RichmanAlexanderPortfolio


 * 1.“Assessing Ozone-Related Health Impacts Under a Changing Climate,” //Environmental Health Perspectives//.**

Kim Knowlton is senior Scientist on NRDC’s Global Warming and Health Project. The other authors in this article hold PhDs and are too concerned with the environmental hazards. Joyce E. Rosenthal is in academia, works a Columbia, and belongs to the National Center for Environmental Research. Her primary focuses is Environmental Equity and Health. The article is very technical too and goes into great detail of how the simulation/experiment was conducted. Also, there is a lot of industry jargon such as Sparse Matrix Operator Kernel Emissions Modeling System, and titration.

The topic that is addressed in this article is the rising concerns of 03**. “**Climate change may increase the frequency and intensity of ozone episodes in future summers in the United States”(1) The article has incorporates an experiment of the 31-county New York metropolitan region and simulates the effects of ozone on these counties in 2050. “The objective of the present report is to assess and compare summer O3-related mortality in the 1990s and 2050s”(2). They ran two simulations one of which one would show the result in 03 levels as it related to natural climate change and the other form green house gasses.

“Counties with the highest percent increases in projected O3 mortality spread beyond the urban core into less densely populated suburban counties.”(2) This is particularly interesting because it shows that air space can grow and that an effect in one particular area can cause harm to another. The other area may have taken preemptive steps to protect its self, but pollution is like a vicious virus spreading. The experiment concluded that “Over the entire region, there was a projected median increase of 4.5% in O3 related deaths.” The sensitivity analysis showed that as there is a great influx in population there will be deaths. Also, the warmer the temperatures that may be caused are an effect of human pollution can attribute to more death.

In a study form the United kingdom there could be a “10% increase in premature mortality could result by 2020, with a 20% increase possible by 2050” I think that it would be interested to see how many people die over all as an effect to ozone because the percentiles might be misleading. But it was nice to see that the article drew from regional and global data. The article suggest that needs to be a focus on developing and implementing new technology to check for air pollution so there can be a better math model. But the data that is given from this article will be good to sue when doing our air study analysis.


 * 2.“Population Disparities in Asthma” //Annual Review of Public Health//. //Annual Review of Public Health// 26:89–113**

Diane R. Gold and Rosalind Wright are both M.Ds and teach and work at //Harvard Medical School, Channing Laboratory, Brigham and Women’s Hospital.. This article addresses the that “//The prevalence of asthma in the United States is higher than in many other countries in the world” (1). It also says that it is the most chronic disease among youths in America.

The experiment focuses on the “ differences in “hygiene” (e.g., family size, use of day care, early-life respiratory infection exposures, endotoxin and other farm-related exposures, microbial colonization of the infant bowel, exposure to parasites, and exposure to large domestic animal sources of allergen), diet, traffic pollution, and cigarette smoking”(1) The study “present data on socioeconomic and ethnic disparities in asthma prevalence and morbidity in the United States and discuss environmental factors contributing to asthma disparities” Data is collected form different countries and analyzed. On of the conclusions that is drawn is that daycare plays a role in viruses spreading. The reason for this is that kids are more in contact with each other and if one kid gets a virus it can spread esily to the others. Another thing that is interesting is there is a hypothesis that having kids drink raw milk from a cow can protect against wheezing. Another way to look at this is that the antibiotics that treat the milk could be a factor. “Asthma was negatively associated with consumption of foods containing Vitamin E in the prospective U.S. Nurses’ Health Study of 77,866 female nurses (54). Increases in allergy and asthma may be related also to decreases in dietary intake of n-3 polyunsaturated fatty acids” (6) “In the United States, asthma prevalence, hospitalization, and mortality are higher for Black/African American compared to Caucasian (White) children” (7) “Black children still had 1.6 times the odds of asthma diagnosis compared with White children” (8) Also people who live in the poorest neighborhoods of NY are more likely to die of Asthma. One reason that was cited was lack of good medical care. The hygiene hypotheses are sometimes challenged to be in accurate. But I think the real reason for hygiene related issues in the city is the lack of space in the household. There will be less circulation of air and a greater chance per square foot that something is contaminated.


 * 3."The Urban Environment and Childhood Asthma (URECA) Birth Cohort Study: Design, Methods, and Study Population," //BMC Pulmonary Medicine// 9:17**

The Researchers were from New Your Sate medical universities. What makes this interesting is that all of the researchers held a medical degree. This article is focused on a study of babies from birth to seven years of age. The Article addresses the issue of babies that are brought up in an urban environment and the challenges that the environment and underlining problems that a parent pose on the baby. At least one of the parents in the study was allergic to something. This study is focused on tracking these kids and how their immune system was responding. Since this article is focused in an urban environment there are so many causes that can affect a kid’s immune system that it is almost impossible to tell what the major under lying cause is. Sure the article states that social economical status is one of the main causes but it could also be the manufacturing firm that is making billions of dollars and releasing something into the year that the study is unaware of The method that was used was the scientific process. There were two hypothesis “First, unique environmental exposures in the inner city interact with genetic factors during the prenatal and postnatal periods to adversely influence the development of the innate and adaptive immune systems, increasing the risk for allergic sensitization and atopic diseases. Second, immune dysregulation in infancy increases the risk of developing lower respiratory infections caused by viruses and perhaps atypical bacteria.” (2)

An Interesting quote is that “Children in the URECA cohorts are at increased risk of developing asthma from a number of perspectives. Both minority and low socioeconomic status are associated with an increased risk of asthma, which likely is a consequence of harmful environmental exposures. The risk of asthma is further increased for the allergic families cohort by having at least one parent with allergic disease” (13)

//**4.Allergy proceeding college students**// Robert Settipane is an MD. Specializing in allergies and asthma. He works in the North East in Rhode Island. He has been practicing medicine for over 25 years. The author decided to write about this topic because he was a recent graduate from medical school and wanted to get his foot in the door probably to start off his career specializing in allergies and asthma. The Topics that are addressed in this article are asthma in college students. As a person become older they have more frequent episodes with asthma. Also during an allergy test if tested positive they were 2.3 times more likely to get hay fever. There are currently more articles out on Alcohol and College student than asthma and college students.The main method to this study is a questionnaire. When administering the Questionnaire and choosing the population there was a non bias in the material administered as well as the people selected. Next people would provide chest x-rays and other relevant medical data to make the study more accurate. Finally there was a skin allergy test done. To determine statistical probability they used a chi square test.

The test had a bias towards men since there were a 70:30 men to women ratio. This is actually quite relevant to a study that will be conducted at RPI. Since our population is almost similar the data can be compared easier. The age of the people who got the skin test were in their 40s. This shows how asthma manifests throughout the years in the human body. New Asthma developed in 20 percent of the people who received skin test. This confirms that the older humans get the more likely they are to develop asthma. A significant quote from this article is “Positive allergy skin tests are significant risk factors for developing new asthma and hay fever”

//**5.NATURAL History of Asthma: A 23 Year Follow UP**// Helen Skolnicick is an M.D. and is a part of Princeton Allergy and Asthma Associates. Her are of expertise is Allergy, Asthma, and Immunology. The study if focused on showing how people at a young age progress into the adult years and the valuable information we can understand from this. The main way to generate data was through having alumnae in their early 40s fill out questionnaires followed by interviews and skin tests. The conclusion of the study was that the people who had inactive asthma were free from any attack for 5 years. There was a 5.2% increase in the number of new onsets over the 23 year period. The conclusion is that “the cumulative presence of asthma continues to increase with age”

//**6. Psychological, Academic, and Work Functioning in College Students**// //**with Childhood-Onset Asthma**// The author of this article is Melisa Carpentier is an assistant Professor in the department of Pediatrics at Indiana University’s School of Medicine. Her research focuses on Adolescent and young adult oncology, including impact of cancer on peer and romantic relationships, quality of life, and health behaviors. The study investigates “differences in psychological, academic, and work functions between college students with and without asthma and identifies predictors of functioning” The student population was made up form student at that were enrolled in a psychology or marketing course at a large Midwestern public university. Then students were give questionnaires to form a data pool. This does create a bias toward cumulative GPA because the study is focusing on one two specific group instead of the general university population. The results of the study where that students who had asthma had” greater anxiety, general psychological distress, and more missed work days” On average students that do have asthma miss 2.8 days of class per semester. Also their cumulative GPA about .1 point lower. This suggests “ students with asthma may make fewer efforts to persist in the face of academic stress. “Asthma is the most common chronic illness of childhood, affecting approximately 6.5 million children 0 to 17 years of age, according to data from the 2005 National Health Interview Survey administered by the Centers for Disease Control and Prevention”

The conclusion is that stints with asthma should be continually monitored and provided with support as they transition from youth to college students. I think that colleges need to have outreach programs so asthma students can cope with their problems. This actually helps to reinforce our abstract for our final project.

//**7.Objective Versus Subjective Ratings of Asthma Severity: Differential Predictors of Illness Uncertainty and Psychological Distress in College Students With Asthma**//

The primary author of this paper is Cortney Wolfe-Christensen. She has a Ph.d and works in Oklahoma State University’s psychology department. Her motivations for writing this article are based on her curiosity to find how to evaluate a bias variable

The paper focuses on the subject versus objective ratings of asthma severity in college students with asthma. The study also want to focus on how to beset assess asthma severity since most of the time severity is subjective. Asthma severity ratings have been described as “ evidence of poor perceptual accuracy. To begin the study 102 college students were pooled of which 37 of them were male and 67 female. So there is some gender bias. These students came from undergraduate psychology and marketing classes. To obtain demographic information a questionnaire was passed out. To find asthma severity students where asked to rate their asthma severity on a scale of 1 to 7. Bi-variate correlations were used to investigate the relation between demographic variables, illness parameters, and variables of interest.Significant correlations were then used to identify specific co-variates.

The results of study show the severity of asthma can be measured using the usage of an inhaler over a given period. There is a small relation that exist between subjective and objective rating of asthma severity. Everyone has different levels of tolerance to pain which suggests that the patient who has asthma knows there problem the best. A significant quote I like is “Asthma is widely recognized as the most common chronic illness of childhood with 8.9 million individuals under the age of 18 being diagnosed with the disease (National Center for Health Statistics, 2002)” from other articles I have annotated I can come up with alinar graphical model to predict further growth.

• Gregg Mitman is Interim Director of the Nelson Institute for Environmental. • He is in Academia – Research and teaching interests span the history of ecology, nature, and health in twentieth-century America across scientific and popular culture. – Particular research areas include the history of ecology, environment and health, 20th century life sciences, science in America, science and film. • Goodale came up with the what could possibly be the first allergy test. He took pollen form and tested it on people. • “ Pollen vaccines promised one form of hay fever prevention. Weed eradication promised another” (65) • “ Pollen was both poison and profit. Drug companies capitalized on increase demand for pollen extracts by furnishing physicians throughout the United States with pollen maps and data organized by place and season”(78) • In the urban environment, ragweed found a place to live in vacant lots and abandon property. • “Ragweed in the city produces ten times more pollen than its counterpart”(88) • Urban reform helped get rid of the ragweed plants. By cleaning up these spaces. • “ During the Great Depression, For example, New York City put fifteen hundred unemployed men to work through the Works Progress Administration to rid the Urban Landscape”(72)
 * 8&9. Mitman -“When Pollen Became Poison”**

Authors: Robyn Teply, Jennifer Campbell, Daniel Hilleman Published Date March 2010, Volume 2010:3
 * 10.Current trends in the treatment of asthma: focus on the simultaneous administration of salmeterol/fluticasone**

Robyn Teply is an Assistant Professor, Creighton University School of Pharmacy. What is interesting to note about Professor Teply is that the also holds and MBA. Though mainly focused on the developlement of pharmasuticals, he may be focused on bring new medication to market that have huge financial benefits. This article focuses on treatment of asthma with great emphasis on the combination inhaler. Most asthma inhalers use one type of medication. The combination inhaler containing salmeterol and fluticasone is one good way to control asthma. The paper run an experiment with people who take just salmeterol and people who just take fluticasone and a group of people who took them both at the same time. All the people who participated in this study were healthy. The results of the study were that there is salmeterol/fluticasone combination (SFC) do help asthmatics more than previously thought. SFC provided asthmatics to use the inhaler less. “More recent research has demonstrated that SFC therapy is clinically equivalent to concurrent salmeterol and fluticasone therapy with separate inhalers.” SFC may be the future of asthmatic medicinal therapy and allow asthmatics to get more independence.

Paula Lozano MD, MPHa, Sean D. Sullivan PhDb, David H. Smith MHA, PhDb and Kevin B. Weiss MD, MPH The authors who wrote this article are both PhDs and MDs. Paula Lozano is a research physician who focuses on a broad range of research. She covers asthma, mental heath, and economic indicators of health services. Here broad range of research makes her well rounded and gives her many perspectives that most researchers would not typically have. Since asthma requires a lot of money to keep under control. This article focuses on the per capita impact on pediatric asthma. “Almost 30% of children with asthma have some limitation in activity compared with 5% of children without asthma”. Students who have asthma are three times more likely to be absent from school. Total expenditures related to asthma in children was half a billion dollars in 1985. Since 1985 the inflation rate has gone up which has resulted which make that number .very significant.
 * 11.The economic burden of asthma in US children: Estimates from the National Medical Expenditure Survey**

The methods that were used to find out the per capita impact on pediatric asthma a survey was administered to a national sample of 35,000 people. The survey looked to see how many ambulatory visits and emergency visits occurred. The results of the survey :“ were more males, younger children, and nonwhites among the children with asthma compared with all children. US children with asthma reported an average of 0.9 ambulatory care visits per year for asthma in 1987. Nonwhite children were hospitalized for asthma 3.5 times as often as white children.”

One average the per capita expenditures were $171 with a Standard deviation of $779. The Standard deviation was very high which suggest that the study was not that accurate in predicting total per capita expenditures. This article is very useful to our presentation and our final paper because it will give us a reference point to compare RPI asthmatic incidences.


 * 12.What Is Worse for Asthma Control and Quality of Life** **Depressive Disorders, Anxiety Disorders, or Both?**

Kim L. Lavoie, PhD, Simon L. Bacon, PhD, Silvana Barone, BSc, Andre Cartier, MD, Blaine Ditto, PhD and Manon Labrecque , MD, MSc, FCCP The authors who wrote this article are both PhDs and MDs. Kim L. Lavoie received her post doctorate in respiratory behavioral medicine and received a doctorate in behavioral psychology. She works in a hospital in Montreal. Her motivations for writing this article is that it touches both upon her doctorate and post doctorate studies combined.

This article is to written to show how having a depressive disorder or anxiety disorder has an effect of asthma control and the quality of life. To begin the study a sample of 404 people were used. These people had asthma. Also a questionnaire was administered to gain an understanding of how someone with asthma could have either a depressive disorder or anxiety disorder disorders. The results of the study were that 31 percent of the people tested had some kind of psychological disorder. Having negative mood states may result in poorer levels of asthma control. The article also suggest that doctors take into account mood states and mental disorders before engaging in treatment of asthma

The Article makes reference to some interesting facts. “The total costs of caring for asthma have been calculated by the World Health Organization to exceed those of AIDS/HIV and tuberculosis combined, with costs reaching nearly $13 billion annually in the United States alone.” This Article helps to shine light on that many people suffer from psychological disorders and that RPI needs to have more counselors to help people.

Lisa Cicutto, ACNP, PhD, Sue Murphy, RN, CAE, Debbie Coutts, RRT, CAE, Janet O’Rourke, Msci, Gail Lang, RRT, Cori Chapman, MHSci and Pamela Coates, MD
 * 13.Breaking the Access Barrier** **Evaluating an Asthma Center’s Efforts to Provide Education to Children With Asthma in Schools**

The author of this article is Lisa Cicutto. She holds a PhD and is also a registered nurse. He area of research is allergies and asthma.

The article focuses on how schools educate students about asthma. To conduct the study 27 schools in Toronto were selected with grade range between 2nd and 5th grade. Some students who had asthma at these schools were selected to participate in an asthma education class. What was taught in the class was “: (1) getting to know each other, goal setting, use of a peak flowmeter, and diary monitoring; (2) trigger identification, control, and avoidance, and basic pathophysiology; (3) medications and the proper use of inhalers; (4) symptom recognition and action plan use; (5) lifestyle, exercise, and managing an asthma episode; and (6) sharing asthma information with teachers and parents. Teaching strategies include puppetry, games, role playing, model building, discussions, and asthma diary recordings.” The results of the experiment were that students that received education were that children had more confidence to manage their asthma as well as feel like they have more independence. Children who attuned this class also had 32% less trips to the doctors or hospital for their asthma.

What was interesting to note about this article is they made reference to asthma and school obstacles when a child needs to manage their asthma. An example is student may not be allowed to access their own inhaler. If schools provide asthma related education courses maybe kids will have better school attendance. Something else to note about this article is that it was conducted in Canada and not in the United States. It would be interesting to see how the United States compares.

Zhihuan J. Huang, PhD; Bonnie J. LaFleur, PhD; James M. Chamberlain, MD; Mark F. Guagliardo, PhD; Jill G. Joseph, MD, PhD //Arch Pediatr Adolesc Med.// 2002;156:67-72.
 * 14.Inpatient Childhood Asthma Treatment Relationship of Hospital Characteristics to Length of Stay and Cost: Analyses of New York State Discharge Data, 1995**

The authors of this article are mainly PhDs. Zhihuan J. Huangz is an associate professor at the school of nursing and health studies at the Georgetown university. Her research is focused on the needs of young immigrant families.

This article is uses discharge data from hospitals in New York State from 1995. The article aims to show the difference in medical expenditures in private and public hospitals. There were 688 patients from 1-17 years of age that were used for this data analysis. The statistical significance used a chi squared distribution. Similar to what the SPSS program uses when comparing our data from the survey. Some of the results from the study were that people who went to a public or teaching hospital were less likely to have commercial insurance. Teaching hospitals were more likely to have minority patients. The cost of going to a private hospital for asthma related incidences was $1868 compared to $1771 in public hospitals and $1528 in teaching hospitals.

There are some excellent teaching hospitals such as Massachusetts General Hospital which is affiliated with Harvard Medical School. This hospital is in the 5 in the country. Regardless if you go to a private or teaching hospital there should not is a huge gap in total expenditures paid. This could be one of the problems with the heath care system in the United States. Doctors over charge for hospital visits which drive the cost of insurance up.

Cynthia S. Minkovitz, MD, MPP; John S. Andrews, MD; Janet R. Serwint, MD //Arch Pediatr Adolesc Med.// 1999;153:727-730.
 * 15.Rehospitalization of Children With Asthma**

The Authors of this article are mainly MD. Cynthia S. Minkovitz focuses much of her attention on improving health care providers’ behavior. This is great explanation of why she wants to do the article. She is probably hoping for someone in the insurance industry to take a look at her finding.

This article shows how children become re hospitalized for asthma related incidences. The study had 119 participants from age 0-14. These children were hospitalized at least one in the given year. The study compares those that were re hospitalized to those who were only hospitalized once. The results were that 35% of the children were re hospitalized for asthma in the same year. The children who were re emitted were likely to have other chronic conditions. This suggests that having asthma with some other underlying condition makes hospitalizations more likely. The kids that were re emitted too had routine asthma medication and a history of admission to an intensive care unit.

A question I raise is that having more medication correlates to more hospitalization? If this is the case parents of children with asthma may want to be more aware of their children and recognize early signs of an asthma attack. Something important to note is that the data was analyzed through SPSS with a chi squared distribution.

Am J Public Health. 1992 January; 82 (1) : 59–65. Willine Car, DrPH, Lisa Zeitel, MPH, and Kevin Weiss, MD
 * 16.Variations in Asthma Hospitalizations and Deaths in New York City**

The authors of this article are MDs. This article focuses on Hospitalizations and deaths in New York City. In 1992 New York City had asthma mortality rate higher than the United States average. The hospitalization rate of African Americans and Hispanics were more than 3 times higher than whites. Also there were more hospitalizations in poorer areas of New York City. The mortality age of the people study ranged from 0-34. Also, the study looked at the number of discharges based on zip code, race, and age. The results of the finding were that 81 percent of the hospitalizations were from Hispanics. To derive at these results the study used a multiple regression analysis. This article confirms that “high rates of both hospitalization and death are strongly associated with poverty and race.”

This article helps in our research because it helps identify a trend that we can compare too. It would be interesting to get multiply years of data and see how the mortality rate changes with the progression of technology.


 * 17. A Synoptic Evaluation of Asthma Hospital Admissions in New York City**
 * PAUL F. JAMASON, LAURENCE S. KALKSTEIN, and PETER J. GERGEN **

The article discusses the relationship to weather and asthma. It shows that air pollution in the spring and summer cause asthmatics to go to the hospital more frequently. Also In winter month the cold ari cause more asthmatic cases. The study use regression analysis. To get Air Pollution Data the study used historical data from the Environmental Protection agency. The highest standard deviation in asthmatic hospitalizations occurred in the fall. Colder over night temperatures are associated with increased hospitalization. NO2 cause hospitalization visits. This is very interesting since most of the studies I have seen have not had any mention of NO2

This article although very detailed and specific, seems to make it sound like everything causes some kind of hospitalization. New York is very dense. The article did not use population density to describe hospitalization. If comparing other cities New York based on population density. This study is good if comparing past results with current results. I think this is a good study but needs to use a null hypothesis when running the analysis.


 * 18. Allergy and asthma in elite summer sport athletes**

Ilkka Helenius, MD, PhD,a,b and Tari Haahtela, MD, PhD,a //Helsinki and Lahti, Finland// from the aDepartment of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, and bPäijät-Häme Central Hospital, Lahti. Received 13 December 1999; revised 29 March 2000. Available online 8 May 2002.

This article is written by a group of Finnish MDs and PHds. This article helps to explain why athletes have a high risk of asthma. “Exercise may increase ventilation up to 200 L/min for short periods of time in speed and power athletes” When swimmers are in a pool they are exposed to bad quality air that is directly above the pool’s water surface. Most of the bad air is a result of off gassing from chlorine. Athletes are exposed to the hash cold during wither months and a lot of pollen during summer months. Cross Country skiers have heavy airway inflammation that is an effect to breathing in cold air. This article shows that the risk for asthma in swimmers is 39-79%. At RPI there are many swimmers that have asthma. To conduct this study, questionares where filled out as well as monitoring a certain athletes as the go through training.

One important finding is that endurance athletes have a great chance of developing asthma. The reason for this is that they are constantly training and breathing in bad quality air. The articles make reference to the summer Olympics of 1996 in which 4-15% of the athletes have asthma. This fact although interesting is in line with the common percentile of people in the United States that do already have asthma. Maybe one way to help athletes is to create some kid of light apparatus that allows an athlete to breath in fresh year.


 * 19-20 Research Exercise- IRB Training.**