Asthma on the job: work-related factors in new-onset asthma and in exacerbations of pre-existing asthma

AbstractOccupational asthma (OA) can be defined as variable airways narrowing causally related to exposure in the working environment to airborne dusts, gases, vapours or fumes. There are many agents in the work-place that can induce asthma or cause substantial deterioration in pre-existing asthma. It has been estimated that 5–15% of adult-onset asthma can be attributed to occupational exposures. Hence adult patients, especially those with new-onset asthma, must be investigated with regard to occupational risk factors for disease. The prognosis for OA is improved if the causal exposure is controlled either by controlling the exposure at the workplace or by moving the patient out of the workplace

Early symptoms and sensations as predictors of lung cancer: a machine learning multivariate model.

The aim of this study was to identify a combination of early predictive symptoms/sensations attributable to primary lung cancer (LC). An interactive e-questionnaire comprised of pre-diagnostic descriptors of first symptoms/sensations was administered to patients referred for suspected LC. Respondents were included in the present analysis only if they later received a primary LC diagnosis or had no cancer; and inclusion of each descriptor required ≥4 observations. Fully-completed data from 506/670 individuals later diagnosed with primary LC (n = 311) or no cancer (n = 195) were modelled with orthogonal projections to latent structures (OPLS). After analysing 145/285 descriptors, meeting inclusion criteria, through randomised seven-fold cross-validation (six-fold training set: n = 433; test set: n = 73), 63 provided best LC prediction. The most-significant LC-positive descriptors included a cough that varied over the day, back pain/aches/discomfort, early satiety, appetite loss, and having less strength. Upon combining the descriptors with the background variables current smoking, a cold/flu or pneumonia within the past two years, female sex, older age, a history of COPD (positive LC-association); antibiotics within the past two years, and a history of pneumonia (negative LC-association); the resulting 70-variable model had accurate cross-validated test set performance: area under the ROC curve = 0.767 (descriptors only: 0.736/background predictors only: 0.652), sensitivity = 84.8% (73.9/76.1%, respectively), specificity = 55.6% (66.7/51.9%, respectively). In conclusion, accurate prediction of LC was found through 63 early symptoms/sensations and seven background factors. Further research and precision in this model may lead to a tool for referral and LC diagnostic decision-making

Toward Guidelines for Harvest Intensities and Regeneration Targets with Minimal Impact Upon Retained Genetic Diversity in Central Hardwood Tree Species

There is an urgent need for a coordinated and systematic approach to the in situ conservation of the genetic resources of commercially important forest tree species in the Central Hardwoods. Effective in situ management of genetic resources would benefit from clear guidelines for how many adult trees can be harvested with minimal impact on allelic diversity. We are constructing a computer model for this purpose, and present preliminary results based upon replicate harvests of a virtual forest stand consisting of 200 adult trees. Our model explores how much regeneration is needed so that there is no more than a 10 percent risk of retaining less than 90 percent of the original allelic diversity. In the absence of regeneration, up to 55 percent of the adult trees can be harvested without exceeding the 10 percent risk level. At higher harvest intensities, locally-derived regeneration is needed to replace the alleles removed from the adult population. When all 200 adult trees are harvested, the 10 percent risk level is not exceeded if there are at least 116 regenerants, provided that these are derived from pre-harvest random mating among the adults. In the presence of substantial pollen flow from a genetically differentiated outside pollen source (e.g., 10-20 percent pollen flow), the minimum amount of regeneration needed is reduced. This indicates that outside pollen can be more efficient, relative to pollen from within the stand, at replacing alleles lost from the adult population

Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with drug-resistant epilepsy treated with vagus nerve stimulation in the AspireSR E-36 trial

Objective: Reports of cardiac arrhythmias and cardiac pathology at postmortem examination of patients with epilepsy suggest a possible cardiac component of risk for sudden unexpected death in epilepsy (SUDEP). T-wave alternans (TWA) is an established marker of cardiac electrical instability and risk for sudden death in patients with cardiovascular disease. We determined the TWA level before vagus nerve stimulation (VNS) system implantation and subsequently the effect of VNS on TWA in patients with drug-resistant epilepsy. Methods: Patients (n = 28) from the Seizure Detection and Automatic Magnet Mode Performance Study (E-36), a clinical trial of the AspireSR (R) VNS Therapy System (R) (NCT01325623), were monitored with ambulatory electrocardiograms (ECGs) similar to 2 weeks before de novo VNS system implantation and following 2- to 4-week VNS titration during a protocol-specified 3- to 5-day epilepsy monitoring unit stay with concurrent EEG/ECG recordings. The TWA level was assessed interictally by the Modified Moving Average (MMA) method. Results: At preimplantation baseline, TWA was elevated above the 47-mu V abnormality cutpoint in 23 (82%) patients with drug-resistant epilepsy. In 16 (70%) patients, TWA level was reduced during VNS treatment to <47 mu V, thereby converting positive TWA test results to negative. Peak TWA level in all 28 patients improved (group mean, 43%, from 72 +/- 4.3 to 41 +/- 2.3 mu V; p < 0.0001). Vagus nerve stimulation was not associated with reduced heart rate (77 +/- 1.4 to 75 +/- 1.4 beats/min; p = 0.18). Heart rate variability was unchanged. Significance: These findings suggest significant interictal cardiac electrical instability in this population of patients with drug-resistant epilepsy and suggest that VNS may be a novel approach to reducing risk

A prospective study of asthma incidence and its predictors: the RHINE study.

To access publisher full text version of this article. Please click on the hyperlink in Additional LinkThe objective of this longitudinal study was to estimate the incidence rate of asthma, and to compare the incidence between subjects with or without baseline reporting of certain respiratory symptoms. A follow-up of the random population samples in the European Respiratory Health Survey (ECRHS) in Sweden, Norway, Denmark, Iceland and Estonia was conducted in 1999-2001, in a population aged 30-54 yrs at follow-up (n=14,731). Asthma was defined as reporting either asthma or physician-diagnosed asthma, and a reported year when asthma symptoms were first noticed. Incidence rates, incidence rate ratios and hazard ratios were calculated with 95% confidence intervals. The incidence rate of asthma was 2.2 cases per 1,000 person-yrs. The incidence was higher among females (2.9 cases.1,000 person-yrs(-1)) than among males (1.5 cases.1,000 person-yrs(-1)). When subjects with baseline reporting of wheezing were excluded, the incidence rate decreased to 1.7 cases.1,000 person-yrs(-1), with a further decrease to 1.5 cases.1,000 person-yrs(-1) after exclusion of subjects with wheezing, nocturnal dyspnoea, chest tightness and cough. There was a strong association between onset of asthma and wheezing at baseline. In this prospective, population-based study, the incidence rate of asthma in the whole population sample ranged 1.5-2.2.1,000 person-yrs(-1), with a higher incidence range among females. The incidence was dependent on the extent to which subjects with respiratory symptoms were excluded from follow-up. Hence, for comparability between studies, the exclusion criteria in the follow-up population must be stated

Effective Dose and Persistence of Rhodamine-B in Wild Pig Vibrissae

As a result of substantial ecological and economic damage attributed to wild pigs (Sus scrofa), there is international interest in using pharmaceutical baits to control populations. To assess the efficacy and specificity of baiting programs, chemical biomarkers can be used to evaluate uptake of pharmaceutical baits. Rhodamine B (RB) is known to be an effective biomarker in wild pigs. However, significant data gaps exist regarding the minimum effective dosage and persistence of RB in wild pigs. We used a controlled doubleblind study experiment conducted in spring of 2014 on the Savannah River Site, Aiken, South Carolina, USA, wherein we administered a one-time dose of RB at 3 treatment levels (5 mg/kg, 15mg/kg, or 30 mg/kg) to 15 captive pigs, with 5 pigs/treatment group to investigate persistence of RB. Facial vibrissae were collected pre-RB ingestion as a control and every 2 weeks post-RB ingestion for 12 weeks. We examined samples for RB presence and used a generalized linear mixed model (GLMM) to determine the influence of treatment dose on persistence of RB. Additionally, we measured distance moved by the RB mark away from the vibrissae root and used a GLMM to assess movement rates of RB bands along growing vibrissae. We found consistently greater persistence of RB in the 15- and 30-mg/kg treatments across the sampling period. A significant, positive movement trend in RB bands was observed within the 15mg/kg and 30 mg/kg groups. Based on our results, a 15 mg/kg dosage can be considered a minimum effective dose for wild pigs and will reliably produce a detectable RB mark up to and likely beyond 12 weeks after ingestion

Climate analogues suggest limited potential for intensification of production on current croplands under climate change

Climate change could pose a major challenge to efforts towards strongly increase food production over the coming decades. However, model simulations of future climate-impacts on crop yields differ substantially in the magnitude and even direction of the projected change. Combining observations of current maximum-attainable yield with climate analogues, we provide a complementary method of assessing the effect of climate change on crop yields. Strong reductions in attainable yields of major cereal crops are found across a large fraction of current cropland by 2050. These areas are vulnerable to climate change and have greatly reduced opportunity for agricultural intensification. However, the total land area, including regions not currently used for crops, climatically suitable for high attainable yields of maize, wheat and rice is similar by 2050 to the present-day. Large shifts in land-use patterns and crop choice will likely be necessary to sustain production growth rates and keep pace with demand