Scalable Multipollutant Exposure Assessment Using Routine Mobile Monitoring Platforms.

INTRODUCTION: The absence of spatially resolved air pollution measurements remains a major gap in health studies of air pollution, especially in disadvantaged communities in the United States and lower-income countries. Many urban air pollutants vary over short spatial scales, owing to unevenly distributed emissions sources, rapid dilution away from sources, and physicochemical transformations. Primary air pollutants from traffic have especially sharp spatial gradients, which lead to disparate effects on human health for populations who live near air pollution sources, with important consequences for environmental justice. Conventional fixed-site pollution monitoring methods lack the spatial resolution needed to characterize these heterogeneous human exposures and localized pollution hotspots. In this study, we assessed the potential for repeated mobile air quality measurements to provide a scalable approach to developing high-resolution pollution exposure estimates. We assessed the utility and validity of mobile monitoring as an exposure assessment technique, compared the insights from this measurement approach against other widely accepted methods, and investigated the potential for mobile monitoring to be scaled up in the United States and low- and middle-income countries. METHODS: Our study had five key analysis modules (M1- M5). The core approach of the study revolved around repeated mobile monitoring to develop time-stable estimates of central-tendency air pollution exposures at high spatial resolution. All mobile monitoring campaigns in California were completed prior to beginning this study. In analysis M1, we conducted an intensive summerlong sampling campaign in West Oakland, California. In M2, we explored the dynamics of ultrafine particles (UFPs) in the San Francisco Bay Area. In analysis M3, we scaled up our multipollutant mobile monitoring approach to 13 different neighborhoods with ~450,000 inhabitants to evaluate within- and between-neighborhood heterogeneity. In M4, we evaluated the coupling of mobile monitoring with land use regression models to estimate intraurban variation. Finally, in M5, we reproduced our mobile monitoring approach in a pilot study in Bangalore, India. RESULTS: For M1, we found a moderate-to-high concordance in the time-averaged spatial patterns between mobile and fixed-site observations of black carbon (BC) in West Oakland. The dense fixed-site monitor network added substantial insight about spatial patterns and local hotspots. For M2, a seasonal divergence in the relationship between UFPs and other traffic-related air pollutants was evident from both approaches. In M3, we found distinct spatial distribution of exposures across the Bay Area for primary and secondary air pollutants. We found substantially unequal exposures by race and ethnicity, mostly driven by between-neighborhood concentration differences. In M4, we demonstrated that empirical modeling via land use regression could dramatically reduce the data requirements for building high-resolution air quality maps. In M5, we developed exposure maps of BC and UFPs in a Bangalore neighborhood and demonstrated that the measurement technique worked successfully. CONCLUSIONS: We demonstrated that mobile monitoring can produce insights about air pollution exposure that are externally validated against multiple other analysis approaches, while adding complementary information about spatial patterns and exposure heterogeneity and inequity that is not readily obtained with other methods.

Patients with suicidal burns and accidental burns: a comparative study of socio-demographic profile in India.

This is a prospective study of 50 consecutive admissions to the burns unit. The socio-demographic data was collected using special proforma and interviewing the patients and relatives. All patients were administered the presumptive stressful life event scale (PSLES). Depending on the presence or absence of suicidal intent, patients were divided into two groups. The two groups were then compared with regards to their socio-demographic profile using the unrelated t-test and the Fisher's exact test. The two groups did not differ significantly with regards to age, sex, education, marital status, occupation or monthly per capita income. The patients who had suicidal intent came from joint family, had more stressful life events and suffered larger burns injuries compared with those who experienced accidental burn injuries. The majority of the patients were below the age of 35, unemployed and females outnumbered males in both the groups.

Malnutrition of children in the Democratic People's Republic of North Korea.

Natural disasters have caused extensive damage to crops and to infrastructure in the Democratic People's Republic of North Korea (DPRK). The international community has responded by providing emergency food aid. To improve understanding of the magnitude of food deficiency in the DPRK. The World Food Programme (WFP) conducted a nutritional assessment survey in August 1997. The survey measured the height and weight of a total of 3984 children <7 y of age in 40 government-selected institutions. Additional information was obtained on institutional access to food and on the care, treatment and parental support of a subsample of severely malnourished and nonmalnourished children. The prevalence of acute malnutrition (wasting), based on weight-for-height Z-score < -2, varied from 0 to 32.7% among institutions, and the prevalence of chronic malnutrition (stunting), based on height-for-age < -2 Z-score varied from 0.6 to 74.1%. The findings from this survey indicate the presence of areas with severe acute or chronic malnutrition in the DPRK.

PIP: An estimated 23.9 million people inhabit the Democratic People's Republic of North Korea (DPRK). In addition to economic and credit problems, DPRK experienced major natural disasters, including hailstorms, floods, drought, and tidal waves during 1994-97. These natural disasters have caused considerable damage to crops and infrastructure in DPRK. In response, the international community has provided emergency food aid. To assess the magnitude of food deficiency in the DPRK, the World Food Program (WFP) conducted a nutritional assessment survey in August 1997, measuring the height and weight of 3984 children under age 7 years in 40 government-selected institutions. Additional information was collected on institutional access to food and the care, treatment, and parental support of a subsample of severely malnourished and nonmalnourished children. The prevalence of acute malnutrition, based upon weight-for-height Z-score of less than -2, was 0-32.7% among institutions, while the prevalence of chronic malnutrition based upon height-for-age Z-score of less than -2 was 0.6-74.1%. This survey has identified areas of the DPRK in which severe acute or chronic malnutrition exists.

Use of nitroglycerin ointment to prevent hypertensive response during electroconvulsive therapy--a study of 50 cases.

Fifty patients of either sex, aged between 20 and 60 years undergoing electroconvulsive therapy were included in our study. Each patient was used as his/her own control. We observed the cardiovascular changes without nitroglycerin ointment in the first sitting and in the next sitting with the application of 2 inches of 2% nitroglycerin ointment 45 min before the electroconvulsive therapy. Arterial blood pressure and heart rate increase during electroconvulsive therapy can be effectively attenuated by application of 2 inches of 2% nitroglycerin ointment 45 min before the electroconvulsive therapy (p < 0.001 and p < 0.01 resp.). This may be especially beneficial for patients who are at increased risk of myocardial ischemia and stroke.

Centbutindole vs trifluoperazine: a double-blind controlled clinical study in acute schizophrenia.

Twenty-nine acute schizophrenic patients were treated under double-blind conditions for six weeks with either centbutindole in a dose range of 3 mg/day to 4.5 mg/day or trifluoperazine in the dose range of 15 mg/day to 22.5 mg/day. Both drugs produced a significant improvement in initial psychopathology. No significant differences were demonstrated between the two treatment conditions.

A study of relationship between background characteristics, media exposure and acceptance of family planning in rural Maharashtra.

PIP: On the basis of data taken from a National Study on the Subject of Reach and Effectiveness of Mass Media in the family welfare program (1980, this paper analyzes the interplay of variables at different levels and their effect on the acceptance of family planning. The level of education is related to exposure to media as well as the use of family planning methods, and negatively related to the degree of apprehension. The higher the level of exposure to media, the greater the acceptance of family planning. However, the relationship between the level of media exposure and degree of apprehension does not show a conclusive trend. The number of living sons is found to be very closely associated with the acceptance of family planning. It is clear that any communication effort which does not attack the problems of sex preference or apprehension will not yield desirable results in terms of acceptance. It is also clear that the proverbial gap between awareness and practice can be better filled by an appropriate use of inter-personal channels.^ieng

Women and food aid: a developmental perspective.

PIP: The unique aspect of food aid projects is that food, rather than money, is used for achieving developmental objectives. As food is usually controlled by women, they benefit most from considering it to be of economic value. Poor women seem to be short of resources--time and money--which can be supplemented by food aid. Through its income-transfer effect, food aid can enable women to work fewer hours/day and thus have more discretionary time. It can also provide, directly or indirectly, the cash necessary for women to use skills they already possess to set themselves up in small businesses. Food aid projects achieve their developmental objectives through: the nutritional content of the distributed commodity; the income transfer effect; cooperatives or associations; specific activities associated with the project; community improvement aspects resulting from the project; and provision of budgetary support to release resources for additional developmental activities. There are a number of ways through which food aid exerts its effect on women from a developmental perspective. Consumption of the food aid commodity provides women with an improved diet. Food aid as an income transfer can enable women to have more discretionary time. Providing women with opportunities for income-generating activities is an important aspect of development. Women's cooperatives or associations funded by food aid commodities can provide women with income. Current food aid projects, if properly planned, can be beneficial to women without the incorporation of specific activities or skills training. One way that food aid helps women gain more time is by freeing them from wage employment. Another way is to use the income transfer for the purchasing of consumer goods that reduce their labor.^ieng

Effects of intravenous metoclopramide in 81 patients with tardive dyskinesia.

We compared acute effects of single intravenous administrations of metoclopramide (40 mg) and placebo in a double-blind crossover study involving 81 patients with tardive dyskinesia. Metoclopramide produced significantly greater reduction in mean total Abnormal Involuntary Movement Scale score as well as in ratings for six of the seven body areas, when compared with placebo. On adjusting each patient's metoclopramide response for his or her placebo response, we found that 35 of the 81 patients had 50% or greater placebo-corrected improvement. There were no apparent clinical differences between metoclopramide responders and nonresponders. Administration of 60 mg of metoclopramide to 15 patients produced greater improvement in tardive dyskinesia as compared with 40 mg; the incidence of acute dystonia, however, jumped from 10% with 40 mg to 33% with 60 mg.

Tardive dyskinesia in India: a prevalence study.

We screened the entire inpatient population (N = 1963) of a state hospital near Bombay, India, for tardive dyskinesia (TD) using specific diagnostic criteria. Prevalence of TD was found to be 9.6%, which was much lower than that reported from the Western countries. Percent prevalence of TD was greatest in the age group 41 to 50, after which it seemed to decline. TD patients had received neuroleptic treatment for significantly longer periods and in significantly greater amounts than non-TD patients. The principal reason for the relatively low prevalence of TD in India is probably the practice of using neuroleptics in comparatively small doses (mean daily dose is about 200 mg of chlorpromazine equivalents). A possible contribution of racial-genetic factors cannot be excluded.

Cross-cultural study of a biochemical abnormality in paranoid schizophrenia.

We studied 24-hour urinary excretion of phenylethylamine (PEA) and creatinine in 50 schizophrenic (39 paranoid and 11 nonparanoid) and 19 nonpsychiatric patients from Bombay, India. Methods for diagnosis, clinical assessment, and 24-hour urine collection were identical to those used in an earlier study done in a Washington, D.C. hospital. Clinical evaluations were done in Bombay, while urinary PEA and creatinine estimations were performed at NIMH, Washington, without knowledge of the subjects' identify. Paranoid schizophrenic patients had significantly greater 24-hour urinary excretion of PEA than both nonparanoid schizophrenic patients and nonpsychiatric controls. The mean amount of PEA per g creatinine in urine was also highest of paranoid schizophrenic patients. Our findings provide cross-cultural support to the possibility of abnormal PEA metabolism in at least some patients with paranoid schizophrenia.

Penfluridol in chronic schizophrenia.

Twenty-eight male chronic schizophrenic patients completed a 6 month treatment with a single weekly dose of 20 to 120 mg penfluridol, a new long- acting oral neuroleptic. Twenty-four patients showed significant improvement at the end of the trial period. Significant reduction in scores could be demonstrated in 21 out of 26 symptom variables. Central side-effects, reported by 19 patients, were mild and transient except in one patient who was withdrawn from the trial. Laboratory investigations and vital signs remained within normal limits.