Consistency of Urban Background Black Carbon Concentration Measurements by Portable AE51 and Reference AE22 Aethalometers: Effect of Corrections for Filter Loading

Monitoring exposure to black carbon with portable devices is an important part of researching the health impacts of combustion-related air pollutants. We collected 786 hourly averaged equivalent black carbon (eBC) measurements from co-located duplicate portable AE51 Aethalometers and a UK Government reference AE22 Aethalometer (the data for the latter were corrected for filter darkening effects using a standard procedure), at an urban background site in Glasgow, UK. The AE51 and the reference concentrations were highly correlated (R 2 ≥ 0.87) for the combined deployment periods. The application of a previously reported method for correcting the AE51’s underestimation of concentrations, associated with filter loading, generally led to an overestimation of values (specifically, the normalised mean bias values for the two AE51s increased from –2% and +3% to +14% and +25% across the full range of measurements after correction). We found only limited and inconsistent evidence that the AE51 Aethalometers (attenuation [AE51_ATN] ≤ ~52) underestimated the eBC concentrations compared to the reference measurements. Thus, our observations indicate that the AE51 can achieve close agreement with the reference AE22 monitor without applying corrections for filter loading at relatively low AE51_ATN values in environments with low eBC concentrations

Estimation of spatial patterns of urban air pollution over a 4-week period from repeated 5-min measurements

Determination of intra-urban spatial variations in air pollutant concentrations for exposure assessment requires substantial time and monitoring equipment. The objective of this study was to establish if short-duration measurements of air pollutants can be used to estimate longer-term pollutant concentrations. We compared 5-min measurements of black carbon (BC) and particle number (PN) concentrations made once per week on 5 occasions, with 4 consecutive 1-week average nitrogen dioxide (NO2) concentrations at 18 locations at a range of distances from busy roads in Glasgow, UK. 5-min BC and PN measurements (averaged over the two 5-min periods at the start and end of a week) explained 40 - 80%, and 7 - 64% respectively, of spatial variation in the intervening 1-week NO2 concentrations for individual weeks. Adjustment for variations in background concentrations increased the percentage of explained variation in the bivariate relationship between the full set of NO2 and BC measurements over the 4-week period from 28% to 50% prior to averaging of repeat measurements. The averages of five 5-min BC and PN measurements made over 5 weeks explained 75% and 33% respectively of the variation in average 1-week NO2 concentrations over the same period. The relatively high explained variation observed between BC and NO2 measured on different time scales suggests that, with appropriate steps to correct or average out temporal variations, repeated short-term measurements can be used to provide useful information on longer-term spatial patterns for these traffic-related pollutants

Temporal changes in field calibration relationships for Aeroqual S500 O3 and NO2 sensor-based monitors

Sensor-based monitors are increasingly used to measure air pollutant concentrations, but require calibration under field conditions. We made intermittent comparisons (6 times over 6-month period) between ozone and nitrogen dioxide concentrations measured by Aeroqual gas-sensitive semiconductor (O3) and electrochemical (NO2) sensors (two of each) and reference analysers in the UK Automatic Urban and Rural Network. Each deployment period was split into equal (n = 48 x1-hour) training and test datasets, to derive and test calibration equations respectively. We observed significant bivariate linear relationships between Aeroqual O3 and Reference O3 concentrations, and significant multiple linear relationships between Aeroqual NO2 and both Reference NO2 and Aeroqual O3 concentrations. Changes in monitor responses over time (including apparent baseline drift in O3 sensor output, and discrepancies between the 2 Aeroqual NO2 sensors) resulted in relatively inaccurate concentrations estimates (cf. reference concentrations) from calibration equations derived in the first training period and applied to subsequent test deployments (e.g. NO2 RMSE = 47.2 μg m-3 (n = 286) for a dataset of all test periods combined, for one of the two monitor pairs). Substantial improvements in accuracy of estimated concentrations were achieved by combination of repeated intermittent training data into a single calibration dataset (NO2 RMSE = 8.5 μg m-3 for same test dataset described above). This latter approach to field calibration is recommended

Influence of wind-speed on short-duration NO2 measurements using Palmes and Ogawa passive diffusion samplers

We assessed the precision and accuracy of nitrogen dioxide (NO2) concentrations over 2-day, 3-day and 7-day exposure periods measured with the following types of passive diffusion samplers: standard (open) Palmes tubes; standard Ogawa samplers with commercially-prepared Ogawa absorbent pads (Ogawa[S]); and modified Ogawa samplers with absorbent-impregnated stainless steel meshes normally used in Palmes tubes (Ogawa[P]). We deployed these passive samplers close to the inlet of a chemiluminescence NO2 analyser at an urban background site in Glasgow, UK over 32 discrete measurement periods. Duplicate relative standard deviation was < 7% for all passive samplers. The Ogawa[P], Ogawa[S] and Palmes samplers explained 93%, 87% and 58% of temporal variation in analyser concentrations respectively. Uptake rates for Palmes and Ogawa[S] samplers were positively and linearly associated with wind-speed (P < 0.01 and P < 0.05 respectively). Computation of adjusted uptake rates using average wind-speed observed during each sampling period increased the variation in analyser concentrations explained by Palmes and Ogawa[S] estimates to 90% and 92% respectively, suggesting that measurements can be corrected for shortening of diffusion path lengths due to wind-speed to improve the accuracy of estimates of short-term NO2 exposure. Monitoring situations where it is difficult to reliably estimate wind-speed variations, e.g. across multiple sites with different unknown exposures to local winds, and personal exposure monitoring, are likely to benefit from protection of these sampling devices from the effects of wind, for example by use of a mesh or membrane across the open end. The uptake rate of Ogawa[P] samplers was not associated with wind-speed resulting in a high correlation between estimated concentrations and observed analyser concentrations. The use of Palmes meshes in Ogawa[P] samplers reduced the cost of sampler preparation and removed uncertainty associated with the unknown manufacturing process for the commercially-prepared collection pads

Furthering the understanding of silicate-substitution in α-tricalcium phosphate : an X-ray diffraction, X-ray fluorescence and solid-state nuclear magnetic resonance study

High-purity (SupT) and reagent-grade (ST), stoichiometric and silicate-containing α-tricalcium phosphate (α-TCP: ST0/SupT0 and Si-TCP x = 0.10: ST10/SupT10) were prepared by solid-state reaction based on the substitution mechanism Ca3(PO4)(2-x)(SiO4)x. Samples were determined to be phase pure by X-ray diffraction (XRD), and Rietveld analysis performed on the XRD data confirmed inclusion of Si in the α-TCP structure as determined by increases in unit cell parameters; particularly marked increases in the b-axis and β-angle were observed. X-ray fluorescence (XRF) confirmed the presence of expected levels of Si in Si-TCP compositions as well as significant levels of impurities (Mg, Al and Fe) present in all ST samples; SupT samples showed both expected levels of Si and a high degree of purity. Phosphorus (31P) magic-angle-spinning solid-state nuclear magnetic resonance (MAS NMR) measurements revealed that the high-purity reagents used in the synthesis of SupT0 can resolve the 12 expected peaks in the 31P spectrum of α-TCP compared to the low-purity ST0 that showed significant spectral line broadening; line broadening was also observed with the inclusion of Si which is indicative of induced structural disorder. Silicon (29Si) MAS NMR was also performed on both Si-TCP samples which revealed Q0 species of Si with additional Si Q1/Q2 species that may indicate a potential charge-balancing mechanism involving the inclusion of disilicate groups; additional Q4 Si species were also observed, but only for ST10. Heating and cooling rates were briefly investigated by 31P MAS NMR which showed no significant line broadening other than that associated with the emergence of β-TCP which was only realised with the reagent-grade sample ST0. This study provides an insight into the structural effects of Si-substitution in α-TCP and could provide a basis for understanding how substitution affects the physicochemical properties of the material

Neutrophil Extracellular Trap–Derived Enzymes Oxidize High‐Density Lipoprotein: An Additional Proatherogenic Mechanism in Systemic Lupus Erythematosus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108351/1/art38703.pd

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Steering Evolution with Sequential Therapy to Prevent the Emergence of Bacterial Antibiotic Resistance

The increasing rate of antibiotic resistance and slowing discovery of novel antibiotic treatments presents a growing threat to public health. Here, we consider a simple model of evolution in asexually reproducing populations which considers adaptation as a biased random walk on a fitness landscape. This model associates the global properties of the fitness landscape with the algebraic properties of a Markov chain transition matrix and allows us to derive general results on the non-commutativity and irreversibility of natural selection as well as antibiotic cycling strategies. Using this formalism, we analyze 15 empirical fitness landscapes of E. coli under selection by different β-lactam antibiotics and demonstrate that the emergence of resistance to a given antibiotic can be either hindered or promoted by different sequences of drug application. Specifically, we demonstrate that the majority, approximately 70%, of sequential drug treatments with 2–4 drugs promote resistance to the final antibiotic. Further, we derive optimal drug application sequences with which we can probabilistically ‘steer’ the population through genotype space to avoid the emergence of resistance. This suggests a new strategy in the war against antibiotic–resistant organisms: drug sequencing to shepherd evolution through genotype space to states from which resistance cannot emerge and by which to maximize the chance of successful therapy

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe