An Approach to Developing a Spatio-Temporal Composite Measure of Climate Change-Related Human Health Impacts in Urban Environments

Introduction: Rapid population growth along with an increase in the frequency and intensity of climate change-related impacts in costal urban environments emphasize the need for the development of new tools to help disaster planners and policy makers select and prioritize mitigation and adaptation measures. Using the concept of the resilience of a community, which is a measure of how rapidly the community can recover to its previous level of functionality following a disruptive event is still a relatively new concept for many engineers, planners and policy makers, but is becoming recognized as an increasingly important and some would argue, essential component for the development and subsequent assessment of adaptation plans being considered for communities at risk of climate change-related events. The holistic approach which is the cornerstone of resilience is designed to integrate physical, economic, health, social and organizational impacts of climate change in urban environments. This research presents a methodology for the development of a quantitative spatial and temporal composite measure for assessing climate change-related health impacts in urban environments. Methods: The proposed method is capable of considering spatial and temporal data from multiple inputs, relating to both physical and social parameters. This approach uses inputs such as the total population density and densities of various demographics, burden of diseases conditions, flood inundation mapping, and land use change for both historical and current conditions. The research has demonstrated that the methodology presented generates sufficiently accurate information to be useful for planning adaptive strategies. To assemble all inputs into a single measure of health impacts, a weighting system was assigned to apply various priorities to the spatio-temporal data sources. Weights may be varied to assess how they impact the final results. Finally, using spatio-temporal extrapolation methods the future behavior of the same key spatial variables can be projected. Although this method was developed for application to any coastal mega-city, this thesis demonstrates the results obtained for Metro Vancouver, British Columbia, Canada. The data was collected for the years 1981, 1986, 1991, 1996, 2001, 2006 and 2011, as information was readily available for these years. Fine resolution spatial data for these years was used in order to give a dynamic simulation of possible health impacts for future projections. Linear and auto-regressive spatio-temporal extrapolations were used for projecting a 2050’s Metro Vancouver health impact map (HIM). Conclusion: Results of this work show that the approach provides a more fully integrated view of the resilience of the city which incorporates aspects of population health. The approach would be useful in the development of more targeted adaptation and risk reduction strategies at a local level. In addition, this methodology can be used to generate inputs for further resilience simulations. The overall value of this approach is that it allows for a more integrated assessment of the city vulnerability and could lead to more effective adaptive strategies

Quantitative Evaluation of Pulmonary Emphysema Using Magnetic Resonance Imaging and x-ray Computed Tomography

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality affecting at least 600 million people worldwide. The most widely used clinical measurements of lung function such as spirometry and plethysmography are generally accepted for diagnosis and monitoring of the disease. However, these tests provide only global measures of lung function and they are insensitive to early disease changes. Imaging tools that are currently available have the potential to provide regional information about lung structure and function but at present are mainly used for qualitative assessment of disease and disease progression. In this thesis, we focused on the application of quantitative measurements of lung structure derived from 1H magnetic resonance imaging (MRI) and high resolution computed tomography (CT) in subjects diagnosed with COPD by a physician. Our results showed that significant and moderately strong relationship exists between 1H signal intensity (SI) and 3He apparent diffusion coefficient (ADC), as well as between 1H SI and CT measurements of emphysema. This suggests that these imaging methods may be quantifying the same tissue changes in COPD, and that pulmonary 1H SI may be used effectively to monitor emphysema as a complement to CT and noble gas MRI. Additionally, our results showed that objective multi-threshold analysis of CT images for emphysema scoring that takes into account the frequency distribution of each Hounsfield unit (HU) threshold was effective in correctly classifying the patient into COPD and healthy subgroups. Finally, we found a significant correlation between whole lung average subjective and objective emphysema scores with high inter-observer agreement. It is concluded that 1H MRI and high resolution CT can be used to quantitatively evaluate lung tissue alterations in COPD subjects

Chest MRI in children: Why bother?

In this issue of Respirology, Montella and colleagues ask this question: How does high‐field chest MRI compare with CT of children with non‐cystic fibrosis (CF) lung disease? In an important extension of the first description of this study where they compared MRI and CT with pulmonary function measurements, the authors evaluated how widely‐used chest CT and almost never‐utilized lung MRI compare for diagnostic imaging of chronic lung disease. Here they show that high‐field (3Tesla as compared with the 1.5Tesla clinical standard) thoracic MRI has high reliability and good‐to‐excellent agreement with CT, definitively answering the important question at hand; their results support more widespread and routine use of MRI in longitudinal monitoring of chronic lung disease, especially in children as well as further optimization and improvement of lung MRI methods. Importantly, non‐CF lung disease accounts for the majority of paediatric pulmonary abnormalities and the increasing prevalence and economic burden related to chronic respiratory disease should motivate the research and development of novel MRI methods for serial and longitudinal imaging

Technical Report: Evaluation of peripheral dose for flattening filter free photon beams

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135019/1/mp8963.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135019/2/mp8963_am.pd

On the role of abnormal DL(CO) in ex-smokers without airflow limitation: symptoms, exercise capacity and hyperpolarised helium-3 MRI

BACKGROUND: The functional effects of abnormal diffusing capacity for carbon monoxide (DLCO) in ex-smokers without chronic obstructive pulmonary disease (COPD) are not well understood. OBJECTIVE: We aimed to evaluate and compare well established clinical, physiological and emerging imaging measurements in ex-smokers with normal spirometry and abnormal DLCO with a group of ex-smokers with normal spirometry and DLCO and ex-smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I COPD. METHODS: We enrolled 38 ex-smokers and 15 subjects with stage I COPD who underwent spirometry, plethysmography, St George\u27s Respiratory Questionnaire (SGRQ), 6 min Walk Test (6MWT), x-ray CT and hyperpolarised helium-3 ((3)He) MRI. The 6MWT distance (6MWD), SGRQ scores, (3)He MRI apparent diffusion coefficients (ADC) and CT attenuation values below -950 HU (RA950) were evaluated. RESULTS: Of 38 ex-smokers without COPD, 19 subjects had abnormal DLCO with significantly worse ADC (p=0.01), 6MWD (p=0.008) and SGRQ (p=0.01) but not RA950 (p=0.53) compared with 19 ex-smokers with normal DLCO. Stage I COPD subjects showed significantly worse ADC (p=0.02), RA950 (p=0.0008) and 6MWD (p=0.005), but not SGRQ (p=0.59) compared with subjects with abnormal DLCO. There was a significant correlation for (3)He ADC with SGRQ (r=0.34, p=0.02) and 6MWD (r=-0.51, p=0.0002). CONCLUSIONS: In ex-smokers with normal spirometry and CT but abnormal DLCO, there were significantly worse symptoms, 6MWD and (3)He ADC compared with ex-smokers with normal DLCO, providing evidence of the impact of mild or early stage emphysema and a better understanding of abnormal DLCO and hyperpolarised (3)He MRI in ex-smokers without COPD

Hyperpolarized 3He and 129Xe magnetic resonance imaging apparent diffusion coefficients: physiological relevance in older never- and ex-smokers

Noble gas pulmonary magnetic resonance imaging (MRI) is transitioning away from (3)He to (129)Xe gas, but the physiological/clinical relevance of (129)Xe apparent diffusion coefficient (ADC) parenchyma measurements is not well understood. Therefore, our objective was to generate (129)Xe MRI ADC for comparison with (3)He ADC and with well-established measurements of alveolar structure and function in older never-smokers and ex-smokers with chronic obstructive pulmonary disease (COPD). In four never-smokers and 10 COPD ex-smokers, (3)He (b = 1.6 sec/cm(2)) and (129)Xe (b = 12, 20, and 30 sec/cm(2)) ADC, computed tomography (CT) density-threshold measurements, and the diffusing capacity for carbon monoxide (DLCO) were measured. To understand regional differences, the anterior-posterior (APG) and superior-inferior (∆SI) ADC differences were evaluated. Compared to never-smokers, COPD ex-smokers showed greater (3)He ADC (P = 0.006), (129)Xe ADCb12 (P = 0.006), and ADCb20 (P = 0.006), but not for ADCb30 (P \u3e 0.05). Never-smokers and COPD ex-smokers had significantly different APG for (3)He ADC (P = 0.02), (129)Xe ADCb12 (P = 0.006), and ADCb20 (P = 0.01), but not for ADCb30 (P \u3e 0.05). ∆SI for never- and ex-smokers was significantly different for (3)He ADC (P = 0.046), but not for (129)Xe ADC (P \u3e 0.05). There were strong correlations for DLCO with (3)He ADC and (129)Xe ADCb12 (both r = -0.95, P \u3c 0.05); in a multivariate model (129)Xe ADCb12 was the only significant predictor of DLCO (P = 0.049). For COPD ex-smokers, CT relative are

Blood Trace Element Status in Multiple Sclerosis: a Systematic Review and Meta-analysis

The aim of this meta-analysis was to investigate whether the blood concentrations of patients with multiple sclerosis (MS) are associated with those of the healthy control group in terms of trace elements including zinc (Zn), iron (Fe), manganese (Mn), magnesium (Mg), selenium (Se), and copper (Cu). A comprehensive search was performed in online databases including PubMed, Scopus, Embase, and Web of Science for studies, which have addressed trace elements in MS up to July 23, 2020. The chi-square test and I2 statistic were utilized to evaluate inter-study heterogeneity across the included studies. Weighted mean differences (WMDs) and corresponding 95% CI were considered as a pooled effect size (ES). Twenty-seven articles (or 32 studies) with a total sample comprised of 2895 participants (MS patients (n = 1567) and controls (n = 1328)) were included. Pooled results using random-effects model indicated that the levels of Zn (WMD = − 7.83 mcg/dl, 95% CI = − 12.78 to − 2.87, Z = 3.09, P = 0.002), and Fe (WMD = − 13.66 mcg/dl, 95% CI = − 23.13 to − 4.19, Z = 2.83, P = 0.005) were significantly lower in MS patients than in controls. However, it was found that levels of Mn (WMD = 0.03 mcg/dl, 95% CI = 0.01 to 0.04, Z = 2.89, P = 0.004) were significantly higher in MS patients. Yet, no significant differences were observed in the levels of Mg, Se, and Cu between both groups. This meta-analysis revealed that the circulating levels of Zn and Fe were significantly lower in MS patients and that Mn level was significantly higher than those in the control group. However, it was found that there was no significant difference between MS patients and controls with regard to levels of Mg, Se, and Cu