Referrals in Focus: A Retrospective Study of Palliative Care Referrals from Rheumatology Providers at an Academic Medical Center.

People with rheumatic diseases suffer from serious complications of their illness, though little research is available on the utilization of palliative care (PC) for this population. We performed a retrospective chart review of patients referred to outpatient PC from a single academic rheumatology practice over five years and reviewed patients seen concurrently by rheumatology and PC in the inpatient setting over one year. Of 18,441 patients seen in the outpatient rheumatology practice over five years, 11 (0.

Top Ten Tips Palliative Care Clinicians Should Know About Rheumatology.

Systemic autoimmune rheumatic diseases (SARDs) consist of a broad range of immune-mediated multisystem diseases. They are chronic, incurable illnesses that often present in early to mid-life and can be associated with a high symptom burden, disability, and early mortality. Treatment guidelines for similar chronic, life-limiting conditions with uncertain disease courses now recommend palliative care (PC) assessment at the time of diagnosis.

A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients.

Objective: Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to identify factors that enable adherence to immunosuppressive medications among patients with SLE from racial and ethnic minority groups.

Impact of Biomass Burning Organic Aerosol Volatility on Smoke Concentrations Downwind of Fires.

Biomass burning particulate matter (BBPM) affects regional air quality and global climate, with impacts expected to continue to grow over the coming years. We show that studies of North American fires have a systematic altitude dependence in measured BBPM normalized excess mixing ratio (NEMR; ΔPM/ΔCO), with airborne and high-altitude studies showing a factor of 2 higher NEMR than ground-based measurements. We report direct airborne measurements of BBPM volatility that partially explain the difference in the BBPM NEMR observed across platforms.

Shortwave absorption by wildfire smoke dominated by dark brown carbon.

Wildfires emit large amounts of black carbon and light-absorbing organic carbon, known as brown carbon, into the atmosphere. These particles perturb Earth's radiation budget through absorption of incoming shortwave radiation. It is generally thought that brown carbon loses its absorptivity after emission in the atmosphere due to sunlight-driven photochemical bleaching.

Quantification of natural gas and other hydrocarbons from production sites in northern West Virginia using tracer flux ratio methodology.

Tracer flux ratio (TFR) methodology performed downwind of 15 active oil and natural gas production sites in Ohio County, West Virginia sought to quantify air pollutant emissions over two weeks in April 2018. In coordination with a production company, sites were randomly selected depending on wind forecasts and nearby road access. Methane (CH), ethane (CH), and tracer gas compounds (acetylene and nitrous oxide) were measured via tunable infrared direct absorption spectroscopy.

Reconciling Methane Emission Measurements for Offshore Oil and Gas Platforms with Detailed Emission Inventories: Accounting for Emission Intermittency.

Comparisons of observation-based emission estimates with emission inventories for oil and gas production operations have demonstrated that intermittency in emissions is an important factor to be accounted for in reconciling inventories with observations. Most emission inventories do not directly report data on durations of active emissions, and the variability in emissions over time must be inferred from other measurements or engineering calculations. This work examines a unique emission inventory, assembled for offshore oil and gas production platforms in federal waters of the Outer Continental Shelf (OCS) of the United States, which reports production-related sources on individual platforms, along with estimates of emission duration for individual sources.

Methane emissions from oil and gas production sites and their storage tanks in West Virginia.

A measurement campaign characterized methane and other emissions from 15 natural gas production sites. Sites were surveyed using optical gas imaging (OGI) cameras to identify fugitive and vented emissions, with the methane mass emission rate quantified using a full flow sampler. We present storage tank emissions in context of all site emissions, followed by a detailed account of the former.

Evaluating Natural Gas Emissions from Pneumatic Controllers from Upstream Oil and Gas Facilities in West Virginia.

In April of 2018, an optical gas imaging (OGI) and full flow sampler (FFS) emissions measurement study of pneumatic controllers (PCs) was conducted at 15 oil and natural gas production sites in West Virginia. The objective of the study was to identify and characterize PC systems with excessive emissions caused by maintenance issues or nonoptimized process conditions. A total of 391 PC systems were found on the sites and all were classified by the operator as snap-acting (on/off) intermittent venting PCs (IPCs) that should exhibit little gas release while the PC is closed between actuation events.

Assessment of School Staff Knowledge and Perceptions of Student E-cigarette Use and Resource Needs, and E-cigarettes Confiscated at 12 North Carolina High Schools - 2019.

Background: E-cigarettes are the most commonly used tobacco product among US youth and are regularly used on school grounds. We assessed school staff's awareness of students' e-cigarette use, response by schools, and resources needed to address use, and examined e-cigarettes confiscated by school staff in North Carolina to guide prevention and identify needed resources.

Methods: In May 2019, staff from a random sample of 25 of 451 North Carolina public and charter high schools were invited to complete an online survey and semistructured interview; 12 schools consented to ≥ 1 component (survey, N = 514; interviews, N = 35).

Advancing Commercial Tobacco Control and Health Equity Through Policy, Systems, and Environmental Change.

Commercial tobacco products have been protected from regulation, yet are designed to addict, are deadly, and are promoted to young people whose brains are not yet fully developed. Until everyone is protected from addiction and exposure, we must keep working toward fairness and value-based policy, systems, and environmental change.

Traffic, transport, and vegetation drive VOC concentrations in a major urban area in Texas.

The population of Texas has increased rapidly in the past decade. The San Antonio Field Study (SAFS) was designed to investigate ozone (O) production and precursors in this rapidly changing, sprawling metropolitan area. There are still many questions regarding the sources and chemistry of volatile organic compounds (VOCs) in urban areas like San Antonio which are affected by a complex mixture of industry, traffic, biogenic sources and transported pollutants.

Chemical Emissions from Cured and Uncured 3D-Printed Ventilator Patient Circuit Medical Parts.

Medical shortages during the COVID-19 pandemic saw numerous efforts to 3D print personal protective equipment and treatment supplies. There is, however, little research on the potential biocompatibility of 3D-printed parts using typical polymeric resins as pertaining to volatile organic compounds (VOCs), which have specific relevance for respiratory circuit equipment. Here, we measured VOCs emitted from freshly printed stereolithography (SLA) replacement medical parts using proton transfer reaction mass spectrometry and infrared differential absorption spectroscopy, and particulates using a scanning mobility particle sizer.

Characteristics of an Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury-North Carolina, 2019.

In August 2019, the North Carolina Division of Public Health (NCDPH) began investigating e-cigarette, or vaping, product use-associated lung injury (EVALI) cases as part of a national response. We describe clinical, epidemiologic, and laboratory findings of North Carolina EVALI patients. NCDPH requested that physicians report cases of respiratory illness or bilateral pulmonary infiltrates or opacities in patients who reported using e-cigarette, or vaping, products and had no infection or alternative plausible diagnoses.

Oxygenated Aromatic Compounds are Important Precursors of Secondary Organic Aerosol in Biomass-Burning Emissions.

Biomass burning is the largest combustion-related source of volatile organic compounds (VOCs) to the atmosphere. We describe the development of a state-of-the-science model to simulate the photochemical formation of secondary organic aerosol (SOA) from biomass-burning emissions observed in dry (RH <20%) environmental chamber experiments. The modeling is supported by (i) new oxidation chamber measurements, (ii) detailed concurrent measurements of SOA precursors in biomass-burning emissions, and (iii) development of SOA parameters for heterocyclic and oxygenated aromatic compounds based on historical chamber experiments.

Methane Emissions from Offshore Oil and Gas Platforms in the Gulf of Mexico.

Shipboard measurements of offshore oil and gas facilities were conducted in the Gulf of Mexico in February 2018. Species measured at 1 s include methane, ethane, carbon-13 (C) and deuterium (D) isotopes of methane, and several combustion tracers. Significant variability in the emission composition is observed between individual sites, with typical ethane/methane ratios around 5.

A qualitative study of the process of adoption, implementation and enforcement of smoke-free policies in privately-owned affordable housing.

Background: Household smoke-free home rules cannot fully protect nonsmokers from secondhand smoke (SHS) if they live in multi-unit housing (MUH). Instead, property-level smoke-free policies are needed to prevent SHS incursion into apartment units and to keep common areas smoke-free. Smoke-free policies are usually at the discretion of property management companies and owners within the context of market-rate and privately-owned affordable housing in the U.

Use of Light Alkane Fingerprints in Attributing Emissions from Oil and Gas Production.

Spatially resolved emission inventories were used with an atmospheric dispersion model to predict ambient concentrations of methane, ethane, and propane in the Eagle Ford oil and gas production region in south central Texas; predicted concentrations were compared to ground level observations. Using a base case inventory, predicted median propane/ethane concentration ratios were 106% higher (95% CI: 83% higher-226% higher) than observations, while median ethane/methane concentration ratios were 112% higher (95% CI: 17% higher-228% higher) than observations. Predicted median propane and ethane concentrations were factors of 6.

Pilot Study to Describe the Trajectory of Symptoms and Adaptive Strategies of Adults Living with Low-grade Glioma.

Objectives: To describe the adaptability to the patterns in symptoms and quality of life (QoL) during 6 months post low-grade glioma diagnosis by valid and reliable tools; to identify through qualitative interviews patient/provider adaptive techniques and strategies; and to assess associations among patient characteristics, symptoms and QoL, and adaptive techniques or strategies.

Data Sources: Demographic, clinical and pathologic data from medical records. Validated instruments that assess QoL, fatigue, depression, and distress were completed at 2, 4, and 6 months post diagnosis.

Short-term methane emissions from 2 dairy farms in California estimated by different measurement techniques and US Environmental Protection Agency inventory methodology: A case study.

Reported estimates of CH emissions from ruminants and manure management are up to 2 times higher in atmospheric top-down calculations than in bottom-up (BU) inventories. We explored this discrepancy by estimating CH emissions of 2 dairy facilities in California with US Environmental Protection Agency (US EPA) methodology, which is used for BU inventories, and 3 independent measurement techniques: (1) open-path measurements with inverse dispersion modeling (hereafter open-path), (2) vehicle measurements with tracer flux ratio method, and (3) aircraft measurements with the closed-path method. All 3 techniques were used to estimate whole-facility CH emissions during 3 to 6 d per farm in the summer of 2016.

Redefining the Team in Team-Based Care: Role of Public Health.

In North Carolina, our public health infrastructure consists of a state health department and 85 local health departments representing all 100 counties. The state health department, local health departments, health systems, and clinical providers work literally and figuratively as a team to improve the health of our citizens. In this article, we provide examples of the critical role of public health practitioners as part of the broader team addressing health, specifically in the areas of chronic disease, communicable disease, oral health, environmental health, and maternal and child health.