The objective of the NASA Global Climate Change Education (GCCE) project is to provide educators at the elementary, secondary, and undergraduate levels the tools and resources to access NASA climate information and related Earth system information, in order to engage students in critical thinking about global climate change and the potential impacts on human health across the planet. This project incorporates NASA climate change information and other Earth system information related to human health into NASA World Wind, an open source 3-D visualization tool. World Wind uses OGC-compliant Web Coverage Services (WCS) and Web Map Services (WMS) that allow zooming in from satellite altitude to any location on the Earth's surface. Student lessons will use climate data made available through the enhanced NASA World Wind interface to explore potential impacts on human health in areas of food security, water security, and infectious disease. Two existing Web-based resources, the Climate Mapper tool from IAGT and the Population Estimation Service from SEDAC, will be merged and made available through a customized NASA World Wind interface that will launch from the Web. This merger of two NASA-supported tools will allow the technical component and parametric statistics to be applied to additional climate- and human health-related data sets from CIESIN, such as world population grids, malnutrition levels related to changes in temperature and precipitation that would impact staple food production, population displacement related to rising sea levels, and spatial epidemiology of vector-borne diseases and population access to a public health infrastructure.

We examined the utility of a newly developed perceived air pollution (PAP) scale and of a modeled air pollution (MAP) scale derived from it for predicting previously observed birth outcomes of pregnant women enrolled following September 11, 2001. Women reported their home and work locations in the four weeks after September 11, 2001 and the PAP at each site on a four-point scale designed for this purpose. Locations were geocoded and their distance from the World Trade Center (WTC) site determined. PAP values were used to develop a model of air pollution for a 20-mile radius from the WTC site. MAP values were assigned to each geocoded location. We examined the relationship of PAP and MAP values to maternal characteristics and to distance of home and work sites from the WTC site. Both PAP and MAP values were highly correlated with distance from the WTC. Maternal characteristics that were associated with PAP values reported for home or work sites (race, demoralization, material hardship, first trimester on September 11) were not associated with modeled MAP values. Relationships of several birth outcomes to proximity to the WTC, which we previously reported using this data set, were also seen when MAP values were used as the measure of exposure, instead of proximity. MAP developed from reports of PAP may be useful to identify high-risk areas and predict health outcomes when there are multiple sources of pollution and a "distance from source" analysis is impossible.

OBJECTIVE: This study was designed to determine whether prenatal mercury exposure, including potential releases from the World Trade Center (WTC) disaster, adversely affects fetal growth and child development.METHODS: We determined maternal and umbilical cord blood total mercury of nonsmoking women who delivered at term in lower Manhattan after I I September 200 1, and measured birth outcomes and child development.RESULTS: Levels of total mercury in cord and maternal blood were not significantly higher for women who resided or worked within I or 2 miles of the WTC in the month after 11 September, compared with women who lived and worked farther away. Average cord mercury levels were more than twice maternal levels, and both were elevated in women who reported eating fish/seafood during pregnancy. Regression analyses showed no significant association between (In) cord of maternal blood total mercury and birth outcomes. Log cord mercury was inversely associated with the Bayley Scales of Infant Development psychomotor score [Psychomotor Development Index (PDI)] at 36 months (b = -4.2, p = 0.007) and with Performance (b = -3.4, p = 0.023), Verbal (b = -2.9, p = 0.023), and Full IQ scores (b = -3.8, p = 0.002) on the Wechsler Preschool and Primary Scale of Intelligence, Revised (WPPSI-R), at 48 months, after controlling for fish/seafood consumption and other confounders. Fish/seafood consumption during pregnancy was significantly associated with a 5.6- to 9.9-point increase in 36-month PDI, and 48-month Verbal and Full IQ scores.CONCLUSIONS: Blood mercury was not significantly raised in women living or working close to the WTC site in the weeks after 11 September 2001. Higher cord blood mercury was associated with reductions in developmental scores at 36 and 48 months, after adjusting for the positive effects of fish/seafood consumption during pregnancy.

BackgroundPolycyclic aromatic hydrocarbons (PAHs), including benzo[a]pyrene (BaP), are air pollutants released by the World Trade Center (WTC) fires and urban combustion sources. BaP–DNA adducts provide a measure of PAH-specific genetic damage, which has been associated with increased risk of adverse birth outcomes and cancer. We previously reported that levels of BaP–DNA adducts in maternal and umbilical cord blood obtained at delivery were elevated among subjects who had resided within 1 mile of the WTC site during the month after 9/11; and that elevated blood adducts in combination with in utero exposure to environmental tobacco smoke (ETS) were significantly associated with decreased fetal growth.ObjectiveOur aim was to assess possible effects of prenatal exposure to WTC pollutants on child development.MethodsAfter 11 September 2001, we enrolled a cohort of nonsmoking pregnant women who delivered at three lower Manhattan hospitals. We have followed a subset of children through their third birthdays and measured cognitive and motor development using the Bayley-II Scales of Child Development (BSID-II).ResultsIn multivariate analyses, we found a significant interaction between cord blood adducts and in utero exposure to ETS on mental development index score at 3 years of age (p = 0.02, n = 98) whereas neither adducts nor ETS alone was a significant predictor of (BSID-II) cognitive development.ConclusionAlthough limited by small numbers, these results suggest that exposure to elevated levels of PAHs in conjunction with prenatal ETS exposure may have contributed to a modest reduction in cognitive development among cohort children.

MS7-08 Abstract: Accumulating evidence from recent epidemiologic studies suggests that traffic-related air pollution contributes to the health effects associated with long-term exposure to air pollution. Many of these epidemiologic studies lack adequate methods of evaluating small-scale (intraurban) spatial variations in air pollution. We are developing a regression-mapping model to estimate small-scale ambient diesel exhaust particle (DEP) concentrations in New York City. This model is being developed using a dataset of 100 residential outdoor DEP measurements as the outcome measure and land use and traffic characteristics measured at the same sites as predictors. DEP measurements were obtained as part of the ongoing Columbia Center for Children's Environmental Health Study, in which 100 homes throughout Northern Manhattan and the South Bronx were sampled to assess the health impacts of PM2.5 and DEP. Simultaneous indoor and outdoor samples were collected over 2 48-hour periods over a 2-week period at each home. Samples were collected on 25-mm Teflon filters at 4 L/min and were analyzed for mass using a microbalance and for reflectance using a smoke-stain reflectometer. Using the reflectance results, an absorption coefficient was calculated, which is directly correlated to black carbon content, a surrogate for DEP. Based on a preliminary sample of 66 homes, absorption coefficients (mean ± standard deviation) were 1.38 ± 0.51 and 1.30 ± 0.46 for the outdoor and indoor samples, respectively. Indoor and outdoor measurements were highly correlated (r = 0.79, P < 0.001), indicating a strong impact of outdoor sources on the DEP content of indoor air. Slightly higher absorption coefficients were measured in the outdoor samples than in the indoor samples during warmer months (r = 0.86, P < 0.001), and similar coefficients were measured during colder months (r = 0.74, P < 0.001). Using annual average daily traffic volume estimates obtained from the New York State Department of Transportation, a low but significant correlation (r = 0.32) was found between outdoor absorption coefficients and daily traffic volume estimates. We are also performing a validation of the New York Metropolitan Transportation Council's Best Practice Model (NYMTC BPM), a traffic-forecasting model that is being used to predict traffic volumes, against New York State Department of Transportation official traffic count data. The BPM includes a highway network containing 53,000 links, encompassing most minor arterial and above roadway facilities. This study lends validity to using BPM estimates in traffic studies as well as provides a reliable tool for estimating outdoor exposure to traffic-related pollutants for use in health studies.

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions'Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators. Involvement by multiple hospital units in the QI effort is associated with worse values on all four patient safety indicators. Percentages of hospital staff and of senior managers participating in QI teams exhibited no statistically significant association with any patient safety indicator. Percentage of physicians participating in QI teams is associated with better values on two patient safety indicators.

Purpose: To (1) examine the association between the intensity of care management (CM) implementation in hospitals and hospital performance on 4 selected indicators of patient safety among hospitalized Medicare recipients and (2) assess the extent to which these relationships are moderated by hospital organizational and environmental context. Design and Methods: Primary data from the 1997 mailed survey of hospital quality improvement practices; secondary data from the Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, Area Resource File; and 2 proprietary data sets compiled by Solucient Inc. were used in the study. A cross-sectional analysis of 1784 community hospitals was performed to assess the relationship between CM implementation intensity and 4 hospital-level patient safety indicators. Two-stage instrumental variables estimation, in which predicted values (instruments) of 4 CM implementation intensity variables plus control (exogenous) variables were used to estimate hospital-level patient safety indicators. Results: Results of main effects provided inconsistent support to our hypotheses that greater implementation of CM would result in improved patient safety. For example, more extensive use of statistical and process management tools was positively associated with 3 of the 4 patient safety indicators. Similarly, hospitals reporting a greater number of clinical guidelines in use exhibited significantly worse values on 3 of the 4 patient safety indicators. However, results also indicate that forces external and internal to the hospital condition the association of particular CM activities and patient safety indicators: specifically data use, statistical and process management tool use, and organizational emphasis on continuous quality improvement. For example, we observed that hospitals' relative focus on improving systems and processes of care lead to better patient safety results as the financial position of the hospital improved. Similarly, hospitals with more extensive use of statistical and process management tools in high managed care penetration markets were more likely to experience fewer adverse patient safety incidents than hospitals using the same practices in markets with lower managed care penetration. Implications: It is unlikely that CM per se will improve patient safety for hospitalized patients without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital. In designing approaches to CM, managers and physicians need to consider both the internal and external conditions necessary to support effective CM implementation.

The development of highly sophisticated imaging techniques in the past 20 years has made it possible for neuroscientists to study the brain like never before. The resulting findings, particularly about emotions, are challenging psychotherapists of all orientations to reevaluate their theories and practices. These considerations are a particularly daunting task for therapists whose work reflects the post-modern denial of objective reality, like that of Solution-Focused therapists. In this article, the authors have juxtaposed solution-focused theory and practice with some key neuroscientific ideas in order to explore fit and incompatibility. Possible benefits for Solution-Focused practice are discussed.

ISEE-471 Abstract: To determine the effects of exposure to the WTC event on birth outcomes and child growth and development, 329 pregnant women (42.0% White, 32.5% Asian, 15.6% Black, 9.8% other/unidentified) were enrolled between Dec. 2001 and June 2002, at the time of delivery in 3 hospitals close to the WTC site. Cord blood and maternal blood and urine were collected. Birth outcome data (including birth weight, length and head circumference) and characteristics of the pregnancy were abstracted from the medical records. The mother was interviewed in the hospital to determine exact home and work locations in the 4 weeks after 9-11-01, lifestyle sources of toxicant exposure, and demographics. The biological samples were analyzed for biomarkers of exposure: PAH-DNA adducts, dioxins, furans, PCBs, polybrominated diphenyl ethers, lead, cadmium and mercury. Home and work locations were geocoded and distance and bearing from the WTC site were computed. More than a third of the women lived and/or worked <2 mi. from the WTC (Manhattan, Brooklyn or NJ) during the 4 weeks after 9-11-01; the remainder lived and/or worked further from the site. Women were re-interviewed at 6 months and 1 year postpartum to assess postnatal lifestyle exposures and infant health and hospitalizations during the first year of life. Physical growth of the children and their mental and motor development (using the Bayley Scales of Infant Development) are being determined at 1 and 2 years of age and beyond. The geocoded addresses are being used to determine effects on birth outcomes of proximity of pregnant women to the WTC site in the 4 weeks after 9-11-01 and to determine associations between proximity to the site and biomarkers of exposure. The associations of proximity and specific biomarkers to birth outcomes, infant health, and child physical, mental and motor development, are being explored. The effects of proximity on gestation duration, birth weight and length and head circumference will be presented.

The effects of prenatal exposure to pollutants from the World Trade Center (WTC) disaster on fetal growth and subsequent health and development of exposed children remain a source of concern. We assessed the impact of gestational timing of the disaster and distance from the WTC in the 4 weeks after 11 September on the birth outcomes of 300 nonsmoking women who were pregnant at the time of the event. They were recruited at delivery between December 2001 and June 2002 from three hospitals close to the WTC site. Residential and work addresses of all participants for each of the 4 weeks after 11 September 2001 were geocoded for classification by place and timing of exposure. Average daily hours spent at each location were based on the women's reports for each week. Biomedical pregnancy and delivery data extracted from the medical records of each mother and newborn included medical complications, type of delivery, length of gestation, birth weight, birth length, and head circumference. Term infants born to women who were pregnant on 11 September 2001 and who were living within a 2-mile radius of the WTC during the month after the event showed significant decrements in term birth weight (-149 g) and birth length (-0.82 cm), compared with infants born to the other pregnant women studied, after controlling for sociodemographic and biomedical risk factors. The decrements remained significant with adjustment for gestational duration (-122 g and -0.74 cm, respectively). Women in the first trimester of pregnancy at the time of the WTC event delivered infants with significantly shorter gestation (-3.6 days) and a smaller head circumference (-0.48 cm), compared with women at later stages of pregnancy, regardless of the distance of their residence or work sites from the WTC. The observed adverse effects suggest an impact of pollutants and/or stress related to the WTC disaster and have implications for the health and development of exposed children.

Background: Consistent long-term viral suppression has been difficult to achieve in children with human immunodeficiency virus type 1 (HIV-1) infection. We tested the safety and antiviral efficacy of a novel combination consisting of efavirenz, nelfinavir, and one or more nucleoside reverse-transcriptase inhibitors in 57 children previously treated with only nucleoside reverse-transcriptase inhibitors.Methods: The children were monitored for 48 weeks after the initiation of therapy. We assessed plasma concentrations of efavirenz and nelfinavir, plasma HIV-1 RNA levels, and lymphocyte subpopulations.Results: At base line, the 57 HIV-1-infected children (age range, 3.8 to 16.8 years) had a median of 699 CD4 cells per cubic millimeter and 10,000 copies of HIV-1 RNA per milliliter of plasma. The most common treatment-related effects of at least moderate severity were rash (in 30 percent of children), diarrhea (in 18 percent), neutropenia (in 12 percent), and biochemical abnormalities (in 12 percent). Serious side effects were uncommon. The mean values for the area under the curve for efavirenz and nelfinavir corresponded to expected values. In an intention-to-treat analysis, 76 percent of children had plasma HIV-1 RNA levels of less than 400 copies per milliliter after 48 weeks of therapy and 63 percent had levels of less than 50 copies per milliliter. A high plasma HIV-1 RNA level at base line significantly decreased the likelihood that plasma levels of HIV-1 RNA would become undetectable during treatment.Conclusions: In HIV-1-infected children who were previously treated with nucleoside reverse-transcriptase inhibitors, the combination of efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors was generally well tolerated and had a potent and sustained antiviral effect. (N Engl J Med 1999;341:1874-81.) (C)1999, Massachusetts Medical Society.

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter Facebook Reddit LinkedIn Tools Icon Tools Reprints and Permissions Cite Icon Cite Search Site Citation Mark Becker; CIP’s Ninth Annual Educational Software Contest. Computers in Physics and IEEE Computational Science & Engineering 1 January 1998; 12 (1): 20. https://doi.org/10.1063/1.168683 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAIP Publishing PortfolioComputer in Physics Search Advanced Search |Citation Search