A Soviet Ship: What\u27s Her Name? Revisited

Editor\u27s Note: Through no fault of the author, two tables in John A. Broadwin\u27s article: A Soviet Ship: What\u27s Her Name?, which appeared on pages 77-86 of the July-August issue, were published incompletely. Herewith, they are published completely

A Soviet Ship: What\u27s Her Name?

In 1979 American naval aviators sighted a new Soviet aircraft carrier whose bow reflected the Mediterranean sun with particular brightness. Flying lower they could make out five strange-looking golden letters welded to her hull-each over eight feet high

Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE

Many epidemiologic studies provide evidence of an association between daily counts of mortality and ambient particulate matter < 10 μm in diameter (PM(10)). Relatively few studies, however, have investigated the relationship of mortality with fine particles [PM < 2.5 μm in diameter (PM(2.5))], especially in a multicity setting. We examined associations between PM(2.5) and daily mortality in nine heavily populated California counties using data from 1999 through 2002. We considered daily counts of all-cause mortality and several cause-specific subcategories (respiratory, cardiovascular, ischemic heart disease, and diabetes). We also examined these associations among several subpopulations, including the elderly (> 65 years of age), males, females, non-high school graduates, whites, and Hispanics. We used Poisson multiple regression models incorporating natural or penalized splines to control for covariates that could affect daily counts of mortality, including time, seasonality, temperature, humidity, and day of the week. We used meta-analyses using random-effects models to pool the observations in all nine counties. The analysis revealed associations of PM(2.5) levels with several mortality categories. Specifically, a 10-μg/m(3) change in 2-day average PM(2.5) concentration corresponded to a 0.6% (95% confidence interval, 0.2–1.0%) increase in all-cause mortality, with similar or greater effect estimates for several other subpopulations and mortality subcategories, including respiratory disease, cardiovascular disease, diabetes, age > 65 years, females, deaths out of the hospital, and non-high school graduates. Results were generally insensitive to model specification and the type of spline model used. This analysis adds to the growing body of evidence linking PM(2.5) with daily mortality

The Effects of Components of Fine Particulate Air Pollution on Mortality in California: Results from CALFINE

OBJECTIVE: Several epidemiologic studies provide evidence of an association between daily mortality and particulate matter < 2.5 μm in diameter (PM(2.5)). Little is known, however, about the relative effects of PM(2.5) constituents. We examined associations between 19 PM(2.5) components and daily mortality in six California counties. DESIGN: We obtained daily data from 2000 to 2003 on mortality and PM(2.5) mass and components, including elemental and organic carbon (EC and OC), nitrates, sulfates, and various metals. We examined associations of PM(2.5) and its constituents with daily counts of several mortality categories: all-cause, cardiovascular, respiratory, and mortality age > 65 years. Poisson regressions incorporating natural splines were used to control for time-varying covariates. Effect estimates were determined for each component in each county and then combined using a random-effects model. RESULTS: PM(2.5) mass and several constituents were associated with multiple mortality categories, especially cardiovascular deaths. For example, for a 3-day lag, the latter increased by 1.6, 2.1, 1.6, and 1.5% for PM(2.5), EC, OC, and nitrates based on interquartile ranges of 14.6, 0.8, 4.6, and 5.5 μg/m(3), respectively. Stronger associations were observed between mortality and additional pollutants, including sulfates and several metals, during the cool season. CONCLUSION: This multicounty analysis adds to the growing body of evidence linking PM(2.5) with mortality and indicates that excess risks may vary among specific PM(2.5) components. Therefore, the use of regression coefficients based on PM(2.5) mass may underestimate associations with some PM(2.5) components. Also, our findings support the hypothesis that combustion-associated pollutants are particularly important in California

Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research

Abstract Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine