Household Air Pollution Concentrations after Liquefied Petroleum Gas Interventions in Rural Peru: Findings from a One-Year Randomized Controlled Trial Followed by a One-Year Pragmatic Crossover Trial

Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic...

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Published in:Environmental health perspectives Vol. 130; no. 5; pp. 57007 - 18
Main Authors: Fandiño-Del-Rio, Magdalena, Kephart, Josiah L., Williams, Kendra N., Shade, Timothy, Adekunle, Temi, Steenland, Kyle, Naeher, Luke P., Moulton, Lawrence H., Gonzales, Gustavo F., Chiang, Marilu, Hossen, Shakir, Chartier, Ryan T., Koehler, Kirsten, Checkley, William
Format: Journal Article
Language:English
Published: United States National Institute of Environmental Health Sciences 01.05.2022
Environmental Health Perspectives
Subjects:
Adult
Air Pollution
Air Pollution, Indoor - analysis
Air quality
Biomass
Biomass energy
Black carbon
Carbon monoxide
Climate change
Clinical trials
Combustion
Cooking
Cross-Over Studies
Environmental aspects
Environmental risk
Exposure
Female
Fuel combustion
Fuel tanks
Gases
Health aspects
Households
Humans
Indoor air pollution
Indoor air quality
Intervention
Kitchens
Liquefied petroleum gas
LPG
Mean
Middle Aged
Morbidity
Outdoor air quality
Ovens & stoves
Particulate emissions
Particulate matter
Particulate Matter - analysis
Peru
Petroleum
Pollutants
Randomization
Risk factors
Rural health
Rural Population
Soot
Stoves
Vouchers
Peru
ISSN:0091-6765, 1552-9924, 1552-9924
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Abstract Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ( ), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. Baseline (kitchen area concentrations vs. ; personal exposure vs. ), CO (kitchen vs. ; personal vs. ), and BC (kitchen vs. ; personal vs. ) were similar between control and intervention participants. Intervention participants had consistently lower concentrations at the 12-month visit for kitchen ( , , and ) and personal exposures ( , , and ) to , BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit , BC, and CO kitchen mean concentrations of , , and and personal exposures of , , and , respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit , BC, and CO kitchen mean concentrations of , , and and personal exposures of , , and , respectively). Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.
AbstractList Background: Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Objective: Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. Methods: We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter [less than or equal to]2.5 [micro]m (P[M.sub.2.5]), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. Results: Baseline mean [+ or -] standard deviation (SD)] P[M.sub.2.5] (kitchen area concentrations 1,220 [+ or -]1,010 vs. 1,190 [+ or -]880 [micro]g/[m.sup.3]; personal exposure 126 [+ or -]214 vs. 104 [+ or -] 100 [micro]g/[m.sup.3]), CO (kitchen 53 [+ or - ]49 vs. 50 [+ or -]41 ppm; personal 7 [+ or -] 8 vs. 7 [+ or -] 8ppm), and BC (kitchen 180 [+ or -] 120 vs. 210 [+ or -] 150 [micro]g/[m.sup.3]; personal 19 [+ or -]16 vs. 21 [+ or -]22 [micro]g/[m.sup.3]) were similar between control and intervention participants. Intervention participants had consistently lower mean ([+ or -] SD) concentrations at the 12-month visit for kitchen (41 [+ or - ]59 [micro]g/[m.sup.3], 3 [+ or - ]6[micro]g/[m.sup.3], and 8 [+ or -] 13 ppm) and personal exposures (26 [+ or - ]34 [micro]g/[m.sup.3], 2[+ or -]3 [micro]g/[m.sup.3], and 3 [+ or -]4ppm) to P[M.sub.2.5], BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit P[M.sub.2.5], BC, and CO kitchen mean concentrations of 34 [+ or -]74 [micro]g/[m.sup.3], 3[+ or -]5 [micro]g/[m.sup.3], and 6 [+ or -]6 ppm and personal exposures of 17 [+ or -] 15 [micro]g/[m.sup.3], 2[+ or -]2[micro]g/[m.sup.3], and 3 [+ or -]4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit P[M.sub.2.5], BC, and CO kitchen mean concentrations of 561 [+ or -] 1,251 [micro]g/[m.sup.3], 82 [+ or -] 124 [micro]g/[m.sup.3], and 23 [+ or -] 28 ppm and personal exposures of 35 [+ or -]38 [micro]g/[m.sup.3], 6[+ or -]6 [micro]g/[m.sup.3], and4[+ or -] 5 ppm, respectively). Discussion: Both home delivery and voucher-based provision of free LPG over a 1- y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health.
Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ( ), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. Baseline (kitchen area concentrations vs. ; personal exposure vs. ), CO (kitchen vs. ; personal vs. ), and BC (kitchen vs. ; personal vs. ) were similar between control and intervention participants. Intervention participants had consistently lower concentrations at the 12-month visit for kitchen ( , , and ) and personal exposures ( , , and ) to , BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit , BC, and CO kitchen mean concentrations of , , and and personal exposures of , , and , respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit , BC, and CO kitchen mean concentrations of , , and and personal exposures of , , and , respectively). Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.
Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide.BACKGROUNDHousehold air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide.Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru.OBJECTIVEMeasure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru.We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization.METHODSWe conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization.Baseline mean [±standard deviation (SD)] PM2.5 (kitchen area concentrations 1,220±1,010 vs. 1,190±880 μg/m3; personal exposure 126±214 vs. 104±100 μg/m3), CO (kitchen 53±49 vs. 50±41 ppm; personal 7±8 vs. 7±8 ppm), and BC (kitchen 180±120 vs. 210±150 μg/m3; personal 19±16 vs. 21±22 μg/m3) were similar between control and intervention participants. Intervention participants had consistently lower mean (±SD) concentrations at the 12-month visit for kitchen (41±59 μg/m3, 3±6 μg/m3, and 8±13 ppm) and personal exposures (26±34 μg/m3, 2±3 μg/m3, and 3±4 ppm) to PM2.5, BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 34±74 μg/m3, 3±5 μg/m3, and 6±6 ppm and personal exposures of 17±15 μg/m3, 2±2 μg/m3, and 3±4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 561±1,251 μg/m3, 82±124 μg/m3, and 23±28 ppm and personal exposures of 35±38 μg/m3, 6±6 μg/m3, and 4±5 ppm, respectively).RESULTSBaseline mean [±standard deviation (SD)] PM2.5 (kitchen area concentrations 1,220±1,010 vs. 1,190±880 μg/m3; personal exposure 126±214 vs. 104±100 μg/m3), CO (kitchen 53±49 vs. 50±41 ppm; personal 7±8 vs. 7±8 ppm), and BC (kitchen 180±120 vs. 210±150 μg/m3; personal 19±16 vs. 21±22 μg/m3) were similar between control and intervention participants. Intervention participants had consistently lower mean (±SD) concentrations at the 12-month visit for kitchen (41±59 μg/m3, 3±6 μg/m3, and 8±13 ppm) and personal exposures (26±34 μg/m3, 2±3 μg/m3, and 3±4 ppm) to PM2.5, BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 34±74 μg/m3, 3±5 μg/m3, and 6±6 ppm and personal exposures of 17±15 μg/m3, 2±2 μg/m3, and 3±4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM2.5, BC, and CO kitchen mean concentrations of 561±1,251 μg/m3, 82±124 μg/m3, and 23±28 ppm and personal exposures of 35±38 μg/m3, 6±6 μg/m3, and 4±5 ppm, respectively).Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.DISCUSSIONBoth home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health. https://doi.org/10.1289/EHP10054.
Background: Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Objective: Measure the effect of liquefied petroleum gas (LPG) interventions on HAP exposures in Puno, Peru. Methods: We conducted a 1-y randomized controlled trial followed by a 1-y pragmatic crossover trial in 180 women age 25-64 y. During the first year, intervention participants received a free LPG stove, continuous fuel delivery, and regular behavioral messaging, whereas controls continued their biomass cooking practices. During the second year, control participants received a free LPG stove, regular behavioral messaging, and vouchers to obtain LPG tanks from a nearby distributor, whereas fuel distribution stopped for intervention participants. We collected 48-h kitchen area concentrations and personal exposures to fine particulate matter (PM) with aerodynamic diameter <2:5 lm (PM2:5), black carbon (BC), and carbon monoxide (CO) at baseline and 3-, 6-, 12-, 18-, and 24-months post randomization. Results: Baseline mean [± standard deviation (SD)] PM2:5 (kitchen area concentrations 1,220 ±1,010 vs. 1,190 ± 880 lg=m3; personal exposure 126±214 vs. 104± 100lg=m3), CO (kitchen 53 ±49 vs. 50±41 ppm; personal 7 ±8 vs. 7 ±8ppm), and BC (kitchen 180± 120 vs. 210± 150lg=m3; personal 19 ±16 vs. 21±22lg=m3) were similar between control and intervention participants. Intervention participants had consistently lower mean (±SD) concentrations at the 12-month visit for kitchen (41 ± 59 lg=m3, 3 ± 6 lg=m3, and 8 ± 13 ppm) and personal exposures (26 ± 34 lg=m3, 2± 3 lg=m3, and 3 ± 4 ppm) to PM2:5, BC, and CO when compared to controls during the first year. In the second year, we observed comparable HAP reductions among controls after the voucher-based intervention for LPG fuel was implemented (24-month visit PM2:5, BC, and CO kitchen mean concentrations of 34 ± 74 lg=m3, 3 ±5 lg=m3, and 6 ± 6 ppm and personal exposures of 17 ± 15 lg=m3, 2±2lg=m3, and 3 ± 4 ppm, respectively), and average reductions were present among intervention participants even after free fuel distribution stopped (24-month visit PM2:5, BC, and CO kitchen mean concentrations of 561 ± 1,251 lg=m3, 82 ± 124 lg=m3,and23 ± 28 ppm and personal exposures of 35 ±38 lg=m3, 6±6 lg=m3, and 4±5ppm, respectively). Discussion: Both home delivery and voucher-based provision of free LPG over a 1-y period, in combination with provision of a free LPG stove and longitudinal behavioral messaging, reduced HAP to levels below 24-h World Health Organization air quality guidelines. Moreover, the effects of the intervention on HAP persisted for a year after fuel delivery stopped. Such strategies could be applied in LPG programs to reduce HAP and potentially improve health.
Audience Academic
Author Adekunle, Temi
Kephart, Josiah L.
Fandiño-Del-Rio, Magdalena
Williams, Kendra N.
Hossen, Shakir
Naeher, Luke P.
Chartier, Ryan T.
Chiang, Marilu
Gonzales, Gustavo F.
Steenland, Kyle
Koehler, Kirsten
Shade, Timothy
Checkley, William
Moulton, Lawrence H.
Author_xml – sequence: 1
  givenname: Magdalena
  orcidid: 0000-0003-0601-4377
  surname: Fandiño-Del-Rio
  fullname: Fandiño-Del-Rio, Magdalena
  organization: Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 2
  givenname: Josiah L.
  orcidid: 0000-0003-2556-4892
  surname: Kephart
  fullname: Kephart, Josiah L.
  organization: Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 3
  givenname: Kendra N.
  orcidid: 0000-0001-9697-048X
  surname: Williams
  fullname: Williams, Kendra N.
  organization: Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA, Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 4
  givenname: Timothy
  orcidid: 0000-0001-9349-1336
  surname: Shade
  fullname: Shade, Timothy
  organization: Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 5
  givenname: Temi
  orcidid: 0000-0001-6213-3843
  surname: Adekunle
  fullname: Adekunle, Temi
  organization: Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 6
  givenname: Kyle
  surname: Steenland
  fullname: Steenland, Kyle
  organization: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
– sequence: 7
  givenname: Luke P.
  orcidid: 0000-0003-3077-5440
  surname: Naeher
  fullname: Naeher, Luke P.
  organization: Environmental Health Science Department, College of Public Health, University of Georgia, Athens, Georgia, USA
– sequence: 8
  givenname: Lawrence H.
  surname: Moulton
  fullname: Moulton, Lawrence H.
  organization: Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 9
  givenname: Gustavo F.
  surname: Gonzales
  fullname: Gonzales, Gustavo F.
  organization: Laboratories of Investigation and Development, Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú, High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Perú
– sequence: 10
  givenname: Marilu
  surname: Chiang
  fullname: Chiang, Marilu
  organization: Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Perú
– sequence: 11
  givenname: Shakir
  surname: Hossen
  fullname: Hossen, Shakir
  organization: Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA, Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 12
  givenname: Ryan T.
  surname: Chartier
  fullname: Chartier, Ryan T.
  organization: RTI International, Durham, North Carolina, USA
– sequence: 13
  givenname: Kirsten
  orcidid: 0000-0002-0516-6945
  surname: Koehler
  fullname: Koehler, Kirsten
  organization: Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
– sequence: 14
  givenname: William
  orcidid: 0000-0003-1106-8812
  surname: Checkley
  fullname: Checkley, William
  organization: Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, USA, Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA, Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35549716$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_1016_j_erss_2025_104239
crossref_primary_10_1289_EHP11016
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2022. This work is published under Reproduced from Environmental Health Perspectives (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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– notice: 2022. This work is published under Reproduced from Environmental Health Perspectives (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
CorporateAuthor Cardiopulmonary outcomes and Household Air Pollution (CHAP) Trial Investigators
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Snippet Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Measure the effect of liquefied...
Background: Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide. Objective: Measure...
Household air pollution (HAP) from biomass fuel combustion remains a leading environmental risk factor for morbidity worldwide.BACKGROUNDHousehold air...
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StartPage 57007
SubjectTerms Adult
Air Pollution
Air Pollution, Indoor - analysis
Air quality
Biomass
Biomass energy
Black carbon
Carbon monoxide
Climate change
Clinical trials
Combustion
Cooking
Cross-Over Studies
Environmental aspects
Environmental risk
Exposure
Female
Fuel combustion
Fuel tanks
Gases
Health aspects
Households
Humans
Indoor air pollution
Indoor air quality
Intervention
Kitchens
Liquefied petroleum gas
LPG
Mean
Middle Aged
Morbidity
Outdoor air quality
Ovens & stoves
Particulate emissions
Particulate matter
Particulate Matter - analysis
Peru
Petroleum
Pollutants
Randomization
Risk factors
Rural health
Rural Population
Soot
Stoves
Vouchers
Title Household Air Pollution Concentrations after Liquefied Petroleum Gas Interventions in Rural Peru: Findings from a One-Year Randomized Controlled Trial Followed by a One-Year Pragmatic Crossover Trial
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Volume 130
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