuve, Health Canada. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Samuel Kacew, University of Ottawa. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accor- dance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the authoring committee and the institution. The committee gratefully acknowledges the following for making presenta- tions to the committee: Joseph Abraham, Coleen Baird, Ronald Ross, and James Sheehy, U.S. Army Center for Health Promotion and Preventive Medicine; Wil- liam Darby, U.S. Army Medical Department Center and School; Alan Gertler, Desert Research Institute; Alan Peterson, University of Texas Health Science Cen- ter at San Antonio; and Michael G. Stockelman, Naval Health Research Center Environmental Health Effects Laboratory. The committee is also grateful for the assistance of the National Research Council staff in preparing this report. Staff members who contributed to the ef- fort are Heidi Murray-Smith, project director; Eileen Abt, senior program offi- cer; James Reisa, director of the Board on Environmental Studies and Toxicol- ogy; Norman Grossblatt, senior editor; Mirsada Karalic-Loncarevic, manager, Technical Information Center; Radiah Rose, manager, editorial projects; and Panola Golson, program associate. I would especially like to thank the members of the committee for their ef- forts throughout the development of this report. Mark J. Utell, Chair Committee for Review of the DOD’s Enhanced Particulate Matter Surveillance Program Report

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Abbreviations AA atomic absorption AC automated colorimetry BALF bronchoalveolar lavage fluid CCSEM computer-controlled scanning electron microscopy DOD Department of Defense DRI Desert Research Institute EC elemental carbon EDXRF energy dispersive x-ray fluorescence EPA U.S. Environmental Protection Agency EPMSP Enhanced Particulate Matter Surveillance Program FEV1 forced expiratory volume in the first second FVC forced-vital capacity IC ion chromatography ICP-MS inductively coupled plasma-mass spectrometry ICP-OES inductively coupled plasma-optical emission spectrometry MEG Military Exposure Guideline NRC National Research Council OC organic carbon PM particulate matter QA quality assurance SEM scanning electron microscopy TOR thermal optical reflectance TOT thermal optical transmission TSP total suspended particulates USACHPPM U.S. Army Center for Health Promotion and Preventive Medicine XRD x-ray diffraction XRF x-ray fluorescence xv

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Contents ABBREVIATIONS .......................................................................................... xv SUMMARY ........................................................................................................ 3 1 INTRODUCTION ............................................................................. 12 Background, 12 Air-Pollution Sources and Exposures Relevant to the Middle East, 13 Exposures of and Health Effects on Military Personnel, 16 History of Particulate-Matter Sampling by Department of Defense, 19 Structure of this Report, 19 References, 20 2 SAMPLING METHODOLOGY USED IN THE DEPARTMENT OF DEFENSE ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM........................................................ 26 Methods of Sample Collection, 26 Strengths and Limitations of Sampling, 29 Conclusions and Recommendations, 34 References, 36 3 EVALUATION OF ANALYTIC RESULTS .................................. 38 Methods, 38 Quality Control, 42 Site-Specific Differences in Particulate-Matter Concentrations Between the Middle East and the United States, 43 Conclusions and Recommendations, 44 References, 46 4 HEALTH RESEARCH AND SURVEILLANCE NEEDS ............. 48 The Need for Health Surveillance of Military Personnel Deployed in the Middle East, 49 xvii

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xviii Contents Morbidity and Mortality in Populations Exposed to Coarse Particles, 49 Exposure Assessment, 51 Health Followup by the U.S. Army Center for Health Promotion and Preventive Medicine, 52 Toxicologic Studies of Particulate Matter Collected by the Enhanced Particulate Matter Surveillance Program, 54 The Value of the Department of Defense Enhanced Particulate Matter Surveillance Program, 56 Surveillance: Continuing Assessment of the Health of Armed Forces Personnel, 57 Considerations for Investigating the Health Effects of Exposure of Military Personnel to Pollutants, 57 Guiding Principles for Assessing the Health of Soldiers in the Middle East Conflicts, 62 Conclusions and Recommendations, 64 References, 65 5 CONCLUSIONS AND RECOMMENDATIONS ........................... 71 Overarching Conclusions, 71 Overarching Recommendations, 72 Technical Recommendations, 73 Concluding Remarks, 74 APPENDIXES A BIOGRAPHIC INFORMATION ON THE COMMITTEE FOR REVIEW OF THE DEPARTMENT OF DEFENSE’S ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM REPORT....................................................................... 76 B STATEMENT OF TASK OF THE COMMITTEE FOR REVIEW OF THE DEPARTMENT OF DEFENSE’S ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM REPORT....................................................................... 81 C PUBLIC AGENDAS .......................................................................... 82 D FINAL REPORT: DEPARTMENT OF DEFENSE ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM (CD-ROM enclosed) .................................................... 85

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xix Contents BOXES, FIGURES, AND TABLES BOXES 2-1 Overloading of Impactors and Introduction of Sampling Artifacts, 33 4-1 General Approach to Medical Surveillance, 58 4-2 Interpretation of Military Exposure Guidelines for Particulate Matter, 59 FIGURES 2-1 Disassembled MiniVol sampler, 31 2-2 Assembled MiniVol sampler, 32 TABLES 1-1 Examples of Health Outcomes Measured in Air-Pollution Exposure Studies, 13 2-1 Sampling Sites and Sampling Periods, 27 2-2 Filter Media and Corresponding Analytic Methods, 28

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