Environmental assessment and exposure reduction are a set of diagnostic and treatment techniques that work in tandem with the traditional medical approach by reducing a patient’s exposure to adverse environmental conditions as part of medical care. Assessment involves identifying the specific exposures to which a patient is sensitive and locating the corresponding contaminants in the patient’s environment. This provides a more complete diagnostic evaluation of a patient’s problem than could be obtained merely by examining the patient alone.

Exposure reduction involves reducing the identified triggers to levels that are below thresholds that are associated with increased risk of sensitization and disease morbidity. Assessment of an environment for contaminants focuses on a chain of factors that include contaminant sources such as cockroaches, rodents, dust mites and fungi that excrete contaminants into an environment, facilitative factors such as moisture, food, water and shelter that help sources to thrive, and reservoirs where contaminants can accumulate prior to subsequent transport to occupants.

By using this model to guide environmental assessments and their corresponding interventions, the root cause of health problems can be addressed, leading to improved quality of life for patients and reduced need for chronic medications.

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In the US and other developed countries, food allergy is a growing epidemic in pediatric populations with a substantial impact on health-related quality of life. As such, there are great efforts underway to unravel the mechanisms of oral mucosal tolerance and to better define the factors related to host and allergen exposure that contribute to the aberrant immune response leading to sensitization and clinical food allergy.

Although more research is needed to eventually develop targeted treatment and prevention strategies, this review highlights our current understanding of the pathogenesis of IgE-mediated food allergy.

CONCLUSIONS: The new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, has a significantly poorer survival than group C, in spite of a higher level of forced expiratory volume in the first second of expiration (FEV1). This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment. PMID: 22997207 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

OBJECTIVE. The purpose of this study is to establish the difference in lung nodule volume between standard-dose contrast-enhanced and low-dose unenhanced CT.

SUBJECTS AND METHODS. Twenty patients with known pulmonary metastases underwent three CT examinations on 1 day: two unenhanced low-dose (120 kVp and 30 mAs) and a standard-dose (120–140 kVp and 75–200 mAs) contrast-enhanced chest CT examinations. For nodules < 1000 mm³, nodule volume was quantified using dedicated software from the CT manufacturer. Wilcoxon’s signed rank tests were used for analysis of nodules ≤ 200 mm³ and > 200 mm³ (approximately diameter of 8 mm).

RESULTS. One hundred one nodules (n = 69 ≤ 200 mm³) were analyzed in 15 of these subjects. Measured volume of nodules ≤ 200 mm³ was systematically lower on both low-dose unenhanced CT examinations when compared with standard-dose contrast-enhanced CT (differences, 13.7% and 15.5%, respectively; p < 0.0001), but nodule volume was not different between low-dose CT (median difference, 1.0%; p = 0.10). Nodule volume was not systematically different between the protocols for nodules > 200 mm³ (p > 0.30).

CONCLUSION. For lung nodules ≤ 200 mm³ (approximately 8 mm) the measured volume on low-dose unenhanced CT is significantly lower when compared with standard-dose contrast-enhanced CT. This effect is likely due to contrast administration rather than other imaging parameters, which should be taken into account in the follow-up of lung nodules because growth can remain undetected or doubling time underestimated.