Preliminary risk assessment database and risk ranking of pharmaceuticals in the environment

There is increasing concern about pharmaceuticals entering surface waters and the impacts these compounds may have on aquatic organisms. Many contaminants, including pharmaceuticals, are not completely removed by wastewater treatment. Discharge of effluent into surface waters results in chronic low-concentration exposure of aquatic organisms to these compounds, with unknown impacts. Exposure of virulent bacteria in wastewater to antibiotic residues may also induce resistance, which could threaten human health. The purpose of this study was to provide information on pharmaceutical threats to the environment. A preliminary risk assessment database for common pharmaceuticals was created and put into a web-accessible database named "Pharmaceuticals in the Environment, Information for Assessing Risk" (PEIAR) to help others evaluate potential risks of pharmaceutical contaminants in the environment. Information from PEIAR was used to prioritize compounds that may threaten the environment, with a focus on marine and estuarine environments. The pharmaceuticals were ranked using five different combinations of physical-chemical and toxicological data, which emphasized different risks. The results of the ranking methods differed in the compounds identified as high risk; however, drugs from the central nervous system, cardiovascular, and anti-infective classes were heavily represented within the top 100 drugs in all rankings. Anti-infectives may pose the greatest overall risk based upon our results using a combination of factors that measure environmental transport, fate, and aquatic toxicity. The dataset is also useful for highlighting information that is still needed to assuredly assess risk.     

Chronic aquatic environmental risks from exposure to human pharmaceuticals

This paper reviews current information on the chronic aquatic toxicity of human pharmaceuticals and how it should be measured. Chronic toxicity tests with Cyanobacteria are likely to be sensitive surrogates for both algae and other unicellular organisms, although possibly not for higher plants. In contrast, there is little evidence of a general need to perform chronic aquatic invertebrate tests for all human pharmaceuticals, although further acute-to-chronic ratio data are required for the main therapeutic classes and modes of action of pharmaceuticals before this issue can be fully resolved. Chronic fish tests may be necessary for some substances, but it is likely that these can be focused more accurately through use of information in mammalian toxicity datasets. For some substances and modes of action, life-cycle or partial life-cycle fish tests may be more relevant than reliance on early life-stage (ELS) tests, because the ELS test is unlikely to respond adequately to all pharmaceutical modes of action. Biomarkers may be useful in focusing research and testing efforts by identifying active substances and receptors of interest in aquatic species, and they may also be useful in field surveys for helping to establish possible cause and effect relationships. QSARs have been used by several authors to predict acute toxic effects, but predictions of chronic effects are currently hampered by the paucity of available chronic data to build predictive models. There seems to be no obvious reason why mixtures of pharmaceuticals in the environment should be treated in a different way to mixtures of other potentially hazardous substances. If mixture toxicity is considered to be an important environmental issue then all substances should be considered within an appropriate risk assessment framework.     

Interactions between toxic chemicals and natural environmental factors — A meta-analysis and case studies

The paper addresses problems arising from effects of natural environmental factors on toxicity of pollutants to organisms. Most studies on interactions between toxicants and natural factors, including those completed in the EU project NoMiracle (Novel Methods for Integrated Risk Assessment of Cumulative Stressors in Europe) described herein, showed that effects of toxic chemicals on organisms can differ vastly depending purely on external conditions. We compiled data from 61 studies on effects of temperature, moisture and dissolved oxygen on toxicity of a range of chemicals representing pesticides, polycyclic aromatic hydrocarbons, plant protection products of bacterial origin and trace metals. In 62.3% cases significant interactions (p ≤ 0.05 or less) between natural factors and chemicals were found, reaching 100% for the effect of dissolved oxygen on toxicity of waterborne chemicals. The meta-analysis of the 61 studies showed that the null hypothesis assuming no interactions between toxic chemicals and natural environmental factors should be rejected at p = 2.7 × 10^− 82 (truncated product method probability). In a few cases of more complex experimental designs, also second-order interactions were found, indicating that natural factors can modify interactions among chemicals. Such data emphasize the necessity of including information on natural factors and their variation in time and across geographic regions in ecological risk assessment. This can be done only if appropriate ecotoxicological test designs are used, in which test organisms are exposed to toxicants at a range of environmental conditions. We advocate designing such tests for the second-tier ecological risk assessment procedures.     

Are pharmaceuticals potent environmental pollutants? Part I: environmental risk assessments of selected active pharmaceutical ingredients

As part of achieving national environmental goals, the Swedish Government commissioned an official report from the Swedish Medical Products Agency on environmental effects of pharmaceuticals. Considering half-lives/biodegradability, environmental occurrence, and Swedish sales statistics, 27 active pharmaceutical ingredients were selected for environmental hazard and risk assessments. Although there were large data gaps for many of the compounds, nine ingredients were identified as dangerous for the aquatic environment. Only the sex hormones oestradiol and ethinyloestradiol were considered to be associated with possible aquatic environmental risks. We conclude that risk for acute toxic effects in the environment with the current use of active pharmaceutical ingredients is unlikely. Chronic environmental toxic effects, however, cannot be excluded due to lack of chronic ecotoxicity data. Measures to reduce potential environmental impact posed by pharmaceutical products must be based on knowledge on chronic ecotoxic effects of both active pharmaceutical ingredients as well as excipients. We believe that the impact pharmaceuticals have on the environment should be further studied and be given greater attention such that informed assessments of hazards as well as risks can be done.     

Toxic and genotoxic evaluation of six antibiotics on non-target organisms

The ecotoxicity of the following six antibiotics on aquatic organisms was investigated: Erythromycin, Oxytetracyclin, Sulfamethoxazole, Ofloxacin, Lincomycin and Clarithromycin. Bioassays were performed on bacteria, algae, rotifers, microcrustaceans and fish to assess acute and chronic toxicity, while SOS Chromotest and Ames test were used to detect the genotoxic potential of the investigated drugs. For risk assessment, the environmental impact was calculated by MEC/PNEC ratio using the available data from the literature regarding their occurrence in the aquatic environment and the toxicity data obtained from the bioassays performed. The ecotoxicological results showed that acute toxicity was in the order of mg/L while, for the chronic data the antibiotics were bioactive at concentrations in the order of microg/L, mainly for the algae. Drugs investigated were one or two order of magnitude less active against rotifers and crustaceans. Ofloxacin was the only genotoxic compound and Sulfamethoxazole, Ofloxacin and Lincomycin were mutagenic. As for environmental risk, the macrolides were found to be the most harmful for the aquatic environment.     

Interaction between density and Cu toxicity for Enchytraeus crypticus and Eisenia fetida reflecting field scenarios

Effect assessment is usually based on responses obtained from standard tests, in which organisms are well fed and in an optimal population density. For a more thorough assessment of ecotoxicological risk, information is needed for chemical effects in systems that closer reflect the potential exposure in the field systems. Responses measured in standard density experiments do not fully reflect the field scenario, where populations' size fluctuate with environmental conditions, leading to very low organism number in certain season/conditions and high number in others. In the present study, the possible interaction between density and Cu-pollution was investigated in regard to population growth, using Enchytraeus crypticus, and for individual juvenile growth, using Eisenia fetida. The standardized ISO and OECD guidelines for enchytraeids and earthworms were adapted to test four densities and four Cu concentrations. The final population number was used to assess the effects and possible interaction between densities and Cu toxicity for population responses and the increase in individual organism wet weight was used as growth response. The study showed that although initial density itself had tremendous impact on population and individual growth, organisms under different densities had the same sensitivity to Cu.     

Ecotoxicity of naproxen and its phototransformation products

The occurrence of pharmaceuticals in the environment is of great concern and only few data are available about the adverse effects of such molecules and their derivatives on non-target aquatic organisms. This study was designed to assess the toxic potential of Naproxen, a nonsteroidal anti-inflammatory, Naproxen Na, its freely water soluble sodium salt and their photoproducts in the aquatic environment. Bioassays were performed on algae, rotifers and microcrustaceans to assess acute and chronic toxicity. Furthermore, possible genotoxic effects of photoderivatives were investigated using SOS chromotest and Ames fluctuation test. The results showed that photoproducts were more toxic than the parent compounds both for acute and chronic values, while genotoxic and mutagenic effects were not found. These findings suggested the opportunity to consider derivatives in ecotoxicology assessment of drugs.     

Interactions between effects of environmental chemicals and natural stressors: A review

Ecotoxicological effect studies often expose test organisms under optimal environmental conditions. However, organisms in their natural settings rarely experience optimal conditions. On the contrary, during most of their lifetime they are forced to cope with sub-optimal conditions and occasionally with severe environmental stress. Interactions between the effects of a natural stressor and a toxicant can sometimes result in greater effects than expected from either of the stress types alone. The aim of the present review is to provide a synthesis of existing knowledge on the interactions between effects of “natural” and chemical (anthropogenic) stressors. More than 150 studies were evaluated covering stressors including heat, cold, desiccation, oxygen depletion, pathogens and immunomodulatory factors combined with a variety of environmental pollutants. This evaluation revealed that synergistic interactions between the effects of various natural stressors and toxicants are not uncommon phenomena. Thus, synergistic interactions were reported in more than 50% of the available studies on these interactions. Antagonistic interactions were also detected, but in fewer cases. Interestingly, about 70% of the tested chemicals were found to compromise the immune system of humans as judged from studies on human cell lines. The challenge for future studies will therefore be to include aspects of combined stressors in effect and risk assessment of chemicals in the environment.     

Leaching behaviour of pharmaceuticals in soil-testing-systems: a part of an environmental risk assessment for groundwater protection

The leaching behaviour of six selected pharmaceuticals was tested in different soils. Leaching experiments are a part of environmental risk assessment to estimate the distribution and fate of these pharmaceuticals in the environment. Based on the results of this assessment their mobility in soil and their potential to contaminate groundwater was evaluated. When assessing the leaching behaviour of these compounds, the influence of the properties (e.g. grain size distribution, pH, Corg) of different soils has to be taken into account. The test results indicated that the leaching potential found could be rated as low for diazepam, ibuprofen, ivermectin and carbamazepine. Therefore, contamination of the groundwater with these substances seems to be unlikely if the groundwater level is covered with sufficient layers of the soils investigated. Clofibric acid and iopromide were very mobile under the experimental conditions and thus, groundwater contamination would be possible if the soil is exposed to these pharmaceuticals, i.e. wastewater irrigation. These results are more or less in agreement with groundwater monitoring data found in the literature for ibuprofen and diazepam which were in general not present in groundwater, while clofibric acid and iopromide were frequently detected. However, a discrepancy was found for carbamazepine, since it occurs very often in groundwater. This discrepancy might be explained by the fact that the leaching tests were performed with soil, whereas in reality the groundwater contamination occurs mainly over river sediments and sub soil from receiving waters.     

Runoff rates and ecotoxicity of zinc induced by atmospheric corrosion

Initiated by regulatory restrictions on the use of zinc for various building and construction applications, together with a lack of knowledge related to the release of zinc induced by atmospheric corrosion, a major interdisciplinary research project was implemented to generate data to be used in future risk assessment. Runoff rates from a large number of commercially available zinc-based materials have been determined on panels inclined 45 degrees from the horizon, facing south, during a 1-year atmospheric exposure in an urban environment in Sweden. Possible environmental effects of runoff water immediately after leaving the surface of the various materials have been evaluated during two different sampling periods of varying season and zinc concentration, using the standard growth inhibition test with algae. Raphidocelis subcapitata (formerly Selenastrum capricornutum). Zinc-specific biosensors with the bacterial strain of Alcaligenes eutrophus, and computer modeling using the water-ligand model MINTEQA2 and the humic aquatic model WHAM, have been used to assess the bioavailability and chemical speciation of zinc in the runoff water. An excellent consistency between the different methods was observed. The results show considerably lower runoff rates of zinc (0.07-3.5 g m(-2) year(-1)) than previously being used for regulatory restrictions, and the concentration of zinc to be predominantly responsible for the observed toxicity of the runoff water towards the green algae. The majority of the released zinc quantity was found to be present as free hydrated zinc ions and, hence, bioavailable. The data do not consider changes in bioavailability and chemical speciation or dilution effects during entry into the environment, and should therefore only be used as an initial assessment of the potential environmental effect of zinc runoff from building applications. This interdisciplinary approach has the potential for studies on the environmental fate of zinc in soil or aquatic systems.     

Environmental risk assessment of industrial facilities: Techniques,regulatory initiatives and insurance

Most companies that manufacture, handle or dispose of chemicals or petroleum products have the potential to cause environmental impairment, especially by longterm or gradual release of materials into the environment. This impairment creates potential liabilities that result from numerous regulations as well as from common law. One way to identify these potential environmental liabilities and exposures is through environmental risk assessment. The primary focus of an environmental risk assessment is to evaluate the potential for off-site gradual impairment arising from a company's operations. Such an assessment reviews the status of the firm's environmental risk exposure and is a useful internal tool for corporate planning. There are three major objectives in performing an environmental risk assessment: risk identification, risk evaluation and risk reduction. To identify risk, numerous criteria are used to determine the individual factors contributing to the potential for off-site exposure. The interaction of these individual risk factors is then used to evaluate the overall potential for gradual environmental impairment. After the risks have been evaluated, recommendations are made to reduce the potential exposures. In addition, implementation of risk reduction strategies accomplish the objective of legislative initiatives for protecting human health and the environment. Environmental risk management can and should be encouraged through legislative initiatives.     

The effects of environmental antidepressants on macroinvertebrates: a mini review

Pharmaceuticals and personal care products constitute one of the most common groups of contaminants in surface waters, and little is known about their impact on aquatic wildlife. The antidepressant fluoxetine is among more prevalent categories of pharmaceuticals detected in the aquatic environment. Typical surface water concentrations are in a wide range that can lead to alterations in life of aquatic macroinvertebrates. Because the mode of fluoxetine action is thought to be by modulation of the neurotransmitter serotonin, macroinvertebrates that possess relevant transporters and receptors sensitive are potentially affected by this pharmaceutical. Available information of how this emerging contaminant may affect macroinvertebrate communities is limited. This review describes the influence of pharmaceuticals on aquatic fauna in general and reports the environmental concentrations of some widely used antidepressants. Additionally, we highlighted the effects of fluoxetine as an antidepressant of concern, because of its abundance and potential for toxicity to aquatic macroinvertebrates.     

The role of nitrite and free nitrous acid (FNA) in wastewater treatment plants

Nitrite is known to accumulate in wastewater treatment plants (WWTPs) under certain environmental conditions. The protonated form of nitrite, free nitrous acid (FNA), has been found to cause severe inhibition to numerous bioprocesses at WWTPs. However, this inhibitory effect of FNA may possibly be gainfully exploited, such as repressing nitrite oxidizing bacteria (NOB) growth to achieve N removal via the nitrite shortcut. However, the inhibition threshold of FNA to repress NOB (∼0.02 mg HNO₂-N/L) may also inhibit other bioprocesses. This paper reviews the inhibitory effects of FNA on nitrifiers, denitrifiers, anammox bacteria, phosphorus accumulating organisms (PAO), methanogens, and other microorganisms in populations used in WWTPs. The possible inhibition mechanisms of FNA on microorganisms are discussed and compared. It is concluded that a single inhibition mechanism is not sufficient to explain the negative impacts of FNA on microbial metabolisms and that multiple inhibitory effects can be generated from FNA. The review would suggest further research is necessary before the FNA inhibition mechanisms can be more effectively used to optimize WWTP bioprocesses. Perspectives on research directions, how the outcomes may be used to manipulate bioprocesses and the overall implications of FNA on WWTPs are also discussed.     

Aquatic environmental assessment of the top 25 English prescription pharmaceuticals

An environmental assessment is presented for the 25 most used pharmaceuticals in the National Health Service (NHS) in England in 2000. Predicted environmental concentrations (PECs) for the aquatic environment were calculated using conservative assumptions and all PECs exceeded 1 ng l⁻¹. The calculation of predicted no-effect concentration (PNEC) based on aquatic toxicity data from the literature was possible for eleven of the pharmaceuticals. PNECs were predicted with ECOSAR for 12 of the remaining 14 but no data was available for two of the compounds. The PEC/PNEC ratio exceeded one for Paracetamol, Amoxycillin, Oxytetracycline and Mefenamic acid. Comparisons of the predicted concentrations of the compounds in sewage sludge based on either calculated sludge-water coefficients (K_d), octanol water coefficients (K_ow), acid base constants (pKa) or environmental modelling revealed large variations. No toxicity data was available for the terrestrial environment and no assessment was made.     

Occurrence of diclofenac and selected metabolites in sewage effluents

Many pharmaceuticals along with their metabolites have been detected in environmental water samples in the recent decades. The analgesic diclofenac is widely used and thus enters the aquatic environment. Already at realistic environmental concentration levels harmful effects to different organisms have been demonstrated. As this could also be expected for its metabolites, their fate was examined. Six wastewater treatment plant effluents collected throughout Germany were analyzed for the drug and two of its hydroxylated metabolites, 4'-hydroxy diclofenac (4'-OHD) and 5-hydroxy diclofenac (5-OHD), together with the lactam of 4'-OHD, 4'-hydroxy diclofenac dehydrate (4'-OHDD). A quantitative analytical method has been developed using solid-phase extraction followed by LC-ESI-MS/MS. The limits of quantitation (LOQ) in sewage effluent were 0.06 mug/l for diclofenac and its hydroxyl metabolites and 0.07 microg/l for 4'-OHDD. Recoveries ranged from 62 to 81%. The metabolites were detected in the samples in median concentration ranges of 相似文献   

Environmental toxicology and risk assessment of pharmaceuticals from hospital wastewater

In this paper, we evaluated the ecotoxicological potential of the 100 pharmaceuticals expected to occur in highest quantities in the wastewater of a general hospital and a psychiatric center in Switzerland. We related the toxicity data to predicted concentrations in different wastewater streams to assess the overall risk potential for different scenarios, including conventional biological pretreatment in the hospital and urine source separation. The concentrations in wastewater were estimated with pharmaceutical usage information provided by the hospitals and literature data on human excretion into feces and urine. Environmental concentrations in the effluents of the exposure scenarios were predicted by estimating dilution in sewers and with literature data on elimination during wastewater treatment. Effect assessment was performed using quantitative structure-activity relationships because experimental ecotoxicity data were only available for less than 20% of the 100 pharmaceuticals with expected highest loads. As many pharmaceuticals are acids or bases, a correction for the speciation was implemented in the toxicity prediction model.The lists of Top-100 pharmaceuticals were distinctly different between the two hospital types with only 37 pharmaceuticals overlapping in both datasets. 31 Pharmaceuticals in the general hospital and 42 pharmaceuticals in the psychiatric center had a risk quotient above 0.01 and thus contributed to the mixture risk quotient. However, together they constituted only 14% (hospital) and 30% (psychiatry) of the load of pharmaceuticals. Hence, medical consumption data alone are insufficient predictors of environmental risk. The risk quotients were dominated by amiodarone, ritonavir, clotrimazole, and diclofenac. Only diclofenac is well researched in ecotoxicology, while amiodarone, ritonavir, and clotrimazole have no or very limited experimental fate or toxicity data available. The presented computational analysis thus helps setting priorities for further testing.Separate treatment of hospital wastewater would reduce the pharmaceutical load of wastewater treatment plants, and the risk from the newly identified priority pharmaceuticals. However, because high-risk pharmaceuticals are excreted mainly with feces, urine source separation is not a viable option for reducing the risk potential from hospital wastewater, while a sorption step could be beneficial.     

Ecotoxicological effects of the antioxidant additive propyl gallate in five aquatic systems

Propyl gallate is an antioxidant widely used in foods, cosmetics and pharmaceuticals. The occurrence and fate of additives in the aquatic environment is an emerging issue in environmental chemistry. To date, there is little available information about the adverse effects of propyl gallate on aquatic organisms. Therefore, the toxic effects were investigated, using five model systems from four trophic levels. The most sensitive system was the hepatoma fish cell line PLHC-1 according to total protein content, with an EC(50) of 10 microM and a NOAEL of 1 microM at 72 h, followed by the immobilization of Daphnia magna, the inhibition of bioluminescence of Vibrio fischeri, the salmonid fish cell line RTG-2 and the inhibition of the growth of Chlorella vulgaris. Although protein content, neutral red uptake, methylthiazol metabolization and acetylcholinesterase activity were reduced in PLHC-1 cells, stimulations were observed for lysosomal function, succinate dehydrogenase, glucose-6-phosphate dehydrogenase and ethoxyresorufin-O-deethylase activities. No changes were observed in metallothionein levels. The main morphological observations were the loss of cells and the induction of cell death mainly by necrosis but also by apoptosis. The protective and toxic effects of propyl gallate were evaluated. General antioxidants and calcium chelators did not modify the toxicity of propyl gallate, but an iron-dependent lipid peroxidation inhibitor gave 22% protection. The results also suggest that propyl gallate cytotoxicity is dependent on glutathione levels, which were modulated by malic acid diethyl ester and 2-oxothiazolidine-4-carboxylic acid. According to the results, propyl gallate should be classified as toxic to aquatic organisms.     

Airborne particulate matter, platinum group elements and human health: A review of recent evidence

Environmental concentrations of the platinum group elements (PGE) platinum (Pt), palladium (Pd) and rhodium (Rh) have been on the rise, due largely to the use of automobile catalytic converters which employ these metals as exhaust catalysts. It has generally been assumed that the health risks associated with environmental exposures to PGE are minimal. More recent studies on PGE toxicity, environmental bioavailability and concentrations in biologically relevant media indicate however that environmental exposures to these metals may indeed pose a health risk, especially at a chronic, subclinical level. The purpose of this paper is to review the most recent evidence and provide an up-to-date assessment of the risks related to environmental exposures of PGE, particularly in airborne particulate matter (PM).This review concludes that these metals may pose a greater health risk than once thought for several reasons. First, emitted PGE may be easily mobilised and solubilised by various compounds commonly present in the environment, thereby enhancing their bioavailability. Second, PGE may be transformed into more toxic species upon uptake by organisms. The presence of chloride in lung fluids, for instance, may lead to the formation of halogenated PGE complexes that have a greater potential to induce cellular damage. Third, a significant proportion of PGE found in airborne PM is present in the fine fraction that been found to be associated with increases in morbidity and mortality. PGE are also a concern to the extent that they contribute to the suite of metals found in fine PM suspected of eliciting a variety of health effects, especially in vulnerable populations. All these factors highlight the need to monitor environmental levels of PGE and continue research on their bioavailability, behaviour, speciation and associated toxicity to enable us to better assess their potential to elicit health effects in humans.     

Evaluation of the accuracy and consistency of the Swedish Environmental Classification and Information System for pharmaceuticals

The Swedish environmental and classification system for pharmaceuticals is a voluntary, industry-owned system with the purpose to provide environmental information about active pharmaceutical ingredients in the Swedish market. In this paper we report the results from a detailed evaluation of the accuracy and consistency of the risk assessments conducted within this system. The evaluation focused on the following three aspects: 1) comparison of the companies' risk assessments with the classification system's own guidance document, 2) how the risk assessments are affected if additional effect data is used, and 3) the consistency of different risk assessments for the same pharmaceutical substance. The analyses show that the system's guidance gives no criteria for when to consider a study “long-term” or “short-term”, and that this confusion affected the outcome of the risk assessments in some cases. Furthermore, when the system's guidance document is followed and the risk assessment was supplemented with effect data from the open scientific literature, then the risk classification for a substantial number of the evaluated substances was altered. Our analyses also revealed that in some cases risk assessors disagree on the outcome of the assessment for the same active pharmaceutical ingredient. Finally we list some recommendations to improve the classification system. The recommendations include clarifying concepts and instructions in the guidance document, introduction of a standardized way of reporting data to the website, and promotion of use of non-standard test data when considered the most relevant.     

Assessment of complex environmental health problems: Framing the structures and structuring the frameworks

Many environmental risks are multi-faceted and their health consequences can be far-ranging in both time and space. It can be a challenging task to develop informed policies for such risks. Integrated environmental health impact assessment aims to support policy by assessing environmental health effects in ways that take into account the complexities and uncertainties involved. For such assessment to be successful, a clear and agreed conceptual framework is needed, which defines the issue under consideration and sets out the principles on which the assessment is based. Conceptual frameworks facilitate involvement of stakeholders, support harmonized discussions, help to make assumptions explicit, and provide a framework for data analysis and interpretation.Various conceptual frameworks have been developed for different purposes, but as yet no clear taxonomy exists. We propose a three-level taxonomy of conceptual frameworks for use in environmental health impact assessment. At the first level of the taxonomy, structural frameworks show the wide context of the issues at hand. At the second level, relational frameworks describe how the assessment variables are causally related. At the third level, this causal structure is translated into an operational model, which serves as a basis for analysis. The different types of frameworks are complementary and all play a role in the assessment process. The taxonomy is illustrated using a hypothetical assessment of urban brownfield development for residential uses.We suggest that a better understanding of types of conceptual frameworks and their potential roles in the different phases of assessment will contribute to more informed assessments and policies.