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Residents of low-income multifamily housing can have elevated exposures to multiple environmental pollutants known to influence asthma. Simulation models can characterize the health implications of changing indoor concentrations, but quantifying the influence of interventions on concentrations is challenging given complex airflow and source characteristics. In this study, we simulated concentrations in a prototype multifamily building using CONTAM, a multizone airflow and contaminant transport program. Contaminants modeled included PM2.5 and NO2, and parameters included stove use, presence and operability of exhaust fans, smoking, unit level, and building leakiness. We developed regression models to explain variability in CONTAM outputs for individual sources, in a manner that could be utilized in simulation modeling of health outcomes. To evaluate our models, we generated a database of 1000 simulated households with characteristics consistent with Boston public housing developments and residents and compared the predicted levels of NO2 and PM2.5 and their correlates with the literature. Our analyses demonstrated that CONTAM outputs could be readily explained by available parameters ( R2 between 0.89 and 0.98 across models), but that one-compartment box models would mischaracterize concentrations and source contributions. Our study quantifies the key drivers for indoor concentrations in multifamily housing and helps to identify opportunities for interventions. Practical Implications Many low-income urban asthmatics live in multifamily housing that may be amenable to ventilation-related interventions such as weatherization or air sealing, wall and ceiling hole repairs, and exhaust fan installation or repair, but such interventions must be designed carefully given their cost and their offsetting effects on energy savings as well as indoor and outdoor pollutants. We developed models to take into account the complex behavior of airflow patterns in multifamily buildings, which can be used to identify and evaluate environmental and non-environmental interventions targeting indoor air pollutants which can trigger asthma exacerbations. [ABSTRACT FROM AUTHOR]

Because smoking is a pervasive risk factor for numerous health outcomes, it is essential to understand smoking patterns in different populations and places. Previous studies have described sociodemographic and geographic variation in smoking across the U.S., providing insight to public health scientists aiming to identify high-risk populations and places in the absence of local data. This study extends previous research by considering the influence of a combination of covariates at the U.S. state, core-based statistical area (CBSA), and individual levels, focusing on a time period when smoking prevalence has decreased significantly but disparities remain. We applied multilevel regression to the 2006-2007 Current Population Survey-Tobacco Use Supplement. We conducted a four-level logistic regression model and evaluated fixed and random effects to quantify the contribution of sociodemographic characteristics at the individual level, area poverty at the CBSA level, and indoor smoking legislation and cigarette taxes at the state level, to the probability of smoking at the individual level and the variance in smoking at the state and CBSA levels. Sociodemographic covariates were significant predictors of smoking and explained 67% of variance at the CBSA level alone but only 41% at the state level. Contextual covariates alone, such as indoor smoking legislation and cigarette taxes at the state level and area poverty at the CBSA level, explained a larger proportion of state variance (82%) but individually had modest statistical significance. Our findings emphasize the continued disparities in smoking patterns in the U.S. despite the decrease of smoking prevalence in the past decade; as well as the ongoing necessity to consider associations with both compositional and contextual factors. Patterns of residual variance emphasize the continued need to identify and evaluate appropriate contextual covariates, with more refined geographic resolution than that available from national surveys at present., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through "income" and "stock" effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.

Concentrations of airborne culturable fungi were measured in the kitchen of a bakery in Boston, Mass., to evaluate variabilities associated with common worker activities, outdoor aerosol distributions, and season. Activities were categorized as early morning preparation, cornmeal sifting and tossing, flour dumping and mixing, sweeping, and low activity. Sets of measurements were taken over 1 day in spring and 1 day in summer. Fungal concentrations were measured using a one-stage culture plate impactor, and bulk samples were taken from suspected fungal reservoirs within the bakery and subsequently cultured. Compared with the low activity category, elevated levels of total culturable fungi were found during all other activities, with the amount of increase closely related to individual worker activity as well as outdoor concentrations and initial bakery conditions. In the spring, Penicillium was the dominant genus showing activity-related elevations in concentrations, while Cladosporium was the dominant genus during the summer. Clearly, due to variabilities in worker activities and ambient fungal concentrations, a standardized sampling protocol involving a large sample size over multiple days is needed to estimate accurately exposure to either total airborne fungi or specific fungal taxa.

Many epidemiological studies have used house characteristics associated with indoor sources as simplified proxies for personal nitrogen dioxide (NO2) exposure. Stove type and presence of a pilot light often been used as the two key characteristics, but significant overlaps have remained in the NO2 concentrations in the exposed and unexposed groups. This has contributed to inconsistencies in epidemiological findings, due to potential misclassification of exposure. In this study, other possible proxies were analyzed by cross-table analyses and were investigated in terms of improvements in both classification and predictive power. Adding building type to the above two proxies resulted in 0-5% of households with concentrations overlapping the observed range for the opposing stratum, compared with 22-42% for the two-proxy model. In spite of this performance, the predictive power of regression models for indoor NO2 was not improved by the addition of the third proxy, and the potential sample population was significantly limited. Using these analytical methods to choose descriptive proxies and evaluate the tradeoffs in their implementation can help epidemiological studies improve their designs and therefore optimize the robustness of their conclusions.

Nitrogen dioxide (NO2) concentrations were measured during two-day winter periods in indoor and outdoor environments, and these concentrations were compared with simultaneously measured personal exposures in 18 cities in 15 countries around the world. Information was also gathered on activity patterns and household characteristics in order to determine the influences of these factors on personal exposures. All NO2 measurements were taken using passive filter badges. Personal exposures were found to vary greatly among the array of cities, with mean concentrations ranging between 11.0 ppb and 51.5 ppb. Personal NO2 exposures were more strongly correlated with indoor concentrations (r = 0.75) than with outdoor concentrations (r = 0.57) when all countries were considered simultaneously. Use of a gas stove in the home was the dominant activity influencing NO2 concentrations, with a 67% increase in mean personal NO2 exposure and an increase in indoor-outdoor ratios from 0.7 to 1.2 for participants using gas stoves, although preliminary evidence indicates the importance of combustion space heaters as well. These associations indicate the global nature of the correlation between personal NO2 exposures and indoor NO2 sources such as gas stoves or space heaters, demonstrating that this relationship is not dependent on country-specific parameters.

A total tumour irradiation dose of 2900 rad and a dose of 2500 rad to a metastasis, as well as the administration of 330 mg/m2 adriamycin, successfully eradicated all traces of malignant disease after partial surgical excision in a 12-year-old Black boy with a rhabdomyosarcoma of the mediastinum. The treatment, however, damaged the heart and caused the death of the patient.

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.

Solitary myeloma of bone occurred in 10 Black patients during the 8-year period from 1967 to 1974. In 4 patients, the solitary myeloma involved the bones of the paranasal sinuses, in 3 patients the pelvis, and in 3 others the manubrium sterni. An IgG monoclonal gammopathy was present in the serum of 4 patients and Bence-Joanes proteinuria was found in 1 patient. Radiation therapy was the treatment of choice and the recommended tumour dosage is 4000-5000 rads. Serial measurements of serum and urine protein electrophoresis and immuno-electrophoresis were most helpful in determining when patients had achieved a complete remission. In 3 patients, 1 of whom died, the myeloma disseminated in periods varying from 26 months to 7 years. Nine patients are alive, of whom 7 are in complete remission, and 5 have lived for more than 5 years since the initial diagnosis of solitary myeloma.

The value of plain chest radiography in the diagnosis of primary hepatocellular cancer (PHC) was assessed in 449 patients. An elevated right hemidiaphragm and pulmonary metastases were present in 11% and strongly suggest a diagnosis of PHC. In all, the right hemidiaphragm was raised in 30% of patients. Pulmonary metastases were present on admission in 19% of patients and appeared later in a further 6%. Secondary deposits were found in the lungs at necropsy in 52% of patients, compared with only 24% in whom there was radiological evidence of metastases during life. In 36% of patients chest radiographs were normal on admission.

The effect of carbachol on the gallbladder was assessed in 24 White and 24 Black volunteers. The results suggest that in Blacks the gallbladder empties to a signigicantly greater degree than it does in Whites after administration of carbachol. This fact may account, in part, for the lower incidence of cholelithiasis in Black populations. No difference in gallbladder contractility was found between men and women nor did gallbladder response appear to be influence by hormonal factors.

Haemangiopericytoma is a very vascular tumour which is slow growing and often painless. It is important to realise the malignant potential of these tumours and to treat them by wide surgical excision. Angiography was helpful in this case because it gave warning of probable malignancy.

A tubulovillous adenoma of the duodenum with a predominant villous pattern in a child aged 11 years underwent malignant change, causing obstructive jaundice, and was diagnosed by percutaneous transhepatic cholangiography. Two of the patient's 9 siblings had previously died of cancer. A review of villous tumours of the duodenum is given.