Colorectal cancer pre-diagnostic symptoms are associated with anatomic cancer site.

BACKGROUND: Signs and red flag symptoms in colorectal cancer (CRC) patients who are below the recommended screening age are often overlooked, leading to delayed diagnosis and worse prognosis. This study investigates how patient pre-diagnostic symptoms are associated with anatomic site of their cancer and whether the association varies by age at CRC diagnosis. METHODS: We ascertained CRC patients' experienced symptoms and screening through medical abstractions from an ongoing population-based study of CRC patients identified through a SEER cancer registry (N = 626). We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between symptoms and CRC anatomic site. Additional analyses were stratified by age at diagnosis. Early-onset was defined as less than 50 years of age at CRC diagnosis. RESULTS: Participants who experienced blood in stool were more likely (odds ratio (95% confidence interval)) to have rectal (vs. colon) cancer (4.37 (3.02, 6.33)), as were patients who experienced changes to stool (1.78 (1.21, 2.60)). Patients diagnosed with colon cancer were more likely to present with abdominal pain (0.30 (0.19, 0.47)), anemia (0.40 (0.21, 0.75)), other symptoms (0.33 (0.19, 0.55)) and no symptoms (0.68 (0.44, 1.04)). When stratifying by age at diagnosis, we found that the association between blood in stool and rectal tumor location was particularly pronounced for patients with early-onset CRC (6.48 (2.73, 15.41)). CONCLUSIONS: Common pre-diagnostic red flag symptoms are associated with CRC anatomic site. These findings can inform best practices for gastroenterologist triage of care and early evaluation of CRC and are of key importance given the rise of early-onset (pre-screening age) CRC. TRIAL REGISTRATION: Not applicable to this study and analysis.

Regional Influence of Aerosol Emissions from Wildfires Driven by Combustion Efficiency: Insights from the BBOP Campaign.

Wildfires are important contributors to atmospheric aerosols and a large source of emissions that impact regional air quality and global climate. In this study, the regional and nearfield influences of wildfire emissions on ambient aerosol concentration and chemical properties in the Pacific Northwest region of the United States were studied using real-time measurements from a fixed ground site located in Central Oregon at the Mt. Bachelor Observatory (∼2700 m a.s.l.) as well as near their sources using an aircraft. The regional characteristics of biomass burning aerosols were found to depend strongly on the modified combustion efficiency (MCE), an index of the combustion processes of a fire. Organic aerosol emissions had negative correlations with MCE, whereas the oxidation state of organic aerosol increased with MCE and plume aging. The relationships between the aerosol properties and MCE were consistent between fresh emissions (∼1 h old) and emissions sampled after atmospheric transport (6-45 h), suggesting that biomass burning organic aerosol concentration and chemical properties were strongly influenced by combustion processes at the source and conserved to a significant extent during regional transport. These results suggest that MCE can be a useful metric for describing aerosol properties of wildfire emissions and their impacts on regional air quality and global climate.

Farmworker-Relevant Heat Exposure in Different Crop and Shade Conditions.

OBJECTIVES: Agricultural workers are at risk of heat-related illness, which is preventable. Few field studies have compared farmworker-relevant heat exposure in different conditions. We examined heat exposure over time in different potential shade and work locations to inform future occupational heat prevention approaches. METHODS: We assessed heat exposure in Eastern Washington State (WA) cherry and grape fields in August 2022. QUESTemp° monitors recorded Wet Bulb Globe Temperature (WBGT) and Black Globe Temperature (BGT) every 10 min from approximately 07:00-14:00 for three days in the center of crop rows (mid-row), under portable shade structures (shade), and in open field (open) locations. Linear mixed effects regression (LMER) models compared WBGT and BGT among field locations. Hourly time-weighted average WBGT and comparisons with occupational exposure limits (OELs) were computed for different hypothetical work-rest cycles during the hottest sampling hours, assuming different worker effort levels, rest locations (mid-row versus shade), and acclimatization statuses. RESULTS: Across all crops and locations during the study period, the mean/SD air temperature was 31°C (88°F)/3.9°C (6.9°F), with a maximum temperature of 39°C (102°F) and a mean/SD relative humidity of 30%/9.6%. LMER models suggested no significant difference in mid-row versus open WBGT but significantly lower WBGT in shade versus open locations for both cherries (main effect -5.14: 95% confidence interval [CI] -6.97,-3.32) and grapes (-6.20: 95%CI -7.73,-4.67), though this difference diminished over the course of the day. BGT was significantly higher in the mid-row than the shade (cherries main effect 14.33: 95%CI 9.52,19.13 and grapes 17.10: 95%CI 13.44,20.75). During the hottest sampling hour, the exceedances of OELs were reduced with assumptions of increased shaded break lengths, reduced effort level, and acclimatization. CONCLUSIONS: Shade canopies, but not the crops studied, provided significant reductions in heat exposure. We observed increased protection from heat assuming longer shaded breaks and reduced effort levels. Results highlight the need for additional field research on the effectiveness, feasibility, and acceptability of different shade types and work-rest cycles to guide employer optimization of best practices for worker protections, including acclimatization before high heat, sufficient shaded rest time, reduced effort levels as the day warms, and avoiding work in peak heat.

Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees.

BACKGROUND: WA Notify was Washington State's smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. OBJECTIVE: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. METHODS: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. RESULTS: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). CONCLUSIONS: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases.

Health-based evaluation of ambient air measurements of PM2.5 and volatile organic compounds near a Marcellus Shale unconventional natural gas well pad site and a school campus.

BACKGROUND: Limited air monitoring studies with long-term measurements during all phases of development and production of natural gas and natural gas liquids have been conducted in close proximity to unconventional natural gas well pads. OBJECTIVE: Conducted in an area of Washington County, Pennsylvania, with extensive Marcellus Shale development, this study investigated whether operations at an unconventional natural gas well pad may contribute to ambient air concentrations of potential health concern at a nearby school campus. METHODS: Almost 2 years of air monitoring for fine particulate matter (PM2.5) and volatile organic compounds (VOCs) was performed at three locations between 1000 and 2800 feet from the study well pad from December 2016 to October 2018. PM2.5 was measured continuously at one of the three sites using a beta attenuation monitor, while 24-h stainless steel canister samples were collected every 6 days at all sites for analysis of 58 VOCs. RESULTS: Mean PM2.5 concentrations measured during the different well activity periods ranged from 5.4 to 9.5 µg/m3, with similar levels and temporal changes as PM2.5 concentrations measured at a regional background location. The majority of VOCs were either detected infrequently or not at all, with measurements for a limited number of VOCs indicating the well pad to be a source of small and transient contributions. SIGNIFICANCE: All measurement data of PM2.5 and 58 VOCs, which reflect the cumulative contributions of emissions from the study well pad and other local/regional air pollutant sources (e.g., other well pads), were below health-based air comparison values, and thus do not provide evidence of either 24-hour or long-term air quality impacts of potential health concern at the school.

Synthesis and health-based evaluation of ambient air monitoring data for the Marcellus Shale region.

In recent years, there has been a marked increase in the amount of ambient air quality data collected near Marcellus Shale oil and gas development (OGD) sites. We integrated air measurement data from over 30 datasets totaling approximately 200 sampling locations nearby to Marcellus Shale development sites, focusing on 11 air pollutants that can be associated with OGD operations: fine particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), acetaldehyde, benzene, ethylbenzene, formaldehyde, n-hexane, toluene, xylenes, and hydrogen sulfide (H2S). We evaluated these data to determine whether there is evidence of community-level air quality impacts of potential health concern, making screening-level comparisons of air monitoring data with acute and chronic health-based air comparison values (HBACVs). Based on the available air monitoring data, we found that only a small fraction of measurements exceeded HBACVs, which is similar to findings from integrative air quality assessments for other shale gas plays. Therefore, the data indicate that air pollutant levels within the Marcellus Shale development region typically are below HBACV exceedance levels; however, the sporadic HBACV exceedances warrant further investigation to determine whether they may be related to specific site characteristics, or certain operations or sources. Like any air monitoring dataset, there is uncertainty as to how well the available Marcellus Shale air monitoring data characterize the range of potential exposures for people living nearby to OGD sites. Given the lesser amounts of air monitoring data available for locations within 1,000 feet of OGD sites as compared to locations between 0.2 and 1 miles, the presence of potential concentration hotspots cannot be ruled out. Additional air monitoring data, in particular more real-time data to further characterize short-term peak concentrations associated with episodic events, are needed to provide for more refined assessments of potential health risks from Marcellus Shale development. Implications: While there is now a sizable amount of ambient air monitoring data collected nearby to OGD activities in the Marcellus Shale region, these data are currently scattered among different databases and studies. As part of an integrative assessment of Marcellus Shale air quality impacts, ambient air data are compiled for a subset of criteria air pollutants and hazardous air pollutants that have been associated with OGD activities, and compared to acute and chronic health-based air comparison values to help assess the air-related public health impacts of Marcellus Shale development.