A Critical Analysis of the Delivery of a Psychosocial Workshop for Cancer Survivors with Lymphedema

Secondary lymphedema is a chronic condition that can develop after the treatment of cancer and can often lead to negative psychological and social impairments. When dealing with chronic illness, hoping and coping are interdependent. Previous research has assessed the outcomes of workshops designed to enhance hope but has not examined the workshop itself to determine how those outcomes were achieved. This study deconstructs the Living Hopefully with Lymphedema workshop to identify (1) what aspects of the workshop facilitated or interfered with therapeutic progress, (2) key aspects of facilitation that contributed to the functioning of the workshop, and (3) how participants responded to the workshop. Two three-day workshops were attended by a total of 19 participants. All sessions were audio taped and the recordings analyzed. Theoretical coding revealed a central theme focused on the importance of a safe environment within the workshop. Facilitators and participants worked together to co-create, maintain, and protect a safe space in which to engage in therapy. Findings are discussed in relation to key aspects of facilitation and the participants’ response to the workshops. Recommendations for future workshop development are presented

Moving beyond the cost–loss ratio : economic assessment of streamflow forecasts for a risk-averse decision maker

A large effort has been made over the past 10 years to promote the operational use of probabilistic or ensemble streamflow forecasts. Numerous studies have shown that ensemble forecasts are of higher quality than deterministic ones. Many studies also conclude that decisions based on ensemble rather than deterministic forecasts lead to better decisions in the context of flood mitigation. Hence, it is believed that ensemble forecasts possess a greater economic and social value for both decision makers and the general population. However, the vast majority of, if not all, existing hydro-economic studies rely on a cost–loss ratio framework that assumes a risk-neutral decision maker. To overcome this important flaw, this study borrows from economics and evaluates the economic value of early warning flood systems using the well-known Constant Absolute Risk Aversion (CARA) utility function, which explicitly accounts for the level of risk aversion of the decision maker. This new framework allows for the full exploitation of the information related to a forecasts’ uncertainty, making it especially suited for the economic assessment of ensemble or probabilistic forecasts. Rather than comparing deterministic and ensemble forecasts, this study focuses on comparing different types of ensemble forecasts. There are multiple ways of assessing and representing forecast uncertainty. Consequently, there exist many different means of building an ensemble forecasting system for future streamflow. One such possibility is to dress deterministic forecasts using the statistics of past error forecasts. Such dressing methods are popular among operational agencies because of their simplicity and intuitiveness. Another approach is the use of ensemble meteorological forecasts for precipitation and temperature, which are then provided as inputs to one or many hydrological model(s). In this study, three concurrent ensemble streamflow forecasting systems are compared: simple statistically dressed deterministic forecasts, forecasts based on meteorological ensembles, and a variant of the latter that also includes an estimation of state variable uncertainty. This comparison takes place for the Montmorency River, a small flood-prone watershed in southern central Quebec, Canada. The assessment of forecasts is performed for lead times of 1 to 5 days, both in terms of forecasts’ quality (relative to the corresponding record of observations) and in terms of economic value, using the new proposed framework based on the CARA utility function. It is found that the economic value of a forecast for a risk-averse decision maker is closely linked to the forecast reliability in predicting the upper tail of the streamflow distribution. Hence, post-processing forecasts to avoid overforecasting could help improve both the quality and the value of forecasts

Spatial variability in levels of benzene, formaldehyde, and total benzene, toluene, ethylbenzene and xylenes in New York City: a land-use regression study

Background Hazardous air pollutant exposures are common in urban areas contributing to increased risk of cancer and other adverse health outcomes. While recent analyses indicate that New York City residents experience significantly higher cancer risks attributable to hazardous air pollutant exposures than the United States as a whole, limited data exist to assess intra-urban variability in air toxics exposures. Methods To assess intra-urban spatial variability in exposures to common hazardous air pollutants, street-level air sampling for volatile organic compounds and aldehydes was conducted at 70 sites throughout New York City during the spring of 2011. Land-use regression models were developed using a subset of 59 sites and validated against the remaining 11 sites to describe the relationship between concentrations of benzene, total BTEX (benzene, toluene, ethylbenzene, xylenes) and formaldehyde to indicators of local sources, adjusting for temporal variation. Results Total BTEX levels exhibited the most spatial variability, followed by benzene and formaldehyde (coefficient of variation of temporally adjusted measurements of 0.57, 0.35, 0.22, respectively). Total roadway length within 100 m, traffic signal density within 400 m of monitoring sites, and an indicator of temporal variation explained 65% of the total variability in benzene while 70% of the total variability in BTEX was accounted for by traffic signal density within 450 m, density of permitted solvent-use industries within 500 m, and an indicator of temporal variation. Measures of temporal variation, traffic signal density within 400 m, road length within 100 m, and interior building area within 100 m (indicator of heating fuel combustion) predicted 83% of the total variability of formaldehyde. The models built with the modeling subset were found to predict concentrations well, predicting 62% to 68% of monitored values at validation sites. Conclusions Traffic and point source emissions cause substantial variation in street-level exposures to common toxic volatile organic compounds in New York City. Land-use regression models were successfully developed for benzene, formaldehyde, and total BTEX using spatial indicators of on-road vehicle emissions and emissions from stationary sources. These estimates will improve the understanding of health effects of individual pollutants in complex urban pollutant mixtures and inform local air quality improvement efforts that reduce disparities in exposure

Summary of the workshop on methodologies for environmental public health tracking of air pollution effects

The US Centers for Disease Control and Prevention established the Environmental Public Health Tracking (EPHT) program to support state and local projects that characterize the impact of the environment on health. The projects involve compiling, linking, analyzing, and disseminating environmental and health surveillance information, thereby engaging stakeholders and guiding actions to improve public health. One of the EPHT objectives is to track the public health impact of ambient air pollution with analyses that are timely and relevant to state and local stakeholders. To address methodological issues relevant to this objective, in January 2008, government officials and researchers from the USA, Canada, and Europe gathered in Baltimore, Maryland for a 2-day workshop. Using commissioned papers and presentations on key methodological issues as well as examples of previous air pollution impact assessments, work group discussions produced a set of consensus recommendations for the EPHT program. These recommendations noted the need for data that will encourage local stakeholders to support continued progress in air pollution control. The limitations of using only local data for analyses were also noted. To improve local estimates of air pollution health impacts, methods were recommended that “borrow strength” from other evidence. An incremental approach to implementing such methods was recommended. The importance and difficulty of communicating uncertainties in local health impact assessments was emphasized, as was the need for coordination among different agencies conducting health impact assessments

Blood Lead Concentrations in Children and Method of Water Fluoridation in the United States, 1988–1994

Some have hypothesized that community water containing sodium silicofluoride and hydrofluosilicic acid may increase blood lead (PbB) concentrations in children by leaching of lead from water conduits and by increasing absorption of lead from water. Our analysis aimed to evaluate the relation between water fluoridation method and PbB concentrations in children. We used PbB concentration data (n = 9,477) from the Third National Health and Nutrition Examination Survey (1988–1994) for children 1–16 years of age, merged with water fluoridation data from the 1992 Fluoridation Census. The main outcome measure was geometric mean PbB concentration, and covariates included age, sex, race/ethnicity, poverty status, urbanicity, and length of time living in residence. Geometric mean PbB concentrations for each water fluoridation method were 2.40 μg/dL (sodium silicofluoride), 2.34 μg/dL (hydrofluosilicic acid), 1.78 μg/dL (sodium fluoride), 2.24 μg/dL (natural fluoride and no fluoride), and 2.14 μg/dL (unknown/mixed status). In multiple linear and logistic regression, there was a statistical interaction between water fluoridation method and year in which dwelling was built. Controlling for covariates, water fluoridation method was significant only in the models that included dwellings built before 1946 and dwellings of unknown age. Across stratum-specific models for dwellings of known age, neither hydrofluosilicic acid nor sodium silicofluoride were associated with higher geometric mean PbB concentrations or prevalence values. Given these findings, our analyses, though not definitive, do not support concerns that silicofluorides in community water systems cause higher PbB concentrations in children. Current evidence does not provide a basis for changing water fluoridation practices, which have a clear public health benefit

Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys

Objective To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases

Prevalence, Awareness, Treatment, and Control of High LDL Cholesterol in New York City, 2004

IntroductionLow-density lipoprotein (LDL) cholesterol is a major contributor to coronary heart disease and the primary target of cholesterol-lowering therapy. Substantial disparities in cholesterol control exist nationally, but it is unclear how these patterns vary locally.MethodsWe estimated the prevalence, awareness, treatment, and control of high LDL cholesterol using data from a unique local survey of New York City's diverse population. The New York City Health and Nutrition Examination Survey 2004 was administered to a probability sample of New York City adults. The National Health and Nutrition Examination Survey 2003-2004 was used for comparison. High LDL cholesterol and coronary heart disease risk were defined using National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines.ResultsMean LDL cholesterol levels in New York City and nationally were similar. In New York City, 28% of adults had high LDL cholesterol, 71% of whom were aware of their condition. Most aware adults reported modifying their diet or activity level (88%), 64% took medication, and 44% had their condition under control. More aware adults in the low ATP III risk group than those in higher risk groups had controlled LDL cholesterol (71% vs 33%-42%); more whites than blacks and Hispanics had controlled LDL cholesterol (53% vs 31% and 32%, respectively).ConclusionHigh prevalence of high LDL cholesterol and inadequate treatment and control contribute to preventable illness and death, especially among those at highest risk. Population approaches - such as making the food environment more heart-healthy - and aggressive clinical management of cholesterol levels are needed