Measures Of Exposure Research Articles

The Influence of Residential Segregation, Urbanicity, and Population Density on Hepatocellular Carcinoma Incidence among a Low Socioeconomic Population.

Hepatocellular carcinoma (HCC) is becoming a leading cause of cancer-related mortality in the United States, with notable disparities observed among racial and ethnic minorities. The objective of this study is to examine the association between social determinants of health (SDoH) and HCC incidence by race (White and Black individuals) using data from the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants recruited from 2002 to 2009. Incident HCC cases were identified during follow-up. Exposure measures, including residential segregation, social vulnerability, population density, rurality, and poverty, were assessed at baseline. Cox proportional hazards regression models were used to estimate hazard ratios associated with SDoH by race with the adjustment of known HCC risk factors. Among the 79,367 eligible participants, there were 491 incident HCC diagnosed, 378 of which were in Black individuals. In Black individuals, increased population density and urban residency were associated with an increased risk of HCC, even after adjusting for potential confounders (HR=1.49, 95%CI 1.04-2.13, HR= 1.70, 95%CI 1.20-2.41, respectively). In White individuals living in the least segregated areas (HR=2.83, 95%CI 1.39-5.78) and in urban settings (HR=2.34, 95%CI 1.17-4.65) had an increased HCC risk, while population density was not associated with risk. We found that individuals residing in urban populations had an increased risk of HCC. These findings underscore the complex interplay of SDoH factors and geographic influences on HCC disparities. Our findings highlight the need for targeted interventions and further research to address HCC health inequities.

Bilinguals’ sensitivity to specificity and genericity: evidence from implicit and explicit knowledge

Abstract The present paper investigates whether school-aged French-English bilingual children’s implicit and explicit knowledge of article use is affected by cross-linguistic influence (CLI) during online and offline sentence comprehension. The studies focus on the encoding of plural and mass nouns in specific and generic contexts. We also explore whether individual measures of oral proficiency, language exposure and age play a role in the children’s performance. Forty-three 8-to-10-year-old French-English bilingual children took part in a Self-Paced Reading task, a Grammaticality Judgement task and a Cloze test in their two languages. Overall, CLI was observed across tasks in English and French. These findings suggest that CLI can be bi-directional and tap into school-aged bilinguals’ implicit and explicit representations during sentence comprehension and production. The data also makes a new contribution to our understanding of the relative amount of language exposure, oral proficiency and age on CLI.

False-Positive Phosphatidylethanol Results Due to Blood Transfusion and Implications in the Process of Liver Transplantation Selection.

Phosphatidylethanol (PEth) testing is becoming increasingly common as a tool to assess for alcohol consumption in the practice of addiction medicine. Its potential to be an objective measure of ethanol exposure is appealing; however, the field has yet to develop a complete understanding of the factors that can influence a PEth level. Here we describe 3 patient cases in which blood transfusion within the preceding 28 days was the reason that PEth studies were positive in patients undergoing liver transplant evaluation. These patients all had in-depth evaluations by physicians on an addiction medicine consult service and were believed abstinent from alcohol. In the field of liver transplant, even a mildly elevated PEth level can result in listing delay or even liver transplant candidacy denial. Further study is needed to understand how PEth is impacted by medical procedures and events such as blood transfusion if we are to maintain a just and ethical practice in the setting of addiction and transplant medicine.

Validation of a spatial model of background radiation using personal measurements in children

BackgroundLimited knowledge about the prediction accuracy of exposure models hinders the interpretation of results from epidemiological studies on childhood cancer risks associated with exposure to background gamma-radiation. ObjectiveWe aimed to validate a spatial exposure model that we recently developed for Switzerland. MethodsWe used individual exposure measurements conducted with D-Shuttle dosimeters by 149 children throughout the country. We ran linear regression models fitting the measured exposure against predictions from the newly developed model, and compared results with the predictions from an earlier model. We further used variograms to investigate the spatial correlation of estimation errors. ResultsThe prediction accuracy of the newly developed exposure model was modest (R2 = 0.2), but better than the earlier model (R2 = 0.13). Prediction errors revealed weak spatial correlation. DiscussionAlthough the new exposure model marks an improvement, the modest prediction accuracy and the remaining spatial correlation of errors show room for further improvement. Our study highlights the need for validation of exposure models for background gamma-radiation used in epidemiological studies.

Sleep Fragmentation Despite Intact Rest-Activity Patterns in Premanifest Huntington's disease: An Actigraphy Study

ObjectiveSleep research in Huntington’s disease (HD) has primarily focused on manifest HD, with significantly less attention given to premanifest HD (Pre-HD). Therefore, we investigated sleep and rest-activity patterns in people with Pre-HD versus healthy controls (HC). MethodsWe conducted a cross-sectional study including 36 Pre-HD and 48 HC participants. Pre-HD participants were stratified into three groups according to their proximity to estimated diagnosis, using a cytosine-adenine-guanine (CAG) and current age-based predictive model: NEAR (<9 years to diagnosis), MID (9-15 years to diagnosis) and FAR (>15 years to diagnosis). Sleep and rest-activity patterns were assessed using wrist-worn actigraphy, a sleep diary, and sleep questionnaires. ResultsNEAR and MID groups experienced higher fragmentation index than HC and FAR groups. NEAR and MID groups also exhibited greater WASO than the FAR group. NEAR and MID groups showed lower intra-daily variability (IV) than HC and FAR groups, with the NEAR group also being more active in the most active 10 hours (M10). Groups did not differ on subjective sleep measures, inter-daily stability (IS), sleep regularity index, relative amplitude, or amount of activity in the least active five hours (L5). Considering all Pre-HD participants, fewer years to diagnosis, higher CAG-age-product (CAP) scores (a measure of cumulative exposure to the HD-causing gene mutation) and larger CAG repeat lengths correlated with higher WASO, fragmentation index, L5, IS, and lower sleep efficiency and IV. Higher CAP score correlated with higher M10. ConclusionsDespite intact rest-activity patterns and similar subjective sleep quality to HC, greater sleep fragmentation is a prominent and early feature in Pre-HD. Therefore, reducing sleep fragmentation may be a potential target for sleep intervention in HD. Longitudinal studies using larger samples are needed to assess sleep across the disease spectrum and its impact on clinical outcomes, like cognition.

Exposure misclassification: an “immortal time” bias in observational studies of training load and injury

Several observational studies of the relationship between training load and injury have found increased risks of injury at low loads. These associations are expected because load is often assessed at the end of the injury follow-up period. As such, athletes who get injured earlier in the follow-up period will have systematically lower loads than athletes who get injured later in the follow-up period. In this commentary, we identify this problem as a type of exposure misclassification occurring from the misalignment of exposure measurement and start of follow-up. This methodological issue has previously been recognized in other areas of epidemiology as “immortal time bias”. We discuss how this bias can be prevented by aligning the measurement of load with the start of follow-up for injury.

Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.

Annual influenza epidemics lead to substantial public health burden, and pregnant people are vulnerable to severe outcomes. Influenza during pregnancy is hypothesized to increase risk of adverse birth outcomes, but population-based epidemiologic evidence remains limited and inconsistent. We conducted a time-series analysis to estimate short-term associations between community-level seasonal influenza activity and daily counts of preterm births in Atlanta, United States from October 17th, 2010 to July 10th, 2017. We defined weekly influenza exposures four ways: (1) percent test-positive from virologic surveillance, (2) percent of patients with symptoms of influenza-like illness (ILI) in outpatient settings, (3) a composite measure of percent test-positive and ILI, and (4) influenza hospitalization rates. We used Poisson log-linear models to estimate associations, adjusting for time-varying confounders and ongoing at-risk pregnancies. We further examined associations by influenza type and exposure lags, and effect modification by maternal characteristics. We studied a total of 316,253 births. We found consistent positive associations between influenza activity and preterm birth across different exposure measures and exposure lags. An interquartile range increase in composite measure of ILI activity and percent test-positive was associated with a 1.014 (95% confidence interval: 1.001, 1.027) increase in preterm birth during the same week. In stratified analyses, associations were more pronounced among married, non-Black, and Hispanic pregnant people. Periods of high influenza activity were associated with increased risk of preterm birth.

High-Potency Prenatal Cannabis Exposure and Birth Outcome Measures

Background/Objectives: Pregnant women have limited information on the impact of prenatal cannabis exposure (PCE) alone. Our aim was to determine if PCE, without alcohol, tobacco, or illicit drug use, is associated with altered birth outcome measures in obstetrically low-risk women. Methods: In this observational cohort study, pregnant women were recruited between 2019 and 2022 from communities in Washington and Oregon, USA, and enrolled following their first trimester. PCE eligibility required a minimum of three days/week of cannabis use during the first trimester with no required minimum use thereafter. For all participants, illicit drug, nicotine, or alcohol use was exclusionary throughout pregnancy and monitored via urine toxicology at multiple time points. Cannabis use was quantified into delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) mg/day using product weight and potency. Outcome measures included gestational age, weight, length, head circumference, and Apgar scores. Results: Study participants included 37 people in the PCE cohort and 35 controls. Average cannabis use for the PCE cohort was 198.0 mg of THC (SD = 221.2 mg)/day and 3.5 mg of CBD (SD = 4.3)/day. PCE newborns weighed less (38th vs. 52nd percentile, p = 0.04) and were shorter (40th vs. 55th percentile, p = 0.03) for their gestational age than controls. Female PCE newborns had smaller head circumference for gestational age (28th percentile; SD = 23), compared to male PCE newborns (55th percentile; SD = 32; p = 0.02). Conclusions: PCE is associated with reduced birth weight and shorter length for gestational age. The effect of PCE on brain growth may be sexually dimorphic. Future PCE studies should include sex as a biological variable and longitudinally evaluate long-term developmental and physiological outcomes.

Mechanistic Modeling of Spatial Heterogeneity of Drug Penetration and Exposure in the Human Central Nervous System and Brain Tumors.

Direct measurement of spatial-temporal drug penetration and exposure in the human central nervous system (CNS) and brain tumors is difficult or infeasible. This study aimed to develop an innovative mechanistic modeling platform for quantitative prediction of spatial pharmacokinetics of systemically administered drugs in the human CNS and brain tumors. A nine-compartment CNS (9-CNS) physiologically-based pharmacokinetic model was developed to account for general anatomical structure and pathophysiological heterogeneity of the human CNS and brain tumors. Drug distribution into and within the CNS and tumors is driven by plasma concentration-time profiles and governed by drug properties and CNS pathophysiology. The model was validated by comparisons of model predictions and clinically observed data of six drugs (abemaciclib, ribociclib, pamiparib, olaparib, temuterkib, and ceritinib) in glioblastoma patients. As rigorously validated, the 9-CNS model allows reliable prediction of spatial pharmacokinetics in different regions of the brain parenchyma (i.e., parenchyma adjacent to CSF and deep parenchyma), tumors (i.e., tumor rim, bulk tumor, and tumor core), and CSF (i.e., ventricular CSF, cranial and spinal subarachnoid CSF). By considering inter-individual plasma pharmacokinetic variability and CNS/tumor heterogeneity, the model well predicts the inter-individual variability and spatial heterogeneity of drug exposure in the CNS and tumors as observed for all six drugs in glioblastoma patients. The 9-CNS model is a first-of-its kind, mechanism-based computational modeling platform that enables early reliable prediction of spatial CNS and tumor pharmacokinetics based on plasma concentration-time profiles. It provides a valuable tool to assist rational drug development and treatment for brain cancer.

Measurement of Cumulative Drug Exposure from Clinical Data Warehouse.

Polypharmacy (PP) and hyperpolypharmacy (HPP), are prevalent among cancer patients and are associated with an increased risk of drug-drug interactions (DDI) and potentially inappropriate medications (PIM). This study aimed to characterize PP, HPP, DDI, and PIM in patients with hematological malignancies hospitalized for hematopoietic stem cell transplantation (HSCT) by introducing a novel metric: cumulative drug exposure. Clinical data warehouse (CDW) records were employed to develop algorithms that quantified patients' cumulative exposure to these prescribing determinants during hospitalization. This entailed determining the number of days during the hospital stay when the patient was exposed to PP, HPP, PIM and/or DDI. For PIM and DDI, the number of PIMs or DDIs administered per day was taken into account in this calculation. Among 339 HSCT patients, PP and HPP were highly prevalent (over 67% of HSCT patients), almost all patients experienced DDI (over 98% of HSCT patients) and almost all elderly patients were exposed to PIM (over 98% of HSCT patients). Cumulative drug exposure differed between allogeneic and autologous HSCT patients, with allogeneic patients being more exposed to HPP (28.5 days vs 4.7 days for autologous HSCT patients) and DDI (255.6 days vs 58.4 for autologous HSCT patients). This study proposes a novel approach to assessing the impact of prescribing determinants on patient outcomes and provides insights for future research into the association between drug exposure and adverse events. Indeed, the use of cumulative drug exposure as a metric provides a comprehensive view of patient exposure throughout hospitalization, thereby enhancing understanding of the impact of prescribing practices on clinical outcomes.

Clinical study design strategies to mitigate confounding effects of time-dependent clearance on dose optimization of therapeutic antibodies.

Time-dependent pharmacokinetics (TDPK) is a frequent confounding factor that misleads exposure-response (ER) analysis of therapeutic antibodies, where a decline in clearance results in increased drug exposure over time in patients who respond to therapy, causing a false-positive ER finding. The object of our simulation study was to explore the influence of clinical trial designs on the frequency of false-positive ER findings. Two previously published population PK models representative of slow- (pembrolizumab) and fast-onset (rituximab) TDPK were used to simulate virtual patient cohorts with time-dependent clearance and the frequency of false-positive ER findings. The impact of varying the number of dose groups, dose range, and sample size was evaluated over time. Study designs with a single tested dose level showed a high probability of showing a false-positive ER finding. When TDPK has a slow onset, use of exposure measures from early timepoints in ER analysis significantly reduces the risk of a false-positive, while with fast onset it did not. Randomization of patients to two dose levels greatly reduced the risk, with a threefold or greater dose range offering the greatest benefit. The likelihood of false-positive increases with a larger sample size, where greater care should be taken to identify confounding factors. Clinical trial simulation supports that appropriate clinical study design and analysis with adequate dose exploration can reduce but cannot entirely eliminate the risk of misleading ER findings.

Associations Between Instrumented Mouthguard-Measured Head Acceleration Events and Post-Match Biomarkers of Astroglial and Axonal Injury in MaleAmateur Australian Football Players.

Advances in instrumented mouthguards (iMGs) allow for accurate quantification of single high-acceleration head impacts and cumulative head acceleration exposure in collision sports. However, relationships between these measures and risk of brain cell injury remain unclear. The purpose of this study was to quantify measures of non-concussive head impact exposure and assess their association with blood glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and phosphorylated-tau-181 (p-tau-181) levels in male Australian football players. A total of 31 athletes underwent in-season (24h post-match) and post-season (> 5weeks) blood collections and/or wore HITIQ Nexus A9 iMGs measuring peak linear (PLA) and rotational (PRA) acceleration. Match footage was used to verify and code impacts. Blood GFAP, NfL, and p-tau-181 were quantified using Simoa and natural log transformed for analysis. Associations between post-match biomarkers and within match maximum single impact and cumulative PLA/PRA were assessed with linear mixed models. In-season versus post-season elevations were found for GFAP (mean difference 0.14, 95% CI 0.01-0.26, p = 0.033), NfL (mean difference = 0.21, 95% CI 0.09-0.32, p = 0.001) and p-tau-181 (mean difference = 0.49, 95% CI 0.33-0.65, p < 0.001). Post-match GFAP was associated with maximum single impact PLA (B = 0.003, 95% CI 0.0002-0.005, p = 0.036), cumulative PLA (B = 0.001, 95% CI 0.0002-0.002, p = 0.017), cumulativePRA (B = 0.01, 95% CI 0.002-0.02, p = 0.014), and impact number (B = 0.03, 95% CI 0.003-0.05, p = 0.029) within a single match. Change in NfL levels between two-matches correlated with cumulative PLA (r = 0.80, 95% CI 0.38-0.95, p = 0.005), PRA (r = 0.71, 95% CI 0.19-0.92, p = 0.019) and impact number (r = 0.63, 95% CI 0.05-0.89, p = 0.038). Maximum and cumulative head accelerations in Australian football, measured by iMGs, were associated with elevated blood biomarkers of brain injury, highlighting the potential of both technologies for head impact management in collision sports.

A Review of Job Assignments and Asbestos Workplace Exposure Measurements for TAWP Mesothelioma Deaths Through 2011.

Asbestos workers have a higher risk of developing mesothelioma; however, few studies have looked at specific jobs and job locations within asbestos factories. The purpose of this study was to investigate asbestos exposure in different job locations of the Tyler, Texas asbestos plant to determine if there was a relationship between the duration of exposure and air fiber concentration burden in workers who developed pleural versus peritoneal mesothelioma. This study used a patient information database to compile secondary data on 23 workers who died from mesothelioma through 2011. The airborne fiber exposure burdens for each of the 23 workers were estimated and then stratified by job location category and by type of mesothelioma for analysis. Most of the worker cases were assigned to the forming area which had the overall highest fiber concentration of all the plant's job locations. Workers who developed pleural mesothelioma spent the most time in the packing and miscellaneous locations, whereas workers who developed peritoneal mesothelioma worked mostly in the forming and miscellaneous locations. There were significant differences in days worked and estimated airborne exposure fiber burden between the pleural and peritoneal mesothelioma cases in the forming and curing locations. Results from this study reiterate the association between occupational asbestos exposure and mesothelioma, emphasizing the importance of concentration of respirable asbestos dust levels and duration of exposure.

Assessment of long-term exposure to traffic-related air pollution: An exposure framework.

Exposure to ambient air pollution is associated with morbidity and mortality, making it an important public health concern. Emissions from motorized traffic are a common source of air pollution but evaluating the contribution of traffic-related air pollution (TRAP) emissions to health risks is challenging because it is difficult to disentangle the contribution of individual air pollution sources to exposure contrasts in an epidemiological study. This paper describes a new framework to identify whether air pollution differences reflect contrasts in TRAP exposures. Because no commonly measured pollutant is entirely specific to on-road motor vehicles, this exposure framework combined information on pollutants, spatial scale (i.e., geographic extent), and exposure assessment methods and their spatial scale to determine whether the estimated effect of air pollution in a given study was related to differences in TRAP. The exposure framework extended beyond the near-road environment to include differences in exposure to TRAP at neighborhood resolution ( ≤ 5 km) across urban, regional, and national scales. It also embedded a stricter set of criteria to identify studies that provided the strongest evidence that exposure contrasts were related to differences in traffic emissions. Application of the framework to the transparent selection of epidemiological studies for a systematic review produced insights on assessing and improving comparability of TRAP exposure measures, particularly for indirect measures such as distances from roads. It also highlighted study design challenges related to the duration of measurements and the structure of epidemiological models. This manuscript describes a new exposure framework to identify studies of traffic-related air pollution, a case study of its application in an HEI systematic review, and its implications for exposure science and air pollution epidemiology experts. It identifies challenges and provides recommendations for the field going forward. It is important to bring this information to the attention of researchers in air pollution exposure science and epidemiology because applying the broader lessons learned will improve the conduct and reporting of studies going forward.

Occupational exposures in low- and middle-income countries: A scoping review.

Exposure to high levels of harmful agents in the workplace can significantly impact workers' health, contributing to morbidity and mortality. Levels of these exposures are often measured in high-income countries in research studies and, in some places, to monitor levels in line with health and safety regulations. However, less is known about workplace exposure levels in low- and middle-income countries (LMICs). Our aim was to describe the quantitative exposure measurements of different occupational agents across industries within LMICs. We conducted a scoping review of peer-reviewed publications available on Web of Science and PubMed from inception to 1 September 2023. Our search focused on quantitative occupational exposure measurements across industries in LMICs. We identified a total of 8,676 publications. After screening, 58 studies from 25 countries were retained for final review. China, Iran, and Tanzania contributed the greatest number of studies. Manufacturing, mining, and agriculture were the most studied sectors, with factory workers and miners being the most common job titles. Exposure measurements included vapour, gases, dust, and fumes (VGDF), solvents, metals, pesticides and particulate matter. Occupational exposure levels for the same industry varied widely across geographical regions. This review provides a comprehensive overview of occupational exposures in LMICs and highlights the absence of data in certain geographical areas and industries. The study contributes valuable insights for directing future research, and the need to optimise the assessment of occupational exposures in LMICs with the aim ultimately of reducing disease.

Evaluating the human abuse potential of concurrent use of electronic cigarettes and low nicotine cigarettes among adults who smoke.

The U.S. Food and Drug Administration has stated its intention to reduce the nicotine content of combustible cigarettes to render them less addictive. This study evaluated the impact of providing adults who smoke with both very low nicotine content cigarettes (VLNCCs) and electronic cigarettes (ECs) of varying nicotine content on measures of human abuse potential. Participants (n = 213) were adult combustible cigarette users. They smoked their usual brand cigarettes (UBCs) during Phase 1 (baseline; week 1) and were provided with and encouraged to exclusively use VLNCCs during Phase 2 (weeks 2-4). During dual-product Phases 3 (weeks 5-7) and 4 (weeks 8-10), participants received both VLNCCs and ECs (assigned to one of two EC devices in higher or lower nicotine concentrations and choice of flavor), with instructions to use them freely in Phases 3 and 4. Assessments included product use, exposure, acceptability, risk perception, and withdrawal-related measures. Results indicated that participants used significantly fewer UBCs during the VLNCC and dual-product phases and smoked fewer VLNCCs during the dual-product phases than the VLNCC-only phase. Neither EC liquid nicotine concentration nor flavor influenced product use. The three study product phases resulted in less product liking and more withdrawal symptoms than the UBC phase. These results suggest that adults who smoke are able to switch much of their tobacco product use from UBCs to VLNCCs and will substitute combustible UBCs and VLNCCs with noncombustible nicotine-containing ECs, but most remain dual users, at least in the short term. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk of severe influenza infection in women with a history of pregnancy complications: A longitudinal cohort study.

Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30-1.69), preeclampsia (HR 1.45, 95% CI 1.28-1.65), placental abruption (HR 1.36, 95% CI 1.12-1.66), preterm birth (HR 1.40, 95% CI 1.27-1.55), cesarean section (HR 1.22, 95% CI 1.13-1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22-1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization.

Long-Term Air Pollution Exposure and Severity of Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry.

While exposure to air pollution is a known risk factor for adverse pulmonary outcomes, its impact in individuals with idiopathic pulmonary fibrosis (IPF) is less well understood. To investigate the effects of long-term exposure to air pollution on disease severity and progression in patients with IPF and to determine whether genomic factors, such as MUC5B promoter polymorphism or telomere length, modify these associations. We performed analyses at enrollment and after one year of follow-up in the IPF-PRO Registry, a prospective observational registry that enrolled individuals with IPF at 46 US sites from June 2014 to October 2018. Five-year average pollution exposures (PM2.5, NO2, O3) prior to enrollment date were estimated at participants' residential addresses with validated national spatio-temporal models. Multivariable regression models estimated associations between pollution exposure and physiologic measurements (FVC, DLCO, supplemental oxygen use at rest) and quality of life measurements (St. George's Respiratory Questionnaire [SGRQ], EuroQoL, Cough and Sputum Assessment Questionnaire) at enrollment. Cox proportional hazard models estimated associations between pollutants and a composite outcome of death, lung transplant, or >10% absolute decline in FVC % predicted in the year after enrollment. Models were adjusted for individual-level and spatial confounders, including proxies for disease onset. Gene-environment interactions with MUC5B and telomere length were assessed. Of 835 participants, 94% were non-Hispanic Whites, 76% were male, mean (SD) age was 70 (7.7) years. In fully adjusted analyses, higher PM2.5 exposure was associated with worse quality of life per SGRQ activity score (3.48 [95% confidence interval (CI) 0.64, 6.32] per 2µg/m3 PM2.5) and EuroQoL scores (-0.04 [95%CI -0.06, -0.01] per 2µg/m3 PM2.5), and lower FVC % predicted and lower DLCO% predicted at enrollment. Each 3 parts per billion difference in O3 exposure was associated with a 1.57% [95% CI 0.15, 2.98] higher FVC % predicted at enrollment, although this effect was attenuated in multi-pollutant models. There was no association between NO2 and enrollment measures, between pollution exposure and one-year outcomes, or evidence for gene-environment interactions. In the IPF-PRO Registry, long-term exposure to PM2.5 was associated with worse quality of life and lung function at enrollment, but not with short-term disease progression or mortality. There was no evidence of effect modification by interaction of genomic factors with pollution. The reason for the unexpected relationship between O3 exposure and higher FVC is unclear.

Trump, China, and the Republicans

AbstractThe Republican Party has been the party most supportive of free trade in US politics for half a century. Donald Trump, the 45th US president, held a different stance from his party on free trade. We assess how Trump's China tariffs in mid‐2018 affected the performance of his party in its midterm House elections later that year. We construct a measure of each county's exposure to Trump's China tariffs and merge that with the Republican share of votes in the county. We find that the counties heavily exposed to the tariffs were more supportive of their Republican House candidates.

Cyanobacteria and microcystins contamination in drinking water sources: a review of occurrence, exposure, and mitigation measures

Cyanobacteria and microcystins contamination in drinking water sources: a review of occurrence, exposure, and mitigation measures