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Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.
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Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Glioblastoma/diagnóstico , Glioblastoma/terapia , Recidiva Local de Neoplasia/terapia , Adulto , Idoso , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Suíça , Resultado do TratamentoRESUMO
Ultrafine particles are emitted at high rates by jet aircraft. To determine the possible impacts of aviation activities on ambient ultrafine particle number concentrations (PNCs), we analyzed PNCs measured from 3 months to 3.67 years at three sites within 7.3 km of Logan International Airport (Boston, MA). At sites 4.0 and 7.3 km from the airport, average PNCs were 2- and 1.33-fold higher, respectively, when winds were from the direction of the airport compared to other directions, indicating that aviation impacts on PNC extend many kilometers downwind of Logan airport. Furthermore, PNCs were positively correlated with flight activity after taking meteorology, time of day and week, and traffic volume into account. Also, when winds were from the direction of the airport, PNCs increased with increasing wind speed, suggesting that buoyant aircraft exhaust plumes were the likely source. Concentrations of other pollutants [CO, black carbon (BC), NO, NO2, NOx, SO2, and fine particulate matter (PM2.5)] decreased with increasing wind speed when winds were from the direction of the airport, indicating a different dominant source (likely roadway traffic emissions). Except for oxides of nitrogen, other pollutants were not correlated with flight activity. Our findings point to the need for PNC exposure assessment studies to take aircraft emissions into consideration, particularly in populated areas near airports.
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Poluentes Atmosféricos/análise , Aeronaves , Aeroportos , Monitoramento Ambiental , Boston , Meteorologia , Tamanho da Partícula , Material Particulado/análise , Silicones , Fuligem , Emissões de Veículos/análise , VentoRESUMO
BACKGROUND AND AIM: Traffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied. METHODS: Within the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants' use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants. RESULTS: Nearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units' HOBO electricity use, from a subset of 45 participants, supported the participants' responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews. CONCLUSIONS: Results from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04279249 . Registered 09 October 2019.
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Filtros de Ar , Estudos Cross-Over , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Poluição do Ar em Ambientes Fechados/prevenção & controle , Poluição do Ar em Ambientes Fechados/efeitos adversos , Emissões de Veículos/prevenção & controle , Emissões de Veículos/análise , Poluição Relacionada com o Tráfego/efeitos adversos , Poluição Relacionada com o Tráfego/prevenção & controle , Inquéritos e Questionários , Habitação , Material Particulado/efeitos adversos , Material Particulado/análise , Fatores de Tempo , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análiseRESUMO
Harmonic generation in the limit of ultrasteep density gradients is studied experimentally. Observations reveal that, while the efficient generation of high order harmonics from relativistic surfaces requires steep plasma density scale lengths (L(p)/λ < 1), the absolute efficiency of the harmonics declines for the steepest plasma density scale length L(p)â0, thus demonstrating that near-steplike density gradients can be achieved for interactions using high-contrast high-intensity laser pulses. Absolute photon yields are obtained using a calibrated detection system. The efficiency of harmonics reflected from the laser driven plasma surface via the relativistic oscillating mirror was estimated to be in the range of 10(-4)-10(-6) of the laser pulse energy for photon energies ranging from 20-40 eV, with the best results being obtained for an intermediate density scale length.
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When a laser pulse hits a solid surface with relativistic intensities, XUV attosecond pulses are generated in the reflected light. We present an experimental and theoretical study of the temporal properties of attosecond pulse trains in this regime. The recorded harmonic spectra show distinct fine structures which can be explained by a varying temporal pulse spacing that can be controlled by the laser contrast. The pulse spacing is directly related to the cycle-averaged motion of the reflecting surface. Thus the harmonic spectrum contains information on the relativistic plasma dynamics.
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OBJECTIVES: To identify individual and household characteristics associated with serious falls, poisonings, burns and road traffic injuries (RTIs) for children in Lima, Peru. METHODS: 5061 households consisting of 10,210 children were included in this community based, cross-sectional study in San Juan de Miraflores (SJM), a low income, urban district of Lima, Peru. Households were eligible if there was a consenting adult and at least one resident child aged < or =18 years. A door to door survey was conducted in SJM, collecting childhood injury, demographic, and socioeconomic data. Analysis was done at the individual and household level for injuries severe enough to have required medical consultation. RESULTS: The greatest burden of injury was from falls and RTIs. For individuals, male gender and age were the most important predictors of injuries. Households in which multiple injuries were reported were more likely to be poor (odds ratio (OR) 1.66, 95% CI 1.24 to 2.22) and overcrowded (OR 1.88, 95% CI 1.20 to 2.94). The occurrence of serious falls, poisonings, burns, and pedestrian RTIs significantly increased the likelihood of a second serious injury in the home (adjusted ORs ranged between 1.88 and 2.99). CONCLUSION: All children from households in which an unintentional injury has occurred appear to have an increased likelihood of future injury; such high risk households may be readily identifiable in the clinical setting. Interventions in this environment designed to prevent subsequent injuries merit further investigation.
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Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Queimaduras/epidemiologia , Intoxicação/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Traumatismo Múltiplo/epidemiologia , Peru/epidemiologia , Fatores Socioeconômicos , Saúde da População Urbana , Ferimentos e Lesões/epidemiologiaRESUMO
Few studies have been made of the impact of major construction on the health of nearby residents. We conducted a feasibility study in one zip code (02111; Chinatown, Boston, MA, USA) in which four large buildings (20-30 stories) were built between 1999 and 2004 and adjacent to which a major highway construction project was in progress. Information about major construction project start and end dates were obtained from a variety of sources. Three sets of health data--emergency department and mortality-were obtained from the Massachusetts Department of Public Health for the years of 1998 - 2004. We used ICD-9 and ICD-10 disease codes to aggregate selected pulmonary and cardiac-related categories that could reasonably be expected to be aggravated by air pollution released from construction sites, including diesel and dust, and noise and vibration. We propose that larger-scale studies are possible and needed using approaches similar to ours.
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Exposição Ambiental/efeitos adversos , Arquitetura de Instituições de Saúde , Cardiopatias/epidemiologia , Pneumopatias/epidemiologia , Poluentes Atmosféricos/toxicidade , Monitoramento Ambiental , Monitoramento Epidemiológico , Cardiopatias/etiologia , Humanos , Pneumopatias/etiologia , Ruído/efeitos adversos , Material Particulado/toxicidade , Análise de Pequenas Áreas , Vibração/efeitos adversosRESUMO
In the March 2002 issue, the following credit line was omitted from Fig. 1(a) on p. 90 (Brugge D, Lai Z, Hill, C, Rand W. Traffic Injury Data, Policy, and Public Health: Lessons from Boston Chinatown. J Urban Health. 2002;79(1):87-103): "This figure is reprinted with permission from Brugge D, A Leong, Z Lai. Can a community inject public health values into transportation questions? Public Health Rep. 1999:114:44."
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OBJECTIVES: This investigation examined whether, despite the Tobacco Institute's Voluntary Cigarette Advertising and Promotion Code, current cigarette print advertising communicates culturally positive messages to youth about smoking. METHODS: Nine hundred thirteen students in grades 6-8 (ages 10-15) were shown a sample of four contemporary cigarette print ads (Camel, Marlboro, Newport, and Virginia Slims) and completed structured written assessments designed to capture their perceptions of each ad. RESULTS: Across the four ads, between 37% and 84% of the students reported that the ads communicated to them that smoking will make people popular, cool, successful in life, sexy, attractive, and healthy. Sizeable percentages of students reported that the ads show people using the product in an "exaggerated" way, and that what people in the ads are doing requires "exercise and physical energy." The median estimated age of the models in the ads was under age 25 for four out of the six models. CONCLUSIONS: As perceived by adolescents, current cigarette print advertising violates basic tenets of the Voluntary Code, thus bringing into question the tobacco industry's ability to self-regulate image advertising. These findings suggest that the FDA ruling to prohibit image advertising for tobacco in publications with significant youth readership deserves serious consideration.
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Comportamento do Adolescente/psicologia , Publicidade/normas , Fumar/psicologia , Indústria do Tabaco/normas , Adolescente , Criança , Intervalos de Confiança , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Publicações Periódicas como Assunto , Fumar/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Quantification of exposure to traffic-related air pollutants near highways is hampered by incomplete knowledge of the scales of temporal variation of pollutant gradients. The goal of this study was to characterize short-term temporal variation of vehicular pollutant gradients within 200-400 m of a major highway (>150 000 vehicles/d). Monitoring was done near Interstate 93 in Somerville (Massachusetts) from 06:00 to 11:00 on 16 January 2008 using a mobile monitoring platform equipped with instruments that measured ultrafine and fine particles (6-1000 nm, particle number concentration (PNC)); particle-phase (>30 nm) [Formula: see text], [Formula: see text], and organic compounds; volatile organic compounds (VOCs); and CO(2), NO, NO(2), and O(3). We observed rapid changes in pollutant gradients due to variations in highway traffic flow rate, wind speed, and surface boundary layer height. Before sunrise and peak traffic flow rates, downwind concentrations of particles, CO(2), NO, and NO(2) were highest within 100-250 m of the highway. After sunrise pollutant levels declined sharply (e.g., PNC and NO were more than halved) and the gradients became less pronounced as wind speed increased and the surface boundary layer rose allowing mixing with cleaner air aloft. The levels of aromatic VOCs and [Formula: see text], [Formula: see text] and organic aerosols were generally low throughout the morning, and their spatial and temporal variations were less pronounced compared to PNC and NO. O(3) levels increased throughout the morning due to mixing with O(3)-enriched air aloft and were generally lowest near the highway reflecting reaction with NO. There was little if any evolution in the size distribution of 6-225 nm particles with distance from the highway. These results suggest that to improve the accuracy of exposure estimates to near-highway pollutants, short-term (e.g., hourly) temporal variations in pollutant gradients must be measured to reflect changes in traffic patterns and local meteorology.
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Populations of Gonyaulax polyedra, in two different phases, about 11 h apart, were mixed, and the intensity of their spontaneous bioluminescence glow recorded for about 2 wk under conditions of constant dim (35 +/- 3 microE/m2/s) white light and constant temperature (19.0 +/- 0.3 degrees C). The phases and amplitudes of glow signals recorded from mixed cultures were compared with those obtained from the arithmetic sum of the intensity data from two control vials. Peaks in control cultures generally remained separate, but there was a spontaneous increase in the period beginning 6-11 d after the onset of constant conditions. This did not occur in cultures in which the medium was exchanged with fresh medium every 2 d. In the actual mixes of two cultures there was a merging of the two subpeaks in the signal, which did not occur when the medium was exchanged. The results indicate that conditioning of the medium by cells may affect the period of the circadian rhythm and that this might result in a type of communication.
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Ritmo Circadiano , Dinoflagellida/fisiologia , Animais , Comunicação Celular , Meios de Cultura , Medições LuminescentesRESUMO
The Asian/Pacific Islander (API) population in the United States is majority immigrant, diverse ethnically, and resides predominately in urban settings. It is possible that urban APIs face health-threatening environmental hazards that differ in form or magnitude from environmental concerns of other definable subpopulations or the overall population in the United States. To date, little or nothing is known about this topic. Spurred by the complaints of one such community, in Boston Chinatown, which is also of low socioeconomic status, we conducted a first-stage survey of randomly chosen residents about environmental health concerns. Despite a small sample size, we were able to document several environmental factors of potential concern that were worthy of further study. These included exhaust and noise from motor vehicle traffic and dust from construction projects, and factors originating inside the home. Pedestrian safety and lack of open/green space emerged as primary community concerns, while residents' knowledge of environmental hazards, such as lead paint, was found to be weak. We conclude that standard surveys of "environmental justice" in communities such as this one require tailoring of methods to specific conditions in order to be effective. For example, our survey preferentially missed working-age men, and about half of all randomly selected persons were not interviewed despite bilingual/bicultural interviewers, support letters from the local health clinic, and in-person attempts at residences.
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OBJECTIVES: To determine frequency of and possible associations between environmental housing factors and self-reported respiratory symptoms in public housing. METHODS: We used a community-participatory method in which trained residents conducted in-person interviews with a random sample of 53 households in one housing development in Boston, Massachusetts. RESULTS: Environmental factors suspected of affecting respiratory health that were reported by more than 30 percent of respondents included: Moisture (43 percent), mold (43 percent), cracks in walls, floors and ceilings (49 percent), sewage leaks (33 percent), unexplained odor (35 percent), use of air fresheners (91 percent), use of gas ovens for heating (38 percent), no vent for the oven (74 percent), stuffy air (66 percent), overheating at least part of the winter (73 percent), cockroaches (70 percent), rodents (40 percent), pets (39 percent), frequent renovations (40 percent), repeated requests for repairs (52 percent), dust from construction (45 percent), use of more than three hazardous household products (32 percent), vehicle traffic nearby (81 percent), and smoking in the household (57 percent). Forty percent of respondents reported having asthma. Respondents also reported that 56 percent of their children had asthma. Forty percent of respondents reported wheeze and 48 percent reported coughing or sneezing episodes in the preceding month. We found the following positive statistically significant associations, adjusted for age, sex, Black or Hispanic origin, and years lived in public housing: wheeze with moisture problems (OR = 4.8; CI = 1.2, 19.3), sewage leaks (OR = 6.3; CI = 1.3, 30.3), odor (OR = 7.5; CI = 1 .4, 39.0), cracks in walls,floors and ceilings (OR = 8.6; CI 1.9, 38.0), and frequency of renovations (OR = 9.8; CI = 1.8, 54.4); cough with moisture problems (OR = 5.3; CI = 1.3, 20.8), stuffy air (OR = 4.4; CI = 1.2, 16.7), cockroaches (OR = 5.4; CI = 1.2, 24.2), smoking (OR = 5.0; CI = 1.2, 20.5), odor (OR = 10.9; CI = 2.3, 53.0), cracks in walls, floors and ceilings (OR = 6.2; CI = 1.8, 22.3) and frequency of renovations (OR = 4.4; CI = 1.1, 17.5); and sneeze with cockroaches (OR = 5.2; CI = 1.1, 24.2), stuffy air (OR = 6.3; CI = 1.5, 26.5), cracks in walls, floors and ceilings (OR = 6.3; CI = 1.7, 23.1), repeated requests for repairs (OR = 5.6; CI = 1.4, 21.5), and construction dust (OR = 15.6; CI = 2.2, 112.3). CONCLUSIONS: Housing conditions that affect respiratory health were common in this public housing development. Self-reported rates of respiratory symptoms and asthma were extremely high. Statistical associations between housing conditions and respiratory symptoms in the preceding month were frequently positive and sometimes statistically significant. Engaging community residents strengthened the research process.
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Asthma management staff at eight Massachusetts managed care organizations (MCOs) were interviewed to learn the extent of inclusion of environmental prevention strategies in their asthma disease management policies. Six of the plans had formal asthma disease management programs, all reported to be based on the National Heart Lung and Blood Institute guidelines, but none followed these guidelines in their entirety. Three MCOs provided for home visits that included addressing environmental factors for severe asthmatics. Despite the limited role that MCOs appear to play in environmental prevention of asthma, the authors identify opportunities and encourage efforts to expand these programs.
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Asma/prevenção & controle , Exposição Ambiental/efeitos adversos , Programas de Assistência Gerenciada , Adulto , Asma/etiologia , Asma/terapia , Criança , Coleta de Dados , Fidelidade a Diretrizes , Humanos , Massachusetts , Educação de Pacientes como AssuntoRESUMO
Nine families of a public housing development in Boston were enrolled in a pilot asthma intervention program designed to gather dense environmental data and generate hypotheses about the relative importance of different contaminants and the viability of interventions. Despite formidable challenges working with this inner-city population, the project team succeeded in gaining active support for the project by forming a partnership with a community-based organization and by building positive relationships between the field team and the residents. Families were provided with physical interventions such as air filters, industrial cleaning and mattress covers to each apartment. Indoor temperature was high and relative humidity low during winter. Insulation of exposed steam pipes did not lower temperature. Cockroach, mouse and pet antigen levels were variable and frequently high in settled dust. Viable fungal spore levels were variable and high in some apartments. Dust-mite allergen levels were below the level of concern. Industrial cleaning led to transient reduction in mouse and cockroach antigen burden. Mattress and pillow covers lowered dust-mite antigen in bedrooms, but not living rooms. Nitrogen dioxide (NO2) levels exceeded ambient concentrations due to use of gas stoves and concentrations of particulate matter with aerodynamic diameter <2.5 microm (PM2.5) were above ambient levels because of smoking. Air filtering systems did not reduce PM levels. Several volatile organic compounds (VOCs) were above adverse risk concentrations. We hypothesize that our findings are consistent with a multifactorial model for exacerbation of asthma in this population and that no single problem dominates.