Background: From 2006 to 2011, the City of Houston received nearly 200 community complaints about air pollution coming from some metal recycling facilities. The investigation by the Houston Health Department (HHD) found that while operating within legal limits, emissions from facilities that use torch cutting, a technique generating metal aerosols, may increase health risks for neighboring residents. Choosing to use collaborative problem solving over legislative rulemaking, HHD reached out to The University of Texas Health Science Center at Houston (UTHealth) to further evaluate and develop plans to mitigate, if necessary, health risks associated with metal emissions from these facilities. Methods: Utilizing a community-based participatory research approach, we constituted a research team from academia, HHD and an air quality advocacy group and a Community Advisory Board (CAB) to draw diverse stakeholders (i.e., frustrated and concerned residents and wary facility managers acting within their legal rights) into an equitable, trusting and respectful space to work together. Next, we investigated metal air pollution and inhalation health risks of adults living near metal recyclers and ascertained community views about environmental health using key informant interviews, focus groups and surveys. Finally, working collaboratively with the CAB, we developed neighborhood-specific public health action plans to address research findings.

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Age-adjusted D-dimer (AADD) appears to increase the proportion of patients in whom pulmonary embolism (PE) can safely be excluded compared with conventional D-dimer (CDD), according to a limited number of studies. The aim if this study was to assess whether the use of an AADD might safely increase the clinical usefulness of CDD for the diagnosis of PE in our setting. Three hundred and sixty two consecutive outpatients with clinically suspected PE in whom plasma samples were obtained to measure D-dimer were included in this post hoc analysis of a previous study. CDD cutoff value was 500 ng/mL and AADD was calculated as (patient's age × 10) ng/mL in patients aged >50. Sensitivity, specificity, clinical usefulness (i.e., proportion of true-negative tests among all patients with suspected PE), and the proportion of false negatives were calculated for both AADD and CDD among patients with low-to-moderate clinical probability of PE according to Well's criteria. PE was confirmed in 98 patients (27%). Among 331 patients with low-to-moderate clinical probability of PE, sensitivity and clinical usefulness were 100 and 27.8% for CDD, respectively, and 100 and 36.5% for AADD, respectively. In 29 patients aged >50 with CDD >500 ng/mL, AADD showed values under its normal cutoff point, without false negatives for the diagnosis of PE (0%, 95% CI 0-11%). AADD increases clinical usefulness notably with respect to that of CDD in patients with clinical suspected PE without losing sensitivity in our cohort. The use of AADD apparently does not reduce the safety of CDD for the exclusion of PE.

Background: Diagnosis of pulmonary embolism (PE) and its clear-cut differentiation with other entities of occasional similar presentation remains difficult in routine clinical practice. High plasmatic levels of D dimer (DD), a specific fibrin derivate, have recently been reported in PE. Objective: The purpose of this study was to prospectively evaluate the diagnostic value of plasmatic DD in a clinical setting. Methods: We studied 52 patients with PE proven with pulmonary scintigraphic studies in relation to 19 patients posteriorly diagnosed of having community-acquired pneumonia and 30 healthy subjects. Evolution of DD levels whilst the patients were on intravenous anticoagulant therapy was evaluated by measuring DD concentration on admission and on day 7 in 10 patients. Results: Plasma DD levels were significantly higher in PE in relation to controls (p < 0.001). DD levels were also higher in patients diagnosed with community-acquired pneumonia in relation to controls (p < 0.05) but lower than those obtained in high probability PE (p < 0.05). Sensitivity and specificity of plasmatic DD in the emergency diagnosis of PE are of 92 and 71%, respectively. Plasma levels of DD were found to progressively decrease during the first week of heparin therapy, but they remained higher than in control subjects. Conclusions: Plasma DD levels are increased in patients with suspected PE and the degree of elevation is related to the results obtained in scintiscans. Moreover, DD concentrations progressively decrease during the first week of anticoagulant therapy. The increased DD levels found in patients with pneumonia make this test useless in the differential diagnosis between these two clinical entities.