The objective of this paper is to explain how to apply, interpret, and present the results of a new instrument to assess the risk of bias (RoB) in non-randomized studies (NRS) dealing with effects of environmental exposures on health outcomes. This instrument is modeled on the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) instrument. The RoB instrument for NRS of exposures assesses RoB along a standardized comparison to a randomized target experiment, instead of the study-design directed RoB approach. We provide specific guidance for the integral steps of developing a research question and target experiment, distinguishing issues of indirectness from RoB, making individual-study judgments, and performing and interpreting sensitivity analyses for RoB judgments across a body of evidence. Also, we present an approach for integrating the RoB assessments within the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of the evidence in the systematic review. Finally, we guide the reader through an overall assessment to support the rating of all domains that determine the certainty of a body of evidence using the GRADE approach.

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Increased risks of lung and bladder cancer have been observed in populations exposed to high levels of inorganic arsenic. However, studies at lower exposures (i.e., less than 100 μg/l in water) have shown inconsistent results. We therefore conducted an ecological analysis of the association between historical drinking water arsenic concentrations and lung and bladder cancer incidence in U.S. counties. We used drinking water arsenic concentrations measured by the U.S. Geological Survey and state agencies in the 1980s and 1990s as proxies for historical exposures in counties where public groundwater systems and private wells are important sources of drinking water. Relationships between arsenic levels and cancer incidence in 2006-2010 were explored by Poisson regression analyses, adjusted for groundwater dependence and important demographic covariates. The median and 95th percentile county mean arsenic concentrations were 1.5 and 15.4 μg/l, respectively. Water arsenic concentrations were significant and positively associated with female and male bladder cancer, and with female lung cancer. Our findings support an association between low water arsenic concentrations and lung and bladder cancer incidence in the United States. However, the limitations of the ecological study design suggest caution in interpreting these results.

Data were drawn from 845 males in the National Survey of Adolescent Males who were initially aged 15-17, and followed-up 2.5 and 4.5 years later, to their early twenties. Mixed-effects regression models (MRM) and semiparametric trajectory analyses (STA) modeled patterns of change in masculinity attitudes at the individual and group levels, guided by gender intensification theory and cognitive-developmental theory. Overall, men's masculinity attitudes became significantly less traditional between middle adolescence and early adulthood. In MRM analyses using time-varying covariates, maintaining paternal coresidence and continuing to have first sex in uncommitted heterosexual relationships were significantly associated with masculinity attitudes remaining relatively traditional. The STA modeling identified three distinct patterns of change in masculinity attitudes. A traditional-liberalizing trajectory of masculinity attitudes was most prevalent, followed by traditional-stable and nontraditional-stable trajectories. Implications for gender intensification and cognitive-developmental approaches to masculinity attitudes are discussed. Keywords masculinity attitudes; gender development; growth modeling; trajectoryThe importance of men's attitudes about masculinity for health and social behaviors has been demonstrated in both the United States (Levant and Richmond 2007;Mahalik et al. 2003;Pleck 1995;Pleck, Sonenstein, and Ku 1994) and in other countries (Levant and Richmond 2007;Mahalik, Lagan, and Morrison 2006;Pulerwitz and Barker 2008). The developmental course of attitudes about masculinity, however, has been little investigated. Analysis of the developmental trajectories of masculinity attitudes from adolescence to adulthood can contribute to the understanding of the interplay between "gender intensification" (Hill and Lynch 1983) and cognitive-developmental processes (Kohlberg and Ullian 1974) promoting more flexible gender-related attitudes during this period. In © The Author(s) 2011 Corresponding Author: Arik V. Marcell, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA amarcell@jhsph.edu. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. NIH Public Access Author ManuscriptMen Masc. Author manuscript; available in PMC 2013 October 30. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript addition, it can help identify points for intervention to minimize the negative health and social outcomes associated with masculinity attitudes during adolescence and later in life. This study's goal is to analyze the trajectories of masculinity attitude development from middle adolescence through early adulthood among U.S. males, and the influences of experiences in family and peer contexts on these trajectories. The research employs data from a nationally representative sample of males, and utilizes recently developed statistical methods for the analysis of ...

Understanding pathogen risks is a critically important consideration in the design of water treatment, particularly for potable reuse projects. As an extension to our published microbial risk assessment methodology to estimate infection risks associated with Direct Potable Reuse (DPR) treatment train unit process combinations, herein, we (1) provide an updated compilation of pathogen density data in raw wastewater and dose-response models; (2) conduct a series of sensitivity analyses to consider potential risk implications using updated data; (3) evaluate the risks associated with log credit allocations in the United States; and (4) identify reference pathogen reductions needed to consistently meet currently applied benchmark risk levels. Sensitivity analyses illustrated changes in cumulative annual risks estimates, the significance of which depends on the pathogen group driving the risk for a given treatment train. For example, updates to norovirus (NoV) raw wastewater values and use of a NoV dose-response approach, capturing the full range of uncertainty, increased risks associated with one of the treatment trains evaluated, but not the other. Additionally, compared to traditional log-credit allocation approaches, our results indicate that the risk methodology provides more nuanced information about how consistently public health benchmarks are achieved. Our results indicate that viruses need to be reduced by 14 logs or more to consistently achieve currently applied benchmark levels of protection associated with DPR. The refined methodology, updated model inputs, and log credit allocation comparisons will be useful to regulators considering DPR projects and design engineers as they consider which unit treatment processes should be employed for particular projects.