Assessing the Human Health Benefits of Climate Mitigation, Pollution Prevention, and Biodiversity Preservation

Background

Since the Industrial Revolution, humanity has amassed great wealth and achieved unprecedented material prosperity. These advances have come, however, at great cost to the planet. They are guided by an economic model that focuses almost exclusively on short-term gain, while ignoring natural capital and human capital. They have relied on the combustion of vast quantities of fossil fuels, massive consumption of the earth's resources, and production and environmental release of enormous quantities of chemicals, pesticides, fertilizers, and plastics. They have caused climate change, pollution, and biodiversity loss, the "Triple Planetary Crisis". They are responsible for more than 9 million premature deaths per year and for widespread disease - impacts that fall disproportionately upon the poor and the vulnerable.

Goals

To map the human health impacts of climate change, pollution, and biodiversity loss. To outline a framework for assessing the health benefits of interventions against these threats.

Findings

Actions taken by national governments and international agencies to mitigate climate change, pollution, and biodiversity loss can improve health, prevent disease, save lives, and enhance human well-being. Yet assessment of health benefits is largely absent from evaluations of environmental remediation programs. This represents a lost opportunity to quantify the full benefits of environmental remediation and to educate policy makers and the public.

Recommendations

We recommend that national governments and international agencies implementing interventions against climate change, pollution, and biodiversity loss develop metrics and strategies for quantifying the health benefits of these interventions. We recommend that they deploy these tools in parallel with assessments of ecologic and economic benefits. Health metrics developed by the Global Burden of Disease (GBD) study may provide a useful starting point.Incorporation of health metrics into assessments of environmental restoration will require building transdisciplinary collaborations. Environmental scientists and engineers will need to work with health scientists to establish evaluation systems that link environmental and economic data with health data. Such systems will assist international agencies as well as national and local governments in prioritizing environmental interventions.

Effectiveness of Adaptive Silverware on Active Range of Motion in Individuals With Rheumatoid Arthritis

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

The purpose of this study was to quantify active range of motion (ROM) required for individuals with rheumatoid arthritis (RA) using built-up spoons with electrogoniometry. Statistical analysis provided quantitative evidence supporting our hypothesis that using a built-up handle requires less active ROM for grasp. Clinical implications suggest built-up handles may be used for people with other conditions with limited hand and wrist ROM, not just RA, increasing participation and independence in daily activiti

Primary Author and Speaker: Susan McDonald

Additional Authors and Speakers: David Levine, Hensley Barnes, Anna Cornett, Caroline Craig, Sally Langager, Lauren Yeager, and Michael Britt

Artificial Intelligence Clinical Evidence Engine for Automatic Identification, Prioritization, and Extraction of Relevant Clinical Oncology Research

PURPOSE

We developed a system to automate analysis of the clinical oncology scientific literature from bibliographic databases and match articles to specific patient cohorts to answer specific questions regarding the efficacy of a treatment. The approach attempts to replicate a clinician's mental processes when reviewing published literature in the context of a patient case. We describe the system and evaluate its performance.

METHODS

We developed separate ground truth data sets for each of the tasks described in the paper. The first ground truth was used to measure the natural language processing (NLP) accuracy from approximately 1,300 papers covering approximately 3,100 statements and approximately 25 concepts; performance was evaluated using a standard F1 score. The ground truth for the expert classifier model was generated by dividing papers cited in clinical guidelines into a training set and a test set in an 80:20 ratio, and performance was evaluated for accuracy, sensitivity, and specificity.

RESULTS

The NLP models were able to identify individual attributes with a 0.7-0.9 F1 score, depending on the attribute of interest. The expert classifier machine learning model was able to classify the individual records with a 0.93 accuracy (95% CI, 0.9 to 0.96, P < .0001), and sensitivity and specificity of 0.95 and 0.91, respectively. Using a decision boundary of 0.5 for the positive (expert) label, the classifier demonstrated an F1 score of 0.92.

CONCLUSION

The system identified and extracted evidence from the oncology literature with a high degree of accuracy, sensitivity, and specificity. This tool enables timely access to the most relevant biomedical literature, providing critical support to evidence-based practice in areas of rapidly evolving science.

Effectiveness of Adaptive Silverware on Active Range of Motion (ROM) in Individuals With Rheumatoid Arthritis

Date Presented 03/26/20

The purpose of this study was to quantify active ROM required for individuals with rheumatoid arthritis using built-up spoons with electrogoniometry. Statistical analysis provided quantitative evidence supporting our hypothesis that using a built-up handle requires less active ROM for grasp. Clinical implications suggest that built-up handles may be used for other conditions with limited hand and wrist ROM, not just RA, increasing participation and independence in daily activities.

Primary Author and Speaker: Susan McDonald

Additional Authors and Speakers: David Levine, Hensley Barnes, Anna Cornett, Kathleen Craig, Sally Langager

Contributing Authors: Lauren Yeager, Michael Britt

Innovations in global dentifrice technology: an advanced stannous-containing sodium fluoride dentifrice

PURPOSE

Despite oral health improvements in many geographies, the prevalence of oral concerns, including caries, gingivitis, dentin hypersensitivity, breath malodor, calculus, and extrinsic staining remains unacceptably high across the globe. Dentifrice offers a convenient and accessible vehicle to deliver ingredients--such as antimicrobials, fluoride, and esthetic-enhancing agents--to treat a broad range of common oral conditions. Recently, a novel stannous-containing sodium fluoride (1450 ppm F-) dentifrice was introduced that has been tested in the lab and/or clinically in diverse geographic regions for its impact on major oral conditions.

METHODS

This next-generation dentifrice, marketed as Crest Pro-Health in China and blend-a-med Pro-Expert in parts of Europe, has been extensively clinically tested in the lab and/or clinically on multiple continents in a broad range of subject populations with varying levels of disease and/or cosmetic concerns. This special issue features a few of the many laboratory and clinical investigations conducted on this formulation.

RESULTS

The findings reported here demonstrate the product's anticaries potential as well as its ability to reduce plaque, improve dentin hypersensitivity, inhibit extrinsic stain, and improve breath malodor.

Neomycin is an agonist at a polyamine site on the N-methyl-D-aspartate receptor

Neomycin appears as a full agonist and spermidine as a partial agonist at the site where polyamines enhance 1-[1-(2-thienyl)cyclohexyl][3H]piperidine ([3H]TCP) binding on the N-methyl-D-aspartate (NMDA) receptor. Other aminoglycosides also enhance [3H]TCP binding with efficacies roughly proportional to the number of primary amine groups. The polyamine antagonists ifenprodil and arcaine inhibit enhancement of [3H]TCP binding by spermidine or neomycin. The inhibition of [3H]TCP binding by arcaine is apparently competitively reduced by neomycin and spermidine, supporting a common site. Diethylenetriamine (previously described as a polyamine antagonist) may be a partial agonist. Enhancement by neomycin or spermidine is not additive to that of Mg2+, consistent with competition of Mg2+ and spermidine or neomycin at the site where these compounds enhance [3H]TCP binding. Polyamines also enhance the binding of the competitive antagonist 2-(2-carboxypiperazin-4-yl)[3H]propyl-1-phosphonic acid ([3H]CPP). Neomycin, which does not enhance [3H]CPP binding, inhibits the enhancement by spermidine. That this site is distinct from the site where spermidine and neomycin increase [3H]TCP binding is supported by different pharmacology. Arcaine and diethylenetriamine do not inhibit spermidine enhancement of [3H]CPP binding. Mg2+ also does not compete with the spermidine enhancement of [3H]CPP binding. Ifenprodil inhibits the spermidine enhancement of [3H]CPP binding. The data suggest two or more polyamine sites, with arcaine selective for the site that enhances [3H]TCP binding. Neomycin is an agonist at one polyamine site and antagonist to the second.

Inhibition of the B to Z transition in poly(dGdC).poly(dGdC) by covalent attachment of ethidium: kinetic studies

The photoaffinity analogue ethidium monoazide was used to prepare samples of poly(dGdC).poly(dGdC) containing covalently attached ethidium. The effects of both noncovalently and covalently bound ethidium on the kinetics of the NaCl-induced B to Z transition in poly(dGdC).poly(dGdC) was examined using absorbance and fluorescence spectroscopy to monitor the reaction. Covalently and noncovalently attached ethidium were equal in the extent to which they reduce the rate of the B to Z transition. By using fluorescence to selectively monitor the fate of noncovalently bound ethidium over the course of the transition, we found that ethidium completely dissociates as the reaction proceeds, but at a rate that lags behind the conversion of the polymer to the Z form. These experiments provide evidence for the redistribution of noncovalently bound ethidium over the course of the B to Z transition, leading to the development of biphasic reaction kinetics. The observed kinetics suggest that the primary effect of both covalently and noncovalently bound ethidium is on the nucleation step of the B to Z transition. The reduction in the rate of the B to Z transition by noncovalently or covalently bound ethidium may be quantitatively explained as resulting from the reduced probability of finding a drug-free length of helix long enough for nucleation to occur. As necessary ancillary experiments, the defined length deoxyoligonucleotides (dGdC)4, (dGdC)5, and (dGdC)6 were synthesized and used in kinetic experiments designed to determine the nucleation length of the B to Z transition, which was found to be 6 bp. The activation energy of the B to Z transition was demonstrated to be independent of the amount of covalently bound ethidium and was found to be 21.2 +/- 1.1 kcal mol-1. Covalent attachment of ethidium was observed to increase the rate of the reverse Z to B transition, presumably by locking regions of the polymer into a right-handed conformation and thereby providing nucleation sites from which the Z to B conversion may propagate.

Reflex sympathetic dystrophy after clavicle fracture: case report

Reflex sympathetic dystrophy (RSD) of the anterior chest wall is a rare entity. A MEDLINE search in all languages of the world's literature from 1966 to the present yielded no report of the association of clavicle fracture with this pain syndrome. Two cases are presented and the anatomic variations of the supraclavicular nerves in relation to the clavicle are discussed.

Stereoselectivity for the (R)-enantiomer of HA-966 (1-hydroxy-3-aminopyrrolidone-2) at the glycine site of the N-methyl-D-aspartate receptor complex

HA-966 (1-hydroxy-3-aminopyrrolidone-2) is an antagonist at the glycine allosteric site of the N-methyl-D-aspartate receptor ionophore complex. Unlike presently known glycine antagonists, HA-966 is chiral. We report stereoselectivity for the (R)-enantiomer at the glycine antagonist site. In [3H]glycine binding, the (R)-enantiomer has an IC50 of 4.1 +/- 0.6 microM. The racemic mixture has an IC50 of 11.2 +/- 0.5 microM, whereas (S)-HA-966 has an IC50 greater than 900 microM. In glycine-stimulated [3H]1-[1-(2- thienyl)cyclohexyl]piperidine binding, the (R)-enantiomer inhibits with an IC50 of 121 +/- 61 microM, whereas the racemic mixture has an IC50 of 216 +/- 113 microM and (S)-HA-966 is inactive. The inhibition by (R)-HA-966 can be prevented by the addition of glycine. (R)-HA-966 and racemic HA-966, but not (S)-HA-966, also prevent N-methyl-D-aspartate cytotoxicity in cortical cultures. The (R)-enantiomer and, less potently, the (S)-enantiomer inhibit N-methyl-D-aspartate-evoked [3H]norepinephrine release from rat hippocampal slices (IC50 values of about 0.3 mM and 1.6 mM, respectively), but only the inhibition by (R)-HA-966 is reversed by added glycine. In glutamate-evoked contractions of the guinea pig ileum, (R)-HA-966 causes a glycine-reversible inhibition (IC50 of about 150 microM), whereas (S)-HA-966 is much less potent (IC50 of greater than 1 mM). These results demonstrate stereoselectivity of the glycine antagonist site of the N-methyl-D-aspartate receptor complex in a variety of tissues and assays. The stereoselectivity also confirms the specificity of N-methyl-D-aspartate receptors in glutamate-evoked contractions of the guinea pig ileum, and supports their similarity to central N-methyl-D-aspartate receptors.

Stereoselective enhancement by (R)-HA-966 of the binding of [3H]CPP to the NMDA receptor complex

The enantiomers of the strychnine-insensitive glycine antagonist, HA-966 (1-hydroxy-3-amino-pyrrolidone-2), stereoselectively enhance binding of the N-methyl-D-aspartate (NMDA) competitive antagonist, [3H]CPP (3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid) to rat brain synaptosomal membranes. The enhancement by the more potent (R)-HA-966 is competitively inhibited by the glycine antagonist 7-chlorokynurenic acid and noncompetitively by the polyamine spermine. Thus, (R)-HA-966, apparently at the glycine site, enhances the binding of antagonist to the NMDA receptor, possibly through a mechanism partially in common with that of spermine.

Site and sequence specificity of the daunomycin-DNA interaction

The site and sequence specificity of the daunomycin-DNA interaction was examined by equilibrium binding methods, by deoxyribonuclease I footprinting studies, and by examination of the effect of the antibiotic on the cleavage of linearized pBR322 DNA by restriction endonucleases PvuI and EcoRI. These three experimental approaches provide mutually consistent results showing that daunomycin indeed recognizes specific sites along the DNA lattice. The affinity of daunomycin toward natural DNA increases with increasing GC content. The quantitative results are most readily explained by binding models in which daunomycin interacts with sites containing two adjacent GC base pairs, possibly occurring as part of a triplet recognition sequence. Deoxyribonuclease I footprinting studies utilizing the 160 base pair (bp) tyrT DNA fragment and 61 and 53 bp restriction fragments isolated from pBR322 DNA further define the sequence specificity of daunomycin binding. Specific, reproducible protection patterns were obtained for each DNA fragment at 4 degrees C. Seven protected sequences, ranging in size from 4 to 14 bp, were identified within the tyrT fragment. Relative to the overall tyrT sequence, these protected sequences were GC rich and contained a more limited and distinct distribution of di- and trinucleotides. Within all of the protected sequences, a triplet containing adjacent GC base pairs flanked by an AT base pair could be found in one or more copies. Nowhere in the tyrT fragment did that triplet occur outside a protected sequence. The same triplet occurred within seven out of nine protected sequences observed in the fragments isolated from pBR322 DNA. In the two remaining cases, three contiguous GC base pairs were found. We conclude that the preferred daunomycin triplet binding site contains adjacent GC base pairs, of variable sequence, flanked by an AT base pair. This conclusion is consistent with the results of a recent theoretical study of daunomycin sequence specificity [Chen, K.-X., Gresh, N., & Pullman, B. (1985) J. Biomol. Struct. Dyn. 3, 445-466]. Adriamycin and the beta-anomer of adriamycin produce the same qualitative pattern of protection as daunomycin with the tyrT fragment. Daunomycin inhibits the rate of digestion of pBR322 DNA by PvuI (recognition sequence 5'-CGATCG-3') to a greater extent than it does EcoRI (recognition sequence 5'-GAATTC-3'), a finding consistent with the conclusions derived from our footprinting studies. Our results, as a whole, are the clearest indication to date that daunomycin recognizes a specific DNA sequence as a preferred binding site.

The interaction of the beta-anomer of doxorubicin with B and Z DNA

Equilibrium and kinetic studies on the interaction of daunorubicin, doxorubicin, and the beta-anomer of doxorubicin with B and Z form DNA were made using spectroscopic and fluorometric methods. The beta-anomer of doxorubicin binds more weakly to calf thymus DNA than do the parent compounds, with a binding constant over 2 orders of magnitude lower than that found for doxorubicin. The ionic strength dependence of the binding constant is identical for daunorubicin and the beta-anomer of doxorubicin, indicating that the electrostatic contribution to the binding free energy is the same for the two compounds. Rate constants for steps along the dissociation pathway are larger for the beta-anomer relative to the parent compounds, indicating a shorter lifetime for the beta-anomer-DNA complex. Daunorubicin and doxorubicin were equally effective as inhibitors of the rate of the B to Z transition of polydeoxyguanylic-deoxycytidylic acid (poly(dGdC] in 3.0 M NaCl. Both compounds bound cooperatively to poly (dGdC) under high salt conditions that initially favor the Z conformation. In contrast, the beta-anomer of doxorubicin did not inhibit the rate of the B to Z transition under these conditions, and would not bind to poly(dGdC) in 3.0 M NaCl. The beta-anomer did inhibit the rate of the transition of poly(dGm5dC) to the Z form in 50 mM NaCl, 2.5 mM MgCl2, although not as effectively as daunorubicin. Further, binding of the beta-anomer to poly(dGm5dC) under these conditions was cooperative, although the beta-anomer was clearly a less efficient allosteric effector on the B to Z transition than was daunorubicin. These results emphasize the importance of the stereochemistry of the daunosamine residue in the specific and preferential binding of anthracycline antibiotics to B form DNA.

Sinus contamination with Pseudomonas paucimobilis: a pseudoepidemic due to contaminated irrigation fluid

During a five-week period, Pseudomonas paucimobilis was isolated from maxillary sinus irrigation washes of four patients who attended an ear, nose and throat clinic. The saline irrigation solution was found to be contaminated with the same organism. Further investigation demonstrated the organism in a majority of hospital sinks surveyed. Although P. paucimobilis was isolated from clinical specimens, the presence of the organism did not appear to have clinical significance.