25 research outputs found

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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    IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

    Exposure and Health Impacts Related to Outdoor and Indoor Air Pollutants

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    The five papers included in this Special Issue represent a diverse selection of contributions [...

    Personal Exposure and Inhaled Dose Estimation of Air Pollutants during Travel between Albany, NY and Boston, MA

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    Out of eight deaths caused worldwide, one death is caused due to air pollution exposure, making it one of the top global killers. Personal exposure measurement for real-time monitoring has been used for inhaled dose estimation during various modes of workplace commuting. However, dose-exposure studies during long commutes are scarce and more information on inhaled doses is needed. This study focuses on personal exposures to size-fractionated particulate matter (PM1, PM2.5, PM4, PM7, PM10, TSP) and black carbon (BC) inside a bus traveling more than 270 kms on a highway between Albany, NY and Boston, MA. Measurements were also made indoors, outdoors, and while walking in each city. Mean PM (PM1, PM2.5, PM4, PM7, PM10, TSP) and mean BC concentrations were calculated to estimate the inhaled exposure dose. The highest average PM2.5 and PM10 exposures concentrations were 30 ± 12 and 111 ± 193 µg/m3, respectively, during Boston to Albany. Notably, personal exposure to BC on a bus from Albany to Boston (5483 ± 2099 ng/m3) was the highest measured during any commute. The average inhaled dose for PM2.5 during commutes ranged from 0.018 µg/km to 0.371 µg/km. Exposure concentrations in indoor settings (average PM2.5 = 37 ± 55 µg/m3, PM10 = 78 ± 82 µg/m3, BC = 5695 ± 1774 ng/m3) were higher than those in outdoor environments. Carpeted flooring, cooking, and vacuuming all tended to increase the indoor particulate level. A high BC concentration (1583 ± 1004 ng/m3) was measured during walking. Typical concentration profiles in long-haul journeys are presented

    Reliability and stability of a statistical model to predict ground-based PM2.5 over 10\ua0years in Karachi, Pakistan, using satellite observations

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    Understanding the complex mechanisms of climate change and its environmental consequences requires the collection and subsequent analysis of geospatial data from observations and numerical modeling. Multivariable linear regression and mixed-effects models were used to estimate daily surface fine particulate matter (PM2.5) levels in the megacity of Pakistan. The main parameters for the multivariable linear regression model were the 10-km-resolution satellite aerosol optical depth (AOD) and daily averaged meteorological parameters from ground monitoring (temperature, dew point, relative humidity, wind speed, wind direction, and planetary boundary layer height). Ground-based PM2.5 was measured in two stations in the city, Korangi (industrial/residential) and Tibet Center (commercial/residential). The initial linear regression model was modified using a stepwise selection procedure and adding interaction parameters. Finally, the modified model showed a strong correlation between the PM2.5–satellite AOD and other meteorological parameters (R2 = 0.88–0.92 and p-value = 10−7 depending on the season and station). The mixed-effect technique improved the model performance by increasing the R2 values to 0.99 and 0.93 for the Korangi and Tibet Center sites, respectively. Cross-validation methods were used to confirm the reliability of the model to predict PM2.5 after 10\ua0years

    Environmental Impacts and Mitigation Costs of Cloth and Leather Exports from Pakistan

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    ©1993 by the Sustainable Development Policy Institut

    Ambient Size-Segregated Particulate Matter Characterization from a Port in Upstate New York

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    Air pollution impacts human health and the environment, especially in urban cities with substantial industrial activities and vehicular traffic emissions. Despite increasingly strict regulations put in place by regulatory agencies, air pollution is still a significant environmental problem in cities across the world. The objective of this study was to evaluate the environmental pollution from stationary and mobile sources using real-time monitoring and sampling techniques to characterize size-segregated particulate matter (PM), black carbon (BC), and ozone (O3) at the Port of Albany, NY. Air pollution monitoring was carried out for 3 consecutive weeks under a 24-hour cycle in 2018 at the New York State Department of Environmental Conservation (NYSDEC) site within the Port. Sampling was done with an AEROCET 531, optical particle sizer (OPS), ozone monitor, and MicroAeth AE51. Higher mass and number concentrations of size-segregated particles were observed during the daytime. PM2.5 and PM10 concentrations ranged from 1 to 271 micrograms per cubic meter (”g/m3) and 1 to 344 ”g/m3, respectively. While these values do not exceed the level of the USEPA 24-hour standards, frequent sharp peaks were observed at higher concentrations. Size-segregated PM at sizes 0.3 ”m and 0.374 ”m recorded maximum concentrations of 101,631 particle number per cubic centimeter (#/cm3) and 43,432 #/cm3, respectively. Wide variations were observed in the particle number concentrations for 0.3 ”m, 0.374 ”m, and 0.465 ”m sizes, which ranged from 1521 to 101,631 #/cm3; 656 to 43,432 #/cm3; and 311 to 29,271 #/cm3, respectively. BC concentration increased during morning and evening rush hours with the maximum concentration of 11,971 ng/m3 recorded at 8:00 AM. This suggests that mobile sources are the primary contributor to anthropogenic sources of BC within the Port. Episodic elevations in the concentrations of size-segregated PM and BC confirmed the contribution of industrial and vehicular activities around the Port of Albany. This study underscores the importance of measuring particles on a size-segregated basis in order to more fully understand the contributions of the multiple sources present within and surrounding a port environment

    Ambient Size-Segregated Particulate Matter Characterization from a Port in Upstate New York

    No full text
    Air pollution impacts human health and the environment, especially in urban cities with substantial industrial activities and vehicular traffic emissions. Despite increasingly strict regulations put in place by regulatory agencies, air pollution is still a significant environmental problem in cities across the world. The objective of this study was to evaluate the environmental pollution from stationary and mobile sources using real-time monitoring and sampling techniques to characterize size-segregated particulate matter (PM), black carbon (BC), and ozone (O3) at the Port of Albany, NY. Air pollution monitoring was carried out for 3 consecutive weeks under a 24-hour cycle in 2018 at the New York State Department of Environmental Conservation (NYSDEC) site within the Port. Sampling was done with an AEROCET 531, optical particle sizer (OPS), ozone monitor, and MicroAeth AE51. Higher mass and number concentrations of size-segregated particles were observed during the daytime. PM2.5 and PM10 concentrations ranged from 1 to 271 micrograms per cubic meter (µg/m3) and 1 to 344 µg/m3, respectively. While these values do not exceed the level of the USEPA 24-hour standards, frequent sharp peaks were observed at higher concentrations. Size-segregated PM at sizes 0.3 µm and 0.374 µm recorded maximum concentrations of 101,631 particle number per cubic centimeter (#/cm3) and 43,432 #/cm3, respectively. Wide variations were observed in the particle number concentrations for 0.3 µm, 0.374 µm, and 0.465 µm sizes, which ranged from 1521 to 101,631 #/cm3; 656 to 43,432 #/cm3; and 311 to 29,271 #/cm3, respectively. BC concentration increased during morning and evening rush hours with the maximum concentration of 11,971 ng/m3 recorded at 8:00 AM. This suggests that mobile sources are the primary contributor to anthropogenic sources of BC within the Port. Episodic elevations in the concentrations of size-segregated PM and BC confirmed the contribution of industrial and vehicular activities around the Port of Albany. This study underscores the importance of measuring particles on a size-segregated basis in order to more fully understand the contributions of the multiple sources present within and surrounding a port environment
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