Environmental Exposure Disorder

DH has a prevalence rate ranging from 1.3% to 92.1%, commonly affecting old ages, and the frequency of DH in patients suffering from periodontal disease is 3-57%. Pakistan has reported prevalence from different cities, with 36.4% from Karachi and 22% from Lahore. The use of laser has opened new dimensions in the treatment of DH. Theories that support laser therapy explain that irradiation blocks the pain in dentinal tubules by melting and recrystallization of dentin or by tertiary dentine production or evaporation of dentinal fluid. Considering the oral soft tissues which contain high amounts of water, Lasotronix SMARTm laser diodes have been carefully designed to show their high transmission. The 635nm wavelength is optimal for activating tolonium chloride dye for photo-activated chemo therapy, eliminating all bacteria and biofilms without any side effects. 200 mW power provides safe cold bio stimulation and photo disinfection within a reasonably short therapy time. Application of Sodium fluoride (NaF) has also been indicated for hypersensitivity pains. Its application in the form of gel occludes the tubule by calcium fluoride precipitation. Agents like potassium nitrate also have promising effects, which increase the concentration of potassium ions in nerve endings and alter the nerve action potential in conducting the sensory stimuli. Recently DH treatment has been conducted with different types of laser with different wavelengths, either alone or in combination with desensitizing agents and varnishes and has revealed effective results. To the author's knowledge, not much research work has been conducted using LASOTRONIX as a treatment modality with CPP-ACP. Therefore, this research aims to determine the effectiveness of Casein phospho peptide paste (CPP-ACP) used alone or combined with a diode laser (LASOTRONIX).

Study Description: This study is designed to collect data and clinical samples from participants with elevated eosinophil counts in the peripheral blood or tissues or their relatives to enhance our understanding of the mechanisms driving eosinophilia and eosinophil activation in patients with a wide range of eosinophilic disorders with the ultimate goal of improving diagnostics and identifying novel treatment modalities for these patients. Eosinophilic participants will undergo an extensive clinical evaluation at baseline and at least yearly thereafter focused on the identification of the cause of eosinophilia and the presence of end organ manifestations. Blood, bone marrow, tissue, and/or body fluids will be collected for research purposes at initial and follow-up visits to address broader questions relating to the varied etiologies of eosinophilia, biomarkers of disease activity and eosinophil activation, and the functional role of eosinophils in homeostasis and disease pathogenesis. While this protocol is not primarily designed to study treatment of eosinophilic patients, the clinical and immunological responses to therapy will be monitored. This protocol will also allow clinical and laboratory evaluation of family members of subjects with eosinophilia to help identify genetic causes of eosinophilia and to provide controls for immunologic studies. Objectives: Primary Objective: to understand the mechanisms driving eosinophilia and eosinophil activation in patients with a wide range of eosinophilic disorders Secondary Objectives: 1. To develop a diagnostic algorithm that accurately classifies eosinophilic patients by underlying etiology 2. To determine the mechanisms underlying eosinophil activation and recruitment to the blood and tissues 3. To understand the mechanisms of action of therapeutic agents used or in development for the treatment of HES 4. To assess the signs and symptoms experienced by patients with HES Exploratory Objectives: 1. To investigate the multifunctional role of eosinophils in settings other than HES 2. To understand the long-term effects of eosinophilia in patients with HES 3. To assess the effects of race, sex, ethnicity, and environmental factors on the prevalence and clinical manifestations of eosinophilic disorders Endpoints: Primary Endpoint: Identification and characterization of clinical and genetic variants of hypereosinophilic syndromes (HES) Secondary Endpoints: 1\. Identification of laboratory and clinical tests that distinguish between clinical and genetic variants of HES 2a. Identification of biomarkers of disease activity and specific organ involvement in eosinophilic disorders 2b. Identification of new therapeutic targets for the treatment of HES 3\. Delineation of the effects of therapeutic agents on eosinophil development, activation, recruitment to tissues and/or apoptosis 4\. Creation of a patient-related outcomes questionnaire for use in future treatment studies of HES Exploratory Endpoints: 1. Description of the consequences of eosinophilia and/or eosinophil depletion in the context of varied immunologic and inflammatory settings 2. Collection of standardized longitudinal data on disease activity and outcome in patients with hypereosinophilia. 3. Comparison of prevalence and clinical manifestations of eosinophilic disorders among varied subpopulations of patients

Martinsville, IN, is a community of 11,000 people that overlays four groundwater contamination sites, including a U.S. Environmental Protection Agency (EPA)-designated Superfund site. The total area of groundwater contamination is over 60 acres and lies within a single aquifer. The contaminates are chlorinated volatile organic compounds (VOCs), primarily tetrachloroethylene (PCE) and trichloroethylene (TCE). These contaminants are thought to originate from several dry cleaning and metal degreasing operations. An activated carbon filtration system has been in operation since 2005 to remove PCE and chlorinated VOCs from the municipal water, which now meets EPA drinking water standards. However, a recent report from the Agency for Toxic Substances and Disease Registry concludes that people's health may be harmed by breathing indoor air contaminated via vapor intrusion, the migration of volatile compounds from contaminated groundwater and soil into buildings above. The long-term goal of this research is to understand how PCE exposure in communities affects health and to empower community members' participation in environmental health decision-making. In this project researchers will work with the community of Martinsville, IN to: 1. Determine the extent and exposure levels to the contaminants by measuring the contamination in residents and at their homes. 2. Assess the community's concern and perceptions about the contamination and associated health risks. 3. Study the impact of the contaminants on visual and neurocognitive functions. 4. Compare cancer rates in Martinsville to county and state rates. The above information will help researchers and community partners co-design a targeted educational campaign to reduce community members' exposure to the contaminants.

This is a pilot randomized, control, clinical trial. We will recruit 24 adults in Buffalo and randomize them to the physical intervention groups. The intervention group will be provided with physical activity courses. We will follow up all participants until the end of the study. We will collect their baseline information via questionnaire, and at the end of the follow-up we will collect the exit questionnaire and biospecimen. The study aims to demonstrate our ability to recruit eligible participants and provide data of the compliance of participants to the intervention.

The purpose of the study is to investigate the impact of co-morbidities, history, and allergen tests on the outcome of allergen provocation tests. Subjects are children aged 0-18 years old investigated for allergy to foods or antibiotics. Data entered in the database are demographics, co-morbidities, symptoms, SPT, specific IgE and details of the allergen provocations.

The METSGREEN study is a hybrid biomedical research project combining an observational environmental-epidemiological study with an experimental clinical trial of healthy behavior. It is implemented under the international MARKOPOLO project framework, funded by the European Commission through the Horizon Europe program. The study is led in Lithuania by Vytautas Magnus University (VMU), with contributions from 15 academic institutions across Europe and North America. METSGREEN aims to explore the impact of ultrafine particulate matter (PM0.1) and noise exposure on cardiometabolic health in middle-aged urban populations and assess whether targeted lifestyle interventions can mitigate these effects. Scientific Background and Rationale: Environmental pollution is increasingly recognized as a major contributor to chronic non-communicable diseases. Ultrafine particles (diameter \<0.1 µm) are especially harmful due to their ability to penetrate deep into the respiratory tract, cross alveolar membranes, and enter systemic circulation. These particles trigger oxidative stress, systemic inflammation, endothelial dysfunction, and coagulation disorder processes implicated in the pathogenesis of metabolic syndrome and cardiovascular diseases (CVD). Epidemiological studies suggest a strong link between long-term exposure to PM0.1 and increased incidence of hypertension, diabetes, central obesity, and other metabolic risk factors. Moreover, urban noise exposure has been shown to exacerbate cardiovascular risks through stress-mediated neuroendocrine pathways. However, many of these associations remain insufficiently understood, particularly in populations with specific vulnerabilities, such as older age or lower socioeconomic status. Nature-based interventions such as physical activity in green spaces are a promising strategy to counteract these effects. Regular exposure to nature has been shown to improve autonomic nervous system balance, reduce cortisol levels, and promote cardiovascular resilience. Dietary interventions, particularly the Mediterranean diet, rich in unsaturated fats, antioxidants, and anti-inflammatory nutrients, are also recognized for their cardioprotective effects. Despite this, very few studies integrate objective environmental exposure assessments with clinical lifestyle interventions and biomarker-based outcomes. Study Objectives: The study is divided into two core components with distinct but complementary objectives: 1. Observational Study (n = 1,000): Model and map environmental exposure to PM0.1 and noise across Kaunas city using land-use regression (LUR) based on data collected at 20 strategic locations. Link environmental exposure estimates to self-reported health status, lifestyle factors, and socioeconomic characteristics using a standardized, anonymized online questionnaire. Assess associations between PM0.1/noise exposure and key cardiometabolic indicators: prevalence of cardiovascular disease, blood pressure, waist circumference, and anthropometric data. Investigate potential effect modifiers such as sex, age, residential environment, and economic status. 2. Experimental Clinical Trial (n = 180): Assess the short-term impact of a healthy lifestyle intervention on metabolic health indicators and biological markers in individuals with early signs of metabolic syndrome (central obesity and/or elevated blood pressure). Compare three groups (1:1:1 allocation): control (no intervention), physical activity in green space (daily 30-minute brisk walk), and Mediterranean diet intervention (dietary counselling and meal planning). Evaluate changes in biological markers (HDL, triglycerides, fasting glucose, body composition, blood pressure, etc.) and omics-level indicators (metabolomics, proteomics, DNA methylation). Determine the interaction between environmental exposure levels and response to lifestyle changes. Study Population: Participants in the observational component are Kaunas city residents aged 45-64, randomly selected from residential registries, excluding individuals in institutional care. The clinical trial cohort will be drawn from this group and include only those with signs of metabolic disturbance, stable health status, and willingness to participate in daily monitoring and clinical visits. Exclusion criteria include pregnancy, severe cardiovascular or neurological disease, alcohol dependence, limited mobility, and use of pacemakers. Intervention Protocol: Participants in the intervention arms will be instructed to follow specific behavioral guidelines over a 7-day period. Green Space Group: Perform daily 30-minute brisk walks in designated urban green areas. Compliance will be tracked via Fitbit Alta wristband sensors. Mediterranean Diet Group: Receive dietary counselling and guidance on meal preparation using approved Mediterranean food groups. Nutritional intake will be self-reported and supervised via regular communication with a dietitian. Control Group: Continue routine daily habits with no behavioral change. All participants will undergo two clinical assessments-on Day 1 and Day 8-at the Family Medicine Clinic of Kaunas Clinics. Clinical procedures include anthropometric measurements (waist circumference, body weight, height), blood pressure assessment, body composition analysis (using bioelectrical impedance), and venous blood sampling (up to 20 ml per visit). Biomarker Analysis: Collected blood samples will be analyzed for: Metabolic Indicators: Fasting plasma glucose, triglycerides, HDL cholesterol. Inflammatory Markers: Selected cytokines and proteins via immunoblotting. Advanced Omics Profiling: Targeted metabolomic, proteomic, and epigenetic analysis. Samples will be processed and analyzed at partner institutions: DNA methylation: National Center of Pathology (Lithuania), Laboratoire National de Santé (Luxembourg). Proteomics: University of Southern Denmark. Metabolomics: University of Eastern Finland. Data Collection and Management: The study employs multiple layers of data protection, including participant coding, restricted data access, and secure storage. Online questionnaires are encrypted and anonymized. Wristband-collected data will be uploaded to a secure digital platform and linked with individual exposure estimates. All clinical, lifestyle, and environmental data will be integrated for comprehensive statistical analysis. Multivariate logistic regression models will be applied, adjusting for potential confounders (age, gender, SES). Exposure-response relationships will be quantified using both linear and non-linear regression methods. The 99.9% confidence level and power of 80% will be maintained to minimize Type I and II errors. Expected Outcomes: The study is expected to yield: Detailed mapping of urban PM0.1 and noise exposure across Kaunas. Quantified links between environmental exposure and cardiometabolic health. Evidence on the effectiveness of nature-based and dietary interventions in reducing metabolic disorder risk. Biomarker-based insight into pathophysiological pathways influenced by environmental stressors and lifestyle. Recommendations for local and European Union (EU) level public health strategies. Ethical Considerations: The study has received ethical approval from the Kaunas Regional Biomedical Research Ethics Committee. Participation is voluntary, with informed consent required for the clinical trial. Participants may withdraw at any time. Minimal risks are anticipated, limited to standard blood sampling. Data Protection: All data are handled according to the General Data Protection Regulation (GDPR). Personally identifiable data are stored separately and securely, accessible only to the principal investigator and designated team members. Participants have the right to access, correct, or withdraw their data. Study Timeline and Dissemination: The total study duration is 48 months. Results will be published in peer-reviewed journals, presented at international conferences, and submitted to the European Environment Agency to provide evidence-based health guidelines. Lay summaries will be provided for participants and the general public. The METSGREEN study represents an integrative approach to understanding and mitigating environmental health risks. By linking advanced exposure modelling with clinical and molecular endpoints, it aims to provide robust scientific evidence for targeted, sustainable, and preventive health strategies in urban settings.

The purpose of this study is to build on our equitable, eight-year Tribal-academic partnership with the Ramapough Nation of northern NJ to advance tradition-centered farming practices and management strategies supporting sustainable food systems to relieve local food insecurity and nutritional deficiency, prevent disease and promote health. Furthermore, assessing the extent of environmental contamination, individual toxicant burdens and micronutrient levels and health disorders in Ramapough Tribal members of both sexes as outlined in the following: * Collect in-person/online survey information on demographics, health and food intake, nutrition, food security, and psychosocial stressors, and perform core anthropometric measurements (i.e., height, weight, body mass index, body circumference and blood pressure) at enrollment on Tribal members to inform health promotion strategies and community actions. * Determine individual-level contaminant burdens and micronutrient concentrations (e.g., iron, calcium, folate, vitamins) in urine and blood from surveyed (sub-aim 1a) Ramapough Turtle Clan volunteers. * Test soil, plants and surface water where Turtle Clan residents live, recreate and attend church in Ringwood, NJ using a community-based, citizen scientist approach.

Primary Hypothesis The study will test the following primary hypothesis: "Patients who receive tailored digital health promotion messages from their primary care providers will perform more heat adaptive proactive behaviours to protect themselves from heat-related illness compared to those who do not receive such messages." Secondary Hypotheses 1. Patients receiving Heat Smart messages will demonstrate greater engagement in specific heat preparedness activities, such as creating heat safety plans and forming networks among friends, neighbours, and relatives (patient survey data). 2. Patients in the intervention group will experience lower rates of heat-related healthcare utilization, as measured by primary care provider visits, emergency department visits and filling prescription drugs during heat events (ICES data). 3. The intervention will be effective across different socio-demographic subpopulations, including older adults, individuals with chronic illnesses, and socially isolated individuals. 4. The integration of primary care into HARS will enhance public health system coordination and improve response strategies for extreme heat events. This study employs a cluster randomized controlled trial (RCT) to evaluate the impact of a heat adaptation digital messages intervention. Only primary care practices with at least 2 participating practitioners will be included in the study, where each PCP will act as a patient cluster. For each practice, the Primary Care Providers will be randomly assigned, and all their adult patient panel will either receive heat smart adaptation digital messages (the exposed group) or non-heat wave health promotion digital messages (the control group). The study follows an intention-to-treat (ITT) design, meaning that all participants who consent to participate will be analyzed based on their original group assignment, regardless of adherence to the heat smart digital messages intervention (e.g., did the participant read the message). The study will have a two-year follow-up period to assess behavioural changes related to heat adaptation. Research Objectives The Heat Smart project aims to enhance primary care involvement in public health led heat adaptation strategies and improve the preparedness of at-risk populations for extreme heat events. 1. Assess Individual-Level Risks for Excessive Heat-Related Illnesses * Identify patients at increased risk of heat-related illness using primary care provider's electronic medical records and patient surveys. * Characterize socio-cultural, demographic, and clinical factors that contribute to heat vulnerability, including: * Age (older adults, children) * Chronic illnesses (e.g., cardiovascular disease, diabetes, asthma, mental health conditions) * Social isolation and poverty * Use of medications that impair thermoregulation * Segment patients into subpopulations based on shared characteristics to tailor interventions. * Assess patients' information needs and barriers to heat preparedness. 2. Implement and Evaluate a Digital Messaging Intervention * Deliver tailored, evidence-based digital messages (via email or text) to all adult patients of participating primary care providers to: * Educate them on heat-related health risks. * Encourage the development of personalized heat safety plans for patients at increased risk. * Provide information about local cooling stations, transportation options, and emergency resources. * Issue early warning alerts to at-risk patients when excessive heat events are imminent. * Evaluate the impact of the intervention through: * Patient surveys assessing self-reported behaviour change in heat preparedness. * Linking patient survey responses to health administrative data to measure healthcare utilization (e.g., emergency department visits, prescription medication use). * Determine the effectiveness of integrating primary care providers into public health-led Heat Alert and Response Systems (HARS). 3. Scale and Expand the Intervention * Refine and adapt the intervention based on rapid-cycle evaluations. * Expand to two additional provinces to test scaling feasibility. * Develop a national model for integrating primary care into climate adaptation strategies, ensuring scalability and sustainability. 4. Improve Health Equity and Climate Resilience * Target vulnerable and equity-deserving populations, ensuring that interventions are tailored to their needs. * Encourage social connectedness by fostering Check-in Companion heat response groups among friends, neighbours, and relatives. * Enhance collaboration between primary care and public health to create a cohesive, system-wide approach to adaptation to extreme heat events. * Provide policy-relevant insights to inform national heat adaptation strategies and reduce health inequities. These objectives align with Canada's HeatADAPT Program and National Adaptation Strategy, ensuring a whole-of-society approach to protecting health during extreme heat events. Randomization * Patients will be assigned to intervention or control arms using cluster randomization. Block of sizes of 2 will be used to randomly assign the primary care provider to either the treatment or control arms, to ensure balance between groups and between practices. * After randomization, balance across the two arms will be assessed using variables associated with vulnerability (e.g., age, sex, housing marginalization (ONT-Marg, based on 6-digit postal code) is included as a covariate to account for socio-economic disparities in vulnerability to heat-related events, neighbourhood rurality, self-reported baseline Heat Action Plan, chronic illness (e.g., cardiovascular disease, diabetes, asthma, mental health conditions) and heat susceptible diseases (e.g., requiring medications that impair thermoregulation)).

This study is an investigative study, taking the elderly in Beijing community as an example, and taking photos of different areas in the home environment of the elderly who agree to participate in the study (a total of seven aspects, including pathways/entrance to home, hallways, stairs/steps, living room, kitchen, restroom, bedroom). Subsequently, the multi-modal large model GPT-4o and a professional occupational therapist will use the "Home Environment Assessment" scale to evaluate the home environment shown in the photos and give corresponding suggestions for modification. A professional occupational therapist (non-evaluator) will analyze and compare the evaluation results and guidance recommendations of GPT-4o and the evaluator, and compare whether there are any significant differences between the two analysis results.

AROMA 1: A total of 648 patients will be recruited for development of an augmented breath test to detect oesophageal and gastric cancer at early stages of disease. Three groups, each containing 216 patients, will be recruited: (i) oesophageal cancer (ii) gastric cancer and (iii) control/normal patients with upper gastrointestinal symptoms. After a baseline breath sample is collected, subjects will then be asked to consume a standard nutrient drink. Further breath samples will be collected at 0 and 15 minutes after consumption of the drink. Breath samples will be stored on thermal desportion tubes before being transfered to a central laboratory for analysis. Breath samples will be analysed in accordance with existing quality-controlled processes. A combined approach of chromatographic- and real time- mass spectrometric techniques will be applied for VOC profiling. BIORESOURCE: Samples from 335 patients will be collected in order to establish a biobank for multi-omic analyses. Three groups, each containing 75 patients, will be recruited: (i) oesophageal adenocarcinoma; (ii) gastric adenocarcinoma and (iii) oesophageal controls - benign conditions/normal gastrointestinal tract with upper gastrointestinal symptoms (iv) gastric controls - benign conditions/normal gastrointestinal tract with upper gastrointestinal symptoms. The following biosamples will be collected: breath, urine, saliva, blood, tissue and gastric contents. Collected samples will be utilised in a wide range of studies to investigate the mechanisms of VOC production in cancer. The following analyses will be performed: volatalomics, metabonomics/lipidomics, microbiome analysis, transcriptomics and cell culture experiments.