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.

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SELECTED ICONIC CHAMBER MUSIC WORKS WITH PIANO FROM THE NINETEENTH AND TWENTIETH CENTURIES

Chamber music repertoire featuring the piano blossomed from the mid-nineteenth through the early twentieth century. The quantity of works increased greatly during this time and the quality of these works reached the highest level. Among the many symbolic works that were composed were sonatas for a single string instrument with piano, piano trios, quartets: and quintets as well as two-piano works and four-hand duets. Being able to study and perform many of these iconic works before I graduated was one of the major goals I set for myself as a collaborative pianist. The abundance of repertoire has made it easy to choose works considered "iconic" for my dissertation's three recitals. Iconic is defined as "very famous or popular, especially being considered to represent particular opinions or a particular time" in the online Cambridge Advanced Leamer's Dictionary & Thesaurus © Cambridge University. The compositions featured in the recitals were composed from 1842 through 1941, including works by Schumann, Brahms, Faure, Rachmaninoff, Ravel, and Lutoslawski. Choosing the repertoire with my fellow performers in mind was an important part of this dissertation. In addition to trying to make balanced programs which include variety, working with different instruments and performers is one of the most fulfilling parts of the musical experience for me as a collaborative pianist. Joining me for the concerts were members of the Aeolus String Quartet (violinist Nicholas Tavani, violinist Rachel Shapiro, violist Greg Luce, and cellist Alan Richardson), pianist Hsiao-Ying Lin (a doctoral student from the Peabody Conservatory), and my colleagues from the Peabody Institute Preparatory Division (faculty violinist Dr. Christian Tremblay and cellist Alicia Ward), and Derek Smith, Associate Principal violist of the Annapolis Symphony Orchestras). The three recitals were performed in the Gildenhom and Ulrich Recital Halls at the University of Maryland, College Park, Maryland. They are recorded on CD and available on compact discs, which can be found in the Digital Repository at the University of Maryland (DRUM).