The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four ...low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial.
We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice - at 1 and 2 months - after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers.
In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 IQR:71-258 and 27 μg/m3 IQR:20-47, while corresponding personal exposures were 75 μg/m3 IQR:55-104 and 36 μg/m3 IQR:26-46, respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 IQR:49-127 at baseline and 25 μg/m3 IQR:18-35 after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 IQR:19-27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance.
An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs.
ClinicalTrials.Gov. NCT02944682 ; Prospectively registered on October 17, 2016.
Background The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children ...across four low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial. Methods We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice - at 1 and 2 months - after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers. Results In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 mug/m3 IQR:71-258 and 27 mug/m3 IQR:20-47, while corresponding personal exposures were 75 mug/m3 IQR:55-104 and 36 mug/m3 IQR:26-46, respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 mug/m3 IQR:49-127 at baseline and 25 mug/m3 IQR:18-35 after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 mug/m3 IQR:19-27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance. Conclusions An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs. Trial registration ClinicalTrials.Gov. NCT02944682; Prospectively registered on October 17, 2016. Keywords: HAPIN trial, LPG intervention, Household air pollution, PM.sub.2.5, Personal exposures, Pregnant women, India
This study explores New York City's underground rock ethos at the legendary, now defunct rock club CBGB & OMFUG (Country Bluegrass Blues & Other Music For Uplifting Gormandizers). The traditional ...confidence (or 'con') game model is employed to examine the processes by which the CBGB event was accomplished. I argue that the club's allure was fundamentally attached to its claims of authenticity, and that the traditional con game model is an underused resource for contesting such claims. By observing the interplay among the club owner, boosters, musicians, support personnel, and patrons, I develop a theory of active cultural production as a kind of collective strategy employed by multiple actors, all in search of authenticity as a commodity to be produced and consumed. While making note of their important differences, the study demonstrates ways in which the production of live music shares many formal properties with that of confidence games.
ABSTRACT
Introduction
Spine pain is one of the largest and costliest burdens to our healthcare systems. While evidence-based guidelines for spine pain have been established, and continue to evolve, ...the actual management of this condition continues to burden the healthcare system. This has led to increased costs due to inefficient entry to healthcare, utilization of treatments unsupported by clinical guidelines, and patient navigation through our healthcare systems. The purpose of this study was to assess the healthcare utilization and related outcomes for Active Duty Service Members (ADSM) receiving healthcare services in a novel acute spine pain clinic (ASPC) during the first 5 years of operation at a large Military Treatment Facility.
Materials and Methods
In 2014 the Physical Medicine and Rehabilitation and Physical Therapy (PT) services designed a novel acute spine clinic intended to directly receive ADSM with acute spine symptoms for an initial evaluation by a Physical Therapist. The inclusion criteria into the ASPC were: ADSM, pain less than or equal to 7 days, no more than three prior episodes of acute spine pain in the past 3 years, and not currently receiving care from Chiropractic, Pain Management, or PT services. The exclusion criteria were: significant and/or progressive neurological deficits, bowel or bladder dysfunction, unstable vital signs or fever, hematuria or extensive trauma.
Results
A total of 1,215 patients presented to the ASPC for evaluation between 2014 and 2019. The most common chief complaint was acute pain in the lumbar spine (73%), followed by cervical spine pain (15%), and thoracic spine pain (12%) represented the fewest. The average number of PT visits per patient was 3.5 (range 1-13) with 61.1% utilizing three or fewer visits. Over 95% of cases returned to work the same day as their initial evaluation. Sixty-six percent returned to work without restriction the same day as their initial evaluation. Light duty recommendations were provided to 412 (33.9%) patients ranging from one to 30 days, with greater than 85% of the light duty being less than 14 days. Recommendations to not return to work (sick-in-quarters) were issued to 56 (4.6%) patients. The sick-in-quarters recommendations were for a 24-hour period in 48 cases, 48 hours for seven cases, and 72 hours for one case. All encounters in which the patient first sought care at the ASPC for low back pain met the Healthcare Effectiveness Data Set standard for low back pain care of having no imaging within 28 days of the first encounter for nonspecific low back pain. A medical record review of 100 randomly selected patients within 12 months of the initial evaluation demonstrated decreased utilization of medication, imaging, and referral to surgical services.
Conclusions
This innovative approach demonstrates the potential benefits of rapid access to treatment and education for patients with acute spine pain by a Physical Therapist. Modeling this approach at Military Treatment Facilities may lead to decreased utilization of medications, radiology services, specialty care referrals, and reduced cost of care provided to individuals with acute spine pain.
We hypothesized that the parts of scenes identified by human observers as "objects" show distinct color properties from backgrounds, and that the brain uses this information towards object ...recognition. To test this hypothesis, we examined the color statistics of naturally and artificially colored objects and backgrounds in a database of over 20,000 images annotated with object labels. Objects tended to be warmer colored (L-cone response > M-cone response) and more saturated compared to backgrounds. That the distinguishing chromatic property of objects was defined mostly by the L-M post-receptoral mechanism, rather than the S mechanism, is consistent with the idea that trichromatic color vision evolved in response to a selective pressure to identify objects. We also show that classifiers trained using only color information could distinguish animate versus inanimate objects, and at a performance level that was comparable to classification using shape features. Animate/inanimate is considered a fundamental superordinate category distinction, previously thought to be computed by the brain using only shape information. Our results show that color could contribute to animate/inanimate, and likely other, object-category assignments. Finally, color-tuning measured in two macaque monkeys with functional magnetic resonance imaging (fMRI), and confirmed by fMRI-guided microelectrode recording, supports the idea that responsiveness to color reflects the global functional organization of inferior temporal cortex, the brain region implicated in object vision. More strongly in IT than in V1, colors associated with objects elicited higher responses than colors less often associated with objects.
The Electronic Medical Records and Genomics (eMERGE) network is a network of medical centers with electronic medical records linked to existing biorepository samples for genomic discovery and genomic ...medicine research. The network sought to unify the genetic results from 78 Illumina and Affymetrix genotype array batches from 12 contributing medical centers for joint association analysis of 83,717 human participants. In this report, we describe the imputation of eMERGE results and methods to create the unified imputed merged set of genome‐wide variant genotype data. We imputed the data using the Michigan Imputation Server, which provides a missing single‐nucleotide variant genotype imputation service using the minimac3 imputation algorithm with the Haplotype Reference Consortium genotype reference set. We describe the quality control and filtering steps used in the generation of this data set and suggest generalizable quality thresholds for imputation and phenotype association studies. To test the merged imputed genotype set, we replicated a previously reported chromosome 6 HLA‐B herpes zoster (shingles) association and discovered a novel zoster‐associated loci in an epigenetic binding site near the terminus of chromosome 3 (3p29).
Assessing the risk of common, complex diseases requires consideration of clinical risk factors as well as monogenic and polygenic risks, which in turn may be reflected in family history. Returning ...risks to individuals and providers may influence preventive care or use of prophylactic therapies for those individuals at high genetic risk.
To enable integrated genetic risk assessment, the eMERGE (electronic MEdical Records and GEnomics) network is enrolling 25,000 diverse individuals in a prospective cohort study across 10 sites. The network developed methods to return cross-ancestry polygenic risk scores, monogenic risks, family history, and clinical risk assessments via a genome-informed risk assessment (GIRA) report and will assess uptake of care recommendations after return of results.
GIRAs include summary care recommendations for 11 conditions, education pages, and clinical laboratory reports. The return of high-risk GIRA to individuals and providers includes guidelines for care and lifestyle recommendations. Assembling the GIRA required infrastructure and workflows for ingesting and presenting content from multiple sources. Recruitment began in February 2022.
Return of a novel report for communicating monogenic, polygenic, and family history-based risk factors will inform the benefits of integrated genetic risk assessment for routine health care.
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