Global mortality from outdoor fine particle pollution generated by fossil fuel combustion: Results from GEOS-Chem

The burning of fossil fuels – especially coal, petrol, and diesel – is a major source of airborne fine particulate matter (PM2.5), and a key contributor to the global burden of mortality and disease. Previous risk assessments have examined the health response to total PM2.5, not just PM2.5 from fossil fuel combustion, and have used a concentration-response function with limited support from the literature and data at both high and low concentrations. This assessment examines mortality associated with PM2.5 from only fossil fuel combustion, making use of a recent meta-analysis of newer studies with a wider range of exposure. We also estimated mortality due to lower respiratory infections (LRI) among children under the age of five in the Americas and Europe, regions for which we have reliable data on the relative risk of this health outcome from PM2.5 exposure. We used the chemical transport model GEOS-Chem to estimate global exposure levels to fossil-fuel related PM2.5 in 2012. Relative risks of mortality were modeled using functions that link long-term exposure to PM2.5 and mortality, incorporating nonlinearity in the concentration response. We estimate a global total of 10.2 (95% CI: -47.1 to 17.0) million premature deaths annually attributable to the fossil-fuel component of PM2.5. The greatest mortality impact is estimated over regions with substantial fossil fuel related PM2.5, notably China (3.9 million), India (2.5 million) and parts of eastern US, Europe and Southeast Asia. The estimate for China predates substantial decline in fossil fuel emissions and decreases to 2.4 million premature deaths due to 43.7% reduction in fossil fuel PM2.5 from 2012 to 2018 bringing the global total to 8.7 (95% CI: -1.8 to 14.0) million premature deaths. We also estimated excess annual deaths due to LRI in children (0-4 years old) of 876 in North America, 747 in South America, and 605 in Europe. This study demonstrates that the fossil fuel component of PM2.5 contributes a large mortality burden. The steeper concentration-response function slope at lower concentrations leads to larger estimates than previously found in Europe and North America, and the slower drop-off in slope at higher concentrations results in larger estimates in Asia. Fossil fuel combustion can be more readily controlled than other sources and precursors of PM2.5 such as dust or wildfire smoke, so this is a clear message to policymakers and stakeholders to further incentivize a shift to clean sources of energy

Reprint of “The Single-Case Reporting Guideline In BEhavioural interventions (SCRIBE) 2016: explanation and elaboration”

There is substantial evidence that research studies reported in the scientific literature do not provide adequate information so that readers know exactly what was done and what was found. This problem has been addressed by the development of reporting guidelines which tell authors what should be reported and how it should be described. Many reporting guidelines are now available for different types of research designs. There is no such guideline for one type of research design commonly used in the behavioral sciences, the single-case experimental design (SCED). The present study addressed this gap. This report describes the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016, which is a set of 26 items that authors need to address when writing about SCED research for publication in a scientific journal. Each item is described, a rationale for its inclusion is provided, and examples of adequate reporting taken from the literature are quoted. It is recommended that the SCRIBE 2016 is used by authors preparing manuscripts describing SCED research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Published versio

The advantage of intergenic regions as genomic features for machine-learning-based host attribution of Salmonella Typhimurium from the USA

Salmonella enterica is a taxonomically diverse pathogen with over 2600 serovars associated with a wide variety of animal hosts including humans, other mammals, birds and reptiles. Some serovars are host-specific or host-restricted and cause disease in distinct host species, while others, such as serovar S. Typhimurium (STm), are generalists and have the potential to colonize a wide variety of species. However, even within generalist serovars such as STm it is becoming clear that pathovariants exist that differ in tropism and virulence. Identifying the genetic factors underlying host specificity is complex, but the availability of thousands of genome sequences and advances in machine learning have made it possible to build specific host prediction models to aid outbreak control and predict the human pathogenic potential of isolates from animals and other reservoirs. We have advanced this area by building host-association prediction models trained on a wide range of genomic features and compared them with predictions based on nearest-neighbour phylogeny. SNPs, protein variants (PVs), antimicrobial resistance (AMR) profiles and intergenic regions (IGRs) were extracted from 3883 high-quality STm assemblies collected from humans, swine, bovine and poultry in the USA, and used to construct Random Forest (RF) machine learning models. An additional 244 recent STm assemblies from farm animals were used as a test set for further validation. The models based on PVs and IGRs had the best performance in terms of predicting the host of origin of isolates and outperformed nearest-neighbour phylogenetic host prediction as well as models based on SNPs or AMR data. However, the models did not yield reliable predictions when tested with isolates that were phylogenetically distinct from the training set. The IGR and PV models were often able to differentiate human isolates in clusters where the majority of isolates were from a single animal source. Notably, IGRs were the feature with the best performance across multiple models which may be due to IGRs acting as both a representation of their flanking genes, equivalent to PVs, while also capturing genomic regulatory variation, such as altered promoter regions. The IGR and PV models predict that ~45 % of the human infections with STm in the USA originate from bovine, ~40 % from poultry and ~14.5 % from swine, although sequences of isolates from other sources were not used for training. In summary, the research demonstrates a significant gain in accuracy for models with IGRs and PVs as features compared to SNP-based and core genome phylogeny predictions when applied within the existing population structure. This article contains data hosted by Microreact

Evaluation of “Dream Herb,” Calea zacatechichi

A recent surge in the use of dietary supplements, including herbal remedies, necessitates investigations into their safety profiles. “Dream herb,” Calea zacatechichi, has long been used in traditional folk medicine for a variety of purposes and is currently being marketed in the US for medicinal purposes, including diabetes treatment. Despite the inherent vulnerability of the renal system to xenobiotic toxicity, there is a lack of safety studies on the nephrotoxic potential of this herb. Additionally, the high frequency of diabetes-associated kidney disease makes safety screening of C. zacatechichi for safety especially important. We exposed human proximal tubule HK-2 cells to increasing doses of this herb alongside known toxicant and protectant control compounds to examine potential toxicity effects of C. zacatechichi relative to control compounds. We evaluated both cellular and mitochondrial functional changes related to toxicity of this dietary supplement and found that even at low doses evidence of cellular toxicity was significant. Moreover, these findings correlated with significantly elevated levels of nephrotoxicity biomarkers, lending further support for the need to further scrutinize the safety of this herbal dietary supplement

Adherence and Acceptability of Telehealth Appointments for High Risk Obstetrical Patients During the COVID-19 Pandemic.

Background:Telehealth has been successfully implemented for the delivery of obstetrical care. However, little is known regarding the attitudes and acceptability of patients and providers in high risk obstetrics and if implementation improves access to care in non-rural settings. Objective:The study aims to: 1) Describe patient and provider attitudes toward telehealth for delivery of high risk obstetrical care in a large health care system with both urban and suburban settings. 2) Determine if implementation of a telehealth model improves patient adherence to scheduled appointments in this patient population.Study DesignTwo self-administered surveys were designed. The first survey was sent to all high-risk obstetrical patients who received a telehealth visit between March 1, 2020 and May 30, 2020. The second survey was designed for providers who participated in these visits. We also compared the attended, cancelled and no show visit rates before (March 1-May 30, 2019) and after (March 1-May 30, 2020) telehealth implementation, as well as telehealth versus in person visits in 2020. We reviewed scheduled high-risk prenatal care appointments, diabetes education sessions, and genetic counseling and Maternal- Fetal Medicine consultations. Results:A total of 91 patient surveys and 33 provider surveys were analyzed. Overall, 86.9% of patients were satisfied with the care they received and 78.3% would recommend telehealth visits to others. 87.8% of providers reported having a positive experience using telehealth, and 90.9% believed that telehealth improved patients\u27 access to care. When comparing patient and provider preference regarding future obstetrical care after experiencing telehealth, 73.8% of patients desired a combination of in person and telehealth visits during their pregnancy. However, a significantly higher rate of providers preferred in-person visits (56% vs 23% respectively). When comparing visits between 2019 and 2020, there was a significantly lower rate of no-show appointments, patient-cancelled appointments, and patient same-day cancellations with the implementation of telehealth. There was also a significantly lower rate of patient-cancelled appointments, and patient same-day cancellations with those receiving telehealth visits compared to in person visits in 2020. Conclusion:Implementation of telehealth in high risk obstetrics has the potential to improve access to high risk obstetrical care, by reducing the rate of missed appointments. Both patients and providers surveyed expressed a high rate of satisfaction with telehealth visits and a desire to integrate telehealth into the traditional model of high risk obstetrical care

The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer’s Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK

ABSTRACT Aims: To examine how often General Practitioners (GPs) and Practice Nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions, and whether the Chief Medical Officer’s (CMO’s) revised low-risk drinking guidelines are appropriately advised. Methods: Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January-March 2017 (n=2,020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week), and whether the CMO’s drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). Results: The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (OR=0.77, p=0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR=2.22, p<0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. Conclusion: Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.This research was supported by funding from Cancer Research UK. JMB is supported by the Medical Research Council (MRC) (Grant MC_UU_12015/4)