The association between oil spill cleanup-related total hydrocarbon exposure and diabetes.

BACKGROUND: Although evidence suggests relationships between some crude oil components and glycemic dysregulation, no studies have examined oil spill-related chemical exposures in relation to type 2 diabetes mellitus (DM) risk. This study examined the relationship between total hydrocarbon (THC) exposure among workers involved in the 2010 Deepwater Horizon (DWH) oil spill and risk of DM up to 6 years afterward. METHODS: Participants comprised 2660 oil-spill cleanup or response workers in the prospective GuLF Study who completed a clinical exam and had no self-reported DM diagnosis prior to the spill. Maximum THC exposure was estimated with a job-exposure matrix based on interview data and personal measurements taken during cleanup operations. We defined incident DM by self-reported physician diagnosis of DM, antidiabetic medication use, or a measured hemoglobin A1c value ≥ 6.5%. We used log binomial regression to estimate risk ratios (RRs) for DM across ordinal categories of THC exposure. The fully adjusted model controlled for age, sex, race/ethnicity, education, employment status, and health insurance status. We also stratified on clinical body mass index categories. RESULTS: We observed an exposure-response relationship between maximum daily ordinal THC exposure level and incident DM, especially among overweight participants. RRs among overweight participants were 0.99 (95% CI: 0.37, 2.69), 1.46 (95% CI: 0.54, 3.92), and 2.11 (95% CI: 0.78, 5.74) for exposure categories 0.30-0.99 ppm, 1.00-2.99 ppm, and ≥3.00 ppm, respectively (ptrend = 0.03). CONCLUSION: We observed suggestively increasing DM risk with increasing THC exposure level among overweight participants, but not among normal weight or obese participants.

Quantitative determination of human apolipoprotein D by electroimmunoassay and radial immunodiffusion.

1. An electroimmunoassay and a radial immunodiffusion procedure are described for the quantitative determination of human serum apolipoprotein D. Purified apolipoprotein D and antisera to both lipoprotein D and apolipoprotein D were used to standardize the assays. The assays are applicable to measurement of apolipoprotein D in serum and density classes. The electroimmunoassay is more sensitive (50 ng apolipoprotein D quantitatively detectable), rapid (time required for completion of assay is 5 h) and precise (the within- and between-assay coefficients of variation are 4 and 7%, respectively) than radial immunodiffusion. However, comparable results were obtained by both methods (r = 0.85). 2. Serum apolipoprotein D levels of normal subjects and hyperlipoproteinemic phenotypes IIa, IIb, III, IV and V were in the same range (10 to 12 mg/dl). In contrast, patients with hyperchylomicronemia (type I) had decreased apolipoprotein D levels (5 mg/dl; P less than 0.001). The apolipoprotein D in serum of normolipidemic subjects was detectable in all density classes but measurable only in HDL2 (21%), HDL3 (43%) and VHDL (36%). 3. Rocket electrophoresis is also a valuable tool for assessing the structural relationships among apolipoproteins or their constituent polypeptides. Interaction between serum and a mixture of antibodies to A-I, A-II and apolipoprotein D resulted in the formation of separate lipoprotein A and lipoprotein D rockets indicating that apolipoprotein D is not a constituent polypeptide of apolipoprotein A. This observation confirms the existence of lipoproteins A and D as separate lipoprotein families.

Quantitative determination of human apolipoprotein C-III by electroimmunoassay.

An electroimmunoassay procedure is described for the quantitative determination of human plasma apolipoprotein C-III. Purified apolipoprotein C-III was used for the preparation of monospecific antisera and as the primary standard. This sensitive, specific, rapid (time required for the completion of the assay is 5 h), precise (the within and between-assay coefficients of variation are 6 and 8%, respectively) and accurate electroimmunoassay is applicable to measurement of C-III polypeptide in whole serum and density classes. However, plasma samples containing lipoproteins with Sf less than 400 and/or triacylglycerol levels greater than 700 mg/100 ml must be delipidized. Plasma apolipoprotein C-III levels of normolipidemic subjects and hypercholesterolemic (type IIa) patients were similar (10.4 +/- 3 and 12.0 +/- 6 mg/100 ml, respectively). In contrast, patients with hyperlipoproteinemic phenotypes IIb, III, IV and V had significantly increased levels of apolipoprotein C-III (22 +/- 7; 23 +/- 6, and 54 +/- 12, respectively). The levels of apo C-III in patients with type V were significantly higher (P less than 0.001) than in normal or other hyperlipoproteinemic phenotypes.

Determination of human apolipoprotein E by electroimmunoassay.

1. Apolipoprotein E ("arginine-rich" polypeptide) was isolated from delipidized human very low density lipoproteins by agarose column chromatography in the presence of 6 M guanidine-hydrochloride. 2. An electroimmunoassay ("rocket" electrophoresis) is described for quantitative determination of human serum apolipoprotein E. Purified apolipoprotein E was used for the preparation of monospecific antisera and standardization of assay. This sensitive, specific, rapid (time required for the completion of the assay is 5 h) and precise (the within- and between-assay coefficients of variation are 5 and 8%, respectively) assay is applicable to measurement of apolipoprotein E in whole serum and density classes. The results correlated well with those obtained by radial immunodiffusion (r = 0.85). 3. Serum apolipoprotein E levels of normal subjects and hyperlipoproteinemic phenotypes IIa, IIb and IV were the same (10 to 16 mg/100 ml). In contrast, patients with type III and V hyperlipoproteinemias had markedly elevated serum apolipoprotein E levels )27 and 25 mg/100 ml, respectively). The apolipoprotein E in serum of normolipidemic subjects was equally distributed among three major lipoprotein density classes: d less than 1.030 g/ml (27%), d 1.030-1.063 g/ml (36%)and d 1.063-1.21 g/ml (37%).

Plasma apolipoprotein B and VLDL-, LDL-, and HDL-cholesterol as risk factors in the development of coronary artery disease in male patients examined by angiography.

To assess the potential use of plasma apolipoprotein B (ApoB) as a risk factor for coronary artery disease, this apolipoprotein was quantified by electroimmunoassay in 161 male patients with angiographically documented coronary atherosclerosis and 72 male patients with normal coronary arteries. In addition to ApoB, the analyzed lipoprotein profile included plasma total cholesterol, plasma triglyceride and VLDL-, LDL- and HDL-cholesterol levels. Age, plasma cholesterol, triglyceride, and VLDL- and LDL-cholesterol were significantly greater (P less than 0.05) for patients with coronary artery disease than for patients with normal arteries. In contrast, there was no difference in the mean levels of HDL-cholesterol between these 2 groups of patients. However, patients with HDL-cholesterol les than 40 mg/dl had a higher rate of coronary artery disease than those with HDL-cholesterol greater than 40 mg/dl (P less than 0.05). The results of multivariate analysis showed that age and plasma cholesterol were the 2 variables most significantly (P less than 0.01) related to the presence of coronary artery disease. However, in a subgroup of patients with plasma cholesterol less than 265 mg/dl, the most reliable variable was ApoB (P less than 0.01). For patients under 50 years of age ApoB and LDL-cholesterol were the most significant variables (P less than 0.05), whereas for patients at 50 years of age or older VLDL-cholesterol was the most significant variable (P less than 0.01). Results of this study indicate that measurement of ApoB may offer important predictive value for coronary artery disease, especially at lower levels of plasma cholesterol. Whether this and other conclusions also apply to general population, remains to be established in future studies.

Patterns of race and gender representation in health assessment textbooks.

With growing diversity in the nursing profession and in society, nursing educators face the challenge of selecting textbooks that promote cultural competence. A content analysis of photographs in nine health assessment textbooks was conducted in order to determine: 1) how accurately nurses and patients are presented in terms of race and gender; 2) how race and gender representations have changed over the last decade; and 3) how gender representations vary across different types of chapters within the texts. Although some recently published textbooks included a substantial proportion of photos of minority nurses, males and racial minorities were generally under-represented as nurses. Women and most ethnic minorities were consistently under-represented as patients. Female patients were also under-represented in cardiovascular and respiratory chapters and over-represented in chapters on reproduction. Nursing educators should screen visual images in textbooks for evidence of race and gender bias and inform publishers of the need for non-biased teaching materials.

A community-based nursing approach to the prevention of otitis media.

Otitis media (OM), a disease of the middle ear, is one of the most common diseases of childhood. Although the medical and surgical treatment of the disease by physicians is covered at length in the literature, information about the role of nurses in dealing with OM is scant. The purpose of this article is to propose a community-based nursing prevention plan for OM based on what is known about its prevalence and pathogenesis.

Determination of apolipoprotein A and its constitutive A-I and A-II polypeptides by separate electroimmunoassays.

Electroimmunoassays ("rocket" electrophoresis) are described for human serum apolipoprotein A and its constitutive A-I and A-II polypeptides. Purified lipoprotein A, A-I, and A-II were used to prepare monospecific antisera and to standardize assays. These specific, rapid (5-8 h), precise (the within-and between-assay coefficients of variations are 5 and 7%, respectively), and accurate (by gravimetry) assays are applicable to measurement of these polypeptides in whole serum and in various density classes of lipoproteins. Comparable results are obtained with intact and delipidized lipoproteins. Results correlated well with those obtained by radial immunodiffusion or radioimmunoassay. However, the present procedure is more rapid than the former and simpler than the latter immunoassay. Concentrations of A-I and A-II in the serum of normal men and women were similar (143 +/- 24 and 146 +/- 78 mg/dl, respectively, for A-I and 78 +/- 17 and 83 +/- 25 mg/dl for A-II). Subjects with type lla, llb, and IV hyperlipoproteinemias had similar concentrations of both polypeptides, while patients with type I disease, lecithin:cholesterol acyltransferase deficiency and LP-A deficiency had lowest concentrations of A-I (0.3-30 mg/dl) and A-II (11-20 mg/dl). The molar ratio of A-I/A-II in the serum and high-density lipoproteins was close to unity.

Electroimmunoassay, radioimmunoassay, and radial immunodiffusion assay evaluated for quantification of human apolipoprotein B.

We examined three immunoassay techniques for measuring apolipoprotein B in serum and major lipoprotein density fractions from normolipidemic and hyperlipoproteinemic persons, comparing values by electroimmunoassay, radioimmunoassay, and radial immunodiffusion assay with those determined gravimetrically. Electroimmunoassay is faster and simpler than radioimmunoassay, and equally precise (within- and between-assay coefficients of variation for both were 5 and 7%, respectively). All the immunoassays gave results that agreed with those by gravimetry for normolipidemic sera and the corresponding lipoprotein density fractions, but only electroimmunoassay results agreed with those by gravimetry for apolipoprotein B in lipoproteins of d less than 1.019 g/ml isolated from hypertriglyceridemic patients. Concentrations of apolipoprotein B in plasma, determined by electroimmunoassay in a population of normal persons and patients with primary hyperlipoproteinemias, were: normals, 980 +/- 200; type I, 700 +/- 160; type IIa, 2000 +/- 260; type IIb, 2180 +/- 300; type III, 1300 +/- 340; type IV, 1470 +/- 400; and type V, 1550 +/- 390 mg/liter (mean +/- SD). Lipoprotein density fractions from the hyperlipoproteinemic patients each had a characteristic distribution of free and associated forms of lipoprotein family B. The absolute concentration and distribution of apolipoprotein B between the free and associated forms of lipoprotein B may represent a useful indicator of the underlying biochemical defect(s).

Quantitative determination of apolipoproteins C-I and C-II in human plasma by separate electroimmunoassays.

Separate electroimmunoassays are described for measuring human plasma apolipoproteins C-I and C-II. Purified apolipoproteins C-I and CII were used in preparing monospecific antisera and as the primary standards. These assays are sensitive (maximal sensitivity, 20 ng), specific, rapid, precise (the within- and between-assay coefficients of variation for both assays were 5 and 8%, respectively), and accurate (accuracy was based on comparison of calculated and measured C-I, C-II, and C-III contents of an ApoC-containing column-eluent fraction) and are applicable to measurement of C-I and C-II polypeptides in whole plasma and density classes. However, plasma samples with triglyceride (triacylglycerol) concentrations greater than 6000 mg/L must be delipidized before analysis for C-II, as must those with greater than 12 000 mg/L before analysis for C-I polypeptide. Mean concentrations (and SD) of C-I in plasma of normolipidemic subjects and hyperlipoproteinemic phenotypes IIa, IIb, IV, and V were 60 (15), 70 (20), 100 (20), 100 (20), and 260 (94) mg/L, respectively. The corresponding C-II values were 40 (20), 43 (20), 68 (20), 65 (20), and 210 (70), respectively. C-I and C-II concentrations in patients with phenotypes IIb v, IV, or V significantly (p less than 0.001) exceeded those in normal persons or phenotype IIa. The observed correlations (r = 0.92 and r = 0.94) between triglyceride and C-I and C-II values suggest that these two polypeptides, like C-III, are excellent plasma markers for assessing the state of triglyceride metabolism.