Associations and lags between air pollution and acute respiratory visits in an ambulatory care setting: 25-month results from the aerosol research and inhalation epidemiological study

Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0-2 days lagged moving average, as well as the 3-5 days and 6-8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI.     

Childhood asthma acute primary care visits,traffic, and traffic-related pollutants

Previous studies have found associations between traffic-related air pollution and asthma exacerbation in children, where exacerbations were measured according to emergency department visits and hospital admissions. Fewer studies have been undertaken that look at asthma exacerbations in a less severe primary care setting. Therefore, the authors sought to examine the associations between childhood asthma exacerbations, measured as acute visits to a primary care setting, and vehicular-traffic measures in a population of children aged 18 and under in the metropolitan Atlanta area. Statistical tests for differences of mean monthly visits for members with traffic measures above the median compared with below the median and for the upper quartile compared with the lower quartile were conducted. We also compared the odds of having one or more visits in a month for those who lived closer to a major roadway were compared with those who lived farther (greater than 300 m) from a major roadway. Poisson general linear modeling was used to determine associations between daily levels of acute visits for childhood asthma and traffic-related pollutants (zinc, EC [elemental carbon], and PM₁₀ and PM_2.5 [particulate matter with an aerodynamic diameter of ≤10 and ≤2.5 μm, respectively]) for different levels of traffic and distance measures. This analysis found that both larger traffic volumes and smaller distances to the nearest major roadway were positively and significantly associated with larger numbers of childhood asthma visits, when compared with less traffic and larger distances. Our findings point to motor vehicle traffic as an important contributor to childhood asthma exacerbations.

Implications: Previous studies have found associations between traffic-related air pollution and asthma exacerbation in children. However, these studies were mainly conducted in emergency department or hospital admission settings; little is known regarding less acute health effects. This analysis of the association between vehicular traffic measures and childhood asthma in a primary care setting suggests that motor vehicle traffic is a contributor to less acute asthma episodes in children. The present analysis of traffic-related air pollutants and childhood asthma were less conclusive, likely due to methods limitations outlined in the paper. The implication is that further evidence of adverse respiratory health effects in children due to motor vehicle traffic can be found in a primary care setting and similar studies should be considered.     

Surrogate Measures for Providing High Frequency Estimates of Total Suspended Solids and Total Phosphorus Concentrations1

Spackman Jones, Amber, David K. Stevens, Jeffery S. Horsburgh, and Nancy O. Mesner, 2010. Surrogate Measures for Providing High Frequency Estimates of Total Suspended Solids and Total Phosphorus Concentrations. Journal of the American Water Resources Association (JAWRA) 1‐15. DOI: 10.1111/j.1752‐1688.2010.00505.x Abstract: Surrogate measures like turbidity, which can be observed with high frequency in situ, have potential for generating high frequency estimates of total suspended solids (TSS) and total phosphorus (TP) concentrations. In the semiarid, snowmelt‐driven, and irrigation‐regulated Little Bear River watershed of northern Utah, high frequency in situ water quality measurements were recorded in conjunction with periodic chemistry sampling. Site‐specific relationships were developed using turbidity as a surrogate for TP and TSS at two monitoring locations. Methods are presented for employing censored data and for investigating categorical explanatory variables (e.g., hydrologic conditions). Turbidity was a significant explanatory variable for TP and TSS at both sites, which differ in hydrologic and water quality characteristics. The relationship between turbidity and TP was stronger at the upper watershed site where TP is predominantly particulate. At both sites, the relationships between turbidity and TP varied between spring snowmelt and base flow conditions while the relationships between TSS and turbidity were consistent across hydrological conditions. This approach enables the calculation of high frequency time series of TP and TSS concentrations previously unavailable using traditional monitoring approaches. These methods have broad application for situations that require accurate characterization of fluxes of these constituents over a range of hydrologic conditions.     

A semi-automated tool for identifying agricultural roadway crashes in crash narratives

Objective: Crash reports contain precoded structured data fields and a crash narrative that can be a source of rich information not included in the structured data. The narrative can be useful for identifying vulnerable roadway users, such as agricultural workers. However, using the narratives often requires manual reviews that are time consuming and costly. The objective of this research was to develop a simple and relatively inexpensive, semi-automated tool for screening crash narratives and expediting the process of identifying crashes with specific characteristics, such as agricultural crashes.

Methods: Crash records for Louisiana from 2010 to 2015 were obtained from the Louisiana Department of Transportation (LaDOTD). Records with narratives were extracted and stratified by vehicle type. The majority of analyses focused on a vehicle type of farm equipment (Type T). Two keyword lists, an inclusion list and an exclusion list, were created based on the published literature, subject-matter experts, and findings from a pilot project. Next, a semi-automated tool was developed in Microsoft Excel to identify agricultural crashes. Lastly, the tool’s performance was assessed using a gold standard set of agricultural narratives identified through manual review.

Results: The tool reduced the search space (e.g., number of narratives that need manual review) for narratives requiring manual review from 6.7 to 59.4% depending on the research question. Sensitivity was high, with 96.1% of agricultural crash narratives being correctly classified. Of the gold standard agricultural narratives, 58.3% included an equipment keyword and 72.8% included a farm equipment brand.

Conclusion: This article provides information on how crash narratives can supplement structured crash data. It also provides an easy-to-implement method to facilitate incorporating narratives into safety research along with keyword lists for identifying agricultural crashes.     

How Technology Features Influence Public Response to New Agrifood Technologies

New agrifood technologies are often difficult to grasp for the public, which may lead to resistance or even rejection. Insight into which technology features determine public acceptability of the technology could offer guidelines for responsible technology development. This paper systematically assesses the relative importance of specific technology features for consumer response in the agrifood domain in two consecutive studies. Prominent technology features were selected from expert judgment and literature. The effects of these features on consumer evaluation were tested in a consumer study (n = 745). Fictitious technologies were used to avoid any uncontrollable contextual influences that existing new technologies may evoke. Results show that technologies that were seen as more natural and newer were perceived less risky, more beneficial, and were evaluated more positively. Technologies applied to food were judged to be more beneficial, but also more risky than those applied to non-food. Technologies used in the production process were perceived to be less risky and evaluated more positively than those used in the product. Technologies owned by the market leader were perceived to be more beneficial, and evaluated more positively than those that were freely available. In a next study (n = 440), effects of the technology features on consumer response were tested for existing new agrifood technologies. This study replicated the results for perceived naturalness, perceived newness, and place in the production process where the technology is applied. However, in contrast to the first study, we did not find an effect of application area (food versus non-food) and technology ownership.     

Comparison of recidivism rates for a teenage trauma prevention program after the addition of high-fidelity patient simulation

Objectives: We evaluated the benefits of adding high-fidelity simulation to a teenage trauma prevention program to decrease recidivism rates and encourage teens to discuss actionable steps toward safe driving.

Methods: A simulated pediatric trauma scenario was integrated into an established trauma prevention program. Participants were recruited because they were court-ordered to attend this program after misdemeanor convictions for moving violations. The teenage participants viewed this simulation from the emergency medical services (EMS) handoff to complete trauma care. Participants completed a postsimulation knowledge assessment and care evaluation, which included narrative data about the experience. Qualitative analysis of color-coded responses identified common themes and experiences in participants' answers. Court records were reviewed 6 years after course completion to determine short- and long-term recidivism rates, which were then compared to our program's historical rate.

Results: One hundred twenty-four students aged 16–20 years participated over a 2-year study period. Narrative responses included general reflection, impressions, and thoughts about what they might change as a result of the course. Participants reported that they would decrease speed (30%), wear seat belts (15%), decrease cell phone use (11%), and increase caution (28%). The recidivism rate was 55% within 6 years. At 6 months it was 8.4%, at 1 year it was 20%, and it increased approximately 5–8% per year after the first year. Compared with our programs, for historical 6-month and 2-year recidivism rates, no significant difference was seen with or without simulation.

Conclusions: Adding simulation is well received by participants and leads to positive reflections regarding changes in risk-taking behaviors but resulted in no changes to the high recidivism rates This may be due to the often ineffectiveness of fear appeals.