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Particulate matter as a possible risk factor for eosinophilic esophagitis
Get PDFAir pollution, including particulate matter smaller than 10 (PM10) and 2.5 (PM2.5) µm, increases the risk for heart and lung diseases, including asthma, but has not been extensively studied as a possible etiology in eosinophilic esophagitis (EoE). We aimed to estimate the associations between exposure to PM2.5 or PM10 and EoE. In this case-control study, using a large national pathology database of esophageal biopsies, EoE cases were defined by having biopsies with ≥15 eosinophils per high-powered field in the absence of other histopathologic causes. Controls were all other patients with esophageal biopsies. Patient residential addresses were geocoded and exposure to PM2.5 and PM10 were estimated using National Emissions Inventory data at the county level for a 5-year period including the biopsy. We estimated the odds ratios (OR) for EoE as a function of PM2.5 or PM10 exposure in tons emitted per year air using mixed logistic regression models adjusted for individual- and census tract-level characteristics. Among 12,062 EoE cases and 229,397 non-EoE controls, the unadjusted OR for PM2.5 was 1.12 (0.99–1.25) and the adjusted OR was 1.10 (95% CI, 0.99–1.23). The unadjusted OR for PM10 was 1.04 (1.00–1.07) and the adjusted odds ratio was 1.02 (95% CI, 0.99–1.06). Exposure to higher levels of PM25 and PM10 was modestly associated with EoE case status but the association was attenuated by adjusting for potential confounders. The findings suggest any etiologic role for these particulates in EoE would be of small magnitude
Dyspnea in Chronic Obstructive Pulmonary Disease: Expert Assessment of Management in Clinical Practice
Get PDFChronic obstructive pulmonary disease (COPD) is a multifaceted lung condition characterized by persistent airflow limitation that leads to chronic symptoms, including dyspnea, cough, and exacerbations. To date, a major focus for the assessment and management of COPD has been on mitigating exacerbations. However, dyspnea is the most common symptom of COPD and is responsible for substantial negative effects on patients’ quality of life. Dyspnea is also a substantial contributor to the symptoms associated with acute exacerbations in COPD. Though a portion of the current recommendations for the assessment and management of COPD are dedicated to dyspnea treatment intervention strategies, there remains a need for improvement in communication between healthcare practitioners and their patients regarding the understanding of dyspnea and the implementation of key nonpharmacologic and pharmacologic treatment options. This clinical commentary outlines practical considerations and recommendations for the real-world assessment and management of dyspnea in COPD, including underlying causes, patient and healthcare provider dialogue, measurement of severity, and management strategies
Impact of Land Cover Change on Eutrophication Processes in Phewa Lake, Nepal
Get PDFIncreasing demand for land and resources in Himalayan catchments is altering hydrological processes and threatening freshwater ecosystems. Sediment mobilization and nutrient fluxes, especially during monsoon rainfall events, are intensifying the degradation of water bodies. This study investigates land cover change and its effects on nutrient dynamics in the Phewa Lake catchment, Nepal. Landsat imagery from 1990 to 2021, processed through Google Earth Engine, was used to map land changes. Nutrient loading for the two time periods was estimated with the InVEST model. Surface soils were sampled across the catchment to analyze nitrogen and phosphorus distribution, while their particle-bound transport to the lake was assessed through riverbed sediments and the suspended sediments collected during monsoon rainfalls. Pre-monsoon water quality was examined to evaluate eutrophication levels across different lake zones. Results reveal forest recovery in the upper catchment, but agricultural land in the lower catchment is being rapidly converted to urban areas. While forest recovery has enhanced sediment retention, nutrient inputs to the lake, particularly nitrogen and phosphorus, have increased. Fertilizer leaching and untreated sewage emerge as key sources in rural and urban areas, respectively. Seasonal constraints of the dataset may underestimate the overall extent of water quality deterioration, as indicated by high nutrient loads in monsoon suspended sediments. Overall, this study highlights the dual effect of land cover change: forest regrowth coincides with rising nutrient discharge. Without timely interventions, growing urban populations in the region may face worsening water quality challenges
Empowering Internal Champions in Black/African American Churches: Facilitators, Barriers, and the Role of Academic Partners.
Get PDFHealth for Hearts United provides valuable insights into the role of Internal Champions (IC) in promoting health within church-based settings. ICs' success depends not only on their personal traits and motivation but also on the community support and social networks that academic partners can help facilitate. Our findings suggest that, beyond their traditional roles, academic partners can significantly contribute to program success by providing emotional support, fostering a sense of belonging, and nurturing community relationships. Moving forward, future research should further explore how academic partners can integrate more deeply into community dynamics to promote long-term sustainability and engagement in church-based health interventions
Psychosocial, Behavioral, and HIV-Related Health Among Men Living with HIV Who Have a History of Incarceration
Get PDFIncarceration is intricately linked with the HIV epidemic, with incarcerated individuals exhibiting HIV prevalence rates three times higher than the general population. We used baseline data from the Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) to describe select health outcomes among men living with HIV (MWH) who have never been incarcerated and with a history of lifetime incarceration, specifically recent (within the past-year) and multiple incarcerations. Participants (N = 526) completed quantitative assessments of self-reported incarceration history, behavioral (e.g., antiretroviral therapy (ART) adherence, stimulant use) and psychosocial factors (e.g., depression, perceived stress), and provided biospecimens to assess immune function (i.e., CD4:CD8 ratio) and quantification of plasma HIV viral load. MWH with a history of any incarceration had significantly higher levels of depressive symptoms, recent stimulant use, detectable HIV viral load, and poorer ART adherence and lower CD4:CD8 ratios compared to MWH who had never been incarcerated. Among MWH with any incarceration, recent incarceration (versus not past-year) was associated with lower CD4:CD8 and poorer ART adherence. Recently incarcerated MWH were less often white and generally younger than MWH who had been incarcerated more than a year earlier, and MWH with multiple incarcerations more often identified as heterosexual compared to MWH who had only been incarcerated once. These findings underscore the critical need for tailored interventions aimed at MWH within a year following release from incarceration, focusing on enhancing mental health and HIV-related health outcomes
Virtual reality and augmented reality in ophthalmology: A recent update
Get PDFVirtual reality (VR) and augmented reality (AR) are three-dimensional (3D) environments designed to mimic the real world. They have shown significant applications in science, especially in medicine. Their use spans various areas, including education, surgical training, patient education, and medical instruction. In ophthalmology, which is considered a field of microsurgery, VR and AR provide a 3D environment for practicing precise procedures. The ability to repeat exercises, independence from real patients, and tactile feedback allow residents to practice numerous times in a risk-free setting. Learning in a 3D environment is not limited to surgical techniques but it also supports learning theoretical concepts and practicing patient history-taking, reducing dependence on traditional professional training. This approach allows students in low socioeconomic countries to access high-quality training platforms. Beyond medical education, VR and AR can also be used to educate patients in a simple and accessible way, helping them understand their pathophysiology. Raising awareness about signs and symptoms is an effective method to prevent the progression of eye conditions. In this narrative review, we discuss the applications of VR and AR in ophthalmology, their benefits, and future directions
Validation of the patient health questionnaire (PHQ)-9 and PHQ-2 in patients with COPD in China
Get PDFBackground Patient Health Questionnaire (PHQ-9) and PHQ-2 are commonly used screening tools for depression but have not been validated in Chronic obstructive pulmonary disease (COPD) patients. We aimed to validate PHQ-9 and PHQ-2 among COPD patients in China. Methods Stable COPD patients were assessed using a PHQ-9 questionnaire and then assessed by a senior psychiatrist to confirm the diagnosis of major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Receiver operating characteristic curve analysis was performed to validate the PHQ-9/PHQ-2. Results Out of 265 COPD patients, 11.7% were diagnosed with MDD. The Cronbach’s α-coefficient for PHQ-9 was 0.751. Both PHQ-9 and PHQ-2 showed good correlations with COPD symptoms and quality of life. The AUC values of PHQ-9 and PHQ-2 were 0.848 and 0.736, respectively, for identifying MDD. Based on the highest Youden index, the optimal cut-off scores were PHQ-9 ≥ 7 and PHQ-2 ≥ 2, with a sensitivity of 74.2% and 58.1% and specificity of 89.7% and 89.3%, respectively. Conclusion PHQ-9 score ≥ 7 and PHQ-2 score ≥ 2 should be used as the optimal cut-offs for COPD patients in China. PHQ-9 is a valid tool for detecting MDD in COPD patients, while PHQ-2 (score < 2) is more useful for quickly excluding MDD
Prenatal melamine, aromatic amine, and psychosocial stress exposures and their association with gestational diabetes mellitus in a San Francisco pregnancy cohort
Get PDFBackground Research suggests exposure to chemical and non-chemical stressors may increase the risk of pregnancy complications, including gestational diabetes mellitus (GDM). Exposure to melamine and aromatic amines (AAs) is ubiquitous among pregnant people. However, studies investigating the maternal and fetal health effects of prenatal exposure are limited. Objectives This cross-sectional study aimed to (1) evaluate relationships between exposure to aromatic amines, melamine and its derivatives, and gestational diabetes in a pregnancy cohort in San Francisco, California, USA, (2) explore if non-chemical stressors modify these relationships, and (3) assess fetal sex differences using stratification. Methods We measured 36 AAs, melamine, and three of its derivatives in second-trimester urine samples (n = 607). Financial strain and psychosocial stress were assessed using self-reported questionnaires. GDM status was abstracted from medical records. We used unadjusted and adjusted logistic regression models to calculate the odds of GDM associated with an interquartile range increase in urinary concentrations of melamine and AAs or higher levels of non-chemical stress, overall and stratified by infant sex. Interaction terms between each chemical and non-chemical stressor were used to test for effect modification. Results Eight analytes were detected in >65% of participants, with 100% detection of melamine and cyanuric acid. Among male infants, summed urinary concentrations of melamine and its analogs and o-Anisidine were associated with increased odds of GDM (OR: 1.08 [1.00, 1.17], OR: 1.18 [1.03, 1.36], respectively). Higher levels of perceived stress and discrimination were also associated with increased odds of GDM (OR: 1.41 [0.73, 2.70], OR: 2.33 [1.16, 4.67], respectively). We found limited evidence of interaction between chemical and non-chemical stressors. Impact This study revealed positive associations between melamine and its analogs, some aromatic amines, and gestational diabetes, especially among pregnant women carrying male fetuses. We also found that levels of perceived stress and discrimination were associated with gestational diabetes
Hydrophilic monomer and crosslinker effects on optical and chemical properties of hydrophobic intraocular lenses (IOLs)
Get PDFAn experimental study was conducted to reduce glistening and minimize posterior capsule opacification (PCO) in hydrophobic intraocular lenses (IOLs). This approach involved the copolymerization of hydrophilic 2-hydroxyethyl acrylate (HEA) at various concentrations with hydrophobic monomers, along with incorporating different amounts of ethylene glycol di-methacrylate (EGDMA) as a crosslinker to optimize the chemical, thermal, and optical properties. Sixteen IOL formulations were synthesized and systematically analyzed using equilibrium water content (EWC) measurements, glass-transition temperature (Tg) measurements, and optical evaluation. Optimizing the balance of hydrophilic monomer and crosslinker effectively eliminates glistening and mitigates PCO while maintaining the essential optical property of hydrophobic IOLs. Graphical Abstrac
Influence of Flash Droughts and High Fuel Prices on Recent Spikes in Grain Barge Rates on the Mississippi River
Get PDFIn 2022, 2023 and 2024, flash droughts in the U.S. Midwest caused the lower Mississippi River to drop to record low levels during corn and soybean harvest season. Grain barges that move the crops downriver to New Orleans for export were forced to reduce their loads to avoid grounding. The load reductions and by extension the low river levels have been attributed as the causes for significant spikes in barge spot prices during the droughts, which for the transit from St. Louis, MO to New Orleans, LA climbed from an average pre‐drought maximum of 27/ton to as high as >105/ton in 2022. A dynamic regression model was developed to test whether the barge rate highs might also be the result of high fuel costs over the same period. Results produced by the model not only support this hypothesis but indicate that the increases in fuel costs were the dominant reason barge rates spiked. The influence of the flash droughts on the other hand was estimated to account for ≤16% of the peak rates. These results are supported by the fact that the rates did not surge during past events when barge loads had to be reduced and shipping was delayed, including during flash droughts in 2012 and 2013. Grain barge rates on the Mississippi River spiked during fall flash droughts in 2022, 2023 and 2024 The rate spikes have been attributed to shipping restrictions during the droughts, but are primarily due to high barge fuel costs The fraction of the barge rate spikes attributable to the flash droughts is estimated to be ≤16% Grain barge rates on the Mississippi River spiked during fall flash droughts in 2022, 2023 and 2024 The rate spikes have been attributed to shipping restrictions during the droughts, but are primarily due to high barge fuel costs The fraction of the barge rate spikes attributable to the flash droughts is estimated to be ≤16