Differences in Perceived Stress During the COVID-19 Pandemic Among Military Dental Postgraduate Residents.

INTRODUCTION: In military training settings, stress can improve focus and motivation fostering effective learning. However, high perceived stress can be debilitating resulting in poor learning and clinical errors. Multiple studies have focused on medical residency stress; but there has been minimal focus on dental residents and even less on the impact of the unique stressors from the COVID-19 pandemic. The objectives of this study were to determine the impact of the COVID-19 pandemic on perceived stress of residents in a military dental residency training program and explore the association among perceived stress and anxiety, depression, sleep quality, and social support. MATERIALS AND METHODS: Dental residents (N = 20) at the Naval Postgraduate Dental School participated in this study. Residents were assessed via self-report measures quarterly from March 2020 through June 2021. The assessment included measures of anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS), fatigue (FSI), and social support (DUKE-SSQ). RESULTS: Before the pandemic shutdown, 60% of participants reported high perceived stress. These residents reported an initial decrease in symptoms of anxiety, depression, and fatigue compared to residents reporting low pre-pandemic perceived stress but returned to baseline levels post-shutdown. Additionally, the high stress participants reported lower social support. CONCLUSIONS: Based on pre-pandemic perceived stress, participants responded differently to the impact of the pandemic shutdown. The low baseline stress participants may have a more robust sense of grit and resilience. These findings suggest that postgraduate dental training programs should integrate coping skills training opportunities, especially for residents reporting high perceived stress before residency.

Characteristics of peak exposure to black carbon pollution in school, commute and home environments among school children in an urban community.

Although real-time personal exposure monitoring devices have the ability to capture a wealth of data regarding fluctuations in pollutant levels, only a few studies have defined 'peaks' in black carbon (BC) exposure utilizing high-resolution data. Furthermore, studies to assess and characterize various features of peak exposure are very limited especially among children. A better understanding of characteristics of BC peak exposure would improve our understanding of health risks associated with BC. By capturing personal BC exposure at 5-min intervals using a real-time monitor during 24-hr monitoring periods among children in New York City (NYC), we defined 'peak characteristics' in 4 different ways across three major microenvironments (school vs. commute vs. home): 1) mean concentrations of BC across the 3 microenvironments, 2) 'peak duration' or time spent above the peak threshold (i.e., ≥1.5 µg/m3), 3) 'peak intensity' or the rate of exposure, defined as time spent above the threshold within each microenvironment divided by the total time spent in the microenvironment and 4) a novel metric of 'peak variability', defined as frequency of peaks (i.e., data points with +50% and -50% changes compared to the preceding and the subsequent data points), divided by the total time spent in the microenvironment. While peak duration was greatest at home, the intensity of peak exposure was greatest during commute hours, despite the short time spent in commute (p < 0.05). Peak variability was highest during commute, yet lowest in home environments (p < 0.05), particularly during non-sleeping hours. Children residing in a high-density urban setting spent on average, 5.4 hr per day above our peak threshold (≥1.5 µg/m3) in their everyday environments. Policies that limit children's exposure during high traffic periods and improved efforts to increase the number of vehicles using clean air technology could reduce the intensity of peaks and peak variability in children's BC exposure.

Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021.

On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).

Manganese redox buffering limits arsenic release from contaminated sediments, Union Lake, New Jersey.

The sediments of Union Lake in Southern New Jersey are contaminated with arsenic released from the Vineland Chemical Company Superfund site 11 km upstream. Seasonal anoxia has been shown to release arsenic from sediments to similar lakes; this process was hypothesized as a major arsenic source to Union Lake. Data indicate, however, that releases of arsenic to bottom waters from the sediments or from pore waters within the sediments are relatively minor: bottom water arsenic concentrations reached ~30 ppb (~12 µM) at most, representing <13% of the dissolved arsenic content of the lake. Manganese concentrations increase more quickly and to higher levels than arsenic and iron concentrations; maximum [Mn]= ~13 ppm (~250 µM), maximum [Fe] = ~6 ppm (~120 µM). Incubation experiments support the hypothesis that manganese acts as a redox buffer and prevents large arsenic releases. Under the observed conditions, little of the arsenic in the water column is from contaminated sediment. This study also suggests that arsenic release from sediment to lake water may be more important in lakes that remain anoxic more continuously.

Effect of oxalic acid treatment on sediment arsenic concentrations and lability under reducing conditions.

Oxalic acid enhances arsenic (As) mobilization by dissolving As host minerals and competing for sorption sites. Oxalic acid amendments thus could potentially improve the efficiency of widely used pump-and-treat (P&T) remediation. This study investigates the effectiveness of oxalic acid on As mobilization from contaminated sediments with different As input sources and redox conditions, and examines whether residual sediment As after oxalic acid treatment can still be reductively mobilized. Batch extraction, column, and microcosm experiments were performed in the laboratory using sediments from the Dover Municipal Landfill and the Vineland Chemical Company Superfund sites. Oxalic acid mobilized As from both Dover and Vineland sediments, although the efficiency rates were different. The residual As in both Dover and Vineland sediments after oxalic acid treatment was less vulnerable to microbial reduction than before the treatment. Oxalic acid could thus improve the efficiency of P&T. X-ray absorption spectroscopy analysis indicated that the Vineland sediment samples still contained reactive Fe(III) minerals after oxalic acid treatment, and thus released more As into solution under reducing conditions than the treated Dover samples. Therefore, the efficacy of enhanced P&T must consider sediment Fe mineralogy when evaluating its overall potential for remediating groundwater As.

Traffic-related air pollutants and exhaled markers of airway inflammation and oxidative stress in New York City adolescents.

Exposures to ambient diesel exhaust particles have been associated with respiratory symptoms and asthma exacerbations in children; however, epidemiologic evidence linking short-term exposure to ambient diesel exhaust particles with airway inflammation is limited. We conducted a panel study with asthmatic and nonasthmatic adolescents to characterize associations between ambient diesel exhaust particle exposures and exhaled biological markers of airway inflammation and oxidative stress. Over four weeks, exhaled breath condensate was collected twice a week from 18 asthmatics and 18 nonasthmatics (ages 14-19 years) attending two New York City schools and analyzed for pH and 8-isoprostane as indicators of airway inflammation and oxidative stress, respectively. Air concentrations of black carbon, a diesel exhaust particle indicator, were measured outside schools. Air measurements of nitrogen dioxide, ozone, and fine particulate matter were obtained for the closest central monitoring sites. Relationships between ambient pollutants and exhaled biomarkers were characterized using mixed effects models. Among all subjects, increases in 1- to 5-day averages of black carbon were associated with decreases in exhaled breath condensate pH, indicating increased airway inflammation, and increases in 8-isoprostane, indicating increased oxidative stress. Increases in 1- to 5-day averages of nitrogen dioxide were associated with increases in 8-isoprostane. Ozone and fine particulate matter were inconsistently associated with exhaled biomarkers. Associations did not differ between asthmatics and nonasthmatics. The findings indicate that short-term exposure to traffic-related air pollutants may increase airway inflammation and/or oxidative stress in urban youth and provide mechanistic support for associations documented between traffic-related pollutant exposures and respiratory morbidity.

Traffic-related particulate matter and acute respiratory symptoms among New York City area adolescents.

BACKGROUND: Exposure to traffic-related particulate matter (PM) has been associated with adverse respiratory health outcomes in children. Diesel exhaust particles (DEPs) are a local driver of urban fine PM [aerodynamic diameter < or = 2.5 microm (PM(2.5))]; however, evidence linking ambient DEP exposure to acute respiratory symptoms is relatively sparse, and susceptibilities of urban and asthmatic children are inadequately characterized. OBJECTIVES: We examined associations of daily ambient black carbon (BC) concentrations, a DEP indicator, with daily respiratory symptoms among asthmatic and nonasthmatic adolescents in New York City (NYC) and a nearby suburban community. METHODS: BC and PM(2.5) were monitored continuously outside three NYC high schools and one suburban high school for 4-6 weeks, and daily symptom data were obtained from 249 subjects (57 asthmatics, 192 nonasthmatics) using diaries. Associations between pollutants and symptoms were characterized using multilevel generalized linear mixed models, and modification by urban residence and asthma status were examined. RESULTS: Increases in BC were associated with increased wheeze, shortness of breath, and chest tightness. Multiple lags of nitrogen dioxide (NO(2)) exposure were associated with symptoms. For several symptoms, associations with BC and NO(2) were significantly larger in magnitude among urban subjects and asthmatics compared with suburban subjects and nonasthmatics, respectively. PM(2.5) was not consistently associated with increases in symptoms. CONCLUSIONS: Acute exposures to traffic-related pollutants such as DEPs and/or NO(2) may contribute to increased respiratory morbidity among adolescents, and urban residents and asthmatics may be at increased risk. The findings provide support for developing additional strategies to reduce diesel emissions further, especially in populations susceptible because of environment or underlying respiratory disease.

Airborne particulate metals in the New York City subway: a pilot study to assess the potential for health impacts.

A prior study in New York City observed that airborne concentrations of three metals found in steel - iron, manganese, and chromium - are more than 100 times higher in the subway system than in aboveground air. To investigate the potential for health effects of exposure at these levels, we conducted a pilot study of subway workers comparing personal exposures to steel dust with biomarkers of metal exposure, oxidative stress, and DNA damage in blood and urine samples. Workers wore a personal air sampler operating at 4L/m for one to three work shifts with blood and urine samples collected at the end of the final shift. We found that PM(2.5) exposures varied among subway workers on the basis of job title and job activity. The subway workers' mean time-weighted PM(2.5) exposure was 52 microg/m3, with a median of 27 microg/m3, and a range of 6-469 microg/m3. The observed concentrations of PM(2.5), iron, manganese, and chromium fell well below occupational standards. Biomarker concentrations among the 39 subway workers were compared with a group of 11 bus drivers, and a group of 25 suburban office workers. Concentrations of DNA-protein crosslinks and chromium in plasma were significantly higher in subway workers than in bus drivers, but no significant difference was observed for these biomarkers between subway workers and office workers. Urinary isoprostane concentrations were significantly correlated with the number of years working in the subway system, and were detected at higher, though not significantly higher, concentrations in subway workers than in bus drivers or office workers. At the group level, there was no consistent pattern of biomarker concentrations among subway workers significantly exceeding those of the bus drivers and office workers. At the individual level, steel dust exposure was not correlated with any of the biomarkers measured.

Spatial and Temporal Variations in Traffic-related Particulate Matter at New York City High Schools.

Relatively little is known about exposures to traffic-related particulate matter at schools located in dense urban areas. The purpose of this study was to examine the influences of diesel traffic proximity and intensity on ambient concentrations of fine particulate matter (PM(2.5)) and black carbon (BC), an indicator of diesel exhaust particles, at New York City (NYC) high schools. Outdoor PM(2.5) and BC were monitored continuously for 4-6 weeks at each of 3 NYC schools and 1 suburban school located 20 kilometers upwind of the city. Traffic count data were obtained using an automated traffic counter or video camera. BC concentrations were 2-3 fold higher at urban schools compared with the suburban school, and among the 3 urban schools, BC concentrations were higher at schools located adjacent to highways. PM(2.5) concentrations were significantly higher at urban schools than at the suburban school, but concentrations did not vary significantly among urban schools. Both hourly average counts of trucks and buses and meteorological factors such as wind direction, wind speed, and humidity were significantly associated with hourly average ambient BC and PM(2.5) concentrations in multivariate regression models. An increase of 443 trucks/buses per hour was associated with a 0.62 mug/m(3) increase in hourly average BC at a NYC school located adjacent to a major interstate highway. Car traffic counts were not associated with BC. The results suggest that local diesel vehicle traffic may be important sources of airborne fine particles in dense urban areas and consequently may contribute to local variations in PM(2.5) concentrations. In urban areas with higher levels of diesel traffic, local, neighborhood-scale monitoring of pollutants such as BC, which compared to PM(2.5), is a more specific indicator of diesel exhaust particles, may more accurately represent population exposures.

Steel dust in the New York City subway system as a source of manganese, chromium, and iron exposures for transit workers.

The United States Clean Air Act Amendments of 1990 reflected increasing concern about potential effects of low-level airborne metal exposure on a wide array of illnesses. Here we summarize results demonstrating that the New York City (NYC) subway system provides an important microenvironment for metal exposures for NYC commuters and subway workers and also describe an ongoing pilot study of NYC transit workers' exposure to steel dust. Results from the TEACH (Toxic Exposure Assessment, a Columbia and Harvard) study in 1999 of 41 high-school students strongly suggest that elevated levels of iron, manganese, and chromium in personal air samples were due to exposure to steel dust in the NYC subway. Airborne concentrations of these three metals associated with fine particulate matter were observed to be more than 100 times greater in the subway environment than in home indoor or outdoor settings in NYC. While there are currently no known health effects at the airborne levels observed in the subway system, the primary aim of the ongoing pilot study is to ascertain whether the levels of these metals in the subway air affect concentrations of these metals or related metabolites in the blood or urine of exposed transit workers, who due to their job activities could plausibly have appreciably higher exposures than typical commuters. The study design involves recruitment of 40 transit workers representing a large range in expected exposures to steel dust, the collection of personal air samples of fine particulate matter, and the collection of blood and urine samples from each monitored transit worker.

A rapid and precise procedure for Pb isotopes in whole blood by Fe co-precipitation and MC-ICPMS analysis.

Elevated Pb levels in humans through environmental exposure are a significant health concern requiring scientific study of the sources of, and physiological response to this toxin. This requires a simple and precise method for measuring radiogenic Pb isotopes and Pb levels in blood. Presented here is a combination of methods for separation and analysis of Pb previously used predominantly for geologic samples. This includes separation of Pb from the complex matrix of blood samples using an Fe co-precipitation method, followed by isotopic analysis by multi-collector inductively coupled plasma mass spectrometry. Evaluation of the efficacy of this procedure shows that the precision of sample preparations as measured by % difference between the (207)Pb/(206)Pb of duplicate analyses averages 0.064% (n = 48). Using the same preparation and analysis techniques to measure Pb concentrations by isotope dilution resulted in a reproducibility of better than 6%. The method was successfully used to measure uptake of ingested soil Pb in a study of the bioavailability of Pb in contaminated soils.

Elevated airborne exposures of teenagers to manganese, chromium, and iron from steel dust and New York City's subway system.

There is increasing interest in potential health effects of airborne exposures to hazardous air pollutants at relatively low levels. This study focuses on sources, levels, and exposure pathways of manganese, chromium, and iron among inner-city high school students in New York City (NYC) and the contribution of subways. Samples of fine particulate matter (PM2.5) were collected during winter and summer over 48 h periods in a variety of settings including inside homes, outdoors, and personal samples (i.e., sampling packs carried by subjects). PM2.5 samples were also collected in the NYC subway system. For NYC, personal samples had significantly higher concentrations of iron, manganese, and chromium than did home indoor and ambient samples. The ratios and strong correlations between pairs of elements suggested steel dust as the source of these metals for a large subset of the personal samples. Time-activity data suggested NYC subways as a likely source of these elevated personal metals. In duplicate PM2.5 samples that integrated 8 h of underground subway exposure, iron, manganese, and chromium levels (>2 orders of magnitude above ambient levels) and their ratios were consistent with the elevated personal exposures. Steel dust in the NYC subway system was the dominant source of airborne exposures to iron, manganese, and chromium for many young people enrolled in this study, with the same results expected for other NYC subway riders who do not have occupational exposures to these metals. However, there are currently no known health effects at the exposure levels observed in this study.

Association of heterozygous hemochromatosis C282Y gene mutation with hand osteoarthritis.

OBJECTIVE: To determine if there is an association between radiographic osteoarthritis (OA) of the hand and the presence of hemochromatosis HFE gene mutations. METHODS: One hundred seventy-six patients with radiographic OA of the hand were randomly selected from an academic rheumatology practice. We measured serum transferrin saturation (TS) and ferritin levels, and genotyped for the presence of the 2 common HFE mutations, C282Y and H63D. The prevalences of HFE mutations in these patients were compared to those in a hemochromatosis screening study from the same primary care patient base. RESULTS: There was a significantly increased prevalence of the C282Y mutation in the OA population compared to the unselected controls (12.5 vs 7.8%; p = 0.029). The prevalence of C282Y in OA was higher among older patients: 15.75% in the group older than 65 years versus 4.08% in the younger group. The mean TS level was higher among OA patients who were heterozygous for C282Y compared to those who lacked both HFE mutations (35.75 vs 25.93%; p < 0.0001). This difference was also found in the general population. CONCLUSION: This is the first report to show an increased risk of OA among individuals who are heterozygous for the C282Y HFE mutation. The increase in this mutation in patients older than 65 suggests that this is associated with a late onset subset of OA. If this association is substantiated by larger randomized controlled studies, it could have major therapeutic implications in the development of specific therapy directed at individuals heterozygous for C282Y HFE mutation.

Twentieth Century Atmospheric Metal Fluxes into Central Park Lake, New York City.

It is generally assumed that declining atmospheric lead concentrations in urban centers during the 1970s and 1980s were due almost entirely to the progressive introduction of unleaded gasoline. However, most environmental data are from monitoring programs that began only two to three decades ago, which limits their usefulness. Here, trace metal and radionuclide data from sediment cores in Central Park Lake provide a record of atmospheric pollutant deposition in New York City through the 20th century, which suggests that leaded gasoline combustion was not the dominant source of atmospheric lead for NYC. Lead deposition rates, normalized to known Pb-210 atmospheric influxes, were extremely high, reaching maximum values (>70 µg cm(-2) yr(-1)) from the late 1930s to early 1960s, decades before maximum emissions from combustion of leaded gasoline. Temporal trends of lead, zinc, and tin deposition derived from the lake sediments closely resemble the history of solid waste incineration in New York City. Furthermore, widespread use of solid waste incinerators in the United States and Europe over the last century suggests that solid waste incineration may have provided the dominant source of atmospheric lead and several other metals to many urban centers.