END NOTES

[1] Special Assistant for Gulf War Illnesses, "Oil Well Fires," Environmental Exposure Report, September 28, 2000, web site www.gulflink.health.mil/owf_ii.

[2] US Environmental Protection Agency, "Kuwait Oil Fires: Interagency Interim Report," Washington, DC, 1991, p. A-2.

[3] Final Report to the Under Secretary of Defense (Acquisition and Technology), "Report of the Defense Science Board Task Force on Persian Gulf War Health Effects," June 1994, p. 50.

[4] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000.

[5] US Environmental Protection Agency, 40 Code of Federal Regulations, Part 50, "National Ambient Air Quality Standards for Particulate Matter," Final Rule, Federal Register, July 18, 1997, p. 3.

[6] US Army Environmental Hygiene Agency, "Final Report - Kuwait Oil Fire Health Risk Assessment," no. 39-26-L192-91, February 1994, p. G-28, G-2-52.

[7] Lead Sheet No. 22581, Interview with a Gulf War veteran, April 20, 1999.

[8] Defense Intelligence Agency, "Medical Intelligence Overview - Eastern Saudi Arabia, Performance Degradation Due to Climatic Factors," web site www.gulflink.health.mil/declassdocs/dia/19970129/123096_8061116_mic_0001.html.

[9] US Army Central Command, XVIII Corps, Information Paper, Subject: "Hydrogen Sulfide (H2S)," November 1990, p. 3, web site www.gulflink.health.mil/declassimages/army/19960828/082896_apr96_decls2_0003.html; Memorandum from Kuwait Environmental Restoration Office, US Army Corps of Engineers, to Staff Members/DAG Team Chiefs, Subject: "Health Threat from Oil Well Fires - Information Paper," March 1991, p. 9, web site www.gulflink.health.mil/declassimages/army/19960116/011696_92_4_009.html; US General Accounting Office, GAO/HRD-92-50, "Health Effects of the Kuwait Oil Fires," January 1992, p. 4.

[10] Richards, A.L., et al., "Respiratory Disease among Military Personnel in Saudi Arabia during Operation Desert Shield," American Journal of Public Health, vol. 83, 1993, p. 1328.

[11] Hyams, K.C., et al., "The Navy Forward Laboratory During Operations Desert Shield/Desert Storm," Military Medicine, 1993, vol. 158, p. 729-732.

[12] Special Assistant for Gulf War Illnesses, "Medical Surveillance During Operations Desert Shield/Desert Storm," Information Paper, November 6, 1997, web site www.gulflink.health.mil/nfl/.

[13] US Army Environmental Hygiene Agency, "Final Report - Kuwait Oil Fire Health Risk Assessment," no. 39-26-L192-91, February 1994, p. 50.

[14] US Army Environmental Hygiene Agency, "Final Report - Kuwait Oil Fire Health Risk Assessment," no. 39-26-L192-91, February 1994, app. G: table G-2-18-28.

[15] US Army Environmental Hygiene Agency, "Final Report - Kuwait Oil Fire Health Risk Assessment," no. 39-26-L192-91, February 1994, p. G-28, G-2-52.

[16] US Department of Defense, Office of the Under Secretary of Defense for Acquisition and Technology, "Report of the Defense Science Board Task Force on Persian Gulf War Health Effects," June 1994, web site www.gulflink.health.mil/dsbrpt/.

[17] Spektor, D.M., "A Review of the Scientific Literature as it Pertains to Gulf War Illness, Oil Well Fires," RAND, vol. 6, 1998, p. 25.

[18] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. II-ii.

[19] Rabovsky, J., "The Laboratory Studies On Silica Induced Toxicity and Relationship to Carcinogenicity," Journal of Exposure Analysis and Environmental Epidemiology, vol. 7, no. 3, 1997, p. 269.

[20] Parkes, W.R., "Inhaled Particles and their Fate in the Lungs," Occupational Lung Disorders, 2nd ed., Boston, MA., 1983, p. 48-49.

[21] US Navy Bureau of Medicine, "Silicosis and Operational Exposures to Dust and Sand," 1990, web site www.gulflink.health.mil/declassdocs/bumed/19961211/120396_sep96_decls12_0002.html (as of July 2, 2002).

[22] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-15.

[23] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-17, E-19.

[24] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-19 - 22; US Environmental Protection Agency, Office of Air & Radiation, "Health and Environmental Effects of Particulate Matter," Fact Sheet, July 17, 1997, web site www.epa.gov/ttn/oarpg/naaqsfin/pmhealth.html.

[25] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-20.

[26] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-25.

[27] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-20.

[28] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. I, EPA/600/P-99002aC, April 2002, p. E-22, E-42, 8-5.

[29] Schwartz, J., "Air pollution and hospital admissions for cardiovascular disease in Tucson," Epidemiology, vol. 8, 1997, p. 371-377; Lippmann, M., K. Ito, A. N�das, and R.T. Burnett, "Association of particulate matter components with daily mortality and morbidity in urban populations," Health Effects Institute, research report no. 95, Cambridge, MA, 2000; Prescott, G. J., et al., "Urban air pollution and cardiopulmonary ill health: a 14.5 year time series study," Occupational Environmental Medicine, vol. 55, 1998, p. 697-704.

[30] Morris, R. D., E.N. Naumova, "Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures," Environmental Health Perspectives, vol. 106, 1998, p. 649-653; Moolgavkar, S. H., " Air pollution and hospital admissions for diseases of the circulatory system in three U.S. metropolitan areas," Journal of Air Waste Management Association, vol. 50, 2000, p. 1199-1206; Tolbert, P. E., et al., "Interim results of the study of particulates and health in Atlanta (SOPHIA)," Journal of Exposure Analysis and. Environmental Epidemiology, vol. 10, 2000, p. 446-460; Burnett, R. T., S. Cakmak, J.R. Brook, D. Krewski, "The role of particulate size and chemistry in the association between summertime ambient air pollution and hospitalization for cardiorespiratory diseases," Environmental Health Perspectives, vol. 105, 1997, p. 614-620; Stieb, D. M., et al., "Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada," Journal of Exposure Analysis and Environmental Epidemiology, vol. 10, 2000, p. 461-477; Atkinson, R. W., et al., "Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints," European Respiratory Journal, vol. 13, 1999, p. 257-265; Wordley, J., S. Walters, and J.G. Ayres, "Short term variations in hospital admissions and mortality and particulate air pollution," Occupational Environmental Medicine, vol. 54, 1997, p. 108-116; Morgan, G., S. Corbett, J. Wlodarczyk, and P. Lewis, "Air pollution and daily mortality in Sydney, Australia, 1989 through 1993," American Journal of Public Health, vol. 88, 1998, p. 759-764; Ye, F., W.T. Piver, M. Ando, and C.J. Portier, "Effects of temperature and air pollutants on cardiovascular and respiratory diseases for males and females older than 65 years of age in Tokyo, July and August 1980-1995," Environmental Health Perspectives, vol. 109, 2001, p. 355-359.

[31] Linn, W. S., et al., "Air pollution and daily hospital admissions in metropolitan Los Angeles," Environmental Health Perspectives, vol. 108, May 2000, p. 427-434; Wong, C. M., et al., "Effects of ambient air pollution and environmental tobacco smoke on respiratory health of non-smoking women in Hong Kong," International Journal of Epidemiology, vol. 28, 1999, p. 859-864.

[32] Morris, R. D., "Airborne particulates and hospital admissions for cardiovascular disease: a quantitative review of the evidence," Environmental Health Perspectives, vol. 109, supplement no. 4, 2001, p. 495-500.

[33] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 21.

[34] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. II, EPA/600/P-99002aC, April 2002, p. 8-171

[35] Ware, J. H., et al., "Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children," American Review of Respiratory Disease, vol. 133, 1986, p. 834-842; Dockery, D. W., et al., "An epidemiologic study of respiratory health status and indicators of indoor air pollution from combustion sources," in: Harper, J. P., ed. "Combustion processes and the quality of the indoor environment: transactions of an international specialty conference, September 1988, Niagara Falls, NY," Pittsburgh, PA: Air & Waste Management Association, 1989, p. 262-271; Neas, L. M., et al., "Concentration of indoor particulate matter as a determinant of respiratory health in children," American Journal of Epidemiology, vol. 139, 1994, p. 1088-1099.

[36] Raizenne, M., et al., "Health effects of acid aerosols on North American children: pulmonary function," Environmental Health Perspectives, vol. 104, 1996, p. 506-514.

[37] Schwartz, J., D.W. Dockery, and L.M. Neas, "Is daily mortality associated specifically with fine particles?" Journal of the Air & Waste Management Association, vol. 46, 1996, p. 927-939.

[38] US Environmental Protection Agency, National Center for Environmental Assessment, "Air Quality Criteria for Particulate Matter (Draft)," vol. II, EPA/600/P-99002aC, April 2002, p. 8-173; McConnell, R., "Air pollution and bronchitic symptoms in southern California children with asthma," Environmental Health Perspectives, vol. 107, 1999, p. 757-760.

[39] McConnell, R., et al., "Air pollution and bronchitic symptoms in southern California children with asthma," Environmental Health Perspectives, vol. 107, 1999, p. 757-760.

[40] Cohen, A. J., and C.A. Pope III, "Lung cancer and air pollution," Environmental Health Perspectives, vol. 103, supplement no. 8, 1995, p. 219-224.

[41] Cohen, A. J., "Outdoor air pollution and lung cancer," Environmental Health Perspectives, vol. 108, supplement no. 4, 2000, p. 743-750.

[42] Pope III, C. A., et al., "Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution," Journal of the American Medical Association, vol. 287, 2002, p.1132-1141; Abbey, D. E., et al., "Long-term inhalable particles and other air pollutants related to mortality in nonsmokers," American Journal Respiratory Critical Care Medicine, vol. 159, 1999, p. 373-382; Beeson, W. L., D.E. Abbey, and S.F. Knutsen, "Long-term concentrations of ambient air pollutants and incident lung cancer in California adults: results from the AHSMOG study," Environmental Health Perspectives, vol. 106, 1998, p. 813-823.

[43] Bar-Ziv, J. and G.M. Goldberg, "Simple Siliceous Pneumoconiosis in Negev Bedouins," Archives of Environmental Health, vol. 29, 1974, p. 124.

[44] Vallyathan, V., et al., "Generation of Free Radicals from Freshly Fractured Silica Dust," American Review of Respiratory Disease, vol. 138, 1988, p. 1213.

[45] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 19.

[46] Fraser, R.G., et al., Diagnosis of Diseases of the Chest, 3rd ed., Philadelphia, W.B. Saunders Co., 1990, p. 2282-2307; Landrigan, P.J., "Silicosis," Occupational Medicine: State of the Art Reviews, vol. 2, 1987, p. 319.

[47] Navy Bureau of Medicine, "Silicosis and Operational Exposures to Dust and Sand," 1990, web site www.gulflink.health.mil/declassdocs/bumed/19961211/120396_sep96_decls12_0002.html.

[48] Landrigan, P.J., "Silicosis," Occupational Medicine: State of the Art Reviews, vol. 2, 1987, p. 319.

[49] Korenyi-Both, A.L., A.C. Molnar, and R. Fidelus-Gort, "Al Eskan Disease: Desert Storm Pneumonitis," Military Medicine, vol. 157, 1992, p. 452-462.

[50] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 22.

[51] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 23.

[52] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 25.

[53] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 26; National Institute for Occupational Safety and Health, "Criteria for a Recommended Standard -Occupational Exposure to Carbon Black," NIOSH Publication 78-204, Cincinnati, OH, 1978, p. 107.

[54] Risk is a relative term that describes the likelihood that an individual or population will develop a short- or long-term health effect from exposure to hazardous or toxic substances.

[55] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 6.

[56] Klaassen C.D., J. Doull, and M.O. Amdur, Casarett and Doull's Toxicology - The Basic Science of Poisons, Fifth Ed., The McGraw-Hill Companies, Inc., 1996, p. 84.

[57] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 6.

[58] US Army Center for Health Promotion and Preventive Medicine, Technical Guide 230, "Chemical Exposure Guidelines for Deployed Military Personnel," January 2002.

[59] US Army Medical Research and Materiel Command, "Metabolic Cost of Military Physical Tasks in MOPP 0 and MOPP 4," US Army Research Institute of Environmental Medicine, Natick, Massachusetts, April 1995.

[60] In estimating the inhalation rate, deployed personnel are assumed to have spent 6 hours sleeping (at an inhalation rate of 0.4 m3/hr), 4 hours for sedentary activities (at 0.5 m3/hr), 6 hours for light duties (at 1.2 m3/hr), and 8 hours for moderate duties (at 2.2 m3/hr). Therefore: (0.4 m3/hr x 6hrs) + (0.5 m3/hr x 4hrs) + (1.2 m3/hr x 6hrs) + (2.2 m3/hr x 8hrs) = 29.2 m3/24-hour day.

[61] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 8, 27.

[62] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 7.

[63] A value of 1.76 years was derived to enable comparison between Gulf War personnel exposures and researched occupational levels. The average deployment to the Kuwait theater of operation was for 153 days. This equates to a 1.76 year occupational equivalent when considering personnel were exposed 24 hrs/day or 168 hrs/wk, e.g., [168 hrs/wk]/[40 hrs/wk] x [153 days]/[365 days/yr] = 1.76 years. This formula assumes occupational exposures are 8 hours per day 365 days per year.

[64] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 8, 26, 27. [These exposures are based on upper confidence 95% level data and a respirable silica content of 6.5%.]

[65] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000.

[66] The dose estimate assumes that all of the particulate matter collected by the PM10 air samplers was respirable, which may overstate the dose.

[67] Heller, Jack, US Army Center for Health Promotion and Preventive Medicine, personal communication, Contact ID: 52084, June 27, 2002.

[68] The reader is directed to the HRA for details on how these values were calculated.

[69] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 8, 26, 27.

[70] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 33.

[71] Thomas, R.B., T. Vigerstad, J. Meagher, and C. McMullin, "Particulate Exposure During the Persian Gulf War," May 2000, p. 21.


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