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Biomedical subjects

J I Levy

Publications and source records attributed to J I Levy.

At least 19 recordsLinked to original sources
PubMed2005

Ventilation in public housing: implications for indoor nitrogen dioxide concentrations.

UNLABELLED: Although elevated nitrogen dioxide (NO2) exposures may exacerbate asthma, few studies have examined indoor NO2 levels in low-income, urban neighborhoods, where asthma prevalence is high. As part of the Healthy Public Housing Initiative, NO2 was measured in 77 homes within three Boston public housing developments, using Palmes tubes placed in the kitchen, living room, and outdoors. Air exchange rates (AERs) were assessed using a perfluorocarbon tracer technique. Overall NO2 levels were [mean (ppb)+/-s.d.]: kitchen (43+/-20, n=100), living room (36+/-17, n=102), outdoor (19+/-6, n=91). Indoor NO2 levels were significantly higher in the heating season (living room: 43 ppb vs. 26 ppb, kitchen: 50 ppb vs. 33 ppb), while AERs were significantly lower in the heating season (medians 0.49/h vs. 0.85/h). Significant univariate predictors of indoor concentrations include: outdoor NO2 levels, AERs, and occupancy. AERs and outdoor NO2 remained significant in multivariate models (P<0.05). A dummy variable for supplemental heating with gas stove was not significant (P=0.14), but had a large, positive coefficient. Indoor NO2 levels in this cohort are higher than those generally reported in residential US settings, associated in part with increased gas stove usage and decreased AERs during the heating season. PRACTICAL IMPLICATIONS: Indoor air quality is mainly a function of outdoor concentrations, indoor sources, ventilation, and residential behavior. Indoor exposures to nitrogen dioxide and other combustion pollutants may be elevated within low-income housing developments due to the presence of multiple sources, poor ventilation, small apartment size, and behavioral responses to apartment conditions (e.g. supplemental heating with gas stove). This information may be used by housing authorities and other landlords to decrease potential environmental stressors, through interventions such as source substitution and improved ventilation, particularly for sensitive sub-populations such as asthmatics.

Air Pollution, Indoor↗
PubMed2001

Assessing the public health benefits of reduced ozone concentrations.

In this paper we examine scientific evidence and related uncertainties in two steps of benefit-cost analyses of ozone reduction: estimating the health improvements attributable to reductions in ozone and determining the appropriate monetary values of these improvements. Although substantial evidence exists on molecular and physiologic impacts, the evidence needed to establish concentration-response functions is somewhat limited. Furthermore, because exposure to ozone depends on factors such as air conditioning use, past epidemiologic studies may not be directly applicable in unstudied settings. To evaluate the evidence likely to contribute significantly to benefits, we focus on four health outcomes: premature mortality, chronic asthma, respiratory hospital admissions, and minor restricted activity days. We determine concentration-response functions for these health outcomes for a hypothetical case study in Houston, Texas, using probabilistic weighting reflecting our judgment of the strength of the evidence and the possibility of confounding. We make a similar presentation for valuation, where uncertainty is due primarily to the lack of willingness-to-pay data for the population affected by ozone. We estimate that the annual monetary value of health benefits from reducing ozone concentrations in Houston is approximately $10 per person per microgram per cubic meter (24-hr average) reduced (95% confidence interval, $0.70-$40). The central estimate exceeds past estimates by approximately a factor of five, driven by the inclusion of mortality. We discuss the implications of our findings for future analyses and determine areas of research that might help reduce the uncertainties in benefit estimation.

Activities of Daily Living↗
PubMed2001

Fine particulate matter and polycyclic aromatic hydrocarbon concentration patterns in Roxbury, Massachusetts: a community-based GIS analysis.

Given an elevated prevalence of respiratory disease and density of pollution sources, residents of Roxbury, Massachusetts, have been interested in better understanding their exposures to air pollution. To determine whether local transportation sources contribute significantly to exposures, we conducted a community-based pilot investigation to measure concentrations of fine particulate matter (particulate matter < 2.5 microm; PM(2.5)) and particle-bound polycyclic aromatic hydrocarbons (PAHs) in Roxbury in the summer of 1999. Community members carried portable monitors on the streets in a 1-mile radius around a large bus terminal to create a geographic information system (GIS) map of concentrations and gathered data on site characteristics that could predict ambient concentrations. Both PM(2.5) and PAH concentrations were greater during morning rush hours and on weekdays. In linear mixed-effects regressions controlling for temporal autocorrelation, PAH concentrations were significantly higher with closer proximity to the bus terminal (p < 0.05), and both pollutants were elevated, but not statistically significantly so, on bus routes. Regressions on a subset of measurements for which detailed site characteristics were gathered showed higher concentrations of both pollutants on roads reported to have heavy bus traffic. Although a more comprehensive monitoring protocol would be needed to develop robust predictive functions for air pollution, our study demonstrates that pollution patterns in an urban area can be characterized with limited monitoring equipment and that university-community partnerships can yield relevant exposure information.

Cities↗
PubMed2000

Estimating the mortality impacts of particulate matter: what can be learned from between-study variability?

Epidemiologic studies of the link between particulate matter (PM) concentrations and mortality rates have yielded a range of estimates, leading to disagreement about the magnitude of the relationship and the strength of the causal connection. Previous meta-analyses of this literature have provided pooled effect estimates, but have not addressed between-study variability that may be associated with analytical models, pollution patterns, and exposed populations. To determine whether study-specific factors can explain some of the variability in the time-series studies on mortality from particulate matter [less than/equal to] 10 microm in aerodynamic diameter (PM(10)), we applied an empirical Bayes meta-analysis. We estimate that mortality rates increase on average by 0.7% per 10 microg/m(3) increase in PM(10) concentrations, with greater effects at sites with higher ratios of particulate matter [less than/equal to] 2.5 microm in aerodynamic diameter (PM(2.5))/PM(10). This finding did not change with the inclusion of a number of potential confounders and effect modifiers, although there is some evidence that PM effects are influenced by climate, housing characteristics, demographics, and the presence of sulfur dioxide and ozone. Although further analysis would be needed to determine which factors causally influence the relationship between PM(10) and mortality, these findings can help guide future epidemiologic investigations and policy decisions.

Air Pollution↗
PubMed2000

Particle concentrations in urban microenvironments.

Although ambient particulate matter has been associated with a range of health outcomes, the health risks for individuals depend in part on their daily activities. Information about particle mass concentrations and size distributions in indoor and outdoor microenvironments can help identify high-risk individuals and the significant contributors to personal exposure. To address these issues in an urban setting, we measured particle count concentrations in four size ranges and particulate matter (3/4) 10 microm (PM(10)) concentrations outdoors and in seven indoor microenvironments in Boston, Massachusetts. Particle counts and PM(10) concentrations were continuously measured with two light-scattering devices. Because of the autocorrelation between sequential measurements, we used linear mixed effects models with an AR-1 autoregressive correlation structure to evaluate whether differences between microenvironments were statistically significant. In general, larger particles were elevated in the vicinity of significant human activity, and smaller particles were elevated in the vicinity of combustion sources, with indoor PM(10) concentrations significantly higher than the outdoors on buses and trolleys. Statistical models demonstrated significant variability among some indoor microenvironments, with greater variability for smaller particles. These findings imply that personal exposures can depend on activity patterns and that microenvironmental concentration information can improve the accuracy of personal exposure estimation.

Air Pollutants↗
PubMed1999

Residential building codes, affordability, and health protection: a risk-tradeoff approach.

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through "income" and "stock" effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.

Energy-Generating Resources↗
PubMed1998

Impact of residential nitrogen dioxide exposure on personal exposure: an international study.

Nitrogen dioxide (NO2) concentrations were measured during two-day winter periods in indoor and outdoor environments, and these concentrations were compared with simultaneously measured personal exposures in 18 cities in 15 countries around the world. Information was also gathered on activity patterns and household characteristics in order to determine the influences of these factors on personal exposures. All NO2 measurements were taken using passive filter badges. Personal exposures were found to vary greatly among the array of cities, with mean concentrations ranging between 11.0 ppb and 51.5 ppb. Personal NO2 exposures were more strongly correlated with indoor concentrations (r = 0.75) than with outdoor concentrations (r = 0.57) when all countries were considered simultaneously. Use of a gas stove in the home was the dominant activity influencing NO2 concentrations, with a 67% increase in mean personal NO2 exposure and an increase in indoor-outdoor ratios from 0.7 to 1.2 for participants using gas stoves, although preliminary evidence indicates the importance of combustion space heaters as well. These associations indicate the global nature of the correlation between personal NO2 exposures and indoor NO2 sources such as gas stoves or space heaters, demonstrating that this relationship is not dependent on country-specific parameters.

Air Pollution, Indoor↗
PubMed1998

The Boston residential nitrogen dioxide characterization study: classification and prediction of indoor NO2 exposure.

Many epidemiological studies have used house characteristics associated with indoor sources as simplified proxies for personal nitrogen dioxide (NO2) exposure. Stove type and presence of a pilot light often been used as the two key characteristics, but significant overlaps have remained in the NO2 concentrations in the exposed and unexposed groups. This has contributed to inconsistencies in epidemiological findings, due to potential misclassification of exposure. In this study, other possible proxies were analyzed by cross-table analyses and were investigated in terms of improvements in both classification and predictive power. Adding building type to the above two proxies resulted in 0-5% of households with concentrations overlapping the observed range for the opposing stratum, compared with 22-42% for the two-proxy model. In spite of this performance, the predictive power of regression models for indoor NO2 was not improved by the addition of the third proxy, and the potential sample population was significantly limited. Using these analytical methods to choose descriptive proxies and evaluate the tradeoffs in their implementation can help epidemiological studies improve their designs and therefore optimize the robustness of their conclusions.

Air Pollution, Indoor↗
PubMed1998

Determinants of nitrogen dioxide concentrations in indoor ice skating rinks.

OBJECTIVES: The combination of poor ventilation and fuel-powered ice resurfacers has resulted in elevated nitrogen dioxide (NO2) concentrations in many indoor ice skating rinks. This study examined the factors influencing concentrations and the effects of various engineering controls in ice rinks with different resurfacer fuels. METHODS: Indoor NO2 concentrations were measured in 19 enclosed ice skating rinks over 3 winters by means of passive samplers, with 1-week average measurements during the first winter pilot study and single-day working-hour measurements in the final 2 winters. Personal exposures to drivers also were assessed during the last winter. RESULTS: Rinks in which propane-fueled resurfacers were used had a daily mean indoor NO2 concentration of 206 ppb, compared with 132 ppb for gasoline-fueled and 37 ppb for electric-powered resurfacers. Engineering controls, such as increased ventilation and resurfacer tuning, reduced NO2 concentrations by 65% on average, but outcomes varied widely, and concentrations increased in subsequent months. CONCLUSIONS: Electric ice resurfacers, increased ventilation, or emission control systems are recommended to protect the health of workers and patrons, with surveillance programs proposed to track implementation and maintain an observer effect.

Air Pollutants, Occupational↗
PubMed1985

Unusual skeletal metastases in carcinoma of the cervix.

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.

Adult↗
PubMed1980

A villous tumour of the duodenum with malignant change in a child: A case report.

A tubulovillous adenoma of the duodenum with a predominant villous pattern in a child aged 11 years underwent malignant change, causing obstructive jaundice, and was diagnosed by percutaneous transhepatic cholangiography. Two of the patient's 9 siblings had previously died of cancer. A review of villous tumours of the duodenum is given.

Adenocarcinoma, Papillary↗
PubMed1978

AADS and the ERA.

Explore the source record for details and available documents.

Schools, Dental↗
PubMed1977

The effect of carbachol on the gallbladder in Black and White subjects.

The effect of carbachol on the gallbladder was assessed in 24 White and 24 Black volunteers. The results suggest that in Blacks the gallbladder empties to a signigicantly greater degree than it does in Whites after administration of carbachol. This fact may account, in part, for the lower incidence of cholelithiasis in Black populations. No difference in gallbladder contractility was found between men and women nor did gallbladder response appear to be influence by hormonal factors.

Adult↗
PubMed1977

The hazards of combined chemotherapy and radiotherapy in rhabdomyosarcoma of the mediastinum: a case report.

A total tumour irradiation dose of 2900 rad and a dose of 2500 rad to a metastasis, as well as the administration of 330 mg/m2 adriamycin, successfully eradicated all traces of malignant disease after partial surgical excision in a 12-year-old Black boy with a rhabdomyosarcoma of the mediastinum. The treatment, however, damaged the heart and caused the death of the patient.

Cardiomyopathies↗
PubMed1976

The chest radiograph in primary liver cancer: an analysis of 449 cases.

The value of plain chest radiography in the diagnosis of primary hepatocellular cancer (PHC) was assessed in 449 patients. An elevated right hemidiaphragm and pulmonary metastases were present in 11% and strongly suggest a diagnosis of PHC. In all, the right hemidiaphragm was raised in 30% of patients. Pulmonary metastases were present on admission in 19% of patients and appeared later in a further 6%. Secondary deposits were found in the lungs at necropsy in 52% of patients, compared with only 24% in whom there was radiological evidence of metastases during life. In 36% of patients chest radiographs were normal on admission.

Adult↗