Influence of geocoding quality on environmental exposure assessment of children living near high traffic roads

BACKGROUND: The widespread availability of powerful geocoding tools in commercial GIS software and the interest in spatial analysis at the individual level have made address geocoding a widely employed technique in epidemiological studies. This study determined the effect of the positional error in street geocoding on the analysis of traffic-related air pollution on children. METHODS: For a case-study of a large sample of school children in Orange County, Florida (n = 104,865) the positional error of street geocoding was determined through comparison with a parcel database. The effect of this error was evaluated by analyzing the proximity of street and parcel geocoded locations to road segments with high traffic volume and determining the accuracy of the classification using the results of street geocoding. Of the original sample of 163,886 addresses 36% were not used in the final analysis because they could not be reliably geocoded using either street or parcel geocoding. The estimates of positional error can therefore be considered conservative underestimates. RESULTS: Street geocoding was found to have a median error of 41 meters, a 90(th )percentile of 100 meters, a 95(th )percentile of 137 meters and a 99(th )percentile of 273 meters. These positional errors were found to be non-random in nature and introduced substantial bias and error in the estimates of potential exposure to traffic-related air pollution. Street geocoding was found to consistently over-estimate the number of potentially exposed children at small distances up to 250 meters. False positives and negatives were also found to be very common at these small distances. CONCLUSION: Results of the case-study presented here strongly suggest that typical street geocoding is insufficient for fine-scale analysis and more accurate alternatives need to be considered

Improving environmental exposure analysis using cumulative distribution functions and individual geocoding

BACKGROUND: Assessments of environmental exposure and health risks that utilize Geographic Information Systems (GIS) often make simplifying assumptions when using: (a) one or more discrete buffer distances to define the spatial extent of impacted regions, and (b) aggregated demographic data at the level of census enumeration units to derive the characteristics of the potentially exposed population. A case-study of school children in Orange County, Florida, is used to demonstrate how these limitations can be overcome by the application of cumulative distribution functions (CDFs) and individual geocoded locations. Exposure potential for 159,923 school children was determined at the childrens' home residences and at school locations by determining the distance to the nearest gasoline station, stationary air pollution source, and industrial facility listed in the Toxic Release Inventory (TRI). Errors and biases introduced by the use of discrete buffer distances and data aggregation were examined. RESULTS: The use of discrete buffers distances in proximity-based exposure analysis introduced substantial bias in terms of determining the potentially exposed population, and the results are strongly dependent on the choice of buffer distance(s). Comparisons of exposure potential between home and school locations indicated that different buffer distances yield different results and contradictory conclusions. The use of a CDF provided a much more meaningful representation and is not based on the a-priori assumption that any particular distance is more relevant than another. The use of individual geocoded locations also provided a more accurate characterization of the exposed population and allowed for more reliable comparisons among sub-groups. In the comparison of children's home residences and school locations, the use of data aggregated at the census block group and tract level introduced variability as well as bias, leading to incorrect conclusions as to whether exposure potential was higher at school or at home. CONCLUSION: The use of CDFs in distance-based environmental exposure assessment provides more robust results than the use of discrete buffer distances. Unless specific circumstances warrant the use of discrete buffer distances, their applcation should be discouraged in favor of CDFs. The use of aggregated data at the census tract or block group level introduces substantial bias in environmental exposure assessment, which can be reduced through individual geocoding. The use of aggregation should be minimized when individual-level data are available. Existing GIS analysis techniques are well suited to determine CDFs as well as reliably geocode large datasets, and computational issues do not present a barrier for their more widespread use in environmental exposure and risk assessment

Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke (MAAS): study protocol for a randomized controlled trial

Background: Impaired glucose tolerance is present in one third of patients with a TIA or ischemic stroke and is associated with a two-fold risk of recurrent stroke. Metformin improves glucose tolerance, but often leads to side effects. The aim of this study is to explore the feasibility, safety, and effects on glucose metabolism of metformin and sitagliptin in patients with TIA or minor ischemic stroke and impaired glucose tolerance. We will also assess whether a slow increase in metformin dose and better support and information on this treatment will reduce the incidence of side effects in these patients. Methods/Design: The Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke trial (MAAS trial) is a phase II, multicenter, randomized, controlled, open-label trial with blinded outcome assessment. Non-diabetic patients (n = 100) with a recent (<6 months) TIA, amaurosis fugax or minor ischemic stroke (modified Rankin scale ≤ 3) and impaired glucose tolerance, defined as 2-hour post-load glucose levels between 7.8 and 11.0 mmol/L after repeated standard oral glucose tolerance test, will be included. Patients with renal or liver impairment, heart failure, chronic hypoxic lung disease stage III-IV, history of lactate acidosis or diabetic ketoacidosis, pregnancy or breastfeeding, pancreatitis and use of digoxin will be excluded. The patients will be randomly assigned in a 1:1:2 ratio to metformin, sitagliptin or "no treatment." Patients allocated to metformin will start with 500 mg twice daily, which will be slowly increased during a 6-week period to a twice daily dose of 1000 mg. Patients allocated to sitagliptin will be treated with a daily fixed dose of 100 mg. The study has been registered as NTR 3196 in The Netherlands Trial Register. Primary outcomes include percentage still on treatment, percentage of (serious) adverse events, and the baseline adjusted difference in 2-hour post-load glucose levels at 6 months. Discussion: This study will give more information about the feasibility and safety of metformin and sitagliptin as well as the effect on 2-hour post-load glucose levels at 6 months in patients with TIA or ischemic stroke and impaired glucose tolerance

The tick-borne rickettsia Cowdria ruminantium has a Chlamydia-like developmental cycle

The development of the tick-borne rickettsial pathogen Cowdria ruminantium (S stock) was studied in bovine umbilical endothelial (BUE) cell cultures and in goat choroid plexus, by light- and electron microscopy. Cowdria divided by binary fission within intracytoplasmic vacuoles resulting in large colonies of reticulate bodies. After three to four days in culture, reticulate bodies developed into smaller intermediate bodies characterized by an electron-dense core. Shortly before disruption of the host cells, intermediate bodies condensed further into electron-dense elementary bodies, which were released into the culture medium. Elementary bodies invade other endothelial cells thus initiating a new infectious cycle which lasts between 5 and 6 days. In the infected goat choroid plexus similar reticulate and intermediate bodies were identified within vacuoles of capillary endothelial cells. However, extracellular elementary bodies were not detected. Another stock of Cowdria (W) showed an identical developmental cycle as that of the S stock. The W isolate was also pathogenic for mice, making it possible to test the infectivity of reticulate and elementary bodies in these animals. Reticulate bodies appeared to be less infective than elementary bodies. The developmental cycle of Cowdria resembles the cycle known to occur in Chlamydia. Moreover, Cowdria has other similarities with Chlamydia. It has a Gram-negative envelope, it does not store iodine-stainable carbohydrates and may lack peptidoglycan as does Chlamydia. It is concluded, that Cowdria and Chlamydia are to a certain extent related, confirming a recent report that both organisms have certain antigenic determinants in common. Since Cowdria is also related to Ehrlichia it may well be that Cowdria takes an intermediate position between Chlamydia and Ehrlichia. The phylogenetic relationship between Cowdria and Chlamydia and also with Ehrlichia should be further elucidated by molecular analysis using 16S ribosomal DNA sequences.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.European Community (Directorate General XII).mn201

Prediction of Persistent Impaired Glucose Tolerance in Patients with Minor Ischemic Stroke or Transient Ischemic Attack

Background: Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal, reflecting an acute stress response, or persist. Persistent IGT is associated with an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable outcome after stroke. We aim to validate our previously developed model to identify patients at risk of persistent IGT in an independent data set, and, if necessary, update the model. Methods: The validation data set consisted of 239 nondiabetic patients with a minor ischemic stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between 7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated oral glucose tolerance test after a median of 46 days. The discriminative ability of the original model was assessed with the area under the ROC curve (AUC). The updated model was internally validated with bootstrap resampling and cross-validated in the development population of the original model. Results: One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model, with the predictors age, current smoking, statin use, triglyceride, hypertension, history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose performed poorly (AUC .60). The newly developed model included only BMI, hypertension, statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery atherosclerosis, and predicted persistent IGT more accurately (internally validated AUC 0.66, externally validated AUC .71). Conclusions: This prediction model with simple clinical variables can be used to predict persistent IGT in patients with IGT directly after minor stroke or TIA, and may be useful to optimize secondary prevention by early identification of patients with disturbed glucose metabolism