Particulate Pb emission factors from wildland fires in the United States

Wildland fires, which includes both wild and prescribed fires, and agricultural fires in sum are one of the largest sources of fine particulate matter (PM2.5) emissions to the atmosphere in the United States (US). Although wildland fire PM2.5 emissions are primarily composed of carbonaceous material, many other elements including trace metals are emitted at very low levels. Lead (Pb) is a US Environmental Protection Agency (EPA) criteria pollutant that is ubiquitous in the environment at very low concentrations including in biomass that can burn and emit Pb into the atmosphere. Although fires may emit Pb at very low concentrations, they can be a source of sizeable Pb emissions to the atmosphere because of the large quantity of PM2.5 emitted from fires. In this work, we measure Pb concentrations in unburned biomass, ash/residues, and particulate matter <2.5 μm (PM2.5) emitted from wildland fires using in-field measurements near prescribed fires and in laboratory simulations. Emission factors were calculated for multiple biomass types, representative of different regions of the US including grasslands in Oregon and Kansas; forest litter from Oregon, Montana, Minnesota, and North Carolina; and peat cores from Minnesota. Most of the biomass Pb remains in the ash/residues. The small percentage (<10%) that is emitted in PM2.5 is dependent on the biomass Pb concentration. The emissions factors measured here are several orders of magnitude lower than some reported in the literature, but the studies exhibited a wide range of values, which may be due to large uncertainties in the measurement method rather than differences in Pb emissions. Wildland fires are expected to increase in size and frequency in future years and these new emission factors can be used to improve the accuracy of Pb emissions estimates and better constrain our understanding of Pb emissions to the atmosphere.

Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

Hazardous air pollutant emissions estimates from wildfires in the wildland urban interface

Fires that occur in the wildland urban interface (WUI) often burn structures, vehicles, and their contents in addition to biomass in the natural landscape. Because these fires burn near population centers, their emissions may have a sizeable impact on public health, necessitating a better understanding of criteria and hazardous air pollutants emitted from these fires and how they differ from wildland fires. Previous studies on the toxicity of emissions from the combustion of building materials and vehicles have shown that urban fires may emit numerous toxic species such as hydrogen cyanide, hydrogen fluoride, hydrogen chloride, isocyanates, polycyclic aromatic hydrocarbons (PAHs), dioxins and furans, and a range of toxic organic compounds (e.g. benzene toluene, xylenes, styrene, and formaldehyde) and metals (e.g. lead, chromium, cadmium, and arsenic). We surveyed the literature to create a compendium of emission factors for species emitted from the combustion of building and vehicle materials and compared them with those from wildland fires. Emission factors for some toxic species like PAH and some organic compounds were several orders of magnitude greater than those from wildfires. We used this emission factor compendium to calculate a bounding estimate of the emissions from several notable WUI fires in the western United States to show that urban fuels may contribute a sizeable portion of the toxic emissions into the atmosphere. However, large gaps remain in our understanding of the fuel composition, fuel consumption, and combustion conditions in WUI fires that constrain our ability to estimate the impact of WUI fires.

Superficial temporal artery injury and delayed post-cranioplasty infection

OBJECTIVE

Complications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication.

METHODS

A retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups.

RESULTS

Fifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26).

CONCLUSIONS

There is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.

Clinical outcomes among distinct groups of patients with severe tricuspid valve regurgitation

Introduction

Severe tricuspid valve regurgitation (TR) is associated with increased 1-year morbidity and mortality. Characterization by valve etiology (primary, secondary, and lead-associated), a classification borrowed from mitral valve disease, has not been universally shown to correlate with outcomes.

Purpose

Among a large, racially diverse cohort with newly identified severe TR, we aimed to 1) characterize outcomes of severe TR by etiology, and 2) assess whether unsupervised phenoclustering or supervised outcome-driven prediction trees were more effective in establishing subgroups of TR with differential clinical risk profiles.

Methods

We retrospectively analyzed outcomes of 5-year all-cause death and a composite of death or heart failure hospitalization (HFH) among adult patients with new severe TR identified by echocardiography between 2007 to 2018 at a large academic tertiary referral center in the United States. Patients were initially categorized by etiology of TR, including primary, secondary, and lead-associated. Second, we separately applied unsupervised hierarchical clustering to identify distinct clusters using demographics, clinical, and echo data at the time of diagnosis. Third, we applied a supervised recursive partitioning algorithm (survival trees) by each outcome to identify distinct TR subgroups. We estimated the cumulative incidence of death and composite death or HFH over 5 years by 1) etiology of TR, 2) distinct clusters, and 3) groups identified by supervised learning (prediction trees).

Results

Among 2,379 consecutive patients with newly identified severe TR, the median age was 70 years, 61% were female, and 40% were Black. Event rates (95% CI) were 30.9 (29.0 to 32.8) events/100 PY for death and 49.0 (45.9 to 52.2) events/100 PY for composite death or HFH over median follow-up of 1.6 years. Event rates were similarly high across TR etiology groups for both death and composite death or HFH (Figure 1). Multiple methods of unsupervised clustering did not yield distinct clusters by patient demographic and imaging characteristics. After applying supervised survival tree modeling, four phenoclusters with distinct clinical prognoses were separately identified for death and composite death or HFH (Figure 2). Variables identified to partition the cohort to discriminate both death and composite death or HFH were age, albumin, blood urea nitrogen, right ventricular contractility, and right ventricular systolic pressure (all p&lt;0.05).

Conclusions

Five-year cumulative incidence of adverse events among patients with newly diagnosed severe TR was 69% for death and 80% for composite death or HFH. TR etiology did not stratify prognosis, while supervised survival tree models identified phenoclusters with distinct clinical risk. The identified subgroups of severe TR with differential outcomes offer insights towards enrichment in clinical trials of TR and risk/benefit analysis in patients undergoing TR therapies.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Abbott

Polysomnography Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Introduction

Sleep disturbances are common following traumatic brain injury (TBI) worsening morbidity and other neuropsychiatric symptoms. Post-TBI alterations in sleep architecture require further study.

Objectives

(1) To evaluate polysomnographic measures of sleep architecture in participants with history of TBI compared to controls and as meta-analyses of pooled means. (2) To evaluate effects of timing and severity of TBI on polysomnographic outcomes.

Methods

PRISMA compliant systematic review was conducted of MEDLINE, PsycINFO, EMBASE and Scopus. Inclusion criteria: 1) reporting polysomnography in the context of TBI and 2) operationalizing TBI using clear/formalized criteria. Data were pooled in random-effects meta-analyses with outcomes expressed as mean differences (MD).

Results

In participants with TBI, sleep was comprised of 19.39% REM sleep, 8.13% N1, 51.18% N2, and 17.53% N3, as determined by meta-analyses of single means. Total sleep time was reduced in chronic (>6 months) TBI compared to acute-intermediate TBI (<6 months) (p=0.01). Compared to controls, participants with TBI differed with increased N1 sleep (MD=0.64%; 95%CI=0.02,1.25; p=0.04), reduced sleep efficiency (MD=-1.65%; 95%CI=-3.18,-0.12; p=0.03), and reduced sleep latency on the multiple sleep latency test (MD=-5.90mins; 95%CI=-10.09,-1.72; p<0.01). On sub-group analyses, participants with mild TBI differed from controls with reduced total sleep time (MD=-29.22mins, 95%CI=-54.16,-4.27; p=0.02). Similarly, participants with acute-intermediate TBI exhibited increased sleep latency compared to controls (MD=8.96mins; 95%CI=4.07,13.85; p<0.01) and differed significantly from participants with chronic TBI (X2(1,N=608)=6.54; p=0.01).

Conclusions

Sleep architecture is altered following TBI with potential implications regarding functional outcomes and recovery. These alterations appear to differ based on severity of injury and time since injury.

Disclosure

No significant relationships.

Comparing Outcomes of COVID-19 vs NonCOVID-19 Lung Transplant Recipients on ECMO as a Bridge to Transplant

Purpose

Methods

Results

Conclusion

Reactive organic carbon emissions from volatile chemical products

Volatile chemical products (VCPs) are an increasingly important source of anthropogenic reactive organic carbon (ROC) emissions. Among these sources are everyday items, such as personal care products, general cleaners, architectural coatings, pesticides, adhesives, and printing inks. Here, we develop VCPy, a new framework to model organic emissions from VCPs throughout the United States, including spatial allocation to regional and local scales. Evaporation of a species from a VCP mixture in the VCPy framework is a function of the compound-specific physiochemical properties that govern volatilization and the timescale relevant for product evaporation. We introduce two terms to describe these processes: evaporation timescale and use timescale. Using this framework, predicted national per capita organic emissions from VCPs are 9.5 kg per person per year (6.4 kg C per person per year) for 2016, which translates to 3.05 Tg (2.06 Tg C), making VCPs a dominant source of anthropogenic organic emissions in the United States. Uncertainty associated with this framework and sensitivity to select parameters were characterized through Monte Carlo analysis, resulting in a 95 % confidence interval of national VCP emissions for 2016 of 2.61-3.53 Tg (1.76-2.38 Tg C). This nationwide total is broadly consistent with the U.S. EPA's 2017 National Emission Inventory (NEI); however, county-level and categorical estimates can differ substantially from NEI values. VCPy predicts higher VCP emissions than the NEI for approximately half of all counties, with 5 % of all counties having greater than 55 % higher emissions. Categorically, application of the VCPy framework yields higher emissions for personal care products (150 %) and paints and coatings (25 %) when compared to the NEI, whereas pesticides (-54 %) and printing inks (-13 %) feature lower emissions. An observational evaluation indicates emissions of key species from VCPs are reproduced with high fidelity using the VCPy framework (normalized mean bias of -13 % with r =0.95). Sector-wide, the effective secondary organic aerosol yield and maximum incremental reactivity of VCPs are 5.3 % by mass and 1.58 gO3 g-1, respectively, indicating VCPs are an important, and likely to date underrepresented, source of secondary pollution in urban environments.

The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory: Wildland fire emissions developed for the 2011 and 2014 U.S. National Emissions Inventory

Wildland fire emissions from both wildfires and prescribed fires represent a major component of overall U.S. emissions. Obtaining an accurate, time-resolved inventory of these emissions is important for many purposes, including to account for emissions of greenhouse gases and short-lived climate forcers, as well as to model air quality for health, regulatory, and planning purposes. For the U.S. Environmental Protection Agency's 2011 and 2014 National Emissions Inventories, a new methodology was developed to reconcile the wide range of available fire information sources into a single coherent inventory. The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory effort utilized satellite fire detections as well as a large number of national, state, tribal, and local databases. The methodology and results for CONUS and Alaska were documented and compared against other fire emissions databases, and the efficacy of the overall effort was evaluated. Results show the overall spatial pattern differences and relative seasonality of wildfires and prescribed fires across the country. Prescribed burn emissions occurred primarily in non-summer months were concentrated in the Southeast, Northwest, and lower Midwest, and were relatively consistent year to year. Wildfire emissions were much more variable but occurred primarily in the summer and fall. Overall, CFIRE represents a third of total emitted PM2.5 across all sources in the National Emissions Inventory, with prescribed fires accounting for nearly half of all CFIRE emissions. Compared with other wildland fire emissions inventories derived solely from satellite detections, the CFIRE inventory shows markedly increased emissions, reflecting the importance of the multiple national and regional databases included in CFIRE in capturing small fires and prescribed fires in particular. Implications: Wildland fire emissions inventories need to incorporate multiple sources of fire information in order to better represent the full range of fire activity, including prescribed burns and smaller fires. For the 2011 and 2014 U.S. National Emissions Inventory, a methodology was developed to collect, associate, and reconcile fire information from satellite data as well as a large number of national, regional, state, local, and tribal fire information databases across the country. The resulting emissions inventory shows the importance of this type of integration and reconciliation when compared against other emissions inventories for the same period.

Reflecting on progress since the 2005 NARSTO emissions inventory report

Emission inventories are the foundation for cost-effective air quality management activities. In 2005, a report by the public/private partnership North American Research Strategy for Tropospheric Ozone (NARSTO) evaluated the strengths and weaknesses of North American emissions inventories and made recommendations for improving their effectiveness. This paper reviews the recommendation areas and briefly discusses what has been addressed, what remains unchanged, and new questions that have arisen. The findings reveal that all emissions inventory improvement areas identified by the 2005 NARSTO publication have been explored and implemented to some degree. The U.S. National Emissions Inventory has become more detailed and has incorporated new research into previously under-characterized sources such as fine particles and biomass burning. Additionally, it is now easier to access the emissions inventory and the documentation of the inventory via the internet. However, many emissions-related research needs exist, on topics such as emission estimation methods, speciation, scalable emission factor development, incorporation of new emission measurement techniques, estimation of uncertainty, top-down verification, and analysis of uncharacterized sources. A common theme throughout this retrospective summary is the need for increased coordination among stakeholders. Researchers and inventory developers must work together to ensure that planned emissions research and new findings can be used to update the emissions inventory. To continue to address emissions inventory challenges, industry, the scientific community, and government agencies need to continue to leverage resources and collaborate as often as possible. As evidenced by the progress noted, continued investment in and coordination of emissions inventory activities will provide dividends to air quality management programs across the country, continent, and world. Implications: In 2005, a report by the public/private partnership North American Research Strategy for Tropospheric Ozone (NARSTO) evaluated the strengths and weaknesses of North American air pollution emissions inventories. This paper reviews the eight recommendation areas and briefly discusses what has been addressed, what remains unchanged, and new questions that have arisen. Although progress has been made, many opportunities exist for the scientific agencies, industry, and government agencies to leverage resources and collaborate to continue improving emissions inventories.

Low level of exosomal long non-coding RNA HOTTIP is a prognostic biomarker in colorectal cancer

Molecular risk stratification of colorectal cancer can improve patient outcome. A panel of lncRNAs (H19, HOTTIP, HULC and MALAT1) derived from serum exosomes of patients with non-metastatic CRC and healthy donors was analyzed. Exosomes from healthy donors carried significantly more H19, HULC and HOTTIP transcripts in comparison to CRC patients. Correlation analysis between lncRNAs and clinical data revealed a statistical significance between low levels of exosomal HOTTIP and poor overall survival. This was confirmed by multivariate analysis that HOTTIP is an independent prognostic marker for overall survival (HR: 4.5, CI: 1.69-11.98, p = 0.0027). Here, HOTTIP poses to be a valid biomarker for patients with a CRC to predict post-surgical survival time.

An assessment of important SPECIATE profiles in the EPA emissions modeling platform and current data gaps

The United States (US) Environmental Protection Agency (EPA)'s SPECIATE database contains speciated particulate matter (PM) and volatile organic compound (VOC) emissions profiles. Emissions profiles from anthropogenic combustion, industry, wildfires, and agricultural sources among others are key inputs for creating chemically-resolved emissions inventories for air quality modeling. While the database and its use for air quality modeling are routinely updated and evaluated, this work sets out to systematically prioritize future improvements and communicate speciation data needs to the research community. We first identify the most prominent profiles (PM and VOC) used in the EPA's 2014 emissions modeling platform based on PM mass and VOC mass and reactivity. It is important to note that the on-road profiles were excluded from this analysis since speciation for these profiles is computed internally in the MOVES model. We then investigate these profiles further for quality and to determine whether they were being appropriately matched to source types while also considering regional variability of speciated pollutants. We then applied a quantitative needs assessment ranking system which rates the profile based on age, appropriateness (i.e. is the profile being used appropriately), prevalence in the EPA modeling platform and the quality of the reference. Our analysis shows that the highest ranked profiles (e.g. profile assignments with the highest priority for updates) include PM_2.5 profiles for fires (prescribed, agricultural and wild) and VOC profiles for crude oil storage tanks and residential wood combustion of pine wood. Top ranked profiles may indicate either that there are problems with the currently available source testing or that current mappings of profiles to source categories within EPA's modeling platform need improvement. Through this process, we have identified 29 emissions sourcecategories that would benefit from updated mapping. Many of these mapping mismatches are due to lack of emissions testing for appropriate source categories. In addition, we conclude that new source emissions testing would be especially beneficial for residential wood combustion, nonroad gasoline exhaust and nonroad diesel equipment.

The association between platelet dysfunction and adverse outcomes in cardiac surgical patients

Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.