Abstract  Objectives First, we present a general analytical approach to estimating the association between medium-term changes in air pollution and health across small areas. As a specific illustration, we then applied the approach to data on London residents from a 4-year period to test whether reductions in traffic-related air pollution were associated with reductions in cardio-respiratory hospital admissions. Methods A binomial distribution was used to model change in admissions over time in each small area, which was measured as the proportion of admissions in 2003–2004 out of admissions over all study years (2001–2004). Annual average concentrations of nitrogen oxides (NOx) were modelled using an emissions-dispersion model. The association between change in NOx and change in hospital admissions was estimated using logistic regression and an instrumental variable approach. Results For some diagnostic groups, suggestive associations between reductions in NOx and reductions in admissions were observed, for example, OR=0.97 (95% CI 0.96 to 0.99) for an IQR decrease in NOx (3 μg/m3) and all respiratory admissions. Accounting for spatial dependence attenuated several of the associations; for respiratory admissions, the OR was 1.00 (95% CI 0.98 to 1.02), leaving only that for bronchiolitis significant (OR=0.91; 95% CI 0.84 to 0.99). In this particular illustration, the instrumental variable approach did not appear to add information. Conclusions In this illustration, there was relatively limited power to detect an association between changes in air pollution and hospital admissions over time. However, the analytical approach could deliver more robust estimates of the health effects of changes in air pollution in settings with greater spatial contrast in changes in air pollution over time.

Abstract  BACKGROUND: Growing evidence indicates that ambient air pollution is associated with exacerbation of chronic diseases like chronic pulmonary disease. A prospective panel study was conducted to investigate short-term changes of blood markers of inflammation and coagulation in response to daily changes in air pollution in Erfurt, Germany. 12 clinical visits were scheduled and blood parameters were measured in 38 male patients with chronic pulmonary disease during winter 2001/2002. Additive mixed models with random patient intercept were applied, adjusting for trend, weekday, and meteorological parameters. Hourly data on ultrafine particles (UFP, 0.01-0.1 mum), accumulation mode particles (ACP, 0.1-1.0 mum), PM10 (particulate matter <10 mum in diameter), elemental (EC) and organic carbon (OC), gaseous pollutants (nitrogen monoxide [NO], nitrogen dioxide [NO2], carbon monoxide [CO], and sulphur dioxide [SO2]) were collected at a central monitoring site and meteorological data were received from an official network. For each person and visit the individual 24-hour average of pollutants immediately preceding the blood withdrawal (lag 0) up to day 5 (lag1-4) and 5-day running means were calculated. RESULTS: Increased levels of fibrinogen were observed for an increase in one interquartile range of UFP, PM10, EC, OC, CO, and NO revealing the strongest effect for lag 3. E-selectin increased in association with ACP and PM10 with a delay of one day. The ACP effect was also seen with the 5-day-mean. The pattern found for D-dimer was inconsistent. Prothrombin fragment 1+2 decreased with lag 4 consistently for all particulate pollutants. Von Willebrand factor antigen (vWF) showed a consistent decrease in association with almost all air pollutants with all lags except for lag 0. No associations were found for C-reactive protein, soluble intercellular adhesion molecule 1, serum amyloid A and factor VII. CONCLUSION: These results suggest that elevated concentrations of air pollution are associated with changes in some blood markers of inflammation and coagulation in patients with chronic pulmonary disease. The clinical implications of these findings need further investigation.

Abstract  In this article we discuss statistical techniques for modeling data from cohort studies that examine long-term effects of air pollution on children’s health by comparing data from multiple communities with a diverse pollution profile. Under a general multilevel modeling paradigm, we discuss models for different outcome types along with their connections to the generalized mixed effects models methodology. The model specifications include linear and flexible models for continuous lung function data, logistic and/or time-to-event models for symptoms data that account for misspecifications via hidden Markov models and Poisson models for school absence counts. The main aim of the modeling scheme is to be able to estimate effects at various levels (e.g., within subjects across time, within communities across subjects and between communities). We also discuss in detail various recurring issues such as ecologic bias, exposure measurement error, multicollinearity in multipollutant models, interrelationships between major endpoints and choice of appropriate exposure metrics. The key conceptual issues and recent methodologic advances are reviewed, with illustrative results from the Southern California Children’s Health Study, a 10-year study of the effects of air pollution on children’s respiratory health.

Abstract  In this study, an assessment of indoor air quality (IAQ) and thermal comfort in the Athens Traffic Control Tower (ATCT) offices of Hellinicon building complex, which is mechanically ventilated, is presented. Measurements of PM10, PM2.5, TVOCs and CO2 concentrations were performed during three experimental cycles, while the Thom Discomfort Index was calculated to describe the employees' feeling of discomfort. The aim of the first cycle was to identify the IAQ status, the second to investigate the effectiveness of certain measures taken, and the third to continuously monitor and control IAQ. During the first two cycles, daily spot measurements of TVOCs and CO2 were performed at various indoor locations and at the respective outdoor air intake positions, in addition with mean 24-h spot measurements of indoor PM10 and PM2.5. Results revealed that pollution levels vary according to the occupancy and the kind of activity. Following that, an automated system (IMAS) was designed and employed to continuously monitor indoor and outdoor CO2, TVOCs, temperature and relative humidity. The ultimate scope was to control the IAQ and offer acceptable comfort conditions to the employees, whose work is of special nature and extremely demanding. Intervention scenarios were formulated and applied to the system to improve indoor conditions, when and where necessary. Regarding the third cycle, 1-year measurements collected from the system to examine its effectiveness. While it was shown that discomfort may be attributed to co-existence of unsatisfactory thermal comfort conditions and IAQ, usually the sole predominant factor of discomfort feeling is thermal comfort.

Abstract  oxygenated additives in gasoline are designed to decrease the ozone-forming hydrocarbons and total air toxics. yet they can increase the emissions of aldehydes and thus increase human exposure to these toxic compounds. This paper describes a study conducted to characterize targeted aldehydes in microenvironments in Sacramento, CA, and Milwaukee, WI, and to improve our understanding of the impact of the urban environment on human exposure to air toxics. Data were obtained from microenvironmental concentration measurements, integrated, 24-h personal measurements, indoor and outdoor pollutant monitors at the participants' residences, from ambient pollutant monitors at fixed-site locations in each city, and from real-time diaries and questionnaires completed by the technicians and participants. As part of this study, a model to predict personal exposures based on individual time/activity data was developed for comparison to measured concentrations. Predicted concentrations were generally within 25% of the measured concentrations. The microenvironments that people encounter daily provide for widely varying exposures to aldehydes. The activities that occur in those microenvironments can modulate the aldehyde concentrations dramatically, especially for environments such as "indoor at home." By considering personal activity, location (microenvironment), duration in the microenvironment. and a knowledge of the general concentrations of aldehydes in the various microenvironments, a simple model can do a reasonably good job of predicting the time-averaged personal exposures to aldehydes, even in the absence of monitoring data. Although concentrations of aldehydes measured indoors at the participants' homes tracked well with personal exposure, there were instances where personal exposures and indoor concentrations differed significantly. Key to the ability to predict exposure based on time/activity data is the quality and completeness of the microenvironmental characterizations for the chemicals of interest. Consistent with many earlier studies, personal exposures are difficult to predict using data from regional outdoor monitors. (C) 2009 Elsevier Ltd. All rights reserved.

Abstract  This paper presents the contribution to population exposure (PE) of regional background fine primary (PPM"2"."5) and secondary inorganic (SIA) particulate matter and its impact on mortality in Europe during 1997-2003 calculated with a...

Abstract  the sea breeze that is developing in Volos area, a medium sized coastal city in central Greece, and to study the influence of sea breeze on concentration levels of ozone and PM10, during the period 2001-2005. The identification of sea breeze days is based on a set of strict, objective criteria, which include the wind direction and its diurnal reversal, the wind direction difference between the surface winds and the winds in the free atmosphere and the thermal contrast between the sea and the land surface. The statistical analysis reveals that sea breeze is developing in 85.6% of days from May until July, with maximum frequency of occurrence 89% in June. Its most frequent onset and cessation time periods are 09:00-11:00 and 20:00-22:00 LST respectively and its usual duration is approximately 10 h. The average maximum strength is 2.6 m/s, usually between 14:00 and 17:00 LST, while the maximum observed value equals 5.9 m/s. Studying the variation of ozone and PM10 levels during the cold and the warm period of the year (October-April and May-September respectively), it is concluded that sea breeze development is associated with an increase of the concentration of both pollutants. This increase is more pronounced during the cold period and is attributed to unfavourable meteorological conditions.

Abstract  Twenty-eight polycyclic aromatic hydrocarbons (PAH) and methylated PAHs (Me-PAH) were measured in daily PM"2"."5 samples collected at an urban site, a suburban site, and a rural site in and near Atlanta during 2004 (5 samples/month/site)....

Abstract  Discussions and applications of the policies and practices of the U.S. Environmental Protection Agency (USEPA) in ecological risk assessment will benefit from continued clarification of the concepts of assessment endpoints and of levels of biological organization. First, assessment endpoint entities and attributes can be defined at different levels of organization. Hence, an organism-level attribute, such as growth or survival, can be applied collectively to a population-level entity such as the brook trout in a stream. Second, assessment endpoints for ecological risk assessment are often mistakenly described as “individual level,” which leads to the idea that such assessments are intended to protect individuals. Finally, populations play a more important role in risk assessments than is generally recognized. Organism-level attributes are used primarily for population-level assessments. In addition, the USEPA and other agencies already are basing management decisions on population or community entities and attributes such as production of fisheries, abundance of migratory bird populations, and aquatic community composition.

Abstract  Background: New approaches to link health surveillance data with environmental and population exposure information are needed to examine the health benefits of risk management decisions. Objective: We examined the feasibility of conducting a local assessment of the public health impacts of cumulative air pollution reduction activities from federal, state, local and voluntary actions in the City of New Haven, CT. Methods: Using a hybrid modeling approach that combines regional and local-scale air quality data, we estimated ambient concentrations for multiple air pollutants (e.g., PM2.5, NOx) for base year 2001 and projected emissions for 2010, 2020, and 2030. We assessed the feasibility of detecting health improvements in relation to air pollution reductions for 26 different pollutant/health outcome linkages using both sample size and exploratory epidemiological simulations to further inform decision-making needs. Results: Model projections suggested decreases (~10% to 60%) in pollutant concentrations, mainly due to decreases in pollutants from local sources between 2001 and 2010. Models indicated considerable spatial variability in the concentrations of most pollutants. Sample size analyses supported the feasibility of identifying linkages between reductions in NOx and improvements in all-cause mortality, prevalence of asthma in children and adults, and cardiovascular and respiratory hospitalizations. Conclusion: Substantial reductions in air pollution (e.g., ~60% shown for NOx) are needed to detect health impacts of environmental actions using traditional epidemiologic study designs in small communities like New Haven. In contrast, exploratory epidemiologic simulations suggest that it may be possible to demonstrate the health impacts of PM reductions by predicting intra-urban pollution gradients within New Haven using coupled models.

Abstract  Background: The link between concentrations of particulate matter and respiratory morbidity has been investigated in numerous studies. Objectives: The aim of this study was to analyze the role of different particle size fractions with respect to respiratory health in Beijing, China. Methods: Data on particle size distributions from 3 nm to 1 µm; PM10, NO2, and SO2 concentrations; and meteorological variables were collected daily during March 2004 to December 2006. Concurrently, daily counts of emergency room visits (ERV) for respiratory diseases were obtained from the Peking University Third Hospital. We estimated pollutant effects in single- and two-pollutant generalized additive models, controlling for meteorological and other time-varying covariates. Time-delayed associations were estimated using polynomial distributed lag, cumulative effects, and single lag models. Results: Associations of respiratory ERV with NO2 concentrations and 100 - 1000 nm particle number or surface area concentrations were of similar magnitude, i.e. ~ 5 % increase in respiratory emergency room visits with an interquartile range increase in air pollution concentration. In general, particles < 50 nm were not positively associated with ERV, whereas particles 50 - 100 nm were adversely associated with respiratory ERV, both being fractions of ultrafine particles. Effect estimates from two-pollutant models were most consistent for NO2. Conclusions: Present levels of air pollution in Beijing were adversely associated with respiratory ERV. NO2 concentrations seemed to be a better surrogate for evaluating overall respiratory health effects of ambient air pollution than PM10 or particle number concentrations in Beijing.

Abstract  BACKGROUND: Short-term changes in levels of fine ambient particulate matter (PM2.5) may increase the risk of acute ischemic stroke; however, results from prior studies have been inconsistent. We examined this hypothesis using data from a multicenter prospective stroke registry. METHODS: We analyzed data from 9202 patients hospitalized with acute ischemic stroke, having a documented date and time of stroke onset, and residing within 50 km of a PM2.5 monitor in 8 cities in Ontario, Canada. We evaluated the risk of ischemic stroke onset associated with PM2.5 in each city using a time-stratified case-crossover design, matching on day of week and time of day. We then combined these city-specific estimates using random-effects meta-analysis techniques. We examined whether the effects of PM2.5 differed across strata defined by patient characteristics and ischemic stroke etiology. RESULTS: Overall, PM2.5 was associated with a -0.7% change in ischemic stroke risk per 10-μg/m increase in PM2.5 (95% confidence interval = -6.3% to 5.1%). These overall negative results were robust to a number of sensitivity analyses. Among patients with diabetes mellitus, PM2.5 was associated with an 11% increase in ischemic stroke risk (1% to 22%). The association between PM2.5 and ischemic stroke risk varied according to stroke etiology, with the strongest associations observed for strokes due to large-artery atherosclerosis and small-vessel occlusion. CONCLUSIONS: These results do not support the hypothesis that short-term increases in PM2.5 levels are associated with ischemic stroke risk overall. However, specific patient subgroups may be at increased risk of particulate-related ischemic strokes.

Abstract  The paper aims to evaluate the indoor air limit of 1 microg/m(3) (0.8 ppb) formaldehyde as advised by the European Commission [the INDEX project; Kotzias, D., Koistinen, K., Kephalopoulos, S., Schlitt, C., Carrer, P., Maroni, M., Jantunen, M., Cochet, C., Kirchner, S., Lindvall, T., McLaughlin, J., Molhave, L., de Oliveira Fernandes, E., Seifert, B., 2005. Critical appraisal of the setting and implementation of indoor exposure limits in the EU. European Commission, Institute for Health and Consumer Protection, Physical and Chemical Exposure Unit, Ispra, Italy, pp. 1-50]. The limit has been based on a nose and throat irritation threshold of 0.1mg/m(3) (0.08 ppm; LOAEL), a NOAEL of 0.03 mg/m(3) (0.025 ppm) and an assessment factor of 30, including a factor of 3 for the higher sensitivity of children. Nose and throat irritation, at concentrations below which hyperplasia/metaplasia occurs, are most likely the manifestation of trigeminal nerve stimulation (sensory irritation). The threshold for sensory irritation in human volunteers is 1 ppm, much higher than the 0.1mg/m(3) indicated above. Eye irritation is the most sensitive effect reported in human volunteers but has been mentioned only occasionally in the studies used by the European Commission. Moreover, sensory irritation is a local reaction that requires a low assessment factor, if any. It is difficult to judge the sensitivity for sensory irritation in children because of the potential confounding factors in the evaluated studies. It is concluded that an indoor air level of 0.1 ppm (0.12 mg/m(3)) formaldehyde, as indicated by Appel et al. (2006) [Appel, K.E., Bernauer, U., Herbst, U., Madle, S., Schulte, A., Richter-Reichhelm, H.B., Gundert-Remy, U. 2006. Kann fur Formaldehyd eine "sichere" Konzentration abgeleitet werden?--Analyse der Daten zur krebserzeugenden Wirkung (Can a "safe" concentration be established for formaldehyde?--Analysis of carcinogenicity data)? Umweltmed. Forsch. Prax. 11, 347-361], can be considered a safe and appropriate level.

Abstract  Pediatric asthma has many causes and can manifest differently in different children and at different times. Understanding the many factors related to the development and exacerbation of asthma is complicated by the complexity of the many environmental exposures related to asthma development and morbidity. Furthermore, the same environmental exposures that may cause increased symptoms at 1 point in time may be protective when the exposure occurs earlier or at high enough levels. We know that environmental exposures such as allergens, irritants, and pollutants are quite complex in their composition; further examination of this complexity may improve our understanding of this complex and highly prevalent disease. Pediatrics 2009; 123:S160-S167

Abstract  The aim of this work was to investigate ultrafine particles (<0.1 mu m) in primary school classrooms, in relation to the classroom activities. The investigations were conducted in three classrooms during two measuring campaigns, which together encompassed a period of 60 days. Initial investigations showed that under the normal operating conditions of the school there were many occasions in all three classrooms where indoor particle concentrations increased significantly compared to outdoor levels. By far the highest increases in the classroom resulted from art activities (painting, gluing, and drawing), at times reaching over 1.4 x 10(5) particle cm(-3). The indoor particle concentrations exceeded outdoor concentrations by approximately 1 order of magnitude, with a count median diameter ranging from 20 to 50 nm. Significant increases also occurred during cleaning activities, when detergents were used. GC-MS analysis conducted on 4 samples randomly selected from about 30 different paints and glues, as well as the detergent used in the school, showed that d-limonene was one of the main organic compounds of the detergent, however, it was not detected in the samples of the paints and the glue. Controlled experiments showed that this monoterpene, emitted from the detergent, reacted with O-3 (at outdoor ambient concentrations ranging from 0.06 to 0.08 ppm) and formed secondary organic aerosols. Further investigations to identify other liquids that may be potential sources of the precursors of secondary organic aerosols were outside the scope of this project, however, it is expected that the problem identified by this study could be more widely spread, since most primary schools use liquid materials for art classes, and all schools use detergents for cleaning. Further studies are therefore recommended to better understand this phenomenon and also to minimize exposure of school children to ultrafine particles from these indoor sources.

Abstract  Background: A growing body of research suggests that prenatal exposure to air pollution may be harmful to fetal development. We assessed the association between exposure to air pollution during pregnancy and anthropometric measures at birth in four areas within the Spanish Children's Health and Environment (INMA) mother and child cohort study. Methods: Exposure to ambient nitrogen dioxide (NO2) and benzene was estimated for the residence of each woman (n = 2,337) for each trimester and for the entire pregnancy. Outcomes included birth weight, length, and head circumference. The association between residential outdoor air pollution exposure and birth outcomes was assessed with linear regression models controlled for potential confounders. We also performed sensitivity analyses for the subset of women who spent more time at home during pregnancy. Finally, we performed a combined analysis with meta-analysis techniques. Results: In the combined analysis, an increase of 10 µg/m3 in NO2 exposure during pregnancy was associated with a decrease in birth length of -0.9 mm [95% confidence interval (CI), -1.8 to -0.1 mm]. For the subset of women who spent ≥ 15 hr/day at home, the association was stronger (-0.16 mm; 95% CI, -0.27 to -0.04). For this same subset of women, a reduction of 22 g in birth weight was associated with each 10-µg/m3 increase in NO2 exposure in the second trimester (95% CI, -45.3 to 1.9). We observed no significant relationship between benzene levels and birth outcomes. Conclusions: NO2 exposure was associated with reductions in both length and weight at birth. This association was clearer for the subset of women who spent more time at home.

Abstract  Many regulations issued by the U.S. Environmental Protection Agency (EPA) are based on the results of computer models. Models help EPA explain environmental phenomena in settings where direct observations are limited or unavailable, and anticipate the effects of agency policies on the environment, human health and the economy. Given the critical role played by models, the EPA asked the National Research Council to assess scientific issues related to the agency's selection and use of models in its decisions. The book recommends a series of guidelines and principles for improving agency models and decision-making processes. The centerpiece of the book's recommended vision is a life-cycle approach to model evaluation which includes peer review, corroboration of results, and other activities. This will enhance the agency's ability to respond to requirements from a 2001 law on information quality and improve policy development and implementation.

Abstract  There are currently no epidemiological studies on health effects of long-term exposure to ultrafine particles (UFP), largely because data on spatial exposure contrasts for UFP is lacking. The objective of this study was to develop a land use regression (LUR) model for UFP in the city of Amsterdam. Total particle number concentrations (PNC), PM10, PM2.5, and its soot content were measured directly outside 50 homes spread over the city of Amsterdam. Each home was measured during one week. Continuous measurements at a central urban background site were used to adjust the average concentration for temporal variation. Predictor variables (traffic, address density, land use) were obtained using geographic information systems. A model including the product of traffic intensity and the inverse distance to the nearest road squared, address density, and location near the port explained 67% of the variability in measured PNC. LUR models for PM2.5, soot, and coarse particles (PM10, PM2.5) explained 57%, 76%, and 37% of the variability in measured concentrations. Predictions from the PNC model correlated highly with predictions from LUR models for PM2.5, soot, and coarse particles. A LUR model for PNC has been developed, with similar validity as previous models for more commonly measured pollutants.

Abstract  Emissions of aromatic air toxics from aircraft ground equipment (AGE) were measured with a resonance enhanced multiphoton ionization–time of flight mass spectrometry (REMPI–TOFMS) system consisting of a pulsed solid state laser for photoionization and a TOFMS for mass discrimination. This instrument was capable of characterizing turbine emissions and the effect of varying load operations on pollutant production. REMPI–TOFMS is capable of high selectivity and low detection limits (part per trillion to part per billion) in real time (1 s resolution). Hazardous air pollutants and criteria pollutants were measured during startups and idle and full load operations. Measurements of compounds such as benzene, toluene, ethylbenzene, xylenes, styrene, and polycyclic aromatic hydrocarbons compared well with standard methods. Startup emissions from the AGE data showed persistent concentrations of pollutants, unlike those from a diesel generator, where a sharp spike in emissions rapidly declined to steady state levels. The time-resolved responses of air toxics concentrations varied significantly by source, complicating efforts to minimize these emissions with common operating prescriptions. The time-resolved measurements showed that pollutant concentrations decline (up to 5×) in a species-specific manner over the course of multiple hours of operation, complicating determination of accurate and precise emission factors via standard extractive sampling. Correlations of air toxic concentrations with more commonly measured pollutants such as CO or PM were poor due to the relatively greater changes in the measured toxics’ concentrations.

Abstract  Background Ambient fine particles (particular matter <2.5 μm diameter [PM2.5]) and ozone exacerbate respiratory conditions including asthma. There is little documentation determining whether children are more vulnerable to the effects of ambient pollution than adults, or whether pollution causes life-threatening episodes requiring intensive care unit (ICU) admission. Objective We investigate the relationship between severe asthma morbidity and PM2.5 and ozone in the warm season, and determine whether there is an age-related susceptibility to pollution. Methods Daily time-series analysis of 6008 asthma ICU admissions and 69,375 general (non-ICU) asthma admissions in 4 age groups (<6, 6-18, 19-49, and 50+ years) in 74 New York City hospitals for the months April to August from 1999 to 2006. The regression model adjusted for temporal trends, weather, and day of the week. Risks were estimated for interquartile range increases in the a priori exposure time window of the average of 0-day and 1-day lagged pollutants. Results Age was a significant effect modifier for hospitalizations, and children age 6 to 18 years consistently had the highest risk. Among children age 6 to 18 years, there was a 26% (95% CI, 10% to 44%) increased rate of ICU admissions and a 19% increased rate of general hospitalizations (95% CI, 12% to 27%) for each 12-μg/m3 increase in PM2.5. For each 22-ppb increase in ozone, there was a 19% (95% CI, 1% to 40%) increased risk for ICU admissions and a 20% (95% CI, 11% to 29%) increased risk for general hospitalizations. Conclusion Warm weather patterns of ozone and PM2.5 disproportionately affect children with asthma and appear responsible for severe attacks that could have been avoided.

Abstract  In the present work, annual time series of traffic related pollutants (CO and PM(10)) were considered for frequency analysis (Fourier series) with the aim to understand the underlying physical processes and the influence of emission sources on the variability of the air pollutant concentrations. Several urban traffic and suburban background air quality stations located in Porto metropolitan area (Portugal) were analysed. The results obtained for CO and PM(10) reveal the important contributions of short-term fluctuations (12 h and 24 h periods). However, the spectrum signals at low frequencies are significantly different between these pollutants thus stressing that temporal variations of CO and PM(10) are influenced by different processes. Cross-spectrum analysis of the air quality time series against wind measurements and traffic counts allowed us to identify the contribution of long-range transport over a period of about 21 days to the PM(10) fluctuations. Also, a correlation of over 80% between the pollution levels in the vicinity of traffic sources and suburban background levels are found for these harmonic components in the PM(10) spectrum, while correlations for CO is below a significant level. Thus, the spectrum and cross-spectrum analysis performed in this study reveal the distinct influence of local traffic emissions and long-range transport to CO and PM(10) fluctuations in the polluted urban area. The methodology shows to be a powerful tool for the analysis of the causes of air pollution.

Abstract  Heat waves are considered to be increasing in frequency and intensity whereas they comprise a significant weather-related cause of deaths in several countries. Two heat waves occurred in Greece in summer 2007. These severe heat waves are assessed by analyzing the prevailing synoptic conditions, evaluating human thermal discomfort, through the Heat Load Index (HL), as well as investigating its interrelation of air pollutant concentrations, and the daily air quality stress index (AQSI), in the greater region of Athens (Attica), Greece. Furthermore, the relation of HL values and the number of heatstroke and heat exhaustion events recorded in public hospitals operating within the Greek National Health System is examined. Data included radiosonde measurements from the Athens airport station (LGAT), NCEP/NCAR reanalysis data in order to obtain the position of the Subtropical Jet Stream (STJ), GDAS meteorological data for back-trajectory calculation, 10-min meteorological data from 10 Hydro-Meteorological stations and mean hourly values of nitric dioxide (NO(2)), sulphur dioxide (SO(2)) and ozone (O(3)) concentrations, measured at 7 different sites, for the last 10-day period of June and July 2007. Spearman's rank correlation test was used to observe any possible correlation between HL values and air pollutant concentrations, and AQSI values. The results demonstrated different synoptic characteristics for the heat waves of June and July. In the heat wave of June, higher ambient temperatures were recorded and greater HL values were calculated. Extreme discomfort conditions were identified in both heat waves during both day-time and night-time hours. The air pollution analysis showed poor air quality conditions for the heat wave of July, while a significant correlation was found between HL values and average hourly concentrations of O(3), NO(2) and SO(2). The number of heat-affected patients reported during the June heat wave was larger.

Abstract  Background: Many chronic diseases are the product of an underlying pathologic condition and superimposed acute exacerbations. This model may apply to several conditions such as asthma, other obstructive lung diseases, or atherosclerosis. For exposures affecting both the development of chronic disease and its exacerbation, the usual methods to derive attributable risks (AR) are inappropriate. Methods: We expand traditional risk assessment methods to estimate the AR for exacerbations under a "chronic disease model." We use asthma in children as the chronic disease and air pollution as the exposure of interest. We estimate bronchitis symptom exacerbations attributable to air pollution, using data from the Children's Health Study to estimate asthma prevalence and symptom occurrence, and we examine the distribution of exposure and its acute and chronic effects. Results: In the combined AR model, 39.8% of exacerbations were attributable to air pollution, compared with 33.5% in the traditional model, which ignores a chronic effect of pollution on asthma development. Thus, there is a 1.19-fold higher estimated burden with the combined model. The difference is due to exacerbations caused by other factors (ie, not by air pollution) but nonetheless occurring among those assumed to have asthma that developed due to traffic-related pollution. The proposed model is applicable to other risk factors that play a role both in both the development of a chronic disease and its exacerbation. Conclusions: Traditional approaches to the calculation of attributable risk may underestimate the health impact of long-term environmental or other exposures that produce both chronic and acute disease.

Abstract  Exposure to ambient ultrafine particles induces airway inflammatory reactions and tissue remodeling. In this experiment, to determine whether ultrafine carbon black (ufCB) affects proliferation of airway epithelium and, if so, what the mechanism of action is, we studied human primary bronchial epithelial cell cultures. Incubation of cells in the serum-free medium with ufCB increased incorporations of [3H]thymidine and [3H]leucine into cells in a time- and dose-dependent manner. This effect was attenuated by Cu- and Zn-containing superoxide dismutase (Cu/Zn SOD) and apocynin, an inhibitor of NADPH oxidase, and completely inhibited by pretreatment with the epidermal growth factor receptor (EGF-R) tyrosine kinase inhibitors AG-1478 and BIBX-1382, and the mitogen-activated protein kinase kinase inhibitor PD-98059. Transfection of a dominant-negative mutant of H-Ras likewise abolished the effect ufCB. Stimulation with ufCB also induced processing of membrane-anchored proheparin-binding (HB)-EGF, release of soluble HB-EGF into the medium, association of phosphorylated EGF-R and Shc with glutathione-S-transferase-Grb2 fusion protein, and phosphorylation of extracellular signal-regulated kinase (ERK). Pretreatment with AG-1478, [Glu52]Diphtheria toxin, a specific inhibitor of HB-EGF, neutralizing HB-EGF antibody, Cu/Zn SOD, and apocynin each inhibited ufCB-induced ERK activation. These results suggest that ufCB causes oxidative stress-mediated proliferation of airway epithelium, involving processing of HB-EGF and the concomitant activation of EGF-R and ERK cascade.

Abstract  The extensive thermodynamic and optical properties recently reported [Tang and Munkelwitz, 1994a] for sulfate and nitrate solution droplets are incorporated into a visibility model for computing light scattering by hygroscopic aerosols. The following aerosol systems are considered: NH4HSO4, (NH4)2SO4, (NH4)3H(SO4), NaHSO4, Na2SO4, NH4NO3, and NaNO3. In addition, H2SO4 and NaCl are included to represent freshly formed sulfate and background sea-salt aerosols, respectively. Scattering coefficients, based on 1 ?g dry salt per cubic meter of air, are calculated as a function of relative humidity for aerosols of various chemical compositions and lognormal size distributions. For a given size distribution the light scattered by aerosol particles per unit dry-salt mass concentration is only weakly dependent on chemical constituents of the hygroscopic sulfate and nitrate aerosols. Sulfuric acid and sodium chloride aerosols, however, are exceptions and scatter light more efficiently than all other inorganic salt aerosols considered in this study. Both internal and external mixtures exhibit similar light-scattering properties. Thus for common sulfate and nitrate aerosols, since the chemical effect is outweighed by the size effect, it follows that observed light scattering by the ambient aerosol can be approximated, within practical measurement uncertainties, by assuming the aerosol being an external mixture. This has a definite advantage for either visibility degradation or climatic impact modeling calculations, because relevant data are now available for external mixtures but only very scarce for internal mixtures.