An open-label,prospective, randomized,controlled, multicenter,phase 1b study of StrataGraft skin tissue versus autografting in patients with deep partial-thickness thermal burns

ObjectiveThis open-label, controlled, randomized study assessed the safety, tolerability, and efficacy of StrataGraft tissue compared to autograft in the treatment of deep partial-thickness (DPT) burns.MethodsThirty subjects with DPT thermal burns (3%–43% total body surface area) were treated with StrataGraft tissue as follows: cohort 1, ≤220 cm² refrigerated tissue; cohort 2, ≤440 cm² refrigerated tissue; and cohort 3, ≤440 cm² cryopreserved tissue. On each subject, two comparable areas of DPT burn were randomized to receive StrataGraft tissue or autograft. Coprimary end points were the percent area of the StrataGraft tissue treatment site undergoing salvage autografting by Day 28 and wound closure of treatment sites by 3 months.ResultsBy Day 28, no StrataGraft tissue treatment sites underwent autografting. By 3 months, 93% and 100% of the StrataGraft tissue and autograft treatment sites achieved complete wound closure, respectively. No significant differences in observer total and overall opinion POSAS scores between StrataGraft tissue and autograft treatment sites were observed at any timepoint. The most common adverse event was pruritus (17%).ConclusionsStrataGraft tissue treatment of DPT thermal burns reduced the need for autograft, resulted in wound closure and treatment-site cosmesis comparable to that of autograft, and was well tolerated.     

Self-management of osteoarthritis: A culturally-specific Chronic Care Model for South Asians

Osteoarthritis (OA) is the most common and frequently disabling of the joint disorders. By age 75 years, 85% of the population has either radiographic or clinical evidence of OA. For many people, OA is chronic, progressively painful and impedes mobility and diminishes quality of life. Developing effective programs for managing OA is a health care imperative.The Chronic Care Model is an approach to improving chronic illness care and is based on four pillars: self management, decision supports, delivery system design and information systems. The CCM has been widely tested and found to improve patient care and outcomes (Coleman et al., 2009).Immigration from South Asian (SA) countries has increased ethnic diversity in cities world wide. Family systems, beliefs and values held by immigrants influence their interactions, perceptions and experiences in managing osteoarthritis. The purpose of this paper is to introduce the reader to the South Asian culture and the Chronic Care Model applied to osteoarthritis management. The Chronic Care Model may be a useful tool to guide the planning of culturally appropriate health care services for this population.     

Age-based normative data for a computerized dynamic posturography system that uses a virtual visual surround environment

Background: Computerized dynamic posturography (CDP) is the gold standard to differentiate between sensory, motor, and central adaptive impairments to postural control.

Objective: To obtain normative values in healthy adults age 20–69 for a CDP system that uses a full-field dynamic visual surround. This is in contrast to the mechanically movable visual surround used in traditional CDP systems.

Methods: Fifty healthy adults divided into five age groups were tested during the three test protocols for CDP: sensory organization test (SOT), motor control test (MCT), and adaptation test (ADT). Outcomes were compared across age groups and to published normative CDP values. Repeatability was assessed in five different subjects (23–30 years old) on 2 days, 1 week apart.

Results: Most outcomes were comparable to published norms with notable differences in SOT condition 4 and ADT. SOT composite and conditions 4–6, all MCT translations, and ADT toes up showed moderate to good repeatability (r?=?0.60 to 0.99). Age group and gender differences were not substantial.

Conclusions: Some but not all CDP outcomes with a virtual visual environment were comparable to published norms. The differences are likely related to the virtual surround having a more compelling effect on balance even in conditions with a stationary surround.     

Associations of Mortality with Long-Term Exposures to Fine and Ultrafine Particles,Species and Sources: Results from the California Teachers Study Cohort

Background

Although several cohort studies report associations between chronic exposure to fine particles (PM_2.5) and mortality, few have studied the effects of chronic exposure to ultrafine (UF) particles. In addition, few studies have estimated the effects of the constituents of either PM_2.5 or UF particles.

Methods

We used a statewide cohort of > 100,000 women from the California Teachers Study who were followed from 2001 through 2007. Exposure data at the residential level were provided by a chemical transport model that computed pollutant concentrations from > 900 sources in California. Besides particle mass, monthly concentrations of 11 species and 8 sources or primary particles were generated at 4-km grids. We used a Cox proportional hazards model to estimate the association between the pollutants and all-cause, cardiovascular, ischemic heart disease (IHD), and respiratory mortality.

Results

We observed statistically significant (p < 0.05) associations of IHD with PM_2.5 mass, nitrate, elemental carbon (EC), copper (Cu), and secondary organics and the sources gas- and diesel-fueled vehicles, meat cooking, and high-sulfur fuel combustion. The hazard ratio estimate of 1.19 (95% CI: 1.08, 1.31) for IHD in association with a 10-μg/m³ increase in PM_2.5 is consistent with findings from the American Cancer Society cohort. We also observed significant positive associations between IHD and several UF components including EC, Cu, metals, and mobile sources.

Conclusions

Using an emissions-based model with a 4-km spatial scale, we observed significant positive associations between IHD mortality and both fine and ultrafine particle species and sources. Our results suggest that the exposure model effectively measured local exposures and facilitated the examination of the relative toxicity of particle species.

Citation

Ostro B, Hu J, Goldberg D, Reynolds P, Hertz A, Bernstein L, Kleeman MJ. 2015. Associations of mortality with long-term exposures to fine and ultrafine particles, species and sources: results from the California Teachers Study cohort. Environ Health Perspect 123:549–556; http://dx.doi.org/10.1289/ehp.1408565