Characteristics of sub-micron aerosols in the Yellow Sea and its environmental implications.

The Yellow Sea, characterized by an influx of both natural marine and anthropogenic pollutants, coupled with favorable photochemical conditions, serve as key sites for potential interactions between atmospheric gases and aerosols. A recent air monitoring campaign in the Yellow Sea revealed aerosol contributions from four sources, with the highest mass concentrations and dominance of NO3- (38.1 ± 0.37 %) during winds from China. Indications of potential secondary aerosol formation were observed through the presence of hydrolysis and oxidation products of nitrate and volatile organic compounds. Correlations between time series distributions of biomass burning organic aerosols and particle number counts (Dp 100-500 nm, R2 = 0.94) further suggest potential size growth through adsorption and scavenging processes. The results from this study provide observational evidence of a shift in atmospheric compositions from sulfate to nitrate, leading to an increased atmospheric nitrogen deposition in the Yellow Sea.

Emissions from ships' activities in the anchorage zone: A potential source of sub-micron aerosols in port areas.

Busan Port is among the world's top ten most air-polluted ports, but the role of the anchorage zone as a significant contributor to pollution has not been studied. To assess the emission characteristics of sub-micron aerosols, a high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS) was deployed in Busan, South Korea from September 10 to October 6, 2020. The concentration of all AMS-identified species and black carbon were highest when the winds came from the anchorage zone (11.9 µg·m-3) and lowest with winds from the open ocean (6.64 µg·m-3). The positive matrix factorization model identified one hydrocarbon-like organic aerosol (HOA) and two oxygenated organic aerosol (OOA) sources. HOAs were highest with winds from Busan Port, while oxidized OOAs were predominant with winds from the anchorage zone (less oxidized) and the open ocean (more oxidized). We calculated the emissions from the anchorage zone using ship activity data and compared them to the total emissions from Busan Port. Our results suggest that emissions from ship activities in the anchorage zone should be considered a significant source of pollution in the Busan Port area, especially given the substantial contributions of gaseous emissions (NOx: 8.78%; volatile organic compounds: 7.52%) and their oxidized moieties as secondary aerosols.

Mobile measurement of vehicle emission factors in a roadway tunnel: A concentration gradient approach.

Tunnels are the preferred experimental environments for estimating vehicle emission factors (EFs) under real-world driving conditions. In this study, online measurements of traffic-related air pollutants (including CO2, NOX, SO2, O3, particulate matter [PM], and volatile organic compounds [VOCs]) were conducted using a mobile laboratory in the Sujungsan Tunnel in Busan, Korea. Mobile measurements generated concentration profiles of the target exhaust emissions inside the tunnel. These data were used to produce a zonation of the tunnel, i.e., mixing and accumulation zones. There were differences between the CO2, SO2, and NOX profiles, and a starting point that was free from ambient air mixing effects could be set at 600 m from the tunnel entrance. The EFs of vehicle exhaust emissions were calculated using pollutant concentration gradients. The average EFs for CO2, NO, NO2, SO2, PM10, PM2.5, and ∑VOCs were 149,000, 380, 55, 29.2, 9.64, 4.33, and 16.7 mg km-1·veh-1, respectively. Among the VOC groups, alkanes contributed more than 70% of the VOC EF. Mobile measurement-derived EFs were validated using the conventional EFs from stationary measurements. The EF results from the mobile measurements matched those from the stationary measurements, while the absolute concentration differences between them implied complex aerodynamic movements of the target pollutants inside the tunnel. This study demonstrated the usefulness and advantages of applying mobile measurements in a tunnel environment and indicated the potential of the approach for observation-based policymaking.

Capillary flow velocity profile analysis on paper-based microfluidic chips for screening oil types using machine learning.

We conceived a novel approach to screen oil types on a wax-printed paper-based microfluidic platform. Various oil samples spontaneously flowed through a micrometer-scale channel via capillary action while their components were filtered and partitioned. The resulting capillary flow velocity profile fluctuated during the flow, which was used to screen oil types. Raspberry Pi camera captured the video clips, and a custom Python code analyzed them to obtain the capillary flow velocity profiles. 106 velocity profiles (each with 125 frames for 5 s) were recorded from various oil samples to build a training database. Principal component analysis (PCA), support vector machine (SVM), and linear discriminant analysis (LDA) were used to classify the oil types into heavy-to-medium crude, light crude, marine fuel, lubricant, and diesel oils. The second-order polynomial SVM model with PCA as a pre-processing step showed the highest accuracy: 90% in classifying crude oils and 81% in classifying non-crude oils. The assay took less than 30 s from the sample to answer, with 5 s of the capillary action-driven flow. This simple and effective assay will allow rapid preliminary screening of oil types, enable early tracking, and reduce the number of suspect samples to be analyzed by laboratory fingerprinting analysis.

Chemical characterization of sub-micron aerosols over the East Sea (Sea of Japan).

Studies of the land-sea-air interactions of aerosol are scarce considering their significant role in global environmental changes. Here, we investigated potential sources of sub-micron aerosols over the East Sea (Sea of Japan), which is strongly influenced by continental and marine aerosols. A high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS) was used to measure the size-resolved chemical compositions of sub-micron aerosols during the period March 10-15, 2020. Concentrations of all AMS species, black carbon (BC), PM10 (particulate matter <10 µm) and PM2.5 (particulate matter <2.5 µm) were higher when cruising in industrialized coastal areas compared to the offshore region. A positive matrix factorization (PMF) model identified five distinct sources, i.e., hydrocarbon-like organic aerosol, semi-volatile and low-volatile oxygenated aerosols, methanesulfonic acid (MSA), and dimethyl sulfide (DMS; C2H6S) oxidation, which accounted for 5.98 %, 21.6 %, 28.3 %, 34.5 %, and 9.64 % of the total organic mass, respectively. The spatiotemporal variation of MSA, as well as the MSA to sulfate ratio (MSA:SO42-) over the East Sea, was determined for the first time. The mass concentrations of MSA displayed a similar time series distribution pattern to those of DMS. The time series distributions of the MSA:SO42- ratio displayed distinct differences, with higher ratios downwind of the ocean (0.216 ± 0.083 µg·m-3) than land (0.089 ± 0.030 µg·m-3). The growth of ultrafine particles (10-35 nm) was observed during two of the elevated MSA:SO42- ratio events, suggesting a potential role of MSA in new particle formation.

Determination of anthropogenic organics in dichlomethane extracts of aerosol particulate matter collected from four different locations in China and Republic of Korea by GC-MS and FTICR-MS.

In this study, the hypothesis that particulate matter in east of Korea peninsula would be significantly influenced by particulate matter originated from east of China was evaluated. To test the hypothesis, water-insoluble compounds in particulate matter samples collected from three different locations in Korea and one in China were characterized by atmospheric pressure photoionization (APPI) coupled with Fourier transform ion cyclotron resonance mass spectrometry (FTICR-MS) and gas chromatography mass spectrometry (GC-MS). Each sample was collected twice, in winter and in spring. The GC-MS data revealed the presence of high levels of polycyclic aromatic hydrocarbons (PAHs), such as benzo[a]anthracene in the samples from Tianjin, China. The sample collected in the winter from Baengnyeong Island, which is the location in Korea that is geographically closest to the east coast of China was also rich in aromatic compounds. Meanwhile, the APPI FTICR-MS data showed that polycondensed PAHs and two- to four-ring PAHs with long alkyl chains were abundant in the winter samples from Tianjin and Baengnyeong Island which stems most likely from coal combustion in the eastern China. In contrast, nonaromatic compounds with a biogenic origin were mostly observed in samples collected from islands located in eastern (Ulleung Island) and southern (Jeju Island) Korea. A principal component analysis by FTICR-MS and GC-MS also showed that the samples from Tianjin and those collected from Baengnyeong Island in the winter are strongly associated with coal combustion, whereas the other samples are mainly influenced by vehicle emissions. Therefore, it is concluded that the atmosphere from east of China has significant influence over atmosphere in west of Korea peninsula.

Seawater contamination associated with in-water cleaning of ship hulls and the potential risk to the marine environment.

In-water cleaning can clear-off foulants from ship hulls to prevent transportation of non-indigenous species and reduce hull friction and consequent fuel use. However, during cleaning, antifouling paint residues containing toxic substances can be released into the environment. To understand the potential risks of in-water hull cleaning, cleaning effluents were collected and analyzed for total suspended solid (TSS), particle size distribution, and metal concentrations. TSS concentrations were 97.3-249 mg/L, corresponding to release rates of 12.9-37.5 g/m2 from the hull surface. Particles with sizes of ≥8 µm contributed 75-94% of the TSS. Average Cu and Zn concentrations in the effluents were 209 µg/L and 1510 µg/L, respectively, which were used for risk assessment in two port scenarios. Although the risks vary with the scale of the hull cleaning and the ports, in-water cleaning poses clear risks to marine environments, unless the effluents are recovered or treated before being released.

Knowledge and Attitudes About Sterilization and Long-Acting Reversible Contraception.

OBJECTIVES: To describe understanding of the irreversible nature of permanent contraception and knowledge and attitudes about long-acting reversible contraception (LARC) among individuals seeking and not seeking permanent contraception. METHODS: We performed a cross-sectional survey among patients with Medicaid insurance attending an obstetrics and gynecology clinic in [location]. The survey consisted of 20 true/false and Likert questions assessing knowledge and perceptions about permanent contraception and LARC. Sixty-seven participants were needed to detect a small-to-medium Cohen's effect size f2 = 0.20, with 95% power and alpha = 0.05. RESULTS: Ninety potential participants were contacted and 67 were recruited. Forty-three participants desired permanent contraception and 24 did not. Approximately half of all participants were not aware that permanent contraception is irreversible. Participants who desired permanent contraception had lower LARC knowledge scores (62% correct versus 70%, p = 0.042) and more negative perceptions about LARC (54% versus 38%, p = 0.048). Fewer participants desiring permanent contraception identified LARC efficacy as equal to permanent contraception (32% versus 83%, p < 0.01), and fewer would consider using LARC (intrauterine device: 23% versus 58%, p < 0.01; implant: 16% versus 46%, p < 0.01). These differences persisted in multivariable models adjusting for age, gravidity, and parity. CONCLUSIONS FOR PRACTICE: Individuals who desire permanent contraception may not be aware of its permanence, or of equally effective alternatives. They were also found to have more negative perceptions of LARC in our sample. Additional research is needed to understand factors underlying these differences. Counseling practices should be tailored to ensure accurate knowledge about permanent contraception and LARC for all people seeking to avoid pregnancy.

Development of a portable oil type classifier using laser-induced fluorescence spectrometer coupled with chemometrics.

Due to the recurrent small spills, oil pollution along coastal regions is still a major environmental issue. Standardized oil fingerprinting techniques are useful for oil spill identifications, but time- and resource-consuming. There have been ongoing needs for simple yet rapid approach for field screening of oil spill. Laser induced fluorescence (LIF) technology can be incorporated into a spectrometer, and with the integration of chemometrics can be consolidated as a potentially useful portable oil type classification device. Using a LIF spectrometer, 775 oil spectra were calibrated into supervised classification models and validated with 162 oil spectra. Reliability of the device to accurately remove background emission from fluorescence spectra was verified. Prediction performance and model robustness were further validated by comparison between commonly used classification models such as partial least square discriminant analysis (PLS-DA) and support vector machine-discriminant analysis (SVM-DA). Robustness in both models were comparable with PLS-DA having a lower number of misclassification (PLS-DA: 5.50%, SVM-DA: 13.8%) while SVM-DA having a lower number of unassigned samples (PLS-DA: 10.9%; SVM-DA: 16 1.39%). This study explicitly demonstrated the development of a new convenient and handy device which can be used as part of the screening process for oil spill fingerprinting.

High-throughput screening of oil fingerprint using FT-IR coupled with chemometrics.

An important element of the oil spill emergency response is the ability to rapidly identify the properties of oil spilled. Chemometrics provides large numbers of multivariate analysis tools that allow for more extensive use of data. Fourier transformed infrared spectroscopy coupled with classification and prediction models such as partial least square (PLS) and PLS-DA (discriminant analysis) allows the rapid identification of oil type and characteristics. By searching for the maximum covariance with the variables of interest, PLS allows the visualization of relations between samples and variables. The framework of this study is based on two main steps: The first is classification of oil and the second is prediction of physicochemical properties. Separated into four main categories: crude, light fuel, heavy fuel, and lubricant, spectrums of 92 oils were calibrated to predict the oil type and physicochemical properties of 26 oils. The predictability and robustness of the model was further validated using weathered oil. The classification and prediction models have accuracy of >95%. Most of the PLS models have root mean square error of calibration and prediction ranging from 0.10-3.07 and 0.3-2.8, respectively. External cross validations using weathered oils showed high prediction accuracy (relative standard deviations <5%). By increasing the number of oil type and samples, this approach is a promising method and can be included as part of the oil spill fingerprinting protocols.

Handheld UV fluorescence spectrophotometer device for the classification and analysis of petroleum oil samples.

Oil spills can be environmentally devastating and result in unintended economic and social consequences. An important element of the concerted effort to respond to spills includes the ability to rapidly classify and characterize oil spill samples, preferably on-site. An easy-to-use, handheld sensor is developed and demonstrated in this work, capable of classifying oil spills rapidly on-site. Our device uses the computational power and affordability of a Raspberry Pi microcontroller and a Pi camera, coupled with three ultraviolet light emitting diodes (UV-LEDs), a diffraction grating, and collimation slit, in order to collect a large data set of UV fluorescence fingerprints from various oil samples. Based on a 160-sample (in 5x replicates each with slightly varied dilutions) database this platform is able to classify oil samples into four broad categories: crude oil, heavy fuel oil, light fuel oil, and lubricating oil. The device uses principal component analysis (PCA) to reduce spectral dimensionality (1203 features) and support vector machine (SVM) for classification with 95% accuracy. The device is also able to predict some physiochemical properties, specifically saturate, aromatic, resin, and asphaltene percentages (SARA) based off linear relationships between different principal components (PCs) and the percentages of these residues. Sample preparation for our device is also straightforward and appropriate for field deployment, requiring little more than a Pasteur pipette and not being affected by dilution factors. These properties make our device a valuable field-deployable tool for oil sample analysis.

Environmental significance of lubricant oil: A systematic study of photooxidation and its consequences.

Lubricant (lube) oil discharge from ships has been widely considered as normal "operational consumption", but is now deemed to be oil pollution. Despite the chronic contamination of the marine environment by lube oil, the number of studies related to its environmental impact, characteristics, and toxicity is limited. This study is the first attempt to investigate the environmental fate of lube oil subjected to photooxidation using in situ mesocosms. A tiered approach using thin-layer chromatography-flame ionization detection (TLC-FID), Fourier-transform infrared spectroscopy (FTIR) and gas chromatography-mass spectrometry (GC-MS) demonstrated compositional changes in lube oil and the water-soluble fraction (WSF). Total polycyclic aromatic hydrocarbons (ΣPAHs) in lube oil after 96 h of photooxidation were measured at 79.8 and 41 µg/g in the control (Con) and exposure (Exp) groups, respectively. Meanwhile, the ΣPAHs concentration in WSF after 96 h was very low, at 0.25 and 0.45 µg/L in Con and Exp, respectively. FTIR and GC-MS helped identify bond changes and photoproducts in WSF. A wide range of photoproducts, including carboxylic acids, esters, anhydrides, aldehydes and ketones, were identified in WSF. Toxic effects of WSF in both the Con and Exp groups obtained after 96 h of photooxidation were evaluated on olive flounder (Paralichthys olivaceus) embryos. Morphological defects, especially tail fin fold defects, were found to be significantly elevated in both the Con and Exp groups, with marginally higher frequency in Exp. The results of this study demonstrate the need for further research on lube oil weathering, including monitoring over prolonged periods of time.

Stability of mechanically and chemically dispersed oil: Effect of particle types on oil dispersion.

Oil spill dispersant (OSD) application is one of the preferred cleanup options to cope with oil spills at sea. OSD, in principle, can enhance biodegradation of oil because of its effectiveness in producing relatively small droplets and dispersing them into the water column. Under turbulent conditions, suspended particulate matter (SPM) which are present naturally in the environment can interact with oil to form aggregates known as oil-SPM aggregates (OSA) which also enhances biodegradation of oil. Despite its high dispersion effectiveness, chemically dispersed oil (CDO) has a tendency to resurface with increasing time which decreases the biodegradation potential. Meanwhile, the presence of SPM prevents recoalescence of dispersed oil which can enhance stability of oil droplets. This study focused on the effects of SPM on the dispersion effectiveness and stability of mechanically dispersed oil (MDO) and CDO. Dispersion tests of MDO and CDO extended to 72 h with and without SPM to see the initial effectiveness and the prolonged stability of dispersed oil. In the presence of SPM, the oil dispersed by MDO increased by 14.8-40.7%, while the resurfacing oil by CDO decreased by 8.7-19.4%. Regardless of SPM type, oil dispersion effectiveness and stability of MDO and CDO were significantly increased. Long-term stability test for 3 months showed that stability of OSA increased as the particle size decreased and particle counts increased.

Suspended particles enhance biodegradation of oil in sea.

Biodegradation patterns of oil in four distinct phases were compared over a 14-day series of exposures. The dispersibility and stability of oil droplets in the water column were important factors affecting oil biodegradation. Due to the stability of oil droplets with particle interactions, oil-suspended particulate matter aggregates (OSA) showed a five-fold enhancement in biodegradation compared to non-dispersed oil. The reduction of total petroleum hydrocarbons was highest in OSA (51.45%), followed by chemically dispersed oil (33.5%), oil film (21.6%), and water-accommodated fractions (WAF, 14.3%). Polycyclic aromatic hydrocarbon (PAH) profiles and percentage weathering plots showed that reductions in PAHs in WAF, oil film, and chemically dispersed oil were mainly due to evaporation (41.5-69.5%) and only partially due to biodegradation (7.4-16.3%). However, the reduction of PAHs in OSA was driven more by biodegradation (36.8%) than evaporation (29.7%). The strong PAH-particle interactions in OSA inhibited evaporation of PAHs and enhanced microorganism biodegradation in the water column.

Fate of residual oils during remediation activities after the Wu Yi San oil spill.

In this study, the fate of residual oils was investigated during remediation activities for a year after the Wu Yi San oil spill. Microscope observations showed that relatively large amounts of oil-suspended particulate matter aggregate (OSA) were formed. Negatively buoyant OSA was the dominant form (>95%), followed by neutrally (~5%) and positively buoyant (<1%) forms. To elucidate the dominance of negative buoyancy OSA, physicochemical properties of the mineral and residual oils were identified. Chemical analysis showed that the weathering percentage of residual oils was 43.7 ±â€¯2.59%, which was the driving factor for sedimentation of OSA. As the density of oil increased with weathering stages, the density of OSA also increased simultaneously. These results showed that, during mechanical remediation activities, resurfaced residual oils can form negative buoyancy OSA which tends to sink and transfers oil contaminants from intertidal to benthic environments.

A systematic study of the effects of solvents on phenanthrene photooxidation.

A systematic study of the photooxidation of phenanthrene under simulated environmental conditions was conducted in vitro using polar (methanol, acetonitrile) and non-polar (isooctane, hexane) solvents as media. In all solvents, phenanthrene concentration decreased exponentially as exposure time increased. Fourier-transform infrared spectroscopy (FTIR) and gas chromatography-mass spectrometry (GC-MS) analysis were used to investigate the structural changes induced by photooxidation. After 24 h of photooxidation, FTIR showed the formation of characteristic bands of carboxylic acid in all solvents. In non-polar solvents, characteristic phenanthrene peaks were completely depleted after 48 h. In polar solvents, phenanthrene peaks disappeared at a slower rate, with peaks in acetonitrile disappearing at 72 h and methanol persisting at trace levels at 96 h. The reaction rate was higher in non-polar solvents. The obtained half-lives were observed in the following order: isooctane (13.2 h) > hexane (13.5 h) > methanol (18.0 h) > acetonitrile (22.8 h). FTIR and GC-MS results were in good agreement and showed the formation of carboxylic acids, aldehydes, and ketones in polar solvents and carboxylic acids, alkanes, and alkanoic acids in non-polar solvents. Products such as primary amides induced by solvent effects were observed in acetonitrile. Based on the results, the solvents were rated and a solvent selection guide for photooxidation of PAHs was provided.

A preliminary study on the role of suspended particulate matter in the bioavailability of oil-derived polycyclic aromatic hydrocarbons to oysters.

Suspended particulate matter (SPM) refers to fine-grained materials that are suspended in water columns. By providing a surface for the adsorption of non-polar organic compounds, SPM is a carrier for persistent and toxic contaminants. A wide range of organic pollutants, including polycyclic aromatic hydrocarbons (PAHs), can be adsorbed onto SPM. The formation of particle-associated PAHs can sequentially increase the potential for exposure to and bioaccumulation by organisms. Until recently, most oil exposure studies were performed using freely dissolved and dispersed forms, and therefore the role of SPM in influencing the bioavailability and bioaccumulation of PAHs has not been considered. This study found that SPM influences the bioavailability of petrogenic PAHs in the water column and their potential for accumulation in oysters. SPM significantly enhanced the water column entrainment of petrogenic PAHs, thus increasing the potentials for uptake by exposed organisms. PAHs in the water column was highest from mechanically dispersed oil (MDO; 2.27 µg/mL) ≥ oil-SPM aggregate (OSA; 1.96 µg/mL) > water accommodated fraction (WAF; 0.19 µg/mL) but the percentage of PAHs accumulated in oysters were highest from WAF (18.3%) > MDO (14.2%) > OSA (9.62%). Despite the high water column available PAHs, oysters exposed to SPM-associated oil accumulated PAHs at half the accumulation efficiency compared with those exposed to PAHs without SPM.

Contamination and Human Health Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Oysters After the Wu Yi San Oil Spill in Korea.

After the collision of the Singapore-registered oil tanker M/V Wu Yi San into the oil terminal of Yeosu, Korea on January 31, 2014, approximately 900 m3 of oil and oil mixture were released from the ruptured pipelines. The oil affected more than 10 km of coastline along Gwangyang Bay. Emergency oil spill responses recovered bulk oil at sea and cleaned up the stranded oil on shore. As part of an emergency environmental impact assessment, region-wide monitoring of oil contamination in oyster had been conducted for 2 months. Highly elevated concentrations of polycyclic aromatic hydrocarbons (PAHs) were detected at most of the spill affected sites. Four days after the spill, the levels of PAHs in oysters increased dramatically to 627-81,000 ng/g, the average of which was 20 times higher than those found before the spill (321-4040 ng/g). The level of PAHs in these oysters increased until 10 days after the spill and then decreased. Due to the strong tidal current and easterly winter winds, the eastern part of the Bay-the Namhae region-was heavily contaminated compared with other regions. The accumulation and depuration of spilled oil in oyster corresponded with the duration and intensity of the cleanup activities, which is the first field observation in oil spill cases. Human health risk assessments showed that benzo[a]pyrene equivalent concentrations exceeded levels of concern in the highly contaminated sites, even 60 days after the spill.

MUC5AC and inflammatory mediators associated with respiratory outcomes in the British 1946 birth cohort.

BACKGROUND AND OBJECTIVE: Dysregulation of respiratory mucins, MUC5AC in particular, has been implicated in respiratory disease and MUC5AC expression is up-regulated in response to environmental challenges and inflammatory mediators. The aim of this study was to examine the effect of genetic variation on susceptibility to common respiratory conditions. METHODS: The association of MUC5AC and the closely linked genes MUC2 and MUC5B with respiratory outcomes was tested in the MRC National Survey of Health and Development, a longitudinal birth cohort of men and women born in 1946. Also examined were the functional variants of the genes encoding inflammatory mediators, IL13, IL1B, IL1RN, TNFA and ERBB1, for which there is a likely influence on MUC5AC expression and were explored potential gene-gene interactions with these inflammatory mediators. RESULTS: Statistically significant associations between the 3'ter MUC5AC simple nucleotide polymorphism (SNP) rs1132440 and various non-independent respiratory outcomes (bronchitis, wheeze, asthma, hay fever) were reported while the adjacent loci show slight (but largely non-statistically significant) differences, presumably reflective of linkage disequilibrium (allelic association) across the region. A novel association between bronchitis and a non-synonymous functional ERBB1 SNP, rs2227983 (aka epidermal growth factor receptor:R497K, R521K) is also reported and evidence presented of interaction between MUC5AC and ERBB1 and between MUC5AC and IL1RN with respect to bronchitis. The ERBB1 result suggests a clear mechanism for a biological interaction in which the allelic variants of epidermal growth factor receptor differentially affect mucin expression. CONCLUSIONS: The MUC5AC association and the interactions with inflammatory mediators suggest that genetically determined differences in MUC5AC expression alter susceptibility to respiratory disease.

Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness.

BACKGROUND: Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer. OBJECTIVE: To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval. DESIGN: Markov microsimulation model. DATA SOURCES: Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature. TARGET POPULATION: U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4. TIME HORIZON: Lifetime. PERSPECTIVE: National health payer. INTERVENTION: Mammography annually, biennially, or every 3 to 4 years or no mammography. OUTCOME MEASURES: Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer. RESULTS OF BASE-CASE ANALYSIS: Biennial mammography cost less than $100,000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50,000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density. RESULTS OF SENSITIVITY ANALYSIS: Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered. LIMITATION: Results are not applicable to carriers of BRCA1 or BRCA2 mutations. CONCLUSION: Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening. PRIMARY FUNDING SOURCE: Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium.