Military burn pit exposure and airway disease: Implications for our Veteran population.

Millions of veterans have been exposed to burn pit smoke during combat deployments throughout the last three decades. Toxic compounds present in burn pit fumes that may cause or exacerbate upper and lower airway diseases include dioxins, polyaromatic hydrocarbons, and particulate matter, among others. There have been several observational studies evaluating the potential role of burn pit exposure in the development of a multitude chronic health conditions, and the veterans Administration has established the Airborne Hazards and Open Burn Pit Registry in 2014. However, specific causality of airway disease from burn pits has been difficult to prove, and there are multiple barriers toward etiologic research. Preclinical models have demonstrated airway dysfunction and inflammation but modeling human exposures remains challenging. Here, we review the current literature on the potential impact of burn pit exposure on chronic airway disease.

How can we meet the needs of patients, their families and their communities? A qualitative study including clinicians, consumer representatives, patients, and community members.

BACKGROUND: The Diversity Working Group was formed in response to Australian Quality and Safety Health Care Standards that require organisations plan service delivery that incorporates information about the diversity of consumers, and those at higher risk of harm. METHODS: A qualitative gap analysis was conducted by a team from varied professional backgrounds including a clinician researcher, a nurse researcher with expertise in culturally and linguistically diverse care and a consumer representative with expertise in advocacy and carer representation. Qualitative questions were co-designed, using a person-centred care lens. Community organisation members, and clinicians and patients from both ambulatory and inpatient areas were approached. Responses were coded independently and synthesised using a Framework Methodology. RESULTS: In total 3 community organisation members, 40 clinicians and 30 patients consented to participate in the qualitative study over a period of three weeks. There were three key themes across responses, 'What are diverse needs?'; 'Assigning people to a group does not address a need'; 'Unplanned care makes people feel vulnerable'. Those patients who are isolated, for any number of reasons, were identified as at greater risk of harm. CONCLUSION: Taking a person-centred approach can potentially better understand the needs of patients and communities so that this information can be incorporated into health service delivery. Resources are needed to support patients and their families at times of transition care, particularly when care is unplanned.

Alcohol-Induced Sudden Cardiac Death in a Teenager With PPA2 Gene Mutations.

ABSTRACT: The PPA2 gene encodes a mitochondrial pyrophosphatase protein. Mutations in the gene are inherited in an autosomal recessive fashion and, when mutated, function to induce mitochondrial ATP production failure resulting in increased stress on the heart and sudden cardiac death, especially when combined with alcohol. Herein, we describe a case of a 19-year-old female patient with a history of "alcohol intolerance" who was found unexpectedly deceased after consuming a minimal amount of alcohol. Histological examination of her heart revealed widespread fibrosis of the left ventricle and the interventricular septum. Other findings include hypertrophied myocytes, including some with pleomorphic nuclei. Genetic studies were performed on postmortem blood, revealing heterozygous PPA2 gene mutations, the pathogenic variant c.683C>T (p.Pro228Leu), and the other variant c.814C>T (p.His272Tyr), a novel variant of undetermined significance. We propose that the variant of undetermined significance is likely a pathogenic mutation due to the decedent's phenotype.

Spontaneous Multiple Arterial Dissection in a COVID-19-Positive Decedent.

ABSTRACT: Spontaneous multiple arterial dissection (SMAD) is a rarely reported phenomenon and has been previously linked to connective tissue diseases and specifically the genetic mutations in SMAD3 and COL3A1. Herein we describe a case of SMAD with scattered thrombi in a COVID-19-positive patient with a history of unspecified mitochondrial myopathy. Vasculopathy involved the splenic artery, inferior mesenteric artery, internal mammary arteries, omental arteries, mesenteric arteries, and small renal arteries. Dissections were confirmed by histology in the splenic artery, inferior mesenteric artery, and bilateral renal medullary arteries. Genetic studies were done to rule out SMAD3 and COL3A1 mutations. Because the Smad3 protein has been previously implicated in COVID-19-associated tissue fibrosis, it may play a role in endothelial dysfunction as well.

HEPA filtration improves asthma control in children exposed to traffic-related airborne particles.

Traffic-related airborne particles are associated with asthma morbidity. The aim of this study was to assess the impact of a high-efficiency particulate air (HEPA) filtration on the concentrations of traffic particles and the resultant effect on children with asthma. Forty-three children with asthma were enrolled in this double-blind, placebo-controlled crossover design. A HEPA air cleaner or a placebo "dummy" was placed in participants' homes for four weeks, interrupted by a one-month washout period, before crossing over to the other treatment arm for four weeks. Air sampling and health outcomes, including asthma control (ACQ) and quality of life (AQLQ) measures, were completed prior to and at the end of each treatment arm. Indoor concentrations of traffic particles were significantly reduced with the HEPA treatment but not with the "dummy" treatment. In participants with poorly controlled asthma and lower quality of life at baseline, ACQ and AQLQ scores were significantly improved (1.3 to 0.9, P = .003 and 4.9 to 5.5, P = .02, respectively) following the HEPA treatment. In this study, HEPA filtration is associated with improved clinical outcomes and quality of life measures in children with uncontrolled asthma.

Exploring Parent Experience of Communication About Therapeutic Hypothermia in the Neonatal Intensive Care Unit.

BACKGROUND: The unique communication challenges faced by parents of infants undergoing therapeutic hypothermia have not been well characterized. PURPOSE: To develop awareness of communication challenges experienced by families of infants treated with therapeutic hypothermia. METHODS: Semistructured interviews were conducted in a group setting with parents matched into groups according to the severity of the infant's presenting encephalopathy. The interviews were transcribed and coded into principal and additional subthemes. RESULTS: Thirty adults were interviewed including 15 mothers, 12 fathers, 2 grandmothers, and 1 grandfather. The 15 infants were between 2 and 24 months of age at the time of the interviews. The principal theme of communication included the following 3 subthemes; transparency, consistency, and delivery style. Parents reported a strong desire for improved early and transparent communication about therapeutic hypothermia, particularly during transfer from an outside hospital. Parents also reported a preference for consistent communication and highlighted parental touch of the hypothermic infant, obstetrical nurse-to-neonatal intensive care unit nurse communication, and parent and visitor presence in the infant's room as areas in need of greater communication consistency. Parents valued direct and compassionate communication styles that excluded medical jargon. IMPLICATIONS FOR PRACTICE: All providers can implement recommendations for communication to parents of infants treated with therapeutic hypothermia by increasing transparency, developing greater consistency in the communication delivered, and employing a direct and compassionate style to improve the parental experience of therapeutic hypothermia. IMPLICATIONS FOR RESEARCH: Further investigation is needed into the specific challenges parents face with a lack of transparent communication prior to the transfer of an infant for therapeutic hypothermia.

Survey of Neonatal Intensive Care Unit Nurse Attitudes Toward Therapeutic Hypothermia Treatment.

BACKGROUND: The traumatic experiences of parents of babies treated with therapeutic hypothermia (TH) have been described. No research has assessed neonatal intensive care unit (NICU) nurse experience in providing care to hypothermic babies and emotional support to their parents. PURPOSE: To assess NICU nurse attitudes to the provision of TH with respect to perceptions about baby pain/sedation, need for nurse and parent education, decision making about initiation of TH, and barriers to best care. METHODS: A survey was electronically sent to 219 nurses at 2 affiliated academic level III NICUs: 1 rural and 1 urban location. There were 17 questions where responses were selected from a preset list and 7 opportunities for nurses to provide free text responses. FINDINGS: The response rate was 38% (N = 83). Overwhelming similarities between the urban and rural institutions were found with NICU nurses expressing understanding of the indications for initiating TH, agreement that TH improves long-term outcomes and that the benefits of TH outweigh the risks. Nurses at the urban institution more frequently expressed concerns surrounding inadequate treatment of baby pain/sedation, and nurses at both institutions strongly emphasized the need for more nurse and parent education about TH and improved timeliness of decision making for initiation of TH. IMPLICATIONS FOR PRACTICE: NICU nurses specifically want to learn more about outcomes of babies after treatment with TH and feel that parents need more education about TH. IMPLICATIONS FOR RESEARCH: Research is urgently needed to better understand the implications of TH treatment for parent-baby bonding.

Hydrotherapy for the long-term ventilated patient: A case study and implications for practice.

Hydrotherapy of mechanically ventilated patients has been shown to be safe and feasible in both the acute stages of critical illness and in those requiring long term mechanical ventilation. This case study describes the hydrotherapy sessions of a 36 year old female, who after suffering complications of pneumococcal meningitis, became an incomplete quadriplegic and required long term mechanical ventilation. When implementing hydrotherapy with patients on mechanical ventilation a number of factors should be considered. These include staff resources and training, airway and ventilation management, patient preparation and safety procedures. Hydrotherapy can be safely utilised with mechanically ventilated patients, and may facilitate a patient's ability to participate in active exercise and rehabilitation.

Chronic health conditions and adolescents' social connectedness.

This study investigated associations between chronic developmental/behavioral and physical health conditions and social connectedness of adolescents using rich population-based data from a national U.S. birth cohort study. Potentially disabling health conditions were reported by caregivers and categorized by our team as developmental/behavioral or physical. Social connectedness was assessed using a validated scale that measured adolescents' reports of positive social connectedness across relevant contexts (family, friends, school). Of the 3,207 adolescents included, over one third had at least one chronic health condition. Unadjusted and adjusted linear and logistic regression models of associations between the presence of chronic health conditions (any developmental/behavioral health condition and any physical health condition, compared to no conditions) and adolescents' social connectedness outcomes were estimated. Compared to those with no chronic health conditions, adolescents with developmental/behavioral health conditions had lower odds of high positive social connectedness scores (adjusted odds ratio [AOR]: 0.80; CI [0.67, 0.94]), having friends they really care about (AOR: 0.76; CI [0.61, 0.94]), having people who care (AOR: 0.65; CI [0.50, 0.84]), and having people with whom to share good news (AOR: 0.77; CI [0.63, 0.94]). Adolescents with chronic physical health conditions had lower odds of reporting having people who care about them (AOR: 0.72; CI [0.55, 0.94]). The findings point to the need for interventions designed to foster the development of positive interpersonal relationships, reduce loneliness, and increase positive social identity among adolescents with chronic health conditions, particularly those with developmental/behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent Chronic Health Conditions and School Disconnectedness.

OBJECTIVE: The objective of this study was to examine associations between chronic health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization at age 15. METHOD: We conducted a secondary analysis of population-based data from the Fragile Families and Child Wellbeing birth cohort to investigate associations between chronic developmental/behavioral and physical health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization of adolescents using mother-reported child health conditions and youth-reported relationships/experiences at school ascertained from standardized scales. Associations were examined using linear and logistic regression models adjusting for confounding factors. RESULTS: Of the 2874 adolescents included, more than one-third had at least 1 chronic health condition. Compared with those with no chronic health conditions, adolescents with developmental/behavioral health conditions felt more disconnected from school (by 0.22 SDs), had more trouble getting along with others at school (0.22 SD), and were more victimized by peers at school (0.20 SD). Teens with physical health conditions also felt more disconnected from school (0.10 SD), had more trouble getting along with others at school (0.12 SD), and were more victimized by peers (0.12 SD). One noteworthy difference was that adolescents with developmental/behavioral conditions were more likely than those with no conditions to report trouble getting along with teachers, but adolescents with physical health conditions were not. CONCLUSION: Chronic health conditions were associated with disconnectedness from school and negative school social interactions in this study of US urban youth, suggesting that targeted resources and interventions for this population are needed.

Computationally derived rules for persistence of C60 nanowires on recumbent pentacene bilayers.

The tendency for C(60) nanowires to persist on two monolayers of recumbent pentacene is studied using molecular dynamics (MD) simulations. A review of existing experimental literature for the tilt angle adopted by pentacene on noble metal surfaces shows that studies cover a limited range from 55° to 90°, motivating simulation studies of essentially the entire range of tilt angles (10°-90°) to predict the optimum surface tilt angle for C(60) nanowire formation. The persistence of a 1D nanowire depends sensitively on this tilt angle, the amount of initial tensile strain, and the presence of surface step edges. At room temperature, C(60) nanowires oriented along the pentacene short axes persist for several nanoseconds and are more likely to occur if they reside between, or within, pentacene rows for ϕ ≤ ∼60°. The likelihood of this persistence increases the smaller the tilt angle. Nanowires oriented along the long axes of pentacene molecules are unlikely to form. The limit of stability of nanowires was tested by raising the temperature to 400 K. Nanowires located between pentacene rows survived this temperature rise, but those located initially within pentacene rows are only stable in the range ϕ(1) = 30°-50°. Flatter pentacene surfaces, that is, tilt angles above about 60°, are subject to disorder caused by C(60) molecules "burrowing" into the pentacene surface. An initial strain of 5% applied to the C(60) nanowires significantly decreases the likelihood of nanowire persistence. In contrast, any appreciable surface roughness, even by half a monolayer in height of a third pentacene monolayer, strongly enhances the likelihood of nanowire formation due to the strong binding energy of C(60) molecules to step edges.

Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability.

OBJECTIVE: To examine associations between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship. METHODS: We conducted a secondary analysis of population-based data from the Fragile Families & Child Wellbeing Study urban birth cohort. Disability status included physical/developmental/behavioral conditions (ages 1-5) using mother-reported child health conditions and cognitive disability (age 9), measured by the Peabody Picture Vocabulary Test (PPVT), an assessment of receptive vocabulary. We investigated whether either disability type moderates the relationship between ACEs occurring between ages 5 to 9 and behavior outcomes at age 15, specifically, standardized scales of caregiver-reported externalizing and youth-reported internalizing and delinquent behaviors. Associations were examined using multivariate linear regression models, including interaction effects of ACEs with low PPVT score and disability conditions to assess for potential moderation. RESULTS: Of the 3038 children included, 15% had a cognitive disability and 24% had a disabling health condition. The presence of 2 or more ACEs (compared to none) is associated with more externalizing (by 0.34 standard deviations [SD]), internalizing (0.18 SD), and delinquent (0.18 SD) behaviors. Cognitive disability exacerbates this association for externalizing behaviors and delinquent behaviors while other disabling health conditions do not. CONCLUSIONS: ACEs were associated with more behavior problems among urban youth. Cognitive disability, but not other disabling health conditions, compounded this association for externalizing and delinquent behaviors, indicating these children may be particularly vulnerable to the effects of trauma and adversity. Targeted assessment and resources for youth with cognitive disability are critical.

Parental perceptions of neonatal therapeutic hypothermia; emotional and healing experiences.

Introduction: Parents of infants who undergo therapeutic hypothermia experience emotional challenges that have not been fully characterized. Comprehensive understanding of the parental experience of hypothermia is needed to provide better care to the family of the infant. This study aimed to improve the understanding of the parental emotional experience of therapeutic hypothermia in the Neonatal Intensive Care Unit (NICU).Methods: Semistructured interviews were conducted in a group setting with parents matched into groups according to the severity of the infant's presenting encephalopathy. The interviews were transcribed and coded into principal and additional subthemes.Results: Families of 15 infants, who were between 2 months and 2 years at the time of the interview, participated. Infants had a mean gestational age of 40.0 weeks and 11 (73%) were male. Eleven (73%) were transferred from other hospitals following birth and eight (53%) had seizures. Emotional Experiences was a principal theme and included subthemes of traumatic experiences, Loss of normalcy, and Separation of parent and infant. The birth was frequently described as traumatic with descriptions of chest compressions, excessive blood loss and infants not crying. Trauma was also described in the parental observations of the shivering hypothermic infant. Parents highlighted the loss of normalcy in terms of their expected birth narrative and the loss of the early opportunity to breastfeed and hold their infant. Parents reported that the physical separation imposed by hypothermia adversely impacted their ability to bond with their infant. Healing Experiences was the other principal theme with subthemes identified as Incorporation of parents into NICU care, Reclaiming parenthood and Support from other hypothermia families. Parents reported feeling a connection to their infant when they were involved in medical rounds and when asked to participate in routine care of their infant. Occasionally, parents strongly advocated for their own participation in a particular aspect of their infant's care such as a diaper change and this was perceived as reinforcing their role as parent. Lastly, parents requested greater access to peer support from parents who had experienced therapeutic hypothermia.Conclusion: Parents of infants treated with hypothermia reported the experience of their unexpected adverse delivery and their baby subsequently being treated with therapeutic hypothermia as traumatic. This trauma can be compounded by the pale, still and shivering appearance of their newborn and the delay in bonding as a result of physical separation during hypothermia treatment. Parents described feeling connected to their infant in the context of performing routine care activities and desired greater access to peer support. The themes reported in this study could be used to inform high level NICU care and raise provider awareness of the parent experience.

The Effects of Air Pollution on the Development of Atopic Disease.

Air pollution is defined as the presence of noxious substances in the air at levels that impose a health hazard. Thus, there has been long-standing interest in the possible role of indoor and outdoor air pollutants on the development of respiratory disease. In this regard, asthma has been of particular interest but many studies have also been conducted to explore the relationship between air pollution, allergic rhinitis, and atopic dermatitis. Traffic-related air pollutants or TRAP refers to a broad group of pollutants including elemental carbon, black soot, nitrogen dioxide (NO2), nitric oxide (NO), sulfur dioxide (SO2), particulate matter (PM2.5 and PM10), carbon monoxide (CO), and carbon dioxide (CO2). In this review, we aim to examine the current literature regarding the impact of early childhood exposure to TRAP on the development of asthma, allergic rhinitis, and atopic dermatitis. Although there is growing evidence suggesting significant associations, definitive conclusions cannot be made with regard to the effect of TRAP on these diseases. This conundrum may be due to a variety of factors, including different definitions used to define TRAP, case definitions under consideration, a limited number of studies, variation in study designs, and disparities between studies in consideration of confounding factors. Regardless, this review highlights the need for future studies to be conducted, particularly with birth cohorts that explore this relationship further. Such studies may assist in understanding more clearly the pathogenesis of these diseases, as well as other methods by which these diseases could be treated.

Risk factors associated with the carriage of Ixodes scapularis relative to other tick species in a population of pet dogs from southeastern Ontario, Canada.

In eastern North America, the blacklegged tick, Ixodes scapularis, is the vector for Borrelia burgdorferi sensu stricto and Anaplasma phagocytophilum, the causal agents for human and canine Lyme disease and anaplasmosis, respectively. The extensive range expansion of I. scapularis in Ontario is a growing veterinary and public health concern. However, there is limited information on the risk factors associated with I. scapularis carriage on dogs. Within an emerging area for Lyme disease risk in southeastern Ontario, we identified the tick species carried by dogs; determined the prevalence of B. burgdorferi and A. phagocytophilum in I. scapularis; and examined associations between pet demographics, travel history, and geographical location and the odds of: a dog carrying I. scapularis relative to other tick species (i.e., case-case design), and a removed I. scapularis being infected with B. burgdorferi. Seven species of ticks were collected from 543 companion dogs at 20 participating veterinary hospitals from April to December 2015. Ixodes scapularis were detected on 85.6% of parasitized dogs, and 7.5% of these dogs were carrying at least one B. burgdorferi-positive tick. Based on a multivariable logistic regression model, the odds of I. scapularis infestation relative to other tick species was significantly higher in fall and spring compared to summer, with closer proximity to Lake Ontario, in female compared to male dogs, in dogs weighing over 30 kg compared to lighter dogs, and in dogs that had not visited a farm in the 7 days prior to tick removal. Based on univariable exact logistic regression models, the odds of B. burgdorferi-positive I. scapularis carriage relative to B. burgdorferi-negative I. scapularis were significantly higher for dogs that traveled in the 14 days prior to tick removal, for those dogs under 1 year of age, and for those weighing less than 10 kg. This case-case study provides information for veterinarians and public health practitioners to help protect dogs and their owners from Lyme disease in southeastern Ontario.

The Global Face of Eosinophilic Esophagitis: Advocacy and Research Groups.

Although eosinophilic esophagitis (EoE) has been described in the literature for a substantial period, its recognition as a disease entity on the global stage is still relatively new. It has become a major diagnosis of consideration by medical providers when both adult and pediatric patients present with dysphagia, food impaction, and gastroesophageal reflux-like symptoms. In addition to the clinical work of specialists such as allergy-immunologists and gastroenterologists, the evolution of research organizations and advocacy groups focused on EoE have greatly assisted in bringing attention to, and raising awareness about, this disease. As a result of their efforts, diagnosis and treatment guidelines have been developed, and medical providers now have a specific ICD code for EoE. This represents a new model for the interaction of patients and medical provider, where patients not only advocate for their disorder, but also drive physician education and a patient-centered research agenda and its funding. It should be noted, though, that these organizations and advocacy groups are mainly located in North America and Europe, and as a result, EoE has largely been associated with the Caucasian demographic. However, it has been described in Asia, the Middle East, Latin America, and Africa. Physicians from these areas have increased awareness and understanding in the medical and research communities in their countries through case reports and the establishment and analysis of potential patient cohorts. At this time, the prevalence of EoE in these regions is comparably lower, but this may be due to less recognition and understanding of EoE, as well as medical efforts being directed towards more ubiquitous disease processes, such as infectious diseases. With the support and ongoing work of researchers, patients, and their family members, understanding and recognition of EoE as a clinically significant disease entity will continue to grow.

Exploring parent expectations of neonatal therapeutic hypothermia.

OBJECTIVE: We aimed to assess the parent experience of therapeutic hypothermia (TH), specifically focusing on unmet expectations. STUDY DESIGN: Open-ended questions were used in a focus group setting. We employed an inductive approach to develop thematic content from the transcribed recordings. RESULTS: 30 parents of infants treated with TH participated. Within the principal theme of managing expectations, four sub-themes emerged. These included parental concerns about morphine use; specifically the association of morphine with end-of-life care and addiction. Parents perceived their role as key in the decision to implement TH and were emotionally burdened by this during and after TH. Parents recall intense fear for the infant's immediate survival and were not sufficiently reassured regarding survival. Parents also experience ongoing uncertainties about the long-term prognosis after TH. CONCLUSION: The identification of these four areas in which parents have unmet expectations is important in order to improve the delivery of care.

Current and future therapies for the treatment of histamine-induced angioedema.

INTRODUCTION: Angioedema, a sudden, self-limited swelling of localized areas of any part of the body that may or may not be associated with urticaria, is thought to be the result of a mast-cell mediated process versus a bradykinin etiology. Understanding the mechanism is key in determining the proper treatment. Areas Covered: Clinical presentation of varying angioedema types may be similar; however, the appropriate treatment algorithm is dependent upon clinicians' knowledge of the underlying pathophysiology and classification of angioedema. Literature review of recent guidelines, available medications, and alternative therapies was completed to provide an overview of options. CONCLUSION: There are no formal guidelines for treatment of acute or chronic histamine-mediated angioedema, and therefore, algorithms for the treatment of acute and chronic urticaria should be followed until such information becomes available. Differentiating histamine-mediated versus bradykinin mediated angioedema is essential, as treatments and treatment responses are quite different. Further research is needed to better understand idiopathic angioedema that is unresponsive to H1/H2 antagonists, LTMAs, or medications designed to treat bradykinin-mediated angioedema.

Allergen immunotherapy: an updated review of safety.

PURPOSE OF REVIEW: Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy. RECENT FINDINGS: Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon. SUMMARY: Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.