Work-Related Asthma: Diagnosis and Prognosis of Immunological Occupational Asthma and Work-Exacerbated Asthma

Abstract The incidence and prevalence of asthma are increasing. One reason for this trend is the rise in adult-onset asthma, especially occupational asthma, which is 1 of the 2 forms of work-related asthma. Occupational asthma is defined as asthma caused by agents that are present exclusively in the workplace. The presence of pre-existing asthma does not rule out the possibility of developing occupational asthma. A distinction has traditionally been made between immunological occupational asthma (whether IgE-mediated or not) and nonimmunological occupational asthma caused by irritants, the most characteristic example of which is reactive airway dysfunction syndrome. The other form of work-related asthma is known as work-exacerbated asthma, which affects persons with pre-existing or concurrent asthma that is worsened by work-related factors. It is important to differentiate between the 2 entities because their treatment, prognosis, and medical and social repercussions can differ widely. In this review, we discuss diagnostic methods, treatment, and avoidance/nonavoidance of the antigen in immunological occupational asthma and work-exacerbated asthma. Key words: Specific inhalation challenge. Peak expiratory flow. Workplace. Irritants. Resumen La incidencia y prevalencia del asma van en aumento. El asma de inicio en la edad adulta y especialmente el asma ocupacional (AO) podrían ser una de las causas que influyeran en este incremento. El AO, una de las dos formas de asma relacionada con el trabajo (ART), se define como el asma causada por agentes que están presentes exclusivamente en el lugar de trabajo. Clásicamente, se ha realizado una distinción entre AO inmunológica (mediada o no por un mecanismo IgE) y AO no inmunológica causada por irritantes, cuyo ejemplo más característico es el síndrome reactivo de disfunción de la vía aérea. La presencia de asma previa no descarta la posibilidad de desarrollar AO. El asma exacerbada por el trabajo (AET) es la otra forma de ART y se define como aquel asma pre-existente o concurrente que empeora por factores relacionados con el trabajo. Diferenciar estas dos entidades es importante ya que su tratamiento, pronóstico y repercusiones médica y social, pueden diferir ampliamente. En esta revisión se discuten los diversos métodos diagnósticos, tratamientos y las diferentes estrategias de evitación / no evitación del antígeno tanto en el AO inmunológica como en el AET. Palabras clave: Prueba de provocación bronquial específica. Pico flujo espiratorio. Lugar de trabajo. Irritantes. X Muñoz, et al

Heterogeneous N2O5 Uptake During Winter: Aircraft Measurements During the 2015 WINTER Campaign and Critical Evaluation of Current Parameterizations

Nocturnal dinitrogen pentoxide (N2O5) heterogeneous chemistry impacts regional air quality and the distribution and lifetime of tropospheric oxidants. Formed from the oxidation of nitrogen oxides, N2O5 is heterogeneously lost to aerosol with a highly variable reaction probability, γ(N2O5), dependent on aerosol composition and ambient conditions. Reaction products include soluble nitrate (HNO3 or NO3−) and nitryl chloride (ClNO2). We report the first‐ever derivations of γ(N2O5) from ambient wintertime aircraft measurements in the critically important nocturnal residual boundary layer. Box modeling of the 2015 Wintertime INvestigation of Transport, Emissions, and Reactivity (WINTER) campaign over the eastern United States derived 2,876 individual γ(N2O5) values with a median value of 0.0143 and range of 2 × 10−5 to 0.1751. WINTER γ(N2O5) values exhibited the strongest correlation with aerosol water content, but weak correlations with other variables, such as aerosol nitrate and organics, suggesting a complex, nonlinear dependence on multiple factors, or an additional dependence on a nonobserved factor. This factor may be related to aerosol phase, morphology (i.e., core shell), or mixing state, none of which are commonly measured during aircraft field studies. Despite general agreement with previous laboratory observations, comparison of WINTER data with 14 literature parameterizations (used to predict γ(N2O5) in chemical transport models) confirms that none of the current methods reproduce the full range of γ(N2O5) values. Nine reproduce the WINTER median within a factor of 2. Presented here is the first field‐based, empirical parameterization of γ(N2O5), fit to WINTER data, based on the functional form of previous parameterizations

Exact anisotropic brane cosmologies

We present exact solutions of the gravitational field equations in the generalized Randall-Sundrum model for an anisotropic brane with Bianchi type I and V geometry, with perfect fluid and scalar fields as matter sources. Under the assumption of a conformally flat bulk (with vanishing Weyl tensor) for a cosmological fluid obeying a linear barotropic equation of state the general solution of the field equations can be expressed in an exact parametric form for both Bianchi type I and V space-times. In the limiting case of a stiff cosmological fluid with pressure equal to the energy density, for a Bianchi type I Universe the solution of the field equations are obtained in an exact analytic form. Several classes of scalar field models evolution on the brane are also considered, corresponding to different choices of the scalar field potential. For all models the behavior of the observationally important parameters like shear, anisotropy and deceleration parameter is considered in detail.Comment: revised version to appear in PR

Anthropogenic Control over Wintertime Oxidation of Atmospheric Pollutants

Anthropogenic air pollutants such as nitrogen oxides (NO(x) = NO + NO(2)), sulfur dioxide (SO(2)), and volatile organic compounds (VOC), among others, are emitted to the atmosphere throughout the year from energy production and use, transportation, and agriculture. These primary pollutants lead to the formation of secondary pollutants such as fine particulate matter (PM(2.5)) and ozone (O(3)) and perturbations to the abundance and lifetimes of short-lived greenhouse gases. Free radical oxidation reactions driven by solar radiation govern the atmospheric lifetimes and transformations of most primary pollutants and thus their spatial distributions. During winter in the mid and high latitudes, where a large fraction of atmospheric pollutants are emitted globally, such photochemical oxidation is significantly slower. Using observations from a highly instrumented aircraft, we show that multi-phase reactions between gas-phase NO(x) reservoirs and aerosol particles, as well as VOC emissions from anthropogenic activities, lead to a suite of atypical radical precursors dominating the oxidizing capacity in polluted winter air, and thus, the distribution and fate of primary pollutants on a regional to global scale

Steady state free radical budgets and ozone photochemistry during TOPSE

A steady state model, constrained by a number of measured quantities, was used to derive peroxy radical levels for the conditions of the Tropospheric Ozone Production about the Spring Equinox (TOPSE) campaign. The analysis is made using data collected aboard the NCAR/NSF C-130 aircraft from February through May 2000 at latitudes from 40° to 85°N, and at altitudes from the surface to 7.6 km. HO2 + RO2 radical concentrations were measured during the experiment, which are compared with model results over the domain of the study showing good agreement on the average. Average measurement/model ratios are 1.04 (σ = 0.73) and 0.96 (σ = 0.52) for the MLB and HLB, respectively. Budgets of total peroxy radical levels as well as of individual free radical members were constructed, which reveal interesting differences compared to studies at lower latitudes. The midlatitude part of the study region is a significant net source of ozone, while the high latitudes constitute a small net sink leading to the hypothesis that transport from the middle latitudes can explain the observed increase in ozone in the high latitudes. Radical reservoir species concentrations are modeled and compared with the observations. For most conditions, the model does a good job of reproducing the formaldehyde observations, but the peroxide observations are significantly less than steady state for this study. Photostationary state (PSS) derived total peroxy radical levels and NO/NO2ratios are compared with the measurements and the model; PSS-derived results are higher than observations or the steady state model at low NO concentrations

Quantification of inaccurate diagnosis of COPD in primary care medicine: An analysis of the COACH clinical audit

Background: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement

Designing all-graphene nanojunctions by covalent functionalization

We investigated theoretically the effect of covalent edge functionalization, with organic functional groups, on the electronic properties of graphene nanostructures and nano-junctions. Our analysis shows that functionalization can be designed to tune electron affinities and ionization potentials of graphene flakes, and to control the energy alignment of frontier orbitals in nanometer-wide graphene junctions. The stability of the proposed mechanism is discussed with respect to the functional groups, their number as well as the width of graphene nanostructures. The results of our work indicate that different level alignments can be obtained and engineered in order to realize stable all-graphene nanodevices

Conserving the World’s Megafauna and Biodiversity: The Fierce Urgency of Now

First paragraph: In our recent perspective article, we noted that most (approximately 60 percent) terrestrial large carnivore and large herbivore species are now threatened with extinction, and we offered a 13-point declaration designed to promote and guide actions to save these iconic mammalian megafauna (Ripple et al. 2016). Some may worry that a focus on saving megafauna might undermine efforts to conserve biodiversity more broadly. We believe that all dimensions of biodiversity are important and that efforts to conserve megafauna are not in themselves sufficient to halt the dispiriting trends of species and population losses in recent decades. From 1970 to 2012, a recent global analysis showed a 58 percent overall decline in vertebrate population abundance (WWF 2016). Bold and varied approaches are necessary to conserve what remains of Earth’s biodiversity, and our declaration in no way disputes the value of specific conservation initiatives targeting other taxa. Indeed, the evidence is clear that without massively scaling up conservation efforts for all species, we will fail to achieve internationally agreed-upon targets for biodiversity (Tittensor et al. 2014).Additional co-authors: Holly T Dublin, James A Estes, Kristoffer T Everatt, Mauro Galetti, Varun R Goswami, Matt W Hayward, Simon Hedges, Michael Hoffmann, Luke TB Hunter, Graham IH Kerley, Mike Letnic, Taal Levi, John C Morrison, Michael Paul Nelson, Thomas M Newsome, Luke Painter, Robert M Pringle, Christopher J Sandom, John Terborgh, Adrian Treves, Blaire Van Valkenburgh, John A Vucetich, Aaron J Wirsing, Arian D Wallach, Christopher Wolf, Rosie Woodroffe, Hillary Young, And Li Zhan

Inequality, Fiscal Capacity and the Political Regime: Lessons from the Post-Communist Transition

Using panel data for twenty-seven post-communist economies between 1987-2003, we examine the nexus of relationships between inequality, fiscal capacity (defined as the ability to raise taxes efficiently) and the political regime. Investigating the impact of political reform we find that full political freedom is associated with lower levels of income inequality. Under more oligarchic (authoritarian) regimes, the level of inequality is conditioned by the state’s fiscal capacity. Specifically, oligarchic regimes with more developed fiscal systems are able to defend the prevailing vested interests at a lower cost in terms of social injustice. This empirical finding is consistent with the model developed by Acemoglu (2006). We also find that transition countries undertaking early macroeconomic stabilisation now enjoy lower levels of inequality; we confirm that education fosters equality and the suggestion of Commander et al (1999) that larger countries are prone to higher levels of inequality.http://deepblue.lib.umich.edu/bitstream/2027.42/57211/1/wp831 .pd

Steady state free radical budgets and ozone photochemistry during TOPSE

A steady state model, constrained by a number of measured quantities, was used to derive peroxy radical levels for the conditions of the Tropospheric Ozone Production about the Spring Equinox (TOPSE) campaign. The analysis is made using data collected aboard the NCAR/NSF C‐130 aircraft from February through May 2000 at latitudes from 40° to 85°N, and at altitudes from the surface to 7.6 km. HO2 + RO2 radical concentrations were measured during the experiment, which are compared with model results over the domain of the study showing good agreement on the average. Average measurement/model ratios are 1.04 (σ = 0.73) and 0.96 (σ = 0.52) for the MLB and HLB, respectively. Budgets of total peroxy radical levels as well as of individual free radical members were constructed, which reveal interesting differences compared to studies at lower latitudes. The midlatitude part of the study region is a significant net source of ozone, while the high latitudes constitute a small net sink leading to the hypothesis that transport from the middle latitudes can explain the observed increase in ozone in the high latitudes. Radical reservoir species concentrations are modeled and compared with the observations. For most conditions, the model does a good job of reproducing the formaldehyde observations, but the peroxide observations are significantly less than steady state for this study. Photostationary state (PSS) derived total peroxy radical levels and NO/NO2 ratios are compared with the measurements and the model; PSS‐derived results are higher than observations or the steady state model at low NO concentrations