Scalable Multipollutant Exposure Assessment Using Routine Mobile Monitoring Platforms.

INTRODUCTION: The absence of spatially resolved air pollution measurements remains a major gap in health studies of air pollution, especially in disadvantaged communities in the United States and lower-income countries. Many urban air pollutants vary over short spatial scales, owing to unevenly distributed emissions sources, rapid dilution away from sources, and physicochemical transformations. Primary air pollutants from traffic have especially sharp spatial gradients, which lead to disparate effects on human health for populations who live near air pollution sources, with important consequences for environmental justice. Conventional fixed-site pollution monitoring methods lack the spatial resolution needed to characterize these heterogeneous human exposures and localized pollution hotspots. In this study, we assessed the potential for repeated mobile air quality measurements to provide a scalable approach to developing high-resolution pollution exposure estimates. We assessed the utility and validity of mobile monitoring as an exposure assessment technique, compared the insights from this measurement approach against other widely accepted methods, and investigated the potential for mobile monitoring to be scaled up in the United States and low- and middle-income countries. METHODS: Our study had five key analysis modules (M1- M5). The core approach of the study revolved around repeated mobile monitoring to develop time-stable estimates of central-tendency air pollution exposures at high spatial resolution. All mobile monitoring campaigns in California were completed prior to beginning this study. In analysis M1, we conducted an intensive summerlong sampling campaign in West Oakland, California. In M2, we explored the dynamics of ultrafine particles (UFPs) in the San Francisco Bay Area. In analysis M3, we scaled up our multipollutant mobile monitoring approach to 13 different neighborhoods with ~450,000 inhabitants to evaluate within- and between-neighborhood heterogeneity. In M4, we evaluated the coupling of mobile monitoring with land use regression models to estimate intraurban variation. Finally, in M5, we reproduced our mobile monitoring approach in a pilot study in Bangalore, India. RESULTS: For M1, we found a moderate-to-high concordance in the time-averaged spatial patterns between mobile and fixed-site observations of black carbon (BC) in West Oakland. The dense fixed-site monitor network added substantial insight about spatial patterns and local hotspots. For M2, a seasonal divergence in the relationship between UFPs and other traffic-related air pollutants was evident from both approaches. In M3, we found distinct spatial distribution of exposures across the Bay Area for primary and secondary air pollutants. We found substantially unequal exposures by race and ethnicity, mostly driven by between-neighborhood concentration differences. In M4, we demonstrated that empirical modeling via land use regression could dramatically reduce the data requirements for building high-resolution air quality maps. In M5, we developed exposure maps of BC and UFPs in a Bangalore neighborhood and demonstrated that the measurement technique worked successfully. CONCLUSIONS: We demonstrated that mobile monitoring can produce insights about air pollution exposure that are externally validated against multiple other analysis approaches, while adding complementary information about spatial patterns and exposure heterogeneity and inequity that is not readily obtained with other methods.

Multi-season mobile monitoring campaign of on-road air pollution in Bengaluru, India: High-resolution mapping and estimation of quasi-emission factors.

Mobile monitoring can supplement regulatory measurements, particularly in low-income countries where stationary monitoring is sparse. Here, we report results from a ~ year-long mobile monitoring campaign of on-road concentrations of black carbon (BC), ultrafine particles (UFP), and carbon dioxide (CO2) in Bengaluru, India. The study route included 150 unique kms (average: ~22 repeat measurements per monitored road segment). After cleaning the data for known instrument artifacts and sensitivities, we generated 30 m high-resolution stable 'data only' spatial maps of BC, UFP, and CO2 for the study route. For the urban residential areas, the mean BC levels for residential roads, arterials, and highways were ~ 10, 22, and 56 µg m-3, respectively. A similar pattern (highways being characterized by highest pollution levels) was also observed for UFP and CO2. Using the data from repeat measurements, we carried out a Monte Carlo subsampling analysis to understand the minimum number of repeat measures to generate stable maps of pollution in the city. Leveraging the simultaneous nature of the measurements, we also mapped the quasi-emission factors (QEF) of the pollutants under investigation. The current study is the first multi-season mobile monitoring exercise conducted in a low or middle -income country (LMIC) urban setting that oversampled the study route and investigated the optimum number of repeat rides required to achieve representative pollution spatial patterns characterized with high precision and low bias. Finally, the results are discussed in the context of technical aspects of the campaign, limitations, and their policy relevance for our study location and for other locations. Given the day-to-day variability in the pollution levels, the presence of dynamic and unorganized sources, and active government pollution mitigation policies, multi-year mobile measurement campaigns would help test the long-term representativeness of the current results.

Urban Air-Quality Estimation Using Visual Cues and a Deep Convolutional Neural Network in Bengaluru (Bangalore), India.

Mobile monitoring provides robust measurements of air pollution. However, resource constraints often limit the number of measurements so that assessments cannot be obtained in all locations of interest. In response, surrogate measurement methodologies, such as videos and images, have been suggested. Previous studies of air pollution and images have used static images (e.g., satellite images or Google Street View images). The current study was designed to develop deep learning methodologies to infer on-road pollutant concentrations from videos acquired with dashboard cameras. Fifty hours of on-road measurements of four pollutants (black carbon, particle number concentration, PM2.5 mass concentration, carbon dioxide) in Bengaluru, India, were analyzed. The analysis of each video frame involved identifying objects and determining motion (by segmentation and optical flow). Based on these visual cues, a regression convolutional neural network (CNN) was used to deduce pollution concentrations. The findings showed that the CNN approach outperformed several other machine learning (ML) techniques and more conventional analyses (e.g., linear regression). The CO2 prediction model achieved a normalized root-mean-square error of 10-13.7% for the different train-validation division methods. The results here thus contribute to the literature by using video and the relative motion of on-screen objects rather than static images and by implementing a rapid-analysis approach enabling analysis of the video in real time. These methods can be applied to other mobile-monitoring campaigns since the only additional equipment they require is an inexpensive dashboard camera.

Bias in PM2.5 measurements using collocated reference-grade and optical instruments.

Optical PM2.5 measurements are sensitive to aerosol properties that can vary with space and time. Here, we compared PM2.5 measurements from collocated reference-grade (beta attenuation monitors, BAMs) and optical instruments (two DustTrak II and two DustTrak DRX) over 6 months. We performed inter-model (two different models), intra-model (two units of the same model), and inter-type (two different device types: optical vs. reference-grade) comparisons under ambient conditions. Averaged over our study period, PM2.5 measured concentrations were 46.0 and 45.5 µg m-3 for the two DustTrak II units, 29.8 and 38.4 µg m-3 for DRX units, and 18.3 and 19.0 µg m-3 for BAMs. The normalized root square difference (NRMSD; compares PM2.5 measurements from paired instruments of the same type) was ~ 5% (DustTrak II), ~ 27% (DRX), and ~ 15% (BAM). The normalized root mean square error (NRMSE; compares PM2.5 measurements from optical instruments against a reference instrument) was ~ 165% for DustTrak II, ~ 74% after applying literature-based humidity correction and ~ 27% after applying both the humidity and BAM corrections. Although optical instruments are highly precise in their PM2.5 measurements, they tend to be strongly biased relative to reference-grade devices. We also explored two different methods to compensate for relative humidity bias and found that the results differed by ~ 50% between the two methods. This study highlights the limitations of adopting a literature-derived calibration equation and the need for conducting local model-specific calibration. Moreover, this is one of the few studies to perform an intra-model comparison of collocated reference-grade devices.

Characteristics and health risk assessment of fine particulate matter and surface ozone: results from Bengaluru, India.

Urban air pollution is a complex problem, which requires a multi-pronged approach to understand its dynamics. In the current study, various aspects of air pollution over Bengaluru city were studied utilizing simultaneous reference-grade measurements (during the period July 2019 to June 2020) of fine particulate matter mass concentration (PM2.5), aerosol black carbon mass concentrations (BC), and surface ozone (O3) concentrations. The study period mean PM2.5, BC, and O3 were observed to be 26.8 ± 11.5 µg m-3, 5.6 ± 2.8 µg m-3, and 25.5 ± 12.4 ppb, respectively. Statistical methods such as principal component analysis, moving average subtraction method, conditional bivariate probability function, and concentration weighted trajectory analysis were performed to understand the dynamics of air pollution over Bengaluru and its long-range transportation pathways. Some of the major findings from the statistical analyses include (i) contrasting association in BC versus O3 and PM2.5 versus O3; (ii) around one-fourth of the observed receptor site BC was contributed by local sources/emissions; and (iii) the source locations potentially contributing to BC and PM2.5 were spatially different. In Bengaluru, long-term exposure to PM2.5 resulted in around 3413, 3393, 1016, and 147 attributable deaths for the health endpoints chronic obstructive pulmonary disorder, ischemic heart disease, stroke, and lung cancer, respectively. Long-term exposure to O3 resulted in around 155 attributable deaths for respiratory diseases, as estimated by the AirQ + model. Finally, the limitations of the study in terms of data availability and analysis have been detailed.

Impact of COVID-19 lockdown on the fine particulate matter concentration levels: Results from Bengaluru megacity, India.

Leveraging the COVID-19 India-wide lockdown situation, the present study attempts to quantify the reduction in the ambient fine particulate matter concentrations during the lockdown (compared with that of the pre-lockdown period), owing to the highly reduced specific anthropogenic activities and thereby pollutant emissions. The study was conducted over Bengaluru (India), using PM2.5 (mass concentration of particulate matter having size less than or equal to 2.5 µm) and Black Carbon mass concentration (BC) data. Open-access datasets from pollution control board (PCB) were also utilised to understand the spatial variability and region-specific reduction in PM2.5 across the city. The highest percentage reduction was observed in BCff (black carbon attributable to fossil fuel combustion), followed by total BC and PM2.5. No decrease in BCbb (black carbon attributable to wood/biomass burning) was observed, suggesting unaltered wood-based cooking activities and biomass-burning (local/regional) throughout the study period. Results support the general understanding of multi-source (natural and anthropogenic) nature of PM2.5 in contrast to limited-source (combustion based) nature of BC. The diurnal amplitudes in BC and BCff were reduced, while they remained almost the same for PM2.5 and BCbb. Analysis of PCB data reveal the highest reduction in PM2.5 in an industrial cluster area. The current lockdown situation acted as a natural model to understand the role of a few major anthropogenic activities (viz., traffic, construction, industries related to non-essential goods, etc.) in enhancing the background fine particulate matter levels. Contemporary studies reporting reduction in surface fine particulate matter and satellite retrieved columnar Aerosol Optical Depth (AOD) during COVID-19 lockdown period are discussed.

Climatological trends in satellite-derived aerosol optical depth over North India and its relationship with crop residue burning: Rural-urban contrast.

Columnar Aerosol Optical Depths (AOD) over an urban area (Chandigarh) and a rural area (Khera, Fatehgarh Sahib district) situated in the Indo-Gangetic Plains (IGP) of India were analysed to study their temporal heterogeneity in terms of interannual, seasonal and monthly variations. Over the last few decades, IGP has become one of the global hotspots of air pollution due to the increased anthropogenic activities such as traffic, industries, agricultural waste burning etc. Level-2 AODs (550 nm) were retrieved from the Moderate Resolution Imaging Spectroradiometer (MODIS) sensors onboard NASA's Terra and Aqua satellites, for a period of 14 years (2005-2018). The climatological mean Terra-MODIS (Aqua-MODIS) AOD over the urban location was ~0.497 ± 0.238 (0.474 ± 0.228), whereas over the rural location it was 0.542 ± 0.269 (0.534 ± 0.282). Linear trend analysis estimated an increase in annual mean Terra-MODIS (Aqua-MODIS) AOD at a rate of ~0.009 (0.013) per year over the urban site; whereas over the rural location the rate of increase was ~0.003 (0.004) per year. Results show that the observed increase is ~1.49% (2.41%) of climatological mean AOD over the urban location for Terra-MODIS (Aqua-MODIS), whereas, over the rural location, it was ~0.50% (0.67%). Using the HYSPLIT trajectory model, it was concluded that, during post-monsoon, the observed high AODs can be related to massive crop residue burning in the IGP region. These AOD trends can also be used to track the regional anthropogenic air-pollution changes. An empirical relation between AOD and PM10 was established, which can be used to estimate PM10 over the urban and rural areas of IGP (using MODIS AODs), complementing the sparse ground-based monitoring. Further, satellite-based air pollution data can be used for baseline assessment and understanding the impact of control policies such as National Clean Air Programme and to support formulate evidence-based pollution control strategies.

Developing a Low-Cost Passive Method for Long-Term Average Levels of Light-Absorbing Carbon Air Pollution in Polluted Indoor Environments.

We propose a low-cost passive method for monitoring long-term average levels of light-absorbing carbon air pollution in polluted indoor environments. Building on prior work, the method here estimates the change in reflectance of a passively exposed surface through analysis of digital images. To determine reproducibility and limits of detection, we tested low-cost passive samplers with exposure to kerosene smoke in the laboratory and to environmental pollution in 20 indoor locations. Preliminary results suggest robust reproducibility (r = 0.99) and limits of detection appropriate for longer-term (~1-3 months) monitoring in households that use solid fuels. The results here suggest high precision; further testing involving "gold standard" measurements is needed to investigate accuracy.

Personal exposure to particulate matter in peri-urban India: predictors and association with ambient concentration at residence.

Scalable exposure assessment approaches that capture personal exposure to particles for purposes of epidemiology are currently limited, but valuable, particularly in low-/middle-income countries where sources of personal exposure are often distinct from those of ambient concentrations. We measured 2 × 24-h integrated personal exposure to PM2.5 and black carbon in two seasons in 402 participants living in peri-urban South India. Means (sd) of PM2.5 personal exposure were 55.1(82.8) µg/m3 for men and 58.5(58.8) µg/m3 for women; corresponding figures for black carbon were 4.6(7.0) µg/m3 and 6.1(9.6) µg/m3. Most variability in personal exposure was within participant (intra-class correlation ~20%). Personal exposure measurements were not correlated (Rspearman < 0.2) with annual ambient concentration at residence modeled by land-use regression; no subgroup with moderate or good agreement could be identified (weighted kappa ≤ 0.3 in all subgroups). We developed models to predict personal exposure in men and women separately, based on time-invariant characteristics collected at baseline (individual, household, and general time-activity) using forward stepwise model building with mixed models. Models for women included cooking activities and household socio-economic position, while models for men included smoking and occupation. Models performed moderately in terms of between-participant variance explained (38-53%) and correlations between predictions and measurements (Rspearman: 0.30-0.50). More detailed, time-varying time-activity data did not substantially improve the performance of the models. Our results demonstrate the feasibility of predicting personal exposure in support of epidemiological studies investigating long-term particulate matter exposure in settings characterized by solid fuel use and high occupational exposure to particles.

Identifying predictors of personal exposure to air temperature in peri-urban India.

Characterizing personal exposure to air temperature is critical to understanding exposure measurement error in epidemiologic studies using fixed-site exposure data and to identify strategies to protect public health. To date, no study evaluating personal air temperature in the general population has been conducted in a low-and-middle income country. We used data from the CHAI study consisting of 50 adults monitored in up to six non-consecutive 24 h sessions in peri-urban south India. We quantified the agreement and association between fixed-site ambient and personal air temperature, and identified predictors of personal air temperature based on housing assessment, self-reported, GPS, remote sensing, and wearable camera data. Mean (SD) daytime (6 am-10 pm) average personal air temperature was 31.2 (2.6) °C and mean nighttime (10 pm-6 am) average temperature was 28.8 (2.8) °C. Agreement between average personal air and fixed-site ambient temperatures was limited, especially at night when personal air temperatures were underestimated by fixed-site temperatures (MBE = -5.6 °C). The proportion of average personal nighttime temperature variability explained by ambient fixed-site temperatures was moderate (R2mar = 0.39); daytime associations were stronger for women (R2mar = 0.51) than for men (R2mar = 0.3). Other predictors of average nighttime personal air temperature included residential altitude, ceiling height, and household income. Predictors of average daytime personal air temperature included roof materials, GPS-tracked altitude, time working in agriculture (for women), and time travelling (for men). No biomass cooking, urban heat island, or greenspace effects were identified. R2mar between ambient fixed-site and personal air temperature indicate that ambient fixed-site temperature is only a moderately useful proxy of personal air temperature in the context of peri-urban India. Our findings suggest that people living in houses at lower altitude, with lower ceiling height and asbestos roofing sheets might be more vulnerable to heat. We also identified households with higher income, women working in agriculture and men with long commutes as disproportionately exposed to high temperatures.

When, Where, and What? Characterizing Personal PM2.5 Exposure in Periurban India by Integrating GPS, Wearable Camera, and Ambient and Personal Monitoring Data.

Evidence identifying factors that influence personal exposure to air pollutants in low- and middle-income countries is scarce. Our objective was to identify the relative contribution of the time of the day ( when?), location ( where?), and individuals' activities ( what?) to PM2.5 personal exposure in periurban South India. We conducted a panel study in which 50 participants were monitored in up to six 24-h sessions ( n = 227). We integrated data from multiple sources: continuous personal and ambient PM2.5 concentrations; questionnaire, GPS, and wearable camera data; and modeled long-term exposure at residence. Mean 24-h personal exposure was 43.8 µg/m3 (SD 24.6) for men and 39.7 µg/m3 (SD 12.0) for women. Temporal patterns in exposure varied between women (peak exposure in the morning) and men (more exposed throughout the rest of the day). Most exposure occurred at home, 67% for men and 89% for women, which was proportional to the time spent in this location. Ambient daily PM2.5 was an important predictor of 24-h personal exposure for both genders. Among men, activities predictive of higher hourly average exposure included presence near food preparation, in the kitchen, in the vicinity of smoking, or in industry. For women, predictors of exposure were largely related to cooking.

Wearable camera-derived microenvironments in relation to personal exposure to PM2.5.

Data regarding which microenvironments drive exposure to air pollution in low and middle income countries are scarce. Our objective was to identify sources of time-resolved personal PM2.5 exposure in peri-urban India using wearable camera-derived microenvironmental information. We conducted a panel study with up to 6 repeated non-consecutive 24 h measurements on 45 participants (186 participant-days). Camera images were manually annotated to derive visual concepts indicative of microenvironments and activities. Men had slightly higher daily mean PM2.5 exposure (43 µg/m3) compared to women (39 µg/m3). Cameras helped identify that men also had higher exposures when near a biomass cooking unit (mean (sd) µg/m3: 119 (383) for men vs 83 (196) for women) and presence in the kitchen (133 (311) for men vs 48 (94) for women). Visual concepts associated in regression analysis with higher 5-minute PM2.5 for both sexes included: smoking (+93% (95% confidence interval: 63%, 129%) in men, +29% (95% CI: 2%, 63%) in women), biomass cooking unit (+57% (95% CI: 28%, 93%) in men, +69% (95% CI: 48%, 93%) in women), visible flame or smoke (+90% (95% CI: 48%, 144%) in men, +39% (95% CI: 6%, 83%) in women), and presence in the kitchen (+49% (95% CI: 27%, 75%) in men, +14% (95% CI: 7%, 20%) in women). Our results indicate wearable cameras can provide objective, high time-resolution microenvironmental data useful for identifying peak exposures and providing insights not evident using standard self-reported time-activity.

Use of spatiotemporal characteristics of ambient PM2.5 in rural South India to infer local versus regional contributions.

This study uses spatiotemporal patterns in ambient concentrations to infer the contribution of regional versus local sources. We collected 12 months of monitoring data for outdoor fine particulate matter (PM2.5) in rural southern India. Rural India includes more than one-tenth of the global population and annually accounts for around half a million air pollution deaths, yet little is known about the relative contribution of local sources to outdoor air pollution. We measured 1-min averaged outdoor PM2.5 concentrations during June 2015-May 2016 in three villages, which varied in population size, socioeconomic status, and type and usage of domestic fuel. The daily geometric-mean PM2.5 concentration was ∼30 µg m-3 (geometric standard deviation: ∼1.5). Concentrations exceeded the Indian National Ambient Air Quality standards (60 µg m-3) during 2-5% of observation days. Average concentrations were ∼25 µg m-3 higher during winter than during monsoon and ∼8 µg m-3 higher during morning hours than the diurnal average. A moving average subtraction method based on 1-min average PM2.5 concentrations indicated that local contributions (e.g., nearby biomass combustion, brick kilns) were greater in the most populated village, and that overall the majority of ambient PM2.5 in our study was regional, implying that local air pollution control strategies alone may have limited influence on local ambient concentrations. We compared the relatively new moving average subtraction method against a more established approach. Both methods broadly agree on the relative contribution of local sources across the three sites. The moving average subtraction method has broad applicability across locations.

Development of land-use regression models for fine particles and black carbon in peri-urban South India.

Land-use regression (LUR) has been used to model local spatial variability of particulate matter in cities of high-income countries. Performance of LUR models is unknown in less urbanized areas of low-/middle-income countries (LMICs) experiencing complex sources of ambient air pollution and which typically have limited land use data. To address these concerns, we developed LUR models using satellite imagery (e.g., vegetation, urbanicity) and manually-collected data from a comprehensive built-environment survey (e.g., roads, industries, non-residential places) for a peri-urban area outside Hyderabad, India. As part of the CHAI (Cardiovascular Health effects of Air pollution in Telangana, India) project, concentrations of fine particulate matter (PM2.5) and black carbon were measured over two seasons at 23 sites. Annual mean (sd) was 34.1 (3.2) µg/m3 for PM2.5 and 2.7 (0.5) µg/m3 for black carbon. The LUR model for annual black carbon explained 78% of total variance and included both local-scale (energy supply places) and regional-scale (roads) predictors. Explained variance was 58% for annual PM2.5 and the included predictors were only regional (urbanicity, vegetation). During leave-one-out cross-validation and cross-holdout validation, only the black carbon model showed consistent performance. The LUR model for black carbon explained a substantial proportion of the spatial variability that could not be captured by simpler interpolation technique (ordinary kriging). This is the first study to develop a LUR model for ambient concentrations of PM2.5 and black carbon in a non-urban area of LMICs, supporting the applicability of the LUR approach in such settings. Our results provide insights on the added value of manually-collected built-environment data to improve the performance of LUR models in settings with limited data availability. For both pollutants, LUR models predicted substantial within-village variability, an important feature for future epidemiological studies.

Integrated assessment of exposure to PM2.5 in South India and its relation with cardiovascular risk: Design of the CHAI observational cohort study.

While there is convincing evidence that fine particulate matter causes cardiovascular mortality and morbidity, little of the evidence is based on populations outside of high income countries, leaving large uncertainties at high exposures. India is an attractive setting for investigating the cardiovascular risk of particles across a wide concentration range, including concentrations for which there is the largest uncertainty in the exposure-response relationship. CHAI is a European Research Council funded project that investigates the relationship between particulate air pollution from outdoor and household sources with markers of atherosclerosis, an important cardiovascular pathology. The project aims to (1) characterize the exposure of a cohort of adults to particulate air pollution from household and outdoor sources (2) integrate information from GPS, wearable cameras, and continuous measurements of personal exposure to particles to understand where and through which activities people are most exposed and (3) quantify the association between particles and markers of atherosclerosis. CHAI has the potential to make important methodological contributions to modeling air pollution exposure integrating outdoor and household sources as well as in the application of wearable camera data in environmental exposure assessment.

On the classification and sub-classification of aerosol key types over south central peninsular India: MODIS-OMI algorithm.

Long-term (8 years), simultaneous data on aerosol optical properties from MODIS and OMI satellite sensors are analyzed to study their temporal characteristics and to infer on the major aerosol types present over the study location, Bangalore situated in south central peninsular India. Investigations are carried out on Aerosol Optical Depths (AODs), Angstrom exponent (α) and Aerosol Index (AI) for the purpose. Aerosol parameters exhibited significant seasonal variations: AODs peaking during monsoon, α during post-monsoon and AI during summer. Seasonal air mass back trajectories are computed to infer on the transport component over the study region. By assigning proper thresholds (depending on the nature of the location and transport pathways) on AOD and α values, aerosols are discriminated into their major types viz., marine influenced, desert dust, urban/industrialized and mixed types. Further sub-categorization of the aerosols has been done on an annual scale taking into account of their absorptance information in terms of the OMI-AI values. Mixed type aerosols contributed the most during all the seasons. Next to mixed type aerosols, marine influenced aerosols dominated during winter, desert dust during monsoon and summer, urban/industrialized aerosols during post-monsoon. Considering the urban nature of the study location, urban/industrialized/carbonaceous type aerosols have been significantly underestimated in these methodologies. Finally, discussion has been made on the consistency of the results obtained from the methodologies (i) based on AODs and α; (ii) based on AODs, α and AI.

A case of emotional facial palsy with ipsilateral anterior inferior cerebellar artery territory infarction.

Emotional facial palsy (EFP) commonly results from anterolateral thalamic or striatocapsular infarcts. Its occurrence in brainstem lesions is uncommon, with previously reported cases being restricted to superior cerebellar artery infarction (3 cases). We report an unusual case of EFP ipsilateral to an anterior inferior cerebellar artery infarction, which opens new insights into the facial corticobulbar tract pathway.

Doxycycline in the treatment of rheumatoid arthritis--a pilot study.

OBJECTIVE: To assess the efficacy and safety of doxycycline as a disease modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA) and compare it with methotrexate, a standard DMARD. MATERIAL AND METHODS: A single (assessor) blind prospective study with 15 patients of RA randomized to doxycycline and 14 to methotrexate. Baseline disease characteristics were similar in both groups. RESULTS: All disease activity measures studied viz. tender and swollen joint counts, physician and patient global assessment, visual analogue pain scale, health assessment questionnaire and ESR improved in both the treatment groups after six months of treatment. The difference between doxycycline and methotrexate was not statistically significant. No major side effects necessitating drug withdrawal were reported from either group. The side effects were few and mostly gastrointestinal. CONCLUSION: Doxycycline is a safe disease modifying drug in RA whose effect is sustained at six months. It compared favourably with methotrexate over a six month follow up.