A respiratory alert model for the Shenandoah Valley, Virginia, USA.

Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches.

Tear lacritin levels by age, sex, and time of day in healthy adults.

PURPOSE: Several small proteomic studies suggest that the prosecretory tear protein lacritin may be selectively downregulated in dry eye syndrome and in blepharitis, yet little information is available about normal baseline levels. This study assessed lacritin levels in tears from healthy individuals and addressed whether they differ according to sex, age, or time of day. METHODS: Rabbit antibodies against lacritin N-terminal peptide EDASSDSTGADPAQEAGTS (Pep Lac N-Term) were generated and characterized against human recombinant lacritin and N-65 truncation mutant. Basal tears were collected from 66 healthy individuals ranging in age from 18 to 52 years, and at four times during one 24-hour period from 34 other individuals. Lacritin levels were then analyzed by ELISA and Western blotting. RESULTS: Anti-Pep Lac N-Term bound lacritin, but not truncation mutant N-65 that lacks the N-terminal antigenic site. Tear lacritin levels followed a normal distribution with a mean of 4.2 ± 1.17 ng/100 ng total tear protein. Levels differed little by age or sex, and decreased slightly between 4 and 8 hours in a 24-hour cycle. Tear-blocking effects were minimal, as suggested by spiking of tears with recombinant lacritin. CONCLUSIONS: Anti-Pep Lac N-Term-detectable lacritin comprises ~4.2 ng/100 ng total tear protein in healthy individuals, with no significant differences between males and females or among individuals between 18 and 52 years old. Levels decrease slightly in the late afternoon. These findings provide a baseline for future immunodiagnostic studies of lacritin in dry eye and other ocular diseases.

Trekking poles increase physiological responses to hiking without increased perceived exertion.

Trekking poles are used by hikers for improved stability and lowered leg fatigue due to increased upper body muscle involvement. However, the weight of the poles and exaggerated upper body movement when using poles may increase total energy expenditure at a given walking speed. Few studies have investigated the physiological responses of hiking with trekking poles outside the laboratory setting. The purposes of this study were to determine if trekking poles altered physiological responses to hiking on varied terrain, and whether responses between trials were dependent on the grade of the terrain. Fourteen recreational hikers completed four hiking trials over a course that included sustained sections of flat (0 +/- 1% grade), steep uphill (>10% grade), gradual uphill (5% grade), gradual downhill (-5% grade) and steep downhill (<-10% grade) terrain. Subjects walked at a self-selected speed that was matched across trials using time-splits and a metronome. Two trials were conducted with hiking poles and two without poles. [latin capital V with dot above]O2 was significantly elevated (p <0.05) during the pole trials (1502.9 +/- 510.7 ml/min) compared to the no-pole trials (1362.4 +/- 473.2 ml/min). Similarly, ventilatory efficiency ([latin capital V with dot above]E) (43.1 +/- 9.6; 38.3 +/- 10.1 L/min) and heart rate (HR) (112.1 +/- 9.7; 105.7 +/- 10.4 bt/min) were significantly higher during the pole trials than the no-pole trials. However, ratings of perceived exertion (RPE) was not altered by pole condition (8.5 +/- 0.7; 8.4 +/- 0.8). Comparisons within each grade revealed significantly higher physiological responses for [latin capital V with dot above]O2, [latin capital V with dot above]E and HR in the pole-condition at all grades, with no significant variable*grade interactions. RPE measures were not significantly different between pole trials at any grade. These data suggest that trekking poles may be a beneficial tool for increasing caloric expenditure, as energy production increased during exercise without increased perceptions of effort.

Bringing order out of chaos: effective strategies for medical response to mass chemical exposure.

An accident or a deliberate terrorism attack releasing hazardous chemicals will create chaos, confusion, and seeming unpredictability that complicates the emergency response. Clinicians are challenged to urgently treat patients needing care, even before a chemical is confirmed. Emergency response planning that focuses on preparing for predictable challenges to the health care system and applies basic toxicologic principles to clinical decision-making can bring a sense of order to the chaos and provide medical care that will be best for the most victims of an incident.

Hazardous Air Pollution from Mobile Sources: A Comparison of Alternative Fuel and Reformulated Gasoline Vehicles.

Although there have been several studies examining emissions of criteria pollutants from in-use alternative fuel vehicles (AFVs), little is known about emissions of hazardous air pollutants (HAPs) from these vehicles. This paper explores HAP tailpipe emissions from a variety of AFVs operating in the federal government fleet and compares these emissions to emissions from identical vehicles operating on reformulated gasoline. Emissions estimates are presented for a variety of fuel/model combinations and on four HAPs (acetaldehyde, 1,3-butadi-ene, benzene, and formaldehyde). The results indicate that all AFVs tested offer reduced emissions of HAPs, with the following exceptions: ethanol fueled vehicles emit more acetaldehyde than RFG vehicles, and ethanol- and methanol-fueled vehicles emit more formaldehyde than RFG vehicles. The results from this paper can lead to more accurate emissions factors for HAPs, thus improving HAP inventory and associated risk estimates for both AFVs and conventional vehicles.