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The exposure-response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. The Ghana Randomized Air Pollution and Health Study enrolled pregnant women at gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ( )] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length (WLZ)-scores were calculated. For each anthropometric measure, we employed latent class growth analysis to generate growth trajectories over the first year of life and assigned each child to a trajectory group. We then employed ordinal logistic regression to determine associations between HAP exposures and growth trajectory assignments. Associations with stove intervention arm were also considered. Of the 1,306 live births, 1,144 had valid CO data and anthropometric variables measured at least once. Prenatal HAP exposure increased risk for lower length [CO 1.17, 95% CI: 1.01, 1.35 per 1-ppm increase; 1.07, 95% CI: 1.02, 1.13 increase], lower LAZ -score (CO 1.15, 95% CI: 1.01, 1.32 per 1-ppm increase) and stunting (CO 1.25, 95% CI: 1.08, 1.45) trajectories. Postnatal HAP exposure increased risk for smaller HC (CO 1.09, 95% CI: 1.04, 1.13 per 1-ppm increase), smaller MUAC and lower WLZ-score ( 1.07, 95% CI: 1.00, 1.14 and 1.09, 95% CI: 1.01, 1.19 increase, respectively) trajectories. Infants in the LPG arm had decreased odds of having smaller HC and MUAC trajectories as compared with those in the open fire stove arm ( 0.58, 95% CI: 0.37, 0.92 and 0.45, 95% CI: 0.22, 0.90, respectively). Higher early life HAP exposure (during pregnancy and through the first year of life) was associated with poorer infant growth trajectories among children in rural Ghana. A cleaner-burning stove intervention may have improved some growth trajectories. https://doi.org/10.1289/EHP8109.

BackgroundClean cooking interventions to reduce air pollution exposure from burning biomass for daily cooking and heating needs have the potential to reduce a large burden of disease globally.ObjectiveThe objective of this study is to evaluate the air pollution exposure impacts of a fan-assisted efficient biomass-burning cookstove and a liquefied petroleum gas (LPG) stove intervention in rural Ghana.MethodsWe randomized 1414 households in rural Ghana with pregnant mothers into a control arm (N = 526) or one of two clean cooking intervention arms: a fan-assisted efficient biomass-burning cookstove (N = 527) or an LPG stove and cylinder refills as needed (N = 361). We monitored personal maternal carbon monoxide (CO) at baseline and six times after intervention and fine particulate matter (PM2.5) exposure twice after intervention. Children received three CO exposure monitoring sessions.ResultsWe obtained 5655 48-h maternal CO exposure estimates and 1903 for children, as well as 1379 maternal PM2.5 exposure estimates. Median baseline CO exposures in the control, improved biomass, and LPG arms were 1.17, 1.17, and 1.30 ppm, respectively. Based on a differences-in-differences approach, the LPG arm showed a 47% reduction (95% confidence interval: 34–57%) in mean 48-h CO exposure compared to the control arm. Mean maternal PM2.5 exposure in the LPG arm was 32% lower than the control arm during the post-intervention period (52 ± 29 vs. 77 ± 44 μg/m3). The biomass stove did not meaningfully reduce CO or PM2.5 exposure.ConclusionsWe show that LPG interventions lowered air pollution exposure significantly compared to three-stone fires. However, post-intervention exposures still exceeded health-relevant targets.SignificanceIn a large controlled trial of cleaner cooking interventions, an LPG stove and fuel intervention reduced air pollution exposure in a vulnerable population in a low-resource setting.

This pilot study investigated whether high-resolution spectral-domain optical coherence tomography (SD-OCT) could detect differences in inner retinal layer (IRL), peripapillary retinal nerve fiber layer (RNFL), and macular thickness between patients with Parkinson's disease (PD) and controls. Both eyes of patients with PD and age-matched controls were imaged with the Heidelberg Spectralis(®) HRA + OCT. RNFL, IRL, and macular thickness were measured for each eye using Heidelberg software. These measurements were compared with validated, published normal values for macular and RNFL thickness, and compared with matched controls for IRL thickness. Eighteen eyes from nine subjects with PD and 19 eyes of 16 control subjects were evaluated using SD-OCT. The average age of PD patients was 64 years with a range of 52-75 years. The average age of controls was 67 years with a range of 50-81 years. No significant reduction in IRL thickness was detected between PD patients and age-matched controls at 13 points along a 6 mm horizontal section through the fovea. No significant difference in RNFL thickness was detected between PD patients and published normal values. Overall average RNFL thickness was 97 μm for PD patients, which exactly matched the normative database value. However, significant differences in macular thickness were detected in three of nine subfields between PD subjects and published normal values. In PD subjects, the outer superior subfield was 2.8% thinner (P = 0.026), while the outer nasal and inner inferior subfields were 2.8% (P = 0.016) and 2.7% (P = 0.001) thicker compared to published normal values. In this pilot study, significant differences in macular thickness were detected in three of nine subfields by SD-OCT. However, SD-OCT did not detect significant reductions in peripapillary RNFL and IRL thickness between PD patients and controls. This suggests that macular thickness measurements by SD-OCT may potentially be used as an objective, noninvasive, and easily quantifiable in vivo biomarker in PD. Larger, longitudinal studies are needed to explore these relationships further.

The association between prenatal household air pollution (HAP) exposure and childhood blood pressure (BP) is unknown. Within the Ghana Randomized Air Pollution and Health Study (GRAPHS) we examined time-varying associations between ) maternal prenatal and ) first-year-of-life HAP exposure with BP at 4 years of age and, separately, whether a stove intervention delivered prenatally and continued through the first year of life could improve BP at 4 years of age. GRAPHS was a cluster-randomized cookstove intervention trial wherein pregnant women were randomized to one of two stove interventions: ) a liquefied petroleum gas (LPG) stove or improved biomass stove, or ) control (open fire cooking). Maternal HAP exposure over pregnancy and child HAP exposure over the first year of life was quantified by repeated carbon monoxide (CO) measurements; a subset of women ( ) also performed one prenatal and one postnatal personal fine particulate matter ( ) measurement. Systolic and diastolic BP (SBP and DBP) were measured in 4-y-old children along with their exposure ( ). We examined the effect of the intervention on resting BP -scores. We also employed reverse distributed lag models to examine time-varying associations between ) maternal prenatal and ) first-year-of-life HAP exposure and resting BP -scores. Among those with measures, we examined associations between and resting BP -scores. Sex-specific effects were considered. Intention-to-treat analyses identified that DBP -score at 4 years of age was lower among children born in the LPG arm (LPG ; 95% CI: , ) as compared with those in the control arm, and females were most susceptible to the intervention. Higher CO exposure in late gestation was associated with higher SBP and DBP -score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP -score. In the subset with measurements, higher maternal postnatal exposure was associated with higher SBP -scores. These findings suggest that prenatal and first-year-of-life HAP exposure are associated with child BP and support the need for reductions in exposure to HAP, with interventions such as cleaner cooking beginning in pregnancy. https://doi.org/10.1289/EHP13225.

Bone islands (BI; enostoses) may be solitary or occur in the setting of osteopoikilosis (multiple bone islands) and are sometimes associated with Gardner’s Syndrome (osteopoikilosis and colonic polyposis). Characteristic features of bone islands are (1) absence of pain or local tenderness, (2) typical radio dense central appearance with peripheral radiating spicules (rose thorn), (3) Mean CT (computerized tomography) attenuation values above 885 Hounsfield units (HU) (4) absence of uptake on bone scan and (5) radiographic stability over time. However, when enostoses display atypical features of pain, unusual radiographic appearance, aberrant HU, increased radiotracer uptake, and/or enlargement, they can be difficult to differentiate from more sinister bony lesions such as osteoblastic metastasis, low grade central osteosarcoma, osteoid osteoma and osteoblastoma. In this retrospective case series, the demographic, clinical, radiographic, treatment and outcome for ten patients with eleven atypical bone islands (ABI) are presented, some showing associated pain (5), some with atypical radiographic appearance (3), some with increased activity on BS (4), some with documented enlargement over time (7), one with abnormal CT attenuation value, some in the setting of osteopoikilosis (2), one in the setting of Gardner’s Syndrome and one osteoid osteoma simulating a bone island. This series represents the spectrum of presentations of ABI. Comprehensive review of the literature reveals that the previous largest series of ABI showing enlargement as the atypical feature was in younger patients with jaw BI. Hence, this represents one of the largest series reported of ABI of all types in adults.

Aim and Objectives: The aim of the study was to assess the Vitamin D status in children with autoimmune thyroiditis at tertiary care hospital, Sangareddy, Telangana. [4] Several community studies from India reported a prevalence of Vitamin D ranging from 50% to 94% due to lower dietary intake of calcium and lack of sufficient exposure to the sun.^ Vitamin D intimately prevalents in autoimmune thyroiditis and has an immunomodulatory effects. [10] Gomathi et al. assessed the Vitamin D trends in 75 cases and 75 control children with autoimmune thyroiditis and reported that the mean 25(OH)D (15.07 ng/ml in cases and 17.82 ng/ml in controls) and serum calcium levels (9.35 mg/dl in cases and 9.73 mg/dl in controls) were significantly less in cases than controls (P < 0.005). A randomized clinical trial study by Aghili et al. assessed Vitamin D status in 30 cases and reported that the level of antithyroid antibodies and thyroid volume was decreased after Vitamin D intervention.

The present impediments to the implementation of sustainable practices in residential and commercial structures in the United States, India and Afghanistan will be evaluated and compared in this study. This study intends to identify the barriers to sustainable development within the residential and commercial buildings creating a basis for the methods to address these issues. The selection of these three countries was based on taking the United States as a developed country, India as developing country and Afghanistan as an undeveloped country. Understanding the barriers studied will establish a path to overcoming them and allow the market to open up to the widespread implementation of sustainable practices. According to the survey conducted, about 91% of respondents in Afghanistan, about 71% in India and 32% of respondents in the USA have moderate to low knowledge on sustainable construction. Other barriers mentioned in the study include the high cost of materials, insufficient training, government policy, and so on.

Infective endocarditis (IE) is a serious cardiovascular condition with the potential to lead to severe valvular regurgitation. We present a case of a 65-year-old male who presented with a fever and was diagnosed with IE through point-of-care ultrasound (POCUS). The patient's condition subsequently led to severe aortic regurgitation. Timely diagnosis facilitated by POCUS played a crucial role in the management of this case. The patient underwent successful timely surgical intervention to prevent further infective embolism and heart failure due to severe acute aortic regurgitation. This case underscores the pivotal role of POCUS in the early diagnosis and multidisciplinary management of cardiology diseases, highlighting its importance in delivering optimal patient care.

The biomass gasification process is widely accepted as a popular technology to produce fuel for the application in gas turbines and Organic Rankine Cycle (ORC). Chemical reactions of this process can be separated into three reaction zones: pyrolysis, combustion, and reduction. In this study, sensitivity analysis with respect to three input parameters (gasification temperature, equivalence ratio, and steam-to-biomass ratio) has been carried out to achieve energy self-sufficient conditions in a steam gasification process under the criteria that the carbon conversion efficiency must be more than 70%, and carbon dioxide gas is lower than 20%. Simulation models of the steam gasification process have been carried out by ASPEN Plus and validated with both experimental data and simulation results from Nikoo & Mahinpey (2008). Gasification temperature of 911 °C, equivalence ratio of 0.18, and a steam-to-biomass ratio of 1.78, are considered as an optimal operation point to achieve energy self-sufficient condition. This operating point gives the maximum of carbon conversion efficiency at 91.03%, and carbon dioxide gas at 15.18 volumetric percentages. In this study, life cycle assessment (LCA) is included to compare the environmental performance of conventional and energy self-sufficient gasification for steam biomass gasification.

Background Three billion individuals worldwide rely on biomass fuel [dung, wood, crops] for cooking and heating. Further, health conditions resulting from household air pollution (HAP) are responsible for approximately 3.9 million premature deaths each year. Though transition away from traditional biomass stoves is projected curb the health effects of HAP by mitigating exposure, the benefits of newer clean cookstove technologies can only be fully realized if use of these new stoves is exclusive and sustained. However, the conditions under which individuals adopt and sustain use of clean cookstoves is not well understood. Methods The Enhancing LPG Adoption in Ghana (ELAG) study is a cluster-randomized controlled trial employing a factorial intervention design. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. This intervention seeks to align these five behavioral factors with clean cookstove adoption and sustained use. A second intervention is access-related and will improve LPG availability by offering a direct-delivery refueling service. These two interventions will be integrated via a factorial design whereby 27 communities are assigned to one of the following: the control arm, the educational intervention, the delivery, or a combined intervention. Intervention allocation is determined by a covariate-constrained randomization approach. After intervention, approximately 900 households’ individual fuel use is tracked for 12 months via iButton stove use monitors. Analysis will include hierarchical linear models used to compare intervention households’ fuel use to control households. Discussion Literature to-date demonstrates that recipients of improved cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can then lead to HAP-reductions and consequent improvements in public health. Trial registration NCT03352830 (November 24, 2017).