Temporal trends in motor vehicle and secondary organic tracers using in situ methylation thermal desorption GCMS.

Organic aerosol measurements with high temporal resolution can differentiate primary organic carbon (POC) from secondary organic carbon (SOC) and can be used to distinguish morning rush hour traffic emissions and subsequent photo-oxidation. In the current study, five hour filter samples were collected during the Summer Study for Organic Aerosols at Riverside (SOAR-1 in CA, USA) for analysis of organic molecular markers. To achieve the low detection limits required for the high temporal resolution data, a laboratory-based in situ methylation thermal desorption gas chromatography-mass spectrometry method was developed. This enabled the measurement of potential markers of SOC, including phthalic acid, along with markers for traffic emissions, including norhopane. The aromatic acids correlated well with unapportioned OC from a molecular marker chemical mass balance model (SOC-cmb; r(2) = 0.46-0.70) and SOC from the elemental carbon tracer method (SOC-ec; r(2) = 0.40-0.56). The aromatic acid/norhopane ratio increased substantially over the course of each day. The average mid-day phthalic acid ratio compared to previously published roadway emissions was a factor of 4 times higher, while the average 1,2,3-benzenetricarboxylic acid ratio was a factor of 40 times higher than roadway emissions. Using correlation plots of SOC-cmb and phthalic acid, it was estimated that 2.9 ± 0.6 µg m(-3) SOC was associated with mid-day aromatic acid production in Riverside.

Sensitivity and bias of molecular marker-based aerosol source apportionment models to small conltibutions of coal combustion soot.

Carbonaceous atmospheric particulate matter (PM25) collected in the midwestern United States revealed that soot emissions from incomplete coal combustion were important sources of several organic molecular markers used in source apportionment studies. Despite not constituting a major source of organic carbon in the PM25, coal soot was an important source of polyaromatic hydrocarbons, hopanes, and elemental carbon. These marker compounds are becoming widely used for source apportionment of atmospheric organic PM, meaning that significant emissions of these marker compounds from unaccounted sources such as coal soot could bias apportionment results. This concept was demonstrated using measurements of atmospheric PM collected on a 1-in-6 day schedule at three monitoring sites in Ohio: Mingo Junction (near Steubenville), Cincinnati, and Cleveland. Impacts of coal sootwere measured to be significant at Mingo Junction and small at Cleveland and Cincinnati. As a result, biases in apportionment results were substantial at Mingo Junction and insignificant at Cleveland and Cincinnati. Misapportionments of organic carbon mass at Mingo Junction were significant when coal soot was detected in the particulate samples as identified bythe presence of picene, but when coal soot was not included in the model: gasoline engines (+8% to +58% of OC), smoking engines (0% to -17% of OC), biomass combustion (+1% to +11% of OC), diesel engines (-1% to -2% of OC), natural gas combustion (0% to -2% of OC), and unapportioned OC (0% to -47% of OC). These results suggest that the role of coal soot in source apportionment studies needs to be better examined in many parts of the United States and other parts of the world.

A comparison of summertime secondary organic aerosol source contributions at contrasting urban locations.

Primary and secondary sources contributing to atmospheric organic aerosol during the months of July and August were quantitatively assessed in three North American urban areas: Cleveland, Ohio, and Detroit, Michigan, in the Midwest region and Riverside, California, in the Los Angeles Air Basin. Organic molecular marker species unique to primary aerosol sources and secondarytracers derived from isoprene, alpha-pinene, beta-caryophyllene, and toluene were measured using gas chromatography-mass spectrometry. Source contributions from motor vehicles, biomass burning, vegetative detritus, and secondary organic aerosol (SOA) were estimated using chemical mass balance (CMB) modeling. In Cleveland, primary sources accounted for 37 +/- 2% of ambient organic carbon, measured biogenic and anthropogenic secondary sources contributed 46 +/- 6%, and other unknown sources contributed 17 +/- 4%. Similarly, Detroit aerosol was determined to be 44 +/- 5% primary and 37 +/- 3% secondary, while 19 +/- 7% was unaccounted for by measured sources. In Riverside, 21 +/- 3% of organic carbon came from primary sources, 26 +/- 5% was attributed to measured secondary sources, and 53 +/- 3% came from other sources that were expected to be secondary in nature. The comparison of samples across these two regions demonstrated that summertime SOA in the Midwestern United States was substantially different from the summertime SOA in the Los Angeles Air Basin and indicated the need to exert caution when generalizing about the sources and nature of SOA across different urban areas. Furthermore, the results of this study suggestthatthe contemporary understanding of SOA sources and formation mechanisms is satisfactory to explainthe majority of SOA in the Midwest Additional SOA sources and mechanisms of formation are needed to explain the majority of SOA in the Los Angeles Air Basin.

Apportionment of primary and secondary organic aerosols in southern California during the 2005 study of organic aerosols in riverside (SOAR-1).

Ambient sampling was conducted in Riverside, California during the 2005 Study of Organic Aerosols in Riverside to characterize the composition and sources of organic aerosol using a variety of state-of-the-art instrumentation and source apportionmenttechniques. The secondary organic aerosol (SOA) mass is estimated by elemental carbon and carbon monoxide tracer methods, water soluble organic carbon content, chemical mass balance of organic molecular markers, and positive matrix factorization of high-resolution aerosol mass spectrometer data. Estimates obtained from each ofthese methods indicate that the organic fraction in ambient aerosol is overwhelmingly secondary in nature during a period of several weeks with moderate ozone concentrations and that SOA is the single largest component of PM1 aerosol in Riverside. Average SOA/OA contributions of 70-90% were observed during midday periods, whereas minimum SOA contributions of approximately 45% were observed during peak morning traffic periods. These results are contraryto previous estimates of SOAthroughout the Los Angeles Basin which reported that, other than during severe photochemical smog episodes, SOA was lower than primary OA. Possible reasons for these differences are discussed.

Comparison of outcomes of arteriovenous grafts and fistulas at a single Veterans' Affairs medical center.

BACKGROUND: Before 2003, almost all dialysis access procedures performed at the G.V. Montgomery Veterans' Affairs Medical Center were arteriovenous grafts. In mid-2003, it was decided to place fistulas in most patients. This study compared the patency rates and frequency of interventions to maintain function between the 2 procedures. METHODS: Patency rates for 64 grafts and 50 fistulas were computed using Kaplan-Meier life-tables and compared using the Cox-Mantel log- rank test. The frequency of interventions to maintain function was compared using a Poisson model. RESULTS: Primary patency of grafts at 1 and 2 years was 39% and 26%, and that of fistulas was 44% and 37%. Secondary patency of grafts at 1 and 2 years was 71% and 63%, and that of fistulas was 75% and 72%. Neither difference reached significance. The difference in interventions also was insignificant. CONCLUSIONS: Switching from grafts to fistulas did not significantly improve the patency and frequency of interventions.

A comparison of speciated atmospheric mercury at an urban center and an upwind rural location.

Gaseous elemental mercury (GEM), particulate mercury (PHg) and reactive gaseous mercury (RGM) were measured every other hour at a rural location in south central Wisconsin (Devil's Lake State Park, WI, USA) between April 2003 and March 2004, and at a predominantly downwind urban site in southeastern Wisconsin (Milwaukee, WI, USA) between June 2004 and May 2005. Annual averages of GEM, PHg, and RGM at the urban site were statistically higher than those measured at the rural site. Pollution roses of GEM and reactive mercury (RM; sum of PHg and RGM) at the rural and urban sites revealed the influences of point source emissions in surrounding counties that were consistent with the US EPA 1999 National Emission Inventory and the 2003-2005 US EPA Toxics Release Inventory. Source-receptor relationships at both sites were studied by quantifying the impacts of point sources on mercury concentrations. Time series of GEM, PHg, and RGM concentrations were sorted into two categories; time periods dominated by impacts from point sources, and time periods dominated by mercury from non-point sources. The analysis revealed average point source contributions to GEM, PHg, and RGM concentration measurements to be significant over the year long studies. At the rural site, contributions to annual average concentrations were: GEM (2%; 0.04 ng m(-3)); and, RM (48%; 5.7 pg m(-3)). At the urban site, contributions to annual average concentrations were: GEM (33%; 0.81 ng m(-3)); and, RM (64%; 13.8 pg m(-3)).

Sources of speciated atmospheric mercury at a residential neighborhood impacted by industrial sources.

Speciated measurements of atmospheric mercury plumes were obtained at an industrially impacted residential area of East St. Louis, IL. These plumes were found to result in extremely high mercury concentrations at ground level that were composed of a wide distribution of mercury species. Ground level concentrations as high as 235 ng m(-3) for elemental mercury (Hg0) and 38 300 pg m(-3) for reactive mercury species (reactive gaseous (RGM) plus particulate (PHg) mercury) were measured. The highest mercury concentrations observed during the study were associated with plumes that contained high concentrations of all mercury species (Hg0, RGM, and PHg) and originated from a source located southwest of the sampling site. Variations in proportions of Hg0/RGM/PHg among plumes, with Hg0 dominating some plumes and RGM and/or PHg dominating others, were attributed to differences in emissions from different sources. Correlations between mercury plumes and elevated NO(x) were not observed; however, a correlation between elevated SO2 and mercury plumes was observed during some but not all plume events. Despite the presence of six coal-fired power plants within 60 km of the study site, wind direction data along with Hg/SO2 and Hg/NO(x) ratios suggest that high-concentration mercury plumes impacting the St. Louis-Midwest Particle Matter Supersite are attributable to local point sources within 5 km of the site.

Total abdominal colectomy: patient satisfaction and outcomes.

Total abdominal colectomy is required for many colonic diseases. The authors studied the outcomes of this operation and the quality of life based on the decision to perform an ileostomy or an anastomosis. Patients who underwent total abdominal colectomy (excluding those with inflammatory bowel disease and chronic constipation) had either ileoproctostomy or ileostomy and were compared. Patients were surveyed to assess satisfaction. Thirty-seven patients with ileoproctostomy and 23 patients with ileostomy were identified. There were no significant differences between groups with regard to urgency of operation, preoperative and total blood units received, and preoperative hospital stay. Morbidity and mortality were higher in the ileostomy group (38 vs 57% and 5 vs 17%), with odds ratios of 2.14 and 3.68 respectively; this was not, however, statistically significant (P = 0.157 and 0.132, power = 20% and 6%). All (14 of 14) surveyed ileostomy patients were at least satisfied versus 90 per cent (19 of 21) of ileoproctostomy patients. Of the latter, only 15 of 20 patients were continent, with 6.85 average daily bowel movements. Total abdominal colectomy has high morbidity and mortality rates. Performing an ileoproctostomy does not influence outcome but may lead to a high frequency of bowel movements and incontinence in some patients.

Retrospective review of forefoot amputations at a Veterans Affairs hospital and evaluation of post-amputation follow-up.

BACKGROUND: Forefoot amputations in diabetic and vascular patients often are followed by subsequent amputations. We evaluated the outcomes of forefoot amputations and the efficacy of our care in preventing subsequent amputations. MATERIAL AND METHODS: Charts of all patients undergoing forefoot amputations were reviewed. Comorbid conditions, subsequent amputations, and the nature of pre- and post-amputation care were noted. A subset of patients followed more than 2 years post-amputation was studied to evaluate post-amputation care. RESULTS: Of the 81 patients, 26% underwent subsequent forefoot amputations and 37% underwent subsequent proximal amputations. Forty-one patients followed more than 2 years were divided into 2 groups: those followed closely by foot-care specialists and those followed by primary care providers. The former group experienced fewer amputations, but the difference was not statistically significant. CONCLUSIONS: Previous forefoot amputation is a high-risk factor for repeat amputations. Our post-amputation care did not effectively reduce subsequent amputations.

Short-course rifampin and pyrazinamide compared with isoniazid for latent tuberculosis infection: a cost-effectiveness analysis based on a multicenter clinical trial.

Two months of treatment with rifampin-pyrazinamide (RZ) and 9 months of treatment with isoniazid are both recommended for treatment of latent tuberculosis infection in adults without human immunodeficiency virus infection, but the relative cost-effectiveness of these 2 treatments is unknown. We used a Markov model to conduct a cost-effectiveness analysis to assess the impact on life expectancy and costs based on the results of a recent clinical trial that compared the rates of adverse events and completion of the 2 treatment regimens. Compared with no treatment, both regimens increased life expectancy by 1.2 years, but RZ cost 273 dollars more per patient. Sensitivity analyses showed that, assuming equal efficacy between the 2 regimens, there was no threshold completion rate for RZ at which the 2 treatments would be of equal net cost. Under most circumstances, treatment of latent tuberculosis infection with isoniazid is cost-saving than treatment with RZ.