Clinical Assessments

We will perform clinical assessments of 600 people (400 among community members in the area affected by the blowout and 200 among community members in non-affected comparison areas). We will collect general measures of health and measures specific to disaster exposures.

General measures of health include assessments of cardiac, liver, kidney, metabolic, immune, cognitive, and blood system functions. Disaster-specific measures of exposure are selected based on a comprehensive risk assessment database. This database was used to estimate unique risk factors and adverse health effects from exposure to the gas blowout, informing choice of disaster-specific clinical measures.

Licensed and certified members of the clinical research team will conduct the following in-person assessments:

  • vital signs – heart rate, blood pressure, breathing rate, and temperature

  • height/weight and waist/hip ratio

  • cognitive screening
  • spirometry (lung function test – FEV1, FVC, FEV1/FVC)

  • blood and urine collection to test for: blood-related diseases, liver and kidney function, immune status, lipid profile, and metabolomics.

To select participants for the clinical assessments, the health survey team will use research sampling techniques to identify and invite people from a subset of participants who complete the health screening survey. The survey team will also obtain consent from all participants in the clinical assessments.

The clinical team will contact those who volunteer to re-confirm eligibility and provide information on how to prepare for the visit. Clinical assessments will be scheduled at sites within the local community for the convenience of participants.

Data collected during clinical assessments will be combined with other Health Study data that include high-resolution exposure data on air toxics. Studying these data together will allow us to determine if there are relationships between health status and exposures and whether people in the disaster-affected communities show more clinical signs and symptoms of chronic diseases than people in comparison communities.

Additional Information on Clinical Assessments:

Clinical Assessment Assays and Measures

  1. Weight and height
  2. Waist and hip circumference to measure body fat.

Body fat is related to general health, is used to interpret a number of clinical test findings, and affects chemical accumulation and storage of fat-soluble toxins in the body.

Cognitive screening will be done using the Montreal Cognitive Assessment tool, which is used for early detection of mild cognitive impairment.

This test assesses how well an individual’s lungs are functioning by measuring airflow out of the lungs. Spirometry is used to measure effects from inhaled toxics.

    1. Forced Expiratory Volume in 1 second (FEV1): This is the maximum air an individual can force out of their lungs in 1 second.
    2. Forced Vital Capacity (FVC): The greatest total amount of air an individual can forcefully breathe out after breathing in as deeply as possible.
    3. FEV1/FVC: The FEV1/FVC ratio is a number that represents the percentage of an individual’s lung capacity they are able to exhale in 1 second.
    4. FEF 25-75 (Forced Expiratory Flow from 25% to 75% of Forced Vital Capacity) is a spirometry measurement indicating the average airflow from the point when 25% of the air has been exhaled to when 75% has been exhaled.

Metabolomics is the study of metabolites, which are the small molecules produced during the body’s metabolism. We will conduct metabolomics analysis on blood samples of individuals affected by the disaster and of people in comparison communities.

a. Complete blood cell count, differential, and platelets: Some of the disaster exposures are known to be toxic to bone marrow/blood-forming tissue. These assays may be done as part of a regular physical exam, but also to diagnose diseases of the blood such as leukemia.

Complete blood cell count includes:

  • White blood cell (WBC, leukocyte) count
  • White blood cell types (WBC differential)
  • Red blood cell (RBC) count
  • Hematocrit (HCT, packed cell volume, PCV)
  • Hemoglobin (Hgb)
  • Red blood cell indices
  • Platelet (thrombocyte) count
  • Mean platelet volume (MPV)

b. Comprehensive metabolic panel includes a general health composite of 14 blood tests which provide an overview of how liver and kidneys are working, blood sugar (glucose) level, electrolyte and fluid balance, and protein levels.

Specific tests included in the complete metabolic panel:

  • Alkaline phosphate (ALP)
  • Alanine aminotransferase (ALT)
  • Aspartate aminotransferase (AST)
  • Bilirubin
  • Blood urea nitrogen (BUN)
  • Creatinine
  • Sodium
  • Potassium
  • Carbon dioxide (CO2)
  • Chloride
  • Albumin
  • Total protein
  • Glucose
  • Calcium

c. Lipid panel: Lipid panels provide general health indicators of cardiovascular health by analyzing blood cholesterol. They help diagnose conditions that might affect your heart and blood vessels.

  1. Lipid panel contains:
    • Low density lipoprotein (LDL) cholesterol
    • Very low-density lipoprotein (VDL) cholesterol
    • High-density lipoprotein (HDL) cholesterol
    • Total cholesterol
    • Triglycerides
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d. Interleukin 6 (IL-6), NFκB, TNFα: These are immune and inflammatory markers.

e. C-Reactive Protein: C-reactive protein (CRP) is a protein made in the liver, and the level of CRP increases when there is inflammation in the body.

f. Total Protein Electrophoresis: Total protein electrophoresis (TPE) is a test primarily used to screen for and monitor monoclonal gammopathies. The test assesses elevated or reduced serum total protein and immunoglobulin.