Most people in the United States spend far more time indoors than outdoors. Yet, many air pollution regulations and risk assessments focus on outdoor air. These often overlook contact with harmful contaminants that may be at their most dangerous concentrations indoors. A new book from the National Research Council explores the need for strategies to address indoor and outdoor exposures and examines the methods and tools available for finding out where and when significant exposures occur. The volume includes: A conceptual framework and common terminology that investigators from different disciplines can use to make more accurate assessments of human exposure to airborne contaminants. An update of important developments in assessing exposure to airborne contaminants: ambient air sampling and physical chemical measurements, biological markers, questionnaires, time-activity diaries, and modeling. A series of examples of how exposure assessments have been applied-properly and improperly-to public health issues and how the committee's suggested framework can be brought into practice. This volume will provide important insights to improve risk assessment, risk management, pollution control, and regulatory programs.
Most people in the United States spend far more time indoors than outdoors. Yet, many air pollution regulations and risk assessments focus on outdoor air. These often overlook contact with harmful contaminants that may be at their most dangerous concentrations indoors. A new book from the National Research Council explores the need for strategies to address indoor and outdoor exposures and examines the methods and tools available for finding out where and when significant exposures occur. The volume includes: A conceptual framework and common terminology that investigators from different disciplines can use to make more accurate assessments of human exposure to airborne contaminants. An update of important developments in assessing exposure to airborne contaminants: ambient air sampling and physical chemical measurements, biological markers, questionnaires, time-activity diaries, and modeling. A series of examples of how exposure assessments have been applied-properly and improperly-to public health issues and how the committee's suggested framework can be brought into practice. This volume will provide important insights to improve risk assessment, risk management, pollution control, and regulatory programs.
In the effort to reduce the scientific and technical uncertainties over regulation of airborne particulate matter in the United States, Research Priorities for Airborne Particulate Matter: II. Evaluating Research Progress and Updating the Portfolio, the second book in a four-part series requested by Congress, describes the plans of the committee to monitor the progress of the research on particulate matter conducted by the U.S. Environmental Protection Agency (EPA), other federal and state government agencies, and nongovernmental organizations. The book also reviews and updates the committee's portfolio of recommended research in its first volume, Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research Portfolio (NRC, 1998). The committee substantially revised two of the ten high-priority research areas recommended in Part I. Part II notes that Congress, EPA, and the scientific community have given strong support to the committee's recommendations and have implemented substantial changes in research efforts in response to Part I of the series. One important research area-studies of the effects of long-term exposure to particulate matter and other major air pollutants-however, does not appear to be underway or planned.
The regulation of carbon monoxide has been one of the great success stories in air pollution control. While more than 90 percent of the locations with carbon monoxide monitors were in violation in 1971, today the number of monitors showing violations has fallen to only a few, on a small number of days and mainly in areas with unique meteorological and topographical conditions.
It is widely understood that stem cell treatments have the potential to revolutionize medicine. Because of this potential, in 2004 California voters approved Proposition 71 to set up a 10-year, $3 billion program to fund research on stem cells. Under the direction of the California Institute for Regenerative Medicine, this program will pay to build facilities for stem cell research and will fund doctors and scientists to carry out research with the ultimate goal of helping to develop therapies based on stem cells. For this research to move forward, however, will require a steady supply of stem cells, particularly human embryonic stem cells. Those stem cells are collected from developing human embryos created from eggs-or oocytes-harvested from the ovaries of female donors. Thus much of the promise of stem cells depends on women choosing to donate oocytes to the research effort. The oocyte donation process is not without risk, however. Donors are given doses of hormones to trigger the production of more eggs than would normally be produced, and this hormone treatment can have various side effects. Once the eggs have matured in the ovary, they must be retrieved via a surgical procedure that is typically performed under anesthesia, and both the surgery and the anesthesia carry their own risks. Furthermore, given the very personal nature of egg donation, the experience may carry psychological risks for some women as well. With this in mind, in 2006 the California Institute for Regenerative Medicine contracted with the National Academies to organize a workshop that would bring together experts from various areas to speak about the potential risks of oocyte donation and to summarize what is known and what needs to be known about this topic. The Committee on Assessing the Medical Risks of Human Oocyte Donation for Stem Cell Research was formed to plan the workshop, which was held in San Francisco on September 28, 2006. This report is a summary and synthesis of that workshop.
The public depends on competent risk assessment from the federal government and the scientific community to grapple with the threat of pollution. When risk reports turn out to be overblownâ€"or when risks are overlookedâ€"public skepticism abounds. This comprehensive and readable book explores how the U.S. Environmental Protection Agency (EPA) can improve its risk assessment practices, with a focus on implementation of the 1990 Clean Air Act Amendments. With a wealth of detailed information, pertinent examples, and revealing analysis, the volume explores the "default option" and other basic concepts. It offers two views of EPA operations: The first examines how EPA currently assesses exposure to hazardous air pollutants, evaluates the toxicity of a substance, and characterizes the risk to the public. The second, more holistic, view explores how EPA can improve in several critical areas of risk assessment by focusing on cross-cutting themes and incorporating more scientific judgment. This comprehensive volume will be important to the EPA and other agencies, risk managers, environmental advocates, scientists, faculty, students, and concerned individuals.
Carbon monoxide (CO) is a toxic air pollutant produced largely from vehicle emissions. Breathing CO at high concentrations leads to reduced oxygen transport by hemoglobin, which has health effects that include impaired reaction timing, headaches, lightheadedness, nausea, vomiting, weakness, clouding of consciousness, coma, and, at high enough concentrations and long enough exposure, death. In recognition of those health effects, the U.S. Environmental Protection Agency (EPA), as directed by the Clean Air Act, established the health-based National Ambient Air Quality Standards (NAAQS) for CO in 1971. Most areas that were previously designated as "nonattainment" areas have come into compliance with the NAAQS for CO, but some locations still have difficulty in attaining the CO standards. Those locations tend to have topographical or meteorological characteristics that exacerbate pollution. In view of the challenges posed for some areas to attain compliance with the NAAQS for CO, congress asked the National Research Council to investigate the problem of CO in areas with meteorological and topographical problems. This interim report deals specifically with Fairbanks, Alaska. Fairbanks was chosen as a case study because its meteorological and topographical characteristics make it susceptible to severe winter inversions that trap CO and other pollutants at ground level.
From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of U.S. base camps and outlying fire-support bases. In response to concerns and continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Veterans and Agent Orange provides a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam. The 2008 report is the eighth volume in this series of biennial updates. It will be of interest to policy makers and physicians in the federal government, veterans and their families, veterans' organizations, researchers, and health professionals.
Each day, nearly 60 Americans receive a transplanted kidney, liver, or other organâ€"a literal "second chance at life"â€"but 11 others die waiting for an organ transplant. The number of donors, although rising, is not growing fast enough to meet the increasing demand. Intended to improve the current system of organ procurement and allocation, the "Final Rule," a 1998 regulation issued by the U.S. Department of Health and Human Services, sparked further controversy with its attempts to eliminate the apparent geographic disparities in the time an individual must wait for an organ. This book assesses the potential impact of the Final Rule on organ transplantation. It also presents new, original analyses of data, and assesses medical practices, social and economic observations, and other information on: access to transplantation services for low-income populations and racial and ethnic minority groups; organ donation rates; waiting times for transplantation; patient survival rates and organ failure rates leading to retransplantation; and cost of organ transplantation services.
The U.S. Environmental Protection Agency (EPA) has a mission and regulatory responsibility to protect human health and the environment. EPA's pursuit of that goal includes a variety of research activities involving human subjects, such as epidemiologic studies and surveys. Those research activities also involve studies of individuals who volunteer to be exposed to air pollutants intentionally in controlled laboratory settings so that measurements can be made of transient and reversible biomarker or physiologic responses to those exposures that can indicate pathways of toxicity and mechanisms of air-pollution responses. The results of those controlled human inhalation exposure (CHIE) studies, also referred to as human clinical studies or human challenge studies, are used to inform policy decisions and help establish or revise standards to protect public health and improve air quality. Controlled Human Inhalation-Exposure Studies at EPA addresses scientific issues and provides guidance on the conduct of CHIE studies. This report assesses the utility of CHIE studies to inform and reduce uncertainties in setting air-pollution standards to protect public health and assess whether continuation of such studies is warranted. It also evaluates the potential health risks to test subjects who participated in recent studies of air pollutants at EPA's clinical research facility.
From the use of personal products to our consumption of food, water, and air, people are exposed to a wide array of agents each day-many with the potential to affect health. Exposure Science in the 21st Century: A Vision and A Strategy investigates the contact of humans or other organisms with those agents (that is, chemical, physical, and biologic stressors) and their fate in living systems. The concept of exposure science has been instrumental in helping us understand how stressors affect human and ecosystem health, and in efforts to prevent or reduce contact with harmful stressors. In this way exposure science has played an integral role in many areas of environmental health, and can help meet growing needs in environmental regulation, urban and ecosystem planning, and disaster management. Exposure Science in the 21st Century: A Vision and A Strategy explains that there are increasing demands for exposure science information, for example to meet needs for data on the thousands of chemicals introduced into the market each year, and to better understand the health effects of prolonged low-level exposure to stressors. Recent advances in tools and technologies-including sensor systems, analytic methods, molecular technologies, computational tools, and bioinformatics-have provided the potential for more accurate and comprehensive exposure science data than ever before. This report also provides a roadmap to take advantage of the technologic innovations and strategic collaborations to move exposure science into the future.
The U.S. Environmental Protection Agency (EPA) is one of several federal agencies responsible for protecting Americans against significant risks to human health and the environment. As part of that mission, EPA estimates the nature, magnitude, and likelihood of risks to human health and the environment; identifies the potential regulatory actions that will mitigate those risks and protect public health1 and the environment; and uses that information to decide on appropriate regulatory action. Uncertainties, both qualitative and quantitative, in the data and analyses on which these decisions are based enter into the process at each step. As a result, the informed identification and use of the uncertainties inherent in the process is an essential feature of environmental decision making. EPA requested that the Institute of Medicine (IOM) convene a committee to provide guidance to its decision makers and their partners in states and localities on approaches to managing risk in different contexts when uncertainty is present. It also sought guidance on how information on uncertainty should be presented to help risk managers make sound decisions and to increase transparency in its communications with the public about those decisions. Given that its charge is not limited to human health risk assessment and includes broad questions about managing risks and decision making, in this report the committee examines the analysis of uncertainty in those other areas in addition to human health risks. Environmental Decisions in the Face of Uncertainty explains the statement of task and summarizes the findings of the committee.
To safeguard public health, the US Environmental Protection Agency (EPA) must keep abreast of new scientific information and emerging technologies so that it can apply them to regulatory decision-making. For decades the agency has dealt with questions about what animal-testing data to use to make predictions about human health hazards, how to perform dose-response extrapolations, how to identify and protect susceptible subpopulations, and how to address uncertainties. As alternatives to traditional toxicity testing have emerged, the agency has been faced with additional questions about how to incorporate data from such tests into its chemical assessments and whether such tests can replace some traditional testing methods. Endocrine active chemicals (EACs) have raised concerns that traditional toxicity-testing protocols might be inadequate to identify all potential hazards to human health because they have the ability to modulate normal hormone function, and small alterations in hormone concentrations, particularly during sensitive life stages, can have lasting and significant effects. To address concerns about potential human health effects from EACs at low doses, this report develops a strategy to evaluate the evidence for such low-dose effects.
Despite the increase in funding for research and the rising numbers of peer-reviewed publications over the past decade that address the environmental, health, and safety aspects of engineered nanomaterials (ENMs), uncertainty about the implications of potential exposures of consumers, workers, and ecosystems to these materials persists. Consumers and workers want to know which of these materials they are exposed to and whether the materials can harm them. Industry is concerned about being able to predict with sufficient certainty whether products that it makes and markets will pose any environmental, health or safety issues and what measures should be taken regarding manufacturing practices and worldwide distribution to minimize any potential risk. However, there remains a disconnect between the research that is being carried out and its relevance to and use by decision-makers and regulators to make informed public health and environmental policy and regulatory decisions. Research Progress on Environmental, Health, and Safety Aspects of Nanomaterials evaluates research progress and updates research priorities and resource estimates on the basis of results of studies and emerging trends in the nanotechnology industry. This report follows up the 2012 report A Research Strategy for Environmental, Health, and Safety Aspects of Engineered Nanomaterials, which presented a strategic approach for developing the science and research infrastructure needed to address uncertainties regarding the potential environmental, health, and safety risks posed by ENMs. This new report looks at the state of nanotechnology research, examines market and regulatory conditions and their affect on research priorities, and considers the criteria for evaluating research progress on the environmental, health, and safety aspects of nanotechnology.
Incineration has been used widely for waste disposal, including household, hazardous, and medical wasteâ€"but there is increasing public concern over the benefits of combusting the waste versus the health risk from pollutants emitted during combustion. Waste Incineration and Public Health informs the emerging debate with the most up-to-date information available on incineration, pollution, and human healthâ€"along with expert conclusions and recommendations for further research and improvement of such areas as risk communication. The committee provides details on: Processes involved in incineration and how contaminants are released. Environmental dynamics of contaminants and routes of human exposure. Tools and approaches for assessing possible human health effects. Scientific concerns pertinent to future regulatory actions. The book also examines some of the social, psychological, and economic factors that affect the communities where incineration takes place and addresses the problem of uncertainty and variation in predicting the health effects of incineration processes.
Over the last decade, several large-scale United States and international programs have been initiated to incorporate advances in molecular and cellular biology, -omics technologies, analytical methods, bioinformatics, and computational tools and methods into the field of toxicology. Similar efforts are being pursued in the field of exposure science with the goals of obtaining more accurate and complete exposure data on individuals and populations for thousands of chemicals over the lifespan; predicting exposures from use data and chemical-property information; and translating exposures between test systems and humans. Using 21st Century Science to Improve Risk-Related Evaluations makes recommendations for integrating new scientific approaches into risk-based evaluations. This study considers the scientific advances that have occurred following the publication of the NRC reports Toxicity Testing in the 21st Century: A Vision and a Strategy and Exposure Science in the 21st Century: A Vision and a Strategy. Given the various ongoing lines of investigation and new data streams that have emerged, this publication proposes how best to integrate and use the emerging results in evaluating chemical risk. Using 21st Century Science to Improve Risk-Related Evaluations considers whether a new paradigm is needed for data validation, how to integrate the divergent data streams, how uncertainty might need to be characterized, and how best to communicate the new approaches so that they are understandable to various stakeholders.
This book reviews a draft report from the federal government that assesses the effects of oxygenated gasoline on public health, air quality, fuel economy, engine performance, and water quality. In addition to evaluating the scientific basis of the report, the book identifies research needed to better understand the impacts of oxygenated fuels. Methyl tertiary-butyl ether (MTBE), which is intended to reduce carbon monoxide pollution during winter, is the most commonly used additive in the federal oxygenated fuels program. MTBE has been implicated in complaints by the public of headaches, coughs, and nausea. Other questions have been raised about reduced fuel economy and engine performance and pollution of ground water due to the use of MTBE in gasoline. The book provides conclusions and recommendations about each major topic addressed in the government's report.
Gulf War and Health, Volume 2, is the second in a series of congressionally-mandated studies by the Institute of Medicine that provides a comprehensive assessment of the available scientific literature on potential health effects of exposure to certain biological, chemical, and environmental agents associated with the Gulf War. In this second study, the committee evaluated the published, peer-reviewed literature on exposure to insecticides and solvents thought to have been present during the 1990-1991 war. Because little information exists on actual exposure levels â€" a critical factor when assessing health effects â€" the committee could not draw specific conclusions about the health problems of Gulf War veterans. However, the study found some evidence, although usually limited, to link specific long-term health outcomes with exposure to certain insecticides and solvents. The next phase of the series will examine the literature on potential health effects associated with exposure to selected environmental pollutants and particulates, such as oil-well fires and jet fuels.
The 1993 regulation (Part 503 Rule) governing the land application of biosolids was established to protect public health and the environment from reasonably anticipated adverse effects. Included in the regulation are chemical pollutant limits, operational standards designed to reduce pathogens and the attraction of disease vectors, and management practices. This report from the Board on Environmental Studies and Toxicology evaluates the technical methods and approaches used by EPA to establish those standards and practices, focusing specifically on human health protection. The report examines improvements in risk-assessment practices and advances in the scientific database since promulgation of the regulation, and makes recommendations for addressing public health concerns, uncertainties, and data gaps about the technical basis of the biosolids standards.
More than 50 million Americans, one out of five, suffer from hay fever, asthma, and other allergic diseases. Many of these conditions are caused by exposure to allergens in indoor environments such as the house, work, and schoolâ€"where we spend as much as 98 percent of our time. Developed by medical, public health, and engineering professionals working together, this unique volume summarizes what is known about indoor allergens, how they affect human health, the magnitude of their effect on various populations, and how they can be controlled. The book addresses controversies, recommends research directions, and suggests how to assist and educate allergy patients, as well as professionals. Indoor Allergens presents a wealth of information about common indoor allergens and their varying effects, from significant hay fever to life-threatening asthma. The volume discusses sources of allergens, from fungi and dust mites to allergenic chemicals, plants, and animals, and examines practical measures for their control. Indoor Allergens discusses how the human airway and immune system respond to inhaled allergens and assesses patient testing methods, covering the importance of the patient's medical history and outlining procedures and approaches to interpretation for skin tests, in vitro diagnostic tests, and tests of patients' pulmonary function. This comprehensive and practical volume will be important to allergists and other health care providers; public health professionals; specialists in building design, construction, and maintenance; faculty and students in public health; and interested allergy patients.
Some investigators have hypothesized that estrogens and other hormonally active agents found in the environment might be involved in breast cancer increases and sperm count declines in humans as well as deformities and reproductive problems seen in wildlife. This book looks in detail at the science behind the ominous prospect of "estrogen mimics" threatening health and well-being, from the level of ecosystems and populations to individual people and animals. The committee identifies research needs and offers specific recommendations to decision-makers. This authoritative volume: Critically evaluates the literature on hormonally active agents in the environment and identifies known and suspected toxicologic mechanisms and effects of fish, wildlife, and humans. Examines whether and how exposure to hormonally active agents occursâ€"in diet, in pharmaceuticals, from industrial releases into the environmentâ€"and why the debate centers on estrogens. Identifies significant uncertainties, limitations of knowledge, and weaknesses in the scientific literature. The book presents a wealth of information and investigates a wide range of examples across the spectrum of life that might be related to these agents.
Methyl bromide is gaseous pesticide used to fumigate soil, crops, commodity warehouses, and commodity-shipping facilities. Up to 17 million pounds of methyl bromide are used annually in California to treat grapes, almonds, strawberries, and other crops. Methyl bromide is also a known stratospheric ozone depleter and, as such, is scheduled to be phased out of use in the United States by 2005 under the United Nations Montreal Protocol. In California, the use of methyl bromide is regulated by the Department of Pesticide Regulation (DPR), which is responsible for establishing the permit conditions that govern the application of methyl bromide for pest control. The actual permits for use are issued on a site-specific basis by the local county agricultural commissioners. Because of concern for potential adverse health effects, in 1999 DPR developed a draft risk characterization document for inhalation exposure to methyl bromide. The DPR document is intended to support new regulations regarding the agricultural use of this pesticide. The proposed regulations encompass changes to protect children in nearby schools, establish minimum buffer zones around application sites, require notification of nearby residents, and set new limits on hours that fumigation employees may work. The State of California requires that DPR arrange for an external peer review of the scientific basis for all regulations. To this end, the National Research Council (NRC) was asked to review independently the draft risk characterization document prepared by DPR for inhalation exposure to methyl bromide. The task given to NRC's subcommittee on methyl bromide states the following: The subcommittee will perform an independent scientific review of the California Environmental Protection Agency's risk assessment document on methyl bromide. The subcommittee will (1) determine whether all relevant data were considered, (2) determine the appropriateness of the critical studies, (3) consider the mode of action of methyl bromide and its implications in risk assessment, and (4) determine the appropriateness of the exposure assessment and mathematical models used. The subcommittee will also identify data gaps and make recommendations for further research relevant to setting exposure limits for methyl bromide. This report evaluates the toxicological and exposure data on methyl bromide that characterize risks at current exposure levels for field workers and nearby residents. The remainder of this report contains the subcommittee's analysis of DPR's risk characterization for methyl bromide. In Chapter 2, the critical toxicological studies and endpoints identified in the DPR document are evaluated. Chapter 3 summarizes DPR's exposure assessment, and the data quality and modeling techniques employed in its assessment are critiqued. Chapter 4 provides a review of DPR's risk assessment, including the adequacy of the toxicological database DPR used for hazard identification, an analysis of the margin-of-exposure data, and appropriateness of uncertainty factors used by DPR. Chapter 5 contains the subcommittee's conclusions about DPR's risk characterization, highlights data gaps, and makes recommendations for future research.
EPA estimates that thousands of premature deaths and cases of illnesses may be avoided by reducing air pollution. At the request of Congress, this report reviews the scientific basis of EPA's methods used in estimating the public health benefits from its air pollution regulations.
The National Aeronautics and Space Administration (NASA) is aware of the potential toxicological hazards to crew members that might be associated with prolonged spacecraft missions. Despite major engineering advances in controlling the atmosphere within spacecraft, some contamination of the air appears inevitable. NASA has measured numerous airborne contaminants during space missions. As the missions increase in duration and complexity, ensuring the health and well-being of astronauts traveling and working in this unique environment becomes increasingly difficult. As part of its efforts to promote safe conditions aboard spacecraft, NASA requested the National Research Council (NRC) to develop guidelines for establishing spacecraft maximum allowable concentrations (SMACs) for contaminants, and to review SMACs for various spacecraft contaminants to determine whether NASA's recommended exposure limits are consistent with the guidelines recommended by the subcommittee. In response to this request, the NRC first developed criteria and methods for preparing SMACs for spacecraft contaminants, published in its 1992 report Guidelines for Developing Spacecraft Maximum Allowable Concentrations for Space Station Contaminants. Since then, the NRC's Subcommittee on Spacecraft Maximum Allowable Concentrations has been reviewing NASA's documentation of chemical-specific SMACs. This report is the fourth volume in the series Spacecraft Maximum Allowable Concentrations for Space Station Contaminants. The first volume was published in 1994 and the second and third in 1996. Spacecraft Maximum Allowable Concentrations for Selected Airborne Contaminants: Volume 4 has been reviewed in draft form by individuals chosen for their technical expertise and diverse perspectives in accordance with procedures approved by the NRC's Report Review Committee for reviewing NRC and Institute of Medicine reports. The purpose of that Independent review was to provide candid and critical comments to assist the NRC in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
In 1997, the U.S. Environmental Protection Agency (EPA) established regulatory standards to address health risks posed by inhaling tiny particles from smoke, vehicle exhaust, and other sources. At the same time, Congress and the EPA began a multimillion dollar research effort to better understand the sources of these airborne particles, the levels of exposure to people, and the ways that these particles cause disease. To provide independent guidance to the EPA, Congress asked the National Research Council to study the relevant issues. The result was a series of four reports on the particulate-matter research program. The first two books offered a conceptual framework for a national research program, identified the 10 most critical research needs, and described the recommended timing and estimated costs of such research. The third volume began the task of assessing initial progress made in implementing the research program. This, the fourth and final volume, gauged research progress made over a 5-year period on each of the 10 research topics. The National Research Council concludes that particulate matter research has led to a better understanding of the health effects caused by tiny airborne particles. However, the EPA, in concert with other agencies, should continue research to reduce further uncertainties and inform long-term decisions.
Emissions inspection and maintenance (I/M) programs subject vehicles to periodic inspections of their emission control systems. Despite widespread use of these programs in air-quality management, policy makers and the public have found a number of problems associated with them. Prominent among these issues is the perception that emissions benefits and other impacts of I/M programs have not been evaluated adequately. Evaluating Vehicle Emissions Inspection and Maintenance Programs assesses the effectiveness of these programs for reducing mobile source emissions. In this report, the committee evaluates the differences in the characteristics of motor vehicle emissions in areas with and without I/M programs, identifies criteria and methodologies for their evaluation, and recommends improvements to the programs. Most useful of all, this book will help summarize the observed benefits of these programs and how they can be redirected in the future to increase their effectiveness.
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