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001"10 Page 112 440 deemed to have been caused by exposure within that environment. Thus,it is generally accepted in the scientific community that a temporal relationship between exposure and subsequent disease alone is insufficient to show that exposure to a chemical has caused a disease. G. Mycotoxin testing in biological samples has not been shown to be useful,reflect exposures,or clinical presentations. It is my understanding that some individuals had their urine specimens analyzed for the presence of mycotoxins by Bio-Trek,National Treatment Centers for Environmental Disease, or North America Institute of Technology. The "presence"of aflatoxins, ochratoxin A,trichothecenes, and citrinin in the urine samples is toxicologically meaningless since mycotoxins are found in a number of foods and are present in everyone from dietary sources. Aflatoxins are found in peanuts,corn, almonds, and milk(only for aflatoxin M1).4° Ochratoxins are found in measurable quantities in maize, wheat, barley,and coffee beans and trichothecenes are found in corn and wheat.41 Wheat, oats, rye, corn, barely, and rice have been reported to contain citrinin.42 A February 2015 report from the Centers for Disease Control and Prevention(CDC)noted that urine mycotoxin tests have not been approved by the Food and Drug Administration (FDA)for accuracy,diagnostic purposes, or for clinical use. 43 These tests have not been shown to be useful,reflect exposures, or clinical presentations. It is important to note that laboratories with Clinical Laboratory Improvement Admendments (CLIA) certifications that offer mycotoxin testing does not mean the laboratory testing has any clinical validity. CDC does not recommend biologic testing of persons who work or live in water-damaged buildings and also does not recommend routine environmental sampling for mold.44 Bacteria and Endotoxins H. Bacteria are ubiquitous and the construction and maintenance of a bacteria-free indoor environment is not possible. Like mold, bacteria are ubiquitous in the environment. The types of bacteria found in the sampled Indian River County Fire Stations are the similar to those commonly found in the environment. 40 Food and Agriculture Organization.(2004),Food and Agriculture Organization.Worldwide Regulations for Mycotoxins in Food and Feed in 2003,FAO Food and Nutrition Papers-81,Rome,Italy. World Health Organization.(1990). /oc. cit. 42 Bennett,J.W.and Klich, M.(2003)./oc. cit. 43 Kawamoto,M. and Page,E.(2015).Use of invalidated urine rnycotoxin tests for the clinical diagnosis of illness- United States,2014.MMWR. 64(6): 157-158. 44 Kawamoto,M. and Page,E.(2015). /cc. cit. 64