2 research outputs found

    Characterizing the Afghanistan aerosol environment using size- and time- resolved aerosol chemical composition measurements

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    Thesis (M.S.) University of Alaska Fairbanks, 2012The exposure to aerosols is one danger U.S. soldiers face in Afghanistan that may go unseen. Using the Davis Rotating-drum Universal-size-cut Monitoring (DRUM) cascade impactor, size- and time- resolved aerosol chemical concentrations from Bagram, Afghanistan were collected. These aerosol concentrations were combined with a meteorological analysis and Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model meteorological backward trajectories to establish source sectors. These sectors, along with time of year, were then used as a predictive tool for the chemical composition and relative concentration of aerosols in Afghanistan. Principal components analysis (PCA) was used to determined potential source types. PM₁₀ and PM₂.₅ were compared to military exposure guidelines and U.S. national ambient air quality standards. Results reveal aerosol concentrations in Afghanistan were at levels for which adverse health effects could be anticipated.1. Introduction -- 1.1. Definition and formation of aerosols -- 1.2. Thesis goals -- 1.3. Climatology of the Afghanistan region -- 1.3.1. Wind patterns -- 1.3.2. Diurnal cycles -- 1.4. Elemental sources and uses -- 1.5. Aerosol chemistry and seasonality -- 1.5.1. Geological dust -- 1.5.2. Anthropogenic aerosols -- 1.5.2.1. Pakistan -- 1.5.2.2. Kazakhstan, Turkmenistan, and Uzbekistan -- 1.5.3. Biomass burning -- 1.5.4. Aerosols over seas and oceans -- 1.6. Health concerns and standards -- 2. Experimental methods -- 2.1. Wind roses -- 2.2. DRUM aerosol impactors -- 2.3. HYSPLIT and sector analysis -- 2.4. Principla components analysis -- 2.4.1. PCA procedure -- 2.4.2. Eigenvector loadings -- 2.4.3. PCA on aerosol samples -- 2.5. Chemical mass balance (CMB) model -- 3. Results and discussion -- 3.1. Wind roses -- 3.2. Elemental concentrations -- 3.2.1. Geological dust -- 3.2.2. Heavy metal events -- 3.3. PM₁₀ and PM₂.₅ concentrations and comparison to health safety standards -- 3.4. Sector analysis -- 3.5. PCA -- 3.6. CMB model -- 4. Conclusions -- 5. Future work -- References

    Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

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    IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality
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