Screening Level Research Articles

Mobility in the context of exposure-based assessment of chemicals for drinking water resourceprotection.

In order to protect European Union (EU) drinking water resources from chemical contamination, criteria for identifying persistent, mobile, and toxic (PMT) chemicals and very persistent and very mobile (vPvM) chemicals under the EU REACH Regulation were proposed by the German Environment Agency (Umweltbundesamt-UBA). Additionally, new hazard classes for PMT and vPvM substances in the revised EU classification, labeling, and packaging (CLP Regulation) are intended. Therefore, a reliable approach in theidentificationof potential drinking water resource contaminants is needed. The scientific basis of the property-based PMT/vPvM criteria, focusing on mobility, which dictates the migration of chemicaldrinking water sources, was evaluated, and a critical analysis of the deviation of sorption metrics from simple behavior was carried out. Based on our evaluation, a Koc may be used for nonionic substances on a screening level only, requiring a higher tier assessment. It is considered inappropriate for hydrophilic and ionizable chemicals, particularly for soils with low organic carbon contents. The nonextractable residue formation is complex and not well understood but remains significant in limiting the mobility of chemicals through soils and sediments. In order to inform the EU commission's work on the introduction of new hazard classes for PMT and vPvM substances into the European legislation, the derivation of a tiered approach is proposed,which utilizes the weight of evidence available, with adoption of appropriate higher tier models commensurate with the nature of the substance and the data available. Integr Environ Assess Manag 2023;19:775-791. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Myocardial perfusion imaging in the era of COVID-19: a systematic review.

As COVID-19 was uncovered, it became evident that specific individuals could experience multi-organ complications for quite a while after infection. Among them, there were several cardiovascular complications. Myocardial perfusion imaging single photon emission computed tomography (MPI SPECT) can be utilized to detect and evaluate cardiac problems regardless of whether COVID caused them. By examining all publications relevant to the impacts of the pandemic on SPECT MPI imaging, we aimed to understand how the COVID pandemic affected different aspects of the MPI, how intense these effects were, and what the consequences were. On the 6th of June, 2022, a four-domain search strategy was developed and implemented by searching the following databases: PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. The retrieved records have been put through two levels of screening. The search for forward and backward citations provided more results. This study contained 32 papers, divided into the following three categories: 1. Case reports and series; 2. A comparison of the number of MPIs conducted before and after the pandemic; and 3. SPECT MPI findings. We observed through the article review that CT scans performed in combination with MPI are crucial and should be interpreted within the context of COVID, especially during outbreaks. Moreover, we discovered that in the initial months of the pandemic, the number of SPECT MPIs performed globally decreased, with the fall being more significant in some countries, primarily in low- to middle-income regions. Lastly, we found that individuals with a history of COVID-19 may be more prone to having MPIs that demonstrate abnormalities, such as ischemia.

Bottled water contaminant exposures and potential human effects

BackgroundBottled water (BW) consumption in the United States and globally has increased amidst heightened concern about environmental contaminant exposures and health risks in drinking water supplies, despite a paucity of directly comparable, environmentally-relevant contaminant exposure data for BW. This study provides insight into exposures and cumulative risks to human health from inorganic/organic/microbial contaminants in BW. MethodsBW from 30 total domestic US (23) and imported (7) sources, including purified tapwater (7) and spring water (23), were analyzed for 3 field parameters, 53 inorganics, 465 organics, 14 microbial metrics, and in vitro estrogen receptor (ER) bioactivity. Health-benchmark-weighted cumulative hazard indices and ratios of organic-contaminant in vitro exposure-activity cutoffs were assessed for detected regulated and unregulated inorganic and organic contaminants. Results48 inorganics and 45 organics were detected in sampled BW. No enforceable chemical quality standards were exceeded, but several inorganic and organic contaminants with maximum contaminant level goal(s) (MCLG) of zero (no known safe level of exposure to vulnerable sub-populations) were detected. Among these, arsenic, lead, and uranium were detected in 67 %, 17 %, and 57 % of BW, respectively, almost exclusively in spring-sourced samples not treated by advanced filtration. Organic MCLG exceedances included frequent detections of disinfection byproducts (DBP) in tapwater-sourced BW and sporadic detections of DBP and volatile organic chemicals in BW sourced from tapwater and springs. Precautionary health-based screening levels were exceeded frequently and attributed primarily to DBP in tapwater-sourced BW and co-occurring inorganic and organic contaminants in spring-sourced BW. ConclusionThe results indicate that simultaneous exposures to multiple drinking-water contaminants of potential human-health concern are common in BW. Improved understandings of human exposures based on more environmentally realistic and directly comparable point-of-use exposure characterizations, like this BW study, are essential to public health because drinking water is a biological necessity and, consequently, a high-vulnerability vector for human contaminant exposures.

Autism Spectrum Disorder Screening Practices of Part C Early Intervention Providers: A Brief Report

An early diagnosis of autism spectrum disorder (ASD) can improve outcomes for children and assist families in accessing services. Part C providers are often tasked with screening for ASD. The purpose of this study was to survey Part C providers nationwide to understand their ASD screening practices and training needs and extend a survey conducted by Tomlin and colleagues. A total of 327 providers participated. Results indicated a majority of respondents (75.8%) screen for ASD using a variety of different measures, while only 26.9% are required by their program to conduct universal screenings. Most participants reported feeling confident in screening for ASD, discussing a child’s red flags with a family, referring a child for further evaluation, and discussing recent evidence surrounding ASD. An area where providers were less confident was working with interpreters to screen for ASD or discuss screening results and ASD with families with cultural or linguistic diversity. Despite high confidence levels in screening for ASD, a vast majority of participants reported they would be interested in attending a training on screening for ASD. Professional development surrounding screening for ASD and discussing ASD with families from diverse backgrounds may assist in improving Part C provider screening practices.

The Contaminate Infiltration Model for Heat and Concentration Transport Within Porous Media Under Electromagnetic Fields

Abstract This paper studies the groundwater model of the influence of physical parameters, including input frequency of the electromagnetic, and input concentration of contaminants in groundwater, on the velocity pattern, temperature distribution, and concentration distribution of convective heat transfer in saturated porous media as soil. The mathematical models have solved seven equations in this simulation study, i.e., Maxwell's equation, heat transfer in fluid and solid phases, momentum, and concentration equations. The effect of frequencies and input concentrations of contaminants on the convective heat transfer and concentration distribution in porous media as soil under an electromagnetic wave is investigated. The results indicate that the electromagnetic wave frequency of 2.45 GHz has the most influence on the temperature distribution, velocity patterns, and concentration distribution of the fluid within the porous media as soil during saturated flow in groundwater. The inlet fluid concentration of the contaminant at 30 mol/dm3 has the most impact on the temperature distribution between the implementation of an electromagnetic wave of 2.45 GHz. So, this numerical model provides simple decision data based on comparing the maximum contaminant concentrations of porous media as soil samples with surface soil screening levels such as petroleum engineering and agricultural engineering. This result can be used by the engineer as a guide to determine whether further investigation is needed.

Assessment of natural radioactivity in bottled mineral water from Brazil

The approach taken in the WHO Guidelines for controlling radiological hazards in public water supplies has two stages. The first is an initial screening for gross alpha and beta activity to determine whether the activity concentrations are below levels at which no further action is required; and if these screening levels are exceeded, investigation of the concentration of individual radionuclides and comparison with specific guidance levels. Mineral water is obtained directly from natural sources or by extracting groundwater, it is characterized by the quantity of mineral salts, trace elements and other constituents. The bottled water industry is present in the major regions of the world, and the population consumption has increased every year in Brazil and world, also increasing new mineral water mining sites, so it is necessary to constantly check the amount of radioactivity in mineral water. The aim of this study is to quantify the concentration of the natural radionuclides in the bottled mineral water consumed in São Paulo city. The bottled mineral water samples were purchased in a supermarket in São Paulo, with 23 different brands. The determination of gross alpha and beta activity concentration in bottled mineral water by Liquid Scintillation Counting measurement was performed using a 1220 Quantulus™ Ultra Low-Level Liquid Scintillation Spectrometer. The natural radionuclides (226Ra, 228Ra, 210Pb and 40K) were measured by gamma spectrometry, using an HPGe detector. The results obtained in this study can be used for a database on bottled mineral water radioactivity from Brazil.

A national-scale distribution of organochlorine pesticides (OCPs) in cropland soils and major types of food crops in China: Co-occurrence and associated risks

Organochlorine pesticides (OCPs) are persistent organic pollutants (POPs) that resist degradation in the environment. OCPs remain detectable in cropland systems in China. However, spatial distribution of OCPs across China and associated ecological and health risks, as well as the relationship between levels of OCPs in cropland soils and crops, remain to be elucidated. To fill these gaps, we conducted a national-scale characterization of 19 individual OCPs in cropland soils and food crops including cereals and legumes in China, which were on-spot sampled simultaneously. Sparse canonical correlation analysis was employed to investigate the co-occurrence of OCPs in cropland soils and corresponding food crops. The ecological soil screening levels and risk quotient method were adopted for ecological and health risk assessment, respectively. Dichlorodiphenyltrichloroethanes (DDTs) were dominant in cropland systems, with its levels ranging up to 337 and 22.8 μg/kg in cropland soils and food crops, respectively. The mean ∑OCP levels in cropland soils varied from below the limit of detection to 337 μg/kg. Peanuts were the most contaminated crop, in which endosulfans and hexachlorobenzene (HCB) were co-occurrent with those in cropland soils (correlation coefficient R = 0.999 and 0.947, respectively). Besides, lindane and β-endosulfan in rice were co-occurrent with those in cropland soils (R = 0.810 and 0.868, respectively). The componential ratio analysis indicated fresh inputs of technical DDT, lindane, chlordane, endosulfan, HCB and aldrin. Among these pesticides, ecological impacts of DDTs, lindane, aldrin and β-endosulfan could be expected. Human health risk assessment suggested that daily consumption of the OCP-contaminated food crops raises a health concern especially for male teens. It is concluded that OCPs remain present in cropland systems in China at levels that raise a concern for both environment and human health.

A scoping review of the healthcare provided by nurses to people experiencing domestic violence in primary health care settings.

Domestic and family violence is a significant and growing public health concern in many communities around the world. Nurses are often the first and sometimes only point of contact for people seeking healthcare following DFV incidents and are therefore well placed to identify and support these vulnerable people. The aim of this scoping review is to examine the English language studies of healthcare provided by nurses in primary healthcare settings to people experiencing domestic and family violence. A scoping review of the following databases was undertaken between March-June 2021: CINAHL, Medline, and PubMed. Primary studies were included if written in English, published from 2000 onwards, and focused on the care provided by primary healthcare nurses to people experiencing DFV. A critical appraisal of included studies was conducted using the Mixed Methods Appraisal Tool (MMAT). Results were synthesised narratively. Six studies were included, from the United States (n=2), United Kingdom (n=1), Sweden (n=2), and Brazil (n=1). Five studies were quantitative and one qualitative. A fundamental aspect of the healthcare provided by nurses, reported by all studies, was the screening of DFV. Other healthcare provided includes physical and mental health assessment and referral to other services, including sexual assault clinics, social supports, and law enforcement agencies. Findings suggest the level of DFV screening conducted by nurses is limited. Nurses' knowledge of how to support people experiencing DFV was also reportedly limited. Two studies reported that nurses were unfamiliar with DFV practice guidelines and the existence and availability of support networks for people experiencing DFV. Findings suggest inconsistency in primary healthcare nurses' level of education, skill and knowledge, and detection of people experiencing DFV. As the largest healthcare professional discipline, nurses have frequent contact with people experiencing DFV. There is an urgent need for nurses to be better educationally prepared and more organisationally supported in order to adequately respond and provide healthcare to people experiencing DFV. Given that the number of people experiencing DFV has increased due to the COVID-19 pandemic, it is ever more important for nurses to be well equipped to identify and respond appropriately.

Contaminants in fish from U.S. rivers: Probability-based national assessments

Most fish consumption advisories in the United States (U.S.) are issued for mercury and polychlorinated biphenyls (PCBs), and recently per- and polyfluoroalkyl substances (PFAS) have become a contaminant group that warrants fish consumption advice. An unequal probability survey design was developed to allow a comprehensive characterization of mercury, PCB, and PFAS contamination in fish from U.S. rivers on a national scale. During 2013–14 and 2018–19, fish fillet samples were collected from 353 and 290 river sites, respectively, selected randomly from the target population of rivers (≥5th order in size) in the conterminous U.S. These comprised nationally representative samples, with results extrapolated to chemical-specific sampled populations of 48,826–79,448 river kilometers (km) in 2013–14 and 66,142 river km in 2018–19. National distribution estimates were developed for total mercury, all 209 PCB congeners, and up to 33 PFAS (including perfluorooctane sulfonate or PFOS) in river fish. All fillet tissue samples contained detectable levels of mercury and PCBs. One or more PFAS were detected in 99.7 % and 95.2 % of the fillet samples from fish collected in 2013–14 and 2018–19, respectively. Fish tissue screening levels applied to national contaminant probability distributions allowed an estimation of the percentage of the sampled population of river lengths that contained fish with fillet concentrations above a level protective of human health. Fish tissue screening level exceedances for an average level of fish consumption ranged from 23.5 % to 26.0 % for mercury, 17.3 % to 51.6 % for PCBs, and 0.7 % to 9.1 % for PFOS.

Measuring the quality of antenatal care in a context of high utilisation: evidence from Telangana, India

BackgroundAntenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources.MethodsData from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019–21; Health Management Information System (HMIS), 2019–20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed.ResultsNFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively.ConclusionDespite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women’s experiences of care.

Contamination and health risks of heavy metals in the soil of a historical landfill in northern China

Landfill-induced heavy metal (HM) contamination of soils is a widespread and complex problem. The levels and potential hazards of HM contamination in landfills must be evaluated before they can be reused for any purpose. In order to reuse a historical landfill in northern China, 376 sampling sites were selected in 2019 using the checkerboard layout method, and the levels of arsenic (As), mercury (Hg), antimony (Sb), copper (Cu), lead (Pb), cadmium (Cd), nickel (Ni), zinc (Zn), and thallium (Tl) in the soil were measured. Multiple evaluation methods established the HM pollution levels, agricultural suitability, and health risks associated with the sampling sites. In most parts of the study area, the concentrations of all nine HMs exceeded the screening levels and maximum allowable concentrations for agricultural soils. Only the soils in Zones 5 and 6 can be used for agricultural activity. Moreover, the deep soils were heavily contaminated with HMs in certain areas, possibly because of leaching and infiltration in the surface soil and the rise and diffusion of polluted groundwater. The soil HMs in the study area posed a higher carcinogenic risks to both adults and children. The average carcinogenic risk associated with As was 6.12 × 10−4, which was the major contributor to carcinogenic risk at all HM-contaminated sites. The results of this work empirically demonstrated that soil HM pollution is severe and problematic in the study area and remedial measures are urgently required.

A Study of the Factors Related to Screening of Cervical Cancer of Women in Ardabil Health Centers

Background and aims: Cervical cancer is the second most prevalent cancer in women after breast cancer. By prevention and using prevention methods, its development and the resultant morality rate will no doubt decrease. Therefore, the present study aimed to examine the related causes through screening of cervical cancer of women in Ardabil, Iran.Methodology: In this descriptive-analytic study, 300 women coming to health centers in Ardabil were selected through multi-step sampling. The data were collected through a researcher-made questionnaire composed of two parts, including knowledge and attitude questions, and a form to be filled with demographic information, family details, socioeconomic status, and midwifery-obstetrics risk factors. The data were analyzed by SPSS ver. 16 using descriptive and inferential statistics.Findings: The rate of cervical cancer screening was found to be 25.3%. There was a significant relationship between cervical cancer screening and educational level (p < .001) and the history of sexual diseases. We could not observe a significant relationship between the test and insurance, smoking history, the age of the first marriage, and the number of marriages by each subject (p > .05).Conclusion: With an eye on some crucial factors and their role in taking screening tests and an understanding of inaction regarding preventive practices, attention to other barriers and removing them is emphasized.

Abstract 11199: Disparities in Screening for Postpartum Depression - Insights From American Heart Association Research Goes Red Registry

Introduction: Postpartum depression (PPD) affects 1 in 5 women in the United States and is associated with cardiovascular disease. Disparities in PPD screening have not been well studied. We investigated the level of self-reported screening, diagnosis of PPD, and disparities in screening. Methods: We utilized data from participants enrolled in the AHA Research Goes Red Registry, an online research platform powered by Verily, who responded to the Fertility and Pregnancy survey. Of the 3128 women who had responded as of May 2022, 311 participants were self-identified as postpartum women and were included in this analysis. The definition of postpartum in the survey was “I have been pregnant within the last 12 months ”. The survey included questions on PPD screening and diagnosis. We used chi-squared testing to examine differences by race-ethnicity, education, income, and proximity to healthcare in PPD screening. Results: Among the 311 postpartum women (mean age: 33.3 ± 4.8 years), 83% recalled being screened for PPD. Of the 311 women, 15% reported a diagnosis of PPD, of which 92% received treatment. There were no significant differences in PPD screening by race-ethnicity: non-Hispanic White (82%), non-Hispanic Black (83%), Asian (88%), Hispanic (80%) (p=0.91), possibly limited by sample size (Fig 1a). Similarly, there were no significant differences by educational status (p=0.22) (Fig 1b) or income (p=0.53) (Fig 1c). Women who lived in a big city with access to many hospitals had higher proportion of screening (88%), while rural area dwellers had the least (74%, p=0.54) (Fig 1d). Conclusion: Among this multiracial cohort of postpartum women, the prevalence of self-reported screening and diagnosis of PPD was 83% and 15%, respectively. The prevalence of screening did not significantly differ by race-ethnicity, education, income, and proximity to healthcare. Future larger studies were suggested to explore screening of PPD by race and other social determinants of health.

Identification of Decreased Butyrylcholinesterase in Sudden Infant Death Syndrome Is, at Best, a First Step Toward Preventive Screening.

The identification of a biomarker associated with increased risk of sudden infant death syndrome (SIDS), as described by Harrington et al. (1) is an exciting yet cautionary tale combining the incremental progress of scientific research and the hazards of media hype. The authors propose an association of decreased butyrylcholinesterase (BChE) activity levels in newborn screening (NBS) dried blood spots collected from infants who died of SIDS compared to surviving controls. This association was not seen in a cohort of non-SIDS deaths when compared to surviving controls. The authors theorize that decreased BChE activity is a marker for autonomic dysfunction, a vulnerability previously suspected to be implicated in the triple risk model for SIDS (2). While considerable decreases in SIDS deaths have been accomplished through NBS programs and safe sleep education, a significant number of infants still die of SIDS, and other promising diagnostic approaches (e.g., genomic analyses) are so far only pursued in the research environment (3). Harringtons study had a robust design with well-defined cases and controls. Utilizing NBS dried blood samples recognizes the need for future screening to work within existing systems for sample collection and availability, and takes advantage of preserved samples for the potential benefit of babies and families in the future. This study was made possible in part by the recognition that stored NBS blood samples can provide valuable information for future expansion of NBS panels. The rarity of most conditions targeted for NBS precludes prospective case identification. Regions that destroy samples after short retention periods are limiting opportunities for improvement and expansion of screening programs, as well as for families to obtain critical information from these samples.

Mercury in Kansas Fish: Levels, Patterns, and Risk-Based Safe Consumption Limits for Mercury Sensitive Individuals

In wet environments a portion of ambient inorganic mercury (Hg) is transformed to methylmercury (MeHg); a neurotoxin that readily concentrates in fish. Public health entities monitor Hg levels in fish to inform consumers of the types and amounts of fish that are safe to eat. In this study, monitoring data collected from stream and lakes across Kansas were used to summarize fillet tissue total mercury (THg = MeHg + Hg) levels in 36 fish species and hybrids. Data associated with eleven food fish taxa (genus and species) were presented in detail and statewide risk-based monthly safe consumption limits (SCLs) protective of Hg sensitive individuals were calculated, including two size categories (< or ≥ 508 mm) for larger growing taxa. Linear mixed effects models (LMEMs) were used to generate least squares (LS) mean fish THg values for between habitat (lakes and streams) and within habitat (waterbody size, ecoregion, and major river basin) categorical variables, and for individual sample sites. Sample site LS means were used to identify potential fish THg hotspots among lakes (LS means ≥ 90th percentile) and streams (Getis-Ord Gi* statistic). Across all samples (n = 2,106) a more than 200-fold difference existed between the highest (2.1 mg/kg) and lowest THg (0.01 mg/kg) concentrations, but most samples were below the Kansas Department of Health and Environment's (KDHE) human health screening level (HSL) (0.23 mg/kg). Statewide safe consumption limits ranged from 1 meal/month in ≥ 508 mm flathead catfish to 8 meals/mo. in crappie spp. Least squares mean fish THg was significantly higher in streams than lakes, and significantly higher in small lakes (< 10 surface acres) than larger lakes. Stream size did not affect fish THg levels. In both lakes and streams, ecoregion and major river basin significantly affected fish THg levels with higher levels more prevalent in eastern geographic areas. Lakes identified as potential fish THg hotspots were widely distributed throughout the study area, but all stream hotspot sites were clustered in the southeast portion of the state.

Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease.

The prevalence of obesity and comorbidities is high in the population with spinal cord injury (SCI). We sought to determine the effect of SCI on the functional form of the relationship between body mass index (BMI) and risk of developing nonalcoholic fatty liver disease (NAFLD), and assess whether SCI-specific mapping of BMI to risk of developing NAFLD is needed. Longitudinal cohort study comparing Veterans Health Administration patients with a diagnosis of SCI to a 1:2 matched control group without SCI. The relationship between BMI and development of NAFLD at any time was assessed with propensity score matched Cox regression models; NAFLD development at 10-year with a propensity score matched logistic model. The positive predictive value of developing NAFLD at 10years was calculated for BMI 19-45kg/m2. 14,890 individuals with SCI met study inclusion criteria, and 29,780 Non-SCI individuals in matched control group. Overall, 9.2% in SCI group and 7.3% in Non-SCI group developed NAFLD during the study period. A logistic model assessing the relationship between BMI and the probability of developing a diagnosis of NAFLD demonstrated that the probability of developing disease increased as BMI increased in both cohorts. The probability was significantly higher in the SCI cohort at each BMI threshold (p<0.01), and increased at a higher rate compared with the Non-SCI cohort as BMI increased 19-45kg/m2. Positive predictive value for developing a diagnosis of NAFLD was higher in the SCI group for any given BMI threshold from 19kg/m2 to BMI 45kg/m2. The probability of developing NAFLD is greater in individuals with SCI than without SCI, at every BMI level 19kg/m2 to 45kg/m2. Individuals with SCI may warrant a higher level of suspicion and closer screening for NAFLD. The association of SCI and BMI is not linear.

Treating 'osteoporosis': a near miss in an unusual case of FGF-23-mediated hypophosphataemic osteomalacia.

We present the case of a 60-year-old female who developed repeated atraumatic stress fractures. She was initially diagnosed with osteoporosis based on her dual-energy X-ray absorptiometry (DXA) scan bone mineral density (BMD) T-scores and started on denosumab therapy. Secondary osteoporosis screen revealed abnormal myeloma screen and low serum phosphate levels. It was thought that the patient had multiple myeloma with associated Fanconi-related tubular dysfunction. However, fibroblast growth factor-23 (FGF-23) levels were grossly elevated, making Fanconi syndrome unlikely. The patient was subsequently diagnosed with two separate conditions, namely cardiac amyloid light-chain (AL) amyloidosis and FGF-23-related hypophosphataemia, likely due to tumour-induced osteomalacia. This case highlights the importance of excluding osteomalacia as a cause of low BMD and checking FGF-23 levels in the workup for hypophosphataemia. Tumour-induced osteomalacia is a difficult diagnosis as the tumour is often small and slow growing. Imaging may fail to identify a tumour, and treatment therefore consists of calcitriol and phosphate replacement. Tumour-induced osteomalacia should be suspected in the adult presenting with new-onset hypophosphataemia, elevated FGF-23 levels and isolated renal phosphate wasting. Serum phosphate is not part of the routine chemistry panels. Routinely checking phosphate levels prior to initiating antiresorptive therapy is warranted. DXA cannot distinguish low bone mineral density due to osteoporosis from osteomalacia. Antiresorptive therapy should be avoided in osteomalacia due to the risk of clinical and radiographic deterioration.

Industrial Particulate Pollution and Historical Land Use Contribute Metals of Concern to Dust Deposited in Neighborhoods Along the Wasatch Front, UT, USA.

The Salt Lake Valley, UT, USA, is proximal to the desiccating Great Salt Lake (GSL). Prior work has found that this lakebed/playa contributes metals-laden dust to snow in the Wasatch and Uinta Mountains. Dust and industrial particulate pollution are also delivered to communities along the Wasatch Front, but their sources, compositions, and fluxes are poorly characterized. In this study, we analyzed the dust deposited in 18 passive samplers positioned near the GSL, in cities in and near the Salt Lake Valley for total dust flux, the <63µm dust fraction, 87Sr/86Sr, and trace element geochemistry. We compared spatial patterns in metal flux and abundance with community-level socioeconomic metrics. We observed the highest dust fluxes at sites near the GSL playa. Within the urban corridor, 87Sr/86Sr and trace element relative abundances suggest that most of the dust to which people are regularly exposed may be fugitive dust from local soil materials. The trace metal content of dust deposited along the Wasatch Front exceeded Environmental Protection Agency screening levels and exhibited enrichment relative to both the upper continental crust and the dust collected adjacent to GSL. Sources of metals to dust deposited along the Wasatch Front may include industrial activities like mining, oil refining, as well as past historical pesticide and herbicide applications. Arsenic and vanadium indicated a statistically significant positive correlation with income, whereas lead, thallium, and nickel exhibited higher concentrations in the least wealthy and least white neighborhoods.

Serum neurofilament-light and glial fibrillary acidic protein levels in hydroxychloroquine-treated primary progressive multiple sclerosis.

In a recent trial, hydroxychloroquine (HCQ) treatment reduced the expected rate of disability worsening at 18 months in primary progressive multiple sclerosis (PPMS). Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are emerging biomarkers in multiple sclerosis. We measured NfL and GFAP levels in serum samples from 39 patients with inactive PPMS included in a phase II clinical trial of HCQ treatment in PPMS at multiple time points over 18 months, and investigated the association of these biomarkers with clinical disability at screening and during follow-up. Screening and 12-month retinal nerve fiber layer (RNFL) thickness was also recorded and analyzed. NfL and GFAP levels increased over time, but only significantly from screening to month 6. NfL and GFAP levels did not significantly increase from month 6 up to month 18. At screening, NfL and GFAP levels did not correlate with the Expanded Disability Status Scale(EDSS), and GFAP but not NfL modestly correlated with Timed 25-Foot Walk test (T25FW). Screening NfL and GFAP levels did not predict disability worsening (≥20% worsening on the T25FW) at month 18. RNFL thickness decreased significantly from screening to month 12 and independently predicted disability worsening. In this cohort of people with inactive PPMS, HCQ treatment attenuated the increase of NfL and GFAP after 6 months of treatment and up to 18 months of follow-up, suggesting a treatment effect of HCQ over these biomarkers. RNFL thickness, a marker of neuroaxonal atrophy, was associated with disability worsening, and should be explored further as a prognostic marker in this population.

Circulating Tumor HPV-DNA Kinetics in p16+ Oropharyngeal Cancer Patients Undergoing Adaptive Radiation De-Escalation Based on Mid-Treatment Nodal Response

<h3>Purpose/Objective(s)</h3> Human-papilloma virus-positive (HPV+) OPSCC is known to have an excellent prognosis with a favorable response to CRT. Several studies have shown that de-intensified treatment in select patients (pts) can achieve similar survival outcomes to standard treatment while reducing acute and long-term toxicity. Additionally, rapid clearance of circulating tumor HPV DNA may be useful in predicting the likelihood of disease control. <h3>Materials/Methods</h3> We evaluated pts enrolled on a phase II institutional clinical trial. Pts with HPV+ OPSCC were included and were treated with definitive CRT with cisplatin. All pts were initially planned to receive standard radiation dose (S-RT) to 70 Gy; those who achieved a favorable mid-treatment response (FMTR) of >40% lymph node shrinkage at week 4 of radiation (RT) received a de-escalated dose (D-RT) to 60 Gy. Blood samples were taken at screening, week 4 of RT, and at follow-up visit after RT and circulating tumor tissue modified viral HPV NDA (TTMV) was qualtified. We define a "substantial TTMV clearance" as either >95% reduction in TTMV from screening to week 4 (screening level >200 copies/ml) or undetectable ctHPVDNA at week 4 (any detectable screening level). Fisher tests were used to evaluate the association of TTMV and treatment group. <h3>Results</h3> At the time of this analysis, 35 pts were enrolled in the clinical trial with a median age of 60 years at diagnosis (range 38 to 76). 25 pts achieved a FMTR and received D-RT while 10 pts received S-RT. 29 pts (7 S-RT, 18 D-RT) had detectable screening TTMV and week 4 TTMV samples available for analysis. D-RT pts had a significantly higher rate of substantial TTMV clearance at week 4 compared to S-RT: 14.3% (1/7) pts in the S-RT vs. 61.1% (11/18) pts in the D-RT (OR 0.090 [0.002 - 0.105], p=0.036). 6 of 25 pts (24%) had a flare in their TTMV from screening to week 4 including 57.1% (4/7) of the S-RT and 11.1% (2/18) of the D-RT; there was a significantly higher likelihood of TTMV flare in the S-RT group (OR 9.34 [0.898 - 150.960], p=0.032). 24 pts (6 S-RT, 18 D-RT) with initial detectable screening TTMV also had a follow-up TTMV sample available. The median time from screening to follow-up was 81.0 days for all pts (76.5 days for D-RT, 84.0 days for S-RT). 95.7% of pts (83.3% of S-RT, 100%% of D-RT) had complete TTMV clearance at follow-up. <h3>Conclusion</h3> We report a statistically significant correlation between substantial TTMV clearance and a FMTR of >40% nodal shrinkage. 61.1% of D-RT pts achieved a substantial TTMV clearance compared to 14.3% in the S-RT group. Additionally, we observed that pts who did not achieve a FMTR had a higher likelihood of TTMV flare at week 4. Nearly all pts achieved a complete TTMV clearance by follow-up. Mid-treatment TTMV clearance may help identify pts who may benefit from further de-escalation as well as those who should continue with standard therapy. This study has the ClinicalTrials.gov identifier NCT03215719.