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Background Exposures to volatile organic compounds could influence glycemic regulation. This study examines hemoglobin A1c (HbA1c) in a cohort of oil spill cleanup workers up to 6 years post-exposure in relation to benzene, toluene, ethylbenzene, and xylenes (BTEX) exposures, individually and as a mixture, as well as a separate estimation of the aggregate sum of BTEX (total BTEX). Methods Data for this analysis are from the Gulf Long-term Follow-up (GuLF) Study– a prospective cohort of workers involved in the 2010 Deepwater Horizon oil spill cleanup. HbA1c and medication information were obtained at Home Visit and Clinical Exam phases 1–3 years and up to 6 years post-exposure, respectively. Cumulative inhalation exposure to the individual BTEX chemicals and to total BTEX were estimated using a job-exposure matrix linking air measurements to detailed individual worker cleanup work histories. We used Tobit regression models to examine associations between exposure to the chemicals and latent, untreated HbA1c, accounting for medication-reduced HbA1c. We used quantile g-computation to examine exposure to the mixture of BTEX chemicals and HbA1c. Results In results examining Home Visit HbA1c we observed no discernable patterns but found suggestive evidence of an association with total BTEX. In results for Clinical Exam HbA1c, we did not observe monotonic patterns, but rather an inverted-U pattern with elevations in Q2 or Q3 or no clear pattern. Similarly, in results for final HbA1c adjusting for initial HbA1c, total BTEX difference estimates showed an inverted-U pattern in point estimates across Q2 (0.24 95%CI (0.14, 0.34)), Q3 (0.13 95%CI (0.03, 0.24)), and Q4 (0.00 95% CI (-0.11, 0.10)), compared to Q1. Conclusion Exposures to the moderate levels of the BTEX chemicals observed in this study population, individually and as an aggregate, may be associated with elevated HbA1c up to 6 years after exposure, with an inverted-U pattern.

BackgroundNatural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC).MethodsWe used publicly available NC death records data to estimate associations between Hurricane Florence and monthly suicide death rates using a controlled, interrupted time series analysis. Hurricane exposure was determined by using county-level support designations from the Federal Emergency Management Agency. We examined effect modification by sex, age group, and race/ethnicity.Results8363 suicide deaths occurred between January 2014 and December 2019. The overall suicide death rate in NC between 2014 and 2019 was 15.53 per 100 000 person-years (95% CI 15.20 to 15.87). Post-Hurricane, there was a small, immediate increase in the suicide death rate among exposed counties (0.89/100 000 PY; 95% CI −2.69 to 4.48). Comparing exposed and unexposed counties, there was no sustained post-Hurricane Florence change in suicide death rate trends (0.02/100 000 PY per month; 95% CI −0.33 to 0.38). Relative to 2018, NC experienced a statewide decline in suicides in 2019. An immediate increase in suicide deaths in Hurricane-affected counties versus Hurricane-unaffected counties was observed among women, people under age 65 and non-Hispanic black individuals, but there was no sustained change in the months after Hurricane Florence.ConclusionsAlthough results did not indicate a strong post-Hurricane Florence impact on suicide rates, subgroup analysis suggests differential impacts of Hurricane Florence on several groups, warranting future follow-up.

Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m 2 higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Individual records were available for 221 934 people in 17 countries (14 297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63 821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m 2 or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17–1·29) with BMI, 1·27 (1·20–1·33) with waist circumference, and 1·25 (1·19–1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03–1·11) with BMI, 1·10 (1·05–1·14) with waist circumference, and 1·12 (1·08–1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of −0·0001, −0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement −0·19%, −0·05%, and −0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93–0·97) than for waist circumference (0·86, 0·83–0·89) or waist-to-hip ratio (0·63, 0·57–0·70). BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids. British Heart Foundation and UK Medical Research Council.

Objectives Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. Methods Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. Results Patients were primarily male ( n  = 25, 61.0%), white ( n  = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology ( n  = 34, 82.9%), with Bartonella henselae ( n  = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin ( n  = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment ( n  = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability ( n  = 5, 31.3%). Conclusions In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.

We analyze 45 spectropolarimetric observations of the eclipsing, interacting binary star V356 Sgr, obtained over a period of 21 years, to characterize the geometry of the system's circumstellar material. After removing interstellar polarization from these data, we find the system exhibits a large intrinsic polarization signature arising from electron scattering. In addition, the lack of repeatable eclipses in the polarization phase curves indicates the presence of a substantial pool of scatterers not occulted by either star. We suggest that these scatterers form either a circumbinary disk coplanar with the gainer's accretion disk or an elongated structure perpendicular to the orbital plane of V356 Sgr, possibly formed by bipolar outflows. We also observe small-scale, cycle-to-cycle variations in the magnitude of intrinsic polarization at individual phases, which we interpret as evidence of variability in the amount of scattering material present within and around the system. This may indicate a mass transfer or mass loss rate that varies on the time-scale of the system's orbital period. Finally, we compare the basic polarimetric properties of V356 Sgr with those of the well studied beta Lyr system; the significant differences observed between the two systems suggests diversity in the basic circumstellar geometry of Roche-lobe overflow systems