Cardiopulmonary Health Research Articles

Physico-Chemical and Biological Characteristics of Faecal Sludge in Pit Latrines with Depth

There is limited information about the characteristics of faecal sludges in ordinary pit latrines. Knowledge of the physico-chemical and biological characteristics of pit sludge from different layers of the pit apart from providing an indication of the nature of pit contents endeavoured to provide information and decision support for managing pit latrines during their normal lifespan. Therefore, this paper was aimed at investigating the physico-chemical and biological characteristics of pit sludge samples to equip latrine owners with environmental and health implications of this sludge. Legislation that establishes regulations specifically for the treatment and discharge, enduse, or disposal of faecal sludge is therefore essential. Thus, faecal sludges sampled from ten (10) pit latrines were subjected to laboratory analyses with particular reference to selected parameters. From the study, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total solids (TS), moisture content, suspended solids (SS) and volatile solids (VS) showed decreasing trend throughout as the pit depth increased. Temperature presented double scenarios, increasing initially and decreasing afterwards with the highest values within 0.4m to 0.6m pit depth in all the pit latrines. Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

Physico-Chemical and Biological Characteristics of Faecal Sludge in Pit Latrines with Depth

There is limited information about the characteristics of faecal sludges in ordinary pit latrines. Knowledge of the physico-chemical and biological characteristics of pit sludge from different layers of the pit apart from providing an indication of the nature of pit contents endeavoured to provide information and decision support for managing pit latrines during their normal lifespan. Therefore, this paper was aimed at investigating the physico-chemical and biological characteristics of pit sludge samples to equip latrine owners with environmental and health implications of this sludge. Legislation that establishes regulations specifically for the treatment and discharge, enduse, or disposal of faecal sludge is therefore essential. Thus, faecal sludges sampled from ten (10) pit latrines were subjected to laboratory analyses with particular reference to selected parameters. From the study, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total solids (TS), moisture content, suspended solids (SS) and volatile solids (VS) showed decreasing trend throughout as the pit depth increased. Temperature presented double scenarios, increasing initially and decreasing afterwards with the highest values within 0.4m to 0.6m pit depth in all the pit latrines. Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

A Noncontact Ballistocardiography-Based IoMT System for Cardiopulmonary Health Monitoring of Discharged COVID-19 Patients.

We developed a ballistocardiography (BCG)-based Internet-of-Medical-Things (IoMT) system for remote monitoring of cardiopulmonary health. The system composes of BCG sensor, edge node, and cloud platform. To improve computational efficiency and system stability, the system adopted collaborative computing between edge nodes and cloud platforms. Edge nodes undertake signal processing tasks, namely approximate entropy for signal quality assessment, a lifting wavelet scheme for separating the BCG and respiration signal, and the lightweight BCG and respiration signal peaks detection. Heart rate variability (HRV), respiratory rate variability (RRV) analysis and other intelligent computing are performed on cloud platform. In experiments with 25 participants, the proposed method achieved a mean absolute error (MAE)±standard deviation of absolute error (SDAE) of 9.6±8.2 ms for heartbeat intervals detection, and a MAE±SDAE of 22.4±31.1 ms for respiration intervals detection. To study the recovery of cardiopulmonary function in patients with coronavirus disease 2019 (COVID-19), this study recruited 186 discharged patients with COVID-19 and 186 control volunteers. The results indicate that the recovery performance of the respiratory rhythm is better than the heart rhythm among discharged patients with COVID-19. This reminds the patients to be aware of the risk of cardiovascular disease after recovering from COVID-19. Therefore, our remote monitoring system has the ability to play a major role in the follow up and management of discharged patients with COVID-19.

Malondialdehyde in Dried Blood Spots: A Biomarker of Systemic Lipid Peroxidation Linked to Cardiopulmonary Effects

Background: Few systemic oxidative biomarkers have been validated for use in resource-limited settings (e.g., rural Africa), where blood collection facilities are lacking. This study aims to evaluate the potential of malondialdehyde (MDA) in dried blood spots (DBS) as a convenient biomarker of cardiopulmonary effects. Methods: We conducted a cross-validation comparison of matched capillary DBS, plasma, and whole venous blood collected from nine healthy volunteers for the measurement of total MDA (free + conjugated) and C-reactive protein (CRP), a well-established biomarker of systemic inflammation. A field study was then conducted in a population of 441 rural Senegalese women facing routine exposure to severe household air pollution, to examine longitudinal associations of MDA and CRP levels with cardiopulmonary health outcomes and risk factors. Findings: In the cross-validation study, CRP levels were strongly correlated across DBS, plasma, and whole blood samples. MDA levels were similarly correlated across DBS and whole blood, and were 1~2 orders of magnitude lower in plasma, suggesting that DBS MDA may reflect total oxidation levels in intracellular and extracellular compartments. In the field study, we observed significantly higher MDA levels in women with a history of cardiovascular disease or secondhand smoke exposure. An interquartile range increase in MDA concentration was associated with 0·99% (95% CI: 0·02 – 1·96%) and 22% (95% CI: -2 – 51%) increases in systolic blood pressure and self-reported incidence of chest tightness, respectively. CRP levels were not similarly associated with these outcomes or risk factors. Interpretation: Results support the use of convenient DBS measures of MDA as a biomarker for cardiopulmonary health risk. Funding: International Initiative for Impact Evaluation, German Corporation for International Cooperation GmbH, German Federal Ministry of Education and Research, and Duke University’s Energy Initiative. Declaration of Interest: None to declare. Ethical Approval: This study consisted of cross-validation and field-vacomponents, both of which were approved by the institutional review board of Duke University.

Differential Cardiopulmonary Health Impacts of Local and Long-Range Transport of Wildfire Smoke.

We estimated cardiopulmonary morbidity and mortality associated with wildfire smoke (WFS) fine particulate matter (PM2.5) in the Front Range of Colorado from 2010 to 2015. To estimate WFS PM2.5, we developed a daily kriged PM2.5 surface at a 15 × 15 km resolution based on the Environmental Protection Agency Air Quality System monitors for the western United States; we subtracted out local seasonal‐average PM2.5 of nonsmoky days, identified using satellite‐based smoke plume estimates, from the local daily estimated PM2.5 if smoke was identified by National Oceanic and Atmospheric Administration’s Hazard Mapping System. We implemented time‐stratified case‐crossover analyses to estimate the effect of a 10 µg/m3 increase in WFS PM2.5 with cardiopulmonary hospitalizations and deaths using single and distributed lag models for lags 0–5 and distinct annual impacts based on local and long‐range smoke during 2012, and long‐range transport of smoke in 2015. A 10 µg/m3 increase in WFS was associated with all respiratory, asthma, and chronic obstructive pulmonary disease hospitalizations for lag day 3 and hospitalizations for ischemic heart disease at lag days 2 and 3. Cardiac arrest deaths were associated with WFS PM2.5 at lag day 0. For 2012 local wildfires, asthma hospitalizations had an inverse association with WFS PM2.5 (OR: 0.716, 95% CI: 0.517–0.993), but a positive association with WFS PM2.5 during the 2015 long‐range transport event (OR: 1.455, 95% CI: 1.093–1.939). Cardiovascular mortality was associated with the 2012 long‐range transport event (OR: 1.478, 95% CI: 1.124–1.944).

Angiotensin II type 1 receptor mediates pulmonary hypertension and right ventricular remodeling induced by inhaled nicotine.

Use of electronic cigarettes is rapidly increasing among youth and young adults, but little is known regarding the long-term cardiopulmonary health impacts of these nicotine-containing devices. Our group has previously demonstrated that chronic, inhaled nicotine induces pulmonary hypertension (PH) and right ventricular (RV) remodeling in mice. These changes were associated with upregulated RV angiotensin-converting enzyme (ACE). Angiotensin II receptor blockers (ARBs) have been shown to reverse cigarette smoking-induced PH in rats. ACE inhibitor and ARB use in a large retrospective cohort of patients with PH is associated with improved survival. Here, we utilized losartan (an ARB specific for angiotensin II type 1 receptor) to further explore nicotine-induced PH. Male C57BL/6 mice received nicotine vapor for 12 h/day, and exposure was assessed using serum cotinine to achieve levels comparable to human smokers or electronic cigarette users. Mice were exposed to nicotine for 8 wk and a subset was treated with losartan via an osmotic minipump. Cardiac function was assessed using echocardiography and catheterization. Although nicotine exposure increased angiotensin II in the RV and lung, this finding was nonsignificant. Chronic, inhaled nicotine significantly increased RV systolic pressure and RV free wall thickness versus air control. These parameters were significantly lower in mice receiving both nicotine and losartan. Nicotine significantly increased RV internal diameter, with no differences seen between the nicotine and nicotine-losartan group. Neither nicotine nor losartan affected left ventricular structure or function. These findings provide the first evidence that antagonism of the angiotensin II type 1 receptor can ameliorate chronic, inhaled nicotine-induced PH and RV remodeling.NEW & NOTEWORTHY Chronic, inhaled nicotine causes pulmonary hypertension and right ventricular remodeling in mice. Treatment with losartan, an angiotensin II type 1 receptor antagonist, ameliorates nicotine-induced pulmonary hypertension and right ventricular remodeling. This novel finding provides preclinical evidence for the use of renin-angiotensin system-based therapies in the treatment of pulmonary hypertension, particularly in patients with a history of tobacco-product use.

E-Cigarettes and Cardiopulmonary Health.

E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.

Health-Promoting Behaviors, Health Literacy, and Levels of Knowledge about Smoking-Related Diseases among Smokers and Non-smokers: A Cross-Sectional Study

BackgroundFor generations, cigarette smoking has presented an important public health concern. This study aimed to compare the health-promoting behavior, exercise capacity, physical activity level, health literacy, and knowledge level of smoking-related diseases between smokers and non-smokers.MethodsThe study included 71 smokers (mean age, 32.69±8.55 years) and 72 non-smokers (mean age, 31.88±9.94 years) between the ages of 20 and 60 years. Assessments included a 6-minute walking test (6MWT), Godin Leisure-Time Physical Activity Questionnaire, Health-Promoting Lifestyle Profile II (HPLP-II), Cardiovascular Risk Factors Knowledge Level Scale (CARRF-KL), Asthma/COPD Awareness Questionnaire, the World Health Organization Quality of Life-Bref questionnaire (WHOQoL-Bref [TR]), and Health Literacy Questionnaire (HLQ).ResultsThe results from the study show that the number of coronary artery disease risk factors measured significantly higher among the smoker group members when compared to that of the non-smoker group members (p=0.001). Smokers had significantly lower %6MWT distance than non-smokers (84.83±4.72 and 93.45±7.16, respectively; p<0.05). However, there were no significant differences between the smokers and non-smokers in terms of physical activity, CARRF-KL, HLQ, WHOQoL-Bref, and HPLP-II subscales or total scores (p>0.05). Additionally, while only forty-one smokers (57.7%) were active, 48 of the non-smoker group was active (66.7%).ConclusionSmokers suffer greater negative effects to their exercise capacity in comparison to non-smokers. Although smokers and non-smokers have similar levels of health literacy and similar levels of knowledge about cardiovascular disease risk factors and obstructive lung diseases, health professionals could continue to further increase individuals’ awareness of smoking-related risk factors and continue to emphasize the importance of physical activity and exercise for protecting cardiopulmonary health.

Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily nursing: A protocol for systematic review and meta-analysis.

Objectives:To assess the effect of aerobic exercise (AE) on cognition function in people with schizophrenia (SZ) during daily nursing.MethodsThe literature search will be conducted via PubMed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence intervals (CIs) will be adopted to calculate the association between AE and cognitive function in patients with SZ. Publication bias will be performed by Begg test. When there is publication bias, “cut-and-fill method” will be adopted to adjust publication bias. Sensitivity analysis will be used to test the stability of the result. When the heterogeneity is large (I2 ≥ 50%), meta regression will be used to explore the source of inter-study heterogeneity. When the heterogeneity is large (I2 ≥ 50%) and the results are statistically significant (P < .05), age, sex, duration of disease, duration of intervention, amount of exercise per week, improvement of cardiopulmonary health, and other factors will be sub-analyzed.ConclusionThis meta-analysis will evaluate the impact of aerobic exercise on cognitive function in patients with SZ during daily nursing on the basis of existing evidence.OSF registration number10.17605/OSF.IO/C8ABX

Cell cycle arrest of human bronchial epithelial cells modulated by differences in chemical components of particulate matter.

There is increasing interest in understanding the role of airborne chemical components in modulating the cell cycle of human bronchial epithelial (HBE) cells that is associated with burden of cardiopulmonary disease. To address this need, our study collected ambient PM10 (particles with aerodynamic diameter less than or equal to 10 μm) and PM2.5 (particles with aerodynamic diameter less than or equal to 2.5 μm) across four sampling sites in Beijing during the year of 2015. Chemical components including organic carbon (OC), elemental carbon (EC), polycyclic aromatic hydrocarbons (PAHs), metals and water soluble ions were determined. Spearman's rank-order correlation was performed to examine the associations between chemical components in ambient particles and cell cycle distributions with p-values adjusted by Bonferroni methodology. Our results demonstrated the significant associations between certain chemical compositions (i.e., PAHs, EC, As and Ni) and percentages of HBE cells in G0/G1 and G1/G2 phases, respectively. Our results highlighted the need to reduce the specific toxins (e.g., PAHs, EC, As and Ni) from ambient particles to protect cardiopulmonary health associated with air pollution. Future study may focus on illustrating the mechanism of certain chemical compositions in altering the cell cycle in HBE cells.

Effects of a Household Air Pollution Intervention with Liquefied Petroleum Gas on Cardiopulmonary Outcomes in Peru. A Randomized Controlled Trial.

Rationale: Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels. Objectives: We sought to determine if a household air pollution intervention with liquefied petroleum gas (LPG) improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru. Methods: We conducted a randomized controlled field trial in 180 women aged 25-64 years living in rural Puno, Peru. Intervention women received an LPG stove, continuous fuel delivery for 1 year, education, and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households. Measurements and Main Results: We measured blood pressure, peak expiratory flow (PEF), and respiratory symptoms using the St. George's Respiratory Questionnaire at baseline and at 3-4 visits after randomization. Intervention women used their LPG stove exclusively for 98% of days. We did not find differences in average postrandomization systolic blood pressure (intervention - control 0.7 mm Hg; 95% confidence interval, -2.1 to 3.4), diastolic blood pressure (0.3 mm Hg; -1.5 to 2.0), prebronchodilator peak expiratory flow/height2 (0.14 L/s/m2; -0.02 to 0.29), postbronchodilator peak expiratory flow/height2 (0.11 L/s/m2; -0.05 to 0.27), or St. George's Respiratory Questionnaire total score (-1.4; -3.9 to 1.2) over 1 year in intention-to-treat analysis. There were no reported harms related to the intervention. Conclusions: We did not find evidence of a difference in blood pressure, lung function, or respiratory symptoms during the year-long intervention with LPG. Clinical trial registered with www.clinicaltrials.gov (NCT02994680).

Air Pollution-Related Health Impacts on Individuals Experiencing Homelessness: Environmental Justice and Health Vulnerability in Salt Lake County, Utah.

Experiences of homelessness, although widely varied, are characterized by extensive time in public spaces, often outdoors. However, there has been little empirical research about the ways in which environmental factors affect individuals experiencing homelessness (IEHs). Therefore, the purpose of this study was to use an environmental justice approach to understand how cardiopulmonary health of IEHs is affected by episodic poor air quality in Salt Lake County. It was hypothesized that people who had experienced unsheltered homelessness and those who had been experiencing homelessness for longer periods of time would report greater health difficulties from poor air quality exposure. Through a combination of in-person semistructured interviews with IEHs (n = 138) and access to corresponding state-based service provider databases, researchers examined both overall descriptives of and relationships between types (sheltered and unsheltered) and duration (chronic and nonchronic) of homelessness. More than 61% of IEHs reported physical reactions to air pollution, 37% reported air pollution-related emotional stress, and more than 89% had sought medical attention for a condition related to air pollution. Findings indicate that while IEHs report a number of health effects related to poor air quality, there were no significant differences between individuals based on either sheltered status or duration of their experiences of homelessness. This study provides an initial empirical inquiry to understand how environmental disamenities negatively influence IEHs, as well as noting that sheltered status and duration of homelessness are less impactful than originally hypothesized.

Blood pressure, spirometry, and indoor fine particulate matter in homes heated by wood stoves: pre-intervention results from the EldersAIR randomized trial

Background/Aim: Household air pollution from burning biomass fuels can lead to high concentrations of indoor fine particulate matter (PM2.5) and is associated with many adverse health outcomes. Household heating using wood stoves is common in rural American Indian (AI) communities; however, research on the associations between PM2.5 and health in such communities is limited. Our aims were to assess PM2.5 concentrations and indicators of cardiopulmonary health in older AI adults who use wood stoves for heating, and to evaluate the feasibility of interventions (i.e., education and air filtration) that lower household levels of PM2.5.Methods: EldersAIR was a three-arm pre-post randomized trial in wood stove households from a Northern Rocky Mountain Reservation (n=68) and a Southwestern United States Reservation (n=76). Here, we present pre-intervention concentrations of indoor PM2.5 measured over 2-day sampling periods and measures of peripheral systolic and diastolic blood pressure (SBP; DBP), forced vital capacity (FVC), and forced expiratory volume (FEV1) in older adults.Results: In preliminary analyses, the mean indoor PM2.5 concentration was 38 µg/m3 (standard deviation [sd]=85, median=10) across all homes; 43% of homes had mean PM2.5 concentrations &gt;= 25 µg/m3. Participants were 69 years of age on average (sd=9) with mean body mass index of 30 kg/m2 (sd=6). Participants had mean SBP of 138 mmHg (sd=20) and mean DBP of 77 mmHg (sd=13); 46% had stage-2 hypertension (SBP&gt;=140 or DBP&gt;=90). Mean percent-predicted FVC for participants was 79% (sd=16) and mean percent-predicted FEV1 was 85% (sd=20); 30% had FEV1/FVC ratio &lt; 0.7 or percent-predicted FEV1 &lt; 75%.Conclusions: We observed elevated PM2.5 concentrations inside rural AI homes that used wood stoves for heating. Participants had high SBP and low percent-predicted FVC and FEV1. Our findings highlight the need for interventions that reduce indoor air pollution in an effort to improve health in AI communities.

Air Quality Improvement and Brain Health: evidence from the WHIMS-ECHO study

Background/AimAir quality (AQ) improvement has benefited cardiopulmonary health and reduced mortality. However, whether and how brain health of older people benefit from AQ improvement is unclear.MethodsWe examined associations between AQ improvement and brain health reflected by Episodic memory (EM) trajectories in the US-based Women’s Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO) cohort (N=2042, aged 74-92 in 2008). EM was measured annually (2008-18) using immediate recall total correct (3-trials) in telephone-based California Verbal Learning Test. AQ improvement was defined by reduction in 3-year average exposures from remote period 10 years earlier to recent years prior to ECHO inception. PM2.5 (particulate matter &lt;2.5μm) and NO2 (proxy of traffic-related pollutants) exposures were estimated from validated regionalized universal kriging models. Considering heterogeneity in EM decline, we stratified the cohort by baseline age (≤80 vs. 80+). Latent-class mixed models were used to classify EM trajectories and examine associations with exposure, adjusting for sociodemographic, lifestyle and clinical covariates, and time-varying propensity scores to account for selective attrition.ResultsAQ improved significantly over ~ 10 years with exposure reduction in both PM2.5 (13.3±2.7µg/m3 to 10.6±2.0µg/m3; p&lt;0.001) and NO2 (15.8±7.3ppb to 10.5±5.0ppb; p&lt;0.001). In each subcohort, we identified two latent EM trajectories. Among those aged 80+ (N=1206), women with no apparent decline (30% subcohort) had improved EM function over time if residing in locations with greater exposure reduction (PM2.5: β=0.152/year, per inter-quartile-range [IQR]=1.78µg/m3, p=0.006; NO2: β=0.144/year, per IQR=3.96ppm, p=0.03), equivalent to slowing cognitive aging by 1.7-1.8 years. Such presumed benefits were not observed in those aged 80+ with steady decline (70% subcohort). No associations were found among women ≤80 years (N=836), regardless their respective EM trajectories.ConclusionsImproved AQ, especially PM2.5, was associated with better maintenance of EM function over time in the women aged 80+ with no apparent cognitive aging.

Fine Particulate Matter and Polycystic Ovary Morphology: A Retrospective Investigation of Electronic Medical Records and PM2.5

Background/Aim: Air pollution is widely known to have adverse cardiopulmonary health impacts, and research has only recently investigated associations between ambient air pollution and women’s reproductive health. Still, a dearth of evidence exists on the association between air pollution and polycystic ovary morphology (PCOM).Methods: We conducted a retrospective electronic medical record review of 25,535 reproductive-aged women who underwent pelvic ultrasound examinations to identify PCOM at Boston Medical Center between 2003-2016. Medical report machine learning text algorithms were employed to classify PCOM by ultrasound following the 2003 Rotterdam Consensus Criteria for polycystic ovary syndrome. We used the ambient annual average particulate matter 2.5 (PM2.5) model built for the global burden of disease based on the combination of aerosol optical depth measurements and chemical transport model results to yield estimated annual average PM2.5 concentrations. PM2.5 estimates were matched by geocoding home addresses and assigning cumulative concentrations over the study period. We evaluated the association between PM2.5 concentrations and odds of PCOM using logistic regression for complete cases (n=17,902), adjusting for age and race. We additionally modeled these analyses stratified by race/ethnicity.Results: PM2.5 annual average cumulative levels ranged from 5.40 to 17.43 (mean=10.62) μg/m3. A total of 6,005 women were confirmed to have PCOM by ultrasound text algorithms. Women had a mean age of 31 years and 47% of the women were Black/African American. PM2.5 concentrations were not strongly associated with odds of PCOM (odds ratio [OR]: 0.96, 95% CI: 0.93, 1.00). When stratified by race/ethnicity, ORs ranged from 0.96 (95% CI: 0.91, 1.00) among Black/African American women to 1.05 (95% CI: 0.86, 1.28) among Asian women.Conclusion: In this study of reproductive-aged women, we observed little evidence of the association between annual average PM2.5 and PCOM, and our results found no varying effects of this association by race/ethnicity.

Protective effect of supplementation with Ginseng, Lilii Bulbus and Poria against PM2 .5 in air pollution-induced cardiopulmonary damage among adults.

Exposure to PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 μm) has been associated with increased cardiopulmonary outcomes, mediated by a hypothesized biological mechanism of systemic inflammation and oxidation. This randomized, double-blinded and placebo-controlled trial among 120 healthy adults in Wuhan, China, was conducted to evaluate whether the supplementation of herbal product composed of Ginseng, Lilii Bulbus and Poria (GLP) which have been shown to have anti-inflammatory and anti-oxidant activity offers protective effects on PM2.5 -induced damage to cardiopulmonary health. Participants received four rounds of health examinations and two rounds of blood sample collection from November 2018 to January 2019. Compared to the placebo group, the GLP group showed significant increased antioxidant biomarkers such as superoxide dismutase (SOD) and paraoxonase1 (PON1). What is more, interleukin-6 (IL-6), an inflammatory biomarker, was significantly decreased in the GLP group. In addition, nitric oxide and club cell secretory protein (CC16) were increased but heart rate was decreased in the GLP group. As for pulmonary function indicators, significantly increased fractional exhaled nitric oxide (FeNO) was observed in the GLP group. Taken together, we concluded that GLP supplementation is associated with decreased inflammatory biomarker and increased antioxidant biomarkers suggesting cardiopulmonary benefits against PM2.5 exposure among young adults in China.

Using low-cost sensor technologies and advanced computational methods to improve dose estimations in health panel studies: results of the AIRLESS project.

Air pollution epidemiology has primarily relied on fixed outdoor air quality monitoring networks and static populations. Taking advantage of recent advancements in sensor technologies and computational techniques, this paper presents a novel methodological approach that improves dose estimations of multiple air pollutants in large-scale health studies. We show the results of an intensive field campaign that measured personal exposures to gaseous pollutants and particulate matter of a health panel of 251 participants residing in urban and peri-urban Beijing with 60 personal air quality monitors (PAMs). Outdoor air pollution measurements were collected in monitoring stations close to the participants' residential addresses. Based on parameters collected with the PAMs, we developed an advanced computational model that automatically classified time-activity-location patterns of each individual during daily life at high spatial and temporal resolution. Applying this methodological approach in two established cohorts, we found substantial differences between doses estimated from outdoor and personal air quality measurements. The PAM measurements also significantly reduced the correlation between pollutant species often observed in static outdoor measurements, reducing confounding effects. Future work will utilise these improved dose estimations to investigate the underlying mechanisms of air pollution on cardio-pulmonary health outcomes using detailed medical biomarkers in a way that has not been possible before.

Deep learning for predicting the occurrence of cardiopulmonary diseases in Nanjing, China

The efficiency of disease prevention and medical care service necessitated the prediction of incidence. However, predictive accuracy and power were largely impeded in a complex system including multiple environmental stressors and health outcome of which the occurrence might be episodic and irregular in time. In this study, we established four different deep learning (DL) models to capture inherent long-term dependencies in sequences and potential complex relationships among constituents by initiating with the original input into a representation at a higher abstract level. We collected 504,555 and 786,324 hospital outpatient visits of grouped categories of respiratory (RESD) and circulatory system disease (CCD), respectively, in Nanjing from 2013 through 2018. The matched observations in time-series that might pose risk to cardiopulmonary health involved conventional air pollutants concentrations and metrological conditions. The results showed that a well-trained network architecture built upon long short-term memory block and a working day enhancer achieved optimal performance by three quantitative statistics, i.e., 0.879 and 0.902 of Nash-Sutcliffe efficiency, 0.921% and 0.667% of percent bias, and 0.347 and 0.312 of root mean square error-standard deviation ratio for RESD and CCD hospital visits, respectively. We observed the non-linear association of nitrogen dioxide and ambient air temperature with CCD hospital visits. Furthermore, these two environmental stressors were identified as the most sensitive predictive variables, and exerted synergetic effect for two health outcomes, particular in winter season. Our study indicated that high-quality surveillance data of atmospheric environments could provide novel opportunity for anticipating temporal trend of cardiopulmonary health outcomes based on DL model.

1174 Assessing Sleep Disorders in Primary Care: A Provider Survey About the Importance of Sleep Health

Abstract Introduction Conditions commonly managed by primary care providers (PCPs) such as depression, diabetes, and heart disease, commonly co-occur with sleep disorders. If PCPs could readily identify comorbid sleep disorders in this context, it may provide a pathway to more effective management of both types of disorders. Currently, it is unknown what might encourage or discourage PCPs from routinely screening their patients for sleep disorders. Methods PCPs from UPENN and GHS completed surveys regarding sleep health. The 30-item instrument comprised demographic, 14 VAS (0%-100%=strongly disagree-strongly agree), 4 open-ended, 3 yes/no, and 2 multiple-choice questions. Results Ninety-nine PCPs responded and were predominately female (61% F, 37%M, 2% other), Caucasian (81%), on-average 45yrs old (25-70) and in primary care for 16yrs (1-43). Fifty-six percent were MDs, 21%DOs, 17%PAs, and 6%NPs. PCPs rated sleep disorders as highly important for cardiopulmonary, mental, and general health (85, 84, &amp; 83%), with no difference (per linear regression, p&amp;gt;0.05) according to system or provider characteristics. PCPs reported high importance for knowing about and diagnosing sleep disorders (88% &amp; 82%) within their practices. Lower comfort levels were reported for discussing (78%) sleep disorders, overseeing/following (62%), diagnosing (60%), or treating (48%) patients. Eighty percent of PCPs stated an efficient sleep disorders screener would be useful for their practice; this perception varied (per logistic regression) according to provider credentials (Wald=0.037) and Hispanic/Latino ethnicity (Wald=0.025). PCPs reported time constraints limit their responsiveness to sleep disorders Conclusion A large disparity exists between the importance PCPs place on sleep disorders and their low comfort levels with following, diagnosing, and treating sleep disorders. PCPs endorsed the need to have available an efficient sleep disorders screener to use in their practice. Support No funding was received for this study.

Reference Values and Predictive Equations for Cardiopulmonary Exercise Testing in Thai Adults

Background: A series of racial specific predictive equations for exercise parameters are needed to determine a lack of cardiopulmonary fitness or having an exercise limitation on cardiopulmonary exercise testing (CPET). Objectives: The study aimed to develop a new set of predictive equations of CPET parameters during maximal cycling exercise for Thai adults. Methods: A sample of 580 Thai adults whom could pass screening tests were asked to fill a health questionnaire and the Global Physical Activity questionnaire. Participants with history of symptomatic heart and pulmonary diseases, current smokers, history of smoking ≥ 10 pack-years, and abnormal spirometry were excluded. The CPET was performed using a cycle ergometer with an incremental symptom-limited protocol. Values of CPET parameters at the peak exercise (oxygen uptake [V̇O2], work rate, heart rate, oxygen pulse, and minute ventilation), lactic acidosis threshold, and ventilatory equivalents for oxygen and carbon dioxide were documented. Analyses were stratified using age and gender criterion. Predictive equations for CPET parameters were established using multivariable linear regression with age (A), weight (W), height (H), and physical activity level (Act) as independent variables. Results: A total of 493 participants (208 men and 285 women) were analysed. The predictive equation of V̇O2peak (L.min-1) for males was: -2.268 + (0.037 × A) - (0.0005 × A2) + (0.016 × W) + (0.014 × H) + (0.104 × Act), (R2 = 0.41, SEE = 0.392), and for females, it was: -0.34 + (0.009 × A) - (0.0002 × A2) + (0.012 × W) + (0.005 × H) + (0.058 × Act), (R2 = 0.44, SEE = 0.220). Conclusions: This is the first study that constructed the predictive equations for cycling CPET parameters in Thai adults. These equations are useful to evaluate the cardiopulmonary health of the Thai population and may be generalized to other populations with geographical or ethnic proximity to the Thai people.