A Quicker, Cheaper Method to Quantify Total Carbonyls in Air and Biological Samples

Carbonyl compounds exist in air, water, food, biological fluids and tissues, as well as nonbiological materials. Many methods have been developed to detect carbonyl compounds in the air, including numerous derivatization reagents to make carbonyl compounds more stable, multiple extraction methods, as well as multiple detection methods. These methods can be costly and time consuming, and also make use of toxic solvents. We sought a quick and inexpensive method to detect and quantify total carbonyls in air samples, specifically diesel exhaust samples, as well as extra cellular media in biological samples. We derivatized standard carbonyl compounds with 2,4-dinitrophenyl hydrazine(DNPH); heptane was more efficient than pentane or hexane in extraction of the derivatives and leaves excess DNPH almost entirely in the aqueous phase. To test the usefulness of this technique carbonyls from diesel exhaust were collected on Sep-Pak DNPH-Silica cartridges, eluted, extracted with heptane, and analyzed by spectrophotometry and HPLC/UV/MS. Linear regression analysis indicated a strong correlation (0.9821) between the UV absorbance (365nm) of each sample and the total mass of carbonyl derivatives separated by HPLC and determined by MS. The usefulness of this technique was also tested on a biological sample. BEAS- 2B cells were exposed to differing concentrations of residual oil fly ash (ROFA). UV absorbance increased with increasing ROFA concentrations, suggesting that carbonyl groups (products of lipid peroxidation) increased with increasing concentrations of ROFA. These results indicate that a quick and inexpensive method to detect and quantify total carbonyls in air samples, specifically diesel exhaust samples, as well as extracellular media in biological samples, may be achieved through the extraction of carbonyl derivatives with heptane and subsequent detection by spectrophotometry. In the future, there is potential to use this method to detect carbonyls in food and water samples.Master of Science in Public Healt

Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

BACKGROUND/AIMS: This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. METHODS: Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. RESULTS: Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. CONCLUSIONS: CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax.ope

A Randomized Trial of Real-Time Geriatric Assessment Reporting in Nonelectively Hospitalized Older Adults with Cancer

Background: Hospitalized older adults have significant geriatric deficits that may lead to poor outcomes. We conducted a randomized trial to investigate the effectiveness of providing clinicians with a real-time geriatric assessment (GA) report in nonelectively hospitalized older patients with cancer. Subjects, Materials, and Methods: We developed a web-based software platform for administering a modified GA (Cancer 2005; 104:1998–2005) to older (>70 years) nonelectively hospitalized patients with pathologically confirmed malignancy. Patients were randomized to have their GA report provided to their treating clinicians (Intervention arm) or not provided (Control arm). Results: Our study included 135 patients, median age 76 years, 52% female, 75% white, 21% black, 79% greater than high school education, 59% married, and 17% living alone. All patients had at least one GA-identified deficit, including physical function deficits (90%), cognitive impairment (22%), >5 comorbidities (28%), polypharmacy (>9 medications; 38%), weight loss ≥10% in the past 6 months (40%), anxiety (32%), or depression (30%). There was no difference between the Intervention (6%) and Control arms (9%) in the proportion of patients who were referred by their clinical team for an intervention to address a deficit (p =.53). Conclusion: Many older nonelectively hospitalized patients with cancer have geriatric deficits that are amenable to evidence-based interventions. Real-time GA reports provided to the care team prior to discharge did not influence provider referral for such interventions. There is a need for systems-level interventions to address deficits in this vulnerable patient population. Implications for Practice: Geriatric deficits are common in hospitalized older adults with cancer and lead to poor outcomes. Addressing modifiable deficits represents an appealing way to improve outcomes. Widespread geriatrician consultation is impractical owing to resource and personnel constraints. This work tested whether prompt delivery of a mostly self-administered, web-based geriatric assessment report to clinicians improved referral rates for evidence-informed interventions. It confirmed frequent geriatric deficits and high readmission rates in this population but found that real-time geriatric assessment reporting did not influence provider referral for evidence-informed interventions on geriatric assessment identified deficits. These findings highlight the need for systems-level intervention to improve outcomes in this vulnerable patient population

Construction of a US-based Multi-pollutant Air Quality Index

Background: To communicate health risks associated with short-term changes in air pollution the US EPA reports air quality through the Air Quality Index (AQI). However, it remains unclear whether the current regulatory-based, single-pollutant AQI fully represents the actual risks of air pollution related illness. A revised AQI, using a multiple pollutant approach based on health effects, could potentially improve public health by better reflecting the health risks associated with exposure to multiple pollutants. Methods: Daily concentrations and AQI values of five criteria pollutants (CO, NO2, O3, PM2.5, and SO2) from 2000-2010 in Bronx, Erie, Queens and Suffolk Counties of New York were used to estimate the burden of illness (cardiovascular hospital admissions and respiratory department emergency department (ED) visits) attributable to each pollutant when the criteria pollutant was the driver pollutant versus days when the AQI of other pollutants was reported. Time-series analyses of total respiratory ED visits using a Poisson generalized linear model from 2005-2010 was completed to generate region-specific beta coefficients, which were used to develop a multi-pollutant air quality health index (AQHI). Multi-pollutant and single pollutant AQI values (2011-2013) were regressed against several health endpoints (i.e. total respiratory ED visits and total respiratory hospital admissions) to determine their effectiveness in representing population level air pollution risks. Results: Cardiovascular hospital admissions and respiratory ED visits attributable to individual pollutants occurred even when the pollutant was not reported as the driver pollutant, and the majority of the burden of illness occurred when the AQI was less than 100 (“good” or “moderate” level of health concern), regardless of whether or not a pollutant was the AQI driver pollutant. Based upon time-series analysis, each pollutant considered was shown to have significant positive associations with respiratory ED visits for at least part of the year and therefore was eligible for potential inclusion in a multi-pollutant index. A multi-pollutant AQHI model with NO2, O3, PM2.5, and SO 2 was found to have stronger associations with total respiratory ED visits than a single pollutant AQI model and was significant annually and seasonally, while associations between respiratory ED visits and the AQI were not significant in the warm season. Conclusions: These results indicate that a single-pollutant index may inadequately communicate the full adverse health risks of air pollution. A multi-pollutant AQI model was more effective than the currently utilized single pollutant model in representing risks across the entire range of pollutant concentrations. The Clean Air Act stipulates that an air quality index must be used to communicate the short term risks of exposure to air pollution; the development and validation of a multi-pollutant AQI for use in the United States will not only improve risk communication to the public, but could also advance the development of multi-pollutant air quality standards

Development of a Health-Based Index to Identify the Association between Air Pollution and Health Effects in Mexico City

Health risks from air pollution continue to be a major concern for residents in Mexico City. These health burdens could be partially alleviated through individual avoidance behavior if accurate information regarding the daily health risks of multiple pollutants became available. A split sample approach was used in this study to create and validate a multi-pollutant, health-based air quality index. Poisson generalized linear models were used to assess the impacts of ambient air pollution (i.e., fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ground-level ozone (O3)) on a total of 610,982 daily emergency department (ED) visits for respiratory disease obtained from 40 facilities in the metropolitan area of Mexico City from 2010 to 2015. Increased risk of respiratory ED visits was observed for interquartile increases in the 4-day average concentrations of PM2.5 (Risk Ratio (RR) 1.03, 95% CI 1.01–1.04), O3 (RR 1.03, 95% CI 1.01–1.05), and to a lesser extent NO2 (RR 1.01, 95% CI 0.99–1.02). An additive, multi-pollutant index was created using coefficients for these three pollutants. Positive associations of index values with daily respiratory ED visits was observed among children (ages 2–17) and adults (ages 18+). The use of previously unavailable daily health records enabled an assessment of short-term ambient air pollution concentrations on respiratory morbidity in Mexico City and the creation of a health-based air quality index, which is now currently in use in Mexico City

Evaluating the U.S. Air Quality Index as a risk communication tool: Comparing associations of index values with respiratory morbidity among adults in California.

BackgroundThe Air Quality Index (AQI) in the United States is widely used to communicate daily air quality information to the public. While use of the AQI has led to reported changes in individual behaviors, such behavior modifications will only mitigate adverse health effects if AQI values are indicative of public health risks. Few studies have assessed the capability of the AQI to accurately predict respiratory morbidity risks.Methods and findingsIn three major regions of California, Poisson generalized linear models were used to assess seasonal associations between 1,373,165 respiratory emergency department visits and short-term exposure to multiple metrics between 2012-2014, including: daily concentrations of NO2, O3, and PM2.5; the daily reported AQI; and a newly constructed health-based air quality index. AQI values were positively associated (average risk ratio = 1.03, 95% CI 1.02-1.04) during the cooler months of the year (November-February) in all three regions when the AQI was very highly correlated with PM2.5 (R2 ≥ 0.89). During the warm season (March-October) in the San Joaquin Valley region, neither AQI values nor the individual underlying air pollutants were associated with respiratory morbidity. Additionally, AQI values were not positively associated with respiratory morbidity in the Southern California region during the warm season, despite strong associations of the individual underlying air pollutants with respiratory morbidity; in contrast, health-based index values were observed to be significantly associated with respiratory morbidity as part of an applied policy analysis in this region, with a combined risk ratio of 1.02 (95% CI: 1.01-1.03).ConclusionsIn regions where individual air pollutants are associated with respiratory morbidity, and during seasons with relatively simple air mixtures, the AQI can effectively serve as a risk communication tool for respiratory health risks. However, the predictive ability of the AQI and any other index is contingent upon the monitored values being representative of actual population exposures. Other approaches, such as health-based indices, may be needed in order to effectively communicate health risks of air pollution in regions and seasons with more complex air mixtures