Psychological distress and line-of-duty head injuries in firefighters.

BACKGROUND: Head injuries are common injury in the fire service; however, very little data exist on the risks this may pose to the development of post-traumatic stress disorder (PTSD) and depression in this high-risk population. AIMS: Our study aimed to compare levels of PTSD and depression symptoms in firefighters with a line-of-duty head injury, non-line-of-duty head injury and no head injury. METHODS: In this cross-sectional study, we assessed current PTSD and depression symptoms as well as retrospective head injuries. RESULTS: Seventy-six per cent of the total sample reported at least one head injury in their lifetime. Depression symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to those with no head injury, but not compared to those who sustained a non-line-of-duty head injury. Depression symptoms did not differ between firefighters with a non-line-of-duty head injury and those with no head injury. PTSD symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to both firefighters with no head injury and those with a non-line-of-duty head injury. CONCLUSIONS: We found that firefighters who reported at least one line-of-duty head injury had significantly higher levels of PTSD and depression symptoms than firefighters who reported no head injuries. Our findings also suggest head injuries sustained outside of fire service could have less of an impact on the firefighter's PTSD symptom severity than head injuries that occur as a direct result of their job.

Cost-effectiveness of alternative changes to a national blood collection service.

OBJECTIVES: To evaluate the cost-effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter-donation interval for donors attending static centres. BACKGROUND: Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. METHODS/MATERIALS: This study estimated the effect of changes to the blood collection service in England on the annual number of whole-blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost-effective. RESULTS: In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter-donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). CONCLUSION: The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost-effective change is to extend opening hours for blood collection at static centres.

The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study.

BACKGROUND: The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs. METHOD: Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping. RESULTS: The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs. CONCLUSIONS: Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs.

Alcohol use and mental health symptoms in female firefighter recruits.

BACKGROUND: Limited research suggests that female firefighters report problem drinking at higher rates than the general population. AIMS: To identify longitudinal drinking patterns in female firefighters, make comparisons to male firefighters and examine problem drinking in relation to post-traumatic stress disorder (PTSD) and depression. METHODS: Study participants included 33 female and 289 male firefighter recruits, who were assessed over their first 3 years of fire service. RESULTS: Female firefighters consumed increasing numbers of drinks per week, with a median of 0.90 drinks per week at baseline, and 1.27 drinks in year 3. Female firefighters reported binge drinking at high rates, with nearly half binging at least once per year across all time points (44-74%). The percentage that reported binge drinking three or more times per month doubled over the course of the study (from 9% to 18%). Overall, males reported higher rates of binge drinking and a greater number of drinks per week; however, binge drinking rates among females increased over time and became comparable to rates of binge drinking among males. A greater percentage of female than male firefighters met the criteria for problem drinking by year 1. Problem drinking was associated with screening positive for PTSD at year 1 and depression at year 2, but not with occupational injury. CONCLUSIONS: Over time, female firefighters reported increasing amounts of drinking, more frequent binge drinking and more negative consequences from drinking. These findings along with existing literature indicate female firefighters change their drinking in the direction of their male counterparts.

Silicon is a frequent component of atmospheric nanoparticles.

Nanoparticles are the largest fraction of aerosol loading by number. Knowledge of the chemical components present in nanoparticulate matter is needed to understand nanoparticle health and climatic impacts. In this work, we present field measurements using the Nano Aerosol Mass Spectrometer (NAMS), which provides quantitative elemental composition of nanoparticles around 20 nm diameter. NAMS measurements indicate that the element silicon (Si) is a frequent component of nanoparticles. Nanoparticulate Si is most abundant in locations heavily impacted by anthropogenic activities. Wind direction correlations suggest the sources of Si are diffuse, and diurnal trends suggest nanoparticulate Si may result from photochemical processing of gas phase Si-containing compounds, such as cyclic siloxanes. Atmospheric modeling of oxidized cyclic siloxanes is consistent with a diffuse photochemical source of aerosol Si. More broadly, these observations indicate a previously overlooked anthropogenic source of nanoaerosol mass. Further investigation is needed to fully resolve its atmospheric role.

Pharmacokinetics and pharmacodynamics of standard nerve agent medical countermeasures in Göttingen Minipigs.

Animal research continues to serve a critical role in the testing and development of medical countermeasures. The Göttingen minipig, developed for laboratory research, may provide many benefits for addressing research questions within chemical defense. Targeted development of the Göttingen minipig model could reduce reliance upon non-human primates, and improve study design, statistical power, and throughput to advance medical countermeasures for regulatory approval and fielding. In this vein, we completed foundational pharmacokinetics and physiological safety studies of intramuscularly administered atropine sulfate, pralidoxime chloride (2-PAM), and diazepam across a broad range of doses (1-6 autoinjector equivalent) using adult male Göttingen minipigs (n=11; n=4-8/study) surgically implanted with vascular access ports and telemetric devices to monitor cardiovascular, respiratory, arterial pressure, and temperature signals. Pharmacokinetic data were orderly and the concentration maximum mirrored available human data at comparably scaled doses clearly for atropine, moderately for 2-PAM, and poorly for diazepam. Time to peak concentration approximated 2, 7, and 20 min for atropine, 2-PAM, and diazepam, respectively, and the elimination half-life of these drugs approximated 2 hr (atropine), 3 hr (2-PAM), and 8 hr (diazepam). Atropine sulfate dose-dependently increased the magnitude and duration of tachycardia and decreased the PR and ST intervals (consistent with findings obtained from other species). Mild hypothermia was observed at the highest diazepam dose. Göttingen minipigs appear to provide a ready and appropriate large animal alternative to non-human primates, and further development and evaluation of novel nerve agent medical countermeasures and treatment strategies in this model are justified.

Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil.

AIMS: The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. METHODS: A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. RESULTS: The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. CONCLUSIONS: This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.

Molecular transformations accompanying the aging of laboratory secondary organic aerosol.

The aging of fresh secondary organic aerosol (SOA), formed in a flow tube reactor by α-pinene ozonolysis, was studied by passing the fresh SOA into a second chamber for reaction with high levels of the hydroxyl radical. Two types of experiments were performed: (1) injection of a short plug of fresh SOA into the second chamber, where the particle mass and average O/C mole ratio were measured as a function of time after injection, and (2) injection of a continuous stream of fresh SOA into the second chamber, where particles were collected on a filter over a period of time for off line analysis by high performance mass spectrometry. These setups allowed the chemistry of SOA aging to be elucidated. The particle mass decreased and average O/C ratio increased with increasing aging time. Aged SOA showed an oligomer distribution shifted to lower molecular weight (fragmentation) and molecular formulas with higher O/C and lower H/C ratios (functionalization). Carbon oxidation states of individual molecules were higher for aged SOA, 0 to +2, than fresh SOA, -1 to 0. Tandem mass spectrometry of oligomers from fresh SOA showed small neutral losses associated with less oxidized functional groups such as aldehydes and ketones, while oligomers from aged SOA showed losses associated with more highly oxidized groups such as acids and peroxyacids. Product ion spectra of fresh SOA showed monomer building blocks with formulas corresponding to primary ozonolysis products such as pinic and pinonic acids, whereas aged SOA monomer building blocks corresponded to extremely oxidized products such as dimethyltricarballylic acid.

Selective detection and characterization of nanoparticles from motor vehicles.

Numerous studies have shown that exposure to motor vehicle emissions increases the probability of heart attacks, asthma attacks, and hospital visits among at-risk individuals. However, while many studies have focused on measurements of ambient nanoparticles near highways, they have not focused on specific road-level domains, such as intersections near population centers. At these locations, very intense spikes in particle number concentration have been observed. These spikes have been linked to motor vehicle activity and have the potential to increase exposure dramatically. Characterizing both the contribution and composition of these spikes is critical in developing exposure models and abatement strategies. To determine the contribution of the particle spikes to the ambient number concentration, we implemented wavelet-based algorithms to isolate the particle spikes from measurements taken during the summer and winter of 2009 in Wilmington, Delaware, adjacent to a roadway intersection that approximately 28,000 vehicles pass through daily. These measurements included both number concentration and size distributions recorded once every second by a condensation particle counter (CPC*; TSI, Inc., St. Paul, MN) and a fast mobility particle sizer (FMPS). The high-frequency portion of the signal, consisting of a series of abrupt spikes in number concentration that varied in length from a few seconds to tens of seconds, accounted for 3% to 35% of the daily ambient number concentration, with spike contributions sometimes greater than 50% of hourly number concentrations. When the data were weighted by particle volume, this portion of the signal contributed an average of 10% to 20% to the daily concentration of particulate matter (PM) < or = 0.1 microm in aerodynamic diameter (PM0.1). The preferred locations for observing particle concentration spikes were those surrounding the measurement site at which motor vehicles accelerated after a red traffic light turned green. As the distance or transit time from emission to sampling increased, the size distribution shifted to a larger particle size, which confirmed the source assignments. To determine the distribution of emissions from individual vehicles, we correlated camera images with the spike contribution to particle number concentration at each time point. A small percentage of motor vehicles were found to emit a disproportionally large concentration of nanoparticles, and these high emitters included both spark-ignition (SI) and heavy-duty diesel (HDD) vehicles. In addition to characterizing the contribution of the spikes (local sources) to the ambient number concentration, we developed a method to determine the net contribution of motor vehicles (all sources) to the total mass concentration of ambient nanoparticles. To do this, we correlated the concentration of spikes with measurements of fast changes in the chemical composition of nanoparticles measured with the nano aerosol mass spectrometer (NAMS; built by the Johnston group). The NAMS irradiates individual, size-selected nanoparticles with a high-energy laser pulse to generate a mass spectrum consisting of multiply charged atomic ions. The elemental composition of each particle was determined from the ion signal intensities of each element. However, overlapping mass-to-charge ratios (m/z) at 4 m/z (O(+4) and C(+3)) and at 8 m/z (O(+2) and S(+4)) needed to be separated into their component ions to obtain a representative composition. To do this, we developed a method to deconvolute these ion signals using sucrose and ammonium sulfate [(NH4)2SO4] as calibration standards. With this approach, the differences between the expected and measured elemental mole fractions of carbon (C), oxygen (O), nitrogen (N), and sulfur (S) for a variety of test particles were generally much less than 10%. Ambient nanoparticles were found to consist mostly of C, O, N, and S. Many particles also contained silicon (Si). The elemental compositions were apportioned into molecular species that are commonly found in ambient aerosol: sulfate (SO4(2-)), nitrate (NO3-), ammonium (NH4+), carbonaceous matter, and when present, silicon dioxide (SiO2). Correlating NAMS chemical-composition measurements with spike contributions allowed for the development of a chemical profile representing motor vehicle emissions, which could be used to apportion their total contribution to the ambient nanoparticle mass. Particles originating from motor vehicles had compositions dominated by unoxidized carbonaceous matter, whereas non-motor vehicle particles consisted mostly of SO42-, NO3-, and oxidized carbonaceous matter. Motor vehicles were found to contribute up to 48% and 60% of the nanoparticle mass and number concentrations, respectively, in the winter measurement period, but only 16% and 49% of the nanoparticle mass and number concentrations, respectively, in the summer period. Chemical-composition profiles and contributions of SI versus HDD vehicles to the nanoparticle mass concentration were estimated by correlating still camera images, chemical composition, and spike contributions at each time point. The total mass contributions from SI and HDD vehicles were roughly equal, but the uncertainty in the split was large. The results of this study suggest that nanoparticle concentrations will be higher adjacent to an intersection than along the same roadway but further from an intersection. Possible ways to reduce the motor vehicle contribution to ambient nanoparticulate matter include minimizing stop-and-go activity at an intersection (i.e., vehicles accelerating after a red light turns green) and identifying the small fraction of motor vehicles that emit a disproportionally large number of nanoparticles.

The involvement of parents in healthcare decisions where adult children are at risk of lacking decision-making capacity: a qualitative study of treatment decisions in epilepsy.

BACKGROUND: Patients with intellectual disabilities (ID) receive health care by proxy. It is family members and/or paid support staff who must recognise health problems, communicate with clinicians, and report the benefits, if any, of a particular treatment. At the same time international and national statutes protect and promote the right of people with disabilities to access the highest attainable standards of health on the basis of free and informed consent. METHODS: To consider the role of parent-proxies in the management of epilepsy in adult children with ID who are at risk of lacking capacity to make decisions about their health care we interviewed 21 mothers. FINDINGS: These mothers are not pursuing changes in treatment that might improve their son or daughter's epilepsy, nor are they willing to countenance changes in treatment. Clinicians concerned to build and sustain therapeutic alliances with these mothers, our evidence suggests, may well avoid going against their wishes. DISCUSSION: Our research highlights the interactional contingencies of a hitherto neglected three-way clinical relationship comprising parent-proxy, an adult at risk of lacking decision-making capacity, and a treating clinician. This is a relationship, our findings suggest, where little importance is attached to either patient consent, or involvement in treatment decisions.

Patient preferences for key drivers and facilitators of adoption of mHealth technology to manage depression: A discrete choice experiment.

BACKGROUND: In time, we may be able to detect the early onset of symptoms of depression and even predict relapse using behavioural data gathered through mobile technologies. However, barriers to adoption exist and understanding the importance of these factors to users is vital to ensure maximum adoption. METHOD: In a discrete choice experiment, people with a history of depression (N = 171) were asked to select their preferred technology from a series of vignettes containing four characteristics: privacy, clinical support, established benefit and device accuracy (i.e., ability to detect symptoms), with different levels. Mixed logit models were used to establish what was most likely to affect adoption. Sub-group analyses explored effects of age, gender, education, technology acceptance and familiarity, and nationality. RESULTS: Higher level of privacy, greater clinical support, increased perceived benefit and better device accuracy were important. Accuracy was the most important, with only modest compromises willing to be made to increase other factors such as privacy. Established benefit was the least valued of the attributes with participants happy with technology that had possible but unknown benefits. Preferences were moderated by technology acceptance, age, nationality, and educational background. CONCLUSION: For people with a history of depression, adoption of technology may be driven by the desire for accurate detection of symptoms. However, people with lower technology acceptance and educational attainment, those who were younger, and specific nationalities may be willing to compromise on some accuracy for more privacy and clinical support. These preferences should help shape design of mHealth tools.

Chemical composition of ambient nanoparticles on a particle-by-particle basis.

The nano aerosol mass spectrometer provides a quantitative measure of the elemental composition of individual, ambient nanoparticles in the 10-30 nm size range. In this work, carbon mole fraction plots are introduced as an efficient means of visualizing the full range of particle compositions in an ambient data set. These plots are constructed by plotting the composition of each particle in the data set, beginning with the particle having the highest carbon mole fraction and ending with the particle having the lowest carbon mole fraction. The method relies on the observation that the carbon content of an ambient particle is generally anticorrelated with oxygen, nitrogen, and sulfur. Carbon mole fraction plots allow internal vs external mixing of particle compositions to be assessed, and they provide a means of exploring the relationship between the oxidation of carbonaceous matter and the presence of inorganic species in a particle. It is shown that unoxidized carbonaceous matter exists primarily as externally mixed particles, whereas oxidized carbonaceous matter is found only in particles that also contain a significant amount of inorganic species. Particles containing oxidized carbonaceous matter are generally neutralized, whereas particles containing unoxidized carbonaceous matter or no carbon at all are acidic. Carbon mole fraction plots show how factor analysis methods such as the Adaptive Resonance Theory-2a algorithm (ART-2a) and positive matrix factorization partition a continuum of particle compositions into a few fixed composition profiles, and they provide a simple way to characterize how ambient particle compositions change with season and/or location.

Quantitative assessment of the sulfuric acid contribution to new particle growth.

The Nano Aerosol Mass Spectrometer (NAMS) was deployed to rural/coastal and urban sites to measure the composition of 20-25 nm diameter nanoparticles during new particle formation (NPF). NAMS provides a quantitative measure of the elemental composition of individual, size-selected nanoparticles. In both environments, particles analyzed during NPF were found to be enhanced in elements associated with inorganic species (nitrogen, sulfur) relative to that associated with organic species (carbon). A molecular apportionment algorithm was applied to the elemental data in order to place the elemental composition into a molecular context. These measurements show that sulfate constitutes a substantial fraction of total particle mass in both environments. The contribution of sulfuric acid to new particle growth was quantitatively determined and the gas-phase sulfuric acid concentration required to incorporate the measured sulfate fraction was calculated. The calculated values were compared to those calculated by a sulfuric acid proxy that considers solar radiation and SO(2) levels. The two values agree within experimental uncertainty. Sulfate accounts for 29-46% of the total mass growth of particles. Other species contributing to growth include ammonium, nitrate, and organics. For each location, the relative amounts of these species do not change significantly with growth rate. However, for the coastal location, sulfate contribution increases with increasing temperature whereas nitrate contribution decreases with increasing temperature.

Apportionment of motor vehicle emissions from fast changes in number concentration and chemical composition of ultrafine particles near a roadway intersection.

High frequency spikes in ultrafine number concentration near a roadway intersection arise from motor vehicles that accelerate after a red light turns green. The present work describes a method to determine the contribution of motor vehicles to the total ambient ultrafine particle mass by correlating these number concentration spikes with fast changes in ultrafine particle chemical composition measured with the nano aerosol mass spectrometer, NAMS. Measurements were performed at an urban air quality monitoring site in Wilmington, Delaware during the summer and winter of 2009. Motor vehicles were found to contribute 48% of the ultrafine particle mass in the winter measurement period, but only 16% of the ultrafine particle mass in the summer period. Chemical composition profiles and contributions to the ultrafine particle mass of spark vs diesel vehicles were estimated by correlating still camera images, chemical composition and spike contribution at each time interval.. The spark and diesel contributions were roughly equal, but the uncertainty in the split was large. The distribution of emissions from individual vehicles was determined by correlating camera images with the spike contribution to particle number concentration at each time interval. A small percentage of motor vehicles were found to emit a disproportionally large concentration of ultrafine particles, and these high emitters included both spark ignition and diesel vehicles.

Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiation Therapy Compared With Surgery and Radiofrequency Ablation in Two Patient Cohorts: Metastatic Liver Cancer and Hepatocellular Carcinoma.

AIMS: To compare the cost-effectiveness of stereotactic ablative body radiation therapy (SABR) with radiofrequency ablation and surgery in adult patients with metastatic liver cancer and hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Two patient cohorts were assessed: liver oligometastases and HCC. For each patient cohort, a decision analytic model was constructed to assess the cost-effectiveness of interventions over a 5-year horizon. A Markov process was embedded in the decision model to simulate the possible prognosis of cancer. Data on transition probabilities, survival, side-effects, quality of life and costs were obtained from published sources and the SABR Commissioning through Evaluation (CtE) scheme. The primary outcome was the incremental cost-effectiveness ratio with respect to quality-adjusted life-years. The robustness of the results was examined in a sensitivity analysis. Analyses were conducted from a National Health Service and Personal Social Services perspective. RESULTS: In the base case analysis, which assumed that all three interventions were associated with the same cancer progression rates and mortality rates, SABR was the most cost-effective intervention for both patient cohorts. This conclusion was sensitive to the cancer progression rate, mortality rate and cost of interventions. Assuming a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, the probability that SABR is cost-effective was 57% and 50% in liver oligometastases and HCC, respectively. CONCLUSIONS: Our results indicate a potential for SABR to be cost-effective for patients with liver oligometastases and HCC. This finding supports further investigation in clinical trials directly comparing SABR with surgery and radiofrequency ablation.

Elemental composition of nanoparticles with the nano aerosol mass spectrometer.

The nano aerosol mass spectrometer (NAMS) irradiates individual, size selected nanoparticles with a high energy laser pulse to generate a mass spectrum consisting of multiply charged atomic ions. The elemental composition of the particle is determined from the ion signal intensities of each element, which requires deconvoluting isobaric ion signals at 4 m/z (O(4+) and C(3+)) and at 8 m/z (O(2+) and S(4+)). A method to deconvolute these ion signals using sucrose and ammonium sulfate as calibrants is presented. The approach is based on the assumption that the charge state distribution of a given element is independent of the chemical form of that element in the particle. Relative to previously reported methodology, the new approach permits accurate and precise determination of sulfur, which is crucial for interpretation of ambient nanoparticle data sets. With this approach, the differences between expected and measured elemental ratios of C, O, N, and S for a variety of test particles were generally much less than 10%, although a difference as high as 16% was observed.

Ultrafine particles near a roadway intersection: origin and apportionment of fast changes in concentration.

A wavelet-based algorithm was implemented to separate the high frequency portion of ambient nanoparticle measurements taken during the summer and winter of 2009 in Wilmington, Delaware. These measurements included both number concentration and size distributions recorded once every second by a condensation particle counter (CPC) and a fast mobility particle sizer (FMPS). The high frequency portion of the signal, consisting of a series of abrupt spikes in number concentration that varied in length from a few seconds to tens of seconds, accounted for 6-35% of the daily ambient number concentration with hourly contributions sometimes greater than 50%. When the data were weighted by particle volume, this portion of the signal contributed an average of 20% to the daily PM(0.1) concentration. Particle concentration spikes were preferentially observed from locations surrounding the measurement site where motor vehicles accelerate after a red traffic light turns green. As the distance or transit time from emission to sampling increased, the size distribution shifted to larger particle diameters.

Switch and template pattern formation in a discrete reaction-diffusion system inspired by the Drosophila eye.

We examine a spatially discrete reaction-diffusion model based on the interactions that create a periodic pattern in the Drosophila eye imaginal disc. This model is known to be capable of generating a regular hexagonal pattern of gene expression behind a moving front, as observed in the fly system. In order to better understand the novel "switch and template" mechanism behind this pattern formation, we present here a detailed study of the model's behavior in one dimension, using a combination of analytic methods and numerical searches of parameter space. We find that patterns are created robustly, provided that there is an appropriate separation of timescales and that self-activation is sufficiently strong, and we derive expressions in this limit for the front speed and the pattern wavelength. Moving fronts in pattern-forming systems near an initial linear instability generically select a unique pattern, but our model operates in a strongly nonlinear regime where the final pattern depends on the initial conditions as well as on parameter values. Our work highlights the important role that cellularization and cell-autonomous feedback can play in biological pattern formation.

Symptomatic treatment of botulism with a clinically approved small molecule.

Botulinum neurotoxins (BoNTs) are potent neuroparalytic toxins that cause mortality through respiratory paralysis. The approved medical countermeasure for BoNT poisoning is infusion of antitoxin immunoglobulins. However, antitoxins have poor therapeutic efficacy in symptomatic patients; thus, there is an urgent need for treatments that reduce the need for artificial ventilation. We report that the US Food and Drug Administration-approved potassium channel blocker 3,4-diaminopyridine (3,4-DAP) reverses respiratory depression and neuromuscular weakness in murine models of acute and chronic botulism. In ex vivo studies, 3,4-DAP restored end-plate potentials and twitch contractions of diaphragms isolated from mice at terminal stages of BoNT serotype A (BoNT/A) botulism. In vivo, human-equivalent doses of 3,4-DAP reversed signs of severe respiratory depression and restored mobility in BoNT/A-intoxicated mice at terminal stages of respiratory collapse. Multiple-dosing administration of 3,4-DAP improved respiration and extended survival at up to 5 LD50 BoNT/A. Finally, 3,4-DAP reduced gastrocnemius muscle paralysis and reversed respiratory depression in sublethal models of serotype A-, B-, and E-induced botulism. These findings make a compelling argument for repurposing 3,4-DAP to symptomatically treat symptoms of muscle paralysis caused by botulism, independent of serotype. Furthermore, they suggest that 3,4-DAP is effective for a range of botulism symptoms at clinically relevant time points.

Assessment of naloxone as a therapeutic for inhaled carfentanil in the ferret.

Carfentanil is a powerful synthetic opioid that is approximately 100 times more potent than fentanyl and 10,000 times more potent than morphine. Carfentanil was originally intended to be used as a sedative for big game animals in a veterinary setting, but it is becoming increasingly recognized as a public health concern. We set out to investigate the effectiveness of naloxone against a potentially lethal dose of inhaled carfentanil in male ferrets. Ferrets were implanted with telemetry devices to study cardiac parameters and exposed to aerosolized carfentanil in a whole-body plethysmography chamber to record respiratory parameters. We observed profound respiratory depression in exposed animals, which led to apneic periods constituting 24-31 % of the exposure period. Concomitant with these apneic periods, we also observed cardiac abnormalities in the form of premature junctional contractions (PJCs). At our acute exposure dose, lethal in 3 % of our animals, naïve ferrets were unresponsive and incapacitated for a total of 126.1 ± 24.6 min. When administered intramuscularly at human equivalent doses (HEDs) of either 5 mg or 10 mg, naloxone significantly reduced the time that ferrets were incapacitated following exposure, although we observed no significant difference in the reduction of time that the animals were incapacitated between the treatment groups. Naloxone was able to quickly resolve the respiratory depression, significantly reducing the frequency of apneic periods in carfentanil-exposed ferrets. Our results suggest that naloxone, when administered via intramuscular injection following incapacitation, is a viable treatment against the effects of a potentially lethal dose of inhaled carfentanil.