State-of-the-Science Data and Methods Need to Guide Place-Based Efforts to Reduce Air Pollution Inequity.

BACKGROUND: Recently enacted environmental justice policies in the United States at the state and federal level emphasize addressing place-based inequities, including persistent disparities in air pollution exposure and associated health impacts. Advances in air quality measurement, models, and analytic methods have demonstrated the importance of finer-scale data and analysis in accurately quantifying the extent of inequity in intraurban pollution exposure, although the necessary degree of spatial resolution remains a complex and context-dependent question. OBJECTIVE: The objectives of this commentary were to a) discuss ways to maximize and evaluate the effectiveness of efforts to reduce air pollution disparities, and b) argue that environmental regulators must employ improved methods to project, measure, and track the distributional impacts of new policies at finer geographic and temporal scales. DISCUSSION: The historic federal investments from the Inflation Reduction Act, the Infrastructure Investment and Jobs Act, and the Biden Administration's commitment to Justice40 present an unprecedented opportunity to advance climate and energy policies that deliver real reductions in pollution-related health inequities. In our opinion, scientists, advocates, policymakers, and implementing agencies must work together to harness critical advances in air quality measurements, models, and analytic methods to ensure success. https://doi.org/10.1289/EHP13063.

Respiratory Center Function and Its Impact in Obesity Hypoventilation Syndrome Treatment

Introduction: Patients with obesity hypoventilation syndrome (OHS) need treatment with positive pressure either with continuous (CPAP) or double pressure (NIV). The apnea–hypopnea index (AHI) is considered a key data for making therapeutic decisions. We hypothesized that HR may be an useful tool to establish different phenotypes and individualize treatment in patients with OHS. Our objective was to analyze the role of the respiratory center response to hypercapnia (HR) in the adequacy of positive airway pressure therapy. Method: We included subjects with OHS treated with CPAP or NIV according to AHI and baseline pCO2. We analyzed therapeutic effectiveness and treatment changes prioritizing CPAP if AHI>30/h. Therapy was considered adequate if it was effective after two years. HR was measured with the p0.1/pEtCO2 ratio and its capability to select therapy was analyzed. The statistical study was performed by means comparison (Student's t) and multivariate analysis (logistic regression). Results: 67 subjects were included of 68(11) years old, 37 (55%) males, initially 45 (67%) treated with NIV and 22 (33%) with CPAP, one case was excluded and in 25 (38%) the treatment was changed. Finally, CPAP was adequate for 29 subjects (44%) and NIV for 37 (56%). The CPAP group showed AHI 57/h (24) and p0.1/pEtCO2 0.37cmH2O/mmHg (0.23), NIV group AHI 43/h (35) and p0.1/pEtCO2 0.24 (0.15) with p=0.049 and 0.006. In multivariate analysis, p0.1/pEtCO2 (p=0.033) and AHI>30 (p=0.001) were predictors of adequate therapy. Conclusion: Measuring the RH of the respiratory center helps to select the most appropriate treatment for patients with OHS. (AU)

Respiratory Center Function and Its Impact in Obesity Hypoventilation Syndrome Treatment.

INTRODUCTION: Patients with obesity hypoventilation syndrome (OHS) need treatment with positive pressure either with continuous (CPAP) or double pressure (NIV). The apnea-hypopnea index (AHI) is considered a key data for making therapeutic decisions. We hypothesized that HR may be an useful tool to establish different phenotypes and individualize treatment in patients with OHS. Our objective was to analyze the role of the respiratory center response to hypercapnia (HR) in the adequacy of positive airway pressure therapy. METHOD: We included subjects with OHS treated with CPAP or NIV according to AHI and baseline pCO2. We analyzed therapeutic effectiveness and treatment changes prioritizing CPAP if AHI>30/h. Therapy was considered adequate if it was effective after two years. HR was measured with the p0.1/pEtCO2 ratio and its capability to select therapy was analyzed. The statistical study was performed by means comparison (Student's t) and multivariate analysis (logistic regression). RESULTS: 67 subjects were included of 68(11) years old, 37 (55%) males, initially 45 (67%) treated with NIV and 22 (33%) with CPAP, one case was excluded and in 25 (38%) the treatment was changed. Finally, CPAP was adequate for 29 subjects (44%) and NIV for 37 (56%). The CPAP group showed AHI 57/h (24) and p0.1/pEtCO2 0.37cmH2O/mmHg (0.23), NIV group AHI 43/h (35) and p0.1/pEtCO2 0.24 (0.15) with p=0.049 and 0.006. In multivariate analysis, p0.1/pEtCO2 (p=0.033) and AHI>30 (p=0.001) were predictors of adequate therapy. CONCLUSION: Measuring the RH of the respiratory center helps to select the most appropriate treatment for patients with OHS.

Laponite Composites: In Situ Films Forming as a Possible Healing Agent.

A healing material must have desirable characteristics such as maintaining a physiological environment, protective barrier-forming abilities, exudate absorption, easy handling, and non-toxicity. Laponite is a synthetic clay with properties such as swelling, physical crosslinking, rheological stability, and drug entrapment, making it an interesting alternative for developing new dressings. This study evaluated its performance in lecithin/gelatin composites (LGL) as well as with the addition of maltodextrin/sodium ascorbate mixture (LGL MAS). These materials were applied as nanoparticles, dispersed, and prepared by using the gelatin desolvation method-eventually being turned into films via the solvent-casting method. Both types of composites were also studied as dispersions and films. Dynamic Light Scattering (DLS) and rheological techniques were used to characterize the dispersions, while the films' mechanical properties and drug release were determined. Laponite in an amount of 8.8 mg developed the optimal composites, reducing the particulate size and avoiding the agglomeration by its physical crosslinker and amphoteric properties. On the films, it enhanced the swelling and provided stability below 50 °C. Moreover, the study of drug release in maltodextrin and sodium ascorbate from LGL MAS was fitted to first-order and Korsmeyer-Peppas models, respectively. The aforementioned systems represent an interesting, innovative, and promising alternative in the field of healing materials.

Identifying Patterns and Sources of Fine and Ultrafine Particulate Matter in London Using Mobile Measurements of Lung-Deposited Surface Area.

We performed more than a year of mobile, 1 Hz measurements of lung-deposited surface area (LDSA, the surface area of 20-400 nm diameter particles, deposited in alveolar regions of lungs) and optically assessed fine particulate matter (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) in central London. We spatially correlated these pollutants to two urban emission sources: major roadways and restaurants. We show that optical PM2.5 is an ineffective indicator of tailpipe emissions on major roadways, where we do observe statistically higher LDSA, BC, and NO2. Additionally, we find pollutant hot spots in commercial neighborhoods with more restaurants. A low LDSA (15 µm2 cm-3) occurs in areas with fewer major roadways and restaurants, while the highest LDSA (25 µm2 cm-3) occurs in areas with more of both sources. By isolating areas that are higher in one source than the other, we demonstrate the comparable impacts of traffic and restaurants on LDSA. Ratios of hyperlocal enhancements (ΔLDSA:ΔBC and ΔLDSA:ΔNO2) are higher in commercial neighborhoods than on major roadways, further demonstrating the influence of restaurant emissions on LDSA. We demonstrate the added value of using particle surface in identifying hyperlocal patterns of health-relevant PM components, especially in areas with strong vehicular emissions where the high LDSA does not translate to high PM2.5.

Effects of a Surgical Mask on Functional Capacity Measured Using the 6-min Walk Test in Patients with Cardiorespiratory Disease

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Usefulness of P0.1 in the Follow-Up of Individuals With Air Trapping and Home Noninvasive Ventilation and CPAP.

BACKGROUND: The ventilatory mechanics of patients with COPD and obesity-hypoventilation syndrome (OHS) are changed when there is air trapping and auto-PEEP, which increase respiratory effort. P0.1 measures the ventilatory drive and, indirectly, respiratory effort. The aim of the study was to measure P0.1 in subjects with COPD or OHS on treatment with positive pressure and to analyze their changes in P0.1 after treatment. METHODS: With a prospective design, subjects with COPD and OHS were studied in whom positive airway pressure was applied in their treatment. P0.1 was determined at study inclusion and after 6 months of treatment. RESULTS: A total of 88 subjects were analyzed: 56% were males, and the mean age of 65 ± 9 y old. Fifty-four (61%) had OHS, and 34 (39%) had COPD. Fifty (56%) had air trapping, with an initial P0.1 value of 3.0 ± 1.3 cm H2O compared with 2.1 ± 0.7 cm H2O for subjects who did not have air trapping (P = .001). After 6 months of treatment, subjects who had air trapping had similar P0.1 as those who did not: 2.3 ± 1.1 and 2.1 ± 1 cm H2O, respectively (P = .53). In subjects with COPD, initial P0.1 was 2.9 ± 1.4 cm H2O and at 6 months 2.2 ± 1.1 cm H2O (P = .02). In subjects with OHS, initial P0.1 was 2.4 ± 1.1 cm H2O and at 6 months 2.2 ± 1.0 cm H2O (P = .28). CONCLUSIONS: COPD and air trapping were associated with greater P0.1 as a marker of respiratory effort. A decrease in P0.1 indicates less respiratory effort after treatment.

Diversity and annual fluctuation of cerambicids (Coleoptera: Cerambycidae) in a tropical forest of southeast Mexico / Diversidad y fluctuación anual de cerambícidos (coleoptera: cerambycidae) en una selva tropical del sureste de méxico

RESUMEN Se estimó la diversidad y fluctuación anual de cerambícidos asociados al borde e interior de una selva tropical. La captura de insectos se realizó con trampas de intercepción cebadas con alcohol etílico y luz ultravioleta como atrayente. Se recolectaron 295 especímenes de tres subfamilias, pertenecientes a 56 especies de 38 géneros. Lamiinae fue la subfamilia con mayor riqueza, con 40 especies distribuidas en 20 géneros, para Cerambycinae se recolectaron 14 especies de 12 géneros y para Parandrinae dos especies de un género. El género con mayor abundancia fue Leptostylus con ocho especies. Se identificaron seis especies como nuevos registros para México y 29 para Tabasco. En el borde de la selva se recolectaron 155 especímenes de dos subfamilias, pertenecientes a 37 especies de 26 géneros. En el interior se recolectaron 140 especímenes de tres subfamilias pertenecientes a 36 especies de 26 géneros. Se determinó que las comunidades comparten 17 especies. El mayor valor de diversidad verdadera se obtuvo en el borde con 15,96 y la menor en el interior con 12,69. Se determinó que los valores de A, A* y A+ implican una baja separación filogenética entre las especies de cerambícidos en ambas comunidades. La fluctuación temporal de la comunidad de cerambícidos presentó los máximos valores de abundancia en febrero, mayo y agosto, meses donde se registra una reducción en la precipitación. Finalmente, la curva de acumulación de especies aún no presenta una asíntota, por lo que se podría incrementar los nuevos registros.

ABSTRACT The diversity and annual fluctuation of cerambicids associated with the rain forest edge and interior was estimated. The capture of insects was performed with interception traps baited with ethyl alcohol and ultraviolet light traps used as attractants. 295 specimens from three subfamilies, belonging to 56 species of 38 genera were collected. Lamiinae was the richest subfamily, with 40 species distributed in 20 genera, for Cerambycinae 14 species from 12 genera were collected and for Parandrinae two species of one genus. The most abundant genus was Leptostylus with eight species. Six species were identified as new records for Mexico and 29 for Tabasco. In the forest edge, 155 specimens from two subfamilies, belonging to 37 species from 26 genera, were collected. In the forest interior 140 specimens were collected from three subfamilies, belonging to 36 species from 26 genera. It was determined that the communities have 17 shared species. The maximum value of true diversity was obtained in the forest edge with 15.96 and the minimum value in the forest interior with 12.69. The values of A, A * and A+ were determined and implied a low phylogenetic separation between the cerambycid species in both communities. The temporal fluctuation of the Cerambycidae community presented the maximum values abundance in February, May and August, months where there is a reduction in the precipitation. Finally, the species accumulation curve does not present an asymptote, so new records may increase.

Suppression of PI3K signaling is linked to autophagy activation and the spatiotemporal induction of the lens organelle free zone.

The terminal steps of lens cell differentiation require elimination of all organelles to create a central Organelle Free Zone (OFZ) that is required for lens function of focusing images on the retina. Previous studies show that the spatiotemporal elimination of these organelles during development is autophagy-dependent. We now show that the inhibition of PI3K signaling in lens organ culture results in the premature induction of autophagy within 24 h, including a significant increase in LAMP1+ lysosomes, and the removal of lens organelles from the center of the lens. Specific inhibition of just the PI3K/Akt signaling axis was directly linked to the elimination of mitochondria and ER, while pan-PI3K inhibitors that block all PI3K downstream signaling removed all organelles, including nuclei. Therefore, blocking the PI3K/Akt pathway was alone insufficient to remove nuclei. RNAseq analysis revealed increased mRNA levels of the endogenous inhibitor of PI3K activation, PIK3IP1, in differentiating lens fiber cells preceding the induction of OFZ formation. Co-immunoprecipitation confirmed that PIK3IP1 associates with multiple PI3K p110 isoforms just prior to formation of the OFZ, providing a likely endogenous mechanism for blocking all PI3K signaling and activating the autophagy pathway required to form the OFZ during lens development.

Heart Failure: Is it a Lung Disease? / Insuficiencia cardíaca: ¿una patología neumológica?

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Pilot Trial of the Performance of Electrocardiogram in the Evaluation of Childhood Syncope in the Emergency Department.

INTRODUCTION: The electrocardiogram (ECG) is widely considered a standard part of the syncope workup, and it is recommended to be obtained in all children with syncope. Nevertheless, a newly recognized cardiac cause is rare and largely incidental findings are commonly seen, leading to unneeded worry, additional testing, and added health care costs. OBJECTIVE: The aim of this study was to analyze the performance of ECG in the evaluation of childhood syncope in the emergency department (ED). METHODS: This was a descriptive, retrospective, multicenter pilot study of patients younger than 14 years diagnosed with syncope in which an ECG was obtained in the ED in 2015 and 2016. RESULTS: During the study period, 440 patients were diagnosed with syncope, of which an ECG was performed in 197 (44.7%). Of these, 64 (32.5%) were related to any concerning features associated with the event, including 33 occurring during or after physical exertion. No major alteration of the ECG was noted, and the ECG revealed multiple minor findings in 38 (19.2%; 95% confidence interval, 14.4-25.4). Twenty-five (12.7%) children were referred to a pediatric cardiologist. No patient was noted to have a previously undiagnosed cardiac cause of syncope. CONCLUSIONS: A newly recognized cardiac cause is extremely rare among children evaluated for syncope in the ED, and ECG is not systematically obtained in this population. Larger studies are needed to clarify if it is possible to identify a group of children that can be safely managed without a systematic ECG. Best practices need to be better implemented for an adequate management of pediatric syncope in the ED.

Salud Bucal y Enfermedades no transmisibles en pacientes de un centro de enseñanza universitaria del área Salud, Montevideo-Uruguay. Parte 2 / Saúde bucal e doenças não transmissíveis em pacientes de uma instituição de ensino superior, Montevidéu, Uruguai 2016. Parte 2 / Oral health and noncommunicable diseases in patients at a higher education institution. Montevideo, Uruguay. Part 2

Resumen Las enfermedades no transmisibles (ENT) comparten factores de riesgo conductuales y metabólicos con las enfermedades bucales. Ambas representan también un problema de salud pública. Objetivo: determinar la prevalencia de caries, paradenciopatías y pérdida dentaria en personas que demandan atención en la facultad de odontología de la udelar. Metodos: se relevó una muestra de los pacientes de la facultad de odontología, que respondieron un cuestionario sobre características sociodemográficas y hábitos vinculados a factores de riesgo comportamentales, se les realizaron mediciones antropométricas, de presión arterial, de glicemia capilar y un examen bucal. Resultados: fueron encuestados 602 individuos, el cpod promedio fue de 16, la prevalencia de caries no tratada fue de 72,8 % y la prevalencia de periodontitis 42,9 %. Conclusiones: Se recomienda la instalación de un programa preventivo-asistencial conjunto entre Facultad de Odontología y área salud de la UDELAR que integre la promoción y prevención de las enfermedades bucales y las no transmisibles.

Resumo As doenças não transmissíveis (DCNT) compartilham fatores de risco comportamentais e metabólicos com as doenças bucais. Ambos também representam um problema de saúde pública. Objetivo: determinar a prevalência de cárie, paradenciopatias e perda de dente em pessoas que exigem atenção na faculdade de odontologia da udelar. Métodos: foram avaliados 602 adultos, que responderam a um questionário sobre características sociodemográficas e hábitos relacionados a fatores de risco comportamentais, medidas antropométricas, pressão arterial, glicemia capilar e realização de exame oral. Resultados: foram pesquisados ​​602 indivíduos com média de 16 cáries, prevalência de cárie não tratada de 72,8% e prevalência de periodontite de 42,9%. Conclusões: Recomenda-se a instalação de um programa de cuidados preventivos conjuntos entre a Faculdade de Odontologia e a área da saúde da UDELAR que integre a promoção e prevenção das doenças bucais e não transmissíveis.

Abstract Noncommunicable diseases (NCDs) share behavioral and metabolic risk factors with oral diseases. Both are also public health issues. Objective: To determine the prevalence of caries, gum conditions, and tooth loss in patients treated at UdelaR's School of Dentistry. Methods: A sample of individuals treated at the School of Dentistry answered a questionnaire on sociodemographic characteristics and habits related to behavioral risk factors. Anthropometric measurements, blood pressure, and capillary blood glucose were recorded, and an oral exam was performed. Results: Six hundred and two individuals were surveyed. The average DMFT was 16, the prevalence of untreated caries, 72.8%, and the prevalence of periodontitis, 42.9%. Conclusions: We recommend implementing a joint preventive-care program run by the School of Dentistry and the health area of UDELAR that integrates the promotion and prevention of oral and noncommunicable diseases.

Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva / Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation

INTRODUCCIÓN: El síndrome de obesidad-hipoventilación (SOH) es un factor de riesgo para presentar insuficiencia cardiaca (IC). Algunos estudios relacionan el uso de ventilación no invasiva (VNI) con la alteración de parámetros hemodinámicos. Nuestro objetivo fue describir la situación hemodinámica de un grupo de pacientes con SOH y estudiar el efecto de la VNI. PACIENTES Y MÉTODOS: Con un diseño transversal de mediciones repetidas, se incluyó a pacientes con SOH tratados con VNI en situación estable. Se estudió su hemodinámica con bioimpedancia: 30 min basales y otros 30 con VNI. Se midieron el gasto cardiaco (GC), el índice cardiaco y el volumen sistólico. Se tomó como referencia el GC calculado para cada paciente expresado como porcentaje sobre su límite inferior de normalidad (LIN) y se establecieron 2 grupos: sin IC con GC conservado (≥ 100% sobre LIN) y con IC y GC bajo (< 100% del LIN). Se utilizaron la U de Mann-Whitney para comparación de variables independientes y el test de Wilcoxon para variables apareadas, se consideró significativo p < 0,05. RESULTADOS: La muestra final fue de 36 casos, de 66 (8) años, 19 (52%) varones. En 17 (46%) detectamos IC con GC de 3,7 l/min (66%) frente al grupo sin IC con 7 l/min (107%). Tras VNI, los pacientes en IC mejoraron su GC (4,5 l/min [77%] p = 0,009) y no lo modificó el grupo sin IC: 6,8 l/min (104%), p = 0,2. CONCLUSIÓN: Un 46% de pacientes con SOH estable presenta IC. La VNI mejora su hemodinámica y no influye en los pacientes con GC conservado

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P < .05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P = .009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P = .2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO

Comparison of Mobile and Fixed-Site Black Carbon Measurements for High-Resolution Urban Pollution Mapping.

Urban concentrations of black carbon (BC) and other primary pollutants vary on small spatial scales (<100m). Mobile air pollution measurements can provide information on fine-scale spatial variation, thereby informing exposure assessment and mitigation efforts. However, the temporal sparsity of these measurements presents a challenge for estimating representative long-term concentrations. We evaluate the capabilities of mobile monitoring in the represention of time-stable spatial patterns by comparing against a large set of continuous fixed-site measurements from a sampling campaign in West Oakland, California. Custom-built, low-cost aerosol black carbon detectors (ABCDs) provided 100 days of continuous measurements at 97 near-road and 3 background fixed sites during summer 2017; two concurrently operated mobile laboratories collected over 300 h of in-motion measurements using a photoacoustic extinctiometer. The spatial coverage from mobile monitoring reveals patterns missed by the fixed-site network. Time-integrated measurements from mobile lab visits to fixed-site monitors reveal modest correlation (spatial R2 = 0.51) with medians of full daytime fixed-site measurements. Aggregation of mobile monitoring data in space and time can mitigate high levels of uncertainty associated with measurements at precise locations or points in time. However, concentrations estimated by mobile monitoring show a loss of spatial fidelity at spatial aggregations greater than 100 m.