LUNG CANCER IN NEPAL: THE ROLE OF TRADITIONAL TOBACCO PRODUCTS AND COMBUSTION RELATED HOUSEHOLD AIR POLLUTION

The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

The Real-Quaternionic Indicator of Irreducible Self-Conjugate Representations of Real Reductive Algebraic Groups and A Comment on the Local Langlands Correspondence of GL(2, F )

The real-quaternionic indicator, also called the $\delta$ indicator, indicates if a self-conjugate representation is of real or quaternionic type. It is closely related to the Frobenius-Schur indicator, which we call the $\varepsilon$ indicator. The Frobenius-Schur indicator $\varepsilon(\pi)$ is known to be given by a particular value of the central character. We would like a similar result for the $\delta$ indicator. When $G$ is compact, $\delta(\pi)$ and $\varepsilon(\pi)$ coincide. In general, they are not necessarily the same. In this thesis, we will give a relation between the two indicators when $G$ is a real reductive algebraic group. This relation also leads to a formula for $\delta(\pi)$ in terms of the central character. For the second part, we consider the construction of the local Langlands correspondence of $GL(2,F)$ when $F$ is a non-Archimedean local field with odd residual characteristics. By re-examining the construction, we provide new proofs to some important properties of the correspondence. Namely, the construction is independent of the choice of additive character in the theta correspondence.

DIFFERENCES IN PSYCHOPATHOLOGY AMONG SUBSTANCE USERS IN RESIDENTIAL TREATMENT RELATED TO HIV STATUS

HIV-positive individuals engage in substance use at higher rates than the general population and are more likely to also suffer from concurrent psychiatric disorders and substance use disorders. Despite this, little is known about the unique clinical concerns of HIV-positive individuals entering substance use treatment. This study examined the clinical characteristics of clients (N=1712) entering residential substance use treatment as a function of self-reported HIV status (8.65% HIV-positive). Results showed higher levels of concurrent substance use and psychiatric disorders for HIV-positive individuals, who were also significantly more likely to meet criteria for bipolar disorder and borderline personality disorder. Past diagnoses of depression, posttraumatic stress disorder, and social phobia were also significantly more common. Study findings indicate a need to provide more intensive care for HIV-positive individuals, including resources targeted at concurrent psychiatric problems, to ensure positive treatment outcomes following residential substance use treatment discharge.