03-09 "Costs of Preventable Childhood Illness: The Price We Pay for Pollution "

A growing body of scientific literature implicates toxic exposures in childhood illnesses and developmental disorders. When these illnesses and disabilities result from environmental factors under human control, they can and should be prevented. This report documents monetary costs associated with five major areas of health problems in children that have been linked to preventable environmental exposures: cancer, asthma, lead poisoning, neurobehavioral disorders, and birth defects. We review incidence and prevalence estimates for these disorders, as well as estimates of the associated monetary costs. We apply the concept of the “environmentally attributable fraction” (EAF) of an illness, where EAF is the estimated percentage of cases of an illness that result from an environmental exposure. Preventable childhood illnesses and disabilities attributable to environmental factors are associated with large monetary costs. Our estimate of direct and indirect costs ranges from $1.1 to$1.6 billion annually in Massachusetts. Of course, there is no dollar measure of the full practical and emotional burden borne by these children, their families, and the communities in which they live.

Applying Cost-Benefit to Past Decisions: Was Environmental Protection Ever a Good Idea?

In this Article, however, we do not mount a critique from outside the technique of cost-benefit analysis. Instead, we examine an argument that proponents of cost-benefit analysis have offered as a linchpin of the case for cost-benefit: that this technique is neither anti- nor pro-regulatory, but rather a neutral tool for evaluating public policy. In making this argument, these proponents have often invoked the use of cost-benefit analysis to support previous regulatory decisions (their favorite example involves the phase down of lead in gasoline, which we shall shortly discuss) as a sign that this technique can be used to support as well as to undermine protective regulation. As we demonstrate, however, cost-benefit analysis would have stood as an obstacle to early regulatory successes. Before turning to the various case studies illustrating this point, we first take a brief look at previous efforts to undertake retrospective cost-benefit analyses of important regulatory achievements

06-06 “European Chemical Policy and the United States: The Impacts of REACH”

The European Union is moving toward adoption of its new Registration, Evaluation and Authorization of Chemicals (REACH) policy, an innovative system of chemicals regulation that will provide crucial information on the safety profile of chemicals used in industry. Chemicals produced elsewhere, such as in the United States, and exported to Europe will have to meet the same standards as chemicals produced within the European Union. What is at stake for the U.S. is substantial: we estimate that chemical exports to Europe that are subject to REACH amount to about $14 billion per year, and are directly and indirectly responsible for 54,000 jobs. Revenues and employment of this magnitude dwarf the costs of compliance with REACH, which will amount to no more than$14 million per year. Even if, as the U.S. chemicals industry has argued, REACH is a needless mistake, it will be far more profitable to pay the modest compliance costs than to lose access to the enormous European market.

Does Every Patient Need Colonoscopy Follow-up for Diverticulitis?

Background: American College of Gastroenterology guidelines recommend colonoscopy as follow-up after an episode of diverticulitis, as there has been some association between diverticulitis and the diagnosis of colon cancer. There is limited data on the yield of this procedure in this setting. Recent studies have suggested that colonoscopy may only be warranted after episodes of complicated diverticulitis involving CT-proven abscess or reactive lymph nodes, which are associated with a higher likelihood of the presence of occult colon cancer. Objective: The primary objective is to retrospectively examine the results of colonoscopy done for follow-up of diverticulitis at our center, specifically looking for newly diagnosed carcinoma of the colon. We will compare the findings between unique sup-groups based on previous screening status and family history. This study may help to develop future guidelines for follow-up of diverticulitis. Method: A search was performed in the electronic medical record for adult patients with colonoscopy performed for indication “diverticulitis” or “abnormal abdominal CT scan” in the past five years. Of 521 charts screened, 136 with CT-diagnosed diverticulitis and sufficient documentation were included in the study. Data regarding demographics, medical history, imaging, colonoscopy findings, and pathology was reviewed. A descriptive analysis was performed and patient sub-groups were compared using Fisher’s exact test. Results: Of 136 patients with diverticulitis, two had adenocarcinoma of the sigmoid colon diagnosed after follow-up colonoscopy (1.5%). Both carcinomas were diagnosed after first episodes of uncomplicated diverticulitis, and neither in this group had previous colonoscopies. Both localized to the same spot as the diverticulitis by CT. One of the carcinomas was found in a patient under 50 years old who had a reported family history of colon cancer. The second carcinoma was diagnosed in a patient over 50 years old, and this patient had no family history. There was also one neuroendocrine tumor of the rectum incidentally found. There was no significant difference between rates of carcinoma diagnosed among subgroups examined (family history vs. no family history, previous screening colonoscopy vs. never screened, uncomplicated vs. complicated diverticulitis, and age over 50 vs. under 50). Conclusion: Based on these findings, we believe colonoscopy should still be pursued as follow-up after any episode of diverticulitis to rule out occult colon cancer. More evidence and a larger sample size will be needed before recommending changes to the current guidelines

SLT-VEGF Reduces Lung Metastases, Decreases Tumor Recurrence, and Improves Survival in an Orthotopic Melanoma Model

SLT-VEGF is a recombinant cytotoxin comprised of Shiga-like toxin (SLT) subunit A fused to human vascular endothelial growth factor (VEGF). It is highly cytotoxic to tumor endothelial cells overexpressing VEGF receptor-2 (VEGFR-2/KDR/Flk1) and inhibits the growth of primary tumors in subcutaneous models of breast and prostate cancer and inhibits metastatic dissemination in orthotopic models of pancreatic cancer. We examined the efficacy of SLT-VEGF in limiting tumor growth and metastasis in an orthotopic melanoma model, using NCR athymic nude mice inoculated with highly metastatic Line IV Cl 1 cultured human melanoma cells. Twice weekly injections of SLT-VEGF were started when tumors became palpable at one week after intradermal injection of 1 × 106 cells/mouse. Despite selective depletion of VEGFR-2 overexpressing endothelial cells from the tumor vasculature, SLT-VEGF treatment did not affect tumor growth. However, after primary tumors were removed, continued SLT-VEGF treatment led to fewer tumor recurrences (p = 0.007), reduced the incidence of lung metastasis (p = 0.038), and improved survival (p = 0.002). These results suggest that SLT-VEGF is effective at the very early stages of tumor development, when selective killing of VEGFR-2 overexpressing endothelial cells can still prevent further progression. We hypothesize that SLT-VEGF could be a promising adjuvant therapy to inhibit or prevent outgrowth of metastatic foci after excision of aggressive primary melanoma lesions

Resilience of Oregon Coastal Communities in Response to External Stressors

This study gathers insights from the leaders and residents in of six Oregon coastal communities to analyze what factors affected their resilience in response to external stressors. The impetus for the study was the creation of nearshore marine reserves off the coast of Oregon which included a mandate for the Oregon Department of Fish and Wildlife (ODFW) to investigate the social and economic impacts of the reserves on nearby communities. Interviews were conducted with community members in Garibaldi, Depoe Bay, Newport, Florence, Port Orford, and Gold Beach to understand how the different communities had demonstrated resilience and what factors determined their degree of resilience. Individual community case studies were developed from interviews in the communities and were then used to compare and contrast the different stressors, impacts, responses, enabling factors, and constraining factors experienced across the communities. The factors of resilience identified through this analysis were: the presence of foundational assets; community livability; the capacity for effective action; community cohesion, engagement, and support; and the salience of external stressors relative to internal stressors. This study includes implications related to these factors of resilience meant to inform policymakers on how best to support and enhance community resilience to external stressors. These implications include: keeping in mind the need for a healthy demographic within a community; identifying and working within the community aspirations; and the management of community-agency tensions through the recognition of common goals and objectives. These findings are meant to support policymakers in enhancing resilience of these and other communities.Master of Science Master of Landscape ArchitectureNatural Resources and EnvironmentUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/123035/1/Resilience of Oregon Coastal Communities Final.pd

Trade in the balance: reconciling trade and climate policy: report of the Working Group on Trade, Investment, and Climate Policy

This repository item contains a report published by the Working Group on Trade, Investment, and Climate Policy at The Frederick S. Pardee Center for the Study of the Longer-Range Future at Boston University, and the Global Economic Governance Initiative at Boston University.This report outlines the general tensions between the trade and investment regime and climate policy, and outlines a framework toward making trade and investment rules more climate friendly. Members of the working group have contributed short pieces addressing a range of issues related to the intersection of trade and climate policy. The first two are by natural scientists. Anthony Janetos discusses the need to address the effects of international trade on efforts to limit the increase in global annual temperature to no more than 2oC over preindustrial levels. James J. Corbett examines the failure of the Trans Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (TTIP) to adequately address the environmental implications of shipping and maritime transport. The next two pieces are by economists who examine economic aspects of the trade-climate linkage. Irene Monasterolo and Marco Raberto discuss the potential impacts of including fossil fuel subsidies reduction under the TTIP. Frank Ackerman explores the economic costs of efforts to promote convergence of regulatory standards between the United States and the European Union under the TTIP. The following two contributions are by legal scholars. Brooke Güven and Lise Johnson explore the potential for international investment treaties to redirect investment flows to support climate change mitigation and adaptation, particularly with regard to China and India. Matt Porterfield provides an overview of the ways in which both existing and proposed trade and investment agreements could have either “climate positive” or “climate negative” effects on mitigation policies. The final article is by Tao Hu, a former WTO trade and environment expert advisor for China and currently at the World Wildlife Fund, arguing that the definition of environmental goods and services’ under the WTO negotiations needs to be expanded to better incorporate climate change

Electromechanical reciprocity and arrhythmogenesis in long-QT syndrome and beyond.

An abundance of literature describes physiological and pathological determinants of cardiac performance, building on the principles of excitation-contraction coupling. However, the mutual influencing of excitation-contraction and mechano-electrical feedback in the beating heart, here designated 'electromechanical reciprocity', remains poorly recognized clinically, despite the awareness that external and cardiac-internal mechanical stimuli can trigger electrical responses and arrhythmia. This review focuses on electromechanical reciprocity in the long-QT syndrome (LQTS), historically considered a purely electrical disease, but now appreciated as paradigmatic for the understanding of mechano-electrical contributions to arrhythmogenesis in this and other cardiac conditions. Electromechanical dispersion in LQTS is characterized by heterogeneously prolonged ventricular repolarization, besides altered contraction duration and relaxation. Mechanical alterations may deviate from what would be expected from global and regional repolarization abnormalities. Pathological repolarization prolongation outlasts mechanical systole in patients with LQTS, yielding a negative electromechanical window (EMW), which is most pronounced in symptomatic patients. The electromechanical window is a superior and independent arrhythmia-risk predictor compared with the heart rate-corrected QT. A negative EMW implies that the ventricle is deformed-by volume loading during the rapid filling phase-when repolarization is still ongoing. This creates a 'sensitized' electromechanical substrate, in which inadvertent electrical or mechanical stimuli such as local after-depolarizations, after-contractions, or dyssynchrony can trigger abnormal impulses. Increased sympathetic-nerve activity and pause-dependent potentiation further exaggerate electromechanical heterogeneities, promoting arrhythmogenesis. Unraveling electromechanical reciprocity advances the understanding of arrhythmia formation in various conditions. Real-time image integration of cardiac electrophysiology and mechanics offers new opportunities to address challenges in arrhythmia management

Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition

The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise