A Systematic Review of Air Pollution Exposure and Brain Structure and Function during Development.

Objectives: Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI). Methods: Using PubMed and Web of Science, we conducted an updated literature search and systematic review of articles published through March 2024, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews informing the World Health Organization Global Air Quality Guidelines. Results: We identified 222 relevant papers, and 14 new studies met our inclusion criteria. Including six studies from our 2019 review, the 20 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old; however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions. Conclusion: Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review, publications doubled-an increase that testifies to the importance of this public health issue. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.

The Use of Telemedicine in Older Patients with Gastrointestinal Diseases.

Purpose of Review: The COVID-19 pandemic helped us understand that telemedicine provides an alternative way to manage patients remotely, with an added benefit of saving time and travel costs. However, barriers may exist in an older population of patients such as inadequate technology availability and knowledge, and lack of internet connectivity. This systematic review and analysis of data at an academic medical center examines the current literature and investigates the efficacy of telemedicine for older adults requiring gastrointestinal care. Recent Findings: In the systematic review, we included 22 manuscripts from an initial 120 that were identified based on inclusion and exclusion criteria. In this existing literature, telemedicine visits were equivalent or better than in-person visits based on many metrics, including patient satisfaction, time and money saved, and standard patient outcomes. At a rural academic medical center, there was a steady decrease in the failure rate of telemedicine visits from April 2020 to May 2022 in all age groups, including the 65 + age group, from 17% in April 2020 to 3% in May 2022. Summary: Telemedicine offers a comparable alternative to in-person visits that is convenient, low-cost, and does not compromise quality of care for older patients obtaining GI care. The COVID-19 pandemic has accelerated progress and uptake of telemedicine, and the successful use by all ages including older patients opens the broader conversation about the continued use of telemedicine for care in various areas of medicine.

Clinical Phenotypes and Outcomes in Monogenic Versus Non-monogenic Very Early Onset Inflammatory Bowel Disease.

BACKGROUND AND AIMS: Over 80 monogenic causes of very early onset inflammatory bowel disease [VEOIBD] have been identified. Prior reports of the natural history of VEOIBD have not considered monogenic disease status. The objective of this study is to describe clinical phenotypes and outcomes in a large single-centre cohort of patients with VEOIBD and universal access to whole exome sequencing [WES]. METHODS: Patients receiving IBD care at a single centre were prospectively enrolled in a longitudinal data repository starting in 2012. WES was offered with enrollment. Enrolled patients were filtered by age of diagnosis <6 years to comprise a VEOIBD cohort. Monogenic disease was identified by filtering proband variants for rare, loss-of-function, or missense variants in known VEOIBD genes inherited according to standard Mendelian inheritance patterns. RESULTS: This analysis included 216 VEOIBD patients, followed for a median of 5.8 years. Seventeen patients [7.9%] had monogenic disease. Patients with monogenic IBD were younger at diagnosis and were more likely to have Crohn's disease phenotype with higher rates of stricturing and penetrating disease and extraintestinal manifestations. Patients with monogenic disease were also more likely to experience outcomes of intensive care unit [ICU] hospitalisation, gastrostomy tube, total parenteral nutrition use, stunting at 3-year follow-up, haematopoietic stem cell transplant, and death. A total of 41 patients [19.0%] had infantile-onset disease. After controlling for monogenic disease, patients with infantile-onset IBD did not have increased risk for most severity outcomes. CONCLUSIONS: Monogenic disease is an important driver of disease severity in VEOIBD. WES is a valuable tool in prognostication and management of VEOIBD.

A multi-year science research or engineering experience in high school gives women confidence to continue in the STEM pipeline or seek advancement in other fields: A 20-year longitudinal study.

There remains a large gender imbalance in the science, technology, engineering and mathematics (STEM) workforce deriving from a leaky pipeline where women start losing interest and confidence in science and engineering as early as primary school. To address this disparity, the Science Research & Engineering Program (SREP) at Hathaway Brown School was established in 1998 to engage and expose their all-female high school students to STEM fields through an internship-like multi-year research experience at partnering institutions. We compare data from existing Hathaway Brown School SREP alumnae records from 1998-2018 (n = 495) to Non-SREP students and national datasets (National Center for Educational Statistics, National Science Foundation, and US Census data) to assess how SREP participation may influence persistence in the STEM pipeline and whether SREP alumnae attribute differences in these outcomes to the confidence and skill sets they learned from the SREP experience. The results reveal that women who participate in the SREP are more likely to pursue a major in a STEM field and continue on to a STEM occupation compared to non-SREP students, national female averages, and national subsets. Participants attribute their outcomes to an increase in confidence, establishment of technical and professional skills, and other traits strengthened through the SREP experience. These data suggest that implementing similar experiential programs for women in science and engineering at the high school stage could be a promising way to combat the remaining gender gap in STEM fields.

Sex Differences in Cancer Incidence and Survival: A Pan-Cancer Analysis.

BACKGROUND: Sex plays an important role in the incidence, prognosis, and mortality of cancers, but often is not considered in disease treatment. METHODS: We quantified sex differences in cancer incidence using the United States Cancer Statistics (USCS) public use database and sex differences in cancer survival using Surveillance, Epidemiology, and End Results (SEER) public use data from 2001 to 2016. Age-adjusted male-to-female incidence rate ratios (IRR) with 95% confidence intervals (CI) were generated by primary cancer site, race, and age groups. In addition, age-adjusted hazard ratios with 95% CI by sex within site were generated. RESULTS: In general, cancer incidence and overall survival were lower in males than females, with Kaposi sarcoma (IRR: 9.751; 95% CI, 9.287-10.242; P < 0.001) having highest male-to-female incidence, and thyroid cancers (HR, 1.774; 95% CI, 1.707-1.845) having largest male-to-female survival difference. Asian or Pacific Islanders had particularly high male-to-female incidence in larynx cancers (IRR: 8.199; 95% CI, 7.203-9.363; P < 0.001), relative to other races. Among primary brain tumors, germ cell tumors had the largest male-to-female incidence (IRR: 3.03; 95% CI, 2.798-3.284, P < 0.001). CONCLUSIONS: Overall, incidence and survival of cancer vary significantly by sex, with males generally having lower incidence and survival compared with females. Male-to-female incidence differences were also noted across race and age groups. These results provide strong evidence that the fundamental biology of sex differences affects cancers of all types. IMPACT: This study represents the most recent and comprehensive reporting of sex differences in cancer incidence and survival in the United States. Identifying disadvantaged groups is critical as it can provide useful information to improve cancer survival, as well as to better understand the etiology and pathogenesis of specific cancers.

Development of a mobile groundwater desalination system for communities in rural India.

The consumption of saline groundwater has contributed to a growing incidence of renal diseases, particularly in coastal communities of India. Although reverse osmosis (RO) is routinely used to remove salt from groundwater, conventional RO systems (i.e. centralized systems using spiral wound RO elements) have limited utility in these communities due to high capital and maintenances costs, and lack of infrastructure to distribute the water. Consequently, there is a need to develop an appropriate solution for groundwater treatment based on small-scale, mobile and community-led systems. In this work, we designed a mobile desalination system to provide a simple platform for water treatment and delivery of goods to rural communities. The system employs tubular RO membranes packed in a single, low-profile vessel which fits below the cargo space. The low-profile enables minimal intrusion on the space available for the transportation of goods. Pressure is delivered by a belt driven clutch pump, powered by the engine. Water is treated locally by connecting the intake to the village well while the vehicle idles. A combined numerical and experimental approach was used to optimise the module/system design, resulting in ∼20% permeate flux enhancement. Experimental results revealed that the system can produce 16 L per square meter of membrane area per hour (LMH) at a salinity level of 80 ppm from a ∼2000 ppm groundwater when it is feed at 1 m3/h at 8 bars. This indicates that a vehicle equipped with 12 m2 of tubular RO membranes can deliver 1 m3 of drinkable water by using ∼0.9 L of diesel. Assuming eight such systems could be implemented in a community to fulfil the water demands for a village with 2000 residents, a social business study revealed that a payback time of 2.5 years is achievable, even if the sale price of the water is relatively low, USD 0.18 (Rs 12, which is half of the lowest market price) per 20 L, including providing a goods transportation service at price of USD 5.25 (Rs 350) per 100 km.

Strongyloidiasis in Ontario: Performance of diagnostic tests over a 14-month period.

BACKGROUND: We evaluated the performance of stool microscopy, serology, and real time PCR (qPCR) for the diagnosis of strongyloidiasis at our reference laboratory. METHODS: Using a convenience sample of specimens submitted between April 1, 2014 and May 31, 2015, positivity rates and performance characteristics were calculated. RESULTS: During the enrolment period, 17,933 stool specimens were examined for O&P, 14 of which were positive for Strongyloides larvae. For stool specimens serially positive for larvae, mean duration of larval shedding was 12.7 days following the initial positive specimen, while for sputum and urine, it was 12 and 2 days, respectively. During the enrolment period, 3258 specimens were processed for Strongyloides serology, 200 of which were reactive (6.1%), 210 indeterminate (6.5%), and 2848 non-reactive (87.4%). qPCR was positive in 11 of 12 (91.7%) stool specimens containing larvae, and negative in all stool specimens without larvae by microscopy. There was no cross-reactivity of Strongyloides-specific qPCR to other stool protozoa or helminths. CONCLUSIONS: In the absence of immunosuppression, larval burden in strongyloidiasis is low, limiting the utility of microscopy, and favoring serologic testing. However, false negative serology can occur in those with hyperinfection necessitating a combined diagnostic approach. qPCR was insufficiently sensitive to replace microscopy for detection of larvae.

Epidemiology of injuries in the elite level female high school lacrosse player.

Female lacrosse has grown 219% in the last decade. This descriptive study explored the epidemiology of elite female high school lacrosse injuries and compared them with those in the collegiate player. Five hundred surveys were completed at tournaments in the northeast United States. Over 60% played other sports; 50% experienced a new injury while playing lacrosse, and 16% had a recurrent injury from another sport. The ankle, knee, and head were most commonly injured. Eleven percent of respondents sustained a concussion; 35% of these experienced some loss of consciousness. Eighty-four percent of injuries occurred via contact. Forty-two percent (42%) of athletes lost 10 or more days of playing time. Frequency data showed that reported injuries are high for elite lacrosse, which is classified as a noncontact sport, and are comparable with those seen in the collegiate player.