The 'Natural' Accord of DuBois and Washington: An Environmentally Racialized Consciousness

The conflict and discord between Booker T. Washington and W.E.B DuBois regarding their premise and approach to racial uplift for Black Americans have been very well documented. While Washington sought equality with accommodation, DuBois functioned through agitation. However, their biophilic accord and unity within the natural environment have been both underrecognized and underappreciated. As an honor to these esteemed racial and social justice giants, this special issue article reveals the universality of their environmental justice ideologies while also celebrating the beauty, power and foresight of their ecological language in script and speech.

Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States

BACKGROUND

Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes.

METHODS

The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics.

RESULTS

Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability.

CONCLUSIONS

Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.

Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Reducing Anxiety with Nature and Gardening (RANG): Evaluating the Impacts of Gardening and Outdoor Activities on Anxiety among U.S. Adults during the COVID-19 Pandemic

The COVID-19 pandemic impacted mental health. Growing research has identified the mental health benefits of nature contact, including gardening. We used a cross-sectional survey to investigate the association between gardening and other outdoor activities with anxiety among U.S. adults. The RANG (Reducing Anxiety with Nature and Gardening) survey was distributed online from June−September 2020 through social media (Twitter and Facebook) and a national Master Gardeners listserv. Survey questions captured demographics, COVID-19 experiences, gardening, outdoor activities, and anxiety using the Generalized Anxiety Disorder 7-item scale. Data were analyzed using chi-square, Fisher’s exact, and Kruskal−Wallis tests, as well as logistic regression. Among participants, 46% reported anxiety symptoms. Participants who had gardened ≥ 15 years and those gardening > 8 h over two weeks had lower anxiety scores. Spending more time outdoors on weekdays also decreased anxiety scores. After adjusting for covariates, lower odds of anxiety were identified for 50−69 and 70−89-year-olds vs. 18−29-year-olds; males vs. females; and Texas vs. Maryland residents. These findings confirm increased anxiety during the COVID-19 pandemic and suggest that sustained gardening and other outdoor activities could help reduce anxiety.

"I Can't Breathe": Examining the Legacy of American Racism on Determinants of Health and the Ongoing Pursuit of Environmental Justice

Purpose of Review

“I can’t breathe” were the last words spoken by Eric Garner (July 17, 2014), Javier Ambler (March 28, 2019), Elijah McClain (August 30, 2019), Manuel Ellis (March 3, 2020), and George Floyd (May 25, 2020). These were all African American men who died at the hands of police in the United States. Recently, police brutality has gained critical and overdue attention as one clear manifestation of systemic racism. However, historical and current policies related to a wide range of environmental hazards have exposed Black, Indigenous, and People of Color (BIPOC) to disproportionately high levels of physical, mental, social, emotional, and cultural toxicities, thus creating unbreathable and unlivable communities.

Recent Findings

This paper traces the roots of systemic anti-Black racism in America from its origins in the 1400s, through systems of scientific racism that pathologized Blackness in order to justify slavery, and through evolving policies and structures that have shifted over time but consistently exposed many African American communities to unsafe and unhealthy environments.

Summary

We conclude with calls for bold solutions to move through and past this oppressive history and toward true environmental justice the enables all communities to thrive together.

Structural Racism and the COVID-19 Experience in the United States

The long, fallacious history of attributing racial disparities in public health outcomes to biological inferiority or poor decision making persists in contemporary conversations about the COVID-19 pandemic. Given the disproportionate impacts of this pandemic on communities of color, it is essential for scholars, practitioners, and policymakers to focus on how structural racism drives these disparate outcomes. In May and June 2020, we conducted a 6-state online survey to examine racial/ethnic differences in exposure to COVID-19, risk mitigation behaviors, risk perceptions, and COVID-19 impacts. Results show that Black and Hispanic individuals were more likely than White respondents to experience factors associated with structural racism (eg, living in larger households, going to work in person, using public transportation) that, by their very nature, increase the likelihood of exposure to COVID-19. Controlling for other demographic and socioeconomic characteristics, non-White respondents were equally or more likely than White respondents to take protective actions against COVID-19, including keeping distance from others and wearing masks. Black and Hispanic respondents also perceived higher risks of dying of the disease and of running out of money due to the pandemic, and 40% of Black respondents reported knowing someone who had died of COVID-19 at a time when the US death toll had just surpassed 100,000 people. To manage the current pandemic and prepare to combat future health crises in an effective, equitable, and antiracist manner, it is imperative to understand the structural factors perpetuating racial inequalities in the COVID-19 experience.

Clinicians, cooks, and cashiers: Examining health equity and the COVID-19 risks to essential workers

In Spring/Summer 2020, most individuals living in the United States experienced several months of social distancing and stay-at-home orders because of the coronavirus (COVID-19) pandemic. Clinicians, restaurant cooks, cashiers, transit operators, and other essential workers (EWs), however, continued to work outside the home during this time in order to keep others alive and maintain a functioning society. In the United States, EWs are often low-income persons of color who are more likely to face socioeconomic vulnerabilities, systemic racism, and health inequities. To assess the various impacts of COVID-19 on EWs, an online survey was distributed to a representative sample of individuals residing in six states during May/June 2020. The sample included 990 individuals who identified as EWs and 736 nonessential workers (NWs). We assessed differences between EW and NW respondents according to three categories related to health equity and social determinants of health: (1) demographics (e.g. race/ethnicity); (2) COVID-19 exposure risk pathways (e.g. ability to social distance); and (3) COVID-19 risk perceptions (e.g. perceived risk of contracting COVID-19). EWs were more likely to be Black or Hispanic than NWs and also had lower incomes and education levels on average. Unsurprisingly, EWs were substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors as compared to NWs. EWs also perceived a slightly greater risk of contracting COVID-19. These findings, which we discuss in the context of persistent structural inequalities, systemic racism, and health inequities within the United States, highlight ways in which COVID-19 exacerbates existing socioeconomic vulnerabilities faced by EWs.

Case-comparison study protocol for gauging effects of neighbourhood trends and sickness: examining the perceptions of transit-Induced gentrification in Prince George's County

INTRODUCTION

Impoverished neighbourhoods and communities of colour often bear the brunt of unintended transit-oriented development (TOD) impacts. These impacts have been known to come in the form of transit-induced gentrification (TIG), a socioeconomic by-product of TOD defined as a phenomenon that occurs when the provision of transit service, particularly light rail transit (LRT), 'up-scales' nearby neighbourhood(s) and displaces existing residents. Consequently, TIG or even the perception of TIG can impact health outcomes (eg, anxiety) and social determinants of health (SDOH) (eg, crime).

METHODS/ANALYSIS

In 2022, the purple line (PL), a 16.2 mile LRT line, is opening in Prince George's County, Maryland, a suburb of Washington, DC, comprised of over 80% African American and Hispanic residents. By taking advantage of this natural experiment, we are proposing the GENTS (Gauging Effects of Neighborhood Trends and Sickness: Examining the Perceptions of Transit-Induced Gentrification in Prince George's County) Study in order to evaluate perceived TIG and associated health outcome and SDOH changes, at two points in time, among Prince George's County adults in a prospective case-comparison design during the pre-PL LRT period. Descriptive analysis and latent growth curve modelling will be used to examine these changes over time.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the University of Maryland Institutional Review Board. The GENTS Study will identify temporal changes in perceived TIG, health outcomes and SDOH among case and comparison residents before the completion and operation of the PL LRT, an under researched period of TOD. The dissemination of GENTS Study findings will be able to address research questions and policy issues that are specifically tailored to PG County while also providing more effective procedural solutions for other regions undergoing TOD and TIG risks.

Environments, Behaviors, and Inequalities: Reflecting on the Impacts of the Influenza and Coronavirus Pandemics in the United States

In the past century, dramatic shifts in demographics, globalization and urbanization have facilitated the rapid spread and transmission of infectious diseases across continents and countries. In a matter of weeks, the 2019 coronavirus pandemic devastated communities worldwide and reinforced the human perception of frailty and mortality. Even though the end of this pandemic story has yet to unfold, there is one parallel that is undeniable when a comparison is drawn between the 2019 coronavirus and the 1918 influenza pandemics. The public health response to disease outbreaks has remained nearly unchanged in the last 101 years. Furthermore, the role of environments and human behaviors on the effect and response to the coronavirus pandemic has brought to light many of the historic and contemporaneous inequalities and injustices that plague the United States. Through a reflection of these pandemic experiences, the American burden of disparity and disproportionality on morbidity, mortality and overall social determinants of health has been examined. Finally, a reimagination of a post-coronavirus existence has also been presented along with a discussion of possible solutions and considerations for moving forward to a new and better normal.

The Color of Health: Residential Segregation, Light Rail Transit Developments, and Gentrification in the United States

As the modern urban–suburban context becomes increasingly problematic with traffic congestion, air pollution, and increased cost of living, city planners are turning their attention to transit-oriented development as a strategy to promote healthy communities. Transit-oriented developments bring valuable resources and improvements in infrastructure, but they also may be reinforcing decades-old processes of residential segregation, gentrification, and displacement of low-income residents and communities of color. Careful consideration of zoning, neighborhood design, and affordability is vital to mitigating the impacts of transit-induced gentrification, a socioeconomic by-product of transit-oriented development whereby the provision of transit service “upscales” nearby neighborhood(s) and displaces existing community members with more affluent and often White residents. To date, the available research and, thus, overall understanding of transit-induced gentrification and the related social determinants of health are limited and mixed. In this review, an overview of racial residential segregation, light rail transit developments, and gentrification in the United States has been provided. Implications for future transit-oriented developments are also presented along with a discussion of possible solutions.

Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth

The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that converge on the AT experiences of low-income youth and youth of color (YOC) that have yet to be fully uncovered. This study uses an intersectional framework, largely focusing on the race-gender-class trinity, to examine youth AT within a context of transportation inequity. Theoretically guided by the Ecological Model of Active Transportation, focus groups were completed with two groups of girls (15 participants) and two groups of boys (nine participants) ranging between the ages of 12–15 years who lived within the Washington D.C. area. This research found race, gender, and class to be inhibitors of AT for both boys and girls, but with more pronounced negative influences on girls.

Modeling underwater noise propagation from marine hydrokinetic power devices through a time-domain, velocity-pressure solution

Marine hydrokinetic (MHK) devices generate electricity from the motion of tidal and ocean currents, as well as ocean waves, to provide an additional source of renewable energy available to the United States. These devices are a source of anthropogenic noise in the marine ecosystem and must meet regulatory guidelines that mandate a maximum amount of noise that may be generated. In the absence of measured levels from in situ deployments, a model for predicting the propagation of sound from an array of MHK sources in a real environment is essential. A set of coupled, linearized velocity-pressure equations in the time-domain are derived and presented in this paper, which are an alternative solution to the Helmholtz and wave equation methods traditionally employed. Discretizing these equations on a three-dimensional (3D), finite-difference grid ultimately permits a finite number of complex sources and spatially varying sound speeds, bathymetry, and bed composition. The solution to this system of equations has been parallelized in an acoustic-wave propagation package developed at Sandia National Labs, called Paracousti. This work presents the broadband sound pressure levels from a single source in two-dimensional (2D) ideal and Pekeris wave-guides and in a 3D domain with a sloping boundary. The paper concludes with demonstration of Paracousti for an array of MHK sources in a simple wave-guide.

Examining the Influence of a New Light Rail Line on the Health of a Demographically Diverse and Understudied Population within the Washington, D.C. Metropolitan Area: A Protocol for a Natural Experiment Study

Approximately two-thirds of adults and youth in Prince George's County, Maryland, a suburb of Washington, D.C. are overweight or obese and less than half are achieving daily physical activity recommendations. Active transportation (AT), such as walking, biking or using public transportation (PT), is a strategic pathway to improving physical activity levels and thus reducing excess weight. Utilizing an expansion of the Washington, D.C. area transportation system with a new light rail line, the Purple Line Outcomes on Transportation (PLOT) Study will exam pre- and post-Purple Line PT use, AT behaviors and attitudes and physical activity among Prince George's County adults and youth. The PLOT Study will take advantage of this natural experiment in an area enduring significant racial/ethnic and gender-based overweight or obesity and physical inactivity disparities. While similar natural experiments on AT have been conducted in other U.S. cities, those studies lacked diverse and representative samples. To effectively evaluate these physical activity outcomes among this population, efforts will be used to recruit African American and Latino populations, the first and second most common racial/ethnic groups in Prince George's County. Finally, the PLOT Study will also examine how contextual effects (e.g., neighborhood built environment) impact PT, AT and physical activity.

The Influence of Family Dog Ownership and Parental Perceived Built Environment Measures on Children's Physical Activity within the Washington, DC Area

Sedentary behavior and physical inactivity are significant contributors to youth obesity in the United States. Neighborhood dog walking is an outlet for physical activity (PA). Therefore, understanding the relationship between built environment, dog ownership, and youth PA is essential. This study examined the influence of dog ownership and parental built environment perceptions on children’s PA in the Washington, D.C. area. In 2014, questionnaires were mailed to 2000 parents to assess family dog ownership; children’s outdoor dog walking or playing; and parental perceived built environment measures. Chi-square analyses examined differences in parental perceived built environment measures between children with and without family dogs. The sample included 144 children (50% female; average-age 9.7 years; 56.3% White; 23.7% African-American; 10.4% Asian-American; 29.9% owned dog). Only 13% and 5.6% of the children walked or played outdoors with the dog daily, respectively. A significantly greater proportion (p-value < 0.05) of parents who owned dogs recognized and observed some home built environment measures (e.g., traffic speed on most streets is 30 mph or less) that were PA -promoting for their children. Findings suggest that dog ownership may provide more positive parental perceptions of the neighborhood built environment, which supports children’s outdoor PA through dog walking and playing.

Missed Opportunity? Leveraging Mobile Technology to Reduce Racial Health Disparities

Blacks and Latinos are less likely than whites to access health insurance and utilize health care. One way to overcome some of these racial barriers to health equity may be through advances in technology that allow people to access and utilize health care in innovative ways. Yet, little research has focused on whether the racial gap that exists for health care utilization also exists for accessing health information online and through mobile technologies. Using data from the Health Information National Trends Survey (HINTS), we examine racial differences in obtaining health information online via mobile devices. We find that blacks and Latinos are more likely to trust online newspapers to get health information than whites. Minorities who have access to a mobile device are more likely to rely on the Internet for health information in a time of strong need. Federally insured individuals who are connected to mobile devices have the highest probability of reliance on the Internet as a go-to source of health information. We conclude by discussing the importance of mobile technologies for health policy, particularly related to developing health literacy, improving health outcomes, and contributing to reducing health disparities by race and health insurance status.

Electronic media time and sedentary behaviors in children: Findings from the Built Environment and Active Play Study in the Washington DC area

An objective of the Built Environment and Active Play (BEAP) Study was to examine whether home built environment, bedroom electronic presence, parental rules and demographics predicted children's sedentary behavior (SB). In 2014, BEAP Study questionnaires were mailed to 2000 parents of children (7–12 years) within the Washington DC area. SB-Duration (hours/day) and SB-Frequency (days/week) were assessed by two questions with multiple subparts relating to SB activity type (e.g. car riding) and SB companionship (e.g. friends). Built environment, bedroom electronic presence, parental rules and demographic data were obtained through questionnaire items and ordered logistic regression models were used to examine whether these variables were associated with SB. Study sample included 144 children (female (50%); average age (9.7 years); White (56.3%); Black/African-American (23.7%); Asian-Americans (10.4%)). Nearly 40% of the sample reported daily solitary SB with car riding being the most frequently reported type of SB. Children living on streets without a dead-end/cul-de-sac exhibited a higher odds in SB-Duration using electric media [2.61 (CI: 1.31, 5.18)] and having no television in a child's bedroom was associated with a lower odds in SB-Frequency [0.048 (CI: 0.006, 0.393)] and SB-Duration [0.085 (CI: 0.018, 0.395)]. Non-Hispanic/Latino children were also found to have higher odds in solitary SB-Frequency when parental rules of electronic use were modeled [8.56 (CI: 1.11, 66.01)]. Based on results from this cross-sectional study, home neighborhood built environment, bedroom electronic presence and absence of parental rules can significantly predict children's SB.

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Children living on streets without dead-end/cul-de-sac exhibited sedentary behavior.

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Car riding most frequently reported type of daily sedentary behavior.

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Bedroom electronics and lack of parental rules associated with sedentary behavior.

Parental perceived built environment measures and active play in Washington DC metropolitan children

OBJECTIVE

Previous research identified associations between perceived built environment and adult physical activity; however, fewer studies have explored associations in children. The Built Environment and Active Play (BEAP) Study examined relationships between children's active play and parental perceptions of home neighborhood built environments within the Washington, DC metropolitan area (DMV).

METHODS

With this cross-sectional study, a questionnaire was administered in 2014 to parents of children (7-12 years old) residing in the DMV. Data were collected on children's active play, home built environment parental perceptions, and demographics. Active play response data were dichotomized by whether the child did or did not meet the 60-min/day Physical Activity Guidelines for Americans (PAGAs) recommendation. Perceived home neighborhood built environment data were also dichotomized. Chi-square tests determined differences in parental perceived built environment measures between active and non-active child groups. Logistic regression assessed the association of parental perceived built environment variables with active play while adjusting for demographic variables.

RESULTS

The BEAP Study population (n = 144) included a uniquely diverse population of children with 23.7% African Americans and 10.4% Asian Americans. A statistically significant greater proportion of active children's parents agreed with the importance of neighborhood esthetics, active play areas, walkability and safety as compared to the parents of non-active children. Fully adjusted logistic regression models demonstrated that some parental perceived built environment measures (e.g. access to play equipment) were predictors of their children meeting the 60-min/day PAGA recommendation.

CONCLUSION

Our findings support the important role of home neighborhood built environment perceptions on childhood active play.

Phase II trial of dasatinib for recurrent or metastatic c-KIT expressing adenoid cystic carcinoma and for nonadenoid cystic malignant salivary tumors

BACKGROUND

Adenoid cystic carcinoma (ACC) is a subtype of malignant salivary gland tumors (MSGT), in which 90% of cases express cKIT. Dasatinib is a potent and selective inhibitor of five oncogenic protein tyrosine kinases (PTKs)/kinase families including cKIT. We conducted a phase II study to determine the antitumor activity of dasatinib in ACC and non-ACC MSGT.

PATIENTS AND METHODS

In a two-stage design, patients with progressive, recurrent/metastatic ACC (+cKIT) and non-ACC MSGT (separate cohort) were treated with dasatinib 70 mg p.o. b.i.d. Response was assessed every 8 weeks using RECIST.

RESULTS

Of 54 patients: 40 ACC, 14 non-ACC (1, ineligible excluded); M:F = 28 : 26, median age 56 years (range 20-82 years), ECOG performance status 0 : 1 : 2 = 24 : 28 : 2, prior radiation: 44, prior chemotherapy: 21. The most frequent adverse events (AEs) (as % of patients, worst grade 2 or higher) were: fatigue (28%), nausea (19%), headache (15%), lymphopenia (7%), dyspnea (11%), alanine aminotransferase increased (7%), anorexia (7%), vomiting (7%), alkaline phosphatase increased (6%), diarrhea (6%), neutropenia (6%), and noncardiac chest pain (6%). No grade 4 AE occurred, 15 patients experienced a grade 3 AE, primarily dyspnea (5) and fatigue (4), and cardiac toxicity (1 prolonged QTc). Among ACC patients, best response to dasatinib: 1 patient (2.5%) had partial response, 20 patients (50%) had stable disease (SD) (3-14 months), 12 patients (30%) had PD, 2 withdrew, 3 discontinued therapy due to AE, and 2 died before cycle 2. Median progression-free survival was 4.8 months. Median overall survival was 14.5 months. For 14 assessable non-ACC patients, none had objective response, triggering early stopping rule. Seven had SD (range 1-7 months), 4 PD, 2 discontinued therapy due to AE, and 1 died before cycle 2.

CONCLUSION

Although there was only one objective response, dasatinib is well tolerated, with tumor stabilization achieved by 50% of ACC patients. Dasatinib demonstrated no activity in non-ACC MSGT.

Built environment and active play among Washington DC metropolitan children: A protocol for a cross-sectional study

Background

Research has demonstrated that children who participate in active play are more likely to be physically active, thereby improving long-term health outcomes. Many adult studies have also shown that neighborhood built environments can encourage or discourage routine physical activity. Limited evidence has demonstrated that children who reside in neighborhoods with a built environment that is more inviting to active play exhibit lower overweight and obesity rates as well as an overall better state of well-being. This Built Environment and Active Play (BEAP) Study aims to develop a neighborhood playability rating system in the Washington, DC (DMV) area. Similar to walkability scores, these playability scores will estimate how affable a neighborhood is to active play. The BEAP Study will attempt to provide a broad view of factors influencing the level and type of active play among children.

Methods/Design

Using a cross-sectional design, the BEAP Study will collect data using a mail questionnaire administered to the parents and/or guardians of 2000 children aged 7-12 years residing in select DMV areas in October of 2014. Questionnaire data, including information on active play, home and neighborhood characteristics, parental perceptions, and sociodemographic characteristics will be merged through a geographic information system (GIS) with objective built environment measures in the participants’ neighborhoods. An ordered logit model will be used to regress an ordinal active play outcome on built environment exposure variables while adjusting for potential confounders. Upon the construction of the final model, predictor coefficients will be used as parameters in the scoring system to develop neighborhood playability scores.

Discussion

The BEAP Study intends to generate a neighborhood playability index by characterizing and quantifying children’s active play using parent-reported physical activity data in children, GIS data and built environment measures in participant neighborhoods. The BEAP Study will improve our understanding of the built environment and childhood playability relationship while also contributing to the body of evidence-based built environment and physical activity research.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-015-0070-3) contains supplementary material, which is available to authorized users.

A prospective randomized evaluation of a pharmacogenomic approach to antiplatelet therapy among patients with ST-elevation myocardial infarction: the RAPID STEMI study

Treatment of carriers of the CYP2C19*2 allele and ABCB1 TT genotype with clopidogrel is associated with increased ischemic complications after percutaneous coronary intervention (PCI). We sought to evaluate a pharmacogenomic strategy among patients undergoing PCI for ST-elevation myocardial infarction (STEMI), by performing a randomized trial, enrolling 102 patients. Point-of-care genetic testing for CYP2C19*2, ABCB1 TT and CYP2C19*17 was performed with carriers of either the CYP2C19*2 allele or ABCB1 TT genotype randomly assigned to a strategy of prasugrel 10 mg daily or an augmented dosing strategy of clopidogrel (150 mg daily for 6 days then 75 mg daily). The primary end point was the proportion of at-risk carriers exhibiting high on-treatment platelet reactivity (HPR), a marker associated with increased adverse cardiovascular events, after 1 month. Fifty-nine subjects (57.8%) were identified as carriers of at least one at-risk variant. Treatment with prasugrel significantly reduced HPR compared with clopidogrel by P2Y12 reaction unit (PRU) thresholds of >234 (0 vs 24.1%, P=0.0046) and PRU>208 (3.3 vs 34.5%, P=0.0025). The sensitivity of point-of-care testing was 100% (95% CI 88.0-100), 100% (86.3-100) and 96.9% (82.0-99.8) and specificity was 97.0% (88.5-99.5), 97.1% (89.0-99.5) and 98.5% (90.9-99.9) for identifying CYP2C19*2, ABCB1 TT and CYP2C19*17, respectively. Logistic regression confirmed carriers as a strong predictor of HPR (OR=6.58, 95% CI 1.24-34.92; P=0.03). We confirmed that concurrent identification of three separate genetic variants in patients with STEMI receiving PCI is feasible at the bedside. Among carriers of at-risk genotypes, treatment with prasugrel was superior to an augmented dosing strategy of clopidogrel in reducing HPR.

Wind turbines: is there a human health risk?

The term "Wind Turbine Syndrome" was coined in a recently self-published book, which hypothesized that a multitude of symptoms such as headache and dizziness resulted from wind turbines generating low frequency sound (LFS). The objective of this article is to provide a summary of the peer-reviewed literature on the research that has examined the relationship between human health effects and exposure to LFS and sound generated from the operation of wind turbines. At present, a specific health condition has not been documented in the peer-reviewed literature that has been classified as a disease caused by exposure to sound levels and frequencies generated by the operation of wind turbines. Communities are experiencing a heightened sense of annoyance and fear from the development and siting of wind turbine farms. High-quality research and effective risk communication can advance this course from one of panic to one of understanding and exemplification for other environmental advancements.

Investigating patterns in the spermiation response of eight Australian frogs administered human chorionic gonadotropin (hCG) and luteinizing hormone-releasing hormone (LHRHa)

Exogenous LHRHa and hCG are routinely employed to induce spermiation in vivo in anurans. To date, however, few studies have directly compared the efficacy of these two hormones. The aim of this study was threefold. First to quantify the spermiation response of eight Australian anuran species (Crinia glauerti, Crinia georgiana, Crinia pseudinsignifera, Geocrinia rosea, Heleioporus albopunctatus, Heleioporuseyrei, Neobatrachus pelobatoides and Pseudophryne guentheri) administered LHRHa and hCG. Second, to determine whether variance in spermiation responses is related to a species' reproductive mode (aquatic vs. terrestrial) or family (Limnodynastidae vs. Myobatrachidae). Third, to compare the quantity and quality of spermatozoa obtained via hormone administration (LHRHa and hCG) to spermatozoa obtained via testis removal and maceration. There was no significant difference in the viability of spermatozoa obtained from hCG or LHRHa administration in any of the eight study species. The sperm viability of samples ranged from 28-84% in C. georgiana and G. rosea, respectively. The hormone that induced the release of the highest number of spermatozoa differed among species, with all five species belonging to the family Myobatrachidae responding better to LHRHa, and the three species from the family Lymnodynastidae releasing a greater number of spermatozoa in response to hCG. Importantly, these results provide the first preliminary evidence that hCG and LHRHa efficacy in anurans may be predicted by phylogeny. Understanding such broad-scale patterns in the response of anurans to exogenous hormones will expedite the application of assisted reproductive technologies to novel species.

Inhibition of transforming growth factor-β-activated kinase-1 blocks cancer cell adhesion, invasion, and metastasis

BACKGROUND

Tumour cell metastasis involves cell adhesion and invasion, processes that depend on signal transduction, which can be influenced by the tumour microenvironment. N-6 polyunsaturated fatty acids, found both in the diet and in response to inflammatory responses, are important components of this microenvironment.

METHODS

We used short hairpin RNA (shRNA) knockdown of TGF-β-activated kinase-1 (TAK1) in human tumour cells to examine its involvement in fatty acid-stimulated cell adhesion and invasion in vitro. An in vivo model of metastasis was developed in which cells, stably expressing firefly luciferase and either a control shRNA or a TAK1-specific shRNA, were injected into the mammary fat pads of mice fed diets, rich in n-6 polyunsaturated fatty acids. Tumour growth and spontaneous metastasis were monitored with in vivo and in situ imaging of bioluminescence.

RESULTS

Arachidonic acid activated TAK1 and downstream kinases in MDA-MB-435 breast cancer cells and led to increased adhesion and invasion. Knockdown of TAK1 blocked this activation and inhibited both cell adhesion and invasion in vitro. Tumour growth at the site of injection was not affected by TAK1 knockdown, but both the incidence and extent of metastasis to the lung were significantly reduced in mice injected with TAK1 knockdown cells compared with mice carrying control tumour cells.

CONCLUSION

These data demonstrate the importance of TAK1 signalling in tumour metastasis in vivo and suggest an opportunity for antimetastatic therapies.

A comparison of rapid and conventional measures of indicator bacteria as predictors of waterborne protozoan pathogen presence and density

E. coli and enterococci in recreational waters are monitored as indicators of fecal contamination, pathogen presence, and health risk. Quantitative polymerase chain reaction (qPCR) tests for fecal indicator bacteria can provide beach managers with same-day information about water quality, unlike culture methods which provide that information the following day. The abilities of qPCR measurements of indicator bacteria, as compared to culture measurements of indicator bacteria, as predictors of pathogen presence or density in surface waters are not well understood. The purpose of this study was to make such comparisons between water samples collected from Chicago area surface waters, including rivers, inland lakes, Lake Michigan, and the Chicago Area Waterways System, which is dominated by wastewater effluent. A total of 294 twenty-litre samples were collected and analyzed for Giardia and Cryptosporidium. qPCR and membrane filtration methods were used to quantify E. coli and enterococci. Correlation, logistic regression, and zero-inflated Poisson modeling were utilized to evaluate associations between indicators and parasites. qPCR and culture measures of the indicator bacteria were similar in their ability to predict parasite presence and density. Correlations between parasites and indicators were generally stronger at waters not dominated by effluent. Associations between indicator density and Giarida presence were observed more consistently than between indicator density and Cryptosporidium presence. Associations between enterococci and parasites were generally stronger than associations between E. coli and parasites. The use of qPCR monitoring in our setting would generate more timely results without compromising the ability to predict parasite presence or density.

Elevated dietary linoleic acid increases gastric carcinoma cell invasion and metastasis in mice

BACKGROUND

Dietary (n-6)-polyunsaturated fatty acids influence cancer development, but the mechanisms have not been well characterised in gastric carcinoma.

METHODS

We used two in vivo models to investigate the effects of these common dietary components on tumour metastasis. In a model of experimental metastasis, immunocompromised mice were fed diets containing linoleic acid (LA) at 2% (LLA), 8% (HLA) or 12% (VHLA) by weight and inoculated intraperitoneally (i.p.) with human gastric carcinoma cells (OCUM-2MD3). To model spontaneous metastasis, OCUM-2MD3 tumours were grafted onto the stomach walls of mice fed with the different diets. In in vitro assays, we investigated invasion and ERK phosphorylation of OCUM-2MD3 cells in the presence or absence of LA. Finally, we tested whether a cyclooxygenase (COX) inhibitor, indomethacin, could block peritoneal metastasis in vivo.

RESULTS

Both the HLA and VHLA groups showed increased incidence of tumour nodules (LA: 53%; HLA: 89%; VHLA: 100%; P<0.03); the VHLA group also displayed increased numbers of tumour nodules and higher total volume relative to LLA group in experimental metastasis model. Both liver invasion (78%) and metastasis to the peritoneal cavity (67%) were more frequent in VHLA group compared with the LLA group (22% and 11%, respectively; P<0.03) in spontaneous metastasis model. We also found that the invasive ability of these cells is greatly enhanced when exposed to LA in vitro. Linoleic acid also increased invasion of other scirrhous gastric carcinoma cells, OCUM-12, NUGC3 and MKN-45. Linoleic acid effect on OCUM-2MD3 cells seems to be dependent on phosphorylation of ERK. The data suggest that invasion and phosphorylation of ERK were dependent on COX. Indomethacin decreased the number of tumours and total tumour volume in both LLA and VHLA groups. Finally, COX-1, which is known to be an important enzyme in the generation of bioactive metabolites from dietary fatty acids, appears to be responsible for the increased metastatic behaviour of OCUM-2MD3 cells in the mouse model.

CONCLUSION

Dietary LA stimulates invasion and peritoneal metastasis of gastric carcinoma cells through COX-catalysed metabolism and activation of ERK, steps that compose pathway potentially amenable to therapeutic intervention.

Benzoate catalysis in the hydrolysis of endo-5-[4'(5')imidazolyl]-bicyclo[2.2.1]hept-endo- 2-yl trans-cinnamate: Implications for the charge-transfer mechanism of catalysis by serine proteases

The acceleration, by a factor of 2500, of the hydrolysis of endo-5-[4'(5')imidazolyl]bicyclo[2.2.1]hept-endo- 2-yl trans-cinnamate by 0.5 M sodium benzoate in 42 mol% dioxane in water can be explained without resort to operation of a "charge-relay" mechanism similar to that often postulated to account for the enzymatic activity of serine proteases. The degree of ionization of 4-methylimidazole and of sodium benzoate in 42 mol% dioxane in water at 60 degrees C have been measured by NMR spectroscopy.

Nuclear Magnetic Resonance Shift Reagents: Abnormal C Shifts Produced by Complexation of Lanthanide Chelates with Saturated Amines and n-Butyl Isocyanide

Lanthanide-induced shfits of (13)C nuclear magnetic resonances are reported for several amines and n-butyl isocyanide. Contact contributions to such shifts, especially of beta carbons, are clearly important for the chelates of Eu(+3) and Pr(+3). The importance of contact terms is shown to change in a rather predictable manner with the structure of the amine.

Nuclear Magnetic Resonance Spectroscopy. A Stereospecific J(CF) Coupling in the Low-Temperature C Nmr Spectrum of 1,1-Difluorocyclohexane

The proton-decoupled (13)C nmr spectrum of 1,1-difluorocyclohexane has been examined at room temperature and at -90 degrees C. There are only minor changes in the one-bond and two-bond carbon-fluorine scalar coupling constants at the lower temperature; however, the triplet observed for C-3 ((3)J(CF) = 4.7 Hz) collapses to a doublet ((3)J(CF) = 9.5 Hz) at -90 degrees C. It is proposed that only the equatorial fluorine is coupled with the C-3 carbon as the result of operation of a back-lobe orbital interaction.

Substituent effects on the nitrogen-15 and carbon-13 shieldings of some N-arylguanidinium chlorides

The (13)C and (15)N chemical shifts of five N-arylguanidinium chlorides carrying polar substituents, ranging in character from 4-methoxy to 4-nitro groups, have been determined by NMR spectroscopy at the natural-abundance level of (13)C and (15)N in dimethyl sulfoxide solution. Comparison of the (13)C shifts of these salts with those of monosubstituted benzenes shows that the guanidinium group induces an average downfield shift of -5.8 ppm of the resonance of the aryl carbon to which it is attached (C1), an average upfield shift of +4.2 ppm for C2 and C6, and a small upfield shift of +1.9 ppm for C4. The shifts of C3 and C5 are small and erratic relative to the corresponding carbons in monosubstituted benzenes. The (15)N resonances of the guanidinium nitrogens are quite sensitive to electric effects resulting from substitution of polar groups at C4. The (15)N shift of the [unk]NAr nitrogen relative to that of the salts suggests that the predominant tautomer for N-arylguanidines is (H(2)N)(2)C[unk]NAr. The (15)N shifts of the (NH(2))(2) nitrogens correlate rather well with sigma(p) (-) parameters, whereas the shifts of the -NHAr nitrogens seem to correlate only with R values derived from the sigma(p) (-) substituent constants.

Evidence for hydrogen abstraction by classical radicals in the norbornenyl-nortricyclyl system

Studies of product compositions and deuterium-label rearrangements at various concentrations of tri-n-butyltin hydride in the reductions of exo-and endo-5-bromonorbornene and 2-bromonortricyclcne to mixtures of norbornene and nortricyclene lead to three main conclusions: (i) at least two radical intermediates contribute to product formation; (ii) each intermediate yields predominantly (80% or more) one product; and (iii) nortricyclene is predominantly derived from a symmetrical intermediate. This constitutes strong evidence for hydrogen abstraction by classical (i.e., single-product) norbornenyl and nortricyclyl radicals. It is argued that the norbornenyl-nortricyclyl system is exceptionally well suited for the generation of a nonclassical (dual-product) radical; hence, the existence of a nonclassical radical in any other system is rather unlikely.

Carbon and chlorine isotope fractionation during aerobic oxidation and reductive dechlorination of vinyl chloride and cis-1,2-dichloroethene

The study investigated carbon and chlorine isotope fractionation during aerobic oxidation and reductive dechlorination of vinyl chloride (VC) and cis-1,2-dichloroethene (cDCE). The experimental data followed a Rayleigh trend. For aerobic oxidation, the average carbon isotope enrichment factors were -7.2 per thousand and -8.5% for VC and cDCE, respectively, while average chlorine isotope enrichment factors were only -0.3 per thousand for both compounds. These values are consistent with an initial transformation by epoxidation for which a significant primary carbon isotope effect and only a small secondary chlorine isotope effect is expected. For reductive dechlorination, larger carbon isotope enrichment factors of -25.2 per thousand for VC and -18.5 per thousand for cDCE were observed consistent with previous studies. Although the average chlorine isotope enrichmentfactors were larger than those of aerobic oxidation (-1.8 per thousand for VC, -1.5 per thousand for cDCE), they were not as large as typically expected for a primary chlorine isotope effect suggesting that no cleavage of C-Cl bonds takes place during the initial rate-limiting step. The ratio of isotope enrichment factors for chlorine and carbon were substantially different for the two reaction mechanisms suggesting that the reaction mechanisms can be differentiated at the field scale using a dual isotope approach.

Breathing pattern, CO2 elimination and the absence of exhaled NO in freely diving Weddell seals

Weddell seals undergo lung collapse during dives below 50 m depth. In order to explore the physiological mechanisms contributing to restoring lung volume and gas exchange after surfacing, we studied ventilatory parameters in three Weddell seals between dives from an isolated ice hole on McMurdo Sound, Antarctica.

METHODS

Lung volumes and CO(2) elimination were investigated using a pneumotachograph, infrared gas analysis, and nitrogen washout. Thoracic circumference was determined with a strain gauge. Exhaled nitric oxide was measured using chemiluminescence.

RESULTS

Breathing of Weddell seals was characterized by an apneustic pattern with end-inspiratory pauses with functional residual capacity at the end of inspiration. Respiratory flow rate and tidal volume peaked within the first 3 min after surfacing. Lung volume reductions before and increases after diving were approximately 20% of the lung volume at rest. Thoracic circumference changed by less than 2% during diving. The excess CO(2) eliminated after dives correlated closely with the duration of the preceding dive. Nitric oxide was not present in the expired gas.

CONCLUSION

Our data suggest that most of the changes in lung volume during diving result from compression and decompression of the gas remaining in the respiratory tract. Cranial shifts of the diaphragm and translocation of blood into the thorax rather than a reduction of thoracic circumference appear to compensate for lung collapse. The time to normalise gas exchange after surfacing was mainly determined by the accumulation of CO(2) during the dive. These findings underline the remarkable adaptations of the Weddell seal for restoring lung volume and gas exchange after diving.

A probabilistic risk assessment of Cryptosporidium exposure among Baltimore urban anglers

In some urban settings, recreational fishing in industrialized waterways may pose a substantial health risk due to the presence of pathogenic microbes such as Cryptosporidium, a pathogen that produces a moderate to fatal gastrointestinal illness in humans. This pilot study examined the risk of exposure to Cryptosporidium based on fish samples and hand wash samples taken from urban anglers. Information regarding fishing frequency and consumption were also collected through an interview questionnaire to further characterize this risk. There were a total of 56 anglers interviewed and 46 fish and hand wash samples collected (18 hand wash samples and 28 fish samples). It was determined that the mean probability of infection using the U.S. Environmental Protection Agency's (EPA) dose-response model for Cryptosporidium and the fish and hand wash samples was 0.11 and 0.81, respectively. Among the positive fish samples, this mean probability was found to be 0.41. Depending on a variety of confounding factors, such as immunity, pre-existing illnesses and other host specific factors, this probability indicated that on average 1 to 8 out of 10 anglers could become infected. The current fish consumption advisories in Maryland and elsewhere provide no apparent information in regard to any microbiological contaminant. This pilot study provided data for possible modifications and improvements to be made to policy and risk communication regarding the potential health risks due to Cryptosporidium exposure from fishing.

Risk of handling as a route of exposure to infectious waterborne Cryptosporidium parvum oocysts via Atlantic blue crabs (Callinectes sapidus)

Commercial Atlantic blue crabs (Callinectes sapidus) were exposed to 2.0x10(4) infectious waterborne oocysts of Cryptosporidium parvum. The study demonstrated that blue crabs can transfer C. parvum oocysts to persons involved in handling or preparing crabs and that they may contaminate other surfaces or products during storage.

Fitness consequences of variable maternal provisioning in quacking frogs (Crinia georgiana)

Variable maternal provisioning may evolve when there is variation in the quality of offspring environments. The frog Crinia georgiana has high variability in egg size both within and between clutches, independent of female phenotype. It breeds in ponds with high spatial and temporal variation in habitat quality. Egg size strongly affected offspring fitness in good and poor quality offspring environments, whether the egg size difference was from between or within clutches. Since there is a trade-off in egg size and number, these fitness consequences translate to strong effects on maternal fitness. In the variable and unpredictable offspring environment of C. georgiana, the maintenance of variable maternal provisioning both within and between clutches is likely to be an evolved response to the offspring environment.

Comparative Analysis of Passive Dosimetry and Biomonitoring for Assessing Chlorpyrifos Exposure in Pesticide Workers

Under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), the US Environmental Protection Agency (EPA) has the authority to regulate the use of pesticides to prevent unreasonable adverse human health effects associated with pesticide exposure. Accordingly, the EPA requires pesticide registrants to perform studies evaluating the potential for pesticide handler exposure. Data from five such studies that included exposure measurements based on both external measurements and biological monitoring were used to examine methods of assessment, routes and determinants of exposure and dose to the pesticide chlorpyrifos. Eighty workers across four job classes were included: mixer/loaders (M/L, n = 24), mixer/loader/applicators (M/L/A, n = 37), applicators (A, n = 9) and re-entry scouts (RS, n = 10). Results showed that doses were highly variable and differed by job class (P < 0.05) with median total (inhalation and dermal combined) exposure-derived absorbed doses (EDADtot) of 129, 88, 85 and 45 microg/application for A, M/L/A, M/L and RS, respectively. Doses derived from the measurement of 3,5,6-trichloro- 2-pyridinol (3,5,6-TCP) in urine were similar in magnitude but differed in rank with median values of 275, 189, 122 and 97 microg/application for A, M/L, RS, and M/L/A, respectively. The relative contribution of dermal to inhalation exposure was examined by their ratio. The median ratios of exposure-derived absorbed dermal dose (EDADderm) (assuming 3% absorption) to exposure-derived absorbed inhalation dose (EDADinh) (assuming 100% absorption) across job classes were 1.7, 1.5, 0.44 and 0.18 for RS, M/L, A and M/L/A, respectively, with an overall median of 0.6. For 34 of 77 workers (44%), this ratio exceeded 1.0, indicating the significance of the dermal exposure pathway. Different dermal absorption factor (DAF) assumptions were examined by comparing EDADtot to the biomarker-derived absorbed dose (BDAD) as a ratio where EDADtot was calculated assuming a DAF of 1, 3 and 10%. Median ratios of 0.45, 0.71 and 1.28, respectively, were determined suggesting the DAF is within the range of 3-10%. A simple linear regression of urinary 3,5,6-TCP against EDADtot indicates a positive association explaining 29% of the variability in the 3,5,6-TCP derived estimate of dose. A multiple linear regression model including the variables EDADderm, EDADinh and application type explained 46% of the variability (R2 = 0.46) in the urinary dose estimate. EDADderm was marginally significant (P = 0.066) while EDADinh was not (P = 0.57). The EDADderm regression coefficient (0.0007) exceeded the coefficient for EDADinh (0.00002) by a factor of 35. This study demonstrates the value of the pesticide registrant database for the purpose of evaluating pesticide worker exposure. It highlights the significance of the dermal exposure pathway, and identifies the need for methods and research to close the gap between external and internal exposure measures.

Senior student nurses information seeking skills: a comparative study

Information seeking is one of the key skills in the problem-solving process. This paper explores and compares the information seeking skills of senior student nurses (n = 253) from three pre-registration nurse education programmes: Registered General Nurse (RGN); diploma Registered Nurse (Diploma RN); and integrated degree. Skills were explored using a paper and pencil simulation exercise. Study findings revealed both similarities and differences between the groups. Few students displayed a holistic approach when acquiring information and the rationale for information requests was cited infrequently. The integrated degree programme participants displayed a more systematic approach to information acquisition, while more RGN programme participants referred to the use of a model. The most favoured model to aid data acquisition was Roper et al.'s [The Elements of Nursing, third ed., Churchill Livingstone, Edinburgh, 1996] Activities of Living Model. The study findings are discussed in the wider context of professional education and practice and the potential for further development of information seeking skills on pre-registration nurse education programmes is noted.

Synaptic and Nonsynaptic Localization of Benzodiazepine/GABAA Receptor/Cl- Channel Complex Using Monoclonal Antibodies in the Dorsal Lateral Geniculate Nucleus of the Cat

The two monoclonal antibodies, bd-17 and bd-24, are specific for beta- and alpha-subunits of the GABAA/benzodiazepine receptor/chloride channel complex respectively. An abundance of both subunits has been revealed in the visual thalamus of the cat by light microscopic immunocytochemistry using these antibodies. The alpha-subunit specific antibody and electron microscopy were used to determine the subcellular distribution of immunoreactivity with respect to specific cell classes in the dorsal lateral geniculate nucleus. Immunoreactivity was always associated with membranes and the degree of immunoreactivity varied greatly between different types of cell as defined by: (i) immunoreactivity for GABA; (ii) soma area; (iii) presence or absence of cytoplasmic laminated bodies (CLB). GABA negative neurons with the smallest soma area showed the strongest immunoreactivity, mainly in the endoplasmic reticulum and also on the somatic plasma membrane. Cytoplasmic laminated bodies could be found in the majority of these neurons. Large GABA negative cells without CLBs were strongly immunoreactive on the plasma membrane of the soma and dendrites, but showed scant if any intracellular immunoreactivity. GABA-positive cells showed weak intracellular immunoreactivity but negligible if any immunoreactivity at the somatic and proximal dendritic plasma membrane. A similar reaction pattern was found in GABA negative cells which contained no CLBs and which constituted a medium sized cell population. It is suggested that the degree of intracellular receptor immunoreactivity is positively correlated with receptor turnover. The dendrites of projection cells, particularly outside the glomeruli, showed strong immunoreactivity on the plasma membrane. The synaptic junctions formed by many boutons (F terminals) establishing symmetrical synapses with dendrites of relay cells were immunopositive, but no immunoreactivity could be detected at the synapses established by the presynaptic dendrites of the local interneurons. Many axo-somatic F1 junctions were also immunoreactive. However, immunoreactivity for the receptor/channel complex was also widely distribution on nonsynaptic plasma membranes of somata and dendrites. Thus GABA may act at both synaptic and non-synaptic sites. Furthermore, the correlation of immunoreactivity for the GABAA receptor complex with previously published properties of physiologically identified cells suggests that the strongly immunoreactive, small, GABA negative cells with CLBs might correspond to the 'lagged' X-type cells, and the large GABA negative receptor outlined cells without CLBs might correspond to some of the Y-type neurons.