Is extreme climate or moderate climate more conducive to longevity in China?

NASA Astrophysics Data System (ADS)

Huang, Yi; Rosenberg, Mark; Wang, Yingli

2018-06-01

Climate is closely related to human longevity. In China, there are many climate types. According to national population censuses from 1982 to 2000, most provinces with a high ratio of centenarians are located in western and northwestern China far from the sea; these areas are characterized by a dry, cold climate, very high altitude, very high daily temperature range, strong winds, and partial hypoxia. Meanwhile, provinces with a high ratio of nonagenarians from 1982 to 2000 are located in southern China near the sea. Previous studies have attributed the high ratio of centenarians in western and northwestern China to the extreme local climate. However, centenarians in these areas decreased greatly in 2010, whereas residents in southern China frequently reached 90 to 100 years old in 2010. This study aims to explain this strange phenomenon and find whether extreme climate in Tibetan plateau and northwestern China or moderate climate in southern China is more conducive to longevity. The study found that mortality rate in Tibetan plateau is much higher than southern China, then a population evolution experiment was proposed to compare longevity indicators between low mortality rate and high mortality rate and shows that longevity indicators will decrease in the near future and increase above their original levels after several decades when the mortality rate is decreased. Results of this study show individuals in northwestern China do not live as long as those in eastern and southern China. A moderate climate is more conducive to longevity than extreme climate in China. The longevity of a region should be judged by long-term longevity indicators.

Women live longer than men even during severe famines and epidemics

PubMed Central

Zarulli, Virginia; Barthold Jones, Julia A.; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W.

2018-01-01

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. PMID:29311321

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.

PubMed

Allyn, Jérôme; Vandroux, David; Jabot, Julien; Brulliard, Caroline; Galliot, Richard; Tabatchnik, Xavier; Combe, Patrice; Martinet, Olivier; Allou, Nicolas

2016-02-01

The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors. We retrospectively analyzed all patients who presented with extreme acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used. Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P < .001), type of lactic acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012). Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of diurnal temperature range on mortality in a high plateau area in southwest China: A time series analysis.

PubMed

Ding, Zan; Guo, Pi; Xie, Fang; Chu, Huifang; Li, Kun; Pu, Jingbo; Pang, Shaojie; Dong, Hongli; Liu, Yahui; Pi, Fuhua; Zhang, Qingying

2015-09-01

Diurnal temperature range (DTR) is an important meteorological indicator that reflects weather stability and is associated with global climate change and urbanization. Previous studies have explored the effect of DTR on human health in coastal cities with small daily temperature variations, but we have little evidence for high plateau regions where large DTRs usually occur. Using daily mortality data (2007-2013), we conducted a time-series analysis to assess the effect of DTR on daily mortality in Yuxi, a high plateau city in southwest China. Poisson regression with distributed lag non-linear model was used to estimate DTR effects on daily mortality, controlling for daily mean temperature, relative humidity, sunshine duration, wind speed, atmospheric pressure, day of the week, and seasonal and long-term trends. The cumulative effects of DTR were J-shaped curves for non-accidental, cardiorespiratory and cardiovascular mortality, with a U-shaped curve for respiratory mortality. Risk assessments showed strong monotonic increases in mortality starting at a DTR of approximately 16 °C. The relative risk of non-accidental morality with extreme high DTR at lag 0 and 0-21 days was 1.03 (95% confidence interval: 0.95-1.11) and 1.33 (0.94-1.89), respectively. The risk of mortality with extreme high DTR was greater for males and age <75 years than females and age ≥75 years. The effect of DTR on mortality was non-linear, with high DTR associated with increased mortality. A DTR of 16 °C may be a cut-off point for mortality prognosis and has implications for developing intervention strategies to address high DTR exposure. Copyright © 2015 Elsevier B.V. All rights reserved.

Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes

PubMed Central

Waterman, Pamela D.; Spasojevic, Jasmina; Li, Wenhui; Maduro, Gil; Van Wye, Gretchen

2016-01-01

Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract–level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. Conclusions. The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation. PMID:26691119

Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality?

PubMed

Gitajn, Ida Leah; Connelly, Daniel; Mascarenhas, Daniel; Breazeale, Stephen; Berger, Peter; Schoonover, Carrie; Martin, Brook; O'Toole, Robert V; Pensy, Raymond; Sciadini, Marcus

2018-02-01

Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p < 0.001). Cox regression analysis controlling for variables including age, Charlson Comorbidity Index, Injury Severity Scale, combined UE/LE injury, injury mechanism (high vs low), sex, BMI and GCS demonstrated that, in comparison to patients who were weight bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations.

PubMed

Stone, Patrick A; Flaherty, Sarah K; Aburahma, Ali F; Hass, Stephen M; Jackson, J Michelle; Hayes, J David; Hofeldt, Matthew J; Hager, Casey S; Elmore, Michael S

2006-03-01

Major lower extremity amputations continue to be associated with significant morbidity and mortality, yet few recent large series have evaluated factors associated with perioperative mortality and wound complications. The purpose of this study was to examine factors affecting perioperative mortality and wound-related complications following major lower extremity amputation. A retrospective review was conducted of all adult patients who underwent nontraumatic major lower extremity amputations over a 5-year period at a single tertiary-care center in southern West Virginia. Demographic and clinical data, perioperative data, and outcomes were collected and analyzed to identify any relationship with perioperative mortality, as well as wound complications and early revisions (within 90 days) to a more proximal level. Variables were examined using chi-squared, two-tailed t-tests, and logistic regression. Three hundred eighty patients (61% male) underwent 412 major lower extremity amputations during 1999-2003. The initial level of amputation included 230 below-knee (BKA), 149 above-knee (AKA), and one hip disarticulation. Perioperative mortality was 15.5% (n = 59). From a regression model, age, albumin level, AKA, and lack of a previous coronary artery bypass graft (CABG) were independently related to mortality. Patients who did not have a previous CABG were nearly three times more likely to die than those who did (p = 0.038). Overall early wound complications were noted in 13.4% (n = 51). Four factors were independently related to experiencing a 90-day wound complication: BKA, community (rather than care facility) living, type of anesthesia, and preoperative hematocrit >30%. Major lower extremity amputation in patients with peripheral vascular disease continues to be associated with considerable perioperative morbidity and mortality. Even though the surgical procedure itself may not be challenging from a technical standpoint, underlying medical conditions put this group at high risk for perioperative death. Wound-healing problems are frequently encountered and must be minimized to facilitate early mobilization and hospital discharge.

Trends in Water Level and Flooding in Dhaka, Bangladesh and Their Impact on Mortality

PubMed Central

Thiele-Eich, Insa; Burkart, Katrin; Simmer, Clemens

2015-01-01

Climate change is expected to impact flooding in many highly populated coastal regions, including Dhaka (Bangladesh), which is currently among the fastest growing cities in the world. In the past, high mortality counts have been associated with extreme flood events. We first analyzed daily water levels of the past 100 years in order to detect potential shifts in extremes. A distributed lag non-linear model was then used to examine the connection between water levels and mortality. Results indicate that for the period of 2003–2007, which entails two major flood events in 2004 and 2007, high water levels do not lead to a significant increase in relative mortality, which indicates a good level of adaptation and capacity to cope with flooding. However, following low water levels, an increase in mortality could be found. As our trend analysis of past water levels shows that minimum water levels have decreased during the past 100 years, action should be taken to ensure that the exposed population is also well-adapted to drought. PMID:25648177

Women live longer than men even during severe famines and epidemics.

PubMed

Zarulli, Virginia; Barthold Jones, Julia A; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W

2018-01-23

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. Copyright © 2018 the Author(s). Published by PNAS.

Mortality gradients within and among dominant plant populations as barometers of ecosystem change during extreme drought.

PubMed

Gitlin, Alicyn R; Sthultz, Christopher M; Bowker, Matthew A; Stumpf, Stacy; Paxton, Kristina L; Kennedy, Karla; Muñoz, Axhel; Bailey, Joseph K; Whitham, Thomas G

2006-10-01

Understanding patterns of plant population mortality during extreme weather events is important to conservation planners because the frequency of such events is expected to increase, creating the need to integrate climatic uncertainty into management. Dominant plants provide habitat and ecosystem structure, so changes in their distribution can be expected to have cascading effects on entire communities. Observing areas that respond quickly to climate fluctuations provides foresight into future ecological changes and will help prioritize conservation efforts. We investigated patterns of mortality in six dominant plant species during a drought in the southwestern United States. We quantified population mortality for each species across its regional distribution and tested hypotheses to identify ecological stress gradients for each species. Our results revealed three major patterns: (1) dominant species from diverse habitat types (i.e., riparian, chaparral, and low- to high-elevation forests) exhibited significant mortality, indicating that the effects of drought were widespread; (2) average mortality differed among dominant species (one-seed juniper[Juniperus monosperma (Engelm.) Sarg.] 3.3%; manzanita[Arctostaphylos pungens Kunth], 14.6%; quaking aspen[Populus tremuloides Michx.], 15.4%; ponderosa pine[Pinus ponderosa P. & C. Lawson], 15.9%; Fremont cottonwood[Populus fremontii S. Wats.], 20.7%; and pinyon pine[Pinus edulis Engelm.], 41.4%); (3) all dominant species showed localized patterns of very high mortality (24-100%) consistent with water stress gradients. Land managers should plan for climatic uncertainty by promoting tree recruitment in rare habitat types, alleviating unnatural levels of competition on dominant plants, and conserving sites across water stress gradients. High-stress sites, such as those we examined, have conservation value as barometers of change and because they may harbor genotypes that are adapted to climatic extremes.

Spatial variability of excess mortality during prolonged dust events in a high-density city: a time-stratified spatial regression approach.

PubMed

Wong, Man Sing; Ho, Hung Chak; Yang, Lin; Shi, Wenzhong; Yang, Jinxin; Chan, Ta-Chien

2017-07-24

Dust events have long been recognized to be associated with a higher mortality risk. However, no study has investigated how prolonged dust events affect the spatial variability of mortality across districts in a downwind city. In this study, we applied a spatial regression approach to estimate the district-level mortality during two extreme dust events in Hong Kong. We compared spatial and non-spatial models to evaluate the ability of each regression to estimate mortality. We also compared prolonged dust events with non-dust events to determine the influences of community factors on mortality across the city. The density of a built environment (estimated by the sky view factor) had positive association with excess mortality in each district, while socioeconomic deprivation contributed by lower income and lower education induced higher mortality impact in each territory planning unit during a prolonged dust event. Based on the model comparison, spatial error modelling with the 1st order of queen contiguity consistently outperformed other models. The high-risk areas with higher increase in mortality were located in an urban high-density environment with higher socioeconomic deprivation. Our model design shows the ability to predict spatial variability of mortality risk during an extreme weather event that is not able to be estimated based on traditional time-series analysis or ecological studies. Our spatial protocol can be used for public health surveillance, sustainable planning and disaster preparation when relevant data are available.

Part 2. Association of daily mortality with ambient air pollution, and effect modification by extremely high temperature in Wuhan, China.

PubMed

Qian, Zhengmin; He, Qingci; Lin, Hung-Mo; Kong, Lingli; Zhou, Dunjin; Liang, Shengwen; Zhu, Zhichao; Liao, Duanping; Liu, Wenshan; Bentley, Christy M; Dan, Jijun; Wang, Beiwei; Yang, Niannian; Xu, Shuangqing; Gong, Jie; Wei, Hongming; Sun, Huilin; Qin, Zudian

2010-11-01

Fewer studies have been published on the association between daily mortality and ambient air pollution in Asia than in the United States and Europe. This study was undertaken in Wuhan, China, to investigate the acute effects of air pollution on mortality with an emphasis on particulate matter (PM*). There were three primary aims: (1) to examine the associations of daily mortality due to all natural causes and daily cause-specific mortality (cardiovascular [CVD], stroke, cardiac [CARD], respiratory [RD], cardiopulmonary [CP], and non-cardiopulmonary [non-CP] causes) with daily mean concentrations (microg/m3) of PM with an aerodynamic diameter--10 pm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), or ozone (O3); (2) to investigate the effect modification of extremely high temperature on the association between air pollution and daily mortality due to all natural causes and daily cause-specific mortality; and (3) to assess the uncertainty of effect estimates caused by the change in International Classification of Disease (ICD) coding of mortality data from Revision 9 (ICD-9) to Revision 10 (ICD-10) code. Wuhan is called an "oven city" in China because of its extremely hot summers (the average daily temperature in July is 37.2 degrees C and maximum daily temperature often exceeds 40 degrees C). Approximately 4.5 million residents live in the core city area of 201 km2, where air pollution levels are higher and ranges are wider than the levels in most cities studied in the published literature. We obtained daily mean levels of PM10, SO2, and NO2 concentrations from five fixed-site air monitoring stations operated by the Wuhan Environmental Monitoring Center (WEMC). O3 data were obtained from two stations, and 8-hour averages, from 10:00 to 18:00, were used. Daily mortality data were obtained from the Wuhan Centres for Disease Prevention and Control (WCDC) during the study period of July 1, 2000, to June 30, 2004. To achieve the first aim, we used a regression of the logarithm of daily counts of mortality due to all natural causes and cause-specific mortality on the daily mean concentrations of the four pollutants while controlling for weather, temporal factors, and other important covariates with generalized additive models (GAMs). We derived pollutant effect estimations for 0-day, 1-day, 2-day, 3-day, and 4-day lagged exposure levels, and the averages of 0-day and 1-day lags (lag 0-1 day) and of 0-day, 1-day, 2-day, and 3-day lags (lag 0-3 days) before the event of death. In addition, we used individual-level data (e.g., age and sex) to classify subgroups in stratified analyses. Furthermore, we explored the nonlinear shapes ("thresholds") of the exposure-response relations. To achieve the second aim, we tested the hypothesis that extremely high temperature modifies the associations between air pollution and daily mortality. We developed three corresponding weather indicators: "extremely hot," "extremely cold," and "normal temperatures." The estimates were obtained from the models for the main effects and for the pollutant-temperature interaction for each pollutant and each cause of mortality. To achieve the third aim, we conducted an additional analysis. We examined the concordance rates and kappa statistics between the ICD-9-coded mortality data and the ICD-10-coded mortality data for the year 2002. We also compared the magnitudes of the estimated effects resulting from the use of the two types of ICD-coded mortality data. In general, the largest pollutant effects were observed at lag 0-1 day. Therefore, for this report, we focused on the results obtained from the lag 0-1 models. We observed consistent associations between PM10 and mortality: every 10-microg/m3 increase in PM10 daily concentration at lag 0-1 day produced a statistically significant association with an increase in mortality due to all natural causes (0.43%; 95% confidence interval [CI], 0.24 to 0.62), CVD (0.57%; 95% CI, 0.31 to 0.84), stroke (0.57%; 95% CI, 0.25 to 0.88), CARD (0.49%; 95% CI, 0.04 to 0.94), RD (0.87%; 95% CI, 0.34 to 1.41), CP (0.52%; 95% CI, 0.27 to 0.77), and non-CP (0.30%; 95% CI, 0.05 to 0.54). In general, these effects were stronger in females than in males and were also stronger among the elderly (> or = 65 years) than among the young. The results of sensitivity testing over the range of exposures from 24.8 to 477.8 microg/m3 also suggest the appropriateness of assuming a linear relation between daily mortality and PM10. Among the gaseous pollutants, we also observed statistically significant associations of mortality with NO, and SO2, and that the estimated effects of these two pollutants were stronger than the PM10 effects. The patterns of NO2 and SO2 associations were similar to those of PM10 in terms of sex, age, and linearity. O3 was not associated with mortality. In the analysis of the effect modification of extremely high temperature on the association between air pollution and daily mortality, only the interaction of PM10 with temperature was statistically significant. Specifically, the interaction terms were statistically significant for mortality due to all natural (P = 0.014), CVD (P = 0.007), and CP (P = 0.014) causes. Across the three temperature groups, the strongest PM10 effects occurred mainly on days with extremely high temperatures for mortality due to all natural (2.20%; 95% CI, 0.74 to 3.68), CVD (3.28%; 95% CI, 1.24 to 5.37), and CP (3.02%; 95% CI, 1.03 to 5.04) causes. The weakest effects occurred at normal temperature days, with the effects on days with low temperatures in the middle. To assess the uncertainty of the effect estimates caused by the change from ICD-9-coded mortality data to ICD-10-coded mortality data, we compared the two sets of data and found high concordance rates (> 99.3%) and kappa statistics close to 1.0 (> 0.98). All effect estimates showed very little change. All statistically significant levels of the estimated effects remained unchanged. In conclusion, the findings for the aims from the current study are consistent with those in most previous studies of air pollution and mortality. The small differences between mortality effects for deaths coded using ICD-9 and ICD-10 show that the change in coding had a minimal impact on our study. Few published papers have reported synergistic effects of extremely high temperatures and air pollution on mortality, and further studies are needed. Establishing causal links between heat, PM10, and mortality will require further toxicologic and cohort studies.

Association between high temperature and mortality in metropolitan areas of four cities in various climatic zones in China: a time-series study

PubMed Central

2014-01-01

Background Numerous studies have reported on the associations between ambient temperatures and mortality. However, few multi-city studies have been conducted in developing countries including China. This study aimed to examine the association between high temperature and mortality outcomes in four cities with different climatic characteristics in China to identify the most vulnerable population, detect the threshold temperatures, and provide scientific evidence for public health policy implementations to respond to challenges from extreme heat. Methods A semi-parametric generalized additive model (GAM) with a Poisson distribution was used to analyze the impacts of the daily maximum temperature over the threshold on mortality after controlling for covariates including time trends, day of the week (DOW), humidity, daily temperature range, and outdoor air pollution. Results The temperature thresholds for all-cause mortality were 29°C, 35°C, 33°C and 34°C for Harbin, Nanjing, Shenzhen and Chongqing, respectively. After adjusting for potential confounders including air pollution, strong associations between daily maximum temperature and daily mortality from all-cause, cardiovascular, endocrine and metabolic outcomes, and particularly diabetes, were observed in different geographical cities, with increases of 3.2-5.5%, 4.6-7.5% and 12.5-31.9% (with 14.7-29.2% in diabetes), respectively, with each 1°C increment in the daily maximum temperature over the threshold. A stronger temperature-associated mortality was detected in females compared to males. Additionally, both the population over 55 years and younger adults aged 30 to 54 years reported significant heat-mortality associations. Conclusions Extreme heat is becoming a huge threat to public health and human welfare due to the strong temperature-mortality associations in China. Climate change with increasing temperatures may make the situation worse. Relevant public health strategies and an early extreme weather and health warning system should be developed and improved at an early stage to prevent and reduce the health risks due to extreme weather and climate change in China, given its huge population, diverse geographic distribution and unbalanced socioeconomic status with various climatic characteristics. PMID:25103276

Association between high temperature and mortality in metropolitan areas of four cities in various climatic zones in China: a time-series study.

PubMed

Li, Yonghong; Cheng, Yibin; Cui, Guoquan; Peng, Chaoqiong; Xu, Yan; Wang, Yulin; Liu, Yingchun; Liu, Jingyi; Li, Chengcheng; Wu, Zhen; Bi, Peng; Jin, Yinlong

2014-08-07

Numerous studies have reported on the associations between ambient temperatures and mortality. However, few multi-city studies have been conducted in developing countries including China. This study aimed to examine the association between high temperature and mortality outcomes in four cities with different climatic characteristics in China to identify the most vulnerable population, detect the threshold temperatures, and provide scientific evidence for public health policy implementations to respond to challenges from extreme heat. A semi-parametric generalized additive model (GAM) with a Poisson distribution was used to analyze the impacts of the daily maximum temperature over the threshold on mortality after controlling for covariates including time trends, day of the week (DOW), humidity, daily temperature range, and outdoor air pollution. The temperature thresholds for all-cause mortality were 29°C, 35°C, 33°C and 34°C for Harbin, Nanjing, Shenzhen and Chongqing, respectively. After adjusting for potential confounders including air pollution, strong associations between daily maximum temperature and daily mortality from all-cause, cardiovascular, endocrine and metabolic outcomes, and particularly diabetes, were observed in different geographical cities, with increases of 3.2-5.5%, 4.6-7.5% and 12.5-31.9% (with 14.7-29.2% in diabetes), respectively, with each 1°C increment in the daily maximum temperature over the threshold. A stronger temperature-associated mortality was detected in females compared to males. Additionally, both the population over 55 years and younger adults aged 30 to 54 years reported significant heat-mortality associations. Extreme heat is becoming a huge threat to public health and human welfare due to the strong temperature-mortality associations in China. Climate change with increasing temperatures may make the situation worse. Relevant public health strategies and an early extreme weather and health warning system should be developed and improved at an early stage to prevent and reduce the health risks due to extreme weather and climate change in China, given its huge population, diverse geographic distribution and unbalanced socioeconomic status with various climatic characteristics.

Extremely cold and hot temperatures increase the risk of ischaemic heart disease mortality: epidemiological evidence from China.

PubMed

Guo, Yuming; Li, Shanshan; Zhang, Yanshen; Armstrong, Ben; Jaakkola, Jouni J K; Tong, Shilu; Pan, Xiaochuan

2013-02-01

To examine the effects of extremely cold and hot temperatures on ischaemic heart disease (IHD) mortality in five cities (Beijing, Tianjin, Shanghai, Wuhan and Guangzhou) in China; and to examine the time relationships between cold and hot temperatures and IHD mortality for each city. A negative binomial regression model combined with a distributed lag non-linear model was used to examine city-specific temperature effects on IHD mortality up to 20 lag days. A meta-analysis was used to pool the cold effects and hot effects across the five cities. 16 559 IHD deaths were monitored by a sentinel surveillance system in five cities during 2004-2008. The relationships between temperature and IHD mortality were non-linear in all five cities. The minimum-mortality temperatures in northern cities were lower than in southern cities. In Beijing, Tianjin and Guangzhou, the effects of extremely cold temperatures were delayed, while Shanghai and Wuhan had immediate cold effects. The effects of extremely hot temperatures appeared immediately in all the cities except Wuhan. Meta-analysis showed that IHD mortality increased 48% at the 1st percentile of temperature (extremely cold temperature) compared with the 10th percentile, while IHD mortality increased 18% at the 99th percentile of temperature (extremely hot temperature) compared with the 90th percentile. Results indicate that both extremely cold and hot temperatures increase IHD mortality in China. Each city has its characteristics of heat effects on IHD mortality. The policy for response to climate change should consider local climate-IHD mortality relationships.

Mortality impact of extreme winter temperatures

NASA Astrophysics Data System (ADS)

Díaz, Julio; García, Ricardo; López, César; Linares, Cristina; Tobías, Aurelio; Prieto, Luis

2005-01-01

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986 1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (Tmax) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occured 7 8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4 5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.

Differences in extreme low salinity timing and duration differentially affect eastern oyster (Crassostrea virginica) size class growth and mortality in Breton Sound, LA

NASA Astrophysics Data System (ADS)

La Peyre, Megan K.; Eberline, Benjamin S.; Soniat, Thomas M.; La Peyre, Jerome F.

2013-12-01

Understanding how different life history stages are impacted by extreme or stochastic environmental variation is critical for predicting and modeling organism population dynamics. This project examined recruitment, growth, and mortality of seed (25-75 mm) and market (>75 mm) sized oysters along a salinity gradient over two years in Breton Sound, LA. In April 2010, management responses to the Deepwater Horizon oil spill resulted in extreme low salinity (<5) at all sites through August 2010; in 2011, a 100-year Mississippi River flood event resulted in low salinity in late spring. Extended low salinity (<5) during hot summer months (>25 °C) significantly and negatively impacted oyster recruitment, survival and growth in 2010, while low salinity (<5) for a shorter period that did not extend into July (<25 °C) in 2011 had minimal impacts on oyster growth and mortality. In 2011, recruitment was limited, which may be due to a combination of low spring time salinities, high 2010 oyster mortality, minimal 2010 recruitment, cumulative effects from 10 years of declining oyster stock in the area, and poor cultch quality. In both 2010 and 2011, Perkinsus marinus infection prevalence remained low throughout the year at all sites and almost all infection intensities were light. Oyster plasma osmolality failed to match surrounding low salinity waters in 2010, while oysters appeared to osmoconform throughout 2011 indicating that the high mortality in 2010 may be due to extended valve closing and resulting starvation or asphyxiation in response to the combination of low salinity during high temperatures (>25 °C). With increasing management of our freshwater inputs to estuaries combined with predicted climate changes, how extreme events affect different life history stages is key to understanding variation in population demographics of commercially important species and predicting future populations.

Differences in extreme low salinity timing and duration differentially affect eastern oyster (Crassostrea virginica) size class growth and mortality in Breton Sound, LA

USGS Publications Warehouse

LaPeyre, Megan K.; Eberline, Benjamin S.; Soniat, Thomas M.; La Peyre, Jerome F.

2013-01-01

Understanding how different life history stages are impacted by extreme or stochastic environmental variation is critical for predicting and modeling organism population dynamics. This project examined recruitment, growth, and mortality of seed (25–75 mm) and market (>75 mm) sized oysters along a salinity gradient over two years in Breton Sound, LA. In April 2010, management responses to the Deepwater Horizon oil spill resulted in extreme low salinity (<5) at all sites through August 2010; in 2011, a 100-year Mississippi River flood event resulted in low salinity in late spring. Extended low salinity (<5) during hot summer months (>25 °C) significantly and negatively impacted oyster recruitment, survival and growth in 2010, while low salinity (<5) for a shorter period that did not extend into July (<25 °C) in 2011 had minimal impacts on oyster growth and mortality. In 2011, recruitment was limited, which may be due to a combination of low spring time salinities, high 2010 oyster mortality, minimal 2010 recruitment, cumulative effects from 10 years of declining oyster stock in the area, and poor cultch quality. In both 2010 and 2011, Perkinsus marinusinfection prevalence remained low throughout the year at all sites and almost all infection intensities were light. Oyster plasma osmolality failed to match surrounding low salinity waters in 2010, while oysters appeared to osmoconform throughout 2011 indicating that the high mortality in 2010 may be due to extended valve closing and resulting starvation or asphyxiation in response to the combination of low salinity during high temperatures (>25 °C). With increasing management of our freshwater inputs to estuaries combined with predicted climate changes, how extreme events affect different life history stages is key to understanding variation in population demographics of commercially important species and predicting future populations.

Acute hypophosphataemia and hypokalaemia in a patient starting antiretroviral therapy in Zambia—a new context for refeeding syndrome?

PubMed Central

Nyirenda, Christopher; Zulu, Isaac; Kabagambe, Edmond K; Bagchi, Shashwatee; Potter, Dara; Bosire, Claire; Krishnasami, Zipporah; Heimburger, Douglas C

2009-01-01

High mortality rates have been reported in the first 90 days of antiretroviral therapy in Zambia and other low-income countries. We report a case of acute hypophosphataemia and hypokalaemia in the first week of antiretroviral therapy in a patient with extreme AIDS wasting. Given its occurrence in an extremely wasted patient, it may be physiologically similar to refeeding syndrome but other causes could be relevant as well. Acute hypophosphataemia may contribute to early antiretroviral therapy associated mortality in low-income countries. PMID:21686792

Complicated Outcomes After Emergent Lower Extremity Surgery in Patients With Solid Organ Transplants.

PubMed

Reid, Alexander T; Perdue, Aaron; Goulet, James A; Robbins, Christopher B; Pour, Aidin Eslam

2016-11-01

The complications of emergent or urgent surgery in solid organ transplant recipients are unclear. The goal of this nonrandomized retrospective case study, conducted at a large public university teaching hospital, was to determine the following: (1) 90-day postsurgical complications in solid organ transplant recipients who undergo fracture surgery of the lower extremities; (2) 90-day and 1-year mortality rates for this cohort; (3) correlation of particular postsurgical complications with the 90-day or 1-year mortality rate; and (4) correlation of body mass index with the 90-day or 1-year mortality rate. Subjects included 36 solid organ transplant recipients who underwent surgical treatment for 37 emergent or urgent lower extremity fractures within 72 hours of presentation to the emergency department. Patients were followed for all medical and surgical complications for 90 days and for all-cause mortality for 1 year. Within 90 days of surgery, patients had complications that included acute renal failure (15, 40.5%), deep venous thrombosis (3, 8.1%), pulmonary embolus (2, 5.4%), pneumonia (7, 18.9%), superficial surgical site infection (3, 8.1%), and nonorthopedic sepsis (4, 10.8%). In addition, 3 (8.1%) and 5 (13.9%) patients died within 90 days and 1 year, respectively. Hospital readmission correlated with a higher 1-year mortality rate (odds ratio, 14.000; P=.016). Higher body mass index correlated with higher 90-day (odds ratio, 1.425; P=.035) and 1-year (odds ratio, 1.334; P=.033) mortality rates. Solid organ transplant recipients with lower extremity fracture have high 90-day and 1-year mortality rates and may have multiple complications within 90 days of treatment. [Orthopedics. 2016; 39(6):e1063-e1069.]. Copyright 2016, SLACK Incorporated.

Growth and stable isotope signals associated with drought-related mortality in saplings of two coexisting pine species.

PubMed

Herrero, Asier; Castro, Jorge; Zamora, Regino; Delgado-Huertas, Antonio; Querejeta, José I

2013-12-01

Drought-induced events of massive tree mortality appear to be increasing worldwide. Species-specific vulnerability to drought mortality may alter patterns of species diversity and affect future forest composition. We have explored the consequences of the extreme drought of 2005, which caused high sapling mortality (approx. 50 %) among 10-year-old saplings of two coexisting pine species in the Mediterranean mountains of Sierra Nevada (Spain): boreo-alpine Pinus sylvestris and Mediterranean P. nigra. Sapling height growth, leaf δ(13)C and δ(18)O, and foliar nitrogen concentration in the four most recent leaf cohorts were measured in dead and surviving saplings. The foliar isotopic composition of dead saplings (which reflects time-integrated leaf gas-exchange until mortality) displayed sharp increases in both δ(13)C and δ(18)O during the extreme drought of 2005, suggesting an important role of stomatal conductance (g(s)) reduction and diffusional limitations to photosynthesis in mortality. While P. nigra showed decreased growth in 2005 compared to the previous wetter year, P. sylvestris maintained similar growth levels in both years. Decreased growth, coupled with a sharper increase in foliar δ(18)O during extreme drought in dead saplings, indicate a more conservative water use strategy for P. nigra. The different physiological behavior of the two pine species in response to drought (further supported by data from surviving saplings) may have influenced 2005 mortality rates, which contributed to 2.4-fold greater survival for P. nigra over the lifespan of the saplings. This species-specific vulnerability to extreme drought could lead to changes in dominance and distribution of pine species in Mediterranean mountain forests.

Mortality Measurement at Advanced Ages: A Study of the Social Security Administration Death Master File

PubMed Central

Gavrilov, Leonid A.; Gavrilova, Natalia S.

2011-01-01

Accurate estimates of mortality at advanced ages are essential to improving forecasts of mortality and the population size of the oldest old age group. However, estimation of hazard rates at extremely old ages poses serious challenges to researchers: (1) The observed mortality deceleration may be at least partially an artifact of mixing different birth cohorts with different mortality (heterogeneity effect); (2) standard assumptions of hazard rate estimates may be invalid when risk of death is extremely high at old ages and (3) ages of very old people may be exaggerated. One way of obtaining estimates of mortality at extreme ages is to pool together international records of persons surviving to extreme ages with subsequent efforts of strict age validation. This approach helps researchers to resolve the third of the above-mentioned problems but does not resolve the first two problems because of inevitable data heterogeneity when data for people belonging to different birth cohorts and countries are pooled together. In this paper we propose an alternative approach, which gives an opportunity to resolve the first two problems by compiling data for more homogeneous single-year birth cohorts with hazard rates measured at narrow (monthly) age intervals. Possible ways of resolving the third problem of hazard rate estimation are elaborated. This approach is based on data from the Social Security Administration Death Master File (DMF). Some birth cohorts covered by DMF could be studied by the method of extinct generations. Availability of month of birth and month of death information provides a unique opportunity to obtain hazard rate estimates for every month of age. Study of several single-year extinct birth cohorts shows that mortality trajectory at advanced ages follows the Gompertz law up to the ages 102–105 years without a noticeable deceleration. Earlier reports of mortality deceleration (deviation of mortality from the Gompertz law) at ages below 100 appear to be artifacts of mixing together several birth cohorts with different mortality levels and using cross-sectional instead of cohort data. Age exaggeration and crude assumptions applied to mortality estimates at advanced ages may also contribute to mortality underestimation at very advanced ages. PMID:22308064

Impact of temperature on mortality in Hubei, China: a multi-county time series analysis

NASA Astrophysics Data System (ADS)

Zhang, Yunquan; Yu, Chuanhua; Bao, Junzhe; Li, Xudong

2017-03-01

We examined the impact of extreme temperatures on mortality in 12 counties across Hubei Province, central China, during 2009-2012. Quasi-Poisson generalized linear regression combined with distributed lag non-linear model was first applied to estimate county-specific relationship between temperature and mortality. A multivariable meta-analysis was then used to pool the estimates of county-specific mortality effects of extreme cold temperature (1st percentile) and hot temperature (99th percentile). An inverse J-shaped relationship was observed between temperature and mortality at the provincial level. Heat effect occurred immediately and persisted for 2-3 days, whereas cold effect was 1-2 days delayed and much longer lasting. Higher mortality risks were observed among females, the elderly aged over 75 years, persons dying outside the hospital and those with high education attainment, especially for cold effects. Our data revealed some slight differences in heat- and cold- related mortality effects on urban and rural residents. These findings may have important implications for developing locally-based preventive and intervention strategies to reduce temperature-related mortality, especially for those susceptible subpopulations. Also, urbanization should be considered as a potential influence factor when evaluating temperature-mortality association in future researches.

High maternal mortality in Jigawa State, Northern Nigeria estimated using the sisterhood method.

PubMed

Sharma, Vandana; Brown, Willa; Kainuwa, Muhammad Abdullahi; Leight, Jessica; Nyqvist, Martina Bjorkman

2017-06-02

Maternal mortality is extremely high in Nigeria. Accurate estimation of maternal mortality is challenging in low-income settings such as Nigeria where vital registration is incomplete. The objective of this study was to estimate the lifetime risk (LTR) of maternal death and the maternal mortality ratio (MMR) in Jigawa State, Northern Nigeria using the Sisterhood Method. Interviews with 7,069 women aged 15-49 in 96 randomly selected clusters of communities in 24 Local Government Areas (LGAs) across Jigawa state were conducted. A retrospective cohort of their sisters of reproductive age was constructed to calculate the lifetime risk of maternal mortality. Using most recent estimates of total fertility for the state, the MMR was estimated. The 7,069 respondents reported 10,957 sisters who reached reproductive age. Of the 1,026 deaths in these sisters, 300 (29.2%) occurred during pregnancy, childbirth or within 42 days after delivery. This corresponds to a LTR of 6.6% and an estimated MMR for the study areas of 1,012 maternal deaths per 100,000 live births (95% CI: 898-1,126) with a time reference of 2001. Jigawa State has an extremely high maternal mortality ratio underscoring the urgent need for health systems improvement and interventions to accelerate reductions in MMR. The trial is registered at clinicaltrials.gov ( NCT01487707 ). Initially registered on December 6, 2011.

Heat-related deaths in hot cities: estimates of human tolerance to high temperature thresholds.

PubMed

Harlan, Sharon L; Chowell, Gerardo; Yang, Shuo; Petitti, Diana B; Morales Butler, Emmanuel J; Ruddell, Benjamin L; Ruddell, Darren M

2014-03-20

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥ 65 during the months May-October for years 2000-2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90-97 °F; 32.2-36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.

Extreme mortality after first introduction of measles virus to the polynesian island of Rotuma, 1911.

PubMed

Shanks, G Dennis; Lee, Seung-Eun; Howard, Alan; Brundage, John F

2011-05-15

Rotuma is an isolated Polynesian island. In January 1911, most residents of Rotuma (population approximately 2,600) were exposed to measles virus for the first time. The official mortality register documented 491 deaths due to all causes among Rotumans during 1911 (cumulative measles-related mortality: 12.8%); most deaths occurred in April-May and were attributed to measles and its sequelae. Measles-related mortality rates were higher among young children (23.4 per 100 person-years) and young adults (17.1 per 100 person-years) than among adolescents (11.0 per 100 person-years) and older adults (5.6 per 100 person-years); females (16.2 per 100 person-years) died at a higher rate than males (13.2 per 100 person-years). Gastrointestinal complications (75%), not respiratory complications, were the predominant clinical manifestations of fatal measles cases; tuberculosis mortality was unusually high during the year of the epidemic. In 1911, measles-related mortality varied by nearly 3-fold across geographic districts (range, 7.4%-21.6%). The extreme mortality due to measles on Rotuma typifies the experiences of isolated populations after first encounters with measles; it suggests that prior exposures to a narrow range of microbes and genetic homogeneity predispose isolated populations to lethal outcomes when they are first exposed to highly contagious and pathogenic viruses (e.g., measles, influenza).

Extreme summer temperatures in Iberia: health impacts and associated synoptic conditions

NASA Astrophysics Data System (ADS)

García-Herrera, R.; Díaz, J.; Trigo, R. M.; Hernández, E.

2005-02-01

This paper examines the effect of extreme summer temperatures on daily mortality in two large cities of Iberia: Lisbon (Portugal) and Madrid (Spain). Daily mortality and meteorological variables are analysed using the same methodology based on Box-Jenkins models. Results reveal that in both cases there is a triggering effect on mortality when maximum daily temperature exceeds a given threshold (34°C in Lisbon and 36°C in Madrid). The impact of most intense heat events is very similar for both cities, with significant mortality values occurring up to 3 days after the temperature threshold has been surpassed. This impact is measured as the percentual increase of mortality associated to a 1°C increase above the threshold temperature. In this respect, Lisbon shows a higher impact, 31%, as compared with Madrid at 21%. The difference can be attributed to demographic and socio-economic factors. Furthermore, the longer life span of Iberian women is critical to explain why, in both cities, females are more susceptible than males to heat effects, with an almost double mortality impact value. The analysis of Sea Level Pressure (SLP), 500hPa geopotential height and temperature fields reveals that, despite being relatively close to each other, Lisbon and Madrid have relatively different synoptic circulation anomalies associated with their respective extreme summer temperature days. The SLP field reveals higher anomalies for Lisbon, but extending over a smaller area. Extreme values in Madrid seem to require a more western location of the Azores High, embracing a greater area over Europe, even if it is not as deep as for Lisbon. The origin of the hot and dry air masses that usually lead to extreme heat days in both cities is located in Northern Africa. However, while Madrid maxima require wind blowing directly from the south, transporting heat from Southern Spain and Northern Africa, Lisbon maxima occur under more easterly conditions, when Northern African air flows over the central Iberian plateau, which had been previously heated.

High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality.

PubMed

Eilber, Fritz C; Rosen, Gerald; Nelson, Scott D; Selch, Michael; Dorey, Frederick; Eckardt, Jeffery; Eilber, Frederick R

2003-02-01

To identify patient characteristics associated with the development of local recurrence and the effect of local recurrence on subsequent morbidity and mortality in patients with intermediate- to high-grade extremity soft tissue sarcomas. Numerous studies on extremity soft tissue sarcomas have consistently shown that presentation with locally recurrent disease is associated with the development of subsequent local recurrences and that large tumor size and high histologic grade are significant factors associated with decreased survival. However, the effect of local recurrence on patient survival remains unclear. From 1975 to 1997, 753 patients with intermediate- to high-grade extremity soft tissue sarcomas were treated at UCLA. Treatment outcomes and patient characteristics were analyzed to identify factors associated with both local recurrence and survival. Patients with locally recurrent disease were at a significantly increased risk of developing a subsequent local recurrence. Local recurrence was a morbid event requiring amputation in 38% of the cases. The development of a local recurrence was the most significant factor associated with decreased survival. Once a patient developed a local recurrence, he or she was about three times more likely to die of disease compared to similar patients who had not developed a local recurrence. Local recurrence in patients with intermediate- to high-grade extremity soft tissue sarcomas is associated with the development of subsequent local recurrences, a morbid event decreasing functional outcomes and the most significant factor associated with decreased survival. Although 85% to 90% of patients with high-grade extremity soft tissue sarcomas are treatable with a limb salvage approach, patients who develop a local recurrence need aggressive treatment and should be considered for trials of adjuvant systemic therapy.

Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors.

PubMed

Li, Shanshan; Flint, Alan; Pai, Jennifer K; Forman, John P; Hu, Frank B; Willett, Walter C; Rexrode, Kathryn M; Mukamal, Kenneth J; Rimm, Eric B

2014-09-22

The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long-term benefits of a low-carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post-MI adherence to an LCD and all-cause and cardiovascular mortality. We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professional Follow-Up Study who had survived a first MI during follow-up and provided a pre-MI and at least 1 post-MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all-cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all-cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal-based LCD prospectively assessed from the pre- to post-MI period was associated with higher all-cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all-cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant-based LCD was not associated with lower all-cause or cardiovascular mortality. Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality post-MI. We did not find a health benefit from greater adherence to an LCD overall after MI. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Heat-Related Deaths in Hot Cities: Estimates of Human Tolerance to High Temperature Thresholds

PubMed Central

Harlan, Sharon L.; Chowell, Gerardo; Yang, Shuo; Petitti, Diana B.; Morales Butler, Emmanuel J.; Ruddell, Benjamin L.; Ruddell, Darren M.

2014-01-01

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide. PMID:24658410

Extreme Water Levels in Bangladesh: Past Trends, Future Projections and their Impact on Mortality

NASA Astrophysics Data System (ADS)

Thiele-Eich, I.; Burkart, K.; Hopson, T. M.; Simmer, C.

2014-12-01

Climate change is expected to have an impact on meteorological and therefore hydrological extremes, thereby possibly altering the vulnerability of exposed populations. Our study focuses on Bangladesh, which is particularly vulnerable to changes in extremes due to both the large population at risk, as well as geographical characteristics such as the low-rising slope of the country through which the outflow of the combined catchments of the Ganges, Brahmaputra and Meghna rivers (GBM, ~1.75 million km2) is channeled.Time series of daily discharge and water level data for the past 100 years were analyzed with respect to trends in frequency, magnitude and duration, focusing on rare but particularly high-risk events using extreme-value theory. Mortality data is available for a five-year period (2003-2007), with a distributed lag non-linear model used to examine possible connections between extreme water levels and mortality. Then, using output from the Community Climate System Model CCSM4, projections were made regarding future flooding due to changes in precipitation intensity and frequency, while also accounting for the backwater effect of sea-level rise. For this, the upper catchment precipitation as well as monthly mean thermosteric sea-level rise at the river mouth outflow were taken from the four CCSM4 1° 20th Century ensemble members as well as from six CCSM4 1° ensemble members for the RCP scenarios RCP 2.6, 4.5, 6.0 and 8.5.Results show that while e.g. the mean water level did not significantly rise during the past 100 years, a change in extreme water levels can be detected. In addition, annual minimum water levels have decreased, which is of particular importance as there is a significant connection to an increase in mortality for low water levels. While mortality does not seem to increase significantly due to extreme floods, our results indicate that return levels projected for the future shift progressively, with the effect being strongest for RCP 8.5. Further measures to strengthen the resilience of the exposed population are therefore required to ensure that climate change effects do not overwhelm the population's coping capacities.

Temperature extremes reduce seagrass growth and induce mortality.

PubMed

Collier, C J; Waycott, M

2014-06-30

Extreme heating (up to 43 °C measured from five-year temperature records) occurs in shallow coastal seagrass meadows of the Great Barrier Reef at low tide. We measured effective quantum yield (ϕPSII), growth, senescence and mortality in four tropical seagrasses to experimental short-duration (2.5h) spikes in water temperature to 35 °C, 40 °C and 43 °C, for 6 days followed by one day at ambient temperature. Increasing temperature to 35 °C had positive effects on ϕPSII (the magnitude varied between days and was highly correlated with PPFD), with no effects on growth or mortality. 40 °C represented a critical threshold as there were strong species differences and there was a large impact on growth and mortality. At 43 °C there was complete mortality after 2-3 days. These findings indicate that increasing duration (more days in a row) of thermal events above 40 °C is likely to affect the ecological function of tropical seagrass meadows. Copyright © 2014 Elsevier Ltd. All rights reserved.

The differential effects of increasing frequency and magnitude of extreme events on coral populations.

PubMed

Fabina, Nicholas S; Baskett, Marissa L; Gross, Kevin

2015-09-01

Extreme events, which have profound ecological consequences, are changing in both frequency and magnitude with climate change. Because extreme temperatures induce coral bleaching, we can explore the relative impacts of changes in frequency and magnitude of high temperature events on coral reefs. Here, we combined climate projections and a dynamic population model to determine how changing bleaching regimes influence coral persistence. We additionally explored how coral traits and competition with macroalgae mediate changes in bleaching regimes. Our results predict that severe bleaching events reduce coral persistence more than frequent bleaching. Corals with low adult mortality and high growth rates are successful when bleaching is mild, but bleaching resistance is necessary to persist when bleaching is severe, regardless of frequency. The existence of macroalgae-dominated stable states reduces coral persistence and changes the relative importance of coral traits. Building on previous studies, our results predict that management efforts may need to prioritize protection of "weaker" corals with high adult mortality when bleaching is mild, and protection of "stronger" corals with high bleaching resistance when bleaching is severe. In summary, future reef projections and conservation targets depend on both local bleaching regimes and biodiversity.

Climate change impacts on extreme temperature mortality in select metropolitan areas of the United States

EPA Science Inventory

Projected mortality from climate change-driven impacts on extremely hot and cold days increases significantly over the 21st century in a large group of United States Metropolitan Statistical Areas. Increases in projected mortality from more hot days are greater than decreases in ...

Morbidity and mortality after emergency lower extremity embolectomy.

PubMed

Casillas-Berumen, Sergio; Sadri, Lili; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Rybin, Denis; Doros, Gheorghe; Siracuse, Jeffrey J

2017-03-01

Emergency lower extremity embolectomy is a common vascular surgical procedure that has poorly defined outcomes. Our goal was to define the perioperative morbidity for emergency embolectomy and develop a risk prediction model for perioperative mortality. The American College of Surgeons National Surgical Quality Improvement database was queried to identify patients undergoing emergency unilateral and lower extremity embolectomy. Patients with previous critical limb ischemia, bilateral embolectomy, nonemergency indication, and those undergoing concurrent bypass were excluded. Patient characteristics and postoperative morbidity and mortality were analyzed. Multivariate analysis for predictors of mortality was performed, and from this, a risk prediction model was developed to identify preoperative predictors of mortality. There were 1749 patients (47.9% male) who met the inclusion criteria. The average age was 68.2 ± 14.8 years. Iliofemoral-popliteal embolectomy was performed in 1231 patients (70.4%), popliteal-tibioperoneal embolectomy in 303 (17.3%), and at both levels in 215 (12.3%). Fasciotomies were performed concurrently with embolectomy in 308 patients (17.6%). The 30-day postoperative mortality was 13.9%. Postoperative complications included myocardial infarction or cardiac arrest (4.7%), pulmonary complications (16.0%), and wound complications (8.2%). The rate of return to the operating room ≤30 days was 25.7%. Hospital length of stay was 9.8 ± 11.5 days, and the 30-day readmission rate was 16.3%. A perioperative mortality risk prediction model based on factors identified in multivariate analysis included age >70 years, male gender, functional dependence, history of chronic obstructive pulmonary disease, congestive heart failure, recent myocardial infarction/angina, chronic renal insufficiency, and steroid use. The model showed good discrimination (C = 0.769; 95% confidence interval, 0733-0.806) and calibrated well. Emergency lower extremity embolectomy has high morbidity, mortality, and resource utilization. These data provide a benchmark for this complex patient population and may assist in risk stratifying patients, allowing for improved informed consent and goals of care at the time of presentation. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Impacts of hot and cold temperature extremes on hospital admissions for cardiovascular diseases

NASA Astrophysics Data System (ADS)

Davídkovová, H.; Kyselý, J.; Kříž, B.

2010-09-01

Elevated mortality associated with high ambient temperatures in summer represents one of the main impacts of weather extremes on human society. Increases in mortality during heat waves were examined in many European countries; much less is known about the effects of heat waves on morbidity, measured for example by the number of hospital admissions. Relatively less understood is also cold-related mortality and morbidity in winter, when the relationships between weather and human health are more complex, less direct, and confounded by other factors such as epidemics of influenza/acute respiratory infections. The present study examines links between hot and cold temperature extremes and daily hospital admissions for cardiovascular diseases in the population of the Czech Republic over 1994-2007. We make use of a recently completed database of all admissions for cardiovascular diseases to hospitals in the area of the Czech Republic since 1994, with a detailed classification of diseases and detailed information concerning each patient (in total 1,467,675 hospital admissions over 1994-2007). The main goals of the study are (i) to identify excess/deficit morbidity during and after periods of heat waves in summer and cold spells in winter, (ii) to compare the links for individual diseases (e.g. acute myocardial infarction, I21; angina pectoris, I20; cerebral infarction, I63; brain ischemia, I64) and to identify those diagnoses that are most closely linked to weather, (iii) to identify population groups most vulnerable to temperature extremes, and (iv) to compare the links to temperature extremes for morbidity and mortality. Periods when morbidity data were affected by epidemics of influenza and acute respiratory infections in winter were excluded from the analysis.

[Predictive factors of mortality in extremely preterm infants].

PubMed

Lin, L; Fang, M C; Jiang, H; Zhu, M L; Chen, S Q; Lin, Z L

2018-04-02

Objective: To investigate the predictive factors of mortality in extremely preterm infants. Methods: The retrospective case-control study was accomplished in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A total of 268 extremely preterm infants seen from January 1, 1999 to December 31, 2015 were divided into survival group (192 cases) and death group (76 cases). The potential predictive factors of mortality were identified by univariate analysis, and then analyzed by multivariate unconditional Logistic regression analysis. The mortality and predictive factors were also compared between two time periods, which were January 1, 1999 to December 31, 2007 (65 cases) and January 1, 2008 to December 31, 2015 (203 cases). Results: The median gestational age (GA) of extremely preterm infants was 27 weeks (23 +3 -27 +6 weeks). The mortality was higher in infants with GA of 25-<26 weeks ( OR= 2.659, 95% CI: 1.211-5.840) and<25 weeks ( OR= 10.029, 95% CI: 3.266-30.792) compared to that in infants with GA> 26 weeks. From January 1, 2008 to December 31, 2015, the number of extremely preterm infants was increased significantly compared to the previous 9 years, while the mortality decreased significantly ( OR= 0.490, 95% CI: 0.272-0.884). Multivariate unconditional Logistic regression analysis showed that GA below 25 weeks ( OR= 6.033, 95% CI: 1.393-26.133), lower birth weight ( OR= 0.997, 95% CI: 0.995-1.000), stage Ⅲ necrotizing enterocolitis (NEC) ( OR= 15.907, 95% CI: 3.613-70.033), grade Ⅰ and Ⅱ intraventricular hemorrhage (IVH) ( OR= 0.260, 95% CI: 0.117-0.575) and dependence on invasive mechanical ventilation ( OR= 3.630, 95% CI: 1.111-11.867) were predictive factors of mortality in extremely preterm infants. Conclusions: GA below 25 weeks, lower birth weight, stage Ⅲ NEC and dependence on invasive mechanical ventilation are risk factors of mortality in extremely preterm infants. But grade ⅠandⅡ IVH is protective factor.

Investigating Extreme Heat and Humidity in the Northeast United States from a Joint Hazard Perspective

NASA Astrophysics Data System (ADS)

Horton, R. M.; Coffel, E.; Kushnir, Y.

2014-12-01

Recent years have seen an increasing focus on extreme high temperature events, as our understanding of societal vulnerability to such extremes has grown. Less climate research has been devoted to heat indices that consider the joint hazard posed by high temperatures and high humidity, even though heat indices are being prioritized by utility providers and public health officials. This paper evaluates how well CMIP5 models are able to reproduce the large-scale features and surface conditions associated with joint high heat and humidity events in the Northeast U.S. Projected changes in heat indices are also shown both for the full set of CMIP5 models and for a subset of models that best reproduce the statistics of historical high heat index events. The importance of considering the relationship between 1) temperature and humidity extremes and 2) projected changes in extreme temperature and humidity extremes, rather than investigating each variable independently, will be emphasized. Potential impacts of the findings on human mortality and energy consumption will be briefly discussed.

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality.

PubMed

Nastasi, A J; McAdams-DeMarco, M A; Schrack, J; Ying, H; Olorundare, I; Warsame, F; Mountford, A; Haugen, C E; González Fernández, M; Norman, S P; Segev, D L

2018-01-01

Prediction models for post-kidney transplantation mortality have had limited success (C-statistics ≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, kidney transplant (KT) survival through intervention. The Short Physical Performance Battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function. SPPB performance and frailty (Fried frailty phenotype) were assessed at admission for KT in a prospective cohort of 719 KT recipients at Johns Hopkins Hospital (8/2009 to 6/2016) and University of Michigan (2/2013 to 12/2016). The independent associations between SPPB impairment (SPPB composite score ≤10) and composite score with post-KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk. The 5-year posttransplantation mortality for impaired recipients was 20.6% compared to 4.5% for unimpaired recipients (p < 0.001). Impaired recipients had a 2.30-fold (adjusted hazard ratio [aHR] 2.30, 95% confidence interval [CI] 1.12-4.74, p = 0.02) increased risk of postkidney transplantation mortality compared to unimpaired recipients. Each one-point decrease in SPPB score was independently associated with a 1.19-fold (95% CI 1.09-1.30, p < 0.001) higher risk of post-KT mortality. SPPB-derived lower extremity function is a potentially highly useful and modifiable objective measure for pre-KT risk prediction. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Characteristics and Mortality of Pneumocystis Pneumonia in Patients With Cushing’s Syndrome: A Plea for Timely Initiation of Chemoprophylaxis

PubMed Central

van Halem, Karlijn; Vrolijk, Lucia; Pereira, Alberto Martin

2017-01-01

Abstract In patients with Cushing’s syndrome, development of Pneumocystis pneumonia (PCP) is associated with extreme cortisol production levels. In this setting, immune reconstitution after abrogation of cortisol excess appears to induce development of symptomatic PCP. The high mortality rate warrants timely initiation of chemoprophylaxis or even preemptive treatment of PCP. PMID:28480275

Projected trends in high-mortality heatwaves under different scenarios of climate, population, and adaptation in 82 US communities.

PubMed

Anderson, G Brooke; Oleson, Keith W; Jones, Bryan; Peng, Roger D

2018-02-01

Some rare heatwaves have extreme daily mortality impacts; moderate heatwaves have lower daily impacts but occur much more frequently at present and so account for large aggregated impacts. We applied health-based models to project trends in high-mortality heatwaves, including proportion of all heatwaves expected to be high-mortality, using the definition that a high-mortality heatwave increases mortality risk by ≥20 %. We projected these trends in 82 US communities in 2061-2080 under two scenarios of climate change (RCP4.5, RCP8.5), two scenarios of population change (SSP3, SSP5), and three scenarios of community adaptation to heat (none, lagged, on-pace) for large- and medium-ensemble versions of the National Center for Atmospheric Research's Community Earth System Model. More high-mortality heatwaves were expected compared to present under all scenarios except on-pace adaptation, and population exposure was expected to increase under all scenarios. At least seven more high-mortality heatwaves were expected in a twenty-year period in the 82 study communities under RCP8.5 than RCP4.5 when assuming no adaptation. However, high-mortality heatwaves were expected to remain <1 % of all heatwaves and heatwave exposure under all scenarios. Projections were most strongly influenced by the adaptation scenario- going from a scenario of on-pace to lagged adaptation or from lagged to no adaptation more than doubled the projected number of and exposure to high-mortality heatwaves. Based on our results, fewer high-mortality heatwaves are expected when following RCP4.5 versus RCP8.5 and under higher levels of adaptation, but high-mortality heatwaves are expected to remain a very small proportion of total heatwave exposure.

Increased temperatures combined with lowered salinities differentially impact oyster size class growth and mortality

USGS Publications Warehouse

LaPeyre, Megan K.; Rybovich, Molly; Hall, Steven G.; La Peyre, Jerome F.

2016-01-01

Changes in the timing and interaction of seasonal high temperatures and low salinities as predicted by climate change models could dramatically alter oyster population dynamics. Little is known explicitly about how low salinity and high temperature combinations affect spat (<25mm), seed (25–75mm), andmarket (>75mm) oyster growth and mortality. Using field and laboratory studies, this project quantified the combined effects of extremely low salinities (<5) and high temperatures (>30°C) on growth and survival of spat, seed, andmarket-sized oysters. In 2012 and 2013, hatchery-produced oysters were placed in open and closed cages at three sites in Breton Sound, LA, along a salinity gradient that typically ranged from 5 to 20. Growth and mortality were recorded monthly. Regardless of size class, oysters at the lowest salinity site (annualmean = 4.8) experienced significantly highermortality and lower growth than oysters located in higher salinity sites (annual means = 11.1 and 13.0, respectively); furthermore, all oysters in open cages at the two higher salinity sites experienced higher mortality than in closed cages, likely due to predation. To explicitly examine oyster responses to extreme low salinity and high temperature combinations, a series of laboratory studies were conducted. Oysters were placed in 18 tanks in a fully crossed temperature (25°C, 32°C) by salinity (1, 5, and 15) study with three replicates, and repeated at least twice for each oyster size class. Regardless of temperature, seed and market oysters held in low salinity tanks (salinity 1) experienced 100% mortality within 7 days. In contrast, at salinity 5, temperature significantly affected mortality; oysters in all size classes experienced greater than 50%mortality at 32°C and less than 40%mortality at 25°C. At the highest salinity tested (15), only market-sized oysters held at 32°C experienced significant mortality (>60%). These studies demonstrate that high water temperatures (>30°C) and low salinities (<5) negatively impact oyster growth and survival differentially and that high temperatures alone may negatively impact market-sized oysters. It is critical to understand the potential impacts of climate and anthropogenic changes on oyster resources to better adapt and manage for long-term sustainability.

The effect of ambient temperature on diabetes mortality in China: A multi-city time series study.

PubMed

Yang, Jun; Yin, Peng; Zhou, Maigeng; Ou, Chun-Quan; Li, Mengmeng; Liu, Yunning; Gao, Jinghong; Chen, Bin; Liu, Jiangmei; Bai, Li; Liu, Qiyong

2016-02-01

Few multi-city studies have been conducted to investigate the acute health effects of low and high temperatures on diabetes mortality worldwide. We aimed to examine effects of ambient temperatures on city-/gender-/age-/education-specific diabetes mortality in nine Chinese cities using a two-stage analysis. Distributed lag non-linear model was first applied to estimate the city-specific non-linear and delayed effects of temperatures on diabetes mortality. Pooled effects of temperatures on diabetes mortality were then obtained using meta-analysis, based on restricted maximum likelihood. We found that heat effects were generally acute and followed by a period of mortality displacement, while cold effects could last for over two weeks. The pooled relative risks of extreme high (99th percentile of temperature) and high temperature (90th percentile of temperature) were 1.29 (95%CI: 1.11-1.47) and 1.11 (1.03-1.19) over lag 0-21 days, compared with the 75th percentile of temperature. In contrast, the pooled relative risks over lag 0-21 days were 1.44 (1.25-1.66) for extreme low (1st percentile of temperature) and 1.20 (1.12-1.30) for low temperature (10th percentile of temperature), compared to 25th percentile of temperature. The estimate of heat effects was relatively higher among females than that among males, with opposite trend for cold effects, and the estimates of heat and cold effects were particularly higher among the elderly and those with low education, although the differences between these subgroups were not statistically significant (P>0.05). These findings have important public health implications for protecting diabetes patients from adverse ambient temperatures. Copyright © 2015 Elsevier B.V. All rights reserved.

Effects of temperature on mortality in Hong Kong: a time series analysis

NASA Astrophysics Data System (ADS)

Yi, Wen; Chan, Albert P. C.

2015-07-01

Although interest in assessing the impacts of hot temperature and mortality in Hong Kong has increased, less evidence on the effect of cold temperature on mortality is available. We examined both the effects of heat and cold temperatures on daily mortality in Hong Kong for the last decade (2002-2011). A quasi-Poisson model combined with a distributed lag non-linear model was used to assess the non-linear and delayed effects of temperatures on cause-specific and age-specific mortality. Non-linear effects of temperature on mortality were identified. The relative risk of non-accidental mortality associated with cold temperature (11.1 °C, 1st percentile of temperature) relative to 19.4 °C (25th percentile of temperature) was 1.17 (95 % confidence interval (CI): 1.04, 1.29) for lags 0-13. The relative risk of non-accidental mortality associated with high temperature (31.5 °C, 99th percentile of temperature) relative to 27.8 °C (75th percentile of temperature) was 1.09 (95 % CI: 1.03, 1.17) for lags 0-3. In Hong Kong, extreme cold and hot temperatures increased the risk of mortality. The effect of cold lasted longer and greater than that of heat. People older than 75 years were the most vulnerable group to cold temperature, while people aged 65-74 were the most vulnerable group to hot temperature. Our findings may have implications for developing intervention strategies for extreme cold and hot temperatures.

Effects of temperature on mortality in Hong Kong: a time series analysis.

PubMed

Yi, Wen; Chan, Albert P C

2015-07-01

Although interest in assessing the impacts of hot temperature and mortality in Hong Kong has increased, less evidence on the effect of cold temperature on mortality is available. We examined both the effects of heat and cold temperatures on daily mortality in Hong Kong for the last decade (2002-2011). A quasi-Poisson model combined with a distributed lag non-linear model was used to assess the non-linear and delayed effects of temperatures on cause-specific and age-specific mortality. Non-linear effects of temperature on mortality were identified. The relative risk of non-accidental mortality associated with cold temperature (11.1 °C, 1st percentile of temperature) relative to 19.4 °C (25th percentile of temperature) was 1.17 (95% confidence interval (CI): 1.04, 1.29) for lags 0-13. The relative risk of non-accidental mortality associated with high temperature (31.5 °C, 99th percentile of temperature) relative to 27.8 °C (75th percentile of temperature) was 1.09 (95% CI: 1.03, 1.17) for lags 0-3. In Hong Kong, extreme cold and hot temperatures increased the risk of mortality. The effect of cold lasted longer and greater than that of heat. People older than 75 years were the most vulnerable group to cold temperature, while people aged 65-74 were the most vulnerable group to hot temperature. Our findings may have implications for developing intervention strategies for extreme cold and hot temperatures.

Mortality risks during extreme temperature events (ETEs) using a distributed lag non-linear model

NASA Astrophysics Data System (ADS)

Allen, Michael J.; Sheridan, Scott C.

2018-01-01

This study investigates the relationship between all-cause mortality and extreme temperature events (ETEs) from 1975 to 2004. For 50 U.S. locations, these heat and cold events were defined based on location-specific thresholds of daily mean apparent temperature. Heat days were defined by a 3-day mean apparent temperature greater than the 95th percentile while extreme heat days were greater than the 97.5th percentile. Similarly, calculations for cold and extreme cold days relied upon the 5th and 2.5th percentiles. A distributed lag non-linear model assessed the relationship between mortality and ETEs for a cumulative 14-day period following exposure. Subsets for season and duration effect denote the differences between early- and late-season as well as short and long ETEs. While longer-lasting heat days resulted in elevated mortality, early season events also impacted mortality outcomes. Over the course of the summer season, heat-related risk decreased, though prolonged heat days still had a greater influence on mortality. Unlike heat, cold-related risk was greatest in more southerly locations. Risk was highest for early season cold events and decreased over the course of the winter season. Statistically, short episodes of cold showed the highest relative risk, suggesting unsettled weather conditions may have some relationship to cold-related mortality. For both heat and cold, results indicate higher risk to the more extreme thresholds. Risk values provide further insight into the role of adaptation, geographical variability, and acclimatization with respect to ETEs.

Declining Mortality Inequality within Cities during the Health Transition.

PubMed

Costa, Dora L; Kahn, Matthew E

2015-05-01

In the United States in the late 19th and early 20th century, large cities had extremely high death rates from infectious disease. Within major cities such as New York City and Philadelphia, there was significant variation at any point in time in the mortality rate across neighborhoods. Between 1900 and 1930 neighborhood mortality convergence took place in New York City and Philadelphia. We document these trends and discuss their consequences for neighborhood quality of life dynamics and the economic incidence of who gains from effective public health interventions.

The association between consecutive days' heat wave and cardiovascular disease mortality in Beijing, China.

PubMed

Yin, Qian; Wang, Jinfeng

2017-02-23

Although many studies have examined the effects of heat waves on the excess mortality risk (ER) posed by cardiovascular disease (CVD), scant attention has been paid to the effects of various combinations of differing heat wave temperatures and durations. We investigated such effects in Beijing, a city of over 20 million residents. A generalized additive model (GAM) was used to analyze the ER of consecutive days' exposure to extreme high temperatures. A key finding was that when extremely high temperatures occur continuously, at varying temperature thresholds and durations, the adverse effects on CVD mortality vary significantly. The longer the heat wave lasts, the greater the mortality risk is. When the daily maximum temperature exceeded 35 °C from the fourth day onward, the ER attributed to consecutive days' high temperature exposure saw an increase to about 10% (p < 0.05), and at the fifth day, the ER even reached 51%. For the thresholds of 32 °C, 33 °C, and 34 °C, from the fifth day onward, the ER also rose sharply (16, 29, and 31%, respectively; p < 0.05). In addition, extreme high temperatures appeared to contribute to a higher proportion of CVD deaths among elderly persons, females and outdoor workers. When the daily maximum temperature was higher than 33 °C from the tenth consecutive day onward, the ER of CVD death among these groups was 94, 104 and 149%, respectively (p < 0.05), which is considerably higher than the ER for the overall population (87%; p < 0.05). The results of this study may assist governments in setting standards for heat waves, creating more accurate heat alerts, and taking measures to prevent or reduce temperature-related deaths, especially against the backdrop of global warming.

The influence of temperature on mortality and its Lag effect: a study in four Chinese cities with different latitudes.

PubMed

Bao, Junzhe; Wang, Zhenkun; Yu, Chuanhua; Li, Xudong

2016-05-04

Global climate change is one of the most serious environmental issues faced by humanity, and the resultant change in frequency and intensity of heat waves and cold spells could increase mortality. The influence of temperature on human health could be immediate or delayed. Latitude, relative humidity, and air pollution may influence the temperature-mortality relationship. We studied the influence of temperature on mortality and its lag effect in four Chinese cities with a range of latitudes over 2008-2011, adjusting for relative humidity and air pollution. We recorded the city-specific distributions of temperature and mortality by month and adopted a Poisson regression model combined with a distributed lag nonlinear model to investigate the lag effect of temperature on mortality. We found that the coldest months in the study area are December through March and the hottest months are June through September. The ratios of deaths during cold months to hot months were 1.43, 1.54, 1.37 and 1.12 for the cities of Wuhan, Changsha, Guilin and Haikou, respectively. The effects of extremely high temperatures generally persisted for 3 days, whereas the risk of extremely low temperatures could persist for 21 days. Compared with the optimum temperature of each city, at a lag of 21 days, the relative risks (95 % confidence interval) of extreme cold temperatures were 4.78 (3.63, 6.29), 2.38 (1.35, 4.19), 2.62 (1.15, 5.95) and 2.62 (1.44, 4.79) for Wuhan, Changsha, Guilin and Haikou, respectively. The respective risks were 1.35 (1.18, 1.55), 1.19 (0.96, 1.48), 1.22 (0.82, 1.82) and 2.47 (1.61, 3.78) for extreme hot temperatures, at a lag of 3 days. Temperature-mortality relationships vary among cities at different latitudes. Local governments should establish regional prevention and protection measures to more effectively confront and adapt to local climate change. The effects of hot temperatures predominantly occur over the short term, whereas those of cold temperatures can persist for an extended number of days.

Outcomes of lower extremity bypass performed for acute limb ischemia

PubMed Central

Baril, Donald T.; Patel, Virendra I.; Judelson, Dejah R.; Goodney, Philip P.; McPhee, James T.; Hevelone, Nathanael D.; Cronenwett, Jack L.; Schanzer, Andres

2013-01-01

Objective Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. Methods All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Results Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function, and respiratory complications. Patients who underwent lower extremity bypass for acute limb ischemia had no difference in rates of graft occlusion (18.1% vs 18.5%; P = .77), but did have significantly higher rates of limb loss (22.4% vs 9.7%; P < .0001) and mortality (20.9% vs 13.1%; P < .0001) at 1 year. On multivariable analysis, acute limb ischemia was an independent predictor of both major amputation (hazard ratio, 2.16; confidence interval, 1.38–3.40; P = .001) and mortality (hazard ratio, 1.41; confidence interval, 1.09–1.83; P = .009) at 1 year. Conclusions Patients who present with acute limb ischemia represent a less medically optimized subgroup within the population of patients undergoing lower extremity bypass. These patients may be expected to have more complex operations followed by increased rates of perioperative adverse events. Additionally, despite equivalent graft patency rates, patients undergoing lower extremity bypass for acute ischemia have significantly higher rates of major amputation and mortality at 1 year. PMID:23714364

Outcomes of lower extremity bypass performed for acute limb ischemia.

PubMed

Baril, Donald T; Patel, Virendra I; Judelson, Dejah R; Goodney, Philip P; McPhee, James T; Hevelone, Nathanael D; Cronenwett, Jack L; Schanzer, Andres

2013-10-01

Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function, and respiratory complications. Patients who underwent lower extremity bypass for acute limb ischemia had no difference in rates of graft occlusion (18.1% vs 18.5%; P = .77), but did have significantly higher rates of limb loss (22.4% vs 9.7%; P < .0001) and mortality (20.9% vs 13.1%; P < .0001) at 1 year. On multivariable analysis, acute limb ischemia was an independent predictor of both major amputation (hazard ratio, 2.16; confidence interval, 1.38-3.40; P = .001) and mortality (hazard ratio, 1.41; confidence interval, 1.09-1.83; P = .009) at 1 year. Patients who present with acute limb ischemia represent a less medically optimized subgroup within the population of patients undergoing lower extremity bypass. These patients may be expected to have more complex operations followed by increased rates of perioperative adverse events. Additionally, despite equivalent graft patency rates, patients undergoing lower extremity bypass for acute ischemia have significantly higher rates of major amputation and mortality at 1 year. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

A window of opportunity for climate-change adaptation: Easing tree mortality by reducing forest basal area

USGS Publications Warehouse

Bradford, John B.; Bell, David M.

2017-01-01

Increasing aridity as a result of climate change is expected to exacerbate tree mortality. Reducing forest basal area – the cross-sectional area of tree stems within a given ground area – can decrease tree competition, which may reduce drought-induced tree mortality. However, neither the magnitude of expected mortality increases, nor the potential effectiveness of basal area reduction, has been quantified in dryland forests such as those of the drought-prone Southwest US. We used thousands of repeatedly measured forest plots to show that unusually warm and dry conditions are related to high tree mortality rates and that mortality is positively related to basal area. Those relationships suggest that while increasing high temperature extremes forecasted by climate models may lead to elevated tree mortality during the 21st century, future tree mortality might be partly ameliorated by reducing stand basal area. This adaptive forest management strategy may provide a window of opportunity for forest managers and policy makers to guide forest transitions to species and/or genotypes more suited to future climates.

Mortality, Disenrollment, and Spending Persistence in Medicaid and CHIP.

PubMed

DeLia, Derek

2017-03-01

Research on spending persistence has not focused on Medicaid and the Children's Health Insurance Program (Medicaid/CHIP), which includes a complex and growing population. The objective of the study was to describe patterns of expenditure persistence, mortality, and disenrollment among nondually eligible Medicaid/CHIP enrollees and identify factors predicting these outcomes. The study is based on New Jersey Medicaid/CHIP claims data from 2011 to 2014. Descriptive and multinomial regression methods were used to characterize persistently extreme spenders, defined as those appearing in the top 1% of statewide spending every year, according to demographics, Medicaid/CHIP eligibility, nursing facility residence, patient risk scores, and clinical diagnostic categories measured in 2011. Similar analyses were done for persistently high spenders (ie, always in the top 10% but not always top 1%) as well as decedents, disenrollees, and moderate spenders (ie, at least 1 year outside of the top 10%). Nondually eligible NJ Medicaid/CHIP enrollees in 2011. One fourth of extreme spenders in 2011 remained in that category throughout 2011-2014. Almost all (89.3%) of the persistently extreme spenders were aged, blind, or disabled. Within the aged, blind, or disabled population, the strongest predictors of persistently extreme spending were diagnoses involving developmental disability, HIV/AIDS, central nervous system conditions, psychiatric disorders, type 1 diabetes, and renal conditions. Individuals in nursing facilities and those with very high risk scores were more likely to die or have persistently high spending than to have persistently extreme spending. The study highlights unique features of spending persistence within Medicaid/CHIP and provides methodological contributions to the broader persistence literature.

Temperature modifies the acute effect of particulate air pollution on mortality in eight Chinese cities.

PubMed

Meng, Xia; Zhang, Yuhao; Zhao, Zhuohui; Duan, Xiaoli; Xu, Xiaohui; Kan, Haidong

2012-10-01

Both temperature and particulate air pollution are associated with increased death risk. However, whether the effect of particulate air pollution on mortality is modified by temperature remains unsettled. A stratified time-series analysis was conducted to examine whether the effects of particulate matter less than 10 μm in aerodynamic diameter (PM(10)) on mortality was modified by temperature in eight Chinese cities. Poisson regression models incorporating natural spline smoothing functions were used to adjust for long-term and seasonal trends of mortality, as well as other time-varying covariates. The bivariate response surface model was applied to visually examine the potential interacting effect. The associations between PM(10) and mortality were stratified by temperature to examine effect modification. The averaged daily concentrations of PM(10) in the eight Chinese cities ranged from 65 μg/m(3) to 124 μg/m(3), which were much higher than in Western countries. We found evidence that the effects of PM(10) on mortality may depend on temperature. The eight-city combined analysis showed that on "normal" (5th-95th percentile) temperature days, a 10-μg/m(3) increment in PM(10) corresponded to a 0.54% (95% CI, 0.39 to 0.69) increase of total mortality, 0.56% (95% CI, 0.36 to 0.76) increase of cardiovascular mortality, and 0.80% (95% CI, 0.64 to 0.96) increase of respiratory mortality. On high temperature (>95th percentile) days, the estimates increased to 1.35% (95% CI, 0.80 to 1.91) for total mortality, 1.57% (95% CI, 0.69 to 2.46) for cardiovascular mortality, and 1.79% (95% CI, 0.75 to 2.83) for respiratory mortality. We did not observe significant effect modification by extreme low temperature. Extreme high temperature increased the associations of PM(10) with daily mortality. These findings may have implication for the health impact associated with both air pollution and global climate change. Copyright © 2012 Elsevier B.V. All rights reserved.

Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave

PubMed Central

Azhar, Gulrez Shah; Mavalankar, Dileep; Nori-Sarma, Amruta; Rajiva, Ajit; Dutta, Priya; Jaiswal, Anjali; Sheffield, Perry; Knowlton, Kim; Hess, Jeremy J.; Azhar, Gulrez Shah; Deol, Bhaskar; Bhaskar, Priya Shekhar; Hess, Jeremy; Jaiswal, Anjali; Khosla, Radhika; Knowlton, Kim; Mavalankar, Mavalankar; Rajiva, Ajit; Sarma, Amruta; Sheffield, Perry

2014-01-01

Introduction In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8°C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. Methods We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. Results The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest “summer” months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83, p<0.001] and 2.12 [95% CI 2.03–2.21] applying reference periods (May 12–18, 2010) from various years. Conclusion The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June. PMID:24633076

Mortality related to extreme temperature for 15 cities in northeast Asia.

PubMed

Chung, Yeonseung; Lim, Youn-Hee; Honda, Yasushi; Guo, Yue-Liang Leon; Hashizume, Masahiro; Bell, Michelle L; Chen, Bing-Yu; Kim, Ho

2015-03-01

Multisite time-series studies for temperature-related mortality have been conducted mainly in the United States and Europe, but are lacking in Asia. This multisite time-series study examined mortality related to extreme temperatures (both cold and hot) in Northeast Asia, focusing on 15 cities of 3 high-income countries. This study includes 3 cities in Taiwan for 1994-2007, 6 cities in Korea for 1992-2010, and 6 cities in Japan for 1972-2009. We used 2-stage Bayesian hierarchical Poisson semiparametric regression to model the nonlinear relationship between temperature and mortality, providing city-specific and country-wide estimates for cold and heat effects. Various exposure time frames, age groups, and causes of death were considered. Cold effects had longer time lags (5-11 days) than heat effects, which were immediate (1-3 days). Cold effects were larger for cities in Taiwan, whereas heat effects were larger for cities in Korea and Japan. Patterns of increasing effects with age were observed in both cold and heat effects. Both cold and heat effects were larger for cardiorespiratory mortality than for other causes of death. Several city characteristics related to weather or air pollution were associated with both cold and heat effects. Mortality increased with either cold or hot temperature in urban populations of high-income countries in Northeast Asia, with spatial variations of effects among cities and countries. Findings suggest that climate factors are major contributors to the spatial heterogeneity of effects in this region, although further research is merited to identify other factors as determinants of variability.

Leaf Area Index Drives Soil Water Availability and Extreme Drought-Related Mortality under Elevated CO2 in a Temperate Grassland Model System

PubMed Central

Manea, Anthony; Leishman, Michelle R.

2014-01-01

The magnitude and frequency of climatic extremes, such as drought, are predicted to increase under future climate change conditions. However, little is known about how other factors such as CO2 concentration will modify plant community responses to these extreme climatic events, even though such modifications are highly likely. We asked whether the response of grasslands to repeat extreme drought events is modified by elevated CO2, and if so, what are the underlying mechanisms? We grew grassland mesocosms consisting of 10 co-occurring grass species common to the Cumberland Plain Woodland of western Sydney under ambient and elevated CO2 and subjected them to repeated extreme drought treatments. The 10 species included a mix of C3, C4, native and exotic species. We hypothesized that a reduction in the stomatal conductance of the grasses under elevated CO2 would be offset by increases in the leaf area index thus the retention of soil water and the consequent vulnerability of the grasses to extreme drought would not differ between the CO2 treatments. Our results did not support this hypothesis: soil water content was significantly lower in the mesocosms grown under elevated CO2 and extreme drought-related mortality of the grasses was greater. The C4 and native grasses had significantly higher leaf area index under elevated CO2 levels. This offset the reduction in the stomatal conductance of the exotic grasses as well as increased rainfall interception, resulting in reduced soil water content in the elevated CO2 mesocosms. Our results suggest that projected increases in net primary productivity globally of grasslands in a high CO2 world may be limited by reduced soil water availability in the future. PMID:24632832

Leaf area index drives soil water availability and extreme drought-related mortality under elevated CO2 in a temperate grassland model system.

PubMed

Manea, Anthony; Leishman, Michelle R

2014-01-01

The magnitude and frequency of climatic extremes, such as drought, are predicted to increase under future climate change conditions. However, little is known about how other factors such as CO2 concentration will modify plant community responses to these extreme climatic events, even though such modifications are highly likely. We asked whether the response of grasslands to repeat extreme drought events is modified by elevated CO2, and if so, what are the underlying mechanisms? We grew grassland mesocosms consisting of 10 co-occurring grass species common to the Cumberland Plain Woodland of western Sydney under ambient and elevated CO2 and subjected them to repeated extreme drought treatments. The 10 species included a mix of C3, C4, native and exotic species. We hypothesized that a reduction in the stomatal conductance of the grasses under elevated CO2 would be offset by increases in the leaf area index thus the retention of soil water and the consequent vulnerability of the grasses to extreme drought would not differ between the CO2 treatments. Our results did not support this hypothesis: soil water content was significantly lower in the mesocosms grown under elevated CO2 and extreme drought-related mortality of the grasses was greater. The C4 and native grasses had significantly higher leaf area index under elevated CO2 levels. This offset the reduction in the stomatal conductance of the exotic grasses as well as increased rainfall interception, resulting in reduced soil water content in the elevated CO2 mesocosms. Our results suggest that projected increases in net primary productivity globally of grasslands in a high CO2 world may be limited by reduced soil water availability in the future.

Historical Evolution of Old-Age Mortality and New Approaches to Mortality Forecasting

PubMed Central

Gavrilov, Leonid A.; Gavrilova, Natalia S.; Krut'ko, Vyacheslav N.

2017-01-01

Knowledge of future mortality levels and trends is important for actuarial practice but poses a challenge to actuaries and demographers. The Lee-Carter method, currently used for mortality forecasting, is based on the assumption that the historical evolution of mortality at all age groups is driven by one factor only. This approach cannot capture an additive manner of mortality decline observed before the 1960s. To overcome the limitation of the one-factor model of mortality and to determine the true number of factors underlying mortality changes over time, we suggest a new approach to mortality analysis and forecasting based on the method of latent variable analysis. The basic assumption of this approach is that most variation in mortality rates over time is a manifestation of a small number of latent variables, variation in which gives rise to the observed mortality patterns. To extract major components of mortality variation, we apply factor analysis to mortality changes in developed countries over the period of 1900–2014. Factor analysis of time series of age-specific death rates in 12 developed countries (data taken from the Human Mortality Database) identified two factors capable of explaining almost 94 to 99 percent of the variance in the temporal changes of adult death rates at ages 25 to 85 years. Analysis of these two factors reveals that the first factor is a “young-age” or background factor with high factor loadings at ages 30 to 45 years. The second factor can be called an “oldage” or senescent factor because of high factor loadings at ages 65 to 85 years. It was found that the senescent factor was relatively stable in the past but now is rapidly declining for both men and women. The decline of the senescent factor is faster for men, although in most countries, it started almost 30 years later. Factor analysis of time series of age-specific death rates conducted for the oldest-old ages (65 to 100 years) found two factors explaining variation of mortality at extremely old ages in the United States. The first factor is comparable to the senescent factor found for adult mortality. The second factor, however, is specific to extreme old ages (96 to 100 years) and shows peaks in 1960 and 2000. Although mortality below 90 to 95 years shows a steady decline with time driven by the senescent factor, mortality of centenarians does not decline and remains relatively stable. The approach suggested in this paper has several advantages. First, it is able to determine the total number of independent factors affecting mortality changes over time. Second, this approach allows researchers to determine the time interval in which underlying factors remain stable or undergo rapid changes. Most methods of mortality projections are not able to identify the best base period for mortality projections, attempting to use the longest-possible time period instead. We observe that the senescent factor of mortality continues to decline, and this decline does not demonstrate any indications of slowing down. At the same time, mortality of centenarians does not decline and remains stable. The lack of mortality decline at extremely old ages may diminish anticipated longevity gains in the future. PMID:29170765

[Influence of daily ambient temperature on mortality and years of life lost in Chongqing].

PubMed

Li, Jing; Luo, Shuquan; Ding, Xianbin; Yang, Jun; Li, Jing; Liu, Xiaobo; Gao, Jinghong; Xu, Lei; Tang, Wenge; Liu, Qiyong

2016-03-01

To evaluate the influence of extreme ambient temperature on mortality and years of life lost (YLL) in Chongqing. The daily mortality, meteorology and air pollution index data in Chongqing from the 1(st) January 2010 to the 31(st) December 2013 were collected. Distributed lag non-linear model (DLNM) was used to assess the influence of daily ambient temperature on daily number of deaths and daily YLL respectively. The delayed and cumulative effects of extreme temperature on sex, age, and cause-specific mortality were also assessed. The relationships between ambient temperature and non-accidental, cardiovascular disease and respiratory disease mortalities and YLL were U-shaped or W-shaped. The effect of heat was obvious on that day, peaked on day 7, and lasted for two weeks, whereas the effect of cold was obvious a week later and lasted for a month. As 1 ℃ increase of ambient temperature, the cumulative relative risks (CRR) of high temperature across lag 0-7 days on non-accidental, respiratory disease and cardiovascular disease mortalities were 1.05 (95%CI: 1.03-1.07), 1.08 (95%CI: 1.05-1.11) and 1.05 (95%CI: 1.01-1.09) respectively. The effects of heat on YLL for each cause were 23.81 (95%CI: 12.31-35.31), 14.34 (95%CI: 8.98-19.70) and 4.43 (95%CI: 1.64-7.21), respectively. On cold days, 1 ℃ decrease of ambient temperature was correlated with an increase in CRR of 1.06 (95%CI: 1.04-1.08), 1.09 (95%CI:1.06-1.12) and 1.06 (95%CI: 1.02-1.11) from lag 0 to 14 for non-accidental, respiratory disease and cardiovascular disease mortalities, respectively. The estimated YLL were 23.34 (95%CI: 10.04-36.64), 16.39 (95%CI: 10.19-22.59) and 2.61 (95%CI: -0.61-5.82). People aged ≥65 years tend to have higher CRR and YLL than those aged <65 years. On high temperature days, the CRR in women was higher than that in men, while the YLL in women was lower than that in men. On low temperature days, both the CRR and YLL in women were higher than those in men. Both high and low ambient temperature have adverse health effects. People aged ≥65 years are more sensitive to both high and low ambient temperature. Younger men are more sensitive to high ambient temperature and women and elder men are sensitive to low ambient temperature. It is necessary to take targeted measures to protect the population in Chongqing from the adverse influence of extreme ambient temperature.

Delineation of Spatial Variability in the Temperature-Mortality Relationship on Extremely Hot Days in Greater Vancouver, Canada.

PubMed

Ho, Hung Chak; Knudby, Anders; Walker, Blake Byron; Henderson, Sarah B

2017-01-01

Climate change has increased the frequency and intensity of extremely hot weather. The health risks associated with extemely hot weather are not uniform across affected areas owing to variability in heat exposure and social vulnerability, but these differences are challenging to map with precision. We developed a spatially and temporally stratified case-crossover approach for delineation of areas with higher and lower risks of mortality on extremely hot days and applied this approach in greater Vancouver, Canada. Records of all deaths with an extremely hot day as a case day or a control day were extracted from an administrative vital statistics database spanning the years of 1998-2014. Three heat exposure and 11 social vulnerability variables were assigned at the residential location of each decedent. Conditional logistic regression was used to estimate the odds ratio for a 1°C increase in daily mean temperature at a fixed site with an interaction term for decedents living above and below different values of the spatial variables. The heat exposure and social vulnerability variables with the strongest spatially stratified results were the apparent temperature and the labor nonparticipation rate, respectively. Areas at higher risk had values ≥ 34.4°C for the maximum apparent temperature and ≥ 60% of the population neither employed nor looking for work. These variables were combined in a composite index to quantify their interaction and to enhance visualization of high-risk areas. Our methods provide a data-driven framework for spatial delineation of the temperature--mortality relationship by heat exposure and social vulnerability. The results can be used to map and target the most vulnerable areas for public health intervention. Citation: Ho HC, Knudby A, Walker BB, Henderson SB. 2017. Delineation of spatial variability in the temperature-mortality relationship on extremely hot days in greater Vancouver, Canada. Environ Health Perspect 125:66-75; http://dx.doi.org/10.1289/EHP224.

Delineation of Spatial Variability in the Temperature–Mortality Relationship on Extremely Hot Days in Greater Vancouver, Canada

PubMed Central

Ho, Hung Chak; Knudby, Anders; Walker, Blake Byron; Henderson, Sarah B.

2016-01-01

Background: Climate change has increased the frequency and intensity of extremely hot weather. The health risks associated with extemely hot weather are not uniform across affected areas owing to variability in heat exposure and social vulnerability, but these differences are challenging to map with precision. Objectives: We developed a spatially and temporally stratified case-crossover approach for delineation of areas with higher and lower risks of mortality on extremely hot days and applied this approach in greater Vancouver, Canada. Methods: Records of all deaths with an extremely hot day as a case day or a control day were extracted from an administrative vital statistics database spanning the years of 1998–2014. Three heat exposure and 11 social vulnerability variables were assigned at the residential location of each decedent. Conditional logistic regression was used to estimate the odds ratio for a 1°C increase in daily mean temperature at a fixed site with an interaction term for decedents living above and below different values of the spatial variables. Results: The heat exposure and social vulnerability variables with the strongest spatially stratified results were the apparent temperature and the labor nonparticipation rate, respectively. Areas at higher risk had values ≥ 34.4°C for the maximum apparent temperature and ≥ 60% of the population neither employed nor looking for work. These variables were combined in a composite index to quantify their interaction and to enhance visualization of high-risk areas. Conclusions: Our methods provide a data-driven framework for spatial delineation of the temperature-–mortality relationship by heat exposure and social vulnerability. The results can be used to map and target the most vulnerable areas for public health intervention. Citation: Ho HC, Knudby A, Walker BB, Henderson SB. 2017. Delineation of spatial variability in the temperature–mortality relationship on extremely hot days in greater Vancouver, Canada. Environ Health Perspect 125:66–75; http://dx.doi.org/10.1289/EHP224 PMID:27346526

Contrasting patterns of hospital admissions and mortality during heat waves: are deaths from circulatory disease a real excess or an artifact?

PubMed

Mastrangelo, Giuseppe; Hajat, Shakoor; Fadda, Emanuela; Buja, Alessandra; Fedeli, Ugo; Spolaore, Paolo

2006-01-01

In old subjects exposed to extreme high temperature during a heat wave, studies have consistently reported an excess of death from cardio- or cerebro-vascular disease. By contrast, dehydration, heat stroke, acute renal insufficiency, and respiratory disease were the main causes of hospital admission in the two studies carried out in elderly during short spells of hot weather. The excess of circulatory disease reported by mortality studies, but not by morbidity studies, could be explained by the hypothesis that deaths from circulatory disease occur rapidly in isolated people before they reach a hospital. Since the contrasting patterns of hospital admission and mortality during heat waves could also be due to chance (random variation over time and space in the spectrum of diseases induced by extreme heat), and bias (poor quality of diagnosis on death certificate and other artifacts), it should be confirmed by a concurrent study of mortality and morbidity. Many heat-related diseases may be preventable with adequate warning and an appropriate response to heat emergencies, but preventive efforts are complicated by the short time interval that may elapse between high temperatures and death. Therefore, prevention programs must be based around rapid identification of high-risk conditions and persons. The effectiveness of the intervention measures must be formally evaluated. If cardio- and cerebro-vascular diseases are rapidly fatal health outcomes with a short time interval between exposure to high temperature and death, deaths from circulatory disease might be an useful indicator in evaluating the effectiveness of a heat watch/warning system.

Mortality of shallow reef corals in the western Arabian Gulf following aerial exposure in winter

NASA Astrophysics Data System (ADS)

Fadlallah, Y. H.; Allen, K. W.; Estudillo, R. A.

1995-05-01

Aerial exposure of patch reef corals occurred in Tarut Bay, western Arabian Gulf, (Saudi Arabia) between December 1991 and May 1992, and coincided with extreme low spring tides (below the predicted lowest astronomical tide-LAT). Colonies of Acropora and Stylophora occurring at the highest levels on the tops of patch reef platforms were most affected by the low tides. Corals fully exposed to air suffered total mortality, whereas those not fully exposed suffered tissue damage to their upper parts. Exposure occurred during winter months when air and water temperatures are at their lowest in the gulf. Coupling of extremely low spring tides with wind-induced negative surges (below LAT) are not regular events but are not infrequent. Cold temperatures and exposure may act in concert to produce disproportionate mortalities of reef flat corals in the shallow coastal areas of eastern Saudi Arabia. It is highly unlikely that the Gulf War oil spill played any role in the observed damage to reef corals in the Gulf in 1992.

Temperature modifies the association between particulate air pollution and mortality: A multi-city study in South Korea.

PubMed

Kim, Satbyul Estella; Lim, Youn-Hee; Kim, Ho

2015-08-15

Substantial epidemiologic literature has demonstrated the effects of air pollution and temperature on mortality. However, there is inconsistent evidence regarding the temperature modification effect on acute mortality due to air pollution. Herein, we investigated the effects of temperature on the relationship between air pollution and mortality due to non-accidental, cardiovascular, and respiratory death in seven cities in South Korea. We applied stratified time-series models to the data sets in order to examine whether the effects of particulate matter <10 μm (PM10) on mortality were modified by temperature. The effect of PM10 on daily mortality was first quantified within different ranges of temperatures at each location using a time-series model, and then the estimates were pooled through a random-effects meta-analysis using the maximum likelihood method. From all the data sets, 828,787 non-accidental deaths were registered from 2000-2009. The highest overall risk between PM10 and non-accidental or cardiovascular mortality was observed on extremely hot days (daily mean temperature: >99th percentile) in individuals aged <65 years. In those aged ≥65 years, the highest overall risk between PM10 and non-accidental or cardiovascular mortality was observed on very hot days and not on extremely hot days (daily mean temperature: 95-99th percentile). There were strong harmful effects from PM10 on non-accidental mortality with the highest temperature range (>99th percentile) in men, with a very high temperature range (95-99th percentile) in women. Our findings showed that temperature can affect the relationship between the PM10 levels and cause-specific mortality. Moreover, the differences were apparent after considering the age and sex groups. Copyright © 2015 Elsevier B.V. All rights reserved.

The effect of mortality salience on women's judgments of male faces.

PubMed

Vaughn, James E; Bradley, Kristopher I; Byrd-Craven, Jennifer; Kennison, Shelia M

2010-08-30

Previous research has shown that individuals who are reminded of their death exhibited a greater desire for offspring than those who were not reminded of their death. The present research investigated whether being reminded of mortality affects mate selection behaviors, such as facial preference judgments. Prior research has shown that women prefer more masculine faces when they are at the high versus low fertility phase of their menstrual cycles. We report an experiment in which women were tested either at their high or fertility phase. They were randomly assigned to either a mortality salience (MS) or control condition and then asked to judge faces ranging from extreme masculine to extreme feminine. The results showed that women's choice of the attractive male face was determined by an interaction between fertility phase and condition. In control conditions, high fertility phase women preferred a significantly more masculine face than women who were in a lower fertility phase of their menstrual cycles. In MS conditions, high fertility phase women preferred a significantly less masculine (i.e., more average) face than women who were in a low fertility phase. The results indicate that biological processes, such as fertility phase, involved in mate selection are sensitive to current environmental factors, such as death reminders. This sensitivity may serve as an adaptive compromise when choosing a mate in potentially adverse environmental conditions.

Heat stress related dairy cow mortality during heat waves and control periods in rural Southern Ontario from 2010-2012.

PubMed

Bishop-Williams, Katherine E; Berke, Olaf; Pearl, David L; Hand, Karen; Kelton, David F

2015-11-27

Heat stress is a physiological response to extreme environmental heat such as heat waves. Heat stress can result in mortality in dairy cows when extreme heat is both rapidly changing and has a long duration. As a result of climate change, heat waves, which are defined as 3 days of temperatures of 32 °C or above, are an increasingly frequent extreme weather phenomenon in Southern Ontario. Heat waves are increasing the risk for on-farm dairy cow mortality in Southern Ontario. Heat stress indices (HSIs) are generally based on temperature and humidity and provide a relative measure of discomfort which can be used to predict increased risk of on-farm dairy cow mortality. In what follows, the heat stress distribution was described over space and presented with maps. Similarly, on-farm mortality was described and mapped. The goal of this study was to demonstrate that heat waves and related HSI increases during 2010-2012 were associated with increased on-farm dairy cow mortality in Southern Ontario. Mortality records and farm locations for all farms registered in the CanWest Dairy Herd Improvement Program in Southern Ontario were retrieved for 3 heat waves and 6 three-day control periods from 2010 to 2012. A random sample of controls (2:1) was taken from the data set to create a risk-based hybrid design. On-farm heat stress was estimated using data from 37 weather stations and subsequently interpolated across Southern Ontario by geostatistical kriging. A Poisson regression model was applied to assess the on-farm mortality in relation to varying levels of the HSI. For every one unit increase in HSI the on-farm mortality rate across Southern Ontario increases by 1.03 times (CI95% (IRR) = (1.025,1.035); p = ≤ 0.001). With a typical 8.6 unit increase in HSI from a control period to a heat wave, mortality rates are predicted to increase by 1.27 times. Southern Ontario was affected by heat waves, as demonstrated by high levels of heat stress and increased on-farm mortality. Farmers should be aware of these risks, and informed of appropriate methods to mitigate such risks.

Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4, High-Molecular Weight Adiponectin, and Cardiovascular Mortality among Men with Type 2 Diabetes: A 22-Year Prospective Study

PubMed Central

Liu, Gang; Ding, Ming; Chiuve, Stephanie E.; Rimm, Eric B.; Franks, Paul W.; Meigs, James B.; Hu, Frank B.; Sun, Qi

2016-01-01

Objective To examine select adipokines, including fatty acid-binding protein 4 (FABP4), retinol-binding protein 4 (RBP4), and high-molecular weight (HMW) adiponectin in relation to cardiovascular disease (CVD) mortality among patients with type 2 diabetes (T2D). Approach and Results Plasma levels of FABP4, RBP4, and HMW adiponectin were measured in 950 men with T2D in the Health Professionals Follow-up Study. After an average of 22 years of follow up (1993–2015), 580 deaths occurred, of whom 220 died of CVD. After multivariate adjustment for covariates, higher levels of FABP4 were significantly associated with a higher CVD mortality: comparing extreme tertiles, the hazard ratio (HR) and 95% confidence interval (CI) of CVD mortality was 1.78 (1.22, 2.59; P trend=0.001). A positive association was also observed for HMW adiponectin: the HR (95% CI) was 2.07 (1.42, 3.06; P trend=0.0002), comparing extreme tertiles, whereas higher RBP4 levels were non-significantly associated with a decreased CVD mortality with an HR (95% CI) of 0.73 (0.50, 1.07; P trend=0.09). A Mendelian randomization (MR) analysis suggested that the causal relationships of HMW adiponectin and RBP4 would be directionally opposite to those observed based on the biomarkers, although none of the MR associations achieved statistical significance. Conclusions These data suggest that higher levels of FABP4 and HMW adiponectin are associated with elevated CVD mortality among men with T2D. Biological mechanisms underlying these observations deserve elucidation, but the associations of HMW adiponectin may partially reflect altered adipose tissue functionality among T2D patients. PMID:27609367

Farmers' perceptions of goat kid mortality under communal farming in Eastern Cape, South Africa.

PubMed

Slayi, Mhlangabezi; Maphosa, Viola; Fayemi, Olutope Peter; Mapfumo, Lizwell

2014-10-01

Rearing of goats under communal farming conditions is characterised by high kid mortality and low weaning percentages. A survey was conducted to determine farmers' perceptions on the causes of kid mortality during summer under the communal farming system in Nkonkobe Local Municipality in the Eastern Cape, South Africa. This was done by administering questionnaires to a total of 162 respondents in 14 villages around Nkonkobe Local Municipality. The study showed that majority of farmers (75 %) keep flock sizes of less than 10 goats and kids, and this indicates that goat production in Nkonkobe Local Municipality is suppressed. According to the farmers, diseases (89 %), endo-parasites (72 %) and ecto-parasites (68 %) were perceived as the major causes of kid mortality. Other causes reported include starvation (15 %), extreme weather conditions (28 %), abortion (7 %), theft (35 %), diarrhoea (43 %), accidents (10 %) and wounds (9 %). The low number of goats could be attributed to high mortalities. It was also found that all causes reported by farmers played a role in high kid mortality in Nkonkobe Local Municipality. However, the causes which require more emphasis to formulate extension support were tick-borne diseases and parasites. This study provided baseline information on possible causes of kid mortalities in Nkonkobe Local Municipality. There is, however, a need to conduct further studies to determine actual causes of high kid mortalities so as to develop preventive strategies that would minimize kid mortality for good economic returns.

Outcomes for extremely premature infants.

PubMed

Glass, Hannah C; Costarino, Andrew T; Stayer, Stephen A; Brett, Claire M; Cladis, Franklyn; Davis, Peter J

2015-06-01

Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and is now approximately 11.39%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23 to 24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal estimated date of confinement. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (<1000 g) remain at high risk for death and disability with 30% to 50% mortality and, in survivors, at least 20% to 50% risk of morbidity. The introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91% and 95% (compared with 85%-89%) avoids excess mortality; however, final analyses of data from these trials have not been published, so definitive recommendations are still pending. The development of neonatal neurocritical intensive care units may improve neurocognitive outcomes in this high-risk group. Long-term follow-up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages.The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, because therapy and supportive care continue to change, the outcomes of extremely low birth weight infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a "moving target."

Synoptic analysis of heat-related mortality in Sydney, Australia, 1993-2001

NASA Astrophysics Data System (ADS)

Vaneckova, Pavla; Hart, Melissa A.; Beggs, Paul J.; de Dear, Richard J.

2008-07-01

Exposure to extremely hot weather has been associated with increased mortality. Temporal Synoptic Index is an effective method used to analyze the relationship between mortality and combined weather factors. The aim of this study is to examine the short-term effect of ambient heat on mortality in Sydney during the warmest 6-month period (October-March) for the years 1993-2001. Eleven synoptic categories were related to daily mortality rates in Sydney. Two distinctive warm categories were associated with significantly higher mortality rates. Hot, dry and relatively rare Synoptic Category 7 (SC7) days showed the highest daily mortality rates, followed by warm and humid SC3 days, which occurred more frequently. Increased mortality was more pronounced among the elderly population, and gender-stratified analysis showed women to be more vulnerable. Mortality on the day of the weather event was higher than 1 or 2 days after the adverse synoptic situation. Ozone and particulate matter smaller than 10 µm were found at high concentrations in SC3 and SC7, respectively, but their impact on mortality was not clear. The population of Sydney was found to be vulnerable to high temperatures, with a lower susceptibility than those of some cities in the USA and Europe.

Co-occurring woody species have diverse hydraulic strategies and mortality rates during an extreme drought

USDA-ARS?s Scientific Manuscript database

From 2011 to 2013, Texas experienced its worst drought in recorded history. This event provided a unique natural experiment to assess species-specific responses to extreme drought and mortality of four co-occurring woody species: Quercus fusiformis, Diospyros texana, Prosopis glandulosa and Juniper...

Do the Brazilian sardine commercial landings respond to local ocean circulation?

PubMed

Gouveia, Mainara B; Gherardi, Douglas F M; Lentini, Carlos A D; Dias, Daniela F; Campos, Paula C

2017-01-01

It has been reported that sea surface temperature (SST) anomalies, flow intensity and mesoscale ocean processes, all affect sardine production, both in eastern and western boundary current systems. Here we tested the hypothesis whether extreme high and low commercial landings of the Brazilian sardine fisheries in the South Brazil Bight (SBB) are sensitive to different oceanic conditions. An ocean model (ROMS) and an individual based model (Ichthyop) were used to assess the relationship between oceanic conditions during the spawning season and commercial landings of the Brazilian sardine one year later. Model output was compared with remote sensing and analysis data showing good consistency. Simulations indicate that mortality of eggs and larvae by low temperature prior to maximum and minimum landings are significantly higher than mortality caused by offshore advection. However, when periods of maximum and minimum sardine landings are compared with respect to these causes of mortality no significant differences were detected. Results indicate that mortality caused by prevailing oceanic conditions at early life stages alone can not be invoked to explain the observed extreme commercial landings of the Brazilian sardine. Likely influencing factors include starvation and predation interacting with the strategy of spawning "at the right place and at the right time".

Abrupt Increases in Amazonian Tree Mortality Due to Drought-Fire Interactions

NASA Technical Reports Server (NTRS)

Brando, Paulo Monteiro; Balch, Jennifer K.; Nepstad, Daniel C.; Morton, Douglas C.; Putz, Francis E.; Coe, Michael T.; Silverio, Divino; Macedo, Marcia N.; Davidson, Eric A.; Nobrega, Caroline C.;

Abrupt increases in Amazonian tree mortality due to drought-fire interactions.

PubMed

Brando, Paulo Monteiro; Balch, Jennifer K; Nepstad, Daniel C; Morton, Douglas C; Putz, Francis E; Coe, Michael T; Silvério, Divino; Macedo, Marcia N; Davidson, Eric A; Nóbrega, Caroline C; Alencar, Ane; Soares-Filho, Britaldo S

2014-04-29

Interactions between climate and land-use change may drive widespread degradation of Amazonian forests. High-intensity fires associated with extreme weather events could accelerate this degradation by abruptly increasing tree mortality, but this process remains poorly understood. Here we present, to our knowledge, the first field-based evidence of a tipping point in Amazon forests due to altered fire regimes. Based on results of a large-scale, long-term experiment with annual and triennial burn regimes (B1yr and B3yr, respectively) in the Amazon, we found abrupt increases in fire-induced tree mortality (226 and 462%) during a severe drought event, when fuel loads and air temperatures were substantially higher and relative humidity was lower than long-term averages. This threshold mortality response had a cascading effect, causing sharp declines in canopy cover (23 and 31%) and aboveground live biomass (12 and 30%) and favoring widespread invasion by flammable grasses across the forest edge area (80 and 63%), where fires were most intense (e.g., 220 and 820 kW ⋅ m(-1)). During the droughts of 2007 and 2010, regional forest fires burned 12 and 5% of southeastern Amazon forests, respectively, compared with <1% in nondrought years. These results show that a few extreme drought events, coupled with forest fragmentation and anthropogenic ignition sources, are already causing widespread fire-induced tree mortality and forest degradation across southeastern Amazon forests. Future projections of vegetation responses to climate change across drier portions of the Amazon require more than simulation of global climate forcing alone and must also include interactions of extreme weather events, fire, and land-use change.

Abrupt increases in Amazonian tree mortality due to drought–fire interactions

PubMed Central

Brando, Paulo Monteiro; Balch, Jennifer K.; Nepstad, Daniel C.; Morton, Douglas C.; Putz, Francis E.; Coe, Michael T.; Silvério, Divino; Macedo, Marcia N.; Davidson, Eric A.; Nóbrega, Caroline C.; Alencar, Ane; Soares-Filho, Britaldo S.

2014-01-01

Interactions between climate and land-use change may drive widespread degradation of Amazonian forests. High-intensity fires associated with extreme weather events could accelerate this degradation by abruptly increasing tree mortality, but this process remains poorly understood. Here we present, to our knowledge, the first field-based evidence of a tipping point in Amazon forests due to altered fire regimes. Based on results of a large-scale, long-term experiment with annual and triennial burn regimes (B1yr and B3yr, respectively) in the Amazon, we found abrupt increases in fire-induced tree mortality (226 and 462%) during a severe drought event, when fuel loads and air temperatures were substantially higher and relative humidity was lower than long-term averages. This threshold mortality response had a cascading effect, causing sharp declines in canopy cover (23 and 31%) and aboveground live biomass (12 and 30%) and favoring widespread invasion by flammable grasses across the forest edge area (80 and 63%), where fires were most intense (e.g., 220 and 820 kW⋅m−1). During the droughts of 2007 and 2010, regional forest fires burned 12 and 5% of southeastern Amazon forests, respectively, compared with <1% in nondrought years. These results show that a few extreme drought events, coupled with forest fragmentation and anthropogenic ignition sources, are already causing widespread fire-induced tree mortality and forest degradation across southeastern Amazon forests. Future projections of vegetation responses to climate change across drier portions of the Amazon require more than simulation of global climate forcing alone and must also include interactions of extreme weather events, fire, and land-use change. PMID:24733937

Threshold Evaluation of Emergency Risk Communication for Health Risks Related to Hazardous Ambient Temperature.

PubMed

Liu, Yang; Hoppe, Brenda O; Convertino, Matteo

2018-04-10

Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure. © 2018 Society for Risk Analysis.

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong

NASA Astrophysics Data System (ADS)

Ho, Hung Chak; Lau, Kevin Ka-Lun; Ren, Chao; Ng, Edward

2017-11-01

Extreme hot weather events are likely to increase under future climate change, and it is exacerbated in urban areas due to the complex urban settings. It causes excess mortality due to prolonged exposure to such extreme heat. However, there is lack of universal definition of prolonged heat or heat wave, which leads to inadequacies of associated risk preparedness. Previous studies focused on estimating temperature-mortality relationship based on temperature thresholds for assessing heat-related health risks but only several studies investigated the association between types of prolonged heat and excess mortality. However, most studies focused on one or a few isolated heat waves, which cannot demonstrate typical scenarios that population has experienced. In addition, there are limited studies on the difference between daytime and nighttime temperature, resulting in insufficiency to conclude the effect of prolonged heat. In sub-tropical high-density cities where prolonged heat is common in summer, it is important to obtain a comprehensive understanding of prolonged heat for a complete assessment of heat-related health risks. In this study, six types of prolonged heat were examined by using a time-stratified analysis. We found that more consecutive hot nights contribute to higher mortality risk while the number of consecutive hot days does not have significant association with excess mortality. For a day after five consecutive hot nights, there were 7.99% [7.64%, 8.35%], 7.74% [6.93%, 8.55%], and 8.14% [7.38%, 8.88%] increases in all-cause, cardiovascular, and respiratory mortality, respectively. Non-consecutive hot days or nights are also found to contribute to short-term mortality risk. For a 7-day-period with at least five non-consecutive hot days and nights, there was 15.61% [14.52%, 16.70%] increase in all-cause mortality at lag 0-1, but only -2.00% [-2.83%, -1.17%] at lag 2-3. Differences in the temperature-mortality relationship caused by hot days and hot nights imply the need to categorize prolonged heat for public health surveillance. Findings also contribute to potential improvement to existing heat-health warning system.

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong.

PubMed

Ho, Hung Chak; Lau, Kevin Ka-Lun; Ren, Chao; Ng, Edward

2017-11-01

Extreme hot weather events are likely to increase under future climate change, and it is exacerbated in urban areas due to the complex urban settings. It causes excess mortality due to prolonged exposure to such extreme heat. However, there is lack of universal definition of prolonged heat or heat wave, which leads to inadequacies of associated risk preparedness. Previous studies focused on estimating temperature-mortality relationship based on temperature thresholds for assessing heat-related health risks but only several studies investigated the association between types of prolonged heat and excess mortality. However, most studies focused on one or a few isolated heat waves, which cannot demonstrate typical scenarios that population has experienced. In addition, there are limited studies on the difference between daytime and nighttime temperature, resulting in insufficiency to conclude the effect of prolonged heat. In sub-tropical high-density cities where prolonged heat is common in summer, it is important to obtain a comprehensive understanding of prolonged heat for a complete assessment of heat-related health risks. In this study, six types of prolonged heat were examined by using a time-stratified analysis. We found that more consecutive hot nights contribute to higher mortality risk while the number of consecutive hot days does not have significant association with excess mortality. For a day after five consecutive hot nights, there were 7.99% [7.64%, 8.35%], 7.74% [6.93%, 8.55%], and 8.14% [7.38%, 8.88%] increases in all-cause, cardiovascular, and respiratory mortality, respectively. Non-consecutive hot days or nights are also found to contribute to short-term mortality risk. For a 7-day-period with at least five non-consecutive hot days and nights, there was 15.61% [14.52%, 16.70%] increase in all-cause mortality at lag 0-1, but only -2.00% [-2.83%, -1.17%] at lag 2-3. Differences in the temperature-mortality relationship caused by hot days and hot nights imply the need to categorize prolonged heat for public health surveillance. Findings also contribute to potential improvement to existing heat-health warning system.

Global issues and opportunities for optimized retinoblastoma care.

PubMed

Gallie, Brenda L; Zhao, Junyang; Vandezande, Kirk; White, Abigail; Chan, Helen S L

2007-12-01

The RB1 gene is important in all human cancers. Studies of human retinoblastoma point to a rare retinal cell with extreme dependency on RB1 for initiation but not progression to full malignancy. In developed countries, genetic testing within affected families can predict children at high risk of retinoblastoma before birth; chemotherapy with local therapy often saves eyes and vision; and mortality is 4%. In less developed countries where 92% of children with retinoblastoma are born, mortality reaches 90%. Global collaboration is building for the dramatic change in mortality that awareness, simple expertise and therapies could achieve in less developed countries. Copyright 2007 Wiley-Liss, Inc.

Mortality risk attributable to high and low ambient temperature: a multicountry observational study

PubMed Central

Gasparrini, Antonio; Guo, Yuming; Hashizume, Masahiro; Lavigne, Eric; Zanobetti, Antonella; Schwartz, Joel; Tobias, Aurelio; Tong, Shilu; Rocklöv, Joacim; Forsberg, Bertil; Leone, Michela; De Sario, Manuela; Bell, Michelle L; Guo, Yue-Liang Leon; Wu, Chang-fu; Kan, Haidong; Yi, Seung-Muk; de Sousa Zanotti Stagliorio Coelho, Micheline; Saldiva, Paulo Hilario Nascimento; Honda, Yasushi; Kim, Ho; Armstrong, Ben

2015-01-01

Summary Background Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures. Methods We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature–mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles. Findings We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43–7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80–90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality. Interpretation Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios. Funding UK Medical Research Council. PMID:26003380

Femoral vessel injuries in modern warfare since Vietnam.

PubMed

Pearl, Jonathan P; McNally, Michael P; Perdue, Philip W

2003-09-01

The incidence of lower extremity injuries is high in modern warfare; however the mortality rate from these injuries is low. Despite the overall low mortality of lower extremity injuries, many deaths in modern conflicts are due to femoral vessel injury. The modern warfare literature was reviewed. In Somalia, 1 of the 14 reported deaths was due to a laceration of the superficial femoral artery. In the Persian Gulf, three deaths were reported in an Army field hospital, one resulted from uncontrolled hemorrhage from a profunda femoris artery wound and two others resulted from traumatic amputations with consequent major arterial injury. Despite the advances in modern body armor, the groin is left unprotected. A strategy to help minimize U.S. casualties in modern warfare may be a method of field hemostasis specifically designed for femoral vessel injury.

Both low and high temperature may increase the risk of stroke mortality

PubMed Central

Chen, Renjie; Wang, Cuicui; Meng, Xia; Chen, Honglei; Thach, Thuan Quoc; Wong, Chit-Ming

2013-01-01

Objective: To examine temperature in relation to stroke mortality in a multicity time series study in China. Methods: We obtained data on daily temperature and mortality from 8 large cities in China. We used quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on stroke mortality across multiple days, adjusting for long-term and seasonal trends, day of the week, air pollution, and relative humidity. We applied the Bayesian hierarchical model to pool city-specific effect estimates. Results: Both cold and hot temperatures were associated with increased risk of stroke mortality. The potential effect of cold temperature might last more than 2 weeks. The pooled relative risks of extreme cold (first percentile of temperature) and cold (10th percentile of temperature) temperatures over lags 0–14 days were 1.39 (95% posterior intervals [PI] 1.18–1.64) and 1.11 (95% PI 1.06–1.17), compared with the 25th percentile of temperature. In contrast, the effect of hot temperature was more immediate. The relative risks of stroke mortality over lags 0–3 days were 1.06 (95% PI 1.02–1.10) for extreme hot temperature (99th percentile of temperature) and 1.14 (95% PI 1.05–1.24) for hot temperature (90th percentile of temperature), compared with the 75th percentile of temperature. Conclusions: This study showed that both cold and hot temperatures were associated with increased risk of stroke mortality in China. Our findings may have important implications for stroke prevention in China. PMID:23946311

Both low and high temperature may increase the risk of stroke mortality.

PubMed

Chen, Renjie; Wang, Cuicui; Meng, Xia; Chen, Honglei; Thach, Thuan Quoc; Wong, Chit-Ming; Kan, Haidong

2013-09-17

To examine temperature in relation to stroke mortality in a multicity time series study in China. We obtained data on daily temperature and mortality from 8 large cities in China. We used quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on stroke mortality across multiple days, adjusting for long-term and seasonal trends, day of the week, air pollution, and relative humidity. We applied the Bayesian hierarchical model to pool city-specific effect estimates. Both cold and hot temperatures were associated with increased risk of stroke mortality. The potential effect of cold temperature might last more than 2 weeks. The pooled relative risks of extreme cold (first percentile of temperature) and cold (10th percentile of temperature) temperatures over lags 0-14 days were 1.39 (95% posterior intervals [PI] 1.18-1.64) and 1.11 (95% PI 1.06-1.17), compared with the 25th percentile of temperature. In contrast, the effect of hot temperature was more immediate. The relative risks of stroke mortality over lags 0-3 days were 1.06 (95% PI 1.02-1.10) for extreme hot temperature (99th percentile of temperature) and 1.14 (95% PI 1.05-1.24) for hot temperature (90th percentile of temperature), compared with the 75th percentile of temperature. This study showed that both cold and hot temperatures were associated with increased risk of stroke mortality in China. Our findings may have important implications for stroke prevention in China.

Projected regional changes in the characteristics of dry and moist heat waves in the United States derived from downscaled CMIP5 models

NASA Astrophysics Data System (ADS)

Schoof, J. T.

2017-12-01

Extreme temperatures affect society in multiple ways, but the impacts are often different depending on the concurrent humidity. For example, the greatest impacts on human morbidity and mortality result when the temperature and humidity are both elevated. Conversely, high temperatures coupled with low humidity often lead to agricultural impacts resulting in lower yields. Despite the importance of humidity in determining heat wave impacts, relatively few students of future temperature extremes have also considered possible changes in humidity. In a recent study, we investigated recent historical changes in the frequency and intensity and low humidity and high humidity extreme temperature events using a framework based on isobaric equivalent temperature. Here, we extend this approach to climate projections from CMIP5 models to explore possible regional changes in extreme heat characteristics. After using quantile mapping to bias correct and downscale the CMIP5 model outputs, we analyze results from two future periods (2031-2055 and 2061-2085) and two representative concentration pathways, RCP 4.5 and RCP 8.5, corresponding to moderate and high levels of radiative forcing from greenhouse gases. For each of seven US regions, we consider changes in extreme temperature frequency, changes in the proportion of extreme temperature days characterized by high humidity, and changes in the magnitude of temperature and humidity on extreme temperature days.

Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation.

PubMed

Sakamoto, Yukiyo; Yamauchi, Yasuhiro; Yasunaga, Hideo; Takeshima, Hideyuki; Hasegawa, Wakae; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

2017-01-01

Community-acquired pneumonia (CAP) has high morbidity and mortality among adults. Several clinical guidelines recommend prompt administration of combined antimicrobial therapy. However, the association between guidelines concordance and mortality in patients with severe pneumonia remains unclear. The present study aimed to examine the impact of guidelines-concordant empiric antimicrobial therapy on 7-day mortality in patients with extremely severe pneumonia who required mechanical ventilation at admission, using a nationwide inpatient database in Japan. Data of CAP patients aged over 20 years who required mechanical ventilation at admission between April 2012 and March 2014 were retrospectively analyzed. Multivariable logistic regression analysis was performed to examine the association between guidelines-concordant empiric antimicrobial therapy and all-cause 7-day mortality, with adjustment for patient backgrounds and pneumonia severity. There were a total of 3719 eligible patients, 836 (22.5%) of whom received guidelines-concordant combination therapy. Overall, 7-day mortality was 29.5%. Higher 7-day mortality was associated with advanced age, confusion, lower systolic blood pressure, malignant tumor or immunocompromised state, and C-reactive protein ≥20mg/dl or infiltration occupying two-thirds of one lung on chest radiography. After adjustment for these variables, guidelines-concordant combined antimicrobial therapy was associated with significantly lower 7-day mortality (odds ratio: 0.78; 95% confidence interval: 0.65-0.95; P=0.013). Adherence to initial empiric treatment as recommended by the guidelines was associated with better short-term prognosis in patients with extremely severe pneumonia who required mechanical ventilation on hospital admission. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Pulmonary Function, Muscle Strength and Mortality in Old Age

PubMed Central

Buchman, A. S.; Boyle, P. A.; Wilson, R.S.; Gu, Liping; Bienias, Julia L.; Bennett, D. A.

2009-01-01

Numerous reports have linked extremity muscle strength with mortality but the mechanism underlying this association is not known. We used data from 960 older persons without dementia participating in the Rush Memory and Aging Project to test two sequential hypotheses: first, that extremity muscle strength is a surrogate for respiratory muscle strength, and second, that the association of respiratory muscle strength with mortality is mediated by pulmonary function. In a series of proportional hazards models, we first demonstrated that the association of extremity muscle strength with mortality was no longer significant after including a term for respiratory muscle strength, controlling for age, sex, education, and body mass index. Next, the association of respiratory muscle strength with mortality was attenuated by more than 50% and no longer significant after including a term for pulmonary function. The findings were unchanged after controlling for cognitive function, parkinsonian signs, physical frailty, balance, physical activity, possible COPD, use of pulmonary medications, vascular risk factors including smoking, chronic vascular diseases, musculoskeletal joint pain, and history of falls. Overall, these findings suggest that pulmonary function may partially account for the association of muscle strength and mortality. PMID:18755207

Necrotizing soft tissue infection caused by Serratia marcescens: A case report and literature review.

PubMed

Hagiya, Hideharu; Ojima, Masahiro; Yoshida, Takeshi; Matsui, Takahiro; Morii, Eiichi; Sato, Kazuaki; Tahara, Shinichiro; Yoshida, Hisao; Tomono, Kazunori

2016-05-01

A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date. Our case is the first evidence of an S. marcescens NSTI in a patient with liver cirrhosis. S. marcescens NSTI has an extremely high mortality rate; total mortality and mortality in cases involving the extremities were 75% (12 of 16 cases) and 83.3% (10 of 12 cases), respectively. Physicians need to be aware that S. marcescens can induce fatal infections in community patients. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Do the Brazilian sardine commercial landings respond to local ocean circulation?

PubMed Central

Gherardi, Douglas F. M.; Lentini, Carlos A. D.; Dias, Daniela F.; Campos, Paula C.

2017-01-01

It has been reported that sea surface temperature (SST) anomalies, flow intensity and mesoscale ocean processes, all affect sardine production, both in eastern and western boundary current systems. Here we tested the hypothesis whether extreme high and low commercial landings of the Brazilian sardine fisheries in the South Brazil Bight (SBB) are sensitive to different oceanic conditions. An ocean model (ROMS) and an individual based model (Ichthyop) were used to assess the relationship between oceanic conditions during the spawning season and commercial landings of the Brazilian sardine one year later. Model output was compared with remote sensing and analysis data showing good consistency. Simulations indicate that mortality of eggs and larvae by low temperature prior to maximum and minimum landings are significantly higher than mortality caused by offshore advection. However, when periods of maximum and minimum sardine landings are compared with respect to these causes of mortality no significant differences were detected. Results indicate that mortality caused by prevailing oceanic conditions at early life stages alone can not be invoked to explain the observed extreme commercial landings of the Brazilian sardine. Likely influencing factors include starvation and predation interacting with the strategy of spawning “at the right place and at the right time”. PMID:28489925

Foetal mortality, infant mortality, and age of parents. An overview.

PubMed

Gourbin, C

2005-11-01

This review article examines the relationship between late foetal and infant mortality, and age of parents. The highest risks are observed at older maternal ages for foetal mortality and at both extremes of reproductive ages for infant mortality. For infant morbidity, the role of intermediate variables is discussed. Increasing paternal age seems to be related to higher foetal and neonatal mortality.

Meta-analysis reveals that hydraulic traits explain cross-species patterns of drought-induced tree mortality across the globe.

PubMed

Anderegg, William R L; Klein, Tamir; Bartlett, Megan; Sack, Lawren; Pellegrini, Adam F A; Choat, Brendan; Jansen, Steven

2016-05-03

Drought-induced tree mortality has been observed globally and is expected to increase under climate change scenarios, with large potential consequences for the terrestrial carbon sink. Predicting mortality across species is crucial for assessing the effects of climate extremes on forest community biodiversity, composition, and carbon sequestration. However, the physiological traits associated with elevated risk of mortality in diverse ecosystems remain unknown, although these traits could greatly improve understanding and prediction of tree mortality in forests. We performed a meta-analysis on species' mortality rates across 475 species from 33 studies around the globe to assess which traits determine a species' mortality risk. We found that species-specific mortality anomalies from community mortality rate in a given drought were associated with plant hydraulic traits. Across all species, mortality was best predicted by a low hydraulic safety margin-the difference between typical minimum xylem water potential and that causing xylem dysfunction-and xylem vulnerability to embolism. Angiosperms and gymnosperms experienced roughly equal mortality risks. Our results provide broad support for the hypothesis that hydraulic traits capture key mechanisms determining tree death and highlight that physiological traits can improve vegetation model prediction of tree mortality during climate extremes.

Successful Occlusion of a Ruptured Aortic Aneurysm Using the Amplatzer Vascular Plug: A Technical Note

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zander, Tobias, E-mail: tobiaszander@gmx.de; Baldi, Sebastian; Rabellino, Martin

2011-02-15

Ruptured abdominal aortic aneurysm is related with a 100% mortality rate if left untreated. Even with surgical intervention or endovascular repair, mortality is still extremely high. However, there are conditions in which neither open surgical aneurysm repair nor endovascular aneurysm repair can be considered a viable therapeutic option because of comorbidities or anatomic reasons. We report a case of successful endovascular treatment in a patient with ruptured abdominal aortic aneurysm by occluding the abdominal aneurysm using the Amplatzer Vascular Plug (AVP II).

Preoperative blood glucose and prognosis in diabetic patients undergoing lower extremity amputation.

PubMed

Nayak, Raj Kumar; Kirketerp-Møller, Klaus

2016-04-01

Previous work has shown that uncontrolled diabetes mellitus is associated with adverse surgical outcomes. The purpose of the present study was to establish if a high peri-operative random blood sugar (RBS) concentration among patients with diabetes with non-traumatic lower-extremity amputation (LEA) is a decisive factor behind post-operative outcomes (re-amputation/mortality) within three months after the first amputation. In this retrospective cohort study, the independent sample t-test, Pearson's chi-squared test and a Cox proportional hazards model were used. A total of 270 patients underwent non-traumatic LEA of whom 105 had diabetes, whereas 81 patients were included for this study. The mean age was 71 years (standard deviation: ± 11.8). Mortality was 27% and 16% were re-amputated within three months after their first amputation.The median pre-operative RBS level was 8.6 mmol/l (range: 4.6-18.7 mmol/l) with tertile ranges as follows: Q1 4.0-7.0 mmol/l; Q2 7.1-11.0 mmol/l; Q3 > 11.0 mmol/l. For the Q3 tertile, the age-adjusted hazard ratio for re-amputation was 0.77 (95% confidence interval (CI): 0.16-3.62) and for mortality it was 1.90 (95% CI: 0.50-7.22), with the Q1 tertile as the reference group. This study does not confirm that a high peri-operative RBS level can predict increased mortality or re-amputation among patients with diabetes who undergo non-traumatic LEA. Furthermore, based on our results, we cannot inform clinical decision-making about whether to delay or to avoid elective surgery in patients with a high RBS preoperatively. Further investigation is warranted. none. This trial was registered with the Danish Data Protection Agency (record no. 01975 HVH-2012-053).

Ambient temperature and coronary heart disease mortality in Beijing, China: a time series study

PubMed Central

2012-01-01

Background Many studies have examined the association between ambient temperature and mortality. However, less evidence is available on the temperature effects on coronary heart disease (CHD) mortality, especially in China. In this study, we examined the relationship between ambient temperature and CHD mortality in Beijing, China during 2000 to 2011. In addition, we compared time series and time-stratified case-crossover models for the non-linear effects of temperature. Methods We examined the effects of temperature on CHD mortality using both time series and time-stratified case-crossover models. We also assessed the effects of temperature on CHD mortality by subgroups: gender (female and male) and age (age > =65 and age < 65). We used a distributed lag non-linear model to examine the non-linear effects of temperature on CHD mortality up to 15 lag days. We used Akaike information criterion to assess the model fit for the two designs. Results The time series models had a better model fit than time-stratified case-crossover models. Both designs showed that the relationships between temperature and group-specific CHD mortality were non-linear. Extreme cold and hot temperatures significantly increased the risk of CHD mortality. Hot effects were acute and short-term, while cold effects were delayed by two days and lasted for five days. The old people and women were more sensitive to extreme cold and hot temperatures than young and men. Conclusions This study suggests that time series models performed better than time-stratified case-crossover models according to the model fit, even though they produced similar non-linear effects of temperature on CHD mortality. In addition, our findings indicate that extreme cold and hot temperatures increase the risk of CHD mortality in Beijing, China, particularly for women and old people. PMID:22909034

Outcomes for Extremely Premature Infants

PubMed Central

Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.

2015-01-01

Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity. The introduction of CPAP, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, since therapy and supportive care continue to change, the outcomes of ELBW infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a “moving target.” PMID:25988638

An Investigation on Attributes of Ambient Temperature and Diurnal Temperature Range on Mortality in Five East-Asian Countries.

PubMed

Lee, Whan-Hee; Lim, Youn-Hee; Dang, Tran Ngoc; Seposo, Xerxes; Honda, Yasushi; Guo, Yue-Liang Leon; Jang, Hye-Min; Kim, Ho

2017-08-31

Interest in the health effects of extremely low/high ambient temperature and the diurnal temperature range (DTR) on mortality as representative indices of temperature variability is growing. Although numerous studies have reported on these indices independently, few studies have provided the attributes of ambient temperature and DTR related to mortality, concurrently. In this study, we aimed to investigate and compare the mortality risk attributable to ambient temperature and DTR. The study included data of 63 cities in five East-Asian countries/regions during various periods between 1972 and 2013. The attributable risk of non-accidental death to ambient temperature was 9.36% (95% confidence interval [CI]: 8.98-9.69%) and to DTR was 0.59% (95% CI: 0.53-0.65%). The attributable cardiovascular mortality risks to ambient temperature (15.63%) and DTR (0.75%) are higher than the risks to non-accidental/respiratory-related mortality. We verified that ambient temperature plays a larger role in temperature-associated mortality, and cardiovascular mortality is susceptible to ambient temperature and DTR.

A biophysical basis for patchy mortality during heat waves.

PubMed

Mislan, K A S; Wethey, David S

2015-04-01

Extreme heat events cause patchy mortality in many habitats. We examine biophysical mechanisms responsible for patchy mortality in beds of the competitively dominant ecosystem engineer, the marine mussel Mytilus californianus, on the west coast of the United States. We used a biophysical model to predict daily fluctuations in body temperature at sites from southern California to Washington and used results of laboratory experiments on thermal tolerance to determine mortality rates from body temperature. In our model, we varied the rate of thermal conduction within mussel beds and found that this factor can account for large differences in body temperature and consequent mortality during heat waves. Mussel beds provide structural habitat for other species and increase local biodiversity, but, as sessile organisms, they are particularly vulnerable to extreme weather conditions. Identifying critical biophysical mechanisms related to mortality and ecological performance will improve our ability to predict the effects of climate change on these vulnerable ecosystems.

Disturbance legacies and climate jointly drive tree growth and mortality in an intensively studied boreal forest

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bond-Lamberty, Benjamin; Rocha, Adrian; Calvin, Katherine V.

2014-01-01

How will regional growth and mortality change with even relatively small climate shifts, even independent of catastrophic disturbances? This question is particularly acute for the North American boreal forest, which is carbon-dense and subject The goals of this study were to combine dendrochronological sampling, inventory records, and machine-learning algorithms to understand how tree growth and death have changed at one highly studied site (Northern Old Black Spruce, NOBS) in the central Canadian boreal forest. Over the 1999-2012 inventory period, mean DBH increased even as stand density and basal area declined significantly from 41.3 to 37.5 m2 ha-1. Tree mortality averagedmore » 1.4±0.6% yr-1, with most mortality occurring in medium-sized trees. A combined tree ring chronology constructed from 2001, 2004, and 2012 sampling showed several periods of extreme growth depression, with increased mortality lagging depressed growth by ~5 years. Minimum and maximum air temperatures exerted a negative influence on tree growth, while precipitation and climate moisture index had a positive effect; both current- and previous-year data exerted significant effects. Models based on these variables explained 23-44% of the ring-width variability. There have been at least one, and probably two, significant recruitment episodes since stand initiation, and we infer that past climate extremes led to significant NOBS mortality still visible in the current forest structure. These results imply that a combination of successional and demographic processes, along with mortality driven by abiotic factors, continue to affect the stand, with significant implications for our understanding of previous work at NOBS and the sustainable management of regional forests.« less

The contribution of preterm birth to the Black-White infant mortality gap, 1990 and 2000.

PubMed

Schempf, Ashley H; Branum, Amy M; Lukacs, Susan L; Schoendorf, Kenneth C

2007-07-01

We evaluated whether the decline of the racial disparity in preterm birth during the last decade was commensurate with a decline in the contribution of preterm birth to the infant mortality gap. We used linked files of 1990 and 2000 data on US infant births and deaths to partition the gap between Black and White infant mortality rates into differences in the (1) distribution of gestational age and (2) gestational age-specific mortality rates. Between 1990 and 2000, the Black-White infant mortality rate ratio did not change significantly (2.3 vs 2.4). Excess deaths among preterm Black infants accounted for nearly 80% of the Black-White infant mortality gap in both 1990 and 2000. The narrowing racial disparity in the preterm birth rate was counterbalanced by greater mortality reductions in White than in Black preterm infants. Extremely preterm birth (<28 weeks) was 4 times higher in Black infants and accounted for more than half of the infant mortality gap. Substantial reductions in the Black-White infant mortality gap will require improved prevention of extremely preterm birth among Black infants.

Impact of extreme temperatures on daily mortality in Madrid (Spain) among the 45-64 age-group.

PubMed

Díaz, Julio; Linares, Cristina; Tobías, Aurelio

2006-07-01

This paper analyses the relationship between extreme temperatures and mortality among persons aged 45-64 years. Daily mortality in Madrid was analysed by sex and cause, from January 1986 to December 1997. Quantitative analyses were performed using generalised additive models, with other covariables, such as influenza, air pollution and seasonality, included as controls. Our results showed that impact on mortality was limited for temperatures ranging from the 5th to the 95th percentiles, and increased sharply thereafter. During the summer period, the effect of heat was detected solely among males in the target age group, with an attributable risk (AR) of 13.3% for circulatory causes. Similarly, NO(2) concentrations registered the main statistically significant associations in females, with an AR of 15% when circulatory causes were considered. During winter, the impact of cold was exclusively observed among females having an AR of 7.7%. The magnitude of the AR indicates that the impact of extreme temperature is by no means negligible.

Impacts of climate change on heat-related mortality risk across the Middle East and North Africa (MENA)

NASA Astrophysics Data System (ADS)

Moradkhani, H.; Ahmadalipour, A.

2017-12-01

It has been reported that even if the global mean temperature increase is limited to 2°C, warming over land will be far beyond that in many regions. Global climate change will increase the frequency and intensity of heatwaves and extreme high temperatures, which will in turn have severe impacts on human life. In this study, the mortality risk caused by excessive heat stress is investigated. Daily maximum air temperature and relative humidity are acquired from 17 CMIP5 Regional Climate Models (RCMs) developed by CORDEX at 0.44 degree spatial resolution. Then, the daily wet-bulb temperature is calculated and a recently developed health risk model is implemented to quantify the mortality risk. The study is applied over the latitudes 6.6°S-42°N and longitudes 20°W-60°E covering parts of 70 countries and accommodating over 600 million inhabitants. The analysis is performed for the historical period of 1951-2005 as well as two future scenarios of RCP4.5 (moderate) and RCP8.5 (business as usual) during 2006-2100. Results indicate about 5 to 30 times higher mortality risk in distant future compared to the historical period. The most aggravation of mortality risk over land is found at the southwestern regions of MENA, due to substantial increase in frequency and intensity of extreme temperatures. Mortality risk is found to be much higher over open waters and coastal regions due to abundant humidity, especially in the coastal regions of the Red sea and Persian Gulf.

Study on the Association Between Ambient Temperature and Mortality Using Spatially Resolved Exposure Data

PubMed Central

Lee, Mihye; Shi, Liuhua; Zanobetti, Antonella; Schwartz, Joel D.

2016-01-01

There are many studies that have posited an association between extreme temperature and increased mortality. However, most studies use temperature at a single station per city as the reference point to analyze deaths. This leads to exposure misclassification and usually the exclusion of exurban, small town, and rural populations. In addition, few studies control for confounding by PM2.5, which is expected to induce upward bias. The high-resolution temperature and PM2.5 data at a resolution of 1 km2 were derived from satellite images and other land use sources. To capture the nonlinear association of temperature with mortality we fit a piecewise linear spline function for temperature, with a change in slope at −1 °C and 28 °C, the temperature threshold at which mortality in Georgia, North Carolina, and South Carolina increases due to cold and heat, respectively. We conducted stratified analyses by age group, sex, race, education, and urban vs nonurban, as well as sensitivity analyses of different temperature threshold and covariate sets. We found a 0.19% (95% CI = −0.98, 1.34%) increase in mortality for each 1 °C decrease in temperature below −1 °C and a 2.05% (95% CI = 0.87, 3.24%) increase in mortality for each 1°C increase in temperature above 28 °C, a 79.8% larger effect size for heat compared to the station-based metric. The effect estimates relying on the monitoring stations were 0.09% (95% CI = −0.79, 0.95%) and 1.14 % (95% CI = 0.08, 1.57%) for the equivalent temperature changes. The estimates were not confounded by PM2.5. Children under 15 years of age had the largest percentage increase per 1 °C increase in temperature (8.19%, 95% CI = −0.38 to 17.49%) followed by Blacks (4.35%, 95% CI = 2.22 to 6.53%). Higher education was a protective factor for the effect of extreme temperature on mortality. There was a suggestion that people in less urban areas were more susceptible to extreme temperature. The relationship between temperature and mortality was stronger when using exposure data with more spatial variability than using exposure data based on existing monitors alone. PMID:27611992

Antibody-Mediated Extreme Insulin Resistance: A Report of Three Cases.

PubMed

Kim, Han Na; Fesseha, Betiel; Anzaldi, Laura; Tsao, Allison; Galiatsatos, Panagis; Sidhaye, Aniket

2018-01-01

Type 2 diabetes mellitus is characterized by relative insulin deficiency and insulin resistance. Features suggesting severe insulin resistance include acanthosis nigricans, hyperandrogenism, weight loss, and recurrent hospital admissions for diabetic ketoacidosis. In rare circumstances, hyperglycemia persists despite administration of massive doses of insulin. In these cases, it is important to consider autoimmune etiologies for insulin resistance, such as type B insulin resistance and insulin antibody-mediated extreme insulin resistance, which carry high morbidity and mortality if untreated. Encouragingly, immunomodulatory regimens have recently been published that induce remission at high rates. We describe 3 cases of extreme insulin resistance mediated by anti-insulin receptor autoantibodies or insulin autoantibodies. All cases were effectively treated with an immunomodulatory regimen. Although cases of extreme insulin resistance are rare, it is important to be aware of autoimmune causes, recognize suggestive signs and symptoms, and pursue appropriate diagnostic evaluation. Prompt treatment with immunomodulators is key to restoring euglycemia in patients with autoimmune etiologies of insulin resistance. Copyright © 2018 Elsevier Inc. All rights reserved.

Heat Vulnerability Index Mapping for Milwaukee and Wisconsin.

PubMed

Christenson, Megan; Geiger, Sarah Dee; Phillips, Jeffrey; Anderson, Ben; Losurdo, Giovanna; Anderson, Henry A

Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.

Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4, High-Molecular-Weight Adiponectin, and Cardiovascular Mortality Among Men With Type 2 Diabetes: A 22-Year Prospective Study.

PubMed

Liu, Gang; Ding, Ming; Chiuve, Stephanie E; Rimm, Eric B; Franks, Paul W; Meigs, James B; Hu, Frank B; Sun, Qi

2016-11-01

To examine select adipokines, including fatty acid-binding protein 4, retinol-binding protein 4, and high-molecular-weight (HMW) adiponectin in relation to cardiovascular disease (CVD) mortality among patients with type 2 diabetes mellitus. Plasma levels of fatty acid-binding protein 4, retinol-binding protein 4, and HMW adiponectin were measured in 950 men with type 2 diabetes mellitus in the Health Professionals Follow-up Study. After an average of 22 years of follow-up (1993-2015), 580 deaths occurred, of whom 220 died of CVD. After multivariate adjustment for covariates, higher levels of fatty acid-binding protein 4 were significantly associated with a higher CVD mortality: comparing extreme tertiles, the hazard ratio and 95% confidence interval of CVD mortality was 1.78 (1.22-2.59; P trend=0.001). A positive association was also observed for HMW adiponectin: the hazard ratio (95% confidence interval) was 2.07 (1.42-3.06; P trend=0.0002), comparing extreme tertiles, whereas higher retinol-binding protein 4 levels were nonsignificantly associated with a decreased CVD mortality with an hazard ratio (95% confidence interval) of 0.73 (0.50-1.07; P trend=0.09). A Mendelian randomization analysis suggested that the causal relationships of HMW adiponectin and retinol-binding protein 4 would be directionally opposite to those observed based on the biomarkers, although none of the Mendelian randomization associations achieved statistical significance. These data suggest that higher levels of fatty acid-binding protein 4 and HMW adiponectin are associated with elevated CVD mortality among men with type 2 diabetes mellitus. Biological mechanisms underlying these observations deserve elucidation, but the associations of HMW adiponectin may partially reflect altered adipose tissue functionality among patients with type 2 diabetes mellitus. © 2016 American Heart Association, Inc.

Spontaneous methicillin-resistant Staphylococcus aureus (MRSA) meningitis.

PubMed

Longhurst, William D; Sheele, Johnathan M

2018-05-01

Spontaneous methicillin-resistant Staphylococcus aureus (MRSA) meningitis is extremely rare and has a high mortality rate. We report a case of MRSA meningitis in an otherwise healthy young adult female with no recent trauma or neurosurgical interventions. Despite antibiotics she suffered a vasculitis-induced cerebral vascular ischemic event. Copyright © 2018 Elsevier Inc. All rights reserved.

Co-occurring woody species have diverse hydraulic strategies and mortality rates during an extreme drought.

PubMed

Johnson, Daniel M; Domec, Jean-Christophe; Carter Berry, Z; Schwantes, Amanda M; McCulloh, Katherine A; Woodruff, David R; Wayne Polley, H; Wortemann, Remí; Swenson, Jennifer J; Scott Mackay, D; McDowell, Nate G; Jackson, Robert B

2018-03-01

From 2011 to 2013, Texas experienced its worst drought in recorded history. This event provided a unique natural experiment to assess species-specific responses to extreme drought and mortality of four co-occurring woody species: Quercus fusiformis, Diospyros texana, Prosopis glandulosa, and Juniperus ashei. We examined hypothesized mechanisms that could promote these species' diverse mortality patterns using postdrought measurements on surviving trees coupled to retrospective process modelling. The species exhibited a wide range of gas exchange responses, hydraulic strategies, and mortality rates. Multiple proposed indices of mortality mechanisms were inconsistent with the observed mortality patterns across species, including measures of the degree of iso/anisohydry, photosynthesis, carbohydrate depletion, and hydraulic safety margins. Large losses of spring and summer whole-tree conductance (driven by belowground losses of conductance) and shallower rooting depths were associated with species that exhibited greater mortality. Based on this retrospective analysis, we suggest that species more vulnerable to drought were more likely to have succumbed to hydraulic failure belowground. © 2018 John Wiley & Sons Ltd.

Long-term climate and competition explain forest mortality patterns under extreme drought.

PubMed

Young, Derek J N; Stevens, Jens T; Earles, J Mason; Moore, Jeffrey; Ellis, Adam; Jirka, Amy L; Latimer, Andrew M

2017-01-01

Rising temperatures are amplifying drought-induced stress and mortality in forests globally. It remains uncertain, however, whether tree mortality across drought-stricken landscapes will be concentrated in particular climatic and competitive environments. We investigated the effects of long-term average climate [i.e. 35-year mean annual climatic water deficit (CWD)] and competition (i.e. tree basal area) on tree mortality patterns, using extensive aerial mortality surveys conducted throughout the forests of California during a 4-year statewide extreme drought lasting from 2012 to 2015. During this period, tree mortality increased by an order of magnitude, typically from tens to hundreds of dead trees per km 2 , rising dramatically during the fourth year of drought. Mortality rates increased independently with average CWD and with basal area, and they increased disproportionately in areas that were both dry and dense. These results can assist forest managers and policy-makers in identifying the most drought-vulnerable forests across broad geographic areas. © 2016 John Wiley & Sons Ltd/CNRS.

High temperatures and nephrology: The climate change problem.

PubMed

de Lorenzo, Alberto; Liaño, Fernando

It is well known that climate change greatly affects human health, even though there are few studies on renal outcomes. Heat waves have been found to increase cardiovascular and respiratory morbidity and mortality, as well as the risk of acute renal failure and hospitalisation due to renal diseases, with related mortality. Recurrent dehydration in people regularly exposed to high temperatures seems to be resulting in an unrecognised cause of proteinuric chronic kidney disease, the underlying pathophysiological mechanism of which is becoming better understood. However, beyond heat waves and extreme temperatures, there is a seasonal variation in glomerular filtration rate that may contribute to the onset of renal failure and electrolyte disorders during extremely hot periods. Although there are few references in the literature, serum sodium disorders seem to increase. The most vulnerable population to heat-related disease are the elderly, children, chronic patients, bedridden people, disabled people, people living alone or with little social contact, and socioeconomically disadvantaged people. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Circulating Omega-6 Polyunsaturated Fatty Acids and Total and Cause-Specific Mortality: The Cardiovascular Health Study

PubMed Central

Wu, Jason HY; Lemaitre, Rozenn N; King, Irena B; Song, Xiaoling; Psaty, Bruce M; Siscovick, David S; Mozaffarian, Dariush

2014-01-01

Background While omega-6 polyunsaturated fatty acids(n-6 PUFA) have been recommended to reduce CHD, controversy remains about benefits vs. harms, including concerns over theorized pro-inflammatory effects of n-6 PUFA. We investigated associations of circulating n-6 PUFA including linoleic acid(LA, the major dietary PUFA), γ-linolenic acid(GLA), dihomo-γ-linolenic acid(DGLA), and arachidonic acid(AA),with total and cause-specific mortality in the Cardiovascular Health Study, a community-based US cohort. Methods and Results Among 2,792 participants(age≥65y) free of CVD at baseline, plasma phospholipid n-6 PUFAwere measured at baseline using standardized methods. All-cause and cause-specific mortality, and total incident CHD and stroke, were assessed and adjudicated centrally. Associations of PUFA with risk were assessed by Cox regression. During 34,291 person-years of follow-up(1992–2010), 1,994 deaths occurred(678 cardiovascular deaths), with 427 fatal and 418 nonfatal CHD, and 154 fatal and 399 nonfatal strokes. In multivariable models, higher LA was associated with lower total mortality, with extreme-quintile HR=0.87(P-trend=0.005). Lower death was largely attributable to CVD causes, especially nonarrhythmic CHD mortality(HR=0.51, 95%CI=0.32–0.82, P-trend=0.001). Circulating GLA, DGLA, and AA were not significantly associated with total or cause-specific mortality; e.g., for AA and CHD death, the extreme-quintile HR was 0.97 (95%CI=0.70–1.34, P-trend=0.87). Evaluated semi-parametrically, LA showed graded inverse associations with total mortality(P=0.005). There was little evidence that associations of n-6 PUFA with total mortality varied by age, sex, race, or plasma n-3 PUFA. Evaluating both n-6 and n-3 PUFA, lowest risk was evident with highest levels of both. Conclusions High circulating LA, but not other n-6 PUFA, was inversely associated with total and CHD mortality in older adults. PMID:25124495

Atmospheric rivers and the mass mortality of wild oysters: insight into an extreme future?

PubMed Central

Chang, Andrew L.; Deck, Anna; Ferner, Matthew C.

2016-01-01

Climate change is predicted to increase the frequency and severity of extreme events. However, the biological consequences of extremes remain poorly resolved owing to their unpredictable nature and difficulty in quantifying their mechanisms and impacts. One key feature delivering precipitation extremes is an atmospheric river (AR), a long and narrow filament of enhanced water vapour transport. Despite recent attention, the biological impacts of ARs remain undocumented. Here, we use biological data coupled with remotely sensed and in situ environmental data to describe the role of ARs in the near 100% mass mortality of wild oysters in northern San Francisco Bay. In March 2011, a series of ARs made landfall within California, contributing an estimated 69.3% of the precipitation within the watershed and driving an extreme freshwater discharge into San Francisco Bay. This discharge caused sustained low salinities (less than 6.3) that almost perfectly matched the known oyster critical salinity tolerance and was coincident with a mass mortality of one of the most abundant populations throughout this species' range. This is a concern, because wild oysters remain a fraction of their historical abundance and have yet to recover. This study highlights a novel mechanism by which precipitation extremes may affect natural systems and the persistence of sensitive species in the face of environmental change. PMID:27974516

Nonlinear Impact of Temperature on Mortality in France

NASA Astrophysics Data System (ADS)

Zhang, A. T.

2016-12-01

Anthropogenic climate change is posing unprecedented challenges to human welfare, yet there is much uncertainty about the cost of its impact. Accurate quantification of the social cost of carbon is crucial for designing effective climate policies that reduce emissions and mitigate the adverse impact of global warming, and human health is an important component of the calculation. Despite a growing body of literature documenting the relationship between temperature and mortality in the U.S., similar results using nationwide data have not been clearly established in other countries. Using random monthly variations in temperature for over a decade, this paper finds a statistically significant nonlinear relationship between monthly mortality rate and daily temperature in France between 1998 and 2012. Extremely hot days are associated with significantly higher mortality rates: One additional day with a mean temperature above 30°C, relative to a day in the 12°C to 15°C range, leads to 10 extra all-age, all-gender monthly deaths per 100,000. The effect of cold temperatures is milder: An extremely cold day with an average temperature from -9 °C to -6 °C increases all-age, all-gender mortality rate by about 1.2 per 100,000 each month. There is also notable heterogeneity in the observed nonlinear relationship across age groups and gender, in which males and the elderly are generally more susceptible to extreme temperatures than females and the young. This highlights that children and youth may be well protected through adaptive behaviors, such as spending more time indoors in temperature-controlled rooms and staying hydrated. Compared to studies done in the U.S., extremely hot days >30°C leads to considerably more deaths in France. Preliminary evidence suggests that there has been very limited adaptation despite two prominent heat waves in 2003 and 2006, although further analysis of electricity consumption and air conditioning usage is needed to ascertain the extent to which protective behavior mitigates mortality risks from temperature extremes.

The Effects of Extreme Temperature Events on Human Mortality in Europe: Winners and Losers

NASA Astrophysics Data System (ADS)

Merte, S.

2016-12-01

Climate change is a sizable threat to public health. Besides the shift in mean temperatures, there is also a change in the frequency of extreme temperature events. While cold spells become less frequent, heat waves become more common. As either of these can cause human death, the net-effect of climate change in terms of human excess mortality is currently unclear and and will vary depending on local conditions. The ability to estimate this net-effect is key when it comes to designing effective climate change adaptation policies as some areas will be affected earlier and/or stronger than others. This work provides the first large-scale estimate of this net-effect for Europe. Utilizing a novel methodology based on singular systems analysis, climate extreme-driven excess mortality is estimated using national-level health data. The first notable finding of this work is the confirmation that extreme temperature events already pose a major environmental risk: tens of thousands of people die every year in the examined European countries as a result of heat waves and cold spells. The second important result is that it demonstrates the need for climate change mitigation: Assuming moderate climate change, some countries in Northern and Western Europe will benefit from the shift in extreme temperature events — they will experience a net-reduction in excess mortality as a result of a drastically reduced frequency of cold spells. In contrast, assuming severe climate change, there will be a significant increase in excess mortality, in particular across countries in Southern Europe. This means that -if climate adaptation fails- there will be no winners, just losers.

Very Low Birth Weight Preterm Infants With Surgical Short Bowel Syndrome: Incidence, Morbidity and Mortality, and Growth Outcomes at 18 to 22 Months

PubMed Central

Cole, Conrad R.; Hansen, Nellie I.; Higgins, Rosemary D.; Ziegler, Thomas R.; Stoll, Barbara J.

2009-01-01

OBJECTIVES The objective of this study was to determine the (1) incidence of short bowel syndrome in very low birth weight (<1500 g) infants, (2) associated morbidity and mortality during initial hospitalization, and (3) impact on short-term growth and nutrition in extremely low birth weight (<1000 g) infants. METHODS Infants who were born from January 1, 2002, through June 30, 2005, and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Risk factors for developing short bowel syndrome as a result of partial bowel resection (surgical short bowel syndrome) and outcomes were evaluated for all neonates until hospital discharge, death, or 120 days. Extremely low birth weight survivors were further evaluated at 18 to 22 months’ corrected age for feeding methods and growth. RESULTS The incidence of surgical short bowel syndrome in this cohort of 12 316 very low birth weight infants was 0.7%. Necrotizing enterocolitis was the most common diagnosis associated with surgical short bowel syndrome. More very low birth weight infants with short bowel syndrome (20%) died during initial hospitalization than those without necrotizing enterocolitis or short bowel syndrome (12%) but fewer than the infants with surgical necrotizing enterocolitis without short bowel syndrome (53%). Among 5657 extremely low birth weight infants, the incidence of surgical short bowel syndrome was 1.1%. At 18 to 22 months, extremely low birth weight infants with short bowel syndrome were more likely to still require tube feeding (33%) and to have been rehospitalized (79%). Moreover, these infants had growth delay with shorter lengths and smaller head circumferences than infants without necrotizing enterocolitis or short bowel syndrome. CONCLUSIONS Short bowel syndrome is rare in neonates but has a high mortality rate. At 18 to 22 months’ corrected age, extremely low birth weight infants with short bowel syndrome were more likely to have growth failure than infants without short bowel syndrome. PMID:18762491

Randomized clinical trial of negative pressure wound therapy for high-risk groin wounds in lower extremity revascularization.

PubMed

Lee, Kevin; Murphy, Patrick B; Ingves, Matthew V; Duncan, Audra; DeRose, Guy; Dubois, Luc; Forbes, Thomas L; Power, Adam

2017-12-01

The surgical site infection (SSI) rate in vascular surgery after groin incision for lower extremity revascularization can lead to significant morbidity and mortality. This trial was designed to study the effect of negative pressure wound therapy (NPWT) on SSI in closed groin wounds after lower extremity revascularization in patients at high risk for SSI. A single-center, randomized, controlled trial was performed at an academic tertiary medical center. Patients with previous femoral artery surgical exposure, body mass index of >30 kg/m 2 or the presence of ischemic tissue loss were classified as a high-risk patient for SSI. All wounds were closed primarily and patients were randomized to either NPWT or standard dressing. The primary outcome of the trial was postoperative 30-day SSI in the groin wound. The secondary outcomes included 90-day SSI, hospital duration of stay, readmissions or reoperations for SSI, and mortality. A total of 102 patients were randomized between August 2014 and December 2015. Patients were classified as at high risk owing to the presence of previous femoral artery cut down (29%), body mass index of >30 kg/m 2 (39%) or presence of ischemic tissue loss (32%). Revascularization procedures performed included femoral to distal artery bypass (57%), femoral endarterectomy (18%), femoral to femoral artery crossover (17%), and other procedures (8%). The primary outcome of 30-day SSI was 11% in NPWT group versus 19% in standard dressing group (P = .24). There was a statistically significant shorter mean duration of hospital stay in the NPWT group (6.4 days) compared with the standard group (8.9 days; P = .01). There was no difference in readmission or reoperation for SSI or mortality between the two groups. This study demonstrated a nonsignificant lower rate of groin SSI in high-risk revascularization patients with NPWT compared with standard dressing. Owing to a lower than expected infection rate, the study was underpowered to detect a difference at the prespecified level. The NPWT group did show significantly shorter mean hospital duration of stay compared with the standard dressing group. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Drought characteristics' role in widespread aspen forest mortality across Colorado, USA.

PubMed

Anderegg, Leander D L; Anderegg, William R L; Abatzoglou, John; Hausladen, Alexandra M; Berry, Joseph A

2013-05-01

Globally documented widespread drought-induced forest mortality has important ramifications for plant community structure, ecosystem function, and the ecosystem services provided by forests. Yet the characteristics of drought seasonality, severity, and duration that trigger mortality events have received little attention despite evidence of changing precipitation regimes, shifting snow melt timing, and increasing temperature stress. This study draws upon stand level ecohydrology and statewide climate and spatial analysis to examine the drought characteristics implicated in the recent widespread mortality of trembling aspen (Populus tremuloides Michx.). We used isotopic observations of aspen xylem sap to determine water source use during natural and experimental drought in a region that experienced high tree mortality. We then drew upon multiple sources of climate data to characterize the drought that triggered aspen mortality. Finally, regression analysis was used to examine the drought characteristics most associated with the spatial patterns of aspen mortality across Colorado. Isotopic analysis indicated that aspens generally utilize shallow soil moisture with little plasticity during drought stress. Climate analysis showed that the mortality-inciting drought was unprecedented in the observational record, especially in 2002 growing season temperature and evaporative deficit, resulting in record low shallow soil moisture reserves. High 2002 summer temperature and low shallow soil moisture were most associated with the spatial patterns of aspen mortality. These results suggest that the 2002 drought subjected Colorado aspens to the most extreme growing season water stress of the past century by creating high atmospheric moisture demand and depleting the shallow soil moisture upon which aspens rely. Our findings highlight the important role of drought characteristics in mediating widespread aspen forest mortality, link this aspen die-off to regional climate change trends, and provide insight into future climate vulnerability of these forests. © 2013 Blackwell Publishing Ltd.

The Exceptionally High Life Expectancy of Costa Rican Nonagenarians

PubMed Central

ROSERO-BIXBY, LUIS

2008-01-01

Robust data from a voter registry show that Costa Rican nonagenarians have an exceptionally high live expectancy. Mortality at age 90 in Costa Rica is at least 14% lower than an average of 13 high-income countries. This advantage increases with age by 1% per year. Males have an additional 12% advantage. Age-90 life expectancy for males is 4.4 years, one-half year more than any other country in the world. These estimates do not use problematic data on reported ages, but ages are computed from birth dates in the Costa Rican birth-registration ledgers. Census data confirm the exceptionally high survival of elderly Costa Ricans, especially males. Comparisons with the United States and Sweden show that the Costa Rican advantage comes mostly from reduced incidence of cardiovascular diseases, coupled with a low prevalence of obesity, as the only available explanatory risk factor. Costa Rican nonagenarians are survivors of cohorts that underwent extremely harsh health conditions when young, and their advantage might be just a heterogeneity in frailty effect that might disappear in more recent cohorts. The availability of reliable estimates for the oldest-old in low-income populations is extremely rare. These results may enlighten the debate over how harsh early-life health conditions affect older-age mortality. PMID:18939667

Terrestrial habitat selection and strong density-dependent mortality in recently metamorphosed amphibians.

PubMed

Patrick, David A; Harper, Elizabeth B; Hunter, Malcolm L; Calhoun, Aram J K

2008-09-01

To predict the effects of terrestrial habitat change on amphibian populations, we need to know how amphibians respond to habitat heterogeneity, and whether habitat choice remains consistent throughout the life-history cycle. We conducted four experiments to evaluate how the spatial distribution of juvenile wood frogs, Rana sylvatica (including both overall abundance and localized density), was influenced by habitat choice and habitat structure, and how this relationship changed with spatial scale and behavioral phase. The four experiments included (1) habitat manipulation on replicated 10-ha landscapes surrounding breeding pools; (2) short-term experiments with individual frogs emigrating through a manipulated landscape of 1 m wide hexagonal patches; and habitat manipulations in (3) small (4-m2); and (4) large (100-m2) enclosures with multiple individuals to compare behavior both during and following emigration. The spatial distribution of juvenile wood frogs following emigration resulted from differences in the scale at which juvenile amphibians responded to habitat heterogeneity during active vs. settled behavioral phases. During emigration, juvenile wood frogs responded to coarse-scale variation in habitat (selection between 2.2-ha forest treatments) but not to fine-scale variation. After settling, however, animals showed habitat selection at much smaller scales (2-4 m2). This resulted in high densities of animals in small patches of suitable habitat where they experienced rapid mortality. No evidence of density-dependent habitat selection was seen, with juveniles typically choosing to remain at extremely high densities in high-quality habitat, rather than occupying low-quality habitat. These experiments demonstrate how prediction of the terrestrial distribution of juvenile amphibians requires understanding of the complex behavioral responses to habitat heterogeneity. Understanding these patterns is important, given that human alterations to amphibian habitats may generate extremely high densities of animals, resulting in high density-dependent mortality.

Temperature extremes and infant mortality in Bangladesh: Hotter months, lower mortality.

PubMed

Babalola, Olufemi; Razzaque, Abdur; Bishai, David

2018-01-01

Our study aims to obtain estimates of the size effects of temperature extremes on infant mortality in Bangladesh using monthly time series data. Data on temperature, child and infant mortality were obtained for Matlab district of rural Bangladesh for January 1982 to December 2008 encompassing 49,426 infant deaths. To investigate the relationship between mortality and temperature, we adopted a regression with Autoregressive Integrated Moving Average (ARIMA) errors model of seasonally adjusted temperature and mortality data. The relationship between monthly mean and maximum temperature on infant mortality was tested at 0 and 1 month lags respectively. Furthermore, our analysis was stratified to determine if the results differed by gender (boys versus girls) and by age (neonates (≤ 30 days) versus post neonates (>30days and <153days)). Dickey Fuller tests were performed to test for stationarity, and since the time series were non-stationary, we conducted the regression analysis based on the first differences of mortality and temperature. Hotter months were associated with lower infant mortality in Bangladesh. Each degree Celsius increase in mean monthly temperature reduced monthly mortality by 3.672 (SE 1.544, p<0.05) points. A one degree increase in mean monthly temperature one month prior reduced mortality by 0.767 (SE 0.439, p<0.1) for boys and by -0.0764 (SE 0.366, NS) for girls. Beneficial effects of maximum monthly temperature were on the order of 0.623 to -0.712 and statistically significant for girls and boys respectively. Effect sizes of mean monthly temperature were larger for neonates at 1.126 (SE 0.499, p<0.05) than for post-neonates at 0.880 (SE 0.310, p<0.05) reductions in mortality per degree. There is no evidence that infant survival is adversely affected by monthly temperature extremes in Bangladesh. This may reflect a more heightened sensitivity of infants to hypothermia than hyperthermia in this environment.

Temperature extremes and infant mortality in Bangladesh: Hotter months, lower mortality

PubMed Central

Babalola, Olufemi; Razzaque, Abdur

2018-01-01

Background Our study aims to obtain estimates of the size effects of temperature extremes on infant mortality in Bangladesh using monthly time series data. Methods Data on temperature, child and infant mortality were obtained for Matlab district of rural Bangladesh for January 1982 to December 2008 encompassing 49,426 infant deaths. To investigate the relationship between mortality and temperature, we adopted a regression with Autoregressive Integrated Moving Average (ARIMA) errors model of seasonally adjusted temperature and mortality data. The relationship between monthly mean and maximum temperature on infant mortality was tested at 0 and 1 month lags respectively. Furthermore, our analysis was stratified to determine if the results differed by gender (boys versus girls) and by age (neonates (≤ 30 days) versus post neonates (>30days and <153days)). Dickey Fuller tests were performed to test for stationarity, and since the time series were non-stationary, we conducted the regression analysis based on the first differences of mortality and temperature. Results Hotter months were associated with lower infant mortality in Bangladesh. Each degree Celsius increase in mean monthly temperature reduced monthly mortality by 3.672 (SE 1.544, p<0.05) points. A one degree increase in mean monthly temperature one month prior reduced mortality by 0.767 (SE 0.439, p<0.1) for boys and by -0.0764 (SE 0.366, NS) for girls. Beneficial effects of maximum monthly temperature were on the order of 0.623 to -0.712 and statistically significant for girls and boys respectively. Effect sizes of mean monthly temperature were larger for neonates at 1.126 (SE 0.499, p<0.05) than for post-neonates at 0.880 (SE 0.310, p<0.05) reductions in mortality per degree. Conclusion There is no evidence that infant survival is adversely affected by monthly temperature extremes in Bangladesh. This may reflect a more heightened sensitivity of infants to hypothermia than hyperthermia in this environment. PMID:29304145

The Arm is Not the Leg: Pathophysiology, Diagnosis, and Management of Upper Extremity Deep Vein Thrombosis.

PubMed

Noyes, Adam M; Dickey, John

2017-05-01

Upper extremity deep venous thrombosis (UEDVT) involves thrombosis of the deep veins of the arm as they enter the thorax. They are increasing in frequency, largely due to the rising use of central venous catheters and implantable cardiac devices, and represent more than 10% of all DVT cases, Upper extremity deep venous thrombosis has been historically misunderstood when compared to lower extremity deep vein thrombosis (LEDVT). Their associated disease states may carry devastating complications, with mortality rates often higher than that of LEDVT. Thus, education on recognition, classification and management is critical to avoid long-term sequelae and mortality from UEDVT. [Full article available at http://rimed.org/rimedicaljournal-2017-05.asp].

Tree mortality predicted from drought-induced vascular damage

USGS Publications Warehouse

Anderegg, William R.L.; Flint, Alan L.; Huang, Cho-ying; Flint, Lorraine E.; Berry, Joseph A.; Davis, Frank W.; Sperry, John S.; Field, Christopher B.

2015-01-01

The projected responses of forest ecosystems to warming and drying associated with twenty-first-century climate change vary widely from resiliency to widespread tree mortality1, 2, 3. Current vegetation models lack the ability to account for mortality of overstorey trees during extreme drought owing to uncertainties in mechanisms and thresholds causing mortality4, 5. Here we assess the causes of tree mortality, using field measurements of branch hydraulic conductivity during ongoing mortality in Populus tremuloides in the southwestern United States and a detailed plant hydraulics model. We identify a lethal plant water stress threshold that corresponds with a loss of vascular transport capacity from air entry into the xylem. We then use this hydraulic-based threshold to simulate forest dieback during historical drought, and compare predictions against three independent mortality data sets. The hydraulic threshold predicted with 75% accuracy regional patterns of tree mortality as found in field plots and mortality maps derived from Landsat imagery. In a high-emissions scenario, climate models project that drought stress will exceed the observed mortality threshold in the southwestern United States by the 2050s. Our approach provides a powerful and tractable way of incorporating tree mortality into vegetation models to resolve uncertainty over the fate of forest ecosystems in a changing climate.

[Trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors in Colombia, 1998-2010].

PubMed

Salazar, Edwin; Buitrago, Carolina; Molina, Federico; Alzate, Catalina Arango

2015-05-01

Determine the trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors. Descriptive study, based on the official registries of deaths reported by the National Statistics Agency, 1998-2010. The trend was analyzed using Poisson regressions. Bivariate correlations and multiple linear regression models were constructed to explore the relationship between mortality and socioeconomic factors: human development index, Gini index, gross domestic product, unsatisfied basic needs, unemployment rate, poverty, extreme poverty, quality of life index, illiteracy rate, and percentage of affiliation to the Social Security System. A total of 2 223 female deaths from external causes were recorded, of which 1 429 occurred during pregnancy and 794 in the postpartum period. The gross mortality rate dropped from 30.7 per 100 000 live births plus fetal deaths in 1998 to 16.7 in 2010. A downward curve with no significant inflection points was shown in the risk of dying from this cause. The multiple linear regression model showed a correlation between mortality and extreme poverty and the illiteracy rate, suggesting that these indicators could explain 89.4% of the change in mortality from external causes in pregnant and postpartum women each year in Colombia. Mortality from external causes in pregnant and postpartum women showed a significant downward trend that may be explained by important socioeconomic changes in the country, including a decrease in extreme poverty and in the illiteracy rate.

Early Lung Cancer Diagnosis by Biosensors

PubMed Central

Zhang, Yuqian; Yang, Dongliang; Weng, Lixing; Wang, Lianhui

2013-01-01

Lung cancer causes an extreme threat to human health, and the mortality rate due to lung cancer has not decreased during the last decade. Prognosis or early diagnosis could help reduce the mortality rate. If microRNA and tumor-associated antigens (TAAs), as well as the corresponding autoantibodies, can be detected prior to clinical diagnosis, such high sensitivity of biosensors makes the early diagnosis and prognosis of cancer realizable. This review provides an overview of tumor-associated biomarker identifying methods and the biosensor technology available today. Laboratorial researches utilizing biosensors for early lung cancer diagnosis will be highlighted. PMID:23892596

Desiccation and Mortality Dynamics in Seedlings of Different European Beech (Fagus sylvatica L.) Populations under Extreme Drought Conditions.

PubMed

Bolte, Andreas; Czajkowski, Tomasz; Cocozza, Claudia; Tognetti, Roberto; de Miguel, Marina; Pšidová, Eva; Ditmarová, Ĺubica; Dinca, Lucian; Delzon, Sylvain; Cochard, Hervè; Ræbild, Anders; de Luis, Martin; Cvjetkovic, Branislav; Heiri, Caroline; Müller, Jürgen

2016-01-01

European beech (Fagus sylvatica L., hereafter beech), one of the major native tree species in Europe, is known to be drought sensitive. Thus, the identification of critical thresholds of drought impact intensity and duration are of high interest for assessing the adaptive potential of European beech to climate change in its native range. In a common garden experiment with one-year-old seedlings originating from central and marginal origins in six European countries (Denmark, Germany, France, Romania, Bosnia-Herzegovina, and Spain), we applied extreme drought stress and observed desiccation and mortality processes among the different populations and related them to plant water status (predawn water potential, ΨPD) and soil hydraulic traits. For the lethal drought assessment, we used a critical threshold of soil water availability that is reached when 50% mortality in seedling populations occurs (LD50SWA). We found significant population differences in LD50SWA (10.5-17.8%), and mortality dynamics that suggest a genetic difference in drought resistance between populations. The LD50SWA values correlate significantly with the mean growing season precipitation at population origins, but not with the geographic margins of beech range. Thus, beech range marginality may be more due to climatic conditions than to geographic range. The outcome of this study suggests the genetic variation has a major influence on the varying adaptive potential of the investigated populations.

Leukaemia, brain tumours and exposure to extremely low frequency magnetic fields: cohort study of Swiss railway employees

PubMed Central

Röösli, Martin; Lörtscher, Manfred; Egger, Matthias; Pfluger, Dominik; Schreier, Nadja; Lörtscher, Emanuel; Locher, Peter; Spoerri, Adrian; Minder, Christoph

2007-01-01

Aims To investigate the relationship between extremely low frequency magnetic field (ELF‐MF) exposure and mortality from leukaemia and brain tumour in a cohort of Swiss railway workers. Methods 20 141 Swiss railway employees with 464 129 person‐years of follow‐up between 1972 and 2002 were studied. Mortality rates for leukaemia and brain tumour of highly exposed train drivers (21 μT average annual exposure) were compared with medium and low exposed occupational groups (i.e. station masters with an average exposure of 1 μT). In addition, individual cumulative exposure was calculated from on‐site measurements and modelling of past exposures. Results The hazard ratio (HR) for leukaemia mortality of train drivers was 1.43 (95% CI 0.74 to 2.77) compared with station masters. For myeloid leukaemia the HR of train drivers was 4.74 (95% CI 1.04 to 21.60) and for Hodgkin's disease 3.29 (95% CI 0.69 to 15.63). Lymphoid leukaemia, non‐Hodgkin's disease and brain tumour mortality were not associated with magnetic field exposure. Concordant results were obtained from analyses based on individual cumulative exposure. Conclusions Some evidence of an exposure–response association was found for myeloid leukaemia and Hodgkin's disease, but not for other haematopoietic and lymphatic malignancies and brain tumours. PMID:17525094

Puerperal group A streptococcal infection: beyond Semmelweis.

PubMed

Anderson, Brenna L

2014-04-01

Ignaz Semmelweiss made one of the most important contributions to modern medicine when he instituted handwashing in an obstetric clinic in Austria in 1847, decreasing mortality there from more than 10% to 2%. Unfortunately, puerperal sepsis remains a leading cause of maternal mortality throughout the world. Group A streptococcus (GAS), Streptococcus pyogenes, is an organism associated with high rates of morbidity and mortality from puerperal infections. When associated with sepsis, known as streptococcal toxic shock syndrome, mortality rates approach 30-50%. Group A streptococcus can cause invasive infections in the form of endometritis, necrotizing fasciitis, or streptococcal toxic shock syndrome. The clinical presentation of women with puerperal GAS infections is often atypical with extremes of temperature, unusual and vague pain, and pain in extremities. Toxin production by the organism may allow GAS to spread across tissue planes and cause necrosis while evading containment by the maternal immune system in the form of a discrete abscess. Endometrial aspiration in addition to blood cultures may be a useful rapid diagnostic tool. Imaging may appear normal and should not dissuade the clinician from aggressive management. When suspected, invasive GAS infections should be treated emergently with fluid resuscitation, antibiotic administration, and source control. The optimal antibiotic regimen contains penicillin and clindamycin. Source control may require extensive wound or vulvar debridement, hysterectomy, or a combination of these, which may be life-saving. The benefit of immunoglobulins in management of puerperal GAS infections is unclear.

Projecting future climate change impacts on heat-related mortality in large urban areas in China.

PubMed

Li, Ying; Ren, Ting; Kinney, Patrick L; Joyner, Andrew; Zhang, Wei

2018-05-01

Global climate change is anticipated to raise overall temperatures and has the potential to increase future mortality attributable to heat. Urban areas are particularly vulnerable to heat because of high concentrations of susceptible people. As the world's largest developing country, China has experienced noticeable changes in climate, partially evidenced by frequent occurrence of extreme heat in urban areas, which could expose millions of residents to summer heat stress that may result in increased health risk, including mortality. While there is a growing literature on future impacts of extreme temperatures on public health, projecting changes in future health outcomes associated with climate warming remains challenging and underexplored, particularly in developing countries. This is an exploratory study aimed at projecting future heat-related mortality risk in major urban areas in China. We focus on the 51 largest Chinese cities that include about one third of the total population in China, and project the potential changes in heat-related mortality based on 19 different global-scale climate models and three Representative Concentration Pathways (RCPs). City-specific risk estimates for high temperature and all-cause mortality were used to estimate annual heat-related mortality over two future twenty-year time periods. We estimated that for the 20-year period in Mid-21st century (2041-2060) relative to 1970-2000, incidence of excess heat-related mortality in the 51 cities to be approximately 37,800 (95% CI: 31,300-43,500), 31,700 (95% CI: 26,200-36,600) and 25,800 (95% CI: 21,300-29,800) deaths per year under RCP8.5, RCP4.5 and RCP2.6, respectively. Slowing climate change through the most stringent emission control scenario RCP2.6, relative to RCP8.5, was estimated to avoid 12,900 (95% CI: 10,800-14,800) deaths per year in the 51 cities in the 2050s, and 35,100 (95% CI: 29,200-40,100) deaths per year in the 2070s. The highest mortality risk is primarily in cities located in the North, East and Central regions of China. Population adaptation to heat is likely to reduce excess heat mortality, but the extent of adaptation is still unclear. Future heat mortality risk attributable to exposure to elevated warm season temperature is likely to be considerable in China's urban centers, with substantial geographic variations. Climate mitigation and heat risk management are needed to reduce such risk and produce substantial public health benefits. Copyright © 2018 Elsevier Inc. All rights reserved.

Severe 2010 Cold-Water Event Caused Unprecedented Mortality to Corals of the Florida Reef Tract and Reversed Previous Survivorship Patterns

PubMed Central

Lirman, Diego; Schopmeyer, Stephanie; Manzello, Derek; Gramer, Lewis J.; Precht, William F.; Muller-Karger, Frank; Banks, Kenneth; Barnes, Brian; Bartels, Erich; Bourque, Amanda; Byrne, James; Donahue, Scott; Duquesnel, Janice; Fisher, Louis; Gilliam, David; Hendee, James; Johnson, Meaghan; Maxwell, Kerry; McDevitt, Erin; Monty, Jamie; Rueda, Digna; Ruzicka, Rob; Thanner, Sara

2011-01-01

Background Coral reefs are facing increasing pressure from natural and anthropogenic stressors that have already caused significant worldwide declines. In January 2010, coral reefs of Florida, United States, were impacted by an extreme cold-water anomaly that exposed corals to temperatures well below their reported thresholds (16°C), causing rapid coral mortality unprecedented in spatial extent and severity. Methodology/Principal Findings Reef surveys were conducted from Martin County to the Lower Florida Keys within weeks of the anomaly. The impacts recorded were catastrophic and exceeded those of any previous disturbances in the region. Coral mortality patterns were directly correlated to in-situ and satellite-derived cold-temperature metrics. These impacts rival, in spatial extent and intensity, the impacts of the well-publicized warm-water bleaching events around the globe. The mean percent coral mortality recorded for all species and subregions was 11.5% in the 2010 winter, compared to 0.5% recorded in the previous five summers, including years like 2005 where warm-water bleaching was prevalent. Highest mean mortality (15%–39%) was documented for inshore habitats where temperatures were <11°C for prolonged periods. Increases in mortality from previous years were significant for 21 of 25 coral species, and were 1–2 orders of magnitude higher for most species. Conclusions/Significance The cold-water anomaly of January 2010 caused the worst coral mortality on record for the Florida Reef Tract, highlighting the potential catastrophic impacts that unusual but extreme climatic events can have on the persistence of coral reefs. Moreover, habitats and species most severely affected were those found in high-coral cover, inshore, shallow reef habitats previously considered the “oases” of the region, having escaped declining patterns observed for more offshore habitats. Thus, the 2010 cold-water anomaly not only caused widespread coral mortality but also reversed prior resistance and resilience patterns that will take decades to recover. PMID:21853066

[Infant and child mortality in Latin America].

PubMed

Behm, H; Primante, D A

1978-04-01

High mortality rates persist in Latin America, and data collection is made very difficult because of the lack of reliable statistics. A study was initiated in 1976 to measure the probability of mortality from birth to 2 years of age in 12 Latin American countries. The Brass method was used and applied to population censuses. Probability of mortality is extremely heterogeneous and regularly very high, varying between a maximum of 202/1000 in Bolivia, to a minimum of 112/1000 in Uruguay. In comparison, the same probability is 21/1000 in the U.S., and 11/1000 in sweden. Mortality in rural areas is much higher than in urban ones, and varies according to the degree of education of the mother, children being born to mothers who had 10 years of formal education having the lowest risk of death. Children born to the indigenous population, largely illiterate and living in the poorest of conditions, have the highest probability of death, a probability reaching 67% of all deaths under 2 years. National health services in Latin America, although vastly improved and improving, still do not meet the needs of the population, especially rural, and structural and historical conditions hamper a wider application of existing medical knowledge.

Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory.

PubMed

Palazzo, Lorella; Guest, Avery; Almgren, Gunnar

2003-01-01

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

The Role of Ambient Ozone in Epidemiologic Studies of Heat-Related Mortality

PubMed Central

Snowden, Jonathan M.; Kontgis, Caitlin; Tager, Ira B.

2012-01-01

Background: A large and growing literature investigating the role of extreme heat on mortality has conceptualized the role of ambient ozone in various ways, sometimes treating it as a confounder, sometimes as an effect modifier, and sometimes as a co-exposure. Thus, there is a lack of consensus about the roles that temperature and ozone together play in causing mortality. Objectives: We applied directed acyclic graphs (DAGs) to the topic of heat-related mortality to graphically represent the subject matter behind the research questions and to provide insight on the analytical options available. Discussion: On the basis of the subject matter encoded in the graphs, we assert that the role of ozone in studies of temperature and mortality is a causal intermediate that is affected by temperature and that can also affect mortality, rather than a confounder. Conclusions: We discuss possible questions of interest implied by this causal structure and propose areas of future work to further clarify the role of air pollutants in epidemiologic studies of extreme temperature. PMID:22899622

Geographic dimensions of heat-related mortality in seven U.S. cities.

PubMed

Hondula, David M; Davis, Robert E; Saha, Michael V; Wegner, Carleigh R; Veazey, Lindsay M

2015-04-01

Spatially targeted interventions may help protect the public when extreme heat occurs. Health outcome data are increasingly being used to map intra-urban variability in heat-health risks, but there has been little effort to compare patterns and risk factors between cities. We sought to identify places within large metropolitan areas where the mortality rate is highest on hot summer days and determine if characteristics of high-risk areas are consistent from one city to another. A Poisson regression model was adapted to quantify temperature-mortality relationships at the postal code scale based on 2.1 million records of daily all-cause mortality counts from seven U.S. cities. Multivariate spatial regression models were then used to determine the demographic and environmental variables most closely associated with intra-city variability in risk. Significant mortality increases on extreme heat days were confined to 12-44% of postal codes comprising each city. Places with greater risk had more developed land, young, elderly, and minority residents, and lower income and educational attainment, but the key explanatory variables varied from one city to another. Regression models accounted for 14-34% of the spatial variability in heat-related mortality. The results emphasize the need for public health plans for heat to be locally tailored and not assume that pre-identified vulnerability indicators are universally applicable. As known risk factors accounted for no more than one third of the spatial variability in heat-health outcomes, consideration of health outcome data is important in efforts to identify and protect residents of the places where the heat-related health risks are the highest. Copyright © 2015 Elsevier Inc. All rights reserved.

Who is more vulnerable to death from extremely cold temperatures? A case-only approach in Hong Kong with a temperate climate

NASA Astrophysics Data System (ADS)

Qiu, Hong; Tian, Linwei; Ho, Kin-fai; Yu, Ignatius T. S.; Thach, Thuan-Quoc; Wong, Chit-Ming

2016-05-01

The short-term effects of ambient cold temperature on mortality have been well documented in the literature worldwide. However, less is known about which subpopulations are more vulnerable to death related to extreme cold. We aimed to examine the personal characteristics and underlying causes of death that modified the association between extreme cold and mortality in a case-only approach. Individual information of 197,680 deaths of natural causes, daily temperature, and air pollution concentrations in cool season (November-April) during 2002-2011 in Hong Kong were collected. Extreme cold was defined as those days with preceding week with a daily maximum temperature at or less than the 1st percentile of its distribution. Logistic regression models were used to estimate the effects of modification, further controlling for age, seasonal pattern, and air pollution. Sensitivity analyses were conducted by using the 5th percentile as cutoff point to define the extreme cold. Subjects with age of 85 and older were more vulnerable to extreme cold, with an odds ratio (OR) of 1.33 (95 % confidence interval (CI), 1.22-1.45). The greater risk of extreme cold-related mortality was observed for total cardiorespiratory diseases and several specific causes including hypertensive diseases, stroke, congestive heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. Hypertensive diseases exhibited the greatest vulnerability to extreme cold exposure, with an OR of 1.37 (95 % CI, 1.13-1.65). Sensitivity analyses showed the robustness of these effect modifications. This evidence on which subpopulations are vulnerable to the adverse effects of extreme cold is important to inform public health measures to minimize those effects.

Resistance and Protective Immunity in Redfish Lake Sockeye Salmon Exposed to M Type Infectious Hematopoietic Necrosis Virus (IHNV)

USGS Publications Warehouse

Kurath, Gael; Garver, Kyle; Purcell, Maureen K.; LaPatra, Scott E.

2010-01-01

Differential virulence of infectious hematopoietic necrosis virus (IHNV) isolates from the U and M phylogenetic subgroups is clearly evident in the Redfish Lake (RFL) strain of sockeye salmon Oncorhynchus nerka. In these fish, experimental immersion challenges with U isolates cause extremely high mortality and M isolates cause low or no mortality. When survivors of M virus immersion challenges were exposed to a secondary challenge with virulent U type virus they experienced high mortality, indicating that the primary M challenge did not elicit protective immunity. Delivery of a moderate dose (2 × 104 plaque-forming units [PFU]/fish) of virus by intraperitoneal injection challenge did not overcome RFL sockeye salmon resistance to M type IHNV. Injection challenge with a high dose (5 × 106 PFU/fish) of M type virus caused 10% mortality, and in this case survivors did develop protective immunity against a secondary U type virus challenge. Thus, although it is possible for M type IHNV to elicit cross-protective immunity in this disease model, it does not develop after immersion challenge despite entry, transient replication of M virus to low levels, stimulation of innate immune genes, and development of neutralizing antibodies in some fish.

Atmospheric rivers and the mass mortality of wild oysters: insight into an extreme future?

PubMed

Cheng, Brian S; Chang, Andrew L; Deck, Anna; Ferner, Matthew C

2016-12-14

Climate change is predicted to increase the frequency and severity of extreme events. However, the biological consequences of extremes remain poorly resolved owing to their unpredictable nature and difficulty in quantifying their mechanisms and impacts. One key feature delivering precipitation extremes is an atmospheric river (AR), a long and narrow filament of enhanced water vapour transport. Despite recent attention, the biological impacts of ARs remain undocumented. Here, we use biological data coupled with remotely sensed and in situ environmental data to describe the role of ARs in the near 100% mass mortality of wild oysters in northern San Francisco Bay. In March 2011, a series of ARs made landfall within California, contributing an estimated 69.3% of the precipitation within the watershed and driving an extreme freshwater discharge into San Francisco Bay. This discharge caused sustained low salinities (less than 6.3) that almost perfectly matched the known oyster critical salinity tolerance and was coincident with a mass mortality of one of the most abundant populations throughout this species' range. This is a concern, because wild oysters remain a fraction of their historical abundance and have yet to recover. This study highlights a novel mechanism by which precipitation extremes may affect natural systems and the persistence of sensitive species in the face of environmental change. © 2016 The Author(s).

Co-occurring woody species have diverse hydraulic strategies and mortality rates during an extreme drought: Belowground hydraulic failure during drought

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Daniel M.; Domec, Jean-Christophe; Carter Berry, Z.

From 2011 to 2013, Texas experienced its worst drought in recorded history. This event provided a unique natural experiment to assess species-specific responses to extreme drought and mortality of four co-occurring woody species: Quercus fusiformis, Diospyros texana, Prosopis glandulosa and Juniperus ashei. We examined hypothesized mechanisms that could promote these species’ diverse mortality patterns using post-drought measurements on surviving trees coupled to retrospective process modeling. The species exhibited a wide range of gas exchange responses, hydraulic strategies, and mortality rates. Multiple proposed indices of mortality mechanisms were not consistent with the observed mortality patterns across species, including measures of iso/anisohydry,more » photosynthesis, carbohydrate depletion, and hydraulic safety margins. Large losses of growing season whole-tree conductance (driven by belowground losses of conductance), and shallower rooting depths, were associated with species that exhibited greater mortality. Based on this retrospective analysis, we suggest that species more vulnerable to drought were more likely to have succumbed to hydraulic failure belowground.« less

Spatial Patterns of Heat-Related Cardiovascular Mortality in the Czech Republic

PubMed Central

Urban, Aleš; Burkart, Katrin; Kyselý, Jan; Schuster, Christian; Plavcová, Eva; Hanzlíková, Hana; Štěpánek, Petr; Lakes, Tobia

2016-01-01

The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994–2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations of mortality from the baseline were calculated on days exceeding the 90th percentile of mean daily temperature in summer, and they were correlated with selected demographic, socioeconomic, and physical-environmental variables for the districts. Groups of districts with similar characteristics were identified according to socioeconomic status and urbanization level in order to provide a more general picture than possible on the district level. We evaluated lagged patterns of excess mortality after hot spell occurrences in: (i) urban areas vs. predominantly rural areas; and (ii) regions with different overall socioeconomic level. Our findings suggest that climatic conditions, altitude, and urbanization generally affect the spatial distribution of districts with the highest excess cardiovascular mortality, while socioeconomic status did not show a significant effect in the analysis across the Czech Republic as a whole. Only within deprived populations, socioeconomic status played a relevant role as well. After taking into account lagged effects of temperature on excess mortality, we found that the effect of hot spells was significant in highly urbanized regions, while most excess deaths in rural districts may be attributed to harvesting effects. PMID:26959044

Risk of mortality, cancer incidence, and stroke in a population potentially exposed to cadmium.

PubMed

Elliott, P; Arnold, R; Cockings, S; Eaton, N; Järup, L; Jones, J; Quinn, M; Rosato, M; Thornton, I; Toledano, M; Tristan, E; Wakefield, J

2000-02-01

To follow up mortality and cancer incidence in a cohort potentially exposed to cadmium and to perform a geographical (ecological) analysis to further assess the health effects of potential exposure to cadmium. The English village of Shipham has very high concentrations of cadmium in the soil. A previous cohort study of residents of Shipham in 1939 showed overall mortality below that expected, but a 40% excess of mortality from stroke. This study extends the follow up of the cohort for mortality to 1997, and includes an analysis of cancer incidence from 1971 to 1992, and a geographical study of mortality and cancer incidence. Standardised mortality and incidence ratios (SMRs and SIRs) were estimated with regional reference rates. Comparisons were made with the nearby village of Hutton. All cause cohort mortality was lower than expected in both villages, although there was excess cancer incidence in both Shipham (SIR 167, 95% confidence interval (95% CI) 106 to 250) and Hutton (SIR 167, 95% CI 105 to 253). There was an excess of mortality from hypertension, cerebrovascular disease, and nephritis and nephrosis, of borderline significance, in Shipham (SMR 128, 95% CI 99 to 162). In the geographical study, all cause mortality in Shipham was also lower than expected (SMR 84, 95% CI 71 to 100). There was an excess in genitourinary cancers in both Shipham (SIR 160, 95% CI 107 to 239) and Hutton (SIR 153, 95% CI 122 to 192). No clear evidence of health effects from possible exposure to cadmium in Shipham was found despite the extremely high concentrations of cadmium in the soil.

Mortality after lower extremity fractures in men with spinal cord injury.

PubMed

Carbone, Laura D; Chin, Amy S; Burns, Stephen P; Svircev, Jelena N; Hoenig, Helen; Heggeness, Michael; Bailey, Lauren; Weaver, Frances

2014-02-01

In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI. © 2014 American Society for Bone and Mineral Research.

The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong.

PubMed

Wong, Ho Ting; Chiu, Marcus Yu Lung; Wu, Cynthia Sau Ting; Lee, Tsz Cheung

2015-03-01

It is believed that extreme hot and cold weather has a negative impact on general health conditions. Much research focuses on mortality, but there is relatively little community health research. This study is aimed at identifying high-risk groups who are sensitive to extreme weather conditions, in particular, very hot and cold days, through an analysis of the health-related help-seeking patterns of over 60,000 Personal Emergency Link (PE-link) users in Hong Kong relative to weather conditions. In the study, 1,659,716 PE-link calls to the help center were analyzed. Results showed that females, older elderly, people who did not live alone, non-subsidized (relatively high-income) users, and those without medical histories of heart disease, hypertension, stroke, and diabetes were more sensitive to extreme weather condition. The results suggest that using official government weather forecast reports to predict health-related help-seeking behavior is feasible. An evidence-based strategic plan could be formulated by using a method similar to that used in this study to identify high-risk groups. Preventive measures could be established for protecting the target groups when extreme weather conditions are forecasted.

The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong

NASA Astrophysics Data System (ADS)

Wong, Ho Ting; Chiu, Marcus Yu Lung; Wu, Cynthia Sau Ting; Lee, Tsz Cheung

2015-03-01

It is believed that extreme hot and cold weather has a negative impact on general health conditions. Much research focuses on mortality, but there is relatively little community health research. This study is aimed at identifying high-risk groups who are sensitive to extreme weather conditions, in particular, very hot and cold days, through an analysis of the health-related help-seeking patterns of over 60,000 Personal Emergency Link (PE-link) users in Hong Kong relative to weather conditions. In the study, 1,659,716 PE-link calls to the help center were analyzed. Results showed that females, older elderly, people who did not live alone, non-subsidized (relatively high-income) users, and those without medical histories of heart disease, hypertension, stroke, and diabetes were more sensitive to extreme weather condition. The results suggest that using official government weather forecast reports to predict health-related help-seeking behavior is feasible. An evidence-based strategic plan could be formulated by using a method similar to that used in this study to identify high-risk groups. Preventive measures could be established for protecting the target groups when extreme weather conditions are forecasted.

High N, dry: Experimental nitrogen deposition exacerbates native shrub loss and nonnative plant invasion during extreme drought.

PubMed

Valliere, Justin M; Irvine, Irina C; Santiago, Louis; Allen, Edith B

2017-10-01

Hotter, longer, and more frequent global change-type drought events may profoundly impact terrestrial ecosystems by triggering widespread vegetation mortality. However, severe drought is only one component of global change, and ecological effects of drought may be compounded by other drivers, such as anthropogenic nitrogen (N) deposition and nonnative plant invasion. Elevated N deposition, for example, may reduce drought tolerance through increased plant productivity, thereby contributing to drought-induced mortality. High N availability also often favors invasive, nonnative plant species, and the loss of woody vegetation due to drought may create a window of opportunity for these invaders. We investigated the effects of multiple levels of simulated N deposition on a Mediterranean-type shrubland plant community in southern California from 2011 to 2016, a period coinciding with an extreme, multiyear drought in the region. We hypothesized that N addition would increase native shrub productivity, but that this would increase susceptibility to drought and result in increased shrub loss over time. We also predicted that N addition would favor nonnatives, especially annual grasses, leading to higher biomass and cover of these species. Consistent with these hypotheses, we found that high N availability increased native shrub canopy loss and mortality, likely due to the higher productivity and leaf area and reduced water-use efficiency we observed in shrubs subject to N addition. As native shrub cover declined, we also observed a concomitant increase in cover and biomass of nonnative annuals, particularly under high levels of experimental N deposition. Together, these results suggest that the impacts of extended drought on shrubland ecosystems may be more severe under elevated N deposition, potentially contributing to the widespread loss of native woody species and vegetation-type conversion. © 2017 John Wiley & Sons Ltd.

Population demography of alpine butterflies: Boloria pales and Boloria napaea (Lepidoptera: Nymphalidae) and their specific adaptations to high mountain environments

NASA Astrophysics Data System (ADS)

Ehl, Stefan; Ebertshäuser, Marlene; Gros, Patrick; Schmitt, Thomas

2017-11-01

High mountain ecosystems are extreme habitats, and adaptation strategies to this ecosystem are still poorly understood in most groups. To unravel such strategies, we performed a MRR study in the Hohe Tauern National Park (Salzburg, Austria) with two nymphalid butterfly species, Boloria pales and B. napaea. We analysed their population structure over one flight period by studying the development of population size and wing wear. B. pales had more individuals and a higher survival probability than B. napaea; the sensitivity to extreme weather conditions or other external influences was higher in B. napaea. We only observed proterandry in B. pales. Imagines of both species survived under snow for at least some days. Additionally, we observed a kind of risk-spreading, in that individuals of both species, and especially B. pales, have regularly emerged throughout the flight period. This emergence pattern divided the population's age structure into three phases: an initial phase with decreasing wing quality (emergence > mortality), followed by an equilibrium phase with mostly constant average wing condition (emergence = mortality) and a final ageing phase with strongly deteriorating wing condition (mortality » emergence). Consequently, neither species would likely become extinct because of particularly unsuitable weather conditions during a single flight period. The observed differences between the two species suggest a better regional adaptation of B. pales, which is restricted to high mountain systems of Europe. In contrast, the arctic-alpine B. napaea might be best adapted to conditions in the Arctic and not the more southern high mountain systems. However, this needs to be examined during future research in the Arctic.

Evolving trends in aortic valve replacement: A statewide experience.

PubMed

Kim, Karen M; Shannon, Francis; Paone, Gaetano; Lall, Shelly; Batra, Sanjay; Boeve, Theodore; DeLucia, Alphonse; Patel, Himanshu J; Theurer, Patricia F; He, Chang; Clark, Melissa J; Sultan, Ibrahim; Deeb, George Michael; Prager, Richard L

2018-06-17

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan. The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017. Patients were divided into low, intermediate, high, and extreme risk groups based on STS predicted risk of mortality (PROM). TAVR patients in the MSTCVS-QC database were also matched with those in the Transcatheter Valve Therapy Registry to determine their Heart Team-designated risk category. During the study period 9517 SAVR and 4470 TAVR cases were performed. Total annual AVR volume increased by 40.0% (from 2086 to 2920), with a 13.3% decrease in number of SAVR cases (from 1892 to 1640) and a 560% increase in number of TAVR cases (from 194 to 1280). Greater than 90% of SAVR patients had PROM ≤8%. While >70% of TAVR patients had PROM ≤ 8%, they were mostly designated as high or extreme risk by a Heart Team. During the study period, SAVR volume gradually declined and TAVR volume dramatically increased. This was mostly due to a new group of patients with lower STS PROM who were designated as higher risk by a Heart Team due to characteristics not completely captured by the STS PROM score. © 2018 Wiley Periodicals, Inc.

Forest tree responses to extreme drought and some biotic events: Towards a selection according to hazard tolerance?

NASA Astrophysics Data System (ADS)

Bréda, Nathalie; Badeau, Vincent

2008-09-01

The aim of this paper is to illustrate how some extreme events could affect forest ecosystems. Forest tree response can be analysed using dendroecological methods, as tree-ring widths are strongly controlled by climatic or biotic events. Years with such events induce similar tree responses and are called pointer years. They can result from extreme climatic events like frost, a heat wave, spring water logging, drought or insect damage… Forest tree species showed contrasting responses to climatic hazards, depending on their sensitivity to water shortage or temperature hardening, as illustrated from our dendrochronological database. For foresters, a drought or a pest disease is an extreme event if visible and durable symptoms are induced (leaf discolouration, leaf loss, perennial organs mortality, tree dieback and mortality). These symptoms here are shown, lagging one or several years behind a climatic or biotic event, from forest decline cases in progress since the 2003 drought or attributed to previous severe droughts or defoliations in France. Tree growth or vitality recovery is illustrated, and the functional interpretation of the long lasting memory of trees is discussed. A coupled approach linking dendrochronology and ecophysiology helps in discussing vulnerability of forest stands, and suggests management advices in order to mitigate extreme drought and cope with selective mortality.

Reverse dipper and high night-time heart rate in acute stage of cerebral infarction are associated with increased mortality.

PubMed

Park, Jae-Hyeong; Lee, Hyun-Seok; Kim, Jun Hyung; Lee, Jae-Hwan; Kim, Jei; Choi, Si Wan

2014-01-01

Reverse dipper, blood pressure (BP) rises during night-time, is a risk factor of increased cardiovascular events in hypertensive patients. However, we have little information whether reverse dipper in acute stage of cerebral infarction (CI) affects on the recurrence and mortality. We studied to assess the relationship between reverse dipper and adverse clinical outcomes in the acute stage of CI. We screened and enrolled consecutive patients with acute CI with ambulatory blood pressure monitoring (ABPM) within 2 weeks after admission from August 2001 to July 2005. According to systolic blood pressure (SBP) dropping pattern during night-time compared with daytime, we classified into extreme dipper (≥20%), dipper (≥10%, <20%), nondipper (≥0%, <10%), and reverse dipper (BP rises during night-time). We analyzed 426 patients (72 ± 13 years old, 255 men) and checked recurrence of CI or all-cause mortality for further 7.6 ± 3.1 years for checking of recurrence or all-cause mortality. Of 426 patients, 202 patients were nondippers (47%), 134 were reverse dippers (32%), 80 were dippers (19%), and 10 were extreme dippers (2%). During the follow-up period, 89 patients (21%) had recurrence of CI. After multivariate analysis, daytime SBP (hazard ratio = 1.014, P = .018) was the significant predictor of recurrence. There were 141 deaths (33%) in our study cohort. Multivariate analysis showed that age (hazard ratio = 1.106, P < .001), nocturnal mean heart rate (hazard ratio = 1.023, P = .004), and reverse dipper (hazard ratio = 1. 676, P = .007) were statistically significant. Reverse dipper and high night-time heart rate in the acute stage of CI were associated with total mortality during long-term follow-up. These findings suggest the clinical utility of ABPM in acute stage of CI. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Insecticide resistance and diminished secondary kill performance of bait formulations against German cockroaches (Dictyoptera: Blattellidae)

PubMed Central

Ko, Alexander E.; Bieman, Donald N.; Schal, Coby; Silverman, Jules

2015-01-01

BACKGROUND Bait formulations are considered the most effective method for reducing German cockroach infestations. An important property of some bait formulations is secondary kill, whereby active ingredient is translocated in insect-produced residues throughout the cockroach population, especially affecting relatively sedentary early instar nymphs. RESULTS Blattella germanica was collected from a location where baits containing hydramethylnon, fipronil, or indoxacarb became ineffective, and these AIs were topically applied to adult males. Results revealed the first evidence for hydramethylnon resistance, moderate resistance to fipronil and extremely high resistance to indoxacarb. Insecticide residues excreted by field-collected males that ingested commercial baits effectively killed nymphs of an insecticide-susceptible laboratory strain of B. germanica but failed to kill most nymphs of the field-collected strain. CONCLUSIONS We report three novel findings: 1) The first evidence for hydramethylnon resistance in any insect; 2) extremely high levels of indoxacarb resistance in a field population; and 3) reduced secondary mortality in an insecticide-resistant field-collected strain of B. germanica. We suggest that while secondary mortality is considered to be advantageous in cockroach interventions, the ingestion of sublethal doses of AI by nymphs may select for high insecticide resistance by increasing the frequency of AI resistance alleles within the population. PMID:26689433

Potential defoliation of trees by outbreak populations of gypsy moth in the Chicago area

Treesearch

David W. Onstad; David J. Nowak; Michael R. Jeffords

1997-01-01

The gypsy moth, Lymantria dispar, will soon become established in much of the Midwest. If an outbreak with extremely high population levels of this serious defoliator is allowed to occur in the Chicago area, what kind of damage can be expected? A model for defoliation, refoliation and mortality was developed based on the number of trees and...

Climate Changes and Human Health: A Review of the Effect of Environmental Stressors on Cardiovascular Diseases Across Epidemiology and Biological Mechanisms.

PubMed

Giorgini, Paolo; Di Giosia, Paolo; Petrarca, Marco; Lattanzio, Francesco; Stamerra, Cosimo Andrea; Ferri, Claudio

2017-01-01

Climate change is rapidly affecting all the regions of our planet. The most relevant example is global warming, which impacts on the earth's ecosystems, threatening human health. Other effects include extreme variations in temperature and increases in air pollution. These events may negatively impact mortality and morbidity for cardiovascular diseases. In this review, we discuss the main effects of climate changes on cardiovascular diseases, reporting the epidemiological evidences and the biological mechanisms linking climate change consequences to hypertension, diabetes, ischemic heart diseases, heart failure and stroke. Up to now, findings suggest that humans acclimate under different weather conditions, even though extreme temperatures and higher levels of air pollution can influence health-related outcomes. In these cases, climate change adversely affects cardiovascular system and the high-risk subjects for cardiovascular diseases are those more exposed. Finally, we examine climate change implications on publich health and suggest adaptation strategies to monitor the high-risk population, and reduce the amount of hospital admissions associated to these events. Such interventions may minimize the costs of public health and reduce the mortality for cardiovascular diseases. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Continuous and discrete extreme climatic events affecting the dynamics of a high-arctic reindeer population.

PubMed

Chan, Kung-Sik; Mysterud, Atle; Øritsland, Nils Are; Severinsen, Torbjørn; Stenseth, Nils Chr

2005-10-01

Climate at northern latitudes are currently changing both with regard to the mean and the temporal variability at any given site, increasing the frequency of extreme events such as cold and warm spells. Here we use a conceptually new modelling approach with two different dynamic terms of the climatic effects on a Svalbard reindeer population (the Brøggerhalvøya population) which underwent an extreme icing event ("locked pastures") with 80% reduction in population size during one winter (1993/94). One term captures the continuous and linear effect depending upon the Arctic Oscillation and another the discrete (rare) "event" process. The introduction of an "event" parameter describing the discrete extreme winter resulted in a more parsimonious model. Such an approach may be useful in strongly age-structured ungulate populations, with young and very old individuals being particularly prone to mortality factors during adverse conditions (resulting in a population structure that differs before and after extreme climatic events). A simulation study demonstrates that our approach is able to properly detect the ecological effects of such extreme climate events.

Body size and mortality rates in coral reef fishes: a three-phase relationship

PubMed Central

Bellwood, David Roy

2016-01-01

Body size is closely linked to mortality rates in many animals, although the overarching patterns in this relationship have rarely been considered for multiple species. A meta-analysis of published size-specific mortality rates for coral reef fishes revealed an exponential decline in mortality rate with increasing body size, however, within this broad relationship there are three distinct phases. Phase one is characterized by naive fishes recruiting to reefs, which suffer extremely high mortality rates. In this well-studied phase, fishes must learn quickly to survive the many predation risks. After just a few days, the surviving fishes enter phase two, in which small increases in body size result in pronounced increases in lifespan (estimated 11 d mm–1). Remarkably, approximately 50% of reef fish individuals remain in phase two throughout their lives. Once fishes reach a size threshold of about 43 mm total length (TL) they enter phase three, where mortality rates are relatively low and the pressure to grow is presumably, significantly reduced. These phases provide a clearer understanding of the impact of body size on mortality rates in coral reef fishes and begin to reveal critical insights into the energetic and trophic dynamics of coral reefs. PMID:27798308

Mortality related to cold and heat. What do we learn from dairy cattle?

PubMed Central

Cox, Bianca; Gasparrini, Antonio; Catry, Boudewijn; Delcloo, Andy; Bijnens, Esmée; Vangronsveld, Jaco; Nawrot, Tim S.

2016-01-01

Extreme temperatures are associated with increased mortality among humans. Because similar epidemiologic studies in animals may add to the existing evidence, we investigated the association between ambient temperature and the risk of mortality among dairy cattle. We used data on 87,108 dairy cow deaths in Belgium from 2006 to 2009, and we combined a case-crossover design with distributed lag non-linear models. Province-specific results were combined in a multivariate meta-analysis. Relative to the estimated minimum mortality temperature of 15.4 °C (75th percentile), the pooled cumulative relative risks over lag 0–25 days were 1.26 (95% CI: 1.11, 1.42) for extreme cold (1st percentile, −3.5 °C), 1.35 (95% CI: 1.19, 1.54) for moderate cold (5th percentile, −0.3 °C), 1.09 (95% CI: 1.02, 1.17) for moderate heat (95th percentile, 19.7 °C), and 1.26 (95% CI: 1.08; 1.48) for extreme heat (99th percentile, 22.6 °C). The temporal pattern of the temperature-mortality association was similar to that observed in humans, i.e. acute effects of heat and delayed and prolonged effects of cold. Seasonal analyses suggested that most of the temperature-related mortality, including cold effects, occurred in the warm season. Our study reinforces the evidence on the plausibility of causal effects in humans. PMID:27236362

Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population.

PubMed

Baril, Donald T; Ghosh, Kaushik; Rosen, Allison B

2014-09-01

Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population. This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates. Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged. Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population

PubMed Central

Baril, Donald T.; Ghosh, Kaushik; Rosen, Allison B.

2015-01-01

Objective Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population. Methods This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates. Results Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged. Conclusions Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged. PMID:24768362

Differential host mortality explains the effect of high temperature on the prevalence of a marine pathogen

PubMed Central

Neigel, Joseph E.

2017-01-01

Infectious diseases threaten marine populations, and the extent of their impacts is often assessed by prevalence of infection (the proportion of infected individuals). Changes in prevalence are often attributed to altered rates of transmission, although the rates of birth, recovery, and mortality also determine prevalence. The parasitic dinoflagellate Hematodinium perezi causes a severe, often fatal disease in blue crabs. It has been speculated that decreases in prevalence associated with high temperatures result from lower rates of infection. We used field collections, environmental sensor data, and high-temperature exposure experiments to investigate the factors that change prevalence of infections in blue crab megalopae (post-larvae). These megalopae migrate from offshore waters, where temperatures are moderate, to marshes where temperatures may be extremely high. Within a few days of arriving in the marsh, the megalopae metamorphose into juvenile crabs. We found a strong negative association between prevalence of Hematodinium infection in megalopae and the cumulative time water temperatures in the marsh exceeded 34°C over the preceding two days. Temperatures this high are known to be lethal for blue crabs, suggesting that higher mortality of infected megalopae could be the cause of reduced prevalence. Experimental exposure of megalopae from the marsh to a temperature of 34°C resulted in higher mortality for infected than uninfected individuals, and decreased the prevalence of infection among survivors from 18% to 3%. PMID:29084257

Plant Water Content is the Best Predictor of Drought-induced Mortality

NASA Astrophysics Data System (ADS)

Sapes, G.; Roskilly, B.; Dobrowski, S.; Sala, A.

2017-12-01

Predicting drought-induced forest mortality remains extremely challenging. Recent research has shown that both plant hydraulics and stored non-structural carbohydrates (NSC) interact during drought-induced mortality. The strong interaction between these two variables and the fact that they are both difficult to measure render drought-induced plant mortality extremely difficult to monitor and predict. A variable that is easier to measure and that integrates hydraulic transport and carbohydrate dynamics may, therefore, improve our ability to monitor and predict mortality. Here, we tested whether plant water content is such an integrator variable and, therefore, a better predictor of mortality under drought. We subjected 250 two-year-old ponderosa pine seedlings to drought until they died in a greenhouse experiment. Periodically during the dry down, we measured percent loss of hydraulic conductivity (PLC), NSC concentration (starch and soluble sugars), and tissue volumetric water content (VWC) in roots, stems and leaves. At each measurement time, a separate set of seedlings were re-watered to estimate the probability of mortality at the population level. Linear models were used to explore whether PLC and NSC were linked to VWC and to determine which of the three variables predicted mortality the best. As expected, plants lost hydraulic conductivity in stems and roots during the dry down. Starch concentrations also decreased in all organs as the drought proceeded. In contrast, soluble sugars increased in stems and roots, consistent with the conversion of stored NSCs into osmotically active compounds. Models containing both PLC and NSC concentrations as predictors of VWC were highly significant in all organs and at the whole plant level, indicating that water content is influenced by both PLC and NSCs. PLC, NSC, and VWC explained mortality across organs and at the whole plant level, but VWC was the best predictor (R2 = 0.99). Our results indicate that plant water content integrates plant hydraulics and carbohydrate availability, two factors commonly interacting and difficult to tease apart. An important advantage of water content is that it is very easy to measure across scales, from leaves to entire ecosystems through remote sensing.

[Epidemiologic reasons for screening programs in the national health service].

PubMed

Ottó, Szabolcs

2003-11-30

The author describes the current health state of the Hungarian population in terms of cancer mortality and morbidity. Based on the comparative analysis of national and international, mainly European, data he describes the unfavourable Hungarian indices trying to identify their causes and the possible breaking free from them, as well. The greatest potential lies in the organised, continuous screenings within the frame of "Johan Béla National Programme of the Decade of Health". Since tumour diseases pose severe and alarming problems in national health care the reduction of extremely high mortality in three tumour localisation (cervix uteri, breast and colorectum) by regular screenings is absolutely justified.

Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts.

PubMed

Fariñas, María Carmen; Campo, Ana; Duran, Raquel; Sarralde, José Aurelio; Nistal, Juan Francisco; Gutiérrez-Díez, José Francisco; Fariñas-Álvarez, Concepción

2017-11-01

The objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). This was a prospective cohort study of all consecutive patients who underwent PVG of the abdominal aorta with or without iliac-femoral involvement and peripheral PVG from April 2008 to August 2009 at a university hospital. Patients younger than 15 years and those with severe immunodeficiency were excluded. The follow-up period was until 3 years after surgery or until death. There were 261 patients included; 230 (88.12%) were male, and the mean age was 67.57 (standard deviation, 10.82) years. The reason for operation was aortic aneurysm in 49 (18.77%) patients or lower limb arteriopathy in 212 (81.23%) patients. NIs occurred in 71 (27.20%) patients. Of these, 42 were surgical site infections (SSIs), of which 61.9% occurred in the lower extremities (14 superficial, 10 deep, and 2 PVG infections) and 38.1% in the abdomen (7 superficial, 7 deep, and 2 PVG infections); 15 were respiratory tract infections; and 15 were urinary tract infections. Active lower extremity skin and soft tissue infection (SSTI) at the time of surgery was a significant predictor of NI for both types of PVG (abdominal aortic PVG: adjusted odds ratio [OR], 12.6; 95% confidence interval [CI], 1.15-138.19; peripheral PVG: adjusted OR, 2.43; 95% CI, 1.08-5.47). Other independent predictors of NI were mechanical ventilation (adjusted OR, 55.96; 95% CI, 3.9-802.39) for abdominal aortic PVG and low hemoglobin levels on admission (adjusted OR, 0.84; 95% CI, 0.71-0.99) and emergent surgery (adjusted OR, 4.39; 95% CI, 1.51-12.74) for peripheral PVG. The in-hospital mortality rate was 1.92%. The probability of surviving the first month was 0.96, and significant predictors of mortality were active lower extremity SSTI (adjusted risk ratio [RR], 12.07; 95% CI, 1.04-154.75), high postsurgical glucose levels (adjusted RR, 1.02; 95% CI, 1.00-1.04), and noninfectious surgical complications (adjusted RR, 19.38; 95% CI, 2.25-167.29). The long-term mortality rate was 11.88%. The probability of surviving at 12, 24, and 36 months was 0.94, 0.92, and 0.87, respectively. Variables significantly associated with long-term death were older age (adjusted RR, 1.08; 95% CI, 1.01-1.15), high values of creatinine on discharge (adjusted RR, 1.91; 95% CI, 1.08-3.38), and an SSI with the highest adjusted RR (6.35; 95% CI, 1.87-21.53). SSI was the primary NI. The risk of NI depended primarily on the presence of a lower extremity SSTI at the time of surgery, whereas mortality was determined by age, surgical complications during the operation, and SSI. These findings suggest that in those cases in which surgery is reasonably delayed, surgery should be deferred until the lower extremity SSTIs are resolved. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The relative contribution of climatic, edaphic, and biotic drivers to risk of tree mortality from drought

NASA Astrophysics Data System (ADS)

March, R. G.; Moore, G. W.; Edgar, C. B.; Lawing, A. M.; Washington-Allen, R. A.

2015-12-01

In recorded history, the 2011 Texas Drought was comparable in severity only to a drought that occurred 300 years ago. By mid-September, 88% of the state experienced 'exceptional' conditions, with the rest experiencing 'extreme' or 'severe' drought. By recent estimates, the 2011 Texas Drought killed 6.2% of all the state's trees, at a rate nearly 9 times greater than average. The vast spatial scale and relatively uniform intensity of this drought has provided an opportunity to examine the comparative interactions among forest types, terrain, and edaphic factors across major climate gradients which in 2011 were subjected to extreme drought conditions that ultimately caused massive tree mortality. We used maximum entropy modeling (Maxent) to rank environmental landscape factors with the potential to drive drought-related tree mortality and test the assumption that the relative importance of these factors are scale-dependent. Occurrence data of dead trees were collected during the summer of 2012 from 599 field plots distributed across Texas with 30% used for model evaluation. Bioclimatic variables, ecoregions, soils characteristics, and topographic variables were modeled with drought-killed tree occurrence. Their relative contribution to the model was seen as their relative importance in driving mortality. To test determinants at a more local scale, we examined Landsat 7 scenes in East and West Texas with moderate-resolution data for the same variables above with the exception of climate. All models were significantly better than random in binomial tests of omission and receiver operating characteristic analyses. The modeled spatial distribution of probability of occurrence showed high probability of mortality in the east-central oak woodlands and the mixed pine-hardwood forest region in northeast Texas. Both regional and local models were dominated by biotic factors (ecoregion and forest type, respectively). Forest density and precipitation of driest month also contributed highly to the regional model. The local models gave more importance to available water storage at root zone and hillshade. Understanding how environmental factors drive drought-related mortality can help predict vulnerable landscapes and aid in preparing for future drought events.

Long-term monitoring study of beached seabirds shows that chronic oil pollution in the southern North Sea has almost halted.

PubMed

Stienen, Eric W M; Courtens, Wouter; Van de Walle, Marc; Vanermen, Nicolas; Verstraete, Hilbran

2017-02-15

Trends in oil rates of beached seabirds reflect temporal and spatial patterns in chronic oil pollution at sea. We analysed a long-term dataset of systematic beached bird surveys along the Belgian North Sea coast during 1962-2015, where extreme high oil contamination rates and consequently high mortality rates of seabirds during the 1960s used to coincide with intensive ship traffic. In the 1960s, >90% of all swimming seabirds that washed ashore were contaminated with oil and estimated oil-induced mortality of seabirds was probably several times higher than natural mortality. More than 50years later oil rates of seabirds have dropped to historically low levels while shipping is still very intense, indicating that chronic oil pollution has significantly declined. The declining trend is discussed in the light of a series of legislative measures that were enacted in the North Sea region to reduce oil pollution. Copyright © 2016 Elsevier Ltd. All rights reserved.

High mortality of Red Sea zooplankton under ambient solar radiation.

PubMed

Al-Aidaroos, Ali M; El-Sherbiny, Mohsen M O; Satheesh, Sathianeson; Mantha, Gopikrishna; Agustī, Susana; Carreja, Beatriz; Duarte, Carlos M

2014-01-01

High solar radiation along with extreme transparency leads to high penetration of solar radiation in the Red Sea, potentially harmful to biota inhabiting the upper water column, including zooplankton. Here we show, based on experimental assessments of solar radiation dose-mortality curves on eight common taxa, the mortality of zooplankton in the oligotrophic waters of the Red Sea to increase steeply with ambient levels of solar radiation in the Red Sea. Responses curves linking solar radiation doses with zooplankton mortality were evaluated by exposing organisms, enclosed in quartz bottles, allowing all the wavelengths of solar radiation to penetrate, to five different levels of ambient solar radiation (100%, 21.6%, 7.2%, 3.2% and 0% of solar radiation). The maximum mortality rates under ambient solar radiation levels averaged (±standard error of the mean, SEM) 18.4±5.8% h(-1), five-fold greater than the average mortality in the dark for the eight taxa tested. The UV-B radiation required for mortality rates to reach ½ of maximum values averaged (±SEM) 12±5.6 h(-1)% of incident UVB radiation, equivalent to the UV-B dose at 19.2±2.7 m depth in open coastal Red Sea waters. These results confirm that Red Sea zooplankton are highly vulnerable to ambient solar radiation, as a consequence of the combination of high incident radiation and high water transparency allowing deep penetration of damaging UV-B radiation. These results provide evidence of the significance of ambient solar radiation levels as a stressor of marine zooplankton communities in tropical, oligotrophic waters. Because the oligotrophic ocean extends across 70% of the ocean surface, solar radiation can be a globally-significant stressor for the ocean ecosystem, by constraining zooplankton use of the upper levels of the water column and, therefore, the efficiency of food transfer up the food web in the oligotrophic ocean.

Desiccation and Mortality Dynamics in Seedlings of Different European Beech (Fagus sylvatica L.) Populations under Extreme Drought Conditions

PubMed Central

Bolte, Andreas; Czajkowski, Tomasz; Cocozza, Claudia; Tognetti, Roberto; de Miguel, Marina; Pšidová, Eva; Ditmarová, Ĺubica; Dinca, Lucian; Delzon, Sylvain; Cochard, Hervè; Ræbild, Anders; de Luis, Martin; Cvjetkovic, Branislav; Heiri, Caroline; Müller, Jürgen

2016-01-01

European beech (Fagus sylvatica L., hereafter beech), one of the major native tree species in Europe, is known to be drought sensitive. Thus, the identification of critical thresholds of drought impact intensity and duration are of high interest for assessing the adaptive potential of European beech to climate change in its native range. In a common garden experiment with one-year-old seedlings originating from central and marginal origins in six European countries (Denmark, Germany, France, Romania, Bosnia-Herzegovina, and Spain), we applied extreme drought stress and observed desiccation and mortality processes among the different populations and related them to plant water status (predawn water potential, ΨPD) and soil hydraulic traits. For the lethal drought assessment, we used a critical threshold of soil water availability that is reached when 50% mortality in seedling populations occurs (LD50SWA). We found significant population differences in LD50SWA (10.5–17.8%), and mortality dynamics that suggest a genetic difference in drought resistance between populations. The LD50SWA values correlate significantly with the mean growing season precipitation at population origins, but not with the geographic margins of beech range. Thus, beech range marginality may be more due to climatic conditions than to geographic range. The outcome of this study suggests the genetic variation has a major influence on the varying adaptive potential of the investigated populations. PMID:27379105

Cardiovascular response to thermoregulatory challenges

PubMed Central

Liu, Cuiqing; Yavar, Zubin

2015-01-01

A growing number of extreme climate events are occurring in the setting of ongoing climate change, with an increase in both the intensity and frequency. It has been shown that ambient temperature challenges have a direct and highly varied impact on cardiovascular health. With a rapidly growing amount of literature on this issue, we aim to review the recent publications regarding the impact of cold and heat on human populations with regard to cardiovascular disease (CVD) mortality/morbidity while also examining lag effects, vulnerable subgroups, and relevant mechanisms. Although the relative risk of morbidity/mortality associated with extreme temperature varied greatly across different studies, both cold and hot temperatures were associated with a positive mean excess of cardiovascular deaths or hospital admissions. Cause-specific study of CVD morbidity/mortality indicated that the sensitivity to temperature was disease-specific, with different patterns for acute and chronic ischemic heart disease. Vulnerability to temperature-related mortality was associated with some characteristics of the populations, including sex, age, location, socioeconomic condition, and comorbidities such as cardiac diseases, kidney diseases, diabetes, and hypertension. Temperature-induced damage is thought to be related to enhanced sympathetic reactivity followed by activation of the sympathetic nervous system, renin-angiotensin system, as well as dehydration and a systemic inflammatory response. Future research should focus on multidisciplinary adaptation strategies that incorporate epidemiology, climatology, indoor/building environments, energy usage, labor legislative perfection, and human thermal comfort models. Studies on the underlying mechanism by which temperature challenge induces pathophysiological response and CVD await profound and lasting investigation. PMID:26432837

Relationship of stand characteristics to drought-induced mortality in three Southwestern pinyon-juniper woodlands

Treesearch

M. Lisa Floyd; Michael Clifford; Neil S. Cob; Dustin Hanna; Robert Delph; Paulette Ford; Dave Turner

2009-01-01

Extreme drought conditions accompanied by rising temperatures have characterized the American Southwest during the past decade, causing widespread tree mortality in pinon-juniper woodlands. Pinon pine (Pinus edulis Engelm.) mortality is linked primarily to outbreaks of the pinyon ips (Ips confusus (Leconte)) precipitated by drought conditions. Although we searched...

Who Died, Where? Quantification of Drought-Induced Tree Mortality in Texas

NASA Astrophysics Data System (ADS)

Schwantes, A.; Swenson, J. J.; Johnson, D. M.; Domec, J. C.; Jackson, R. B.

2014-12-01

During 2011, Texas experienced a severe drought that killed millions of trees across the state. Drought-induced tree mortality can have significant ecological impacts and is expected to increase with climate change. We identify methods to quantify tree mortality in central Texas by using remotely sensed images before and after the drought at multiple spatial resolutions. Fine-scale tree mortality maps were created by classifying 1-m orthophotos from the National Agriculture Imagery Program. These classifications showed a high correlation with field estimates of percent canopy loss (RMSE = 2%; R2=0.9), and were thus used to calibrate coarser scale 30-m Landsat imagery. Random Forest, a machine learning method, was applied to obtain sub-pixel estimates of tree mortality. Traditional per-pixel classification techniques can map mortality of whole stands of trees (e.g. fire). However, these methods are often inadequate in detecting subtle changes in land cover, such as those associated with drought-induced tree mortality, which is often a widespread but scattered disturbance. Our method is unique, because it is capable of mapping death of individual canopies within a pixel. These 30-m tree mortality maps were then used to identify ecological systems most impacted by the drought and edaphic factors that control spatial distributions of tree mortality across central Texas. Ground observations coupled with our remote sensing analyses revealed that the majority of the mortality was Juniperus ashei. From a physiological standpoint this is surprising, because J. ashei is a drought-resistant tree. However, over the last century, this species has recently encroached into many areas previously dominated by grassland. Also, J. ashei tends to occupy landscape positions with lower available water storage, which could explain its high mortality rate. Predominantly tree mortality occurred in dry landscape positions (e.g. areas dominated by shallow soils, a low compound topographic index, and a high heat index). As increases in extreme drought events are predicted to occur with climate change, it will become more important to establish methods capable of detecting associated drought-induced tree mortality, to recognize vulnerable ecological systems, and to identify edaphic factors that predispose trees to mortality.

Pediatric Major Head Injury: Not a Minor Problem.

PubMed

Leetch, Aaron N; Wilson, Bryan

2018-05-01

Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients. Copyright © 2017 Elsevier Inc. All rights reserved.

A Single Hot Event That Does Not Affect Survival but Decreases Reproduction in the Diamondback Moth, Plutella xylostella

PubMed Central

Zhang, Wei; Zhao, Fei; Hoffmann, Ary A.; Ma, Chun-Sen

2013-01-01

Extremely hot events (usually involving a few hours at extreme high temperatures in summer) are expected to increase in frequency in temperate regions under global warming. The impact of these events is generally overlooked in insect population prediction, since they are unlikely to cause widespread mortality, however reproduction may be affected by them. In this study, we examined such stress effects in the diamondback moth, Plutella xylostella. We simulated a single extreme hot day (maximum of 40°C lasting for 3, 4 or 5 h) increasingly experienced under field conditions. This event had no detrimental effects on immediate mortality, copulation duration, mating success, longevity or lifetime fecundity, but stressed females produced 21% (after 3 or 4 h) fewer hatched eggs because of a decline in the number and hatching success of eggs laid on the first two days. These negative effects on reproduction were no longer evident in the following days. Male heat exposure led to a similar but smaller effect on fertile egg production, and exposure extended pre-mating period in both sexes. Our results indicate that a single hot day can have detrimental effects on reproduction, particularly through maternal effects on egg hatching, and thereby influence the population dynamics of diamondback moth. PMID:24116081

Association of Specific Dietary Fats With Total and Cause-Specific Mortality.

PubMed

Wang, Dong D; Li, Yanping; Chiuve, Stephanie E; Stampfer, Meir J; Manson, JoAnn E; Rimm, Eric B; Willett, Walter C; Hu, Frank B

2016-08-01

Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fat and mortality remains limited and inconsistent. To examine the associations of specific dietary fats with total and cause-specific mortality in 2 large ongoing cohort studies. This cohort study investigated 83 349 women from the Nurses' Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012) who were free of cardiovascular disease, cancer, and types 1 and 2 diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Information on mortality was obtained from systematic searches of the vital records of states and the National Death Index, supplemented by reports from family members or postal authorities. Data were analyzed from September 18, 2014, to March 27, 2016. Total and cause-specific mortality. During 3 439 954 person-years of follow-up, 33 304 deaths were documented. After adjustment for known and suspected risk factors, dietary total fat compared with total carbohydrates was inversely associated with total mortality (hazard ratio [HR] comparing extreme quintiles, 0.84; 95% CI, 0.81-0.88; P < .001 for trend). The HRs of total mortality comparing extreme quintiles of specific dietary fats were 1.08 (95% CI, 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fatty acid (PUFA), 0.89 (95% CI, 0.84-0.94) for monounsaturated fatty acid (MUFA), and 1.13 (95% CI, 1.07-1.18) for trans-fat (P < .001 for trend for all). Replacing 5% of energy from saturated fats with equivalent energy from PUFA and MUFA was associated with estimated reductions in total mortality of 27% (HR, 0.73; 95% CI, 0.70-0.77) and 13% (HR, 0.87; 95% CI, 0.82-0.93), respectively. The HR for total mortality comparing extreme quintiles of ω-6 PUFA intake was 0.85 (95% CI, 0.81-0.89; P < .001 for trend). Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes, whereas marine ω-3 PUFA intake was associated with a modestly lower total mortality (HR comparing extreme quintiles, 0.96; 95% CI, 0.93-1.00; P = .002 for trend). Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated fat and trans-fat with unsaturated fats.

General outcomes and risk factors for minor and major amputations in Brazil.

PubMed

Leite, Jose O; Costa, Leandro O; Fonseca, Walter M; Souza, Debora U; Goncalves, Barbara C; Gomes, Gabriela B; Cruz, Lucas A; Nister, Nilder; Navarro, Tulio P; Bath, Jonathan; Dardik, Alan

2018-06-01

Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.

Subcutaneous Emphysema Mimicking Gas Gangrene Following Perforation of the Rectum: A Case Report

PubMed Central

Moon, Eun-Sun; Jung, Sung-Taek; Seo, Hyoung-Yeon

2004-01-01

We report a case of extensive subcutaneous emphysema of the lower extremity mimicking gas gangrene following perforation of the rectum in a 38-yr-old man. Subcutaneous emphysema of the leg may rarely occur secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems and high mortality rates. Therefore, prompt diagnosis and aggressive treatment is imperative. PMID:15483358

Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.

PubMed

Deschepper, Mieke; Waegeman, Willem; Eeckloo, Kristof; Vogelaers, Dirk; Blot, Stijn

2018-05-09

Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. In this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012-2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme). The study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32-2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51-6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96-2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90-1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2-49.1). These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.

High resolution characterization of northwest Mediterranean coastal waters thermal regimes: To better understand responses of benthic communities to climate change

NASA Astrophysics Data System (ADS)

Bensoussan, Nathaniel; Romano, Jean-Claude; Harmelin, Jean-Georges; Garrabou, Joaquim

2010-04-01

In the North West Mediterranean (NWM), mass mortality events (MME) of long-lived benthic species that have occurred over the last two decades have been related to regional warming trend. Gaining robust data sets on thermal regimes is critical to assess conditions to which species have adapted, detect extreme events and critically evaluate biological impacts. High resolution temperature ( T) time series obtained during 1999-2006 from 5 to 40 m depth at four contrasted sites of the NWM were analyzed: Area Marina Protegida de les Illes Medes (NE Spain), Riou (Marseilles, France), Parc National de Port-Cros (France), and Réserve Naturelle de Scandola (Corsica, France). The seasonal pattern showed winter T around 11-13 °C, and summer T mainly around 22-24 °C near surface to 18-20 °C at depth. Stratification dynamics showed recurrent downwellings (>40 m) at Medes, frequent observation (1/3rd of the summer) of deep and cold upwelled waters at Riou, while Scandola exhibited stable summer stratification and highest suprathermoclinal T. Port-Cros showed an intermediate regime that oscillated between Riou and Scandola depending on the occurrence of northern winds. Data distribution study permitted to identify and to characterize 3 large scale positive anomalies concomitant with the mass mortality outbreaks of summers 1999, 2003 and 2006. The analysis of biological surveys on gorgonian populations showed significant impacts during the 3 years with temperature anomalies. Besides the degree of impact showed inter-annual differences which could be related to different T conditions concomitant to mortality events, from slight increase in T extreme of only 1-2 °C over short duration, to lengthened more classical summer conditions. Our results therefore support the hypothesis that shallow NWM populations of long-lived benthic species are living near their upper thermal thresholds. Given actual trends and projections in NWM, the repetition of new MMEs in the next decades is extremely likely. In such context, the acquisition of dedicated high resolution T series proves to be crucial for increasing our detection, understanding and forecasting abilities.

Role of Acclimatization in Weather-Related Human Mortality During the Transition Seasons of Autumn and Spring in a Thermally Extreme Mid-Latitude Continental Climate

PubMed Central

de Freitas, Christopher R.; Grigorieva, Elena A.

2015-01-01

Human mortality is closely related to natural climate-determined levels of thermal environmental stress and the resulting thermophysiological strain. Most climate-mortality research has focused on seasonal extremes during winter and summer when mortality is the highest, while relatively little attention has been paid to mortality during the transitional seasons of autumn and spring. The body acclimatizes to heat in the summer and cold in winter and readjusts through acclimatization during the transitions between the two during which time the body experiences the thermophysiological strain of readjustment. To better understand the influences of weather on mortality through the acclimatization process, the aim here is to examine the periods that link very cold and very warms seasons. The study uses the Acclimatization Thermal Strain Index (ATSI), which is a comparative measure of short-term thermophysiological impact on the body. ATSI centers on heat exchange with the body’s core via the respiratory system, which cannot be protected. The analysis is based on data for a major city in the climatic region of the Russian Far East characterized by very hot summers and extremely cold winters. The results show that although mortality peaks in winter (January) and is at its lowest in summer (August), there is not a smooth rise through autumn nor a smooth decline through spring. A secondary peak occurs in autumn (October) with a smaller jump in May. This suggests the acclimatization from warm-to-cold produces more thermophysiological strain than the transition from cold-to-warm. The study shows that ATSI is a useful metric for quantifying the extent to which biophysical adaptation plays a role in increased strain on the body during re-acclimatization and for this reason is a more appropriate climatic indictor than air temperature alone. The work gives useful bioclimatic information on risks involved in transitional seasons in regions characterized by climatic extremes. This could be handy in planning and managing health services to the public and measures that might be used to help mitigate impacts. PMID:26703633

Role of Acclimatization in Weather-Related Human Mortality During the Transition Seasons of Autumn and Spring in a Thermally Extreme Mid-Latitude Continental Climate.

PubMed

de Freitas, Christopher R; Grigorieva, Elena A

2015-11-26

Human mortality is closely related to natural climate-determined levels of thermal environmental stress and the resulting thermophysiological strain. Most climate-mortality research has focused on seasonal extremes during winter and summer when mortality is the highest, while relatively little attention has been paid to mortality during the transitional seasons of autumn and spring. The body acclimatizes to heat in the summer and cold in winter and readjusts through acclimatization during the transitions between the two during which time the body experiences the thermophysiological strain of readjustment. To better understand the influences of weather on mortality through the acclimatization process, the aim here is to examine the periods that link very cold and very warms seasons. The study uses the Acclimatization Thermal Strain Index (ATSI), which is a comparative measure of short-term thermophysiological impact on the body. ATSI centers on heat exchange with the body’s core via the respiratory system, which cannot be protected. The analysis is based on data for a major city in the climatic region of the Russian Far East characterized by very hot summers and extremely cold winters. The results show that although mortality peaks in winter (January) and is at its lowest in summer (August), there is not a smooth rise through autumn nor a smooth decline through spring. A secondary peak occurs in autumn (October) with a smaller jump in May. This suggests the acclimatization from warm-to-cold produces more thermophysiological strain than the transition from cold-to-warm. The study shows that ATSI is a useful metric for quantifying the extent to which biophysical adaptation plays a role in increased strain on the body during re-acclimatization and for this reason is a more appropriate climatic indictor than air temperature alone. The work gives useful bioclimatic information on risks involved in transitional seasons in regions characterized by climatic extremes. This could be handy in planning and managing health services to the public and measures that might be used to help mitigate impacts.

Increases in external cause mortality due to high and low temperatures: evidence from northeastern Europe

NASA Astrophysics Data System (ADS)

Orru, Hans; Åström, Daniel Oudin

2017-05-01

The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00-Y99) and maximum temperatures over the period 1997-2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1-3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14-1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03-1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.

Acclimatization to extreme heat

NASA Astrophysics Data System (ADS)

Warner, M. E.; Ganguly, A. R.; Bhatia, U.

2017-12-01

Heat extremes throughout the globe, as well as in the United States, are expected to increase. These heat extremes have been shown to impact human health, resulting in some of the highest levels of lives lost as compared with similar natural disasters. But in order to inform decision makers and best understand future mortality and morbidity, adaptation and mitigation must be considered. Defined as the ability for individuals or society to change behavior and/or adapt physiologically, acclimatization encompasses the gradual adaptation that occurs over time. Therefore, this research aims to account for acclimatization to extreme heat by using a hybrid methodology that incorporates future air conditioning use and installation patterns with future temperature-related time series data. While previous studies have not accounted for energy usage patterns and market saturation scenarios, we integrate such factors to compare the impact of air conditioning as a tool for acclimatization, with a particular emphasis on mortality within vulnerable communities.

Heatwaves and Heat-Related Mortality in India

NASA Astrophysics Data System (ADS)

Mazdiyasni, O.; AghaKouchak, A.; Davis, S. J.; Madadgar, S.; Sengupta, A.; Ragno, E.

2016-12-01

Global temperatures are rising, causing increases in the frequency and severity of extreme climatic events, such as droughts and heatwaves. Here we present an analysis of the changes in temperature, number of heatwaves, and heat-related morality rates in India from 1960 - 2009, using data from the India Meteorological Department. We show that the changes in heatwaves from 1960 - 2009 are statistically significant. We then use a copula-based conditional probabilistic model to determine change in mortality in response to change in mean summer temperatures. We show that only 0.5 °C increase in mean summer temperatures in India causes a 140% increase in the probability of heat-related mortality. As global temperatures rise, heat-related mortality rates will increase in developing countries similar to India due to increasing heatwaves and high vulnerability to increased summer temperatures. International aid organizations should implement policies for improved infrastructure and disaster response plans across the developing world to assist in curbing the climate change effects on human health.

An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease

PubMed Central

Owens, Christopher D.; Kim, Ji Min; Hevelone, Nathanael D.; Gasper, Warren J.; Belkin, Michael; Creager, Mark A.; Conte, Michael S.

2012-01-01

Background Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (<5 years) mortality in this population. This study was designed to test the hypothesis that baseline biochemical parameters would add clinically meaningful predictive information in patients undergoing lower extremity bypass. Methods This was a prospective cohort study of subjects with clinically advanced PAD undergoing lower extremity bypass surgery. The Cox proportional hazard was used to assess the main outcome of all-cause mortality. A clinical model was constructed with known cardiovascular risk factors and the incremental value of the addition of clinical chemistry, lipid, and a panel of 11 inflammatory parameters were investigated using c-statistic, the integrated discrimination improvement (IDI) index and Akaike information criterion (AIC). Results 225 subjects were followed for a median 893 days; IQR 539–1315 days). In this study 50 (22.22%) subjects died during the follow-up period. By life table analysis (expressed as percent surviving ± standard error), survival at 1, 2, 3, 4, and 5 years respectively was 90.5 ± 1.9%, 83.4 ± 2.5%, 77.5 ± 3.1%, 71.0 ± 3.8%, and 65.3 ± 6.5%. Compared with survivors, decedents were older, diabetic, had extant CAD, and were more likely to present with CLI as their indication for bypass surgery, P<.05. After adjustment for the above, clinical chemistry and inflammatory parameters significant for all cause mortality were albumin, HR .43 (95% CI .26–.71); P=.001, estimated glomerular filtration rate (eGFR), HR .98 (95% CI .97–.99), P=.023, high sensitivity C-reactive protein (hsCRP), HR 3.21 (95% CI 1.21–8.55), P=.019, and soluble vascular cell adhesion molecule (sVCAM), HR 1.74 (1.04–2.91), P=.034. Of all inflammatory molecules investigated, hsCRP proved most robust and representative of the integrated inflammatory response. Albumin, eGFR, and hsCRP improved the c-statistic and IDI beyond that of the clinical model and produced a final c-statistic of .82. Conclusions A risk prediction model including traditional risk factors and parameters of inflammation, renal function and nutrition had excellent discriminatory ability in predicting all cause mortality in patients with clinically advanced PAD undergoing bypass surgery. PMID:22554422

An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease.

PubMed

Owens, Christopher D; Kim, Ji Min; Hevelone, Nathanael D; Gasper, Warren J; Belkin, Michael; Creager, Mark A; Conte, Michael S

2012-09-01

Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (<5 years) mortality in this population. This study tested the hypothesis that baseline biochemical parameters would add clinically meaningful predictive information in patients undergoing lower extremity bypass operations. This was a prospective cohort study of patients with clinically advanced PAD undergoing lower extremity bypass surgery. The Cox proportional hazard model was used to assess the main outcome of all-cause mortality. A clinical model was constructed with known CV risk factors, and the incremental value of the addition of clinical chemistry, lipid assessment, and a panel of 11 inflammatory parameters was investigated using the C statistic, the integrated discrimination improvement index, and Akaike information criterion. The study monitored 225 patients for a median of 893 days (interquartile range, 539-1315 days). In this study, 50 patients (22.22%) died during the follow-up period. By life-table analysis (expressed as percent surviving ± standard error), survival at 1, 2, 3, 4, and 5 years, respectively, was 90.5% ± 1.9%, 83.4% ± 2.5%, 77.5% ± 3.1%, 71.0% ± 3.8%, and 65.3% ± 6.5%. Compared with survivors, decedents were older, diabetic, had extant coronary artery disease, and were more likely to present with critical limb ischemia as their indication for bypass surgery (P < .05). After adjustment for the above, clinical chemistry and inflammatory parameters significant (hazard ratio [95% confidence interval]) for all-cause mortality were albumin (0.43 [0.26-0.71]; P = .001), estimated glomerular filtration rate (0.98 [0.97-0.99]; P = .023), high-sensitivity C-reactive protein (hsCRP; 3.21 [1.21-8.55]; P = .019), and soluble vascular cell adhesion molecule (1.74 [1.04-2.91]; P = .034). Of the inflammatory molecules investigated, hsCRP proved most robust and representative of the integrated inflammatory response. Albumin, eGFR, and hsCRP improved the C statistic and integrated discrimination improvement index beyond that of the clinical model and produced a final C statistic of 0.82. A risk prediction model including traditional risk factors and parameters of inflammation, renal function, and nutrition had excellent discriminatory ability in predicting all-cause mortality in patients with clinically advanced PAD undergoing bypass surgery. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008.

PubMed

Schlapbach, Luregn J; Adams, Mark; Proietti, Elena; Aebischer, Maude; Grunt, Sebastian; Borradori-Tolsa, Cristina; Bickle-Graz, Myriam; Bucher, Hans Ulrich; Latal, Beatrice; Natalucci, Giancarlo

2012-12-28

While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 24(0/7) and 27(6/7) weeks gestational age during 2000-2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 36(0/7) weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Attributing Human Mortality During Extreme Heat Waves to Anthropogenic Climate Change

NASA Astrophysics Data System (ADS)

Mitchell, D.; Heaviside, C.; Vardoulakis, S.; Huntingford, C.; Masato, G.; Guillod, B. P.; Frumhoff, P. C.; Bowery, A.; Allen, M. R.

2015-12-01

Climate change is the biggest global health threat of the 21st century (Costello et al, 2009; Watts et al, 2015). Perhaps one of the clearest examples of this is the summer heat wave of 2003, which saw up to seventy thousand excess deaths across Europe (Robine et al, 2007). The extreme temperatures are now thought to be significantly enhanced due to anthropogenic climate change (Stott et al, 2004; Christidis et al, 2015). Here, we consider not only the Europe-wide temperature response of the heat wave, but the localised response using a high-resolution regional model simulating 2003 climate conditions thousands of times. For the first time, by employing end-to-end attribution, we attribute changes in mortality to the increased radiative forcing from climate change, with a specific focus on London and Paris. We show that in both cities, a sizable proportion of the excess mortality can be attributed to human emissions. With European heat waves projected to increase into the future, these results provide a worrying reality for what may lie ahead. Christidis, Nikolaos, Gareth S. Jones, and Peter A. Stott. "Dramatically increasing chance of extremely hot summers since the 2003 European heatwave." Nature Climate Change (2014). Costello, Anthony, et al. "Managing the health effects of climate change: lancet and University College London Institute for Global Health Commission." The Lancet 373.9676 (2009): 1693-1733. Stott, Peter A., Dáithí A. Stone, and Myles R. Allen. "Human contribution to the European heatwave of 2003." Nature 432.7017 (2004): 610-614 Watts, N., et al. "Health and climate change: policy responses to protect public health." Lancet. 2015.

Limits to the thermal tolerance of corals adapted to a highly fluctuating, naturally extreme temperature environment

PubMed Central

Schoepf, Verena; Stat, Michael; Falter, James L.; McCulloch, Malcolm T.

2015-01-01

Naturally extreme temperature environments can provide important insights into the processes underlying coral thermal tolerance. We determined the bleaching resistance of Acropora aspera and Dipsastraea sp. from both intertidal and subtidal environments of the naturally extreme Kimberley region in northwest Australia. Here tides of up to 10 m can cause aerial exposure of corals and temperatures as high as 37 °C that fluctuate daily by up to 7 °C. Control corals were maintained at ambient nearshore temperatures which varied diurnally by 4-5 °C, while treatment corals were exposed to similar diurnal variations and heat stress corresponding to ~20 degree heating days. All corals hosted Symbiodinium clade C independent of treatment or origin. Detailed physiological measurements showed that these corals were nevertheless highly sensitive to daily average temperatures exceeding their maximum monthly mean of ~31 °C by 1 °C for only a few days. Generally, Acropora was much more susceptible to bleaching than Dipsastraea and experienced up to 75% mortality, whereas all Dipsastraea survived. Furthermore, subtidal corals, which originated from a more thermally stable environment compared to intertidal corals, were more susceptible to bleaching. This demonstrates that while highly fluctuating temperatures enhance coral resilience to thermal stress, they do not provide immunity to extreme heat stress events. PMID:26627576

Limits to the thermal tolerance of corals adapted to a highly fluctuating, naturally extreme temperature environment.

PubMed

Schoepf, Verena; Stat, Michael; Falter, James L; McCulloch, Malcolm T

2015-12-02

Naturally extreme temperature environments can provide important insights into the processes underlying coral thermal tolerance. We determined the bleaching resistance of Acropora aspera and Dipsastraea sp. from both intertidal and subtidal environments of the naturally extreme Kimberley region in northwest Australia. Here tides of up to 10 m can cause aerial exposure of corals and temperatures as high as 37 °C that fluctuate daily by up to 7 °C. Control corals were maintained at ambient nearshore temperatures which varied diurnally by 4-5 °C, while treatment corals were exposed to similar diurnal variations and heat stress corresponding to ~20 degree heating days. All corals hosted Symbiodinium clade C independent of treatment or origin. Detailed physiological measurements showed that these corals were nevertheless highly sensitive to daily average temperatures exceeding their maximum monthly mean of ~31 °C by 1 °C for only a few days. Generally, Acropora was much more susceptible to bleaching than Dipsastraea and experienced up to 75% mortality, whereas all Dipsastraea survived. Furthermore, subtidal corals, which originated from a more thermally stable environment compared to intertidal corals, were more susceptible to bleaching. This demonstrates that while highly fluctuating temperatures enhance coral resilience to thermal stress, they do not provide immunity to extreme heat stress events.

Emergency surgery for bowel obstruction in extremely aged patients.

PubMed

Oldani, Alberto; Gentile, Valentina; Magaton, Chiara; Calabrò, Marcello; Maroso, Fabio; Ravizzini, Lidia; Deiro, Giacomo; Amato, Maurizio; Gentilli, Sergio

2018-04-13

As a result of the increasing of life expectancy, the incidence of pathologies that can lead to operation for bowel obstruction is also increasing. Comorbidities and reduced physiological reserve can decrease elderly patients' ability to tolerate operations especially in an emergency context. We retrospectively evaluated the treatment and outcomes of a cohort of patients aged more than 85 years who underwent emergency surgery for intestinal occlusion. 278 patients who were admitted to our Institution and operated for acute bowel obstruction have been included in our study. We divided the study population in 2 groups (group A: patients aged > 85 years old; group B patients aged ≤ 85 years). We evaluated the differences between the two groups in terms of intestinal occlusion aetiology, surgical procedures, morbidity and mortality rates. Group A consisted of 57 patients, group B of 221; elderly patients trend in ASA score classification was significantly towards high risk for elderly group; statistical analysis did not show differences in terms of bowel obstruction aetiology (except colon volvulus, more frequent in advanced age), type of procedure, duration of hospital stay, procedure - related complication rate. Perioperative mortality was significantly higher in elderly group, due to the mayor incidence of cardiovascular and respiratory fatal events directly related to pre - existing comorbidities. Despite the high surgical risk, early diagnosis and treatment of the obstructive disease can lead to achieve encouraging outcomes also in extremely advanced age; an aggressive evaluation of comorbidies and the cardio - respiratory risks reduction, when possible, could be useful in improve postoperative outcomes in terms of mortality.

Hypertensive emergencies remain a clinical problem and are associated with high mortality.

PubMed

Roubsanthisuk, Weranuj; Wongsurin, Unticha; Buranakitjaroen, Peera

2010-01-01

We suspect that hypertensive emergencies remain a clinical problem and data on their long-term prognosis are lacking. This study was conducted in order to determine the frequency, management, and outcome of hypertensive emergencies in this era, in which hypertension treatment is more effective than in the past. We reviewed the medical records of patients with hypertensive emergencies admitted to the medical wards of Siriraj Hospital in 2003 and collected data on their characteristic, management, investigations, and follow-ups through 31 December 2007. There were 184 patients included. Hypertension has been previously diagnosed in 89% of cases. Nearly half also had diabetes mellitus and around a quarter had chronic kidney failure. Mean +/- SD of blood pressure at presentation was 205.96 +/- 21.36/114.60 +/- 20.59 mmHg. Cardiac complications and stroke accounted for 71% and 23% of all target organ damage, respectively. Intravenous nitroglycerine and furosemide were most frequently prescribed. Additional investigations to search for the causes of hypertension were performed in only 55 cases. The average hospital stay was 9.8 days. The in-hospital mortality rate was 15%. Some 26% of patients were lost to follow-up and another 20% died later. Only 19% of patients had regular follow-ups until the end of 2007 and remained on an average of 2.4 antihypertensive drugs. Hypertensive emergencies are usually found in patients with a history of hypertension and diabetes mellitus or kidney failure. Recommended investigations usually failed to identify the cause of hypertension. The mortality rate of these patients was extremely high while their adherence to treatment was extremely poor.

Relationship between fine particulate matter, weather condition and daily non-accidental mortality in Shanghai, China: A Bayesian approach.

PubMed

Fang, Xin; Fang, Bo; Wang, Chunfang; Xia, Tian; Bottai, Matteo; Fang, Fang; Cao, Yang

2017-01-01

There are concerns that the reported association of ambient fine particulate matter (PM2.5) with mortality might be a mixture of PM2.5 and weather conditions. We evaluated the effects of extreme weather conditions and weather types on mortality as well as their interactions with PM2.5 concentrations in a time series study. Daily non-accidental deaths, individual demographic information, daily average PM2.5 concentrations and meteorological data between 2012 and 2014 were obtained from Shanghai, China. Days with extreme weather conditions were identified. Six synoptic weather types (SWTs) were generated. The generalized additive model was set up to link the mortality with PM2.5 and weather conditions. Parameter estimation was based on Bayesian methods using both the Jeffreys' prior and an informative normal prior in a sensitivity analysis. We estimate the percent increase in non-accidental mortality per 10 μg/m3 increase in PM2.5 concentration and constructed corresponding 95% credible interval (CrI). In total, 336,379 non-accidental deaths occurred during the study period. Average daily deaths were 307. The results indicated that per 10 μg/m3 increase in daily average PM2.5 concentration alone corresponded to 0.26-0.35% increase in daily non-accidental mortality in Shanghai. Statistically significant positive associations between PM2.5 and mortality were found for favorable SWTs when considering the interaction between PM2.5 and SWTs. The greatest effect was found in hot dry SWT (percent increase = 1.28, 95% CrI: 0.72, 1.83), followed by warm humid SWT (percent increase = 0.64, 95% CrI: 0.15, 1.13). The effect of PM2.5 on non-accidental mortality differed under specific extreme weather conditions and SWTs. Environmental policies and actions should take into account the interrelationship between the two hazardous exposures.

Relationship between fine particulate matter, weather condition and daily non-accidental mortality in Shanghai, China: A Bayesian approach

PubMed Central

Wang, Chunfang; Xia, Tian; Bottai, Matteo; Fang, Fang; Cao, Yang

2017-01-01

There are concerns that the reported association of ambient fine particulate matter (PM2.5) with mortality might be a mixture of PM2.5 and weather conditions. We evaluated the effects of extreme weather conditions and weather types on mortality as well as their interactions with PM2.5 concentrations in a time series study. Daily non-accidental deaths, individual demographic information, daily average PM2.5 concentrations and meteorological data between 2012 and 2014 were obtained from Shanghai, China. Days with extreme weather conditions were identified. Six synoptic weather types (SWTs) were generated. The generalized additive model was set up to link the mortality with PM2.5 and weather conditions. Parameter estimation was based on Bayesian methods using both the Jeffreys’ prior and an informative normal prior in a sensitivity analysis. We estimate the percent increase in non-accidental mortality per 10 μg/m3 increase in PM2.5 concentration and constructed corresponding 95% credible interval (CrI). In total, 336,379 non-accidental deaths occurred during the study period. Average daily deaths were 307. The results indicated that per 10 μg/m3 increase in daily average PM2.5 concentration alone corresponded to 0.26–0.35% increase in daily non-accidental mortality in Shanghai. Statistically significant positive associations between PM2.5 and mortality were found for favorable SWTs when considering the interaction between PM2.5 and SWTs. The greatest effect was found in hot dry SWT (percent increase = 1.28, 95% CrI: 0.72, 1.83), followed by warm humid SWT (percent increase = 0.64, 95% CrI: 0.15, 1.13). The effect of PM2.5 on non-accidental mortality differed under specific extreme weather conditions and SWTs. Environmental policies and actions should take into account the interrelationship between the two hazardous exposures. PMID:29121092

Body size and mortality rates in coral reef fishes: a three-phase relationship.

PubMed

Goatley, Christopher Harry Robert; Bellwood, David Roy

2016-10-26

Body size is closely linked to mortality rates in many animals, although the overarching patterns in this relationship have rarely been considered for multiple species. A meta-analysis of published size-specific mortality rates for coral reef fishes revealed an exponential decline in mortality rate with increasing body size, however, within this broad relationship there are three distinct phases. Phase one is characterized by naive fishes recruiting to reefs, which suffer extremely high mortality rates. In this well-studied phase, fishes must learn quickly to survive the many predation risks. After just a few days, the surviving fishes enter phase two, in which small increases in body size result in pronounced increases in lifespan (estimated 11 d mm -1 ). Remarkably, approximately 50% of reef fish individuals remain in phase two throughout their lives. Once fishes reach a size threshold of about 43 mm total length (TL) they enter phase three, where mortality rates are relatively low and the pressure to grow is presumably, significantly reduced. These phases provide a clearer understanding of the impact of body size on mortality rates in coral reef fishes and begin to reveal critical insights into the energetic and trophic dynamics of coral reefs. © 2016 The Author(s).

Disturbance legacies and climate jointly drive tree growth and mortality in an intensively studied boreal forest.

PubMed

Bond-Lamberty, Ben; Rocha, Adrian V; Calvin, Katherine; Holmes, Bruce; Wang, Chuankuan; Goulden, Michael L

2014-01-01

Most North American forests are at some stage of post-disturbance regrowth, subject to a changing climate, and exhibit growth and mortality patterns that may not be closely coupled to annual environmental conditions. Distinguishing the possibly interacting effects of these processes is necessary to put short-term studies in a longer term context, and particularly important for the carbon-dense, fire-prone boreal forest. The goals of this study were to combine dendrochronological sampling, inventory records, and machine-learning algorithms to understand how tree growth and death have changed at one highly studied site (Northern Old Black Spruce, NOBS) in the central Canadian boreal forest. Over the 1999-2012 inventory period, mean tree diameter increased even as stand density and basal area declined significantly. Tree mortality averaged 1.4 ± 0.6% yr-(1), with most mortality occurring in medium-sized trees; new recruitment was minimal. There have been at least two, and probably three, significant influxes of new trees since stand initiation, but none in recent decades. A combined tree ring chronology constructed from sampling in 2001, 2004, and 2012 showed several periods of extreme growth depression, with increased mortality lagging depressed growth by ~5 years. Higher minimum and maximum air temperatures exerted a negative influence on tree growth, while precipitation and climate moisture index had a positive effect; both current- and previous-year data exerted significant effects. Models based on these variables explained 23-44% of the ring-width variability. We suggest that past climate extremes led to significant mortality still visible in the current forest structure, with decadal dynamics superimposed on slower patterns of fire and succession. These results have significant implications for our understanding of previous work at NOBS, the carbon sequestration capability of old-growth stands in a disturbance-prone landscape, and the sustainable management of regional forests in a changing climate.

Evaluating the Performance of a Climate-Driven Mortality Model during Heat Waves and Cold Spells in Europe

PubMed Central

Lowe, Rachel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R.; Rodó, Xavier

2015-01-01

The impact of climate change on human health is a serious concern. In particular, changes in the frequency and intensity of heat waves and cold spells are of high relevance in terms of mortality and morbidity. This demonstrates the urgent need for reliable early-warning systems to help authorities prepare and respond to emergency situations. In this study, we evaluate the performance of a climate-driven mortality model to provide probabilistic predictions of exceeding emergency mortality thresholds for heat wave and cold spell scenarios. Daily mortality data corresponding to 187 NUTS2 regions across 16 countries in Europe were obtained from 1998–2003. Data were aggregated to 54 larger regions in Europe, defined according to similarities in population structure and climate. Location-specific average mortality rates, at given temperature intervals over the time period, were modelled to account for the increased mortality observed during both high and low temperature extremes and differing comfort temperatures between regions. Model parameters were estimated in a Bayesian framework, in order to generate probabilistic simulations of mortality across Europe for time periods of interest. For the heat wave scenario (1–15 August 2003), the model was successfully able to anticipate the occurrence or non-occurrence of mortality rates exceeding the emergency threshold (75th percentile of the mortality distribution) for 89% of the 54 regions, given a probability decision threshold of 70%. For the cold spell scenario (1–15 January 2003), mortality events in 69% of the regions were correctly anticipated with a probability decision threshold of 70%. By using a more conservative decision threshold of 30%, this proportion increased to 87%. Overall, the model performed better for the heat wave scenario. By replacing observed temperature data in the model with forecast temperature, from state-of-the-art European forecasting systems, probabilistic mortality predictions could potentially be made several months ahead of imminent heat waves and cold spells. PMID:25625407

Evaluating the performance of a climate-driven mortality model during heat waves and cold spells in Europe.

PubMed

Lowe, Rachel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R; Rodó, Xavier

2015-01-23

The impact of climate change on human health is a serious concern. In particular, changes in the frequency and intensity of heat waves and cold spells are of high relevance in terms of mortality and morbidity. This demonstrates the urgent need for reliable early-warning systems to help authorities prepare and respond to emergency situations. In this study, we evaluate the performance of a climate-driven mortality model to provide probabilistic predictions of exceeding emergency mortality thresholds for heat wave and cold spell scenarios. Daily mortality data corresponding to 187 NUTS2 regions across 16 countries in Europe were obtained from 1998-2003. Data were aggregated to 54 larger regions in Europe, defined according to similarities in population structure and climate. Location-specific average mortality rates, at given temperature intervals over the time period, were modelled to account for the increased mortality observed during both high and low temperature extremes and differing comfort temperatures between regions. Model parameters were estimated in a Bayesian framework, in order to generate probabilistic simulations of mortality across Europe for time periods of interest. For the heat wave scenario (1-15 August 2003), the model was successfully able to anticipate the occurrence or non-occurrence of mortality rates exceeding the emergency threshold (75th percentile of the mortality distribution) for 89% of the 54 regions, given a probability decision threshold of 70%. For the cold spell scenario (1-15 January 2003), mortality events in 69% of the regions were correctly anticipated with a probability decision threshold of 70%. By using a more conservative decision threshold of 30%, this proportion increased to 87%. Overall, the model performed better for the heat wave scenario. By replacing observed temperature data in the model with forecast temperature, from state-of-the-art European forecasting systems, probabilistic mortality predictions could potentially be made several months ahead of imminent heat waves and cold spells.

Meadow vole-induced mortality of oak seedlings in a former agricultural field planting

Treesearch

Andrew B. Self; Andrew W. Ezell; Dennis Rowe; Emily B. Schultz; John D. Hodges

2015-01-01

Seedling mortality due to meadow vole herbivory is an often acknowledged but relatively unstudied aspect of hardwood afforestation. Vole-induced mortality is not typically a major item of concern in afforestation attempts. However, damage has been extreme in some plantings. A total of 4,320 bare-root Nuttall oak (Quercus texana Buckley), Shumard oak (Quercus shumardii...

Extreme Precipitation and Flooding: Exposure Characterization and the Association Between Exposure and Mortality in 108 United States Communities, 1987-2005

NASA Astrophysics Data System (ADS)

Severson, R. L.; Peng, R. D.; Anderson, G. B.

2017-12-01

There is substantial evidence that extreme precipitation and flooding are serious threats to public health and safety. These threats are predicted to increase with climate change. Epidemiological studies investigating the health effects of these events vary in the methods used to characterize exposure. Here, we compare two sources of precipitation data (National Oceanic and Atmospheric Administration (NOAA) station-based and North American Land Data Assimilation Systems (NLDAS-2) Reanalysis data-based) for estimating exposure to extreme precipitation and two sources of flooding data, based on United States Geological Survey (USGS) streamflow gages and the NOAA Storm Events database. We investigate associations between each of the four exposure metrics and short-term risk of four causes of mortality (accidental, respiratory-related, cardiovascular-related, and all-cause) in the United States from 1987 through 2005. Average daily precipitation values from the two precipitation data sources were moderately correlated (Spearman's rho = 0.74); however, values from the two data sources were less correlated when comparing binary metrics of exposure to extreme precipitation days (Jaccard index (J) = 0.35). Binary metrics of daily flood exposure were poorly correlated between the two flood data sources (Spearman's rho = 0.07; J = 0.05). There was little correlation between extreme precipitation exposure and flood exposure in study communities. We did not observe evidence of a positive association between any of the four exposure metrics and risk of any of the four mortality outcomes considered. Our results suggest, due to the observed lack of agreement between different extreme precipitation and flood metrics, that exposure to extreme precipitation may not serve as an effective surrogate for exposures related to flooding. Furthermore, It is possible that extreme precipitation and flood exposures may often be too localized to allow accurate exposure assessment at the community level for epidemiological studies.

Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

PubMed Central

Alleman, Brandon W.; Li, Lei; Dagle, John M.; Smith, P. Brian; Ambalavanan, Namasivayam; Laughon, Matthew M.; Stoll, Barbara J.; Goldberg, Ronald N.; Carlo, Waldemar A.; Murray, Jeffrey C.; Cotten, C. Michael; Shankaran, Seetha; Walsh, Michele C.; Laptook, Abbot R.; Ellsbury, Dan L.; Hale, Ellen C.; Newman, Nancy S.; Wallace, Dennis D.; Das, Abhik; Higgins, Rosemary D.

2013-01-01

OBJECTIVE: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006–2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs <25 weeks and ≥25 weeks. RESULTS: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs <25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants <25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at <25 weeks’ GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality. PMID:23753096

The effect of extreme cold temperatures on the risk of death in the two major Portuguese cities

NASA Astrophysics Data System (ADS)

Antunes, Liliana; Silva, Susana Pereira; Marques, Jorge; Nunes, Baltazar; Antunes, Sílvia

2017-01-01

It is well known that meteorological conditions influence the comfort and human health. Southern European countries, including Portugal, show the highest mortality rates during winter, but the effects of extreme cold temperatures in Portugal have never been estimated. The objective of this study was the estimation of the effect of extreme cold temperatures on the risk of death in Lisbon and Oporto, aiming the production of scientific evidence for the development of a real-time health warning system. Poisson regression models combined with distributed lag non-linear models were applied to assess the exposure-response relation and lag patterns of the association between minimum temperature and all-causes mortality and between minimum temperature and circulatory and respiratory system diseases mortality from 1992 to 2012, stratified by age, for the period from November to March. The analysis was adjusted for over dispersion and population size, for the confounding effect of influenza epidemics and controlled for long-term trend, seasonality and day of the week. Results showed that the effect of cold temperatures in mortality was not immediate, presenting a 1-2-day delay, reaching maximum increased risk of death after 6-7 days and lasting up to 20-28 days. The overall effect was generally higher and more persistent in Lisbon than in Oporto, particularly for circulatory and respiratory mortality and for the elderly. Exposure to cold temperatures is an important public health problem for a relevant part of the Portuguese population, in particular in Lisbon.

Clostridial abdominal gas gangrene masquerading as a bowel perforation in an advanced-stage ovarian cancer patient.

PubMed

Abaid, L N; Thomas, R H; Epstein, H D; Goldstein, B H

2013-08-01

The coexistence of clostridial gas gangrene and a gynecologic malignancy is extremely rare, with very few cases involving ovarian cancer. A patient originally presented to our gynecologic oncology service with stage IV ovarian cancer; she underwent a diagnostic laparoscopy and neoadjuvant chemotherapy. On postoperative day 6, the patient developed severe abdominal pain, nausea, and emesis, suggestive of a bowel perforation. Further evaluation confirmed that her symptoms were attributed to Clostridium perfringens-related gas gangrene. Despite immediate surgical intervention, the patient succumbed to her disease. Clostridial gas gangrene is associated with an extremely high mortality rate. Therefore, accurate detection and prompt management are indispensable to ensuring a favorable patient outcome.

Extreme metabolic alkalosis in intensive care.

PubMed

Tripathy, Swagata

2009-10-01

Metabolic alkalosis is a commonly seen imbalance in the intensive care unit (ICU). Extreme metabolic alkalemia, however, is less common. A pH greater than 7.65 may carry a high risk of mortality (up to 80%). We discuss the entity of life threatening metabolic alkalemia by means of two illustrative cases - both with a pH greater than 7.65 on presentation. The cause, modalities of managing and complications of this condition is discussed from the point of view of both the traditional method of Henderson and Hasselbalch and the mathematical model based on physiochemical model described by Stewart. Special mention to the pitfalls in managing patients of metabolic alkalosis with concomitant renal compromise is made.

Cancer-Specific Mortality Relative to Engagement in Muscle-Strengthening Activities and Lower Extremity Strength.

PubMed

Dankel, Scott J; Loenneke, Jeremy P; Loprinzi, Paul D

2018-02-01

Skeletal muscle strength and engagement in muscle-strengthening activities are each inversely associated with all-cause mortality; however, less is known on their relationship with cancer-specific mortality. Data from the 1999-2002 National Health and Nutrition Examination Survey were used assessing 2773 individuals aged 50 years or older. Individuals being dichotomized at the 75th percentile for knee extensor strength, and engagement in muscle-strengthening activities was acquired through self-report with ≥2 sessions per week were classified as meeting guidelines. With respect to cancer-specific mortality, individuals in the upper quartile for muscle strength were at a 50% reduced risk (hazard ratio = 0.50; 95% confidence interval, 0.29-0.85; P = .01) and those meeting muscle-strengthening activities were at a nonsignificant 8% reduced risk (hazard ratio = 0.92; 95% confidence interval, 0.45-1.86, P = .81) of cancer-specific mortality after adjusting for covariates. Clinicians should routinely assess lower extremity strength and promote engagement in muscle-strengthening activities aimed at increasing muscle strength.

A Novel Lung Disease Phenotype Adjusted for Mortality Attrition for Cystic Fibrosis Genetic Modifier Studies

PubMed Central

Taylor, Chelsea; Commander, Clayton W.; Collaco, Joseph M.; Strug, Lisa J.; Li, Weili; Wright, Fred A.; Webel, Aaron D.; Pace, Rhonda G.; Stonebraker, Jaclyn R.; Naughton, Kathleen; Dorfman, Ruslan; Sandford, Andrew; Blackman, Scott M.; Berthiaume, Yves; Paré, Peter; Drumm, Mitchell L.; Zielenski, Julian; Durie, Peter; Cutting, Garry R.; Knowles, Michael R.; Corey, Mary

2011-01-01

SUMMARY Genetic studies of lung disease in Cystic Fibrosis are hampered by the lack of a severity measure that accounts for chronic disease progression and mortality attrition. Further, combining analyses across studies requires common phenotypes that are robust to study design and patient ascertainment. Using data from the North American Cystic Fibrosis Modifier Consortium (Canadian Consortium for CF Genetic Studies, Johns Hopkins University CF Twin and Sibling Study, and University of North Carolina/Case Western Reserve University Gene Modifier Study), the authors calculated age-specific CF percentile values of FEV1 which were adjusted for CF age-specific mortality data. The phenotype was computed for 2061 patients representing the Canadian CF population, 1137 extreme phenotype patients in the UNC/Case Western study, and 1323 patients from multiple CF sib families in the CF Twin and Sibling Study. Despite differences in ascertainment and median age, our phenotype score was distributed in all three samples in a manner consistent with ascertainment differences, reflecting the lung disease severity of each individual in the underlying population. The new phenotype score was highly correlated with the previously recommended complex phenotype, but the new phenotype is more robust for shorter follow-up and for extreme ages. A disease progression and mortality adjusted phenotype reduces the need for stratification or additional covariates, increasing statistical power and avoiding possible distortions. This approach will facilitate large scale genetic and environmental epidemiological studies which will provide targeted therapeutic pathways for the clinical benefit of patients with CF. PMID:21462361

Impact of Prehospital Medical Evacuation (MEDEVAC) Transport Time on Combat Mortality in Patients with Non-Compressible Torso Injury and Traumatic Amputations

DTIC Science & Technology

2018-12-28

MED EV AC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations Sb. GRANT NUMBER Sc. PROGRAM...increased morbidity and mortality. Limited data exists on the influence of transport time on patient outcomes with specific injury types. The...treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI). Methods: We

Comparison of transportation related injury mechanisms and outcome of young road users and adult road users, a retrospective analysis on 24,373 patients derived from the TraumaRegister DGU®.

PubMed

Brockamp, Thomas; Schmucker, Uli; Lefering, Rolf; Mutschler, Manuel; Driessen, Arne; Probst, Christian; Bouillon, Bertil; Koenen, Paola

2017-06-14

Most young people killed in road crashes are known as vulnerable road users. A combination of physical and developmental immaturity as well as inexperience increases the risk of road traffic accidents with a high injury severity rate. Understanding injury mechanism and pattern in a group of young road users may reduce morbidity and mortality. This study analyzes injury patterns and outcomes of young road users compared to adult road users. The comparison takes into account different transportation related injury mechanisms. A retrospective analysis using data collected between 2002 and 2012 from the TraumaRegister DGU® was performed. Only patients with a transportation related injury mechanism (motor vehicle collision (MVC), motorbike, cyclist, and pedestrian) and an ISS ≥ 9 were included in our analysis. Four different groups of young road users were compared to adult trauma data depending on the transportation related injury mechanism. Twenty four thousand three hundred seventy three, datasets were retrieved to compare all subgroups. The mean ISS was 23.3 ± 13.1. The overall mortality rate was 8.61%. In the MVC, the motorbike and the cyclist group, we found young road users having more complex injury patterns with a higher AIS pelvis, AIS head, AIS abdomen and AIS of the extremities and also a lower GCS. Whereas in these three sub-groups the adult trauma group only had a higher AIS thorax. Only in the group of the adult pedestrians we found a higher AIS pelvis, AIS abdomen, AIS thorax, a higher AIS of the extremities and a lower GCS. This study reports on the most common injuries and injury patterns in young trauma patients in comparison to an adult trauma sample. Our analysis show that in contrast to more experienced road users our young collective refers to be a vulnerable trauma group with an increased risk of a high injury severity and high mortality rate. We indicate a striking difference in terms of the region of injury and the mechanism of injury when comparing the young versus the adult trauma collectives. Young drivers of cars, motorbikes and bikes were shown to be on high risk to sustain a specific severe injury pattern and a high mortality rate compared to adult road users. Our data emphasize a characteristic injury pattern of young trauma patients and may be used to improve trauma care and to guide prevention strategies to decrease injury severity and mortality due to road traffic injuries.

Unprecedented Disease-Related Coral Mortality in Southeastern Florida

NASA Astrophysics Data System (ADS)

Precht, William F.; Gintert, Brooke E.; Robbart, Martha L.; Fura, Ryan; van Woesik, Robert

2016-08-01

Anomalously high water temperatures, associated with climate change, are increasing the global prevalence of coral bleaching, coral diseases, and coral-mortality events. Coral bleaching and disease outbreaks are often inter-related phenomena, since many coral diseases are a consequence of opportunistic pathogens that further compromise thermally stressed colonies. Yet, most coral diseases have low prevalence (<5%), and are not considered contagious. By contrast, we document the impact of an extremely high-prevalence outbreak (61%) of white-plague disease at 14 sites off southeastern Florida. White-plague disease was observed near Virginia Key, Florida, in September 2014, and after 12 months had spread 100 km north and 30 km south. The disease outbreak directly followed a high temperature coral-bleaching event and affected at least 13 coral species. Eusmilia fastigiata, Meandrina meandrites, and Dichocoenia stokesi were the most heavily impacted coral species, and were reduced to <3% of their initial population densities. A number of other coral species, including Colpophyllia natans, Pseudodiploria strigosa, Diploria labyrinthiformis, and Orbicella annularis were reduced to <25% of their initial densities. The high prevalence of disease, the number of susceptible species, and the high mortality of corals affected suggests this disease outbreak is arguably one of the most lethal ever recorded on a contemporary coral reef.

Unprecedented Disease-Related Coral Mortality in Southeastern Florida.

PubMed

Precht, William F; Gintert, Brooke E; Robbart, Martha L; Fura, Ryan; van Woesik, Robert

2016-08-10

Anomalously high water temperatures, associated with climate change, are increasing the global prevalence of coral bleaching, coral diseases, and coral-mortality events. Coral bleaching and disease outbreaks are often inter-related phenomena, since many coral diseases are a consequence of opportunistic pathogens that further compromise thermally stressed colonies. Yet, most coral diseases have low prevalence (<5%), and are not considered contagious. By contrast, we document the impact of an extremely high-prevalence outbreak (61%) of white-plague disease at 14 sites off southeastern Florida. White-plague disease was observed near Virginia Key, Florida, in September 2014, and after 12 months had spread 100 km north and 30 km south. The disease outbreak directly followed a high temperature coral-bleaching event and affected at least 13 coral species. Eusmilia fastigiata, Meandrina meandrites, and Dichocoenia stokesi were the most heavily impacted coral species, and were reduced to <3% of their initial population densities. A number of other coral species, including Colpophyllia natans, Pseudodiploria strigosa, Diploria labyrinthiformis, and Orbicella annularis were reduced to <25% of their initial densities. The high prevalence of disease, the number of susceptible species, and the high mortality of corals affected suggests this disease outbreak is arguably one of the most lethal ever recorded on a contemporary coral reef.

A better indicator to measure the effects of meteorological factors on cardiovascular mortality: heat index.

PubMed

Yin, Qian; Wang, Jinfeng

2018-05-31

Although many studies have examined the correlation between temperature and mortality from cardiovascular diseases (CVD), other meteorological factors, such as relative humidity, may modify the relationship. Yet the studies on this aspect are relatively few. We chose a heat index (HI, which is an index that combines air temperature and relative humidity) as an alternative indicator of temperature, and used a distributed lag nonlinear model (DLNM) to analyze the combined effects of temperature and relative humidity on CVD mortality among all of the Beijing residents and subsociodemographic groups by age, sex, and occupation. The heat index can better reflect the human-perceived temperature when relative humidity is combined with air temperature. The results show that females, elderly people, and outdoor workers have higher vulnerability levels in regard to a high heat index. The strongest effect of heat index was found among females, for which the highest mortality risk was about 2.4 (95% CI 1.8-3) times greater than the lowest mortality risk. In addition, we found that there is a significant interaction effect of temperature and relative humidity on CVD mortality. The impact of extreme high temperature may be exacerbated by increases in humidity. Based on these results, we draw the risk level map of CVD death under different temperatures and grades of relative humidity. These findings may aid governments in the development of more accurate heat alerts and the provision of measures to prevent or reduce temperature-related deaths.

Model-supported estimation of mortality rates in Baltic cod (Gadus morhua callarias L.) larvae: the varying impact of 'critical periods'

PubMed Central

Voss, Rüdiger; Hinrichsen, Hans-Harald; Wieland, Kai

2001-01-01

Background Changes in the survival-rate during the larval phase may strongly influence the recruitment level in marine fish species. During the larval phase different 'critical periods' are discussed, e.g. the hatching period and the first-feeding period. No such information was available for the Baltic cod stock, a commercially important stock showing reproduction failure during the last years. We calculated field-based mortality rates for larval Baltic cod during these phases using basin-wide abundance estimates from two consecutive surveys. Survey information was corrected by three dimensional hydrodynamic model runs. Results The corrections applied for transport were of variable impact, depending on the prevailing circulation patterns. Especially at high wind forcing scenarios, abundance estimates have the potential to be biased without accounting for transport processes. In May 1988 mortality between hatch and first feeding amounted to approximately 20% per day. Mortality rates during the onset of feeding were considerably lower with only 7% per day. In August 1991 the situation was vice versa: Extremely low mortality rates of 0.08% per day were calculated between hatch and first feeding, while the period between the onset of feeding to the state of an established feeder was more critical with mortality rates of 22% per day. Conclusions Mortality rates during the different proposed 'critical periods' were found to be highly variable. Survival rates of Baltic cod are not only influenced by a single 'critical period', but can be limited at different points during the larval phase, depending on several biotic and abiotic factors. PMID:11737879

Outcomes after treatment of acute aortic occlusion.

PubMed

de Varona Frolov, Serguei R; Acosta Silva, Marcela P; Volo Pérez, Guido; Fiuza Pérez, Maria D

2015-11-01

Acute aortic occlusion (AAO) is a rare disease with high morbidity and mortality. The aim of this study was to describe the results of surgical treatment of acute aortic occlusion and risk factors for mortality. Retrospective review of the clinical history of 29 patients diagnosed and operated on for AAO during 28 years. The following variables were analysed: age, sex, tabaco use, diabetes, chronic renal insufficiency, chronic heart failure, atrial fibrillation, arterial hypertension, symptoms, diagnosis and treatment, 30-day mortality and long-term survival. A univariant analysis was performed of variables related to mortality. Twenty-nine patients were included (18 male) with a mean age of 66,2 years. The aetiology was: embolism (EM) in 11 cases and Thrombosis (TR) in 18 cases. The surgical procedures performed included bilateral transfemoral thrombectomy (14 cases), aorto-bifemoral by-pass (8 cases), axilo uni/bifemoral by-pass (5 cases) and aortoiliac and renal tromboendarterectomy (2 cases). Morbidity included: renal failure (14 cases), mesenteric ischemia (4 cases), cardiac complications (7 cases), respiratory complications (5 cases) and loss of extremity (2 cases). The in-hospital mortality was 21% (EM 0%, TR 21%). The estimated survival at 1.3 and 5 years was 60, 50 and 44% respectively. Age (p=0.032), arterial hypertension (p=0.039) and aetiology of the AAO (p=0.039) were related to mortality. Acute aortic occlusion is a medical emergency with high mortality rates. Acute renal failure is the most common postoperative complication. Copyright © 2012 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

PubMed

Lin, Shao; Hsu, Wan-Hsiang; Van Zutphen, Alissa R; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-11-01

Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.

Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants.

PubMed

Åström, Christofer; Åström, Daniel Oudin; Andersson, Camilla; Ebi, Kristie L; Forsberg, Bertil

2017-07-07

The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate—Magnitude and Determinants

PubMed Central

Åström, Christofer; Oudin Åström, Daniel; Andersson, Camilla; L. Ebi, Kristie; Forsberg, Bertil

2017-01-01

The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge. PMID:28686197

Unintentional drowning mortality, by age and body of water: an analysis of 60 countries.

PubMed

Lin, Ching-Yih; Wang, Yi-Fong; Lu, Tsung-Hsueh; Kawach, Ichiro

2015-04-01

To examine unintentional drowning mortality by age and body of water across 60 countries, to provide a starting point for further in-depth investigations within individual countries. The latest available three years of mortality data for each country were extracted from WHO Health Statistics and Information Services (updated at 13 November 2013). We calculated mortality rate of unintentional drowning by age group for each country. For countries using International Classification of Disease 10 (ICD-10) detailed 3 or 4 Character List, we further examined the body of water involved. A huge variation in age-standardised mortality rate (deaths per 100 000 population) was noted, from 0.12 in Turkey to 9.19 in Guyana. Of the ten countries with the highest age-standardised mortality rate, six (Belarus, Lithuania, Latvia, Russia, Ukraine and Moldova) were in Eastern Europe and two (Kazakhstan and Kyrgyzstan) were in Central Asia. Some countries (Japan, Finland and Greece) had a relatively low rank in mortality rate among children aged 0-4 years, but had a high rank in mortality rate among older adults. On the contrary, South Africa and Colombia had a relatively high rank among children aged 0-4 years, but had a relatively low rank in mortality rate among older adults. With regard to body of water involved, the proportion involving a bathtub was extremely high in Japan (65%) followed by Canada (11%) and the USA (11%). Of the 13 634 drowning deaths involving bathtubs in Japan between 2009 and 2011, 12 038 (88%) were older adults aged 65 years or above. The percentage involving a swimming pool was high in the USA (18%), Australia (13%), and New Zealand (7%). The proportion involving natural water was high in Finland (93%), Panama (87%), and Lithuania (85%). After considering the completeness of reporting and quality of classifying drowning deaths across countries, we conclude that drowning is a high-priority public health problem in Eastern Europe, Central Asia, Japan (older adults involving bathtubs), and the USA (involving swimming pools). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Seasonal Variation in Solar Ultra Violet Radiation and Early Mortality in Extremely Preterm Infants.

PubMed

Salas, Ariel A; Smith, Kelly A; Rodgers, Mackenzie D; Phillips, Vivien; Ambalavanan, Namasivayam

2015-11-01

Vitamin D production during pregnancy promotes fetal lung development, a major determinant of infant survival after preterm birth. Because vitamin D synthesis in humans is regulated by solar ultraviolet B (UVB) radiation, we hypothesized that seasonal variation in solar UVB doses during fetal development would be associated with variation in neonatal mortality rates. This cohort study included infants born alive with gestational age (GA) between 23 and 28 weeks gestation admitted to a neonatal unit between 1996 and 2010. Three infant cohort groups were defined according to increasing intensities of solar UVB doses at 17 and 22 weeks gestation. The primary outcome was death during the first 28 days after birth. Outcome data of 2,319 infants were analyzed. Mean birth weight was 830 ± 230 g and median gestational age was 26 weeks. Mortality rates were significantly different across groups (p = 0.04). High-intensity solar UVB doses were associated with lower mortality when compared with normal intensity solar UVB doses (hazard ratio: 0.70; 95% confidence interval: 0.54-0.91; p = 0.01). High-intensity solar UVB doses during fetal development seem to be associated with risk reduction of early mortality in preterm infants. Prospective studies are needed to validate these preliminary findings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Chronic and catastrophic natural mortality of three common Caribbean reef corals

NASA Astrophysics Data System (ADS)

Bythell, J. C.; Gladfelter, E. H.; Bythell, M.

1993-11-01

Compared to catastrophic impacts from storms, disease epidemics and bleaching events, little is known about the effects of more routine chronic mortality in reef corals. To monitor this ongoing mortality, monthly visual assessments of the cause of tissue damage were related to mortality rates (changes in planar surface area) of tagged colonies of three common reef corals: Montastrea annularis, Porites astreoides and Diploria strigosa at Buck Island Reef National Monument, St. Croix, US Virgin Islands. During the study Hurricane Hugo, the most powerful cyclone to affect the area in at least 60 y, made a direct impact on the site. Effects of the hurricane were extremely localized, with certain exposed sites being almost completely razed while others showed no detectable changes in community structure. Mortality caused both by the hurricane and by other factors during the 26 month study varied between species and also between site locations around the island. Differences in susceptibility were not dependent solely on gross morphology, because two robust, massive species showed opposite responses to hurricane damage and chronic mortality. Diploria strigosa was virtually unaffected by chronic factors, but was heavily damaged at exposed sites during the hurricane. In contrast, mortality from predation and tissue necrosis was high in Montastrea annularis, but it largely escaped damage from the hurricane because it was absent from the most severely scoured locations. Porites astreoides, with populations dominated by much smaller colonies, was affected by both chronic and hurricanerelated mortality. Differences in susceptibility to the various types of natural disturbance among species, coupled with high spatial and temporal variability in the effects of such disturbances, may be critical to the maintenance of species diversity on the reef.

The decline in child mortality: a reappraisal.

PubMed Central

Ahmad, O. B.; Lopez, A. D.; Inoue, M.

2000-01-01

The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved. PMID:11100613

Aging Will Amplify the Heat-related Mortality Risk under a Changing Climate: Projection for the Elderly in Beijing, China

NASA Astrophysics Data System (ADS)

Li, Tiantian; Horton, Radley M.; Bader, Daniel A.; Zhou, Maigeng; Liang, Xudong; Ban, Jie; Sun, Qinghua; Kinney, Patrick L.

2016-06-01

An aging population could substantially enhance the burden of heat-related health risks in a warming climate because of their higher susceptibility to extreme heat health effects. Here, we project heat-related mortality for adults 65 years and older in Beijing China across 31 downscaled climate models and 2 representative concentration pathways (RCPs) in the 2020s, 2050s, and 2080s. Under a scenario of medium population and RCP8.5, by the 2080s, Beijing is projected to experience 14,401 heat-related deaths per year for elderly individuals, which is a 264.9% increase compared with the 1980s. These impacts could be moderated through adaptation. In the 2080s, even with the 30% and 50% adaptation rate assumed in our study, the increase in heat-related death is approximately 7.4 times and 1.3 times larger than in the 1980s respectively under a scenario of high population and RCP8.5. These findings could assist countries in establishing public health intervention policies for the dual problems of climate change and aging population. Examples could include ensuring facilities with large elderly populations are protected from extreme heat (for example through back-up power supplies and/or passive cooling) and using databases and community networks to ensure the home-bound elderly are safe during extreme heat events.

Aging Will Amplify the Heat-Related Mortality Risk Under a Changing Climate: Projection for the Elderly in Beijing, China

NASA Technical Reports Server (NTRS)

Li, Tiantian; Horton, Radley M.; Bader, Daniel A.; Zhou, Maigeng; Liang, Xudong; Ban, Jie; Sun, Qinghua; Kinney, Patrick L.

2016-01-01

An aging population could substantially enhance the burden of heat-related health risks in a warming climate because of their higher susceptibility to extreme heat health effects. Here, we project heatrelated mortality for adults 65 years and older in Beijing China across 31 downscaled climate models and 2 representative concentration pathways (RCPs) in the 2020s, 2050s, and 2080s. Under a scenario of medium population and RCP8.5, by the 2080s, Beijing is projected to experience 14,401 heat-related deaths per year for elderly individuals, which is a 264.9% increase compared with the 1980s. These impacts could be moderated through adaptation. In the 2080s, even with the 30% and 50% adaptation rate assumed in our study, the increase in heat-related death is approximately 7.4 times and 1.3 times larger than in the 1980s respectively under a scenario of high population and RCP8.5. These findings could assist countries in establishing public health intervention policies for the dual problems of climate change and aging population. Examples could include ensuring facilities with large elderly populations are protected from extreme heat (for example through back-up power supplies and/or passive cooling) and using databases and community networks to ensure the home-bound elderly are safe during extreme heat events.

Modeling regional and gender impacts of the 2003 summer heatwave in excessive mortality in Portugal

NASA Astrophysics Data System (ADS)

Ramos, Alexandre M.; Trigo, Ricardo M.; Nogueira, Paulo J.; Santos, Filipe D.; Garcia-Herrera, Ricardo; Gouveia, Célia; Santo, Fátima E.

2010-05-01

This work evaluates the impact of the 2003 European heatwave on excessive human mortality in Portugal, a country that presents a relatively high level of exposure to heatwave events. To estimate the fortnight expected mortality per district between 30 July and 15 August we have used five distinct baseline periods of mortality. We have opted to use the period that spans between 2000 and 2004, as it corresponds to a good compromise between a relatively long period (to guarantee some stability) and a sufficiently short period (to guarantee the similarity of the underlying population structure). Our findings show a total of 2399 excessive deaths are estimated in continental Portugal, which implies an increase of 58% over the expected deaths for those two weeks. When these values are split by gender, it is seen that women increase (79%), was considerably higher than that recorded for men (41%). The increment of mortality due to this heatwave was detected for all the 18 districts of the country, but its magnitude was significantly higher in the inner districts close to the Spanish border. When we split the regional impact by gender all districts reveal significant mortality increments for women, while the impact in men's excess deaths is not significant over 3 districts. Several temperature derived indices were used and evaluated in their capacity to explain, at the regional level, the excessive mortality (ratio between observed and expected deaths) by gender. The best relationship was found for the total exceedance of extreme days, an index combining the length of the heatwave and its intensity. Both variables hold a linear relationship with r = 0.79 for women and a poorer adjustment (r = 0.50) for men. Additionally, availability of mortality data split by age also allowed obtaining detailed information on the structure of the population in risk, namely by showing that statistically significant increments are concentrated in the last three age classes (45-64, 65-74 and 75 or more). A finer approach is relevant for prevention strategies, since it allows identifying better the target population of any preventive strategy regional and national authorities may be interested to implement. Trigo, R.M., et al. (2009), Evaluating the impact of extreme temperature based indices in the 2003 heatwave excessive mortality in Portugal. Environ. Sci. Policy doi:10.1016/j.envsci.2009.07.007

Abrupt fire regime change may cause landscape-wide loss of mature obligate seeder forests.

PubMed

Bowman, David M J S; Murphy, Brett P; Neyland, Dominic L J; Williamson, Grant J; Prior, Lynda D

2014-03-01

Obligate seeder trees requiring high-severity fires to regenerate may be vulnerable to population collapse if fire frequency increases abruptly. We tested this proposition using a long-lived obligate seeding forest tree, alpine ash (Eucalyptus delegatensis), in the Australian Alps. Since 2002, 85% of the Alps bioregion has been burnt by several very large fires, tracking the regional trend of more frequent extreme fire weather. High-severity fires removed 25% of aboveground tree biomass, and switched fuel arrays from low loads of herbaceous and litter fuels to high loads of flammable shrubs and juvenile trees, priming regenerating stands for subsequent fires. Single high-severity fires caused adult mortality and triggered mass regeneration, but a second fire in quick succession killed 97% of the regenerating alpine ash. Our results indicate that without interventions to reduce fire severity, interactions between flammability of regenerating stands and increased extreme fire weather will eliminate much of the remaining mature alpine ash forest. © 2013 John Wiley & Sons Ltd.

Relationships Between Excessive Heat and Daily Mortality over the Coterminous U.S

NASA Technical Reports Server (NTRS)

Crosson, William L.; Al-Hamdan, Mohammad Z.; Estes, Maury G., Jr.; Estes, Sue M.; Quattrochi, Dale A.

2015-01-01

In the United States, extreme heat is the most deadly weather-related hazard. In the face of a warming climate and urbanization, it is very likely that extreme heat events (EHEs) will become more common and more severe in the U.S. Using National Land Data Assimilation System (NLDAS) meteorological reanalysis data, we have developed several measures of extreme heat to enable assessments of the impacts of heat on public health over the coterminous U.S. These measures include daily maximum and minimum air temperatures, daily maximum heat indices and a new heat stress variable called Net Daily Heat Stress (NDHS) that gives an integrated measure of heat stress (and relief) over the course of a day. All output has been created on the NLDAS 1/8 degree (approximately 12 km) grid and aggregated to the county level, which is the preferred geographic scale of analysis for public health researchers. County-level statistics have been made available through the Centers for Disease Control and Prevention (CDC) via the Wide-ranging Online Data for Epidemiologic Research (WONDER) system. We have examined the relationship between excessive heat events, as defined in eight different ways from the various daily heat metrics, and heat-related and all-cause mortality defined in CDC's National Center for Health Statistics 'Multiple Causes of Death 1999-2010' dataset. To do this, we linked daily, county-level heat mortality counts with EHE occurrence based on each of the eight EHE definitions by region and nationally for the period 1999-2010. The objectives of this analysis are to determine (1) whether heat-related deaths can be clearly tied to excessive heat events, (2) what time lags are critical for predicting heat-related deaths, and (3) which of the heat metrics correlates best with mortality in each US region. Results show large regional differences in the correlations between heat and mortality. Also, the heat metric that provides the best indicator of mortality varied by region. Results from this research will potentially lead to improvements in our ability to anticipate and mitigate any significant impacts of extreme heat events on health.

[Differences in mortality between indigenous and non-indigenous persons in Brazil based on the 2010 Population Census].

PubMed

Campos, Marden Barbosa de; Borges, Gabriel Mendes; Queiroz, Bernardo Lanza; Santos, Ricardo Ventura

2017-06-12

There have been no previous estimates on differences in adult or overall mortality in indigenous peoples in Brazil, although such indicators are extremely important for reducing social iniquities in health in this population segment. Brazil has made significant strides in recent decades to fill the gaps in data on indigenous peoples in the national statistics. The aim of this paper is to present estimated mortality rates for indigenous and non-indigenous persons in different age groups, based on data from the 2010 Population Census. The estimates used the question on deaths from specific household surveys. The results indicate important differences in mortality rates between indigenous and non-indigenous persons in all the selected age groups and in both sexes. These differences are more pronounced in childhood, especially in girls. The indicators corroborate the fact that indigenous peoples in Brazil are in a situation of extreme vulnerability in terms of their health, based on these unprecedented estimates of the size of these differences.

Mistletoe infection alters the transpiration flow path and suppresses water regulation of host trees during extreme events

NASA Astrophysics Data System (ADS)

Griebel, A.; Maier, C.; Barton, C. V.; Metzen, D.; Renchon, A.; Boer, M. M.; Pendall, E.

2017-12-01

Mistletoe is a globally distributed group of parasitic plants that infiltrates the vascular tissue of its host trees to acquire water, carbon and nutrients, making it a leading agent of biotic disturbance. Many mistletoes occur in water-limited ecosystems, thus mistletoe infection in combination with increased climatic stress may exacerbate water stress and potentially accelerate mortality rates of infected trees during extreme events. This is an emerging problem in Australia, as mistletoe distribution is increasing and clear links between mistletoe infection and mortality have been established. However, direct observations about how mistletoes alter host physiological processes during extreme events are rare, which impedes our understanding of mechanisms underlying increased tree mortality rates. We addressed this gap by continuously monitoring stem and branch sap flow and a range of leaf traits of infected and uninfected trees of two co-occurring eucalypt species during a severe heatwave in south-eastern Australia. We demonstrate that mistletoes' leaf water potentials were maintained 30% lower than hosts' to redirect the trees' transpiration flow path towards mistletoe leaves. Eucalypt leaves reduced water loss through stomatal regulation when atmospheric dryness exceeded 2 kPa, but the magnitude of stomatal regulation in non-infected eucalypts differed by species (between 40-80%). Remarkably, when infected, sap flow rates of stems and branches of both eucalypt species remained unregulated even under extreme atmospheric dryness (>8 kPa). Our observations indicate that excessive water use of mistletoes likely increases xylem cavitation rates in hosts during prolonged droughts and supports that hydraulic failure contributes to increased mortality of infected trees. Hence, in order to accurately model the contribution of biotic disturbances to tree mortality under a changing climate, it will be crucial to increase our process-based understanding of the interaction between biotic and abiotic dynamics, especially to establish thresholds of critical cavitation rates of infected trees.

Occupational exposures and Parkinson's disease mortality in a prospective Dutch cohort.

PubMed

Brouwer, Maartje; Koeman, Tom; van den Brandt, Piet A; Kromhout, Hans; Schouten, Leo J; Peters, Susan; Huss, Anke; Vermeulen, Roel

2015-06-01

We investigated the association between six occupational exposures (ie, pesticides, solvents, metals, diesel motor emissions (DME), extremely low frequency magnetic fields (ELF-MF) and electric shocks) and Parkinson's disease (PD) mortality in a large population-based prospective cohort study. The Netherlands Cohort Study on diet and cancer enrolled 58,279 men and 62,573 women aged 55-69 years in 1986. Participants were followed up for cause-specific mortality over 17.3 years, until December 2003, resulting in 402 male and 207 female PD deaths. Following a case-cohort design, a subcohort of 5,000 participants was randomly sampled from the complete cohort. Information on occupational history and potential confounders was collected at baseline. Job-exposure matrices were applied to assign occupational exposures. Associations with PD mortality were evaluated using Cox regression. Among men, elevated HRs were observed for exposure to pesticides (eg, ever high exposed, HR 1.27, 95% CI 0.86 to 1.88) and ever high exposed to ELF-MF (HR 1.54, 95% CI 1.00 to 2.36). No association with exposure duration or trend in cumulative exposure was observed for any of the occupational exposures. Results among women were unstable due to small numbers of high-exposed women. Associations with PD mortality were observed for occupational exposure to pesticides and ELF-MF. However, the weight given to these findings is limited by the absence of a monotonic trend with either duration or cumulative exposure. No associations were found between PD mortality and occupational exposure to solvents, metals, DME or electric shocks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Attribution of Disturbances Causing Tree Mortality for the Continental U.S.

NASA Astrophysics Data System (ADS)

Wang, M.; Xu, C.; Allen, C. D.; McDowell, N. G.

2016-12-01

Broad-scale tree mortality has been frequently reported and documented to increase with warming climate and human activities. However, there is so far no general method to quantify the relative contributions of different disturbances on observed broad-scale tree mortality. In this study, we presented a framework to investigate the contribution of various disturbances causing tree mortality for 2000-2014 in the continental US. Our work is based on the high-resolution forest-loss data developed by Hansen et al. (2013). Firstly, fire-driven mortality was determined using the data from Monitoring Trends in Burn Severity (MTBS) project. Secondly, a landscape-pattern-recognition approach focusing on the differences of boundary complexity caused by natural and anthropogenic disturbances was developed to attribute harvest-driven mortality patches. Then, a drought threshold was determined through conducting an intensive literature survey for attribution of drought-driven mortality. Our results showed that we can correctly attribute 85% harvest-driven mortality as compared to Forest Inventory and Analysis (FIA) data. Based on Evaporative Stress Index (ESI), our literature survey suggests that most mortality events happened at extreme drought (37.7%), then severe (31.4%) and moderate (23.4%) drought. In total, 92.6% of drought-induced mortality events observed during 2000-2014 occurred at drought conditions of moderate or worse with corresponding ESI values ranging from -0.9 -2.49. Therefore, -0.9 will be used as the threshold to attribute drought-driven tree mortality. Overall, these results imply a great potential for using these methods to identify and attribute disturbances driving tree death at broad spatial scales.

Air pollution and mortality: results from a study of Santiago, Chile.

PubMed

Ostro, B; Sanchez, J M; Aranda, C; Eskeland, G S

1996-01-01

In 1986, the U.S. EPA issued an air quality standard for particulate matter that included only particulates below 10 microns in diameter (PM10). Unfortunately, epidemiological research investigating the health effects associated with PM10 has been limited by the lack of available daily data from outdoor monitoring stations. Evidence of high concentrations of PM10 in Eastern Europe and in metropolitan areas such as Mexico City and Santiago, Chile underscores the need to evaluate the association between air pollution and mortality. Over the last few years, daily measures of ambient PM10 have been collected in Santiago. Our analysis examines the relationship between PM10 and daily mortality between 1989 and 1991. In addition to total daily mortality, the data were compiled to record total mortality for all males, all females, and those over 65, and mortality from either respiratory disease or cardiovascular disease. Multiple regression analysis was used to explain mortality, with particular attention to controlling for the influence of season and temperature. The results suggest a strong association between PM10 and all of the alternative measures of mortality. The association persists after controlling for daily minimum temperature and binary variables indicating temperature extremes, the day of the week, the month, and the year. Additional sensitivity analyses suggest a fairly robust relationship. In general, a 10 micrograms/m3 change in daily PM10 was associated with a 1% increase in mortality. This relative risk is consistent with the results of recent studies undertaken in the United States.

EVALUATION OF PROGNOSTIC FACTORS IN DECOMPENSATED LIVER CIRRHOSIS WITH ASCITES AND SPONTANEOUS BACTERIAL PERITONITIS.

PubMed

Dănulescu, Răzvana Munteanu; Stanciu, Carol; Trifan, Anca

2015-01-01

Mortality in spontaneous bacterial peritonitis (SBP) decreased significantly from 90% in 1970 to 10-30% today, but SBP still remains a complication with a poor prognosis. Although there are new preventive measures, such as early diagnosis and treatment with albumin, the introduction of new antibiotics, the prognosis of patients with decompensated cirrhosis and SBP remains poor, with a mortality rate of 20-40%. The installation of an episode of spontaneous bacterial peritonitis reduces the survival rate at 1 year to 30% and to 20% at 2 years. In this context, the identification of patients with increased risk of death is extremely important in order to improve prognosis. The prospective study included 153 patients with cirrhosis admitted to the Institute of Gastroenterology and Hepatology Iaşi from 1 January to 31 December 2010, reevaluated during 2 years. Criteria for the diagnosis of SBP were the presence of a number > 250 PMN / mmc. The presence of ascites and/or upper gastrointestinal bleeding (UGB) marks the decompensated cirrhosis. To assess the severity of cirrhosis, there were used Child-Pugh and MELD scores. Diagnostic paracentesis and ascites fluid cultures were performed in all hospitalized patients with ascites and also in case of signs and symptoms of SBP, before and after antibiotic treatment. Lack of response to empirical therapy was considered in those cases with a decrease in the number of neutrophils < 25% from baseline. Identification of patients with increased risk of death is extremely important to improve prognosis. In peripheral leukocytosis and in the ascites fluid, low hemoglobin can be considered predictors of mortality in patients with PBS. Child-Pugh score, increased levels of bilirubin and creatinine and hyponatremia are independent risk factors of mortality in patients with SBP. Bacteremia and lack of therapeutic response are independent risk factors of mortality associated with SBP. Recent history of variceal bleeding, severity of infection and the degree of hepatic and renal impairment influence short-term prognosis of patients with SBP. Identification of patients with increased risk of death is extremely important to improve prognosis. Therefore, it is important to identify prognostic factors in patients with bacterial infection and cirrhosis, in order to identify high risk patients and to prevent complications and death.

Survival of the faucet snail after chemical disinfection, pH extremes, and heated water bath treatments

USGS Publications Warehouse

Mitchell, A.J.; Cole, Rebecca A.

2008-01-01

The faucet snail Bithynia tentaculata, a nonindigenous aquatic snail from Eurasia, was introduced into Lake Michigan in 1871 and has spread to the mid-Atlantic states, the Great Lakes region, Montana, and most recently, the Mississippi River. The faucet snail serves as intermediate host for several trematodes that have caused large-scale mortality among water birds, primarily in the Great Lakes region and Montana. It is important to limit the spread of the faucet snail; small fisheries equipment can serve as a method of snail distribution. Treatments with chemical disinfection, pH extremes, and heated water baths were tested to determine their effectiveness as a disinfectant for small fisheries equipment. Two treatments eliminated all test snails: (1) a 24-h exposure to Hydrothol 191 at a concentration of at least 20 mg/L and (2) a treatment with 50°C heated water for 1 min or longer. Faucet snails were highly resistant to ethanol, NaCl, formalin, Lysol, potassium permanganate, copper sulfate, Baquacil, Virkon, household bleach, and pH extremes (as low as 1 and as high as 13).

Multi-scale predictions of massive conifer mortality due to chronic temperature rise

NASA Astrophysics Data System (ADS)

McDowell, N. G.; Williams, A. P.; Xu, C.; Pockman, W. T.; Dickman, L. T.; Sevanto, S.; Pangle, R.; Limousin, J.; Plaut, J.; Mackay, D. S.; Ogee, J.; Domec, J. C.; Allen, C. D.; Fisher, R. A.; Jiang, X.; Muss, J. D.; Breshears, D. D.; Rauscher, S. A.; Koven, C.

2016-03-01

Global temperature rise and extremes accompanying drought threaten forests and their associated climatic feedbacks. Our ability to accurately simulate drought-induced forest impacts remains highly uncertain in part owing to our failure to integrate physiological measurements, regional-scale models, and dynamic global vegetation models (DGVMs). Here we show consistent predictions of widespread mortality of needleleaf evergreen trees (NET) within Southwest USA by 2100 using state-of-the-art models evaluated against empirical data sets. Experimentally, dominant Southwest USA NET species died when they fell below predawn water potential (Ψpd) thresholds (April-August mean) beyond which photosynthesis, hydraulic and stomatal conductance, and carbohydrate availability approached zero. The evaluated regional models accurately predicted NET Ψpd, and 91% of predictions (10 out of 11) exceeded mortality thresholds within the twenty-first century due to temperature rise. The independent DGVMs predicted >=50% loss of Northern Hemisphere NET by 2100, consistent with the NET findings for Southwest USA. Notably, the global models underestimated future mortality within Southwest USA, highlighting that predictions of future mortality within global models may be underestimates. Taken together, the validated regional predictions and the global simulations predict widespread conifer loss in coming decades under projected global warming.

Multi-scale predictions of massive conifer mortality due to chronic temperature rise

USGS Publications Warehouse

McDowell, Nathan G.; Williams, A.P.; Xu, C.; Pockman, W. T.; Dickman, L. T.; Sevanto, Sanna; Pangle, R.; Limousin, J.; Plaut, J.J.; Mackay, D.S.; Ogee, J.; Domec, Jean-Christophe; Allen, Craig D.; Fisher, Rosie A.; Jiang, X.; Muss, J.D.; Breshears, D.D.; Rauscher, Sara A.; Koven, C.

2016-01-01

Global temperature rise and extremes accompanying drought threaten forests and their associated climatic feedbacks. Our ability to accurately simulate drought-induced forest impacts remains highly uncertain in part owing to our failure to integrate physiological measurements, regional-scale models, and dynamic global vegetation models (DGVMs). Here we show consistent predictions of widespread mortality of needleleaf evergreen trees (NET) within Southwest USA by 2100 using state-of-the-art models evaluated against empirical data sets. Experimentally, dominant Southwest USA NET species died when they fell below predawn water potential (Ψpd) thresholds (April–August mean) beyond which photosynthesis, hydraulic and stomatal conductance, and carbohydrate availability approached zero. The evaluated regional models accurately predicted NET Ψpd, and 91% of predictions (10 out of 11) exceeded mortality thresholds within the twenty-first century due to temperature rise. The independent DGVMs predicted ≥50% loss of Northern Hemisphere NET by 2100, consistent with the NET findings for Southwest USA. Notably, the global models underestimated future mortality within Southwest USA, highlighting that predictions of future mortality within global models may be underestimates. Taken together, the validated regional predictions and the global simulations predict widespread conifer loss in coming decades under projected global warming.

PubMed

La Torre, Giuseppe; Verrengia, Giovanna; Saulle, Rossella; Kheiraoui, Flavia; Mannocci, Alice

2017-06-28

To identify the determinants of the regional differences in work injuries and mortality rates in Italy. Several linear regression models were built assessing the association between regional differences in work mortality and injury rates (as dependent variables) and socio-demographic factors (occupation and population) and variables describing alcohol consumption, mean age and availability of health care (as independent variables). Data sources are from ISTAT, INAIL, Health for All database and the national report Osservasalute. The analysis was carried out using data coming from all the Italian Regions. The mean work mortality rate for the period 2006-2014 was 7.73 (DS 1.85) per 100,000 workers, while the injury rate was 4503.1 (DS 1413.5) per 100,000 workers. Socio-demographic variables and that related to health care (TC availability) were inversely associated with mortality rates, while for the work injury rates, significant associations with alcohol were found, while Gross domestic product and TC availability were inversely associated. The study pointed out the extreme heterogeneity between different geographical areas in the field of work injury, due to different socio-demographic and economic factors. In the future, health surveillance and work injury and mortality rates could be improved in areas at high risk.

Increased mortality associated with extreme-heat exposure in King County, Washington, 1980-2010

NASA Astrophysics Data System (ADS)

Isaksen, Tania Busch; Fenske, Richard A.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Yost, Michael G.

2016-01-01

Extreme heat has been associated with increased mortality, particularly in temperate climates. Few epidemiologic studies have considered the Pacific Northwest region in their analyses. This study quantified the historical (May to September, 1980-2010) heat-mortality relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the relationship between heat and all-cause mortality on 99th percentile heat days, while a time series analysis, using a piece-wise linear model fit, was used to estimate the effect of heat intensity on mortality, adjusted for temporal trends. For all ages, all causes, we found a 10 % (1.10 (95 % confidence interval (CI), 1.06, 1.14)) increase in the risk of death on a heat day versus non-heat day. When considering the intensity effect of heat on all-cause mortality, we found a 1.69 % (95 % CI, 0.69, 2.70) increase in the risk of death per unit of humidex above 36.0 °C. Mortality stratified by cause and age produced statistically significant results using both types of analyses for: all-cause, non-traumatic, circulatory, cardiovascular, cerebrovascular, and diabetes causes of death. All-cause mortality was statistically significantly modified by the type of synoptic weather type. These results demonstrate that heat, expressed as humidex, is associated with increased mortality on heat days, and that risk increases with heat's intensity. While age was the only individual-level characteristic found to modify mortality risks, statistically significant increases in diabetes-related mortality for the 45-64 age group suggests that underlying health status may contribute to these risks.

Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

PubMed

Narayan, Mayur; Tesoriero, Ronald; Bruns, Brandon R; Klyushnenkova, Elena N; Chen, Hegang; Diaz, Jose J

2015-04-01

Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p < 0.001). Among TCs, the effect was strongest for Level I TC (odds ratio = 0.34). For extreme APR_SOI, mortality was higher at TCs vs NTCs (p < 0.001). Emergency general surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Mortality Trajectories at Exceptionally High Ages: A Study of Supercentenarians

PubMed Central

Gavrilova, Natalia S.; Gavrilov, Leonid A.; Krut'ko, Vyacheslav N.

2017-01-01

The growing number of persons surviving to age 100 years and beyond raises questions about the shape of mortality trajectories at exceptionally high ages, and this problem may become significant for actuaries in the near future. However, such studies are scarce because of the difficulties in obtaining reliable age estimates at exceptionally high ages. The current view about mortality beyond age 110 years suggests that death rates do not grow with age and are virtually flat. The same assumption is made in the new actuarial VBT tables. In this paper, we test the hypothesis that the mortality of supercentenarians (persons living 110+ years) is constant and does not grow with age, and we analyze mortality trajectories at these exceptionally high ages. Death records of supercentenarians were taken from the International Database on Longevity (IDL). All ages of supercentenarians in the database were subjected to careful validation. We used IDL records for persons belonging to extinct birth cohorts (born before 1895) since the last deaths in IDL were observed in 2007. We also compared our results based on IDL data with a more contemporary database maintained by the Gerontology Research Group (GRG). First we attempted to replicate findings by Gampe (2010), who analyzed IDL data and came to the conclusion that “human mortality after age 110 is flat.” We split IDL data into two groups: cohorts born before 1885 and cohorts born in 1885 and later. Hazard rate estimates were conducted using the standard procedure available in Stata software. We found that mortality in both groups grows with age, although in older cohorts, growth was slower compared with more recent cohorts and not statistically significant. Mortality analysis of more numerous 1884–1894 birth cohort with the Akaike goodness-of-fit criterion showed better fit for the Gompertz model than for the exponential model (flat mortality). Mortality analyses with GRG data produced similar results. The remaining life expectancy for the 1884–1894 birth cohort demonstrates rapid decline with age. This decline is similar to the computer-simulated trajectory expected for the Gompertz model, rather than the extremely slow decline in the case of the exponential model. These results demonstrate that hazard rates after age 110 years do not stay constant and suggest that mortality deceleration at older ages is not a universal phenomenon. These findings may represent a challenge to the existing theories of aging and longevity, which predict constant mortality in the late stages of life. One possibility for reconciliation of the observed phenomenon and the existing theoretical consideration is a possibility of mortality deceleration and mortality plateau at very high yet unobservable ages. PMID:29170764

Mortality Trajectories at Exceptionally High Ages: A Study of Supercentenarians.

PubMed

Gavrilova, Natalia S; Gavrilov, Leonid A; Krut'ko, Vyacheslav N

2017-01-01

The growing number of persons surviving to age 100 years and beyond raises questions about the shape of mortality trajectories at exceptionally high ages, and this problem may become significant for actuaries in the near future. However, such studies are scarce because of the difficulties in obtaining reliable age estimates at exceptionally high ages. The current view about mortality beyond age 110 years suggests that death rates do not grow with age and are virtually flat. The same assumption is made in the new actuarial VBT tables. In this paper, we test the hypothesis that the mortality of supercentenarians (persons living 110+ years) is constant and does not grow with age, and we analyze mortality trajectories at these exceptionally high ages. Death records of supercentenarians were taken from the International Database on Longevity (IDL). All ages of supercentenarians in the database were subjected to careful validation. We used IDL records for persons belonging to extinct birth cohorts (born before 1895) since the last deaths in IDL were observed in 2007. We also compared our results based on IDL data with a more contemporary database maintained by the Gerontology Research Group (GRG). First we attempted to replicate findings by Gampe (2010), who analyzed IDL data and came to the conclusion that "human mortality after age 110 is flat." We split IDL data into two groups: cohorts born before 1885 and cohorts born in 1885 and later. Hazard rate estimates were conducted using the standard procedure available in Stata software. We found that mortality in both groups grows with age, although in older cohorts, growth was slower compared with more recent cohorts and not statistically significant. Mortality analysis of more numerous 1884-1894 birth cohort with the Akaike goodness-of-fit criterion showed better fit for the Gompertz model than for the exponential model (flat mortality). Mortality analyses with GRG data produced similar results. The remaining life expectancy for the 1884-1894 birth cohort demonstrates rapid decline with age. This decline is similar to the computer-simulated trajectory expected for the Gompertz model, rather than the extremely slow decline in the case of the exponential model. These results demonstrate that hazard rates after age 110 years do not stay constant and suggest that mortality deceleration at older ages is not a universal phenomenon. These findings may represent a challenge to the existing theories of aging and longevity, which predict constant mortality in the late stages of life. One possibility for reconciliation of the observed phenomenon and the existing theoretical consideration is a possibility of mortality deceleration and mortality plateau at very high yet unobservable ages.

Association of Antenatal Corticosteroids with Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

PubMed Central

Boghossian, Nansi S.; McDonald, Scott A.; Bell, Edward F.; Carlo, Waldemar A.; Brumbaugh, Jane E.; Stoll, Barbara J.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Das, Abhik; Higgins, Rosemary D.

2017-01-01

Importance Little is known about the benefits of antenatal corticosteroids on extremely preterm multiples. Objective To examine in extremely preterm multiples if use of antenatal corticosteroids is associated with improvement in major outcomes. Design, Setting, and Participants Infants with gestational age 22–28 weeks born at an NICHD Neonatal Research Network center (1998–2013) were studied. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Main Outcome Measures In-hospital mortality, the composite outcome of neurodevelopmental impairment at 18–22 months’ corrected age or death before assessment. Results Of 6925 multiple-birth infants, 6094 (88%) were born to women who received antenatal corticosteroids. In-hospital mortality was lower among infants with exposure to antenatal corticosteroids vs no exposure (aRR=0.87, 95% CI 0.78–0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to antenatal corticosteroids vs no exposure (aRR=0.93, 95% CI 0.84–1.03). Other adverse outcomes that occurred less frequently among infants of women receiving antenatal corticosteroids included severe intraventricular hemorrhage (aRR=0.68, 95% CI 0.58–0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to antenatal corticosteroids was associated with a lower risk of mortality and the composite of neurodevelopmental impairment or mortality among non-small for gestational age multiples (aRR=0.82, 95% CI 0.74–0.92 and aRR=0.89, 95% CI 0.80–0.98, respectively) and a higher risk among small for gestational age multiples (aRR=1.40, 95% CI 1.02–1.93 and aRR=1.62, 95% CI 1.22–2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR=1.55, 95% CI 1.00–2.38) but not among infants of mothers without diabetes (aRR=0.91, 95% CI 0.83–1.01). Conclusion In extremely preterm multiples, exposure to antenatal corticosteroids compared with no exposure was associated with a lower risk of mortality with no significant differences for the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples. PMID:27088897

Temporal Changes in Mortality Related to Extreme Temperatures for 15 Cities in Northeast Asia: Adaptation to Heat and Maladaptation to Cold.

PubMed

Chung, Yeonseung; Noh, Heesang; Honda, Yasushi; Hashizume, Masahiro; Bell, Michelle L; Guo, Yue-Liang Leon; Kim, Ho

2017-05-15

Understanding how the temperature-mortality association worldwide changes over time is crucial to addressing questions of human adaptation under climate change. Previous studies investigated the temporal changes in the association over a few discrete time frames or assumed a linear change. Also, most studies focused on attenuation of heat-related mortality and studied the United States or Europe. This research examined continuous temporal changes (potentially nonlinear) in mortality related to extreme temperature (both heat and cold) for 15 cities in Northeast Asia (1972-2009). We used a generalized linear model with splines to simultaneously capture 2 types of nonlinearity: nonlinear association between temperature and mortality and nonlinear change over time in the association. We combined city-specific results to generate country-specific results using Bayesian hierarchical modeling. Cold-related mortality remained roughly constant over decades and slightly increased in the late 2000s, with a larger increase for cardiorespiratory deaths than for deaths from other causes. Heat-related mortality rates have decreased continuously over time, with more substantial decrease in earlier decades, for older populations and for cardiorespiratory deaths. Our findings suggest that future assessment of health effects of climate change should account for the continuous changes in temperature-related health risk and variations by factors such as age, cause of death, and location. © Crown copyright 2017.

Risk Factors for Post-NICU Discharge Mortality Among Extremely Low Birth Weight Infants

PubMed Central

De Jesus, Lilia C.; Pappas, Athina; Shankaran, Seetha; Kendrick, Douglas; Das, Abhik; Higgins, Rosemary D.; Bell, Edward F.; Stoll, Barbara J.; Laptook, Abbot R.; Walsh, Michele C.

2012-01-01

Objective To evaluate maternal and neonatal risk factors associated with post-neonatal intensive care unit (NICU) discharge mortality among ELBW infants. Study design This is a retrospective analysis of extremely low birth weight (<1,000 g) and <27 weeks' gestational age infants born in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network sites from January 2000 to June 2007. Infants were tracked until death or 18–22 months corrected age. Infants who died between NICU discharge and the 18–22 month follow-up visit were classified as post-NICU discharge mortality. Association of maternal and infant risk factors with post-NICU discharge mortality was determined using logistic regression analysis. A prediction model with six significant predictors was developed and validated. Results 5,364 infants survived to NICU discharge. 557 (10%) infants were lost to follow-up, and 107 infants died following NICU discharge. Post-NICU discharge mortality rate was 22.3 per 1000 ELBW infants. In the prediction model, African-American race, unknown maternal health insurance, and hospital stay ≥120 days significantly increased risk, and maternal exposure to intra-partum antibiotics was associated with decreased risk of post-NICU discharge mortality. Conclusion We identified African-American race, unknown medical insurance and prolonged NICU stay as risk factors associated with post-NICU discharge mortality among ELBW infants. PMID:22325187

Extreme mortality in nineteenth-century Africa: the case of Liberian immigrants.

PubMed

McDaniel, A

1992-11-01

Several studies have examined the mortality of immigrants from Europe to Africa in the nineteenth century. This paper examines the level of mortality in Liberia of Africans who emigrated there from the United States. A life table is estimated from data collected by the American Colonization Society from 1820 to 1843. The analysis reflects the mortality experience of a population that is transplanted from one disease environment to another, more exacting, disease environment. The results of this analysis show that these Liberian immigrants experienced the highest mortality rates in accurately recorded human history.

Know your limits? Climate extremes impact the range of Scots pine in unexpected places

PubMed Central

Julio Camarero, J.; Gazol, Antonio; Sancho-Benages, Santiago; Sangüesa-Barreda, Gabriel

2015-01-01

Background and Aims Although extreme climatic events such as drought are known to modify forest dynamics by triggering tree dieback, the impact of extreme cold events, especially at the low-latitude margin (‘rear edge’) of species distributional ranges, has received little attention. The aim of this study was to examine the impact of one such extreme cold event on a population of Scots pine (Pinus sylvestris) along the species’ European southern rear-edge range limit and to determine how such events can be incorporated into species distribution models (SDMs). Methods A combination of dendrochronology and field observation was used to quantify how an extreme cold event in 2001 in eastern Spain affected growth, needle loss and mortality of Scots pine. Long-term European climatic data sets were used to contextualize the severity of the 2001 event, and an SDM for Scots pine in Europe was used to predict climatic range limits. Key Results The 2001 winter reached record minimum temperatures (equivalent to the maximum European-wide diurnal ranges) and, for trees already stressed by a preceding dry summer and autumn, this caused dieback and large-scale mortality. Needle loss and mortality were particularly evident in south-facing sites, where post-event recovery was greatly reduced. The SDM predicted European Scots pine distribution mainly on the basis of responses to maximum and minimum monthly temperatures, but in comparison with this the observed effects of the 2001 cold event at the southerly edge of the range limit were unforeseen. Conclusions The results suggest that in order to better forecast how anthropogenic climate change might affect future forest distributions, distribution modelling techniques such as SDMs must incorporate climatic extremes. For Scots pine, this study shows that the effects of cold extremes should be included across the entire distribution margin, including the southern ‘rear edge’, in order to avoid biased predictions based solely on warmer climatic scenarios. PMID:26292992

[Analysis of the pathogenic characteristics of 162 severely burned patients with bloodstream infection].

PubMed

Gong, Y L; Yang, Z C; Yin, S P; Liu, M X; Zhang, C; Luo, X Q; Peng, Y Z

2016-09-20

To analyze the distribution and drug resistance of pathogen isolated from severely burned patients with bloodstream infection, so as to provide reference for the clinical treatment of these patients. Blood samples of 162 severely burned patients (including 120 patients with extremely severe burn) with bloodstream infection admitted into our burn ICU from January 2011 to December 2014 were collected. Pathogens were cultured by fully automatic blood culture system, and API bacteria identification panels were used to identify pathogen. Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of major Gram-negative and -positive bacteria to 37 antibiotics including ampicillin, piperacillin and teicoplanin, etc. (resistance to vancomycin was detected by E test), and drug resistance of fungi to 5 antibiotics including voriconazole and amphotericin B, etc. Modified Hodge test was used to further identify imipenem and meropenem resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The pathogen distribution and drug resistance rate were analyzed by WHONET 5.5. Mortality rate and infected pathogens of patients with extremely severe burn and patients with non-extremely severe burn were recorded. Data were processed with Wilcoxon rank sum test. (1) Totally 1 658 blood samples were collected during the four years, and 339 (20.4%) strains of pathogens were isolated. The isolation rate of Gram-negative bacteria, Gram-positive bacteria, and fungi were 68.4% (232/339), 24.5% (83/339), and 7.1% (24/339), respectively. The top three pathogens with isolation rate from high to low were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa in turn. (2) Except for the low drug resistance rate to polymyxin B and minocycline, drug resistance rate of Acinetobacter baumannii to the other antibiotics were relatively high (81.0%-100.0%). Pseudomonas aeruginosa was sensitive to polymyxin B but highly resistant to other antibiotics (57.7%-100.0%). Enterobacter cloacae was sensitive to imipenem and meropenem, while its drug resistance rates to ciprofloxacin, levofloxacin, cefoperazone/sulbactam, cefepime, piperacillin/tazobactam were 25.0%-49.0%, and those to the other antibiotics were 66.7%-100.0%. Drug resistance rates of Klebsiella pneumoniae to cefoperazone/sulbactam, imipenem, and meropenem were low (5.9%-15.6%, two imipenem- and meropenem-resistant strains were identified by modified Hodge test), while its drug resistance rates to amoxicillin/clavulanic acid, piperacillin/tazobactam, cefepime, cefoxitin, amikacin, levofloxacin were 35.3%-47.1%, and those to the other antibiotics were 50.0%-100.0%. (3) Drug resistance rates of methicillin-resistant Staphylococcus aureus (MRSA) to most of the antibiotics were higher than those of the methicillin-sensitive Staphylococcus aureus (MSSA). MRSA was sensitive to linezolid, vancomycin, and teicoplanin, while its drug resistance rates to compound sulfamethoxazole, clindamycin, minocycline, and erythromycin were 5.3%-31.6%, and those to the other antibiotics were 81.6%-100.0%. Except for totally resistant to penicillin G and tetracycline, MSSA was sensitive to the other antibiotics. Fourteen Staphylococcus aureus strains were resistant to erythromycin-induced clindamycin. Enterococcus was sensitive to vancomycin and teicoplanin, while its drug resistance rates to linezolid, chloramphenicol, nitrofurantoin, and high unit gentamicin were low (10.0%-30.0%), and those to ciprofloxacin, erythromycin, minocycline, and ampicillin were high (60.0%-80.0%). Enterococcus was fully resistant to rifampicin. (4) Fungi was sensitive to amphotericin B, and drug resistance rates of fungi to voriconazole, fluconazole, itraconazole, and ketoconazole were 7.2%-12.5%. (5) The mortality of patients with extremely severe burn was higher than that of patients with non-extremely severe burn. The variety of infected pathogens in patients with extremely severe burn significantly outnumbered that in patients with non-extremely severe burn (Z=-2.985, P=0.005). The variety of pathogen in severely burned patients with bloodstream infection is wide, with the main pathogens as Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, and the drug resistance situation is grim. The types of infected pathogen in patients with extremely severe burn are more complex, and the mortality of these patients is higher when compared with that of patients with non-extremely severe burn.

Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study.

PubMed

Schmidt, Brian M; Wrobel, James S; Munson, Michael; Rothenberg, Gary; Holmes, Crystal M

2017-04-01

Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data. The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years. We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R 2 (without podiatry)=0.45, R 2 (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05). Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition. Copyright © 2017 Elsevier B.V. All rights reserved.

Using Annual Data to Estimate the Public Health Impact of Extreme Temperatures.

PubMed

Goggins, William B; Yang, Chunyuh; Hokama, Tomiko; Law, Lewis S K; Chan, Emily Y Y

2015-07-01

Short-term associations between both hot and cold ambient temperatures and higher mortality have been found worldwide. Few studies have examined these associations on longer time scales. Age-standardized mortality rates (ASMRs) were calculated for 1976-2012 for Hong Kong SAR, People's Republic of China, defining "annual" time periods in 2 ways: from May through April of the following year and from November through October. Annual frequency and severity of extreme temperatures were summarized by using a degree-days approach with extreme heat expressed as annual degree-days >29.3°C and cold as annual degree-days <27.5°C. For example, a day with a mean temperature of 25.0°C contributes 2.5 cold degree-days to the annual total. Generalized additive models were used to estimate the association between annual hot and cold degree-days and the ASMR, with adjustment for long-term trends. Increases of 10 hot or 200 cold degree-days in an annual period, the approximate interquartile ranges for these variables, were significantly (all P's ≤ 0.011) associated with 1.9% or 3.1% increases, respectively, in the annual ASMR for the May-April analyses and with 2.2% or 2.8% increases, respectively, in the November-October analyses. Associations were stronger for noncancer and elderly mortality. Mortality increases associated with extreme temperature are not simply due to short-term forward displacement of deaths that would have occurred anyway within a few weeks. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A novel method for murine intrahepatic islet transplantation via cecal vein.

PubMed

Byun, Nari; Kim, Hyun-Je; Min, Byoung-Hoon; Shin, Jun-Seop; Yoon, Il-Hee; Kim, Jong-Min; Kim, Yong-Hee; Park, Chung-Gyu

2015-12-01

Islet transplantation is one of the most beneficial treatment modality to treat type 1 diabetic patients with frequent hypoglycemic unawareness. In clinical setting, human islets are infused via portal vein and are settled in the end-portal venules in the liver. However, mouse islets are transplanted into kidney subcapsule or liver through direct portal vein. These conventional transplantation methods have several drawbacks such as different physiological environments around the transplanted islets in kidney subcapsule from the liver and high mortality rate in direct portal vein approach. In this study, we introduced murine intrahepatic islet transplantation method via cecal vein to have the same surgical operation route in humans as well as guaranteeing low mortality rate after islet transplantation. With this protocol, consistent normoglycemia can be obtained in diabetic mice, while keeping operation-related mortality extremely low. This approach with easier accessibility and low mortality will make murine intrahepatic islet transplantation a useful model for studying immunological mechanisms such as strong innate and adaptive immune responses that occur in human islet transplantation. Copyright © 2015 Elsevier B.V. All rights reserved.

Specific Dietary Fats in Relation to Total and Cause-Specific Mortality

PubMed Central

Wang, Dong D.; Li, Yanping; Chiuve, Stephanie E.; Stampfer, Meir J.; Manson, JoAnn E.; Rimm, Eric B.; Willett, Walter C.; Hu, Frank B.

2016-01-01

Importance Previous studies have shown distinct associations between specific dietary fat and cardiovascular disease. However, evidence on specific dietary fats and mortality remains limited and inconsistent. Objective To examine the associations of specific dietary fats with total and cause-specific mortality in two large ongoing prospective cohort studies. Design, setting, and participants We investigated 83,349 women from the Nurses’ Health Study (1980-2012) and 42,884 men from the Health Professionals Follow-up Study (1986-2012) who were free from cardiovascular disease, cancer and diabetes at baseline. Dietary fat intake was assessed at baseline and updated every 2 to 4 years. Main outcomes and measures We performed systematic searches of the vital records of states and of the National Death Index, supplemented by reports from family members or postal authorities. Results We documented 33,304 deaths during 3,439,954 person-years of follow-up. After adjustment for known and suspected risk factors, dietary total fat, compared to total carbohydrate, was inversely associated with total mortality (P for trend <0.001). The hazard ratios (HRs) of total mortality comparing extreme quintiles of specific dietary fats was 1.08, (95% confidence interval (CI), 1.03-1.14) for saturated fat, 0.81 (95% CI, 0.78-0.84) for polyunsaturated fat, 0.89 (95% CI, 0.84-0.94) for monounsaturated fat and 1.13 (95% CI, 1.07-1.18) for trans fat (P for trend <0.001 for all). Replacing 5% of energy from saturated fats with equivalent energy from polyunsaturated fats and monounsaturated fats was associated with 27% (HR =0.73, 95% CI, 0.70-0.77) and 13% (HR =0.87, 95% CI, 0.82-0.93) estimated reductions in total mortality, respectively. HR of total mortality comparing extreme quintiles of n-6 polyunsaturated fat intake was 0.85 (95% CI, 0.81-0.89). Intake of n-6 polyunsaturated fat, especially linoleic acid, was inversely associated with mortality due to most major causes, while marine n-3 polyunsaturated fat intake was associated with a modestly lower total mortality (HR comparing extreme quintiles =0.96, 95% CI, 0.93-1.00). Conclusions and relevance Different types of dietary fats have divergent associations with total and cause-specific mortality. These findings support current dietary recommendations to replace saturated and trans fat with unsaturated fats. PMID:27379574

The response of tropical rainforests to drought-lessons from recent research and future prospects.

PubMed

Bonal, Damien; Burban, Benoit; Stahl, Clément; Wagner, Fabien; Hérault, Bruno

We review the recent findings on the influence of drought on tree mortality, growth or ecosystem functioning in tropical rainforests. Drought plays a major role in shaping tropical rainforests and the response mechanisms are highly diverse and complex. The numerous gaps identified here require the international scientific community to combine efforts in order to conduct comprehensive studies in tropical rainforests on the three continents. These results are essential to simulate the future of these ecosystems under diverse climate scenarios and to predict the future of the global earth carbon balance. Tropical rainforest ecosystems are characterized by high annual rainfall. Nevertheless, rainfall regularly fluctuates during the year and seasonal soil droughts do occur. Over the past decades, a number of extreme droughts have hit tropical rainforests, not only in Amazonia but also in Asia and Africa. The influence of drought events on tree mortality and growth or on ecosystem functioning (carbon and water fluxes) in tropical rainforest ecosystems has been studied intensively, but the response mechanisms are complex. Herein, we review the recent findings related to the response of tropical forest ecosystems to seasonal and extreme droughts and the current knowledge about the future of these ecosystems. This review emphasizes the progress made over recent years and the importance of the studies conducted under extreme drought conditions or in through-fall exclusion experiments in understanding the response of these ecosystems. It also points to the great diversity and complexity of the response of tropical rainforest ecosystems to drought. The numerous gaps identified here require the international scientific community to combine efforts in order to conduct comprehensive studies in tropical forest regions. These results are essential to simulate the future of these ecosystems under diverse climate scenarios and to predict the future of the global earth carbon balance.

Increasing probability of mortality during Indian heat waves.

PubMed

Mazdiyasni, Omid; AghaKouchak, Amir; Davis, Steven J; Madadgar, Shahrbanou; Mehran, Ali; Ragno, Elisa; Sadegh, Mojtaba; Sengupta, Ashmita; Ghosh, Subimal; Dhanya, C T; Niknejad, Mohsen

2017-06-01

Rising global temperatures are causing increases in the frequency and severity of extreme climatic events, such as floods, droughts, and heat waves. We analyze changes in summer temperatures, the frequency, severity, and duration of heat waves, and heat-related mortality in India between 1960 and 2009 using data from the India Meteorological Department. Mean temperatures across India have risen by more than 0.5°C over this period, with statistically significant increases in heat waves. Using a novel probabilistic model, we further show that the increase in summer mean temperatures in India over this period corresponds to a 146% increase in the probability of heat-related mortality events of more than 100 people. In turn, our results suggest that future climate warming will lead to substantial increases in heat-related mortality, particularly in developing low-latitude countries, such as India, where heat waves will become more frequent and populations are especially vulnerable to these extreme temperatures. Our findings indicate that even moderate increases in mean temperatures may cause great increases in heat-related mortality and support the efforts of governments and international organizations to build up the resilience of these vulnerable regions to more severe heat waves.

The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection.

PubMed

Lawton, Jennifer S; Moon, Marc R; Liu, Jingxia; Koerner, Danielle J; Kulshrestha, Kevin; Damiano, Ralph J; Maniar, Hersh; Itoh, Akinobu; Balsara, Keki R; Masood, Faraz M; Melby, Spencer J; Pasque, Michael K

2018-03-01

Surgery for type A aortic dissection is associated with a high operative mortality, and a variety of predictive risk factors have been reported. We hypothesized that a combination of risk factors associated with organ malperfusion and severe acidosis that are not currently documented in databases would be associated with a level of extreme operative risk that would warrant the consideration of treatment paradigms other than immediate ascending aortic surgery. Charts of patients undergoing repair of acute type A aortic dissection between January 1, 1996, and May 1, 2016, were queried for preoperative malperfusion, preoperative base deficit, pH, bicarbonate, cardiopulmonary resuscitation, severe aortic insufficiency, redo status, and preoperative intubation. Multivariable logistic analyses were considered to evaluate interested variables and operative mortality. Between January 1, 1996, and May 1, 2016, 282 patients underwent surgical repair of type A aortic dissection. A total of 66 patients had a calculated base deficit -5 or greater. Eleven of 12 patients (92%) with severe acidosis (base deficit ≥-10) with malperfusion had operative mortality. No patient with severe acidosis with abdominal malperfusion survived. Multivariable analyses identified base deficit, intubation, congestive heart failure, dyslipidemia/statin use, and renal failure as predictors of operative death. The most significant predictor was base deficit -10 or greater (odds ratio, 9.602; 95% confidence interval, 2.649-34.799). The combination of severe acidosis (base deficit ≥-10) with abdominal malperfusion was uniformly fatal. Further research is needed to determine whether the identification of extreme risk warrants consideration of alternate treatment options to address the cause of severe acidosis before ascending aortic procedures. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

[Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution].

PubMed

González Álvarez, Carmen Elena; González García, Lara Gloria; Carrera García, Laura; Díaz Zabala, Mikel; Suárez Rodríguez, Marta; Arias Llorente, Rosa Patricia; Costa Romero, Marta; Solís Sánchez, Gonzalo

HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution. A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place. Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed<1500g (four weighed <1000g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation. Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Extreme all-cause mortality in JUPITER requires reexamination of vital records.

PubMed

Serebruany, Victor L

2011-01-01

To compare all-cause mortality in JUPITER with other statin trials at 21 months of follow-up. Outcome advantages including all-cause mortality reduction yielded from the JUPITER trial support aggressive use of rosuvastatin and, perhaps by extension, other statins for primary prevention. Despite enrolling apparently healthy subjects and early trial termination at 21 months of mean follow-up, JUPITER revealed very high all-cause mortality in both the placebo (2.8%) and rosuvastatin (2.2%) arms. Comparison of all-cause mortality prorated for 21 months in 10 primary prevention studies and 1 acute coronary syndromes statin trial. The all-cause mortality in JUPITER was more than twice that of the average of primary prevention studies, matching well only with specific trials designed in diabetics (ASPEN or CARDS), early hypertension studies (ALLHAT-LLT) or a trial in patients with acute coronary syndromes (PROVE IT). Since the 'play of chance' is unlikely to explain these discrepancies due to excellent baseline match, excess death rates and all-cause mortality rates in both JUPITER arms must be questioned. It may be important that the study sponsor self-monitored sites. Excess all-cause mortality rates in the apparently relatively healthy JUPITER population are alarming and require independent verification. If, indeed, the surprising outcomes in JUPITER are successfully challenged, and considering established harm of statins with regard to rhabdomyolysis as well as, potentially, diabetes, millions of patients may find better and safer options for primary prevention of vascular events. Copyright © 2011 S. Karger AG, Basel.

Role of absorbing aerosols on hot extremes in India in a GCM

NASA Astrophysics Data System (ADS)

Mondal, A.; Sah, N.; Venkataraman, C.; Patil, N.

2017-12-01

Temperature extremes and heat waves in North-Central India during the summer months of March through June are known for causing significant impact in terms of human health, productivity and mortality. While greenhouse gas-induced global warming is generally believed to intensify the magnitude and frequency of such extremes, aerosols are usually associated with an overall cooling, by virtue of their dominant radiation scattering nature, in most world regions. Recently, large-scale atmospheric conditions leading to heat wave and extreme temperature conditions have been analysed for the North-Central Indian region. However, the role of absorbing aerosols, including black carbon and dust, is still not well understood, in mediating hot extremes in the region. In this study, we use 30-year simulations from a chemistry-coupled atmosphere-only General Circulation Model (GCM), ECHAM6-HAM2, forced with evolving aerosol emissions in an interactive aerosol module, along with observed sea surface temperatures, to examine large-scale and mesoscale conditions during hot extremes in India. The model is first validated with observed gridded temperature and reanalysis data, and is found to represent observed variations in temperature in the North-Central region and concurrent large-scale atmospheric conditions during high temperature extremes realistically. During these extreme events, changes in near surface properties include a reduction in single scattering albedo and enhancement in short-wave solar heating rate, compared to climatological conditions. This is accompanied by positive anomalies of black carbon and dust aerosol optical depths. We conclude that the large-scale atmospheric conditions such as the presence of anticyclones and clear skies, conducive to heat waves and high temperature extremes, are exacerbated by absorbing aerosols in North-Central India. Future air quality regulations are expected to reduce sulfate particles and their masking of GHG warming. It is concurrently important to mitigate emissions of warming black carbon particles, to manage future climate change-induced hot extremes.

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico.

PubMed

Méndez-Lázaro, Pablo A; Pérez-Cardona, Cynthia M; Rodríguez, Ernesto; Martínez, Odalys; Taboas, Mariela; Bocanegra, Arelis; Méndez-Tejeda, Rafael

2018-05-01

Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81-41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47-26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico

NASA Astrophysics Data System (ADS)

Méndez-Lázaro, Pablo A.; Pérez-Cardona, Cynthia M.; Rodríguez, Ernesto; Martínez, Odalys; Taboas, Mariela; Bocanegra, Arelis; Méndez-Tejeda, Rafael

2018-05-01

Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81-41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47-26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico

NASA Astrophysics Data System (ADS)

Méndez-Lázaro, Pablo A.; Pérez-Cardona, Cynthia M.; Rodríguez, Ernesto; Martínez, Odalys; Taboas, Mariela; Bocanegra, Arelis; Méndez-Tejeda, Rafael

2016-12-01

Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81-41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47-26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

PubMed Central

Hsu, Wan-Hsiang; Van Zutphen, Alissa R.; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-01-01

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial. PMID:22922791

Humidity May Modify the Relationship between Temperature and Cardiovascular Mortality in Zhejiang Province, China

PubMed Central

Zeng, Jie; Zhang, Xuehai; Yang, Jun; Bao, Junzhe; Dear, Keith; Liu, Qiyong; Lin, Shao; Lin, Aihua; Huang, Cunrui

2017-01-01

Background: The evidence of increased mortality attributable to extreme temperatures is widely characterized in climate-health studies. However, few of these studies have examined the role of humidity on temperature-mortality association. We investigated the joint effect between temperature and humidity on cardiovascular disease (CVD) mortality in Zhejiang Province, China. Methods: We collected data on daily meteorological and CVD mortality from 11 cities in Zhejiang Province during 2010–2013. We first applied time-series Poisson regression analysis within the framework of distributed lag non-linear models to estimate the city-specific effect of temperature and humidity on CVD mortality, after controlling for temporal trends and potential confounding variables. We then applied a multivariate meta-analytical model to pool the effect estimates in the 11 cities to generate an overall provincial estimate. The joint effects between them were calculated by the attributable fraction (AF). The analyses were further stratified by gender, age group, education level, and location of cities. Results: In total, 120,544 CVD deaths were recorded in this study. The mean values of temperature and humidity were 17.6 °C and 72.3%. The joint effect between low temperature and high humidity had the greatest impact on the CVD death burden over a lag of 0–21 days with a significant AF of 31.36% (95% eCI: 14.79–38.41%), while in a condition of low temperature and low humidity with a significant AF of 16.74% (95% eCI: 0.89, 24.44). The AFs were higher at low temperature and high humidity in different subgroups. When considering the levels of humidity, the AFs were significant at low temperature and high humidity for males, youth, those with a low level of education, and coastal area people. Conclusions: The combination of low temperature and high humidity had the greatest impact on the CVD death burden in Zhejiang Province. This evidence has important implications for developing CVD interventions. PMID:29135955

Humidity May Modify the Relationship between Temperature and Cardiovascular Mortality in Zhejiang Province, China.

PubMed

Zeng, Jie; Zhang, Xuehai; Yang, Jun; Bao, Junzhe; Xiang, Hao; Dear, Keith; Liu, Qiyong; Lin, Shao; Lawrence, Wayne R; Lin, Aihua; Huang, Cunrui

2017-11-14

Background : The evidence of increased mortality attributable to extreme temperatures is widely characterized in climate-health studies. However, few of these studies have examined the role of humidity on temperature-mortality association. We investigated the joint effect between temperature and humidity on cardiovascular disease (CVD) mortality in Zhejiang Province, China. Methods : We collected data on daily meteorological and CVD mortality from 11 cities in Zhejiang Province during 2010-2013. We first applied time-series Poisson regression analysis within the framework of distributed lag non-linear models to estimate the city-specific effect of temperature and humidity on CVD mortality, after controlling for temporal trends and potential confounding variables. We then applied a multivariate meta-analytical model to pool the effect estimates in the 11 cities to generate an overall provincial estimate. The joint effects between them were calculated by the attributable fraction (AF). The analyses were further stratified by gender, age group, education level, and location of cities. Results : In total, 120,544 CVD deaths were recorded in this study. The mean values of temperature and humidity were 17.6 °C and 72.3%. The joint effect between low temperature and high humidity had the greatest impact on the CVD death burden over a lag of 0-21 days with a significant AF of 31.36% (95% eCI: 14.79-38.41%), while in a condition of low temperature and low humidity with a significant AF of 16.74% (95% eCI: 0.89, 24.44). The AFs were higher at low temperature and high humidity in different subgroups. When considering the levels of humidity, the AFs were significant at low temperature and high humidity for males, youth, those with a low level of education, and coastal area people. Conclusions : The combination of low temperature and high humidity had the greatest impact on the CVD death burden in Zhejiang Province. This evidence has important implications for developing CVD interventions.

Cancer mortality in the indigenous population of coastal Chukotka, 1961-1990.

PubMed

Dudarev, Alexey A; Chupakhin, Valery S; Odland, Jon Øyvind

2013-01-01

The general aim was to assess the pattern and trend in cancer mortality among the indigenous people of coastal Chukotka during the period 1961-1990. All cases of cancer deaths of indigenous residents of the Chukotsky district in the north-easternmost coast of Chukotka Autonomous Okrug were copied from personal death certificates. There were a total of 219 cancer deaths during the study period. The average annual number of cases, percent, crude, and age-standardized cancer mortality rates (ASMR) per 100,000 among men and women for all sites combined and selected sites were calculated. Data were aggregated into six 5-year periods to assess temporal trends. Direct age-standardization was performed with the Segi-Doll world standard population used by the International Agency for Research on Cancer. The indigenous Chukchi and Eskimo people living in Chukotsky district were at higher risk of death from cancer during the 30-year period between 1961 and 1990, with ASMR among men twice that of Russia, and among women 3.5 times higher. The excess can be attributed to the extremely high mortality from oesophageal cancer and lung cancer. The indigenous people of coastal Chukotka were at very high risk of death from cancer relative to the Russian population nationally. The mortality data from this study correspond to the pattern of incidence reported among other indigenous people of the Russian Arctic. Little information is available since 1990, and the feasibility of ethnic-specific health data is now severely limited.

[Mortality in Nuremberg in the 19th century (about 1800 to 1913)].

PubMed

Vasold, Manfred

2006-01-01

Before the middle of the 19th century urban life was hazardous, life expectancy in big cities was shorter than in the countryside, it was half as high as it is today. Cities used to be called "the graves of mankind"; they were unhygienic, since their inhabitants lived under crowded, unhealthy conditions. In German cities infant mortality was extremely high, one out of three new-born children died within its first year. In most big cities more people died in any given year than were born. In 1806, when the Imperial City of Nuremberg was absorbed by the Kingdom of Bavaria, it had 25 000 inhabitants, fewer than around the year 1600. In the following decades Nuremberg grew quickly, up to 50000 in 1846 and 100000 in 1881, 330000 in 1910. Its population was living extremely crowded within the medieval city-walls, up to 58 000 (1885) in the old parts of the city, more than twice as many as in 1806. Mortality was bound to increase, as more and more people moved to Nuremberg. Mortality rose from 25.5 per thousand in the 1820's to 29.4 in the 1850's and 32.8 in the 1860's. This increase of population was mainly due to migration from outside, from the countryside. New industries settled down in Nuremberg and provided new jobs, the new factories produced lots of smoke and dangerous dust. The general living conditions of the workers were poor, people were much smaller than nowadays. During the industrialisation labor was backbreaking, working hours were extremely long, and annual working hours were more than twice as long as today. New and better legislation was written by the Northern German Confederation, founded in 1867. Now the magistrate of Nuremberg recognised that something had to be done. In the following years physicians began to collect information as to morbidity and mortality in various parts of Nuremberg. Very many people still died of infectious diseases, esp. of tubercolosis, typhoid fever, diphtheria, pertussis, scarlet fever and other infectious diseases. There were many cases of bronchitis and deadly pneumonia. Even suicide was an important cause of death. In 1886 mortality at Nuremberg peaked for the last time above 30. Nuremberg had fewer doctors than other big cities in Germany. The city-fathers noticed that the public wells and the drinking water were dirty--they were getting more and more contaminated as time went by. It proved extremely difficult to provide this fast growing population with "free goods" like clean water and air. In the 1870's Nuremberg began to build a new water supply and a modern municipal sewer system. Cases of typhoid fever declined quickly thereafter. The magistrate did not provide new apartment-houses, but it took care that the new houses were more hygienic, with toilets and other necessary facilities. After 1880 new vaccinations were developed by modern medicine, these and other methods of preventive medicin proved to be more important for prolonging human lifes than therapeutic medicine. In the 1880's a steep rise of income can be registered, it brought more and better food, more meat, and better living and working conditions--and fewer working-hours per year. At the eve of World War I, Nuremberg was one of the ten or twelve biggest cities in Germany, an industrialized city with a hard-working population, people with little education and income. Urban mortality in Nuremberg declined rather slowly. In 1867 35.7 percent of all deceased persons were infants, less than one year old, in 1913 that percentage had declined to 30.7. In 1867 only 9.3 per cent of the deceased were older than 70, in 1913 the elderly constituted 14.2 per cent. Very many people still died in their forties or fifties.

Mortality from disease among fishermen employed in the UK fishing industry from 1948 to 2005.

PubMed

Roberts, Stephen E; Rodgers, Sarah E; Williams, Judy C

2007-01-01

Although commercial fishing has become established as the most hazardous occupation in Western countries, relatively little has been reported on mortality from disease among fishermen. To investigate the causes of work-related mortality from disease in the UK fishing industry from 1948 to 2005, trends in mortality over time and how it varies according to the sector of the fishing industry, to investigate non-work related mortality among fishermen ashore, and to compare it with that in other populations. Examination of paper death inquiry files, death registers and death returns, as well as GIS mapping for a defined population of 1.45 million fishermen-years at risk. From 1948 to 2005, there were a total of 449 work-related deaths from disease identified in the UK fishing industry, with a corresponding mortality rate of 30.9 per 100,000. The mortality rate increased from about 35 per 100,000 in the late 1940s to 60 in the early/mid 1970s but fell sharply to about 10 by the late 1970s. Most of the deaths were caused by ischaemic heart disease followed by other circulatory diseases, respiratory and gastrointestinal diseases. The highest mortality rates were identified for fishermen employed on board distant water trawlers, particularly those operating in Arctic waters. The study shows that fishermen in distant water trawlers, particularly in Arctic conditions, have the highest risks of mortality from disease. The high risks presumably reflect lifestyle risk factors as well as extremely hazardous and stressful working and sleeping conditions.

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries.

PubMed

Macedo, F I B; Sciarretta, J D; Otero, C A; Ruiz, G; Ebler, D J; Pizano, L R; Namias, N

2016-04-01

Secondary abdominal compartment syndrome (ACS) can occur in trauma patients without abdominal injuries. Surgical management of patients presenting with secondary ACS after isolated traumatic lower extremity vascular injury (LEVI) continues to evolve, and associated outcomes remain unknown. From January 2006 to September 2011, 191 adult trauma patients presented to the Ryder Trauma Center, an urban level I trauma center in Miami, Florida with traumatic LEVIs. Among them 10 (5.2 %) patients were diagnosed with secondary ACS. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Mean age was 37.4 ± 18.0 years (range 16-66 years), and the majority of patients were males (8 patients, 80 %). There were 7 (70 %) penetrating injuries (5 gunshot wounds and 2 stab wounds), and 3 blunt injuries with mean Injury Severity Score (ISS) 21.9 ± 14.3 (range 9-50). Surgical management of LEVIs included ligation (4 patients, 40 %), primary repair (1 patient, 10 %), reverse saphenous vein graft (2 patients, 20 %), and PTFE interposition grafting (3 patients, 30 %). The overall mortality rate in this series was 60 %. The association between secondary ACS and lower extremity vascular injuries carries high morbidity and mortality rates. Further research efforts should focus at identifying parameters to accurately determine resuscitation goals, and therefore, prevent such a devastating condition.

Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions.

PubMed

Bonet, M; Cuttini, M; Piedvache, A; Boyle, E M; Jarreau, P H; Kollée, L; Maier, R F; Milligan, Dwa; Van Reempts, P; Weber, T; Barros, H; Gadzinowki, J; Draper, E S; Zeitlin, J

2017-09-01

To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. 70 hospitals in ten European regions. Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). We used McNemar's Chi 2 test, paired t-tests and conditional logistic regression for comparisons over time. Reported policies, mortality and morbidity of EPTIs. The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. Changes in reported policies for management of extremely preterm births were related to mortality declines. © 2017 Royal College of Obstetricians and Gynaecologists.

Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants.

PubMed

Yamakawa, Takuji; Itabashi, Kazuo; Kusuda, Satoshi

2016-01-01

To assess whether the mortality and morbidity risks vary with birth weight standard deviation score (BWSDS) in growth restricted extremely preterm infants. This was a multicenter retrospective cohort study using the database of the Neonatal Research Network of Japan and including 9149 infants born between 2003 and 2010 at <28 weeks gestation. According to the BWSDSs, the infants were classified as: <-2.0, -2.0 to -1.5, -1.5 to -1.0, -1.0 to -0.5, and ≥-0.5. Infants with BWSDS≥-0.5 were defined as non-growth restricted group. After adjusting for covariates, the risks of mortality and some morbidities were different among the BWSDS groups. Compared with non-growth restricted group, the adjusted odds ratio (aOR) for mortality [aOR, 1.69; 95% confidence interval (CI), 1.35-2.12] and chronic lung disease (CLD) (aOR, 1.28; 95% CI, 1.07-1.54) were higher among the infants with BWSDS -1.5 to <-1.0. The aOR for severe retinopathy of prematurity (ROP) (aOR, 1.36; 95% CI, 1.09-1.71) and sepsis (aOR, 1.72; 95% CI, 1.32-2.24) were higher among the infants with BWSDS -2.0 to <-1.5. The aOR for necrotizing enterocolitis (NEC) (aOR, 2.41; 95% CI, 1.64-3.55) was increased at a BWSDS<-2.0. Being growth restricted extremely preterm infants confer additional risks for mortality and morbidities such as CLD, ROP, sepsis and NEC, and these risks may vary with BWSDS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Laser immunotherapy for metastatic pancreatic cancer (Conference Presentation)

NASA Astrophysics Data System (ADS)

Zhou, Feifan

2017-02-01

Pancreatic cancer is an extremely malignant disease with high mortality rate. Currently there is no effective therapeutic strategy for highly metastatic pancreatic cancers. Laser immunotherapy (LIT) is a combination therapeutic approach of targeted phototherapy and immunotherapy, which could destroy treated primary tumors with elimination of untreated metastases. LIT affords a remarkable efficacy in suppressing tumor growth in pancreatic tumors in mice, and results in complete tumor regression in many cases. LIT could synergize targeted phototherapy and immunological effects of immunoadjuvant, which represent a promising treatment modality to induce systemic antitumor response through a local intervention, paving the way for the treatment of highly metastatic pancreatic cancers.

Premature mortality due to social and material deprivation in Nova Scotia, Canada.

PubMed

Saint-Jacques, Nathalie; Dewar, Ron; Cui, Yunsong; Parker, Louise; Dummer, Trevor Jb

2014-10-25

Inequalities in health attributable to inequalities in society have long been recognized. Typically, those most privileged experience better health, regardless of universal access to health care. Associations between social and material deprivation and mortality from all causes of death--a measure of population health, have been described for some regions of Canada. This study further examines the link between deprivation and health, focusing on major causes of mortality for both rural and urban populations. In addition, it quantifies the burden of premature mortality attributable to social and material deprivation in a Canadian setting where health care is accessible to all. The study included 35,266 premature deaths (1995-2005), grouped into five causes and aggregated over census dissemination areas. Two indices of deprivation (social and material) were derived from six socioeconomic census variables. Premature mortality was modeled as a function of these deprivation indices using Poisson regression. Premature mortality increased significantly with increasing levels of social and material deprivation. The impact of material deprivation on premature mortality was similar in urban and rural populations, whereas the impact of social deprivation was generally greater in rural populations. There were a doubling in premature mortality for those experiencing a combination of the most extreme levels of material and social deprivation. Socioeconomic deprivation is an important determinant of health equity and affects every segment of the population. Deprivation accounted for 40% of premature deaths. The 4.3% of the study population living in extreme levels of socioeconomic deprivation experienced a twofold increased risk of dying prematurely. Nationally, this inequitable risk could translate into a significant public health burden.

Drought as a Disturbance: Implications for Peatland Carbon Budgets in the Hudson Bay Lowland

NASA Astrophysics Data System (ADS)

Bello, R.; Abnizova, A.; Miller, E.

2009-05-01

Carbon feedbacks are of particular importance in high latitudes, both because of large circumpolar peatland carbon pools and because climate warming is occurring more rapidly at these latitudes. Longer-term net ecosystem exchange will be influenced by the capacity of plant communities to respond to changing conditions. The nature of community change and the factors inducing change are examined in this study of a disturbance generated by severe drought in 1994 causing widespread mortality in the dominant moss, Dicranum elongatum, occupying an upland tundra site within the Hudson Bay Lowland near Churchill, Manitoba. One quarter of this moss has recently died and become encrusted with the micro-lichen, Ochrolechia spp. Moss cushions affected in this manner exhibit strong allelopathic inhibition of seedling establishment progressing to complete moss decay. Chamber NEE growing-season flux measurements show an average net release of 642 mg C /m2/d from the dead moss compared to an average net uptake of 164 mg C /m2/d from completely healthy cushions. Between these two extremes, stressed living moss cushions support abundant seedling cover which increases in direct proportion with the fractional mortality. A proxy method for estimating the growth rates of cushions, based on the length of green living shoots, indicates that the moss community is uniform in age and established shortly after the most severe drought of historical record in 1966. Subsequent growth rates of cushions show a strong dependency on proximity to the water table (4.17-1.11 mm/y over 58 cm height interval). A growing-season moss water budget identifies the dominant water flow pathways and indicates capillary uptake (0.08 mm h-1) provides 64% of the storage gains, emphasizing the importance of groundwater for growth and survival. Maximum storage capacities are directly related to cushion biomass, leading to both enhanced moisture stress and increased susceptibility to mortality as cushion size decreases. Cushions which are completely dead share the common characteristic that they are small. When cushion data for the entire peatland are divided into 10 classes based on percent mortality there is a significant decrease in mortality as cushion size increases. The best correlate with mortality is cushion surface area to volume ratio (r2=0.79, p<0.001). The advantage of being large and storing large volumes of water is enhanced by the corresponding smaller relative surface area for moisture depletion. In average years, this maintains the growing surface at moisture levels non-limiting to photosynthesis and benefits growth. In extreme drought years, large cushions can fend off lethal desiccation and/or lethal temperatures that completely kill the smallest cushions. Between the two extremes, cushions with patchy mortality show a significantly greater proportion of damage on the south facing aspect (65%) compared to the north facing aspect (19%) (n=195, p<0.001). Dead patches on cushions form depressions on the growing surface which deepen with age as the surrounding living tissue continues to grow. On average, depression depth was 9/35 of cushion height suggesting a common mechanism of formation in 1994 (±3.4 years). The 1994 summer experienced the most severe drought since establishment and was preceded by two additional years of extreme drought in 1993 and 1992. Long term (35 year) apparent rates of carbon accumulation of 92 g C /m2 (moss)/y indicate the moss was an important contributor to the peatland carbon budget that has subsequently shifted to a more negative balance since the drought disturbance.

Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania).

PubMed

Martinez, Gerardo Sanchez; Diaz, Julio; Hooyberghs, Hans; Lauwaet, Dirk; De Ridder, Koen; Linares, Cristina; Carmona, Rocio; Ortiz, Cristina; Kendrovski, Vladimir; Adamonyte, Dovile

2018-06-21

Direct health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. We modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009-2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030-2045) and one in the far future (2085-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009-2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. During the sample period 2009-2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4-38.4) in the near future and to 46 deaths/year (95% CI: 16.4-74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009-2015, we observed increased mortality on days on which the minimum daily temperature fell below - 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8-7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1-0.8). Assuming a "middle ground" between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. Thermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception. Copyright © 2018 Elsevier Inc. All rights reserved.

Mining temporal data sets: hypoplastic left heart syndrome case study

NASA Astrophysics Data System (ADS)

Kusiak, Andrew; Caldarone, Christopher A.; Kelleher, Michael D.; Lamb, Fred S.; Persoon, Thomas J.; Gan, Yuan; Burns, Alex

2003-03-01

Hypoplastic left heart syndrome (HLHS) affects infants and is uniformly fatal without surgery. Post-surgery mortality rates are highly variable and dependent on postoperative management. The high mortality after the first stage surgery usually occurs within the first few days after procedure. Typically, the deaths are attributed to the unstable balance between the pulmonary and systemic circulations. An experienced team of physicians, nurses, and therapists is required to successfully manage the infant. However, even the most experienced teams report significant mortality due to the extremely complex relationships among physiologic parameters in a given patient. A data acquisition system was developed for the simultaneous collection of 73 physiologic, laboratory, and nurse-assessed variables. Data records were created at intervals of 30 seconds. An expert-validated wellness score was computed for each data record. A training data set consisting of over 5000 data records from multiple patients was collected. Preliminary results demonstratd that the knowledge discovery approach was over 94.57% accurate in predicting the "wellness score" of an infant. The discovered knowledge can improve care of complex patients by development of an intelligent simulator that can be used to support decisions.

Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants.

PubMed

Boghossian, Nansi S; McDonald, Scott A; Bell, Edward F; Carlo, Waldemar A; Brumbaugh, Jane E; Stoll, Barbara J; Laptook, Abbot R; Shankaran, Seetha; Walsh, Michele C; Das, Abhik; Higgins, Rosemary D

2016-06-01

Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm multiples. To examine if use of ANS is associated with improvement in major outcomes in extremely preterm multiples. Infants with a gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Antenatal corticosteroids. In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months' corrected age or death before assessment. A total of 6925 multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for gestational age multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for gestational age multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples.

Susceptibility to Mortality in Weather Extremes: Effect Modification by Personal and Small Area Characteristics In a Multi-City Case-Only Analysis

PubMed Central

Zanobetti, Antonella; O’Neill, Marie S.; Gronlund, Carina J.; Schwartz, Joel D

2015-01-01

Background Extremes of temperature have been associated with short-term increases in daily mortality. We identified subpopulations with increased susceptibility to dying during temperature extremes, based on personal demographics, small-area characteristics and preexisting medical conditions. Methods We examined Medicare participants in 135 U.S. cities and identified preexisting conditions based on hospitalization records prior to their deaths, from 1985–2006. Personal characteristics were obtained from the Medicare records, and area characteristics were assigned based on zip-code of residence. We conducted a case-only analysis of over 11 million deaths, and evaluated modification of the risk of dying associated with extremely hot days and extremely cold days, continuous temperatures, and water-vapor pressure. Modifiers included preexisting conditions, personal characteristics, zip-code-level population characteristics, and land-cover characteristics. For each effect modifier, a city-specific logistic regression model was fitted and then an overall national estimate was calculated using meta-analysis. Results People with certain preexisting conditions were more susceptible to extreme heat, with an additional 6% (95% confidence interval= 4% – 8%) increase in the risk of dying on an extremely hot day in subjects with previous admission for atrial fibrillation, an additional 8% (4%–12%) in subjects with Alzheimer disease, and an additional 6% (3%–9%) in subjects with dementia. Zip-code level and personal characteristics were also associated with increased susceptibility to temperature. Conclusions We identified several subgroups of the population who are particularly susceptible to temperature extremes, including persons with atrial fibrillation. PMID:24045717

State-space modeling of the relationship between air quality and mortality.

PubMed

Murray, C J; Nelson, C R

2000-07-01

A portion of a population is assumed to be at risk, with the mortality hazard varying with atmospheric conditions including total suspended particulates (TSP). This at-risk population is not observed and the hazard function is unknown; we wish to estimate these from mortality count and atmospheric variables. Consideration of population dynamics leads to a state-space representation, allowing the Kalman Filter (KF) to be used for estimation. A harvesting effect is thus implied; high mortality is followed by lower mortality until the population is replenished by new arrivals. The model is applied to daily data for Philadelphia, PA, 1973-1990. The estimated hazard function rises with the level of TSP and at extremes of temperature and also reflects a positive interaction between TSP and temperature. The estimated at-risk population averages about 480 and varies seasonally. We find that lags of TSP are statistically significant, but the presence of negative coefficients suggests their role may be partially statistical rather than biological. In the population dynamics framework, the natural metric for health damage from air pollution is its impact on life expectancy. The range of hazard rates over the sample period is 0.07 to 0.085, corresponding to life expectancies of 14.3 and 11.8 days, respectively.

Prediction of mortality after radical cystectomy for bladder cancer by machine learning techniques.

PubMed

Wang, Guanjin; Lam, Kin-Man; Deng, Zhaohong; Choi, Kup-Sze

2015-08-01

Bladder cancer is a common cancer in genitourinary malignancy. For muscle invasive bladder cancer, surgical removal of the bladder, i.e. radical cystectomy, is in general the definitive treatment which, unfortunately, carries significant morbidities and mortalities. Accurate prediction of the mortality of radical cystectomy is therefore needed. Statistical methods have conventionally been used for this purpose, despite the complex interactions of high-dimensional medical data. Machine learning has emerged as a promising technique for handling high-dimensional data, with increasing application in clinical decision support, e.g. cancer prediction and prognosis. Its ability to reveal the hidden nonlinear interactions and interpretable rules between dependent and independent variables is favorable for constructing models of effective generalization performance. In this paper, seven machine learning methods are utilized to predict the 5-year mortality of radical cystectomy, including back-propagation neural network (BPN), radial basis function (RBFN), extreme learning machine (ELM), regularized ELM (RELM), support vector machine (SVM), naive Bayes (NB) classifier and k-nearest neighbour (KNN), on a clinicopathological dataset of 117 patients of the urology unit of a hospital in Hong Kong. The experimental results indicate that RELM achieved the highest average prediction accuracy of 0.8 at a fast learning speed. The research findings demonstrate the potential of applying machine learning techniques to support clinical decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.

Occupational mortality of women aged 15-59 years at death in England and Wales.

PubMed Central

Moser, K A; Goldblatt, P O

1991-01-01

STUDY OBJECTIVE--The aim was to analyse occupational mortality differences among women using follow up data from a large nationally representative sample. DESIGN--Occupational information was obtained from the 1971 census records of women in the Longitudinal Study carried out by the Office of Population Censuses and Surveys (OPCS) and related to their subsequent mortality in the period between the 1971 and 1981 censuses. SETTING--In the Longitudinal Study, census, vital statistics, and other OPCS records are linked for a 1% sample of the population of England and Wales. The women studied in this paper were drawn from the 513,071 persons in the 1971 census who were included in the Longitudinal Study and whose entries were traced at the National Health Service Central Register by 1977. PARTICIPANTS--The analysis was based on 77,081 women aged 15-59 years in the Longitudinal Study for whom occupational information was collected in the 1971 census (99% of whom were in paid employment in the week before the census). There were 1553 deaths among these women in the follow up period analysed here. MEASUREMENTS AND MAIN RESULTS--Numbers of deaths in each occupational group at census were compared to those expected on the basis of age specific death rates among all women in the study. "Professional, technical workers, and artists" had significantly low mortality while "Engineering and allied trades workers nec" had significantly high mortality. Among the latter, cancer mortality of electrical production process workers was extremely high. A number of other cause specific associations (which appear to confirm proportionate Decennial Supplement analyses) were suggested by the data; examples include high levels of mortality from ischaemic heart disease among cooks, lung cancer and respiratory disease among charwomen and cleaners, and accidents, poisonings, and violence among several groups of professional and technical workers. CONCLUSIONS--By using prospective follow up from the census, occupational differences in mortality can be identified among women in paid employment. As follow up of this study continues, numbers of deaths available for analysis will increase, allowing increasingly comprehensive analyses to be undertaken. PMID:2072070

Suitability of oyster restoration sites along the Louisiana coast: Examining site and stock × site interaction

USGS Publications Warehouse

Schwarting Miller, Lindsay; La Peyre, Jerome F.; LaPeyre, Megan K.

2017-01-01

Recognition of the global loss of subtidal oyster reefs has led to a rise in reef restoration efforts, including in the Gulf of Mexico. Created reef success depends entirely on selecting a location that supports long-term oyster growth and survival, including the recruitment and survival of on-reef oysters. Significant changes in estuarine salinity through management of freshwater inflows and through changed precipitation patterns may significantly impact the locations of optimal oyster restoration sites. These rapid shifts in conditions necessitate a need to better understand both impacts to on-reef oyster growth and population development, and variation in oyster stock performance. Oyster growth, mortality, condition, and disease prevalence were examined in three different stocks of oysters located in protected cages, as well as oyster recruitment and mortality on experimental reef units in three different locations representing a salinity gradient, along the Louisiana Gulf coast in 2011 and 2012. Over a 2-y period, the high-salinity site had highest oyster growth rate in protected cages but demonstrated the least likelihood for reef development based on on-reef oyster population failure, likely because of predation-related mortality (high recruitment and 100% mortality). In contrast, the midsalinity site with moderate oyster growth and on-reef recruitment and low mortality demonstrated a higher likelihood for reef development. The lowest salinity site exhibited extreme variability in all oyster responses between years because of extreme variation in environmental conditions during the study, indicating a low likelihood of long-term reef development. Whereas limited differences in stock performance between sites were found, the range of site environmental conditions tested was ultimately much lower than expected and may not have provided a wide enough range of conditions. In areas with limited, low recruitment, or rapidly changing environmental conditions, seeding with stocks selected for best growth and survival under expected future environmental conditions could better ensure reef development by using oyster populations best suited to the predicted conditions. With rapidly changing estuarine conditions from anthropogenic activities and climate change, siting of oyster reef restoration incorporating both oyster population dynamics and in situ biotic and abiotic interactions is critical in better directing site selection for reef restoration efforts.

Can local adaptation explain varying patterns of herbivory tolerance in a recently introduced woody plant in North America?

USDA-ARS?s Scientific Manuscript database

Trends in tree mortality have been linked to global scale environmental changes, such as extreme drought and heat stress, more frequent and intense fires, and increased episodic outbreaks of insects and pathogens. Finer scale studies have also focused on survival and mortality in response to physiol...

Comparison of built environment adaptations to heat exposure and mortality during hot weather, West Midlands region, UK.

PubMed

Taylor, Jonathon; Wilkinson, Paul; Picetti, Roberto; Symonds, Phil; Heaviside, Clare; Macintyre, Helen L; Davies, Michael; Mavrogianni, Anna; Hutchinson, Emma

2018-02-01

There is growing recognition of the need to improve protection against the adverse health effects of hot weather in the context of climate change. We quantify the impact of the Urban Heat Island (UHI) and selected adaptation measures made to dwellings on temperature exposure and mortality in the West Midlands region of the UK. We used 1) building physics models to assess indoor temperatures, initially in the existing housing stock and then following adaptation measures (energy efficiency building fabric upgrades and/or window shutters), of representative dwelling archetypes using data from the English Housing Survey (EHS), and 2) modelled UHI effect on outdoor temperatures. The ages of residents were combined with evidence on the heat-mortality relationship to estimate mortality risk and to quantify population-level changes in risk following adaptations to reduce summertime heat exposure. Results indicate that the UHI effect accounts for an estimated 21% of mortality. External shutters may reduce heat-related mortality by 30-60% depending on weather conditions, while shutters in conjunction with energy-efficient retrofitting may reduce risk by up to 52%. The use of shutters appears to be one of the most effective measures providing protection against heat-related mortality during periods of high summer temperatures, although their effectiveness may be limited under extreme temperatures. Energy efficiency adaptations to the dwellings and measures to increase green space in the urban environment to combat the UHI effect appear to be less beneficial for reducing heat-related mortality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Know your limits? Climate extremes impact the range of Scots pine in unexpected places.

PubMed

Julio Camarero, J; Gazol, Antonio; Sancho-Benages, Santiago; Sangüesa-Barreda, Gabriel

2015-11-01

Although extreme climatic events such as drought are known to modify forest dynamics by triggering tree dieback, the impact of extreme cold events, especially at the low-latitude margin ('rear edge') of species distributional ranges, has received little attention. The aim of this study was to examine the impact of one such extreme cold event on a population of Scots pine (Pinus sylvestris) along the species' European southern rear-edge range limit and to determine how such events can be incorporated into species distribution models (SDMs). A combination of dendrochronology and field observation was used to quantify how an extreme cold event in 2001 in eastern Spain affected growth, needle loss and mortality of Scots pine. Long-term European climatic data sets were used to contextualize the severity of the 2001 event, and an SDM for Scots pine in Europe was used to predict climatic range limits. The 2001 winter reached record minimum temperatures (equivalent to the maximum European-wide diurnal ranges) and, for trees already stressed by a preceding dry summer and autumn, this caused dieback and large-scale mortality. Needle loss and mortality were particularly evident in south-facing sites, where post-event recovery was greatly reduced. The SDM predicted European Scots pine distribution mainly on the basis of responses to maximum and minimum monthly temperatures, but in comparison with this the observed effects of the 2001 cold event at the southerly edge of the range limit were unforeseen. The results suggest that in order to better forecast how anthropogenic climate change might affect future forest distributions, distribution modelling techniques such as SDMs must incorporate climatic extremes. For Scots pine, this study shows that the effects of cold extremes should be included across the entire distribution margin, including the southern 'rear edge', in order to avoid biased predictions based solely on warmer climatic scenarios. © The Author 2015. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Greater mortality and mordidity in extremely preterm infants fed a diet containing cow milk protein products

USDA-ARS?s Scientific Manuscript database

Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. EP infants <1,250 g birth weight recei...

Predictors of Mortality within Prison and after Release among Persons Living with HIV in Indonesia

PubMed Central

Culbert, Gabriel J.; Crawford, Forrest W.; Murni, Astia; Waluyo, Agung; Bazazi, Alexander R.; Sahar, Junaiti; Altice, Frederick L.

2017-01-01

Objectives HIV-related mortality is increasing in Indonesia, where prisons house many people living with HIV and addiction. We examined all-cause mortality in HIV-infected Indonesian prisoners within prison and up to 24 months post-release. Materials and Methods Randomly selected HIV-infected male prisoners (n=102) from two prisons in Jakarta, Indonesia completed surveys in prison and were followed up for 2 years (until study completion) or until they died or were lost to follow-up. Death dates were determined from medical records and interviews with immediate family members. Kaplan-Meier and Cox proportional hazards regression models were analyzed to identify mortality predictors. Results During 103 person-years (PYs) of follow-up, 15 deaths occurred, including ten in prison. The crude mortality rate within prison (125.2 deaths per 1,000 PYs) was surpassed by the crude mortality rate in released prisoners (215.7 deaths per 1,000 PYs). HIV-associated opportunistic infections were the most common probable cause of death. Predictors of within-prison and overall mortality were similar. Shorter survival overall was associated with being incarcerated within a specialized “narcotic” prison for drug offenders (hazard ratio [HR] 9.2, 95% confidence interval [CI] 1.1–76.5; P=0.03), longer incarceration (HR 1.06, 95% CI 1.01–1.1; P=0.01), and advanced HIV infection (CD4+ T-cell count<200cells/μL; HR 4.8, 95% CI 1.2–18.2; P=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01–0.9; P=0.03), although treatment with antiretroviral therapy (ART) or methadone was not. Conclusions Mortality in HIV-infected prisoners is extremely high in Indonesia, despite limited provision of ART in prisons. Interventions to restore immune function with ART and provide prophylaxis for opportunistic infections during incarceration and after release would likely reduce mortality. Narcotics prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments. PMID:29238241

Impact of ambient temperature on children's health: a systematic review.

PubMed

Xu, Zhiwei; Etzel, Ruth A; Su, Hong; Huang, Cunrui; Guo, Yuming; Tong, Shilu

2012-08-01

Children are vulnerable to temperature extremes. This paper aimed to review the literature regarding the relationship between ambient temperature and children's health and to propose future research directions. A literature search was conducted in February 2012 using the databases including PubMed, ProQuest, ScienceDirect, Scopus and Web of Science. Empirical studies regarding the impact of ambient temperature on children's mortality and morbidity were included. The existing literature indicates that very young children, especially children under one year of age, are particularly vulnerable to heat-related deaths. Hot and cold temperatures mainly affect cases of infectious diseases among children, including gastrointestinal diseases, malaria, hand, foot and mouse disease, and respiratory diseases. Pediatric allergic diseases, like eczema, are also sensitive to temperature extremes. During heat waves, the incidences of renal disease, fever and electrolyte imbalance among children increase significantly. Future research is needed to examine the balance between hot- and cold-temperature related mortality and morbidity among children; evaluate the impacts of cold spells on cause-specific mortality in children; identify the most sensitive temperature exposure and health outcomes to quantify the impact of temperature extremes on children; elucidate the possible modifiers of the temperature and children's health relationship; and project children's disease burden under different climate change scenarios. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Added Value of Physical Performance Measures in Predicting Adverse Health-Related Events: Results from the Health, Aging, and Body Composition Study

PubMed Central

Cesari, Matteo; Kritchevsky, Stephen B; Newman, Anne B; Simonsick, Eleanor M; Harris, Tamara B; Penninx, Brenda W; Brach, Jennifer S; Tylavsky, Frances A; Satterfield, Suzanne; Bauer, Doug C; Rubin, Susan M; Visser, Marjolein; Pahor, Marco

2009-01-01

Objectives To determine how three different physical performance measures (PPM) combine for added utility in predicting adverse health events in elders. Design Prospective cohort study. Setting Health, Aging, and Body Composition Study. Participants 3,024 well-functioning older persons (mean age 73.6 years). Measurements Timed gait, repeated chair stands and balance (semi- and full-tandem, and single leg stands each held for 30 seconds) tests were administered at baseline. Usual gait speed was categorized to distinguish high and low risk participants using the previously established 1 m/sec cut-point. The same population-percentile (21.3%) was used to identify cut-points for repeated chair stands (17.05 sec) and balance (53 sec) tests. Cox proportional hazard analyses were performed to evaluate the added value of PPM in predicting mortality, hospitalization, and (severe) mobility limitation events over 6.9 years of follow-up. Results Risk estimates for developing adverse health-related events were similarly large for each of the three high risk groups considered separately. A greater number of PPM scores at the high risk level was associated with a greater risk of developing adverse health-related events. When all three PPMs were considered, having only one poor performance was sufficient to indicate a highly significant higher risk of (severe) lower extremity and mortality events. Conclusion Although gait speed is considered the most important predictor of adverse health events, these findings demonstrate that poor performance on other tests of lower extremity function are equally prognostic. This suggests that chair stand and standing balance performance may be adequate substitutes when gait speed is unavailable. PMID:19207142

Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?

PubMed

Alter, David A; Austin, Peter C; Naylor, C David; Tu, Jack V

2002-01-01

Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction. The authors compared the absolute and relative hospital-specific 30-day acute myocardial infarction mortality rates in 169 hospitals throughout Ontario between April 1, 1994 and March 31, 1997. Patient socioeconomic status was characterized by median neighborhood income using postal codes and 1996 Canadian census data. They examined two risk-adjustment models: the first adjusted for age, sex, and illness severity (standard), whereas the second adjusted for age, sex, illness severity, and median neighborhood income level (socioeconomic status). There was an extremely strong correlation between 'standard' and 'socioeconomic status' risk-adjusted mortality rates (r = 0.99). Absolute differences in 30-day risk-adjusted mortality rates between the socioeconomic status and standard risk-adjustment models were small (median, 0.1%; 25th-75th percentile, 0.1-0.2). The agreement in the quintile rankings of hospitals between the socioeconomic status and standard risk-adjustment models was high (weighted kappa = 0.93). Despite its importance as a determinant of patient outcomes, the effect of socioeconomic status on hospital-specific mortality rates over and above standard risk-adjustment methods for acute myocardial infarction hospital profiling in Ontario was negligible.

Cancer mortality in the indigenous population of coastal Chukotka, 1961–1990

PubMed Central

Dudarev, Alexey A.; Chupakhin, Valery S.; Odland, Jon Øyvind

2013-01-01

Objectives The general aim was to assess the pattern and trend in cancer mortality among the indigenous people of coastal Chukotka during the period 1961–1990. Methods All cases of cancer deaths of indigenous residents of the Chukotsky district in the north-easternmost coast of Chukotka Autonomous Okrug were copied from personal death certificates. There were a total of 219 cancer deaths during the study period. The average annual number of cases, percent, crude, and age-standardized cancer mortality rates (ASMR) per 100,000 among men and women for all sites combined and selected sites were calculated. Data were aggregated into six 5-year periods to assess temporal trends. Direct age-standardization was performed with the Segi-Doll world standard population used by the International Agency for Research on Cancer. Results The indigenous Chukchi and Eskimo people living in Chukotsky district were at higher risk of death from cancer during the 30-year period between 1961 and 1990, with ASMR among men twice that of Russia, and among women 3.5 times higher. The excess can be attributed to the extremely high mortality from oesophageal cancer and lung cancer. Conclusions The indigenous people of coastal Chukotka were at very high risk of death from cancer relative to the Russian population nationally. The mortality data from this study correspond to the pattern of incidence reported among other indigenous people of the Russian Arctic. Little information is available since 1990, and the feasibility of ethnic-specific health data is now severely limited. PMID:23519821

Health effects associated with passenger vehicles: monetary values of air pollution.

PubMed

Marzouk, Mohamed; Madany, Magdy

2012-01-01

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.

The lack of effect of low temperature and high turbidity on operational Bacillus thuringiensis subsp. israelensis activity against larval black flies (Diptera: Simuliidae).

PubMed

Gray, Elmer W; Wyatt, Roger D; Adler, Peter H; Smink, John; Cox, Julie E; Noblet, Ray

2012-06-01

Black fly suppression programs are conducted across a wide range of environmental conditions, targeting a variety of pest species with diverse life histories. Operational applications of Vectobac 12AS (Bacillus thuringiensis subsp. israelensis) were conducted during times characterized by water temperature and turbidity extremes. Applications were conducted in the Yellow River in central Wisconsin targeting Simulium annulus and S. johannseni when water temperatures were 1-2 degrees C. Applications were conducted in the Green River in western North Carolina targeting the S. jenningsi group after a rain event, when portions of the treatment zone experienced turbidities of 276 nephelometric turbidity units. Excellent larvicidal activity was observed in both programs, with 97% mortality or greater being observed at distances over 5 km downstream of a treatment site. Mortality data for larval black flies in 2 operational suppression programs conducted in 2011 demonstrated a negligible effect of near-freezing water temperatures and exceptionally high turbidity on Bti activity.

A retrospective cohort study examining the association between body mass index and mortality in severe sepsis.

PubMed

Gaulton, Timothy Glen; Marshall MacNabb, C; Mikkelsen, Mark Evin; Agarwal, Anish Kumar; Cham Sante, S; Shah, Chirag Vinay; Gaieski, David Foster

2015-06-01

Body mass index (BMI) is an easily calculated indicator of a patient's body mass including muscle mass and body fat percentage and is used to classify patients as underweight or obese. This study is to determine if BMI extremes are associated with increased 28-day mortality and hospital length of stay (LOS) in emergency department (ED) patients presenting with severe sepsis. We performed a retrospective chart review at an urban, level I trauma center of adults admitted with severe sepsis between 1/2005 and 10/2007, and collected socio-demographic variables, comorbidities, initial and most severe vital signs, laboratory values, and infection sources. The primary outcome variables were mortality and LOS. We performed bivariable analysis, logistic regression and restricted cubic spline regression to determine the association between BMI, mortality, and LOS. Amongst 1,191 severe sepsis patients (median age, 57 years; male, 54.7%; median BMI, 25.1 kg/m(2)), 28-day mortality was 19.9% (95% CI 17.8-22.4) and 60-day mortality was 24.4% (95% CI 21.5-26.5). Obese and morbidly obese patients were younger, less severely ill, and more likely to have soft tissue infections. There was no difference in adjusted mortality for underweight patients compared to the normal weight comparator (OR 0.74; CI 0.42-1.39; p = 0.38). The obese and morbidly obese experienced decreased mortality risk, vs. normal BMI; however, after adjustment for baseline characteristics, this was no longer significant (OR 0.66; CI 0.42-1.03; p = 0.06). There was no significant difference in LOS across BMI groups. Neither LOS nor adjusted 28-day mortality was significantly increased or decreased in underweight or obese patients with severe sepsis. Morbidly obese patients may have decreased 28-day mortality, partially due to differences in initial presentation and source of infection. Larger, prospective studies are needed to validate these findings related to BMI extremes in patients with severe sepsis.

Financial Toxicity of Cancer Care: It's Time to Intervene.

PubMed

Zafar, S Yousuf

2016-05-01

Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Drug coated balloon in peripheral artery disease.

PubMed

Shanmugasundaram, Madhan; Murugapandian, Sangeetha; Truong, Huu Tam; Lotun, Kapildeo; Banerjee, Subhash

2018-04-21

Peripheral artery disease (PAD) is highly prevalent but is often underdiagnosed and undertreated. Lower extremity PAD can often be life style limiting. Revascularization in carefully selected lower extremity PAD patients improves symptoms and functional status. Surgical revascularization used to be the only available strategy, but in the recent years, endovascular strategies have gained popularity due to faster recovery times with low morbidity and mortality rates. Endovascular procedures have increased significantly in the United States in the past few years. That being said, higher restenosis rates and low long-term patency rates have been the limiting factors for this strategy. Drug eluting stents have been introduced to help with lowering restenosis, however lower extremity PAD involves long segment where the outcomes of stents are suboptimal. Also, the disease often crosses joint line that makes it less ideal for the stents. Drug coated balloons (DCB) have been introduced to improve patency rates following endovascular intervention for lower extremity PAD. They have gained popularity among endovascular specialists due to its ease of use and the concept of "leave nothing behind". This is a review of scientific evidence supporting DCB use in PAD. Published by Elsevier Inc.

Psychological and Physical Impacts of Extreme Events on Older Adults: Implications for Communications.

PubMed

McClelland, Erin; Amlôt, Richard; Rogers, M Brooke; Rubin, G James; Tesh, John; Pearce, Julia M

2017-02-01

In recent years, a series of large-scale, high-profile natural disasters and terrorist attacks have demonstrated the need for thorough and effective disaster preparedness. While these extreme events affect communities and societies as a whole, they also carry specific risks for particular population groups. Crises such as Hurricane Katrina and the 2011 earthquake and tsunami disaster in Japan have illustrated the risk of significant and disproportionate morbidity and mortality among older adults during disasters. Age does not necessarily equate to vulnerability, but many physical and psychological consequences of the aging process can increase the risk of adverse outcomes. As the older population grows, so too does the need to ensure that adequate, practical, and appropriate measures exist to offset the specific risks from extreme events associated with this subpopulation. Effective risk and crisis communication plays a key role in mitigating the extent to which older adults are differentially affected during extreme events. By identifying the specific issues affecting older adults, this review highlights important areas for action for practitioners and policy-makers, particularly in the realm of crisis communication. (Disaster Med Public Health Preparedness. 2017;11:127-134).

Assessment of the perioperative period in civilians injured in the Syrian Civil War.

PubMed

Hakimoglu, Sedat; Karcıoglu, Murat; Tuzcu, Kasım; Davarcı, Isıl; Koyuncu, Onur; Dikey, İsmail; Turhanoglu, Selim; Sarı, Ali; Acıpayam, Mehmet; Karatepe, Celalettin

2015-01-01

wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Assessment of the perioperative period in civilians injured in the Syrian Civil War].

PubMed

Hakimoglu, Sedat; Karcıoglu, Murat; Tuzcu, Kasım; Davarcı, Isıl; Koyuncu, Onur; Dikey, İsmail; Turhanoglu, Selim; Sarı, Ali; Acıpayam, Mehmet; Karatepe, Celalettin

2015-01-01

Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

The effect of prenatal support on birth outcomes in an urban midwestern county.

PubMed

Schlenker, Thomas; Dresang, Lee T; Ndiaye, Mamadou; Buckingham, William R; Leavitt, Judith W

2012-12-01

In Dane County, Wisconsin, the black-white infant mortality gap started decreasing from 2000 and was eliminated from 2004 to 2007. Unfortunately, it has reappeared since 2008. This paper examines risk factors and levels of prenatal care to identify key contributors to the dramatic decline and recent increase in black infant mortality and extremely premature birth rates. This retrospective cohort study analyzed approximately 100,000 Dane County birth, fetal, and infant death records from 1990 to 2007. Levels of prenatal care received were categorized as "less-than-standard," "standard routine" or "intensive." US Census data analysis identified demographic and socioeconomic changes. Infant mortality rates and extremely premature ( < or = 28 weeks gestation) birth rates were main outcome measures. Contributions to improved outcomes were measured by calculating relative risk, risk difference and population attributable fraction (PAF). Mean income and food stamp use by race were analyzed as indicators of general socioeconomic changes suspected to be responsible for worsening outcomes since 2008. Risk of extremely premature delivery for black women receiving standard routine care and intensive care decreased from 1990-2000 to 2001-2007 by 77.8% (95% CI = 49.9-90.1%) and 57.3% (95% CI = 27.6-74.8%) respectively. Women receiving less-than-standard care showed no significant improvement over time. Racial gaps in mean income and food stamp use narrowed 2002-2007 and widened since 2008. Prenatal support played an important role in improving black birth outcomes and eliminating the Dane County black-white infant mortality gap. Increasing socioeconomic disparities with worsening US economy since 2008 likely contributed to the gap's reappearance.

Pinon pine mortality event in the Southwest: An update for 2005

Treesearch

D. Allen-Reid; J. Anhold; D. Cluck; T. Eager; R. Mask; J. McMillin; S. Munson; J. Negron; T. Rogers; D. Ryerson; E. Smith; S. Smith; B. Steed; R. Thier

2008-01-01

(Please note, this is an abstract only) Drought conditions in the Southwest have persisted for a number of years resulting in large areas of pinon pine mortality. In 2002 drought conditions became extreme, facilitating an outbreak of pinon ips beetles (Ips confusus, Coleoptera: Scolytidae) that killed many millions of pinon pines over a six-state region by 2003. In...

Assessment of spatial variation of risks in small populations.

PubMed Central

Riggan, W B; Manton, K G; Creason, J P; Woodbury, M A; Stallard, E

1991-01-01

Often environmental hazards are assessed by examining the spatial variation of disease-specific mortality or morbidity rates. These rates, when estimated for small local populations, can have a high degree of random variation or uncertainty associated with them. If those rate estimates are used to prioritize environmental clean-up actions or to allocate resources, then those decisions may be influenced by this high degree of uncertainty. Unfortunately, the effect of this uncertainty is not to add "random noise" into the decision-making process, but to systematically bias action toward the smallest populations where uncertainty is greatest and where extreme high and low rate deviations are most likely to be manifest by chance. We present a statistical procedure for adjusting rate estimates for differences in variability due to differentials in local area population sizes. Such adjustments produce rate estimates for areas that have better properties than the unadjusted rates for use in making statistically based decisions about the entire set of areas. Examples are provided for county variation in bladder, stomach, and lung cancer mortality rates for U.S. white males for the period 1970 to 1979. PMID:1820268

BreathSens: A Continuous On-Bed Respiratory Monitoring System With Torso Localization Using an Unobtrusive Pressure Sensing Array.

PubMed

Liu, Jason J; Huang, Ming-Chun; Xu, Wenyao; Zhang, Xiaoyi; Stevens, Luke; Alshurafa, Nabil; Sarrafzadeh, Majid

2015-09-01

The ability to continuously monitor respiration rates of patients in homecare or in clinics is an important goal. Past research showed that monitoring patient breathing can lower the associated mortality rates for long-term bedridden patients. Nowadays, in-bed sensors consisting of pressure sensitive arrays are unobtrusive and are suitable for deployment in a wide range of settings. Such systems aim to extract respiratory signals from time-series pressure sequences. However, variance of movements, such as unpredictable extremities activities, affect the quality of the extracted respiratory signals. BreathSens, a high-density pressure sensing system made of e-Textile, profiles the underbody pressure distribution and localizes torso area based on the high-resolution pressure images. With a robust bodyparts localization algorithm, respiratory signals extracted from the localized torso area are insensitive to arbitrary extremities movements. In a study of 12 subjects, BreathSens demonstrated its respiratory monitoring capability with variations of sleep postures, locations, and commonly tilted clinical bed conditions.

Rapid detection of single bacteria in unprocessed blood using Integrated Comprehensive Droplet Digital Detection

PubMed Central

Kang, Dong-Ku; Ali, M. Monsur; Zhang, Kaixiang; Huang, Susan S.; Peterson, Ellena; Digman, Michelle A.; Gratton, Enrico; Zhao, Weian

2014-01-01

Blood stream infection or sepsis is a major health problem worldwide, with extremely high mortality, which is partly due to the inability to rapidly detect and identify bacteria in the early stages of infection. Here we present a new technology termed ‘Integrated Comprehensive Droplet Digital Detection’ (IC 3D) that can selectively detect bacteria directly from milliliters of diluted blood at single-cell sensitivity in a one-step, culture- and amplification-free process within 1.5–4 h. The IC 3D integrates real-time, DNAzyme-based sensors, droplet microencapsulation and a high-throughput 3D particle counter system. Using Escherichia coli as a target, we demonstrate that the IC 3D can provide absolute quantification of both stock and clinical isolates of E. coli in spiked blood within a broad range of extremely low concentration from 1 to 10,000 bacteria per ml with exceptional robustness and limit of detection in the single digit regime. PMID:25391809

Defining Population Health Vulnerability Following an Extreme Weather Event in an Urban Pacific Island Environment: Honiara, Solomon Islands.

PubMed

Natuzzi, Eileen S; Joshua, Cynthia; Shortus, Matthew; Reubin, Reginald; Dalipanda, Tenneth; Ferran, Karen; Aumua, Audrey; Brodine, Stephanie

2016-08-03

Extreme weather events are common and increasing in intensity in the southwestern Pacific region. Health impacts from cyclones and tropical storms cause acute injuries and infectious disease outbreaks. Defining population vulnerability to extreme weather events by examining a recent flood in Honiara, Solomon Islands, can help stakeholders and policymakers adapt development to reduce future threats. The acute and subacute health impacts following the April 2014 floods were defined using data obtained from hospitals and clinics, the Ministry of Health and in-country World Health Organization office in Honiara. Geographical information system (GIS) was used to assess morbidity and mortality, and vulnerability of the health system infrastructure and households in Honiara. The April flash floods were responsible for 21 acute deaths, 33 injuries, and a diarrhea outbreak that affected 8,584 people with 10 pediatric deaths. A GIS vulnerability assessment of the location of the health system infrastructure and households relative to rivers and the coastline identified 75% of the health infrastructure and over 29% of Honiara's population as vulnerable to future hydrological events. Honiara, Solomon Islands, is a rapidly growing, highly vulnerable urban Pacific Island environment. Evaluation of the mortality and morbidity from the April 2014 floods as well as the infectious disease outbreaks that followed allows public health specialists and policy makers to understand the health system and populations vulnerability to future shocks. Understanding the negative impacts natural disaster have on people living in urban Pacific environments will help the government as well as development partners in crafting resilient adaptation development. © The American Society of Tropical Medicine and Hygiene.

Defining Population Health Vulnerability Following an Extreme Weather Event in an Urban Pacific Island Environment: Honiara, Solomon Islands

PubMed Central

Natuzzi, Eileen S.; Joshua, Cynthia; Shortus, Matthew; Reubin, Reginald; Dalipanda, Tenneth; Ferran, Karen; Aumua, Audrey; Brodine, Stephanie

2016-01-01

Extreme weather events are common and increasing in intensity in the southwestern Pacific region. Health impacts from cyclones and tropical storms cause acute injuries and infectious disease outbreaks. Defining population vulnerability to extreme weather events by examining a recent flood in Honiara, Solomon Islands, can help stakeholders and policymakers adapt development to reduce future threats. The acute and subacute health impacts following the April 2014 floods were defined using data obtained from hospitals and clinics, the Ministry of Health and in-country World Health Organization office in Honiara. Geographical information system (GIS) was used to assess morbidity and mortality, and vulnerability of the health system infrastructure and households in Honiara. The April flash floods were responsible for 21 acute deaths, 33 injuries, and a diarrhea outbreak that affected 8,584 people with 10 pediatric deaths. A GIS vulnerability assessment of the location of the health system infrastructure and households relative to rivers and the coastline identified 75% of the health infrastructure and over 29% of Honiara's population as vulnerable to future hydrological events. Honiara, Solomon Islands, is a rapidly growing, highly vulnerable urban Pacific Island environment. Evaluation of the mortality and morbidity from the April 2014 floods as well as the infectious disease outbreaks that followed allows public health specialists and policy makers to understand the health system and populations vulnerability to future shocks. Understanding the negative impacts natural disaster have on people living in urban Pacific environments will help the government as well as development partners in crafting resilient adaptation development. PMID:27091867

Mortality, Neonatal Morbidity and Two Year Follow-Up of Extremely Preterm Infants Born in the Netherlands in 2007

PubMed Central

de Waal, Cornelia G.; Weisglas-Kuperus, Nynke; van Goudoever, Johannes B.; Walther, Frans J; Vermeulen, M.; Kok, J.H.; Tamminga, P.; Kornelisse, R.F.; Oetomo, S. Bambang; van der Hoeven, M.A.H.B.M.; Liem, K.D.; Baerts, W.; Dijk, P.H.; Bos, A.F.; Brouwers, H.A.A.; Rijken, M.; van Wassenaer, A.G.; Koopman-Esseboom, C.

2012-01-01

Background Extremely preterm infants are at high risk of neonatal mortality and adverse outcome. Survival rates are slowly improving, but increased survival may come at the expense of more handicaps. Methodology/Principal Findings Prospective population-based cohort study of all infants born at 23 to 27 weeks of gestation in the Netherlands in 2007. 276 of 345 (80%) infants were born alive. Early neonatal death occurred in 96 (34.8%) live born infants, including 61 cases of delivery room death. 29 (10.5%) infants died during the late neonatal period. Survival rates for live born infants at 23, 24, 25 and 26 weeks of gestation were 0%, 6.7%, 57.9% and 71% respectively. 43.1% of 144 surviving infants developed severe neonatal morbidity (retinopathy of prematurity grade ≥3, bronchopulmonary dysplasia and/or severe brain injury). At two years of age 70.6% of the children had no disability, 17.6% was mild disabled and 11.8% had a moderate-to-severe disability. Severe brain injury (p = 0.028), retinopathy of prematurity grade ≥3 (p = 0.024), low gestational age (p = 0.019) and non-Dutch nationality of the mother (p = 0.004) increased the risk of disability. Conclusions/Significance 52% of extremely preterm infants born in the Netherlands in 2007 survived. Surviving infants had less severe neonatal morbidity compared to previous studies. At two years of age less than 30% of the infants were disabled. Disability was associated with gestational age and neonatal morbidity. PMID:22911776

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story.

PubMed

Anastasi, Erin; Ekanem, Ekanem; Hill, Olivia; Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin; Bernasconi, Andrea

2017-01-01

Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894-1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations-as in the urban slums of Lagos.

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story

PubMed Central

Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin

2017-01-01

Introduction Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. Materials and methods The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Results Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894–1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. Discussion The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations—as in the urban slums of Lagos. PMID:28489890

Resilience and suicidality among homeless youth.

PubMed

Cleverley, Kristin; Kidd, Sean A

2011-10-01

Homeless and street-involved youth are considered an extremely high risk group, with many studies highlighting trajectories characterized by abusive, neglectful, and unstable family histories, victimization and criminal involvement while on the streets, high rates of physical and mental illness, and extremely high rates of mortality. While there exists a substantial body of knowledge regarding risk, in recent years attention has been increasingly shifting to the examination of resilience, intervention, and service delivery models for these young people. The present study describes the findings from a quantitative examination of personal and street-related demographics, psychological distress, self-esteem, resilience, and suicidality among 47 homeless and street-involved youth. Key findings indicate that the apparent erosion of mental health variables, including resilience, occurs as a function of how long the youths have been without stable housing. Finally, those youths' perceived resilience was associated with less suicidal ideation whereas higher psychological distress was associated with higher suicidal ideation, even when accounting for resiliency. Copyright © 2010 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Raising Awareness on Heat Related Mortality in Bangladesh

NASA Astrophysics Data System (ADS)

Arrighi, J.; Burkart, K.; Nissan, H.

2017-12-01

Extreme heat is the leading cause of weather-related deaths in the United States and Europe, and was responsible for four of the ten deadliest natural disasters worldwide in 2015. Near the tropics, where hot weather is considered the norm, perceived heat risk is often low, but recent heat waves in South Asia have caught the attention of the health community, policy-makers and the public. In a recent collaboration between the Red Cross Red Crescent Climate Centre, Columbia University and BBC Media Action the effects of extreme heat in Bangladesh were analyzed and the findings were subsequently used as a basis to raise awareness about the impacts of extreme heat on the most vulnerable, to the general public. Analysis of excess heat in Bangladesh between 2003 and 2007 showed that heatwaves occur between April and June with most extreme heat events occurring in May. Between 2003 and 2007 it is estimated that an average of 1500 people died per year due to heatwaves lasting three days or longer, with an eight-day heatwave in 2005 resulting in a minimum of 3,800 excess deaths. Utilizing these findings BBC Media Action launched an online communications campaign in May 2017 ultimately reaching approximately 3.9 million people with information on reducing the impacts of extreme heat. This presentation will highlight key findings from the study of heat related mortality in Bangladesh as well as highlight the benefit of collaboration between scientists and communicators for increasing awareness about the effects of extreme heat on the most vulnerable.

Fungal Endocarditis: Update on Diagnosis and Management.

PubMed

Pasha, Ahmed Khurshid; Lee, Justin Z; Low, See-Wei; Desai, Hem; Lee, Kwan S; Al Mohajer, Mayar

2016-10-01

Fungal endocarditis is an extremely debilitating disease associated with high morbidity and mortality. Candida spp. are the most common isolated organisms in fungal endocarditis. It is most prevalent in patients who are immunosuppressed and intravenous drug users. Most patients present with constitutional symptoms, which are indistinguishable from bacterial endocarditis, hence a high index of suspicion is required for pursuing diagnosis. Diagnosis of fungal endocarditis can be very challenging: most of the time, blood cultures are negative or take a long time to yield growth. Fungal endocarditis mandates an aggressive treatment strategy. A medical and surgical combined approach is the cornerstone of therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Isolated and synergistic effects of PM10 and average temperature on cardiovascular and respiratory mortality.

PubMed

Pinheiro, Samya de Lara Lins de Araujo; Saldiva, Paulo Hilário Nascimento; Schwartz, Joel; Zanobetti, Antonella

2014-12-01

OBJECTIVE To analyze the effect of air pollution and temperature on mortality due to cardiovascular and respiratory diseases. METHODS We evaluated the isolated and synergistic effects of temperature and particulate matter with aerodynamic diameter < 10 µm (PM10) on the mortality of individuals > 40 years old due to cardiovascular disease and that of individuals > 60 years old due to respiratory diseases in Sao Paulo, SP, Southeastern Brazil, between 1998 and 2008. Three methodologies were used to evaluate the isolated association: time-series analysis using Poisson regression model, bidirectional case-crossover analysis matched by period, and case-crossover analysis matched by the confounding factor, i.e., average temperature or pollutant concentration. The graphical representation of the response surface, generated by the interaction term between these factors added to the Poisson regression model, was interpreted to evaluate the synergistic effect of the risk factors. RESULTS No differences were observed between the results of the case-crossover and time-series analyses. The percentage change in the relative risk of cardiovascular and respiratory mortality was 0.85% (0.45;1.25) and 1.60% (0.74;2.46), respectively, due to an increase of 10 μg/m3 in the PM10 concentration. The pattern of correlation of the temperature with cardiovascular mortality was U-shaped and that with respiratory mortality was J-shaped, indicating an increased relative risk at high temperatures. The values for the interaction term indicated a higher relative risk for cardiovascular and respiratory mortalities at low temperatures and high temperatures, respectively, when the pollution levels reached approximately 60 μg/m3. CONCLUSIONS The positive association standardized in the Poisson regression model for pollutant concentration is not confounded by temperature, and the effect of temperature is not confounded by the pollutant levels in the time-series analysis. The simultaneous exposure to different levels of environmental factors can create synergistic effects that are as disturbing as those caused by extreme concentrations.

Challenges associated with projecting urbanization-induced heat-related mortality.

PubMed

Hondula, David M; Georgescu, Matei; Balling, Robert C

2014-08-15

Maricopa County, Arizona, anchor to the fastest growing megapolitan area in the United States, is located in a hot desert climate where extreme temperatures are associated with elevated risk of mortality. Continued urbanization in the region will impact atmospheric temperatures and, as a result, potentially affect human health. We aimed to quantify the number of excess deaths attributable to heat in Maricopa County based on three future urbanization and adaptation scenarios and multiple exposure variables. Two scenarios (low and high growth projections) represent the maximum possible uncertainty range associated with urbanization in central Arizona, and a third represents the adaptation of high-albedo cool roof technology. Using a Poisson regression model, we related temperature to mortality using data spanning 1983-2007. Regional climate model simulations based on 2050-projected urbanization scenarios for Maricopa County generated distributions of temperature change, and from these predicted changes future excess heat-related mortality was estimated. Subject to urbanization scenario and exposure variable utilized, projections of heat-related mortality ranged from a decrease of 46 deaths per year (-95%) to an increase of 339 deaths per year (+359%). Projections based on minimum temperature showed the greatest increase for all expansion and adaptation scenarios and were substantially higher than those for daily mean temperature. Projections based on maximum temperature were largely associated with declining mortality. Low-growth and adaptation scenarios led to the smallest increase in predicted heat-related mortality based on mean temperature projections. Use of only one exposure variable to project future heat-related deaths may therefore be misrepresentative in terms of direction of change and magnitude of effects. Because urbanization-induced impacts can vary across the diurnal cycle, projections of heat-related health outcomes that do not consider place-based, time-varying urban heat island effects are neglecting essential elements for policy relevant decision-making. Copyright © 2014 Elsevier B.V. All rights reserved.

What determines tree mortality in dry environments? A multi-perspective approach.

PubMed

Dorman, Michael; Svoray, Tal; Perevolotsky, Avi; Moshe, Yitzhak; Sarris, Dimitrios

2015-06-01

Forest ecosystems function under increasing pressure due to global climate changes, while factors determining when and where mortality events will take place within the wider landscape are poorly understood. Observational studies are essential for documenting forest decline events, understanding their determinants, and developing sustainable management plans. A central obstacle towards achieving this goal is that mortality is often patchy across a range of spatial scales, and characterized by long-term temporal dynamics. Research must therefore integrate different methods, from several scientific disciplines, to capture as many relevant informative patterns as possible. We performed a landscape-scale assessment of mortality and its determinants in two representative Pinus halepensis planted forests from a dry environment (~300 mm), recently experiencing an unprecedented sequence of two severe drought periods. Three data sources were integrated to analyze the spatiotemporal variation in forest performance: (1) Normalized Difference Vegetation Index (NDVI) time-series, from 18 Landsat satellite images; (2) individual dead trees point-pattern, based on a high-resolution aerial photograph; and (3) Basal Area Increment (BAI) time-series, from dendrochronological sampling in three sites. Mortality risk was higher in older-aged sparse stands, on southern aspects, and on deeper soils. However, mortality was patchy across all spatial scales, and the locations of patches within "high-risk" areas could not be fully explained by the examined environmental factors. Moreover, the analysis of past forest performance based on NDVI and tree rings has indicated that the areas affected by each of the two recent droughts do not coincide. The association of mortality with lower tree densities did not support the notion that thinning semiarid forests will increase survival probability of the remaining trees when facing extreme drought. Unique information was obtained when merging dendrochronological and remotely sensed performance indicators, in contrast to potential bias when using a single approach. For example, dendrochronological data suggested highly resilient tree growth, since it was based only on the "surviving" portion of the population, thus failing to identify past demographic changes evident through remote sensing. We therefore suggest that evaluation of forest resilience should be based on several metrics, each suited for detecting transitions at a different level of organization.

Emergency thoracic surgery in elderly patients

PubMed Central

Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

2011-01-01

Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

International study of temperature, heat and urban mortality: the 'ISOTHURM' project.

PubMed

McMichael, Anthony J; Wilkinson, Paul; Kovats, R Sari; Pattenden, Sam; Hajat, Shakoor; Armstrong, Ben; Vajanapoom, Nitaya; Niciu, Emilia M; Mahomed, Hassan; Kingkeow, Chamnong; Kosnik, Mitja; O'Neill, Marie S; Romieu, Isabelle; Ramirez-Aguilar, Matiana; Barreto, Mauricio L; Gouveia, Nelson; Nikiforov, Bojidar

2008-10-01

This study describes heat- and cold-related mortality in 12 urban populations in low- and middle-income countries, thereby extending knowledge of how diverse populations, in non-OECD countries, respond to temperature extremes. The cities were: Delhi, Monterrey, Mexico City, Chiang Mai, Bangkok, Salvador, São Paulo, Santiago, Cape Town, Ljubljana, Bucharest and Sofia. For each city, daily mortality was examined in relation to ambient temperature using autoregressive Poisson models (2- to 5-year series) adjusted for season, relative humidity, air pollution, day of week and public holidays. Most cities showed a U-shaped temperature-mortality relationship, with clear evidence of increasing death rates at colder temperatures in all cities except Ljubljana, Salvador and Delhi and with increasing heat in all cities except Chiang Mai and Cape Town. Estimates of the temperature threshold below which cold-related mortality began to increase ranged from 15 degrees C to 29 degrees C; the threshold for heat-related deaths ranged from 16 degrees C to 31 degrees C. Heat thresholds were generally higher in cities with warmer climates, while cold thresholds were unrelated to climate. Urban populations, in diverse geographic settings, experience increases in mortality due to both high and low temperatures. The effects of heat and cold vary depending on climate and non-climate factors such as the population disease profile and age structure. Although such populations will undergo some adaptation to increasing temperatures, many are likely to have substantial vulnerability to climate change. Additional research is needed to elucidate vulnerability within populations.

[Application of a simple methodological approach to analyze health inequalities: the case of infant mortality in Chile].

PubMed

Frenz, Patricia; González, Claudia

2010-09-01

the infant mortality gradient by maternal education is a good indicator of the health impact of the social inequalities that prevail in Chile. to propose a systematic method of analysis, using simple epidemiological measures, for the comparison of differential health risks between social groups that change over time. data and statistics on births and infant deaths, obtained from the Ministry of Health, were used. Five strata of maternal schooling were defined and various measures were calculated to compare infant mortality, according to maternal education in the periods 1998-2001 and 2001-2003. of particular interest is the distinction between a measure of effect, Relative Risk (RR), which indicates the size of the gap between socioeconomic extremes and the etiological strength of low maternal schooling on infant mortality, and a measure of global impact, the Population Attributable Risk (PAR%), which takes into account the whole socioeconomic distribution and permits comparisons over time independently of the variability in the proportions of the different social strata. The comparison of these measures in the two periods studied, reveals an increase in the infant mortality gap between maternal educational extremes measured by the RR, but a stabilization in the population impact of low maternal schooling. these results can be explained by a decline in the proportion of mothers in the lowest educational level and an increase in the proportion in the highest group.

Baseline fatty acids, food groups, a diet score and 50-year all-cause mortality rates. An ecological analysis of the Seven Countries Study.

PubMed

Menotti, Alessandro; Kromhout, Daan; Puddu, Paolo Emilio; Alberti-Fidanza, Adalberta; Hollman, Peter; Kafatos, Anthony; Tolonen, Hanna; Adachi, Hisashi; Jacobs, David R

2017-12-01

This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in 16 cohorts of the Seven Countries Study. A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r= -0.51 to -0.64) ecologically inversely with the ratios M/S, (M + P)/(S + T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socio-economic status strengthened (r= -0.62 to -0.77) these associations including MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets. KEY MESSAGES We aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study. The 50-year all-cause mortality rates correlated (r = -0.51 to -0.64) ecologically inversely with the ratios M/S [monounsaturated (M) + polyunsaturated (P)]/[saturated (S) + trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socio-economic status, associations with the ratios strengthened (r = -0.62 to -0.77) including also the MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.

Defining High Risk Patients for Endovascular Aneurysm Repair: A National Analysis

PubMed Central

Egorova, Natalia; Giacovelli, Jeannine K.; Gelijns, Annetine; Mureebe, Leila; Greco, Giampaolo; Morrissey, Nicholas; Nowygrod, Roman; Moskowitz, Alan; McKinsey, James; Kent, K. Craig

2011-01-01

Background Endovascular aneurysm repair (EVAR) is commonly used as a minimally invasive technique for repairing infrarenal aortic aneurysms. There have been recent concerns that a subset of high-risk patients experience unfavorable outcomes with this intervention. To determine whether such a high-risk cohort exists and to identify the characteristics of these patients, we analyzed the outcomes of Medicare patients treated with EVAR from 2000–2006. Methods and Results We identified 66,943 patients who underwent EVAR from Inpatient Medicare database. The overall 30-day mortality was 1.6%. A risk model for perioperative mortality was developed by randomly selecting 44,630 patients; the other 1/3 of the dataset was used to validate the model. The model was deemed reliable (Hosmer-Lemeshow statistics was p=0.25 for the development, p=0.24 for the validation model) and accurate (c=0.735 and c=0.731 for the development and the validation model, respectively). In our scoring system, where scores ranged between 1 and 7, the following were identified as significant baseline factors that predict mortality: renal failure with dialysis (score=7), renal failure without dialysis (score=3), clinically significant lower extremity ischemia (score=5), patient age ≥85 (score=3), 75–84 (score=2), 70–74 (score=1), heart failure (score=3), chronic liver disease (score=3), female gender (score=2), neurological disorders (score=2), , chronic pulmonary disease (score=2), surgeon experience in EVAR<3 procedures (score=1) and hospital annual volume in EVAR <7 procedures (score=1). The majority of Medicare patients who were treated (96.6%, n=64,651) had a score of 9 or less, which correlated with a mortality < 5%. Only 3.4% of patients had a mortality ≥ 5% and 0.8% of patients (n=509) had a score of 13 or higher, which correlated with a mortality >10%. Conclusion We conclude that there is a high-risk cohort of patients that should not be treated with EVAR; however, this cohort is small. Our scoring system, which is based on patient and institutional factors, provides criteria that can be easily used by clinicians to quantify perioperative risk for EVAR candidates. PMID:19782526

Exposure of trees to drought-induced die-off is defined by a common climatic threshold across different vegetation types

PubMed Central

Mitchell, Patrick J; O'Grady, Anthony P; Hayes, Keith R; Pinkard, Elizabeth A

2014-01-01

Increases in drought and temperature stress in forest and woodland ecosystems are thought to be responsible for the rise in episodic mortality events observed globally. However, key climatic drivers common to mortality events and the impacts of future extreme droughts on tree survival have not been evaluated. Here, we characterize climatic drivers associated with documented tree die-off events across Australia using standardized climatic indices to represent the key dimensions of drought stress for a range of vegetation types. We identify a common probabilistic threshold associated with an increased risk of die-off across all the sites that we examined. We show that observed die-off events occur when water deficits and maximum temperatures are high and exist outside 98% of the observed range in drought intensity; this threshold was evident at all sites regardless of vegetation type and climate. The observed die-off events also coincided with at least one heat wave (three consecutive days above the 90th percentile for maximum temperature), emphasizing a pivotal role of heat stress in amplifying tree die-off and mortality processes. The joint drought intensity and maximum temperature distributions were modeled for each site to describe the co-occurrence of both hot and dry conditions and evaluate future shifts in climatic thresholds associated with the die-off events. Under a relatively dry and moderate warming scenario, the frequency of droughts capable of inducing significant tree die-off across Australia could increase from 1 in 24 years to 1 in 15 years by 2050, accompanied by a doubling in the occurrence of associated heat waves. By defining commonalities in drought conditions capable of inducing tree die-off, we show a strong interactive effect of water and high temperature stress and provide a consistent approach for assessing changes in the exposure of ecosystems to extreme drought events. PMID:24772285

Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.

PubMed

Popma, Jeffrey J; Adams, David H; Reardon, Michael J; Yakubov, Steven J; Kleiman, Neal S; Heimansohn, David; Hermiller, James; Hughes, G Chad; Harrison, J Kevin; Coselli, Joseph; Diez, Jose; Kafi, Ali; Schreiber, Theodore; Gleason, Thomas G; Conte, John; Buchbinder, Maurice; Deeb, G Michael; Carabello, Blasé; Serruys, Patrick W; Chenoweth, Sharla; Oh, Jae K

2014-05-20

This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery. Untreated severe aortic stenosis is a progressive disease with a poor prognosis. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy. We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG). A total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p < 0.0001). Individual 30-day and 12-month events included all-cause mortality (8.4% and 24.3%, respectively) and major stroke (2.3% and 4.3%, respectively). Procedural events at 30 days included life-threatening/disabling bleeding (12.7%), major vascular complications (8.2%), and need for permanent pacemaker placement (21.6%). The frequency of moderate or severe paravalvular aortic regurgitation was lower 12 months after self-expanding TAVR (4.2%) than at discharge (10.7%; p = 0.004 for paired analysis). TAVR with a self-expanding bioprosthesis was safe and effective in patients with symptomatic severe aortic stenosis at prohibitive risk for surgical valve replacement. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Iteroparity in the variable environment of the salamander Ambystoma tigrinum

USGS Publications Warehouse

Church, D.R.; Bailey, L.L.; Wilbur, H.M.; Kendall, W.L.; Hines, J.E.

2007-01-01

Simultaneous estimation of survival, reproduction, and movement is essential to understanding how species maximize lifetime reproduction in environments that vary across space and time. We conducted a four-year, capture–recapture study of three populations of eastern tiger salamanders (Ambystoma tigrinum tigrinum) and used multistate mark–recapture statistical methods to estimate the manner in which movement, survival, and breeding probabilities vary under different environmental conditions across years and among populations and habitats. We inferred how individuals may mitigate risks of mortality and reproductive failure by deferring breeding or by moving among populations. Movement probabilities among populations were extremely low despite high spatiotemporal variation in reproductive success and survival, suggesting possible costs to movements among breeding ponds. Breeding probabilities varied between wet and dry years and according to whether or not breeding was attempted in the previous year. Estimates of survival in the nonbreeding, forest habitat varied among populations but were consistent across time. Survival in breeding ponds was generally high in years with average or high precipitation, except for males in an especially ephemeral pond. A drought year incurred severe survival costs in all ponds to animals that attempted breeding. Female salamanders appear to defer these episodic survival costs of breeding by choosing not to breed in years when the risk of adult mortality is high. Using stochastic simulations of survival and breeding under historical climate conditions, we found that an interaction between breeding probabilities and mortality limits the probability of multiple breeding attempts differently between the sexes and among populations.

Association of Muscle Endurance, Fatigability, and Strength With Functional Limitation and Mortality in the Health Aging and Body Composition Study

PubMed Central

Patel, Kushang V.; Fried, Linda F.; Robinson-Cohen, Cassianne; de Boer, Ian H.; Harris, Tamara; Murphy, Rachel A.; Satterfield, Suzanne; Goodpaster, Bret H.; Shlipak, Michael; Newman, Anne B.; Kestenbaum, Bryan

2017-01-01

Background: Mobility limitation is highly prevalent among older adults and is central to the loss of functional independence. Dynamic isokinetic muscle fatigue testing may reveal increased vulnerability to disability and mortality beyond strength testing. Methods: We studied community-dwelling older adults enrolled in the Health Aging and Body Composition study (age range: 71–82) free of mobility disability and who underwent isokinetic muscle fatigue testing in 1999–2000 (n = 1,963). Isokinetic quadriceps work and fatigue index was determined over 30 repetitions and compared with isometric quadriceps maximum torque. Work was normalized to leg lean mass accounting for gender-specific differences (specific work). The primary outcome was incident persistent severe lower extremity limitation (PSLL), defined as two consecutive reports of either having a lot of difficulty or being unable to walk 1/4 mile or climb 10 steps without resting. The secondary outcome was all-cause mortality. Results: There were 608 (31%) occurrences of incident PSLL and 488 (25%) deaths during median follow-up of 9.3 years. After adjustment, lower isokinetic work was associated with significantly greater risks of PSLL and mortality across the full measured range. Hazard ratios per standard deviation lower specific isokinetic work were 1.22 (95% CI 1.12, 1.33) for PSLL and 1.21 (95% CI 1.13, 1.30) for mortality, respectively. Lower isometric strength was associated with PSLL, but not mortality. Fatigue index was not associated with PSLL or mortality. Conclusions: Muscle endurance, estimated by isokinetic work, is an indicator of muscle health associated with mobility limitation and mortality providing important insight beyond strength testing. PMID:27907890

Years of life lost due to influenza-attributable mortality in older adults in the Netherlands: a competing risks approach.

PubMed

McDonald, Scott A; van Wijhe, Maarten; van Asten, Liselotte; van der Hoek, Wim; Wallinga, Jacco

2018-02-06

We estimated the influenza mortality burden in adults 60 years of age and older in the Netherlands in terms of years of life lost, taking into account competing mortality risks. Weekly laboratory surveillance data for influenza and other respiratory pathogens and weekly extreme temperature served as covariates in Poisson regression models fitted to weekly age-group specific mortality data for the period 1999/2000 through 2012/13. Burden for age-groups 60-64 through 85-89 years was computed as years of life lost before age 90 (YLL90) using restricted mean lifetimes survival analysis and accounting for competing risks. Influenza-attributable mortality burden was greatest for persons aged 80-84 years, at 914 YLL90 per 100,000 persons (95% uncertainty interval:867, 963), followed by 85-89 years (787 YLL90/100,000; 95% uncertainty interval:741, 834). Ignoring competing mortality risks in the computation of influenza-attributable YLL90 would lead to substantial over-estimation of burden, from 3.5% for 60-64 years to 82% for persons aged 80-89 years at death. Failure to account for competing mortality risks has implications for accuracy of disease burden estimates, especially among persons aged 80 years and older. As the mortality burden borne by the elderly is notably high, prevention initiatives may benefit from being redesigned to more effectively prevent infection in the oldest age-groups. © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Measles vaccination improves the equity of health outcomes: evidence from Bangladesh.

PubMed

Bishai, David; Koenig, Michael; Ali Khan, Mehrab

2003-05-01

This paper asks whether measles vaccination can reduce socioeconomic differentials in under five mortality rates (U5MR) in a setting characterized by extreme poverty and high levels of childhood mortality. Longitudinal cohort study based on quasi experimental design. Data come from the phased introduction of a measles vaccine intervention in Matlab, Bangladesh in 1982. There were 16 270 Bangladeshi children aged 9-60 months. The intervention cohort received measles vaccine. Socioeconomic differentials in U5MR between the lowest and highest socioeconomic status (SES) quintiles in a cohort of 8135 vaccinated children and a cohort of unvaccinated age matched controls. Mantel-Haenszel rate ratios for the lowest to highest SES quintile were computed. SES was measured by factor analysis of maternal schooling, land holdings, dwelling size, and number of rooms. The U5MR ratio of lowest SES to highest was 2.27 (95% CI=1.62-3.19) in the unvaccinated population and 1.42 (95%CI=0.94-2.15) in the vaccinated population. The difference between unvaccinated and vaccinated U5MR ratios was statistically significant (p<0.10) and robust across alternative measures of SES. Children from the poorest quintile were more than twice as likely to die as those from the least quintile in the absence of measles vaccination. Universal distribution of measles vaccination largely nullified SES related mortality differentials within a high mortality population of children. Copyright 2002 John Wiley & Sons, Ltd.

Understanding the Motivational Consequences of Extreme School Violence through the Lens of Mortality Salience: The Case of Academic Self-Stereotyping in Math

ERIC Educational Resources Information Center

Gray, DeLeon L.; Wichman, Aaron L.

2012-01-01

We conducted an investigation into a determinant of academic motivation that has implications for how we respond to school violence and tragedy. We conducted two studies to examine whether exposure to messages related to the salience of one's own mortality cause people to align their own academic beliefs more closely with stereotypical beliefs…

Assessment of geraniol-incorporated polymers to control Aedes albopictus (Diptera: culicidae)

PubMed Central

Chuaycharoensuk, T.; Manguin, S.; Duvallet, G.; Chareonviriyaphap, T.

2012-01-01

Effective control of mosquito borne diseases has proven extremely difficult with both vector and pathogen remaining entrenched and expanding in many disease endemic areas. When lacking an effective vaccine, vector control methods targeting both larval habitats and adult mosquito populations remain the primary strategy for reducing risk. Aedes albopictus from Thailand was used as a reference baseline for evaluation of natural insecticides incorporated in polymer disks and pellets and tested both in laboratory and field conditions. In laboratory and field tests, the highest larval mortality was obtained with disks or pellets containing IKHC (Insect Killer Highly Concentrate) from Fulltec AG Company. This product is reputed to contain geraniol as an active ingredient. With pellets, high mortality of Ae. albopictus larvae (92%) was observed in presence of 1 g of pellets per 500 ml of water at day 1st, and the mortality was 100% at day 1st for larvae in presence of 5 or 10 g of pellets. Fulltec AG Company has not accepted to give us the exact composition of their IKHC product. Therefore, we cannot recommend it, but the principle of using monoterpenes like geraniol, incorporated into polymer disks or pellets as natural larvicide needs more attention as it could be considered as a powerful alternative in mosquito vector control. PMID:22910616

Sick Day Management in Children and Adolescents with Type 1 Diabetes.

PubMed

Choudhary, Abha

2016-06-01

Diabetic Ketoacidosis (DKA) has high morbidity and mortality and can be prevented. It is extremely important to give clear guidance to patients and families on how to manage diabetes during intercurrent illnesses to avoid complications of ketoacidosis, dehydration,uncontrolled or symptomatic hyperglycemia and hypoglycemia. This descriptive review of clinical cases and management guidelines for sick days in children and adolescents with diabetes is provided as a resource for physicians who may take calls from parents of sick children with diabetes or manage these children in a clinic, emergency room or hospital setting.

Evaluation of a mark-recapture method for estimating mortality and migration rates of stratified populations

USGS Publications Warehouse

Dorazio, R.M.; Rago, P.J.

1991-01-01

We simulated mark–recapture experiments to evaluate a method for estimating fishing mortality and migration rates of populations stratified at release and recovery. When fish released in two or more strata were recovered from different recapture strata in nearly the same proportions, conditional recapture probabilities were estimated outside the [0, 1] interval. The maximum likelihood estimates tended to be biased and imprecise when the patterns of recaptures produced extremely "flat" likelihood surfaces. Absence of bias was not guaranteed, however, in experiments where recapture rates could be estimated within the [0, 1] interval. Inadequate numbers of tag releases and recoveries also produced biased estimates, although the bias was easily detected by the high sampling variability of the estimates. A stratified tag–recapture experiment with sockeye salmon (Oncorhynchus nerka) was used to demonstrate procedures for analyzing data that produce biased estimates of recapture probabilities. An estimator was derived to examine the sensitivity of recapture rate estimates to assumed differences in natural and tagging mortality, tag loss, and incomplete reporting of tag recoveries.

[Advances in medical care for extremely low birth weight infants worldwide].

PubMed

Chen, Chun; Zhang, Qian-Shen

2013-08-01

Dramatic advances in neonatal medicine over recent decades have resulted in decreased mortality and morbidity rates for extremely low birth weight infants. However, the survival of these infants is associated with short- and long-term morbidity, including severe intraventricular hemorrhage, periventricular leukomalacia, nosocomial infection and necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and adverse long-term neurodevelopmental sequelae. This article reviewed the latest advances in the medical care for extremely low birth weight infants including survival rate, ethical issues and short- and long-term morbidity, domestically and abroad.

[Changes in the outcome for infants, with birth weight under 500 grams, at our department (First Department of Obstetrics and Gynecology, Semmelweis University, Budapest)].

PubMed

Varga, Péter; Jeager, Judit; Harmath, Ágnes; Berecz, Botond; Kollár, Tímea; Pete, Barbara; Magyar, Zsófia; Rigó, János; Romicsné Görbe, Éva

2015-03-08

The mortality and morbidity of extremely low birth weight infants (birth weight below 1000 grams) are different from low birth weight and term infants. The Centers for Disease Control statistics from the year 2009 shows that the mortality of preterm infants with a birth weight less than 500 grams is 83.4% in the United States. In many cases, serious complications can be expected in survivals. The aim of this retrospective study was to find prognostic factors which may improve the survival of the group of extremely low birth weight infants (<500 grams). Data of extremely low birth weight infants with less than 500 grams born at the 1st Department of Obstetrics and Gynecology, Semmelweis University between January 1, 2006 and June 1, 2012 were analysed, and mortality and morbidity of infants between January 1, 2006 and December 31, 2008 (period I) were compared those found between January 1, 2009 and June 1, 2012 (period II). Statistical analysis was performed with probe-t, -F and -Chi-square. Survival rate of extremely low birth weight infants less than 500 grams in period 1 and II was 26.31% and 55.17%, respectively (p = 0.048), whereas the prevalence of complications were not significantly different between the period examined. The mean gestational age of survived infants (25.57 weeks) was higher than the gestational age of infants who did not survive (24.18 weeks) and the difference was statistically significant (p = 0.0045). Education of the team of the Neonatal Intensive Care Unit, professional routine and technical conditions may improve the survival chance of preterm infants. The use of treatment protocols, conditions of the Neonatal Intensive Care Unit and steroid prophylaxis may improve the survival rate of extremely low birth weight infants.

Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis.

PubMed

Wang, Li; Zhang, Chuanlin; Mu, Shaoyu; Yeh, Chao Hsing; Chen, Liqun; Zhang, Zeju; Wang, Xueqin

2017-09-01

Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT. Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02-0.04), 0.07 (95% CI: 0.05-0.08), and 0.09 (95% CI: 0.08-0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00-0.01) and 0.07 for mortality (95% CI: 0.03-0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94-6.47) and PE (OR = 1.57; 95% CI: 1.37-1.79). Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

CHILDREN HOSPITALIZED WITH LOWER EXTREMITY FRACTURES IN THE UNITED STATES IN 2006: A POPULATION-BASED APPROACH

PubMed Central

Gao, Yubo

2011-01-01

OBJECTIVE The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. METHODS Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under “Injury and Poisoning (800-999).” Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. RESULTS There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. CONCLUSIONS This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals. PMID:22096438

Children hospitalized with lower extremity fractures in the United States in 2006: a population-based approach.

PubMed

Gao, Yubo

2011-01-01

The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under "Injury and Poisoning (800-999)." Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals.

In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

PubMed

Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

2016-02-15

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Updated Global Patterns of Drought and Heat-Induced Forest Die-off, and Ecohydrological Feedbacks

NASA Astrophysics Data System (ADS)

Allen, C. D.

2011-12-01

Ongoing climate changes - particularly increases in mean temperatures as well as frequencies, durations, and severities of extreme drought and heat - can amplify tree physiological stress and thereby drive increases in both background tree mortality rates and episodes of rapid, broad-scale forest die-off. Updates are presented to a recent global synthesis of documented tree mortality episodes attributed to drought and/or heat, further expanding the documented spatial distribution and demonstrating the vulnerability of all major forest types from tropical moist forests and savannas to temperate and boreal forests. Given that anthropogenic climate change is projected to drive substantial increases in both mean temperatures and the frequency/duration/severity of extreme drought and heat in many regions, recent episodes of broad-scale drought-induced forest mortality may reflect increasing global risks of forest die-off, even in environments not normally considered water-limited. Since vegetation cover patterns are closely and interactively linked with ecosystem water fluxes, episodes of massive forest die-off can be expected to significantly affect ecohydrological patterns and processes, ranging from runoff and erosion to evaporation and transpiration, often with nonlinear threshold responses expected. Diverse examples of such feedbacks between climate-induced forest mortality and ecohydrology are presented, ranging from detailed observations of linked changes in vegetation, runoff, and erosion in response to forest mortality in the southwestern US to Western Australia and Amazonian rainforest water cycling. Current research efforts to address the large knowledge gaps that at present hinder our ability to predict climate-induced forest mortality and associated ecohydrological responses are discussed.

Does earlier arrival of the retrieval team improve short-term outcomes in outborn extremely premature infants?

PubMed

Sharpe, Janet B; Davies, Mark W

2018-05-31

The risk of mortality and morbidity is increased in outborn, extremely premature infants. We aim to determine whether earlier arrival of the retrieval team after the birth of infants less than 29 weeks gestation improves short-term mortality and morbidity. This is a retrospective analysis of a cohort of infants less than 29 weeks gestation who were retrieved to the Royal Brisbane and Women's Hospital (RBWH) over a 5-year period. Demographic information regarding the infant and mother, retrieval team arrival time and outcome data was collected. Primary outcomes investigated were mortality prior to discharge from hospital or a composite of mortality or severe intraventricular haemorrhage (IVH). Data on 105 infants were analysed; 88 infants (83.8%) survived to discharge home, and 79 (75.2%) survived to discharge without severe IVH. On univariate analysis, there was no significant association between age at arrival of the retrieval team and death prior to discharge (P = 0.94) or death prior to discharge or severe IVH (P = 0.83). On logistic regression analysis, age at arrival of retrieval team remained non-significant for a reduction in death prior to discharge and composite of death or severe IVH (P = 0.70 and P = 0.99, respectively). The earlier arrival of the retrieval team is not associated with improved short-term outcomes in outborn, extremely preterm infants who are retrieved and admitted to a tertiary neonatal intensive care unit - for infants where the retrieval team arrived within about 8 h of birth. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center.

PubMed

Lee, Ching-Yu; Li, Yen-Yao; Huang, Tsan-Wen; Huang, Tsung-Yu; Hsu, Wei-Hsiu; Tsai, Yao-Hung; Huang, Jou-Chen; Huang, Kuo-Chin

2016-12-01

No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

Risking Your Life without a Second Thought: Intuitive Decision-Making and Extreme Altruism

PubMed Central

Rand, David G.; Epstein, Ziv G.

2014-01-01

When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes. PMID:25333876

Risking your life without a second thought: intuitive decision-making and extreme altruism.

PubMed

Rand, David G; Epstein, Ziv G

2014-01-01

When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes.

Bayes to the Rescue: Continuous Positive Airway Pressure Has Less Mortality Than High-Flow Oxygen.

PubMed

Modesto I Alapont, Vicent; Khemani, Robinder G; Medina, Alberto; Del Villar Guerra, Pablo; Molina Cambra, Alfred

2017-02-01

The merits of high-flow nasal cannula oxygen versus bubble continuous positive airway pressure are debated in children with pneumonia, with suggestions that randomized controlled trials are needed. In light of a previous randomized controlled trial showing a trend for lower mortality with bubble continuous positive airway pressure, we sought to determine the probability that a new randomized controlled trial would find high-flow nasal cannula oxygen superior to bubble continuous positive airway pressure through a "robust" Bayesian analysis. Sample data were extracted from the trial by Chisti et al, and requisite to "robust" Bayesian analysis, we specified three prior distributions to represent clinically meaningful assumptions. These priors (reference, pessimistic, and optimistic) were used to generate three scenarios to represent the range of possible hypotheses. 1) "Reference": we believe bubble continuous positive airway pressure and high-flow nasal cannula oxygen are equally effective with the same uninformative reference priors; 2) "Sceptic on high-flow nasal cannula oxygen": we believe that bubble continuous positive airway pressure is better than high-flow nasal cannula oxygen (bubble continuous positive airway pressure has an optimistic prior and high-flow nasal cannula oxygen has a pessimistic prior); and 3) "Enthusiastic on high-flow nasal cannula oxygen": we believe that high-flow nasal cannula oxygen is better than bubble continuous positive airway pressure (high-flow nasal cannula oxygen has an optimistic prior and bubble continuous positive airway pressure has a pessimistic prior). Finally, posterior empiric Bayesian distributions were obtained through 100,000 Markov Chain Monte Carlo simulations. In all three scenarios, there was a high probability for more death from high-flow nasal cannula oxygen compared with bubble continuous positive airway pressure (reference, 0.98; sceptic on high-flow nasal cannula oxygen, 0.982; enthusiastic on high-flow nasal cannula oxygen, 0.742). The posterior 95% credible interval on the difference in mortality identified a future randomized controlled trial would be extremely unlikely to find a mortality benefit for high-flow nasal cannula oxygen over bubble continuous positive airway pressure, regardless of the scenario. Interpreting these findings using the "range of practical equivalence" framework would recommend rejecting the hypothesis that high-flow nasal cannula oxygen is superior to bubble continuous positive airway pressure for these children. For children younger than 5 years with pneumonia, high-flow nasal cannula oxygen has higher mortality than bubble continuous positive airway pressure. A future randomized controlled trial in this population is unlikely to find high-flow nasal cannula oxygen superior to bubble continuous positive airway pressure.

Perspectives on Extremes as a Climate Scientist and Farmer

NASA Astrophysics Data System (ADS)

Grotjahn, R.

2016-12-01

The speaker is both a climate scientist whose research emphasizes climate extremes and a small farmer in the most agriculturally productive region in the world. He will share some perspectives about the future of extremes over the United States as they relate to farming. General information will be drawn from the National Climate Assessment (NCA) published in 2014. Different weather-related quantities are useful for different commodities. While plant and animal production are time-integrative, extreme events can cause lasting harm long after the event is over. Animal production, including dairy, is sensitive to combinations of high heat and humidity; lasting impacts include suspended milk production, aborted fetuses, and increased mortality. The rice crop can be devastated by the wrong combination of wind and humidity just before harvest time. Extremes at the bud break, flowering, and nascent fruit stage and greatly reduce the fruit production for the year in tree crops. Saturated soils from heavy rainfall cause major losses to some crops (for example, by fostering pathogen growth), harm water delivery systems, and disrupt timing of field activities (primarily harvest).After an overview of some general issues relating to Agriculture, some extreme weather impacts on specific commodities (primarily dairy and specialty crops, some grains) will be highlighted including quantities relevant to agriculture. Example extreme events economic impacts will be summarized. If there is interest, issues related to water availability and management will be described. Projected extreme event changes over the US will be discussed. Some conclusions will be drawn about: future impacts and possible changes to farming (some are already occurring). Perspectives will be given on including the diverse range of quantities useful to agriculture when developing climate models. As time permits, some personal experiences with climate change and discussing it with fellow farmers will be shared.

Predicting Chronic Climate-Driven Disturbances and Their Mitigation

DOE Office of Scientific and Technical Information (OSTI.GOV)

McDowell, Nate G.; Michaletz, Sean T.; Bennett, Katrina E.

Society increasingly demands the stable provision of ecosystem resources to support our population. Resource risks from climate-driven disturbances--including drought, heat, insect outbreaks, and wildfire--are rising as a chronic state of disequilibrium results from increasing temperatures and a greater frequency of extreme events. This confluence of increased demand and risk may soon reach critical thresholds. We explain here why extreme chronic disequilibrium of ecosystem function is likely to increase dramatically across the globe, creating no-analog conditions that challenge adaptation. We also present novel mechanistic theory that combines models for disturbance mortality and metabolic scaling to link size-dependent plant mortality to changesmore » in ecosystem stocks and fluxes. Efforts must anticipate and model chronic ecosystem disequilibrium to properly prepare for resilience planning.« less

Predicting Chronic Climate-Driven Disturbances and Their Mitigation

DOE Office of Scientific and Technical Information (OSTI.GOV)

McDowell, Nate G.; Michaletz, Sean T.; Bennett, Katrina E.

Society increasingly demands the stable provision of ecosystem resources to support our population. Resource risks from climate-driven disturbances, including drought, heat, insect outbreaks, and wildfire, are growing as a chronic state of disequilibrium results from increasing temperatures and a greater frequency of extreme events. This confluence of increased demand and risk may soon reach critical thresholds. Here, we explain here why extreme chronic disequilibrium of ecosystem function is likely to increase dramatically across the globe, creating no-analog conditions that challenge adaptation. We also present novel mechanistic theory that combines models for disturbance mortality and metabolic scaling to link size-dependent plantmore » mortality to changes in ecosystem stocks and fluxes. Our efforts must anticipate and model chronic ecosystem disequilibrium to properly prepare for resilience planning.« less

Predicting Chronic Climate-Driven Disturbances and Their Mitigation

DOE PAGES

McDowell, Nate G.; Michaletz, Sean T.; Bennett, Katrina E.; ...

2017-11-13

Society increasingly demands the stable provision of ecosystem resources to support our population. Resource risks from climate-driven disturbances, including drought, heat, insect outbreaks, and wildfire, are growing as a chronic state of disequilibrium results from increasing temperatures and a greater frequency of extreme events. This confluence of increased demand and risk may soon reach critical thresholds. Here, we explain here why extreme chronic disequilibrium of ecosystem function is likely to increase dramatically across the globe, creating no-analog conditions that challenge adaptation. We also present novel mechanistic theory that combines models for disturbance mortality and metabolic scaling to link size-dependent plantmore » mortality to changes in ecosystem stocks and fluxes. Our efforts must anticipate and model chronic ecosystem disequilibrium to properly prepare for resilience planning.« less

Mortality and potential years of life lost by road traffic injuries in Brazil, 2013

PubMed Central

Andrade, Silvânia Suely Caribé de Araújo; de Mello-Jorge, Maria Helena Prado

2016-01-01

ABSTRACT OBJECTIVE To estimate the potential years of life lost by road traffic injuries three years after the beginning of the Decade of Action for Traffic Safety. METHODS We analyzed the data of the Sistema de Informações sobre Mortalidade (SIM – Mortality Information System) related to road traffic injuries, in 2013. We estimated the crude and standardized mortality rates for Brazil and geographic regions. We calculated, for the Country, the proportional mortality according to age groups, education level, race/skin color, and type or quality of the victim while user of the public highway. We estimated the potential years of life lost according to sex. RESULTS The mortality rate in 2013 was of 21.0 deaths per 100,000 inhabitants for the Country. The Midwest region presented the highest rate (29.9 deaths per 100,000 inhabitants). Most of the deaths by road traffic injuries took place with males (34.9 deaths per 100,000 males). More than half of the people who have died because of road traffic injuries were of black race/skin color, young adults (24.2%), individuals with low schooling (24.0%), and motorcyclists (28.5%). The mortality rate in the triennium 2011-2013 decreased 4.1%, but increased among motorcyclists. Across the Country, more than a million of potential years of life were lost, in 2013, because of road traffic injuries, especially in the age group of 20 to 29 years. CONCLUSIONS The impact of the high mortality rate is of over a million of potential years of life lost by road traffic injuries, especially among adults in productive age (early mortality), in only one year, representing extreme social cost arising from a cause of death that could be prevented. Despite the reduction of mortality by road traffic injuries from 2011 to 2013, the mortality rates increased among motorcyclists. PMID:27706375

Racial Differences in Estimated GFR Decline, ESRD, and Mortality in an Integrated Health System

PubMed Central

Derose, Stephen F.; Rutkowski, Mark P.; Crooks, Peter W.; Shi, Jiaxiao M.; Wang, Jean; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.; Levin, Nathan W.; Jacobsen, Steven J.

2013-01-01

Background Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in ESRD incidence. We used observed eGFR to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design Retrospective cohort. Setting & Participants Adult members of Kaiser Permanente Southern California from 2003–2009 with >2 serum creatinine tests and >180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor Race/ethnicity. Outcomes ESRD (dialysis, transplantation); mortality. Measurements eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73m2 at specified times. Racial differences in projected kidney failure and mortality among those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results Blacks had more extreme rates of eGFR decline (1st percentile, −23.6 mL/min/1.73m2 per year), followed by Hispanics (−20.9 mL/min/1.73m2 per year), whites (−20.1 mL/min/1.73m2 per year), and Asians (−17.6 mL/min/1.73m2 per year; P<0.001). There were 25,065 white, 11,368 Hispanic, 6,785 black, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure vs. whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46–1.62) in blacks, 1.49 (95% CI, 1.42–1.56) in Hispanics, and 1.41 (95% CI, 1.32–1.51) in Asians. Among those with projected kidney failure, the HRs of death vs. whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77–0.88) in blacks, 0.67 (95% CI, 0.63–0.72) in Hispanics, and 0.58 (95% CI, 0.52–0.65) in Asians. Limitations Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality among those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence. PMID:23499049

Social, economic, and political factors in progress towards improving child survival in developing nations.

PubMed

Lykens, Kristine; Singh, Karan P; Ndukwe, Elewichi; Bae, Sejong

2009-01-01

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Partitioning loss rates of early juvenile blue crabs from seagrass habitats into mortality and emigration

USGS Publications Warehouse

Etherington, L.L.; Eggleston, D.B.; Stockhausen, W.T.

2003-01-01

Determining how post-settlement processes modify patterns of settlement is vital in understanding the spatial and temporal patterns of recruitment variability of species with open populations. Generally, either single components of post-settlement loss (mortality or emigration) are examined at a time, or else the total loss is examined without discrimination of mortality and emigration components. The role of mortality in the loss of early juvenile blue crabs, Callinectes sapidus, has been addressed in a few studies; however, the relative contribution of emigration has received little attention. We conducted mark-recapture experiments to examine the relative contribution of mortality and emigration to total loss rates of early juvenile blue crabs from seagrass habitats. Loss was partitioned into emigration and mortality components using a modified version of Jackson's (1939) square-within-a-square method. The field experiments assessed the effects of two size classes of early instars (J1-J2, J3-J5), two densities of juveniles (low: 16 m-2, high: 64 m-2), and time of day (day, night) on loss rates. In general, total loss rates of experimental juveniles and colonization rates by unmarked juveniles were extremely high (range = 10-57 crabs m-2/6 h and 17-51 crabs m-2/6 h, for loss and colonization, respectively). Total loss rates were higher at night than during the day, suggesting that juveniles (or potentially their predators) exhibit increased nocturnal activity. While colonization rates did not differ by time of day, J3-J5 juveniles demonstrated higher rates of colonization than J1-J2 crabs. Overall, there was high variability in both mortality and emigration, particularly for emigration. Average probabilities of mortality across all treatment combinations ranged from 0.25-0.67/6 h, while probabilities of emigration ranged from 0.29-0.72/6 h. Although mean mortality rates were greater than emigration rates in most treatments, the proportion of experimental trials in which crab loss from seagrass due to mortality was greater than losses due to emigration was not significantly different from 50%. Thus, mortality and emigration appear to contribute equally to juvenile loss in seagrass habitats. The difference in magnitude (absolute amount of loss) between mean emigration and mean mortality varied between size classes, such that differences between emigration and mortality were relatively small for J1-J2 crabs, but much larger for J3-J5 crabs. Further, mortality rates were density-dependent for J3-J5 juvenile stages but not for J1-J2 crabs, whereas emigration was inversely density-dependent among J3-J5 stages but not for J1-J2 instars. The co-dependency of mortality and emigration suggests that the loss term (emigration or mortality) which has the relatively stronger contribution to total loss may dictate the patterns of loss under different conditions. For older juveniles (J3-J5), emigration may only have a large impact on juvenile loss where densities are low, since the contribution of mortality appears to be much greater than emigration at high densities. The size-specific pattern of density-dependent mortality supports the notion of an ontogenetic habitat shift by early juvenile blue crabs from seagrass to unvegetated habitats, since larger individuals may experience increased mortality at high densities within seagrass beds. Qualitative comparisons between this study and a concurrent study of planktonic emigration of J1-J5 blue crabs (Blackmon and Eggleston, 2001) suggests that benthic emigration among J1-J2 blue crabs was greater than planktonic emigration; for J3-J5 stages benthic and planktonic emigration were nearly equal. This study demonstrates the potentially large role of emigration in recruitment processes and patterns of early juvenile blue crabs, and illustrates how juvenile size, juvenile density, and time of day can affect mortality and emigration rates as well as total loss and colonization. The components of po

Modeling extreme drought impacts on terrestrial ecosystems when thresholds are exceeded

NASA Astrophysics Data System (ADS)

Holm, J. A.; Rammig, A.; Smith, B.; Medvigy, D.; Lichstein, J. W.; Dukes, J. S.; Allen, C. D.; Beier, C.; Larsen, K. S.; Ficken, C. D.; Pockman, W.; Anderegg, W.; Luo, Y.

2016-12-01

Recent IPCC Assessment Reports suggest that with predicted climate changes future precipitation- and heat-related extreme events are becoming stronger and more frequent with potential for prolonged droughts. To prepare for these changes and their impacts, we need to develop a better understanding of terrestrial ecosystem responses to extreme drought events. In particular, we focus here on large-extent and long-lasting extreme drought events with noticeable impacts on the functioning of forested ecosystems. While most of ecosystem manipulative experiments have been motivated by ongoing and predicted climate change, the majority only applied relatively moderate droughts, not addressing the "very" extreme tail of these scenarios, i.e. "extreme extremes (EEs)". We explore the response of forest ecosystems to EEs using two demographic-based dynamic global vegetation models (DGVMs) (i.e. ED2, LPJ-GUESS) in which the abundances of different plant functional types, as well as tree size- and age-class structure, are emergent properties of resource competition. We evaluate the model's capabilities to represent extreme drought scenarios (i.e., 50% and 90% reduction in precipitation for 1-year, 2-year, and 4-year drought scenarios) at two dry forested sites: Palo Verde, Costa Rica (i.e. tropical) and EucFACE, Australia (i.e. temperate). Through the DGVM modeling outcomes we determine the following five testable hypotheses for future experiments: 1) EEs cannot be extrapolated from mild extremes due to plant plasticity and functional composition. 2) Response to EEs depends on functional diversity, trait combinations, and phenology, such that both models predicted even after 100 years plant biomass did not recover. 3) Mortality from drought reduces the pressure on resources and prevents further damage by subsequent years of drought. 4) Early successional stands are more vulnerable to extreme droughts while older stand are more resilient. 5) Elevated atmospheric CO2 alleviates impacts of extreme droughts while increased temperature exacerbates mortality. This study highlighted a number of questions about our current understanding of EEs and their corresponding thresholds and tipping points, and provides an analysis of confidence in model representation and accuracy of processes related to EEs.

Extreme longevity in a deep-sea vestimentiferan tubeworm and its implications for the evolution of life history strategies

NASA Astrophysics Data System (ADS)

Durkin, Alanna; Fisher, Charles R.; Cordes, Erik E.

2017-08-01

The deep sea is home to many species that have longer life spans than their shallow-water counterparts. This trend is primarily related to the decline in metabolic rates with temperature as depth increases. However, at bathyal depths, the cold-seep vestimentiferan tubeworm species Lamellibrachia luymesi and Seepiophila jonesi reach extremely old ages beyond what is predicted by the simple scaling of life span with body size and temperature. Here, we use individual-based models based on in situ growth rates to show that another species of cold-seep tubeworm found in the Gulf of Mexico, Escarpia laminata, also has an extraordinarily long life span, regularly achieving ages of 100-200 years with some individuals older than 300 years. The distribution of results from individual simulations as well as whole population simulations involving mortality and recruitment rates support these age estimates. The low 0.67% mortality rate measurements from collected populations of E. laminata are similar to mortality rates in L. luymesi and S. jonesi and play a role in evolution of the long life span of cold-seep tubeworms. These results support longevity theory, which states that in the absence of extrinsic mortality threats, natural selection will select for individuals that senesce slower and reproduce continually into their old age.

Physical independence and mortality at the extreme limit of life span: supercentenarians study in Japan.

PubMed

Arai, Yasumichi; Inagaki, Hiroki; Takayama, Michiyo; Abe, Yukiko; Saito, Yasuhiko; Takebayashi, Toru; Gondo, Yasuyuki; Hirose, Nobuyoshi

2014-04-01

Prevention of disability is a major challenge in aging populations; however, the extent to which physical independence can be maintained toward the limit of human life span remains to be determined. We examined the health and functional status of 642 centenarians: 207 younger centenarians (age: 100-104 years), 351 semi-supercentenarians (age: 105-109 years), and 84 supercentenarians (age: >110 years). All-cause mortality was followed by means of an annual telephone or mailed survey. Age-specific disability patterns revealed that the older the age group, the higher the proportion of those manifesting independence in activities of daily living at any given age of entry. Multiple logistic regression analysis identified male gender and better cognitive function as consistent determinants of physical independence across all age categories. In a longitudinal analysis, better physical function was significantly associated with survival advantage until the age of 110. However, mortality beyond that age was predicted neither by functional status nor biomedical measurements, indicating alternative trajectories of mortality at the highest ages. These findings suggest that maintaining physical independence is a key feature of survival into extreme old age. Future studies illuminating genetic and environmental underpinnings of supercentenarians' phenotypes will provide invaluable opportunities not only to improve preventive strategies but also to test the central hypotheses of human aging.

Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products.

PubMed

Abrams, Steven A; Schanler, Richard J; Lee, Martin L; Rechtman, David J

2014-01-01

Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. EP infants <1,250 g birth weight received a diet consisting of either human milk fortified with a human milk protein-based fortifier (HM) (n=167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n=93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN). Mortality (2% versus 8%, p=0.004) and NEC (5% versus 17%, p=0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 17.9% (p<0.001). Growth rates were similar between groups. The duration of PN was 8 days less in the subgroup of infants receiving a diet containing <10% CM versus ≥10% CM (p<0.02). An exclusive human milk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.

Usefulness of the plasma glucose concentration-to-HbA1c ratio in predicting clinical outcomes during acute illness with extreme hyperglycaemia.

PubMed

Su, Y-W; Hsu, C-Y; Guo, Y-W; Chen, H-S

2017-02-01

To evaluate the correlation between the plasma glucose-to-glycated haemoglobin ratio (GAR) and clinical outcome during acute illness. This retrospective observational cohort study enrolled 661 patients who visited the emergency department of our hospital between 1 July 2008 and 30 September 2010 with plasma glucose concentrations>500mg/dL. Systolic blood pressure, heart rate, white blood cells, neutrophils, haematocrit, blood urea nitrogen, serum creatinine, liver function and plasma glucose concentration were recorded at the initial presentation to the emergency department. Data on glycated haemoglobin over the preceding 6 months were reviewed from our hospital database. The glucose-to-HbA 1c ratio (GAR) was calculated as the plasma glucose concentration divided by glycated haemoglobin. The GAR of those who died was significantly higher than that of the survivors (81.0±25.9 vs 67.6±25.0; P<0.001). There was a trend towards a higher 90-day mortality rate in patients with higher GARs (log-rank test P<0.0001 for trend). On multivariate Cox regression analysis, the GAR was significantly related to 90-day mortality (hazard ratio [HR] for 1 standard deviation [SD] change: 1.41, 95% confidence interval [CI]: 1.22-1.63; P<0.001), but not to plasma glucose (HR: 0.89, 95% CI: 0.70-1.13; P=0.328). Rates of intensive care unit (ICU) admission and mechanical ventilator use were also higher in those with higher GARs. GAR independently predicted 90-day mortality, ICU admission and use of mechanical ventilation. It was also a better predictor of patient outcomes than plasma glucose alone in patients with extremely high glucose levels. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

On underestimation of global vulnerability to tree mortality and forest die-off from hotter drought in the Anthropocene

USGS Publications Warehouse

Allen, Craig D.; Breshears, David D.; McDowell, Nathan G.

2015-01-01

Patterns, mechanisms, projections, and consequences of tree mortality and associated broad-scale forest die-off due to drought accompanied by warmer temperatures—“hotter drought”, an emerging characteristic of the Anthropocene—are the focus of rapidly expanding literature. Despite recent observational, experimental, and modeling studies suggesting increased vulnerability of trees to hotter drought and associated pests and pathogens, substantial debate remains among research, management and policy-making communities regarding future tree mortality risks. We summarize key mortality-relevant findings, differentiating between those implying lesser versus greater levels of vulnerability. Evidence suggesting lesser vulnerability includes forest benefits of elevated [CO2] and increased water-use efficiency; observed and modeled increases in forest growth and canopy greening; widespread increases in woody-plant biomass, density, and extent; compensatory physiological, morphological, and genetic mechanisms; dampening ecological feedbacks; and potential mitigation by forest management. In contrast, recent studies document more rapid mortality under hotter drought due to negative tree physiological responses and accelerated biotic attacks. Additional evidence suggesting greater vulnerability includes rising background mortality rates; projected increases in drought frequency, intensity, and duration; limitations of vegetation models such as inadequately represented mortality processes; warming feedbacks from die-off; and wildfire synergies. Grouping these findings we identify ten contrasting perspectives that shape the vulnerability debate but have not been discussed collectively. We also present a set of global vulnerability drivers that are known with high confidence: (1) droughts eventually occur everywhere; (2) warming produces hotter droughts; (3) atmospheric moisture demand increases nonlinearly with temperature during drought; (4) mortality can occur faster in hotter drought, consistent with fundamental physiology; (5) shorter droughts occur more frequently than longer droughts and can become lethal under warming, increasing the frequency of lethal drought nonlinearly; and (6) mortality happens rapidly relative to growth intervals needed for forest recovery. These high-confidence drivers, in concert with research supporting greater vulnerability perspectives, support an overall viewpoint of greater forest vulnerability globally. We surmise that mortality vulnerability is being discounted in part due to difficulties in predicting threshold responses to extreme climate events. Given the profound ecological and societal implications of underestimating global vulnerability to hotter drought, we highlight urgent challenges for research, management, and policy-making communities.

Mortality salience and morality: thinking about death makes people less utilitarian.

PubMed

Trémolière, Bastien; Neys, Wim De; Bonnefon, Jean-François

2012-09-01

According to the dual-process model of moral judgment, utilitarian responses to moral conflict draw on limited cognitive resources. Terror Management Theory, in parallel, postulates that mortality salience mobilizes these resources to suppress thoughts of death out of focal attention. Consequently, we predicted that individuals under mortality salience would be less likely to give utilitarian responses to moral conflicts. Two experiments corroborated this hypothesis. Experiment 1 showed that utilitarian responses to non-lethal harm conflicts were less frequent when participants were reminded of their mortality. Experiment 2 showed that the detrimental effect of mortality salience on utilitarian conflict judgments was comparable to that of an extreme concurrent cognitive load. These findings raise the question of whether private judgment and public debate about controversial moral issues might be shaped by mortality salience effects, since these issues (e.g., assisted suicide) often involve matters of life and death. Copyright © 2012 Elsevier B.V. All rights reserved.

Persistent pulmonary hypertension of the newborn.

PubMed

Nair, P M C; Bataclan, Maria Flordeliz A

2004-06-01

This article attempts to define a complicated, yet not rare disease of the neonate, which presents with extreme hypoxemia due to increased pulmonary vascular resistance, resulting in diversion of the pulmonary venous blood through persistent fetal channels, namely ductus arteriosus and foramen ovale. Pathophysiology, diagnostic approach and the various modalities of management are analyzed. Persistent pulmonary hypertension of the newborn is multi-factorial, which is reflected in the management as well. These babies are extremely labile to hypoxia and should be stabilized with minimum handling. One hundred percent oxygen and ventilation are the mainstay of treatment. The role of hyperventilation, alkalinization, various non-specific vasodilators such as tolazoline, magnesium sulphate, selective vasodilators such as inhaled nitric oxide, adenosine and the role of high frequency oscillatory ventilation and extra corporeal membrane oxygenation are discussed. With the newer modalities of management, the outlook has improved with mortality of less than 20% and fewer long-term deficits.

Poultry management: a useful tool for the control of necrotic enteritis in poultry.

PubMed

Tsiouris, Vasilios

2016-06-01

The intestinal ecosystem of poultry has been inevitably changed as a result of the ban of antimicrobial growth promoters. The re-emergence of necrotic enteritis has been the most significant threat for the poultry industry, which, in clinical form, causes high mortality and in subclinical forms, affects growth and feed conversion. It is one of the most common and economically devastating bacterial diseases in modern broiler flocks in terms of performance, welfare and mortality. Necrotic enteritis is a multi-factorial disease process, in which a number of co-factors are usually required to precipitate an outbreak of the disease. Although, Clostridium perfringens has been identified as the aetiological agent of the disease, the predisposing factors that lead to over-proliferation of C. perfringens and the subsequent progression to disease are poorly understood. Any factor that causes stress in broiler chicks could suppress the immune system and disturb the balance of the intestinal ecosystem, in such a way that the risk of a necrotic enteritis (NE) outbreak increases. Poultry management could significantly affect the pathogenesis of NE. In particular, feed restriction and coccidiosis vaccination can protect against NE, while extreme house temperature, feed mycotoxins and high stocking density predispose to NE. It becomes really important to understand the pathogenesis of the disease, as well as to clarify the interactions between husbandry, nutritional and infectious factors and the outbreak of necrotic enteritis. This is necessary and extremely important in order to develop managerial strategies at the farm level to control the incidence and severity of the disease in the post-antibiotic era.

Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997

NASA Astrophysics Data System (ADS)

Díaz, J.; García, R.; Velázquez de Castro, F.; Hernández, E.; López, C.; Otero, A.

2002-04-01

The effects of heat waves on the population have been described by different authors and a consistent relationship between mortality and temperature has been found, especially in elderly subjects. The present paper studies this effect in Seville, a city in the south of Spain, known for its climate of mild winters and hot summers, when the temperature frequently exceeds 40 °C. This study focuses on the summer months (June to September) for the years from 1986 to 1997. The relationships between total daily mortality and different specific causes for persons older than 65 and 75 years, of each gender, were analysed. Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as environmental variables. The possible confounding effect of different atmospheric pollutants, particularly ozone, were considered. The methodology employed was time series analysis using Box-Jenkins models with exogenous variables. On the basis of dispersion diagrams, we defined extremely hot days as those when the maximum daily temperature surpassed 41 °C. The ARIMA model clearly shows the relationship between temperature and mortality. Mortality for all causes increased up to 51% above the average in the group over 75 years for each degree Celsius beyond 41 °C. The effect is more noticeable for cardiovascular than for respiratory diseases, and more in women than in men. Among the atmospheric pollutants, a relation was found between mortality and concentrations of ozone, especially for men older than 75.

Analysis of wounds incurred by U.S. Army Seventh Corps personnel treated in Corps hospitals during Operation Desert Storm, February 20 to March 10, 1991.

PubMed

Carey, M E

1996-03-01

One hundred and forty-three soldiers who received ballistic injury were actively treated at U.S. Army Seventh Corps hospitals during Operation Desert Storm. Ninety-five percent were wounded by fragments, 5% by bullets. Many had wounds of several body parts, including 17.3% who received a head wound; 4.3% a neck wound; 5.8% a chest wound; 9.3% an abdominal wound; and 90% who had extremity wounds. Three hospital deaths occurred--a 2.1% mortality rate. Only two soldiers sustained a brain wound; in both, the missile entered below the skull area protected by the Kevlar helmet. One brainwounded individual was treated and lived; the other died from hemorrhage and shock from concomitant traumatic lower-extremity amputations. The current U.S. helmet appears to provide significant protection from fragmenting ordnance as does the armored vest. Hemorrhage from proximal extremity wounds caused hospital deaths. Treatment of such wounds will have to be improved to reduce future combat mortality.

Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

PubMed

Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

2016-04-01

Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory. © The Author(s) 2015.

Migration from Mexico to the United States: A High-Speed Cancer Transition

PubMed Central

Pinheiro, Paulo S.; Callahan, Karen E.; Stern, Mariana C.; deVries, Esther

2017-01-01

Differences and similarities in cancer patterns between the country of Mexico and the United States’ Mexican population, 11% of the entire US population, have not been studied. Mortality data from 2008–2012 in Mexico and California were analyzed and compared for causes of cancer death among adult and pediatric populations, using standard techniques and negative binomial regression. A total of 380,227 cancer deaths from Mexico and California were included. Mexican Americans had 49% and 13% higher mortality than their counterparts in Mexico among males and females, respectively. For Mexican Immigrants in the US, overall cancer mortality was similar to Mexico, their country of birth, but all-cancers-combined rates mask wide variation by specific cancer site. The most extreme results were recorded when comparing Mexican Americans to Mexicans in Mexico: with mortality rate ratios ranging from 2.72 (95%CI: 2.44–3.03) for colorectal cancer in males to 0.28 (95%CI: 0.24–0.33) for cervical cancer in females. These findings further reinforce the preeminent role that the environment, in its multiple aspects, has on cancer. Overall, mortality from obesity and tobacco-related cancers was higher among Mexican origin populations in the US compared to Mexico, suggesting a higher risk for these cancers, while mortality from prostate, stomach, and especially cervical and pediatric cancers was markedly higher in Mexico. Among children, brain cancer and neuroblastoma patterns suggest an environmental role in the etiology of these malignancies as well. Partnered research between the US and Mexico for cancer studies is warranted. PMID:28940515

The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project.

PubMed

D'Ippoliti, Daniela; Michelozzi, Paola; Marino, Claudia; de'Donato, Francesca; Menne, Bettina; Katsouyanni, Klea; Kirchmayer, Ursula; Analitis, Antonis; Medina-Ramón, Mercedes; Paldy, Anna; Atkinson, Richard; Kovats, Sari; Bisanti, Luigi; Schneider, Alexandra; Lefranc, Agnès; Iñiguez, Carmen; Perucci, Carlo A

2010-07-16

The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.

Migration from Mexico to the United States: A high-speed cancer transition.

PubMed

Pinheiro, Paulo S; Callahan, Karen E; Stern, Mariana C; de Vries, Esther

2018-02-01

Differences and similarities in cancer patterns between the country of Mexico and the United States' Mexican population, 11% of the entire US population, have not been studied. Mortality data from 2008 to 2012 in Mexico and California were analyzed and compared for causes of cancer death among adult and pediatric populations, using standard techniques and negative binomial regression. A total of 380,227 cancer deaths from Mexico and California were included. Mexican Americans had 49% and 13% higher mortality than their counterparts in Mexico among males and females, respectively. For Mexican Immigrants in the US, overall cancer mortality was similar to Mexico, their country of birth, but all-cancers-combined rates mask wide variation by specific cancer site. The most extreme results were recorded when comparing Mexican Americans to Mexicans in Mexico: with mortality rate ratios ranging from 2.72 (95% CI: 2.44-3.03) for colorectal cancer in males to 0.28 (95% CI: 0.24-0.33) for cervical cancer in females. These findings further reinforce the preeminent role that the environment, in its multiple aspects, has on cancer. Overall, mortality from obesity and tobacco-related cancers was higher among Mexican origin populations in the US compared to Mexico, suggesting a higher risk for these cancers, while mortality from prostate, stomach, and especially cervical and pediatric cancers was markedly higher in Mexico. Among children, brain cancer and neuroblastoma patterns suggest an environmental role in the etiology of these malignancies as well. Partnered research between the US and Mexico for cancer studies is warranted. © 2017 UICC.

Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation.

PubMed

Lietz, K; John, R; Burke, E A; Ankersmit, J H; McCue, J D; Naka, Y; Oz, M C; Mancini, D M; Edwards, N M

2001-07-27

Extremes in body weight are a relative contraindication to cardiac transplantation. We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]<20 kg/m2), 113 overweight (BMI=>27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses. Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02). The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be avoided.

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention.

PubMed

Eid, Hani O; Barss, Peter; Adam, Shehabeldin H; Torab, Fawaz Chikh; Lunsjo, Karl; Grivna, Michal; Abu-Zidan, Fikri M

2009-07-01

To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures. Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression. There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03). Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.

High Temperature Extremes - Will They Transform Structure of Avian Assemblages in the Desert Southwest?

NASA Astrophysics Data System (ADS)

Mutiibwa, D.; Albright, T. P.; Wolf, B. O.; Mckechnie, A. E.; Gerson, A. R.; Talbot, W. A.; Sadoti, G.; O'Neill, J.; Smith, E.

2014-12-01

Extreme weather events can alter ecosystem structure and function and have caused mass mortality events in animals. With climate change, high temperature extremes are increasing in frequency and magnitude. To better understand the consequences of climate change, scientists have frequently employed correlative models based on species occurrence records. However, these approaches may be of limited utility in the context of extremes, as these are often outside historical ranges and may involve strong non-linear responses. Here we describe work linking physiological response informed by experimental data to geospatial climate datasets in order to mechanistically model the dynamics of dehydration risk to dessert passerine birds. Specifically, we modeled and mapped the occurrence of current (1980-2013) high temperature extremes and evaporative water loss rates for eight species of passerine birds ranging in size from 6.5-75g in the US Southwest portion of their range. We then explored the implications of a 4° C warming scenario. Evaporative water loss (EWL) across a range of high temperatures was measured in heat-acclimated birds captured in the field. We used the North American Land Data Assimilation System 2 dataset to obtain hourly estimates of EWL with a 14-km spatial grain. Assuming lethal dehydration occurs when water loss reaches 15% of body weight, we then produced maps of total daily EWL and time to lethal dehydration based on both current data and future scenarios. We found that milder events capable of producing dehydration in passerine birds over four or more hours were not uncommon over the Southwest, but rapid dehydration conditions (<3 hours) were rare. Under the warming scenario, the frequency and extent of dehydration events expanded greatly, often affecting areas several times larger than in present-day climate. Dehydration risk was especially high among smaller bodied passerines due to their higher mass-specific rates of water loss. Even after accounting for the moderating effects of microsite and topoclimatic refugia, the increase in occurrence of lethal dehydration risk is cause for concern. In particular, our results suggest that smaller bodied passerines may have difficulty in avoiding extirpation over portions of their current range in the desert southwest.

The role of wearable sensors and wireless technologies for the assessment of heart rate variability in anorexia nervosa.

PubMed

Billeci, Lucia; Tartarisco, Gennaro; Brunori, Elena; Crifaci, Giulia; Scardigli, Silvia; Balocchi, Rita; Pioggia, Giovanni; Maestro, Sandra; Morales, Maria Aurora

2015-03-01

Bradycardia and abnormal cardiac autonomic function are related to increased mortality in anorexia nervosa (AN). The aim of this study was to assess heart rate (HR) and HR variability of young adolescents with AN as compared to controls by means of wearable sensors and wireless technologies. The ECG signal was recorded in 27 AN girls and 15 healthy girls at rest using a wearable chest strap. The tachogram, the mean intervals between R peaks (meanRR), the root mean square of successive differences (RMSSD), the power of low-frequency (LF) and high-frequency (HF) bands and the LF/HF ratio were assessed. All AN girls showed a reduced HR and an increased meanRR and RMSSD. An HF increase, a LF decrease, and a LF/HF reduction indicated a prevalence of the parasympathetic on sympathetic activity. The instruments used in this pilot study were feasible, unobtrusive and extremely suitable in AN subjects who are burdened by high incidence of cardiovascular mortality; their application could open to new approaches of vital signs monitoring in hospitals as well as in home settings.

Extreme Obesity and Outcomes in Critically Ill Patients

PubMed Central

Martino, Jenny L.; Wang, Miao; Day, Andrew G.; Cahill, Naomi E.; Dixon, Anne E.; Suratt, Benjamin T.; Heyland, Daren K.

2011-01-01

Background: Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI ≥ 40 kg/m2) are unclear. We sought to determine the association between extreme obesity and ICU outcomes. Methods: We analyzed data from a multicenter international observational study of ICU nutrition practices that occurred in 355 ICUs in 33 countries from 2007 to 2009. Included patients were mechanically ventilated adults ≥ 18 years old who remained in the ICU for > 72 h. Using generalized estimating equations and Cox proportional hazard modeling with clustering by ICU and adjusting for potential confounders, we compared extremely obese to normal-weight patients in terms of duration of mechanical ventilation (DMV), ICU length of stay (LOS), hospital LOS, and 60-day mortality. Results: Of the 8,813 patients included in this analysis, 3,490 were normal weight (BMI 18.5-24.9 kg/m2), 348 had BMI 40 to 49.9 kg/m2, 118 had BMI 50 to 59.9 kg/m2, and 58 had BMI ≥ 60 kg/m2. Unadjusted analyses suggested that extremely obese critically ill patients have improved mortality (OR for death, 0.77; 95% CI, 0.62-0.94), but this association was not significant after adjustment for confounders. However, an adjusted analysis of survivors found that extremely obese patients have a longer DMV and ICU LOS, with the most obese patients (BMI ≥ 60 kg/m2) also having longer hospital LOS. Conclusions: During critical illness, extreme obesity is not associated with a worse survival advantage compared with normal weight. However, among survivors, BMI ≥ 40 kg/m2 is associated with longer time on mechanical ventilation and in the ICU. These results may have prognostic implications for extremely obese critically ill patients. PMID:21816911

Warmer and wetter winters: characteristics and implications of an extreme weather event in the High Arctic

NASA Astrophysics Data System (ADS)

Hansen, Brage B.; Isaksen, Ketil; Benestad, Rasmus E.; Kohler, Jack; Pedersen, Åshild Ø.; Loe, Leif E.; Coulson, Stephen J.; Larsen, Jan Otto; Varpe, Øystein

2014-11-01

One predicted consequence of global warming is an increased frequency of extreme weather events, such as heat waves, droughts, or heavy rainfalls. In parts of the Arctic, extreme warm spells and heavy rain-on-snow (ROS) events in winter are already more frequent. How these weather events impact snow-pack and permafrost characteristics is rarely documented empirically, and the implications for wildlife and society are hence far from understood. Here we characterize and document the effects of an extreme warm spell and ROS event that occurred in High Arctic Svalbard in January-February 2012, during the polar night. In this normally cold semi-desert environment, we recorded above-zero temperatures (up to 7 °C) across the entire archipelago and record-breaking precipitation, with up to 98 mm rainfall in one day (return period of >500 years prior to this event) and 272 mm over the two-week long warm spell. These precipitation amounts are equivalent to 25 and 70% respectively of the mean annual total precipitation. The extreme event caused significant increase in permafrost temperatures down to at least 5 m depth, induced slush avalanches with resultant damage to infrastructure, and left a significant ground-ice cover (˜5-20 cm thick basal ice). The ground-ice not only affected inhabitants by closing roads and airports as well as reducing mobility and thereby tourism income, but it also led to high starvation-induced mortality in all monitored populations of the wild reindeer by blocking access to the winter food source. Based on empirical-statistical downscaling of global climate models run under the moderate RCP4.5 emission scenario, we predict strong future warming with average mid-winter temperatures even approaching 0 °C, suggesting increased frequency of ROS. This will have far-reaching implications for Arctic ecosystems and societies through the changes in snow-pack and permafrost properties.

Mortality of riparian box elder from sediment mobilization and extended inundation

USGS Publications Warehouse

Friedman, Jonathan M.; Auble, Gregor T.

1999-01-01

To explore how high flows limit the streamward extent of riparian vegetation we quantified the effects of sediment mobilization and extended inundation on box elder (Acer negundo) saplings along the cobble-bed Gunnison River in Black Canyon of the Gunnison National Monument, Colorado, USA. We counted and aged box elders in 144 plots of 37.2 m2, and combined a hydraulic model with the hydrologic record to determine the maximum shear stress and number of growing-season days inundated for each plot in each year of the record. We quantified the effects of the two mortality factors by calculating the extreme values survived during the lifetime of trees sampled in 1994 and by recounting box elders in the plots following a high flow in 1995. Both mortality factors can be modeled as threshold functions; box elders are killed either by inundation for more than 85 days during the growing season or by shear stress that exceeds the critical value for mobilization of the underlying sediment particles. Construction of upstream reservoirs in the 1960s and 1970s reduced the proportion of the canyon bottom annually cleared of box elders by high flows. Furthermore, because the dams decreased the magnitude of high flows more than their duration, flow regulation has decreased the importance of sediment mobilization relative to extended inundation. We use the threshold functions and cross-section data to develop a response surface predicting the proportion of the canyon bottom cleared at any combination of flow magnitude and duration. This response surface allows vegetation removal to be incorporated into quantitative multi-objective water management decisions.

Quantitative methods for stochastic high frequency spatio-temporal and non-linear analysis: Assessing health effects of exposure to extreme ambient temperature

NASA Astrophysics Data System (ADS)

Liss, Alexander

Extreme weather events, such as heat waves and cold spells, cause substantial excess mortality and morbidity in the vulnerable elderly population, and cost billions of dollars. The accurate and reliable assessment of adverse effects of extreme weather events on human health is crucial for environmental scientists, economists, and public health officials to ensure proper protection of vulnerable populations and efficient allocation of scarce resources. However, the methodology for the analysis of large national databases is yet to be developed. The overarching objective of this dissertation is to examine the effect of extreme weather on the elderly population of the Conterminous US (ConUS) with respect to seasonality in temperature in different climatic regions by utilizing heterogeneous high frequency and spatio-temporal resolution data. To achieve these goals the author: 1) incorporated dissimilar stochastic high frequency big data streams and distinct data types into the integrated data base for use in analytical and decision support frameworks; 2) created an automated climate regionalization system based on remote sensing and machine learning to define climate regions for the Conterminous US; 3) systematically surveyed the current state of the art and identified existing gaps in the scientific knowledge; 4) assessed the dose-response relationship of exposure to temperature extremes on human health in relatively homogeneous climate regions using different statistical models, such as parametric and non-parametric, contemporaneous and asynchronous, applied to the same data; 5) assessed seasonal peak timing and synchronization delay of the exposure and the disease within the framework of contemporaneous high frequency harmonic time series analysis and modification of the effect by the regional climate; 6) modeled using hyperbolic functional form non-linear properties of the effect of exposure to extreme temperature on human health. The proposed climate regionalization method algorithmically forms eight climatically homogeneous regions for Conterminous US from satellite Remote Sensing inputs. The relative risk of hospitalizations due to extreme ambient temperature varied across climatic regions. Difference in regional hospitalization rates suggests presence of an adaptation effect to a prevailing climate. In various climatic regions the hospitalizations peaked earlier than the peak of exposure. This suggests disproportionally high impact of extreme weather events, such as cold spells or heat waves when they occur early in the season. These findings provide an insight into the use of high frequency disjoint data sets for the assessment of the magnitude, timing, synchronization and non-linear properties of adverse health consequences due to exposure to extreme weather events to the elderly in defined climatic regions. These findings assist in the creation of decision support frameworks targeting preventions and adaptation strategies such as improving infrastructure, providing energy assistance, education and early warning notifications for the vulnerable population. This dissertation offers a number of methodological innovations for the assessment of the high frequency spatio-temporal and non-linear impacts of extreme weather events on human health. These innovations help to ensure an improved protection of the elderly population, aid policy makers in the development of efficient disaster prevention strategies, and facilitate more efficient allocation of scarce resources.

Lower extremity strength, systemic inflammation and all-cause mortality: Application to the "fat but fit" paradigm using cross-sectional and longitudinal designs.

PubMed

Buckner, Samuel L; Loenneke, Jeremy P; Loprinzi, Paul D

2015-10-01

No study has applied the "fat-but-fit" paradigm with respect to muscular strength as an index of fitness, despite muscular strength being independently associated with functional ability and mortality. To examine the relationship between lower extremity muscular strength, C-reactive protein (CRP), and all-cause mortality among normal weight, overweight and obese individuals. Data from the 1999-2002 NHANES were used (N=2740 adults; ≥ 50 years). CRP values were obtained from a blood sample. Lower body isokinetic knee extensor strength (IKES) was assessed using a Kin Kom MP isokinetic dynamometer. Participant data was linked to death certificate data from the National Death Index to ascertain all-cause mortality status. Participants were classified, based on body mass index (BMI) and strength as: normal weight and unfit (<75th IKES percentile); overweight and unfit; obese and unfit: normal weight and fit (≥ 75th IKES percentile); overweight and fit; and obese and fit. Independent of physical activity and other confounders, compared to those who were normal weight and unfit, unfit overweight (β=.14, p=0.009), unfit obese (β=.33, p<0.001), and obese and fit (β=.17, p=0.008) participants, had higher CRP levels. However, there was no difference in CRP levels between normal weight and unfit participants and overweight and fit participants (β=0.04, p=0.35). Compared to normal weight unfit adults, overweight fit (HR=0.28; 95% CI: 0.11-0.70; p=0.008) adults had a lower hazard rate for all-cause mortality. These finding suggest that increased lower body strength, independent of physical activity, may reduce premature all-cause mortality and attenuate systemic inflammation among overweight adults. Copyright © 2015 Elsevier Inc. All rights reserved.

Genome-wide association study using extreme truncate selection identifies novel genes affecting bone mineral density and fracture risk.

PubMed

Duncan, Emma L; Danoy, Patrick; Kemp, John P; Leo, Paul J; McCloskey, Eugene; Nicholson, Geoffrey C; Eastell, Richard; Prince, Richard L; Eisman, John A; Jones, Graeme; Sambrook, Philip N; Reid, Ian R; Dennison, Elaine M; Wark, John; Richards, J Brent; Uitterlinden, Andre G; Spector, Tim D; Esapa, Chris; Cox, Roger D; Brown, Steve D M; Thakker, Rajesh V; Addison, Kathryn A; Bradbury, Linda A; Center, Jacqueline R; Cooper, Cyrus; Cremin, Catherine; Estrada, Karol; Felsenberg, Dieter; Glüer, Claus-C; Hadler, Johanna; Henry, Margaret J; Hofman, Albert; Kotowicz, Mark A; Makovey, Joanna; Nguyen, Sing C; Nguyen, Tuan V; Pasco, Julie A; Pryce, Karena; Reid, David M; Rivadeneira, Fernando; Roux, Christian; Stefansson, Kari; Styrkarsdottir, Unnur; Thorleifsson, Gudmar; Tichawangana, Rumbidzai; Evans, David M; Brown, Matthew A

2011-04-01

Osteoporotic fracture is a major cause of morbidity and mortality worldwide. Low bone mineral density (BMD) is a major predisposing factor to fracture and is known to be highly heritable. Site-, gender-, and age-specific genetic effects on BMD are thought to be significant, but have largely not been considered in the design of genome-wide association studies (GWAS) of BMD to date. We report here a GWAS using a novel study design focusing on women of a specific age (postmenopausal women, age 55-85 years), with either extreme high or low hip BMD (age- and gender-adjusted BMD z-scores of +1.5 to +4.0, n = 1055, or -4.0 to -1.5, n = 900), with replication in cohorts of women drawn from the general population (n = 20,898). The study replicates 21 of 26 known BMD-associated genes. Additionally, we report suggestive association of a further six new genetic associations in or around the genes CLCN7, GALNT3, IBSP, LTBP3, RSPO3, and SOX4, with replication in two independent datasets. A novel mouse model with a loss-of-function mutation in GALNT3 is also reported, which has high bone mass, supporting the involvement of this gene in BMD determination. In addition to identifying further genes associated with BMD, this study confirms the efficiency of extreme-truncate selection designs for quantitative trait association studies.

Genome-Wide Association Study Using Extreme Truncate Selection Identifies Novel Genes Affecting Bone Mineral Density and Fracture Risk

PubMed Central

Duncan, Emma L.; Danoy, Patrick; Kemp, John P.; Leo, Paul J.; McCloskey, Eugene; Nicholson, Geoffrey C.; Eastell, Richard; Prince, Richard L.; Eisman, John A.; Jones, Graeme; Sambrook, Philip N.; Reid, Ian R.; Dennison, Elaine M.; Wark, John; Richards, J. Brent; Uitterlinden, Andre G.; Spector, Tim D.; Esapa, Chris; Cox, Roger D.; Brown, Steve D. M.; Thakker, Rajesh V.; Addison, Kathryn A.; Bradbury, Linda A.; Center, Jacqueline R.; Cooper, Cyrus; Cremin, Catherine; Estrada, Karol; Felsenberg, Dieter; Glüer, Claus-C.; Hadler, Johanna; Henry, Margaret J.; Hofman, Albert; Kotowicz, Mark A.; Makovey, Joanna; Nguyen, Sing C.; Nguyen, Tuan V.; Pasco, Julie A.; Pryce, Karena; Reid, David M.; Rivadeneira, Fernando; Roux, Christian; Stefansson, Kari; Styrkarsdottir, Unnur; Thorleifsson, Gudmar; Tichawangana, Rumbidzai; Evans, David M.; Brown, Matthew A.

2011-01-01

Osteoporotic fracture is a major cause of morbidity and mortality worldwide. Low bone mineral density (BMD) is a major predisposing factor to fracture and is known to be highly heritable. Site-, gender-, and age-specific genetic effects on BMD are thought to be significant, but have largely not been considered in the design of genome-wide association studies (GWAS) of BMD to date. We report here a GWAS using a novel study design focusing on women of a specific age (postmenopausal women, age 55–85 years), with either extreme high or low hip BMD (age- and gender-adjusted BMD z-scores of +1.5 to +4.0, n = 1055, or −4.0 to −1.5, n = 900), with replication in cohorts of women drawn from the general population (n = 20,898). The study replicates 21 of 26 known BMD–associated genes. Additionally, we report suggestive association of a further six new genetic associations in or around the genes CLCN7, GALNT3, IBSP, LTBP3, RSPO3, and SOX4, with replication in two independent datasets. A novel mouse model with a loss-of-function mutation in GALNT3 is also reported, which has high bone mass, supporting the involvement of this gene in BMD determination. In addition to identifying further genes associated with BMD, this study confirms the efficiency of extreme-truncate selection designs for quantitative trait association studies. PMID:21533022

Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients.

PubMed

Yi, Xiao-lei; Chen, Jie; Li, Jia; Feng, Liang; Wang, Yan; Zhu, Jia-An; Shen, E; Hu, Bing

2014-03-01

To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12.45 ± 6.17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upper extremity venous thrombosis. © 2013 John Wiley & Sons Ltd.

Final report: Hydraulic mechanisms of survival and mortality during drought in pinon-juniper woodlands of southwestern USA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pockman, William

The goal of this project was to use rainfall manipulation of an intact pinon-juniper woodland in central New Mexico to understand the mechanisms that control the response of these species to extremes of rainfall. Experimental plots were installed in a pinon-juniper woodland at the Sevilleta National Wildlife Refuge and treatments were imposed in August 2007. Treatments consisted of 1) a Drought treatment imposed by diverting approximately 45% of precipitation away from the plot, 2) and Irrigation treatment imposed by applying six 19 mm simulated rainfall events at regular intervals during the growing season, 3) a Cover Control treatment designed tomore » assess the impact of the plastic troughs constructed on Drought plots without imposing the rainfall diversion, and 4) an untreated control that received no modification. Extensive pinon mortality was observed beginning one year after the start of drought treatment on hillslope plots, while a third drought plot on deeper soils did not exhibit pinon mortality until the fifth year of drought treatment. Pinon mortality occurred in the context of high levels of bark beetle activity, motivating the installation of two additional plots in 2010: a control plot and a drought plot built to the same standards as the original treatments but with bark beetle control maintained by pesticide application to the bole of target trees from 2010 - 2016. Although the drought treatment created similar conditions to those experienced on hillslope drought plots, the drought plot with bark beetle control exhibited no pinon mortality for 5 years even in the presence of high regional bark beetle activity in 2012/13. One of the goals of the research was to identify the mechanism of drought-induced mortality in pinon and juniper: 1) mortality due to catastrophic failure of water transport through plant tissues (hydraulic failure), 2) mortality due to limitations in carbon uptake (carbon starvation) and 3) either of the first two mechanisms with the involvement of bark beetles and other pathogens. Data from this study implicate the interaction of hydraulic failure and carbon limitations with bark beetles playing a pivotal role in influencing the timing of mortality. The uncommon nature of this kind of large scale manipulative experiment has motivated widespread use of the data from the various treatments in modeling exercises with several collaborative groups.« less

Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team

PubMed Central

Naidoo, P; Liu, V J; Bergin, S

2015-01-01

Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients. PMID:26111070

Risky business: human factors in critical care.

PubMed

Laussen, Peter C; Allan, Catherine K; Larovere, Joan M

2011-07-01

Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented.

Training for laparoscopic pancreaticoduodenectomy.

PubMed

Kuroki, Tamotsu; Fujioka, Hikaru

2018-05-10

In recent years, laparoscopic procedures have developed rapidly, and the reports of laparoscopic pancreatic resection including laparoscopic pancreaticoduodenectomy (LPD) have increased in number. Although LPD is a complex procedure with high mortality, the training system for LPD remains unestablished. Ensuring patient safety is extremely important, even in challenging surgeries such a LPD. At present, several tools have been developed for surgical education to ensure patient safety preoperatively, such as video learning, virtual reality simulators, and cadaver training. Although LPD is reported as a safe and feasible choice, LPD is still a challenging operation. An LPD training system should be established with a board-certified system.

Natural killer/T-cell lymphoma invading the orbit and globe.

PubMed

Lyons, Lance J; Vrcek, Ivan; Somogyi, Marie; Taheri, Kevin; Admirand, Joan H; Chexal, Saradha; Loukas, Demetrius F; Nakra, Tanuj

2017-10-01

Natural killer/T-cell lymphomas are extremely rare and carry high mortality rates. Epidemiologically, these cancers tend to affect mainly Asian and South American patients and are associated with Epstein-Barr virus seropositivity. This report details a 78-year-old Vietnamese woman who presented initially with vitritis of unknown cause, but later developed proptosis and conjunctival involvement as her disease spread. Biopsies of the orbit, ethmoid sinus, and conjunctiva were found to be significant for natural killer/T-cell lymphoma. The case highlights the diagnostic difficulty of this tumor given its rarity and ability to mimic other disorders.

Natural killer/T-cell lymphoma invading the orbit and globe

PubMed Central

Lyons, Lance J.; Somogyi, Marie; Taheri, Kevin; Admirand, Joan H.; Chexal, Saradha; Loukas, Demetrius F.; Nakra, Tanuj

2017-01-01

Natural killer/T-cell lymphomas are extremely rare and carry high mortality rates. Epidemiologically, these cancers tend to affect mainly Asian and South American patients and are associated with Epstein-Barr virus seropositivity. This report details a 78-year-old Vietnamese woman who presented initially with vitritis of unknown cause, but later developed proptosis and conjunctival involvement as her disease spread. Biopsies of the orbit, ethmoid sinus, and conjunctiva were found to be significant for natural killer/T-cell lymphoma. The case highlights the diagnostic difficulty of this tumor given its rarity and ability to mimic other disorders. PMID:28966461

A Prospective Study of Social Isolation, Loneliness, and Mortality in Finland.

PubMed

Tanskanen, Jussi; Anttila, Timo

2016-11-01

To estimate the simultaneous effects of social isolation and loneliness on mortality. We analyzed a representative Finnish sample (n = 8650) from the cross-sectional Living Conditions Survey of 1994, with a 17-year follow-up period (1995-2011), by using Cox regression models adjusted for several possible confounding variables. We examined the possible nonlinear threshold effect of social isolation on mortality. The analyses revealed that social isolation predicted mortality even after we controlled for loneliness and control variables. The connection between social isolation and mortality was linear in nature and there was no synergistic effect between social isolation and loneliness. The effect of loneliness became nonsignificant when studied simultaneously with social isolation. This study reveals strong evidence for an adverse effect of social isolation on mortality. Social isolation and loneliness seem to have distinct pathways to mortality and health. The results imply that the risk of mortality exists along a continuum, affecting not only those who experience extreme social isolation, but also those who suffer from mild to progressively increasing intensity of isolation.

Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa.

PubMed

Garenne, Michel

2010-06-01

The health of children improved dramatically worldwide during the 20th century, although with major contrasts between developed and developing countries, and urban and rural areas. The quantitative evidence on urban child health from a broad historical and comparative perspective is briefly reviewed here. Before the sanitary revolution, urban mortality tended to be higher than rural mortality. However, after World War I, improvements in water, sanitation, hygiene, nutrition and child care resulted in lower urban child mortality in Europe. Despite a similar mortality decline, urban mortality in developing countries since World War II has been generally lower than rural mortality, probably because of better medical care, higher socio-economic status and better nutrition in urban areas. However, higher urban mortality has recently been seen in the slums of large cities in developing countries as a result of extreme poverty, family disintegration, lack of hygiene, sanitation and medical care, low nutritional status, emerging diseases (HIV/AIDS and tuberculosis) and other health hazards (environmental hazards, accidents, violence). These emerging threats need to be addressed by appropriate policies and programmes.

The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

PubMed

Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

2017-06-01

The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p < 0.01) and chest AIS (odds ratio, 3.55; 95% confidence interval, 1.81-6.97; p < 0.01), but not abdomen, face, neck, spine, or extremity AIS (p > 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality in single-system-injured children. These findings should be considered in benchmarking and performance improvement efforts. Epidemiologic study, level III.

Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center.

PubMed

Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2017-12-11

The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan-Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01-0.39, p = 0.004 and AOR 0.3, 95% CI 0.15-0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly higher odds of adjusted mortality (AOR 8.4, 95% CI 2.84-25.07, p < 0.001) than the patients with head/neck injury. This study found that the risks to mortality in the patients with a given AIS value of serious to critical injury in different injured body regions were not the same, even after controlling for confounding variables such as sex, age, comorbidities, and ISS.

Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center

PubMed Central

Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun

2017-01-01

The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan–Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01–0.39, p = 0.004 and AOR 0.3, 95% CI 0.15–0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly higher odds of adjusted mortality (AOR 8.4, 95% CI 2.84–25.07, p < 0.001) than the patients with head/neck injury. This study found that the risks to mortality in the patients with a given AIS value of serious to critical injury in different injured body regions were not the same, even after controlling for confounding variables such as sex, age, comorbidities, and ISS. PMID:29232883

The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence.

PubMed

Caputo, Lisa M; Salottolo, Kristin M; Slone, Denetta Sue; Mains, Charles W; Bar-Or, David

2014-03-01

To synthesise published and unpublished findings examining the relationship between institutional trauma centre volume or trauma patient volume per surgeon and mortality. Evidence on the relationship between patient volume and survival in trauma patients is inconclusive in the literature and remains controversial. A literature search was performed to identify studies published between 1976 and 2013 via MEDLINE (Pubmed) and the Cumulative Index to Nursing and Allied Health Literature (EbscoHost) as well as footnote chasing. Abstracts from appropriate conferences and ProQuest Dissertations and Theses were also searched. Inclusion criteria required studies to be original research published in English that examined the relationship between mortality and either institutional or per surgeon volume in American trauma centres. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement checklist and flowchart. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the quality of the evidence. Of 1392 studies reviewed, 19 studies met defined inclusion criteria; all studies were retrospective. The definition of volume was heterogeneous across the studies. Patient population and analysis methods also varied across the studies. Sixteen studies (84%) examined the relationship between institutional trauma centre volume and mortality. Of the 16 studies, 12 examined the volume of severely injured patients and eight examined overall trauma patient volume. High institutional volume was associated with at least somewhat improved mortality in ten of 16 studies (63%); however, nearly half of these studies found only some subpopulations experienced benefits. In the remaining six studies, volume was not associated with any benefits. Four studies (25%) analysed the impact of surgeon volume on mortality. High volume per surgeon was associated with improved mortality in only one of four studies (25%). The studies were extremely heterogeneous, thus definitive conclusions cannot be drawn regarding optimal volume before a clear advantage in survival is observed. A prospective study defining volume as a continuous variable is warranted to support current admission criteria for American trauma patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Characterizing the Impact of Extreme Heat on Mortality, Karachi, Pakistan, June 2015.

PubMed

Ghumman, Usman; Horney, Jennifer

2016-06-01

Introduction Karachi, Pakistan was affected by a heat wave in June 2015 during the Muslim holy month of Ramadan. Many media reports attributed the excess deaths in part to the practice of daylight fasting during Ramadan. As much of the published research reports on heat-related mortality in Europe and the United States, an exploration of the effects of extreme heat on residents of a South Asian mega-city address a gap in current disaster research. Hypothesis/Problem This report investigated potential risk factors for excess mortality associated with the June 2015 heat wave in Karachi, Pakistan. Data were obtained through manual review of death certificates at public hospitals and private clinics in Karachi, Pakistan, conducted from July 1 through July 31, 2015 by a trained physician. Demographic data for any deaths with a primary cause of death of heat-related illness were recorded in Microsoft Excel (Microsoft Corp.; Redmond, Washington USA). EpiSheet (2012; Rothman. Modern Epidemiology. Lippincott Williams & Wilkins; Philadelphia, Pennsylvania USA) was used to calculate risk differences (RD), rate ratios (RR), and 95% confidence intervals (95% CI). Overall, residents of Karachi were approximately 17 times as likely to die of a heat-related cause of death during June 2015 (RR=17.68; 95% CI, 13.87-22.53) when compared with the reference period of June 2014. Residents with a monthly income lower than 20,000 Pakistani Rupees (US $196; RD=0.03; 95% CI, 0.01-0.05) and those with less than a fifth grade education (RD=0.03; 95% CI, 0.00-0.05) were at significantly higher risk of death during the 2015 heat wave compared to the reference period. Fasting during Ramadan was not a significant risk factor for mortality from heat-related causes during the Karachi heat wave of June 2015. A large number of excess deaths were reported across all demographic groups, which due to the burden of record keeping in an under-resourced health system during a public health emergency, are almost certainly an underestimate. Ghumman U , Horney J . Characterizing the impact of extreme heat on mortality, Karachi, Pakistan, June 2015. Prehosp Disaster Med. 2016;31(3):263-266.

Climate Change and Health Risks from Extreme Heat and Air Pollution in the Eastern United States

NASA Astrophysics Data System (ADS)

Limaye, V.; Vargo, J.; Harkey, M.; Holloway, T.; Meier, P.; Patz, J.

2013-12-01

Climate change is expected to exacerbate health risks from exposure to extreme heat and air pollution through both direct and indirect mechanisms. Directly, warmer ambient temperatures promote biogenic emissions of ozone precursors and favor the formation of ground-level ozone, while an anticipated increase in the frequency of stagnant air masses will allow fine particulates to accumulate. Indirectly, warmer summertime temperatures stimulate energy demand and exacerbate polluting emissions from the electricity sector. Thus, while technological adaptations such as air conditioning can reduce risks from exposures to extreme heat, they can trigger downstream damage to air quality and public health. Through an interdisciplinary modeling effort, we quantify the impacts of climate change on ambient temperatures, summer energy demand, air quality, and public health. The first phase of this work explores how climate change will directly impact the burden of heat-related mortality. Climatic patterns, demographic trends, and epidemiologic risk models suggest that populations in the eastern United States are likely to experience an increasing heat stress mortality burden in response to rising summertime air temperatures. We use North American Regional Climate Change Assessment Program modeling data to estimate mid-century 2-meter air temperatures and humidity across the eastern US from June-August, and quantify how long-term changes in actual and apparent temperatures from present-day will affect the annual burden of heat-related mortality across this region. With the US Environmental Protection Agency's Environmental Benefits Mapping and Analysis Program, we estimate health risks using concentration-response functions, which relate temperature increases to changes in annual mortality rates. We compare mid-century summertime temperature data, downscaled using the Weather Research and Forecasting model, to 2007 baseline temperatures at a 12 km resolution in order to estimate the number of annual excess deaths attributable to increased summer temperatures. Warmer average temperatures are expected to cause 173 additional deaths due to cardiovascular stress, while higher minimum temperatures will cause 67 additional deaths. This work particularly improves on the spatial resolution of published analyses of heat-related mortality in the US.

Projected health impacts of heat events in Washington State associated with climate change.

PubMed

Isaksen, Tania Busch; Yost, Michael; Hom, Elizabeth; Fenske, Richard

2014-01-01

Climate change is predicted to increase the frequency and duration of extreme-heat events and associated health outcomes. This study used data from the historical heat-health outcome relationship, and a unique prediction model, to estimate mortality for 2025 and 2045. For each one degree change in humidex above threshold, we find a corresponding 1.83% increase in mortality for all ages, all non-traumatic causes of death in King County, Washington. Mortality is projected to increase significantly in 2025 and 2045 for the 85 and older age group (2.3-8.0 and 4.0-22.3 times higher than baseline, respectively).

Reduced Hospital Mortality With Surgical Ligation of Patent Ductus Arteriosus in Premature, Extremely Low Birth Weight Infants: A Propensity Score-matched Outcome Study.

PubMed

Tashiro, Jun; Perez, Eduardo A; Sola, Juan E

2016-03-01

To evaluate outcomes after surgical ligation (SL) of patent ductus arteriosus (PDA) in premature, extremely low birth weight (ELBW) infants. Optimal management of PDA in this specialized population remains undefined. Currently, surgical therapy is largely reserved for infants failing medical management. To date, a large-scale, risk-matched population-based study has not been performed to evaluate differences in mortality and resource utilization. Data on identified premature (<37 weeks) and ELBW (<1000  g) infants with PDA (International Classification of Diseases, 9th revision, Clinical Modification, 747.0) and respiratory distress (769) were obtained from Kids' Inpatient Database (2003-2009). Overall, 12,470 cases were identified, with 3008 undergoing SL. Propensity score-matched analysis of 1620 SL versus 1584 non-SL found reduced mortality (15% vs 26%) and more routine disposition (48% vs 41%) for SL (P < 0.001). SL had longer length of stay and higher total cost (P < 0.001). On multivariate analysis, SL mortality predictors were necrotizing enterocolitis (NEC; surgical odds ratio, 5.95; medical odds ratio, 4.42) and sepsis (3.43) (P < 0.006). Length of stay increased with bronchopulmonary dysplasia (BPD; 1.77), whereas total cost increased with surgical NEC (1.82) and sepsis (1.26) (P < 0.04). Non-SL mortality predictors were NEC (surgical, 76.3; medical, 6.17), sepsis (2.66), and intraventricular hemorrhage (1.97) (P < 0.005). Length of stay increased with BPD (2.92) and NEC (surgical, 2.04; medical, 1.28) (P < 0.03). Total cost increased with surgical NEC (2.06), medical NEC (1.57), sepsis (1.43), and BPD (1.30) (P < 0.001). Propensity score-matched analysis demonstrates reduced mortality in premature/ELBW infants with SL for PDA. NEC and sepsis are predictors of mortality and resource utilization.

Evaluation of an Early-Warning System for Heat Wave-Related Mortality in Europe: Implications for Sub-seasonal to Seasonal Forecasting and Climate Services

PubMed Central

Lowe, Rachel; García-Díez, Markel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R.; Rodó, Xavier

2016-01-01

Heat waves have been responsible for more fatalities in Europe over the past decades than any other extreme weather event. However, temperature-related illnesses and deaths are largely preventable. Reliable sub-seasonal-to-seasonal (S2S) climate forecasts of extreme temperatures could allow for better short-to-medium-term resource management within heat-health action plans, to protect vulnerable populations and ensure access to preventive measures well in advance. The objective of this study is to assess the extent to which S2S climate forecasts could be incorporated into heat-health action plans, to support timely public health decision-making ahead of imminent heat wave events in Europe. Forecasts of apparent temperature at different lead times (e.g., 1 day, 4 days, 8 days, up to 3 months) were used in a mortality model to produce probabilistic mortality forecasts up to several months ahead of the 2003 heat wave event in Europe. Results were compared to mortality predictions, inferred using observed apparent temperature data in the mortality model. In general, we found a decreasing transition in skill between excellent predictions when using observed temperature, to predictions with no skill when using forecast temperature with lead times greater than one week. However, even at lead-times up to three months, there were some regions in Spain and the United Kingdom where excess mortality was detected with some certainty. This suggests that in some areas of Europe, there is potential for S2S climate forecasts to be incorporated in localised heat–health action plans. In general, these results show that the performance of this climate service framework is not limited by the mortality model itself, but rather by the predictability of the climate variables, at S2S time scales, over Europe. PMID:26861369

Evaluation of an Early-Warning System for Heat Wave-Related Mortality in Europe: Implications for Sub-seasonal to Seasonal Forecasting and Climate Services.

PubMed

Lowe, Rachel; García-Díez, Markel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R; Rodó, Xavier

2016-02-06

Heat waves have been responsible for more fatalities in Europe over the past decades than any other extreme weather event. However, temperature-related illnesses and deaths are largely preventable. Reliable sub-seasonal-to-seasonal (S2S) climate forecasts of extreme temperatures could allow for better short-to-medium-term resource management within heat-health action plans, to protect vulnerable populations and ensure access to preventive measures well in advance. The objective of this study is to assess the extent to which S2S climate forecasts could be incorporated into heat-health action plans, to support timely public health decision-making ahead of imminent heat wave events in Europe. Forecasts of apparent temperature at different lead times (e.g., 1 day, 4 days, 8 days, up to 3 months) were used in a mortality model to produce probabilistic mortality forecasts up to several months ahead of the 2003 heat wave event in Europe. Results were compared to mortality predictions, inferred using observed apparent temperature data in the mortality model. In general, we found a decreasing transition in skill between excellent predictions when using observed temperature, to predictions with no skill when using forecast temperature with lead times greater than one week. However, even at lead-times up to three months, there were some regions in Spain and the United Kingdom where excess mortality was detected with some certainty. This suggests that in some areas of Europe, there is potential for S2S climate forecasts to be incorporated in localised heat-health action plans. In general, these results show that the performance of this climate service framework is not limited by the mortality model itself, but rather by the predictability of the climate variables, at S2S time scales, over Europe.

Climate extremes in urban area and their impact on human health: the summer heat waves

NASA Astrophysics Data System (ADS)

Baldi, Marina

2014-05-01

In the period 1951-2012 the average global land and ocean temperature has increased by approximately 0.72°C [0.49-0.89] when described by a linear trend, and is projected to rapidly increase. Each of the past three decades has been warmer than all the previous decades, with the decade of the 2000's as the warmest, and, since 1880, nine of the ten warmest years are in the 21st century, the only exception being 1998, which was warmed by the strongest El Niño event of the past century. In parallel an increase in the frequency and intensity of extremely hot days is detected with differences at different scales, which represent an health risk specially in largely populated areas as documented for several regions in the world including the Euro-Mediterranean region. If it is still under discussion if heat wave episodes are a direct result of the warming of the lower troposphere, or if, more likely, they are a regional climate event, however heat episodes have been studied in order to define their correlation with large scale atmospheric patterns and with changes in the regional circulation. Whatever the causes and the spatio-temporal extension of the episodes, epidemiological studies show that these conditions pose increasing health risks inducing heat-related diseases including hyperthermia and heat stress, cardiovascular and respiratory illnesses in susceptible individuals with a significant increase in morbidity and mortality especially in densely populated urban areas. In several Mediterranean cities peaks of mortality associated with extremely high temperature (with simultaneous high humidity levels) have been documented showing that, in some cases, a large increase in daily mortality has been reached compared to the average for the period. The number of fatalities during the summer 2003 heat wave in Europe was estimated to largely exceed the average value of some between 22000 and 50000 cases. In the same summer it was also unusually hot across much of Asia, and Shanghai, which is particularly prone to heat waves, recorded the hottest summer in over 50 years. During the event, the maximum number of daily deaths was 317, 42% above the non-heat day average, even though an heat warning system in operation. In this study results from the analysis of heat waves events in Italian cities is presented. Indices representative of extremely hot conditions have been taken into account and results of the analysis of indices such as the number of summer days (SU), number of tropical nights (TR), maxima and minima of daily maximum and minimum temperatures (TXx, TXn, TNx, TNn, respectively), exceedances over fixed thresholds is presented. Results show a clear increase in the past decades of the numbers of days affected by heat events. Some considerations are also presented about the impact on human health of the longest events occurred in the Country.

Retention of stored water enables tropical tree saplings to survive extreme drought conditions.

PubMed

Wolfe, Brett T

2017-04-01

Trees generally maintain a small safety margin between the stem water potential (Ψstem) reached during seasonal droughts and the Ψstem associated with their mortality. This pattern may indicate that species face similar mortality risk during extreme droughts. However, if tree species vary in their ability to regulate Ψstem, then safety margins would poorly predict drought mortality. To explore variation among species in Ψstem regulation, I subjected potted saplings of six tropical tree species to extreme drought and compared their responses with well-watered plants and pretreatment reference plants. In the drought treatment, soil water potential reached <-10 MPa, yet three species, Bursera simaruba (L.) Sarg., Cavanillesia platanifolia (Bonpl.) Kunth and Cedrela odorata L. had 100% survival and maintained Ψstem near -1 MPa (i.e., desiccation-avoiding species). Three other species, Cojoba rufescens (Benth.) Britton and Rose, Genipa americana L. and Hymenaea courbaril L. had 50%, 0% and 25% survival, respectively, and survivors had Ψstem <-6 MPa (i.e., desiccation-susceptible species). The desiccation-avoiding species had lower relative water content (RWC) in all organs and tissues (root, stem, bark and xylem) in the drought treatment than in the reference plants (means 72.0-90.4% vs 86.9-97.9%), but the survivors of the desiccation-susceptible C. rufescens had much lower RWC in the drought treatment (44.5-72.1%). Among the reference plants, the desiccation-avoiding species had lower tissue density, leaf-mass fraction and lateral-root surface area (LRA) than the desiccation-susceptible species. Additionally, C. platanifolia and C. odorata had reduced LRA in the drought treatment, which may slow water loss into dry soil. Together, these results suggest that the ability to regulate Ψstem during extreme drought is associated with functional traits that favor retention of stored water and that safety margins during seasonal drought poorly predict survival during extreme drought. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Survival predictors of preterm neonates: Hospital based study in Iran (2010-2011).

PubMed

Haghighi, Ladan; Nojomi, Marzieh; Mohabbatian, Behnaz; Najmi, Zahra

2013-12-01

Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant.

Survival predictors of preterm neonates: Hospital based study in Iran (2010-2011)

PubMed Central

Haghighi, Ladan; Nojomi, Marzieh; Mohabbatian, Behnaz; Najmi, Zahra

2013-01-01

Background: Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Objective: Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. Materials and Methods: This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Results: Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Conclusion: Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant PMID:24639721

Association between maternal nutritional extremes and offspring mortality: A population-based cross-sectional study, Brazil, Demographic Health Survey 2006.

PubMed

Felisbino-Mendes, Mariana Santos; Moreira, Alexandra Dias; Velasquez-Melendez, Gustavo

2015-09-01

to estimate the association between maternal nutritional extremes and offspring mortality in the Brazilian population. this cross-sectional study used secondary data from Brazilian women of reproductive age obtained from the National Demographic and Health Survey 2006. Maternal anthropometric indices were used: height, body mass index (BMI), and waist circumference. Logistic regression modelling was used to evaluate the relationship between obesity and offspring mortality. The data analysis was appropriate for the complex sample design. children of mothers of short stature were at greater risk of death in the postnatal period than children of mothers of normal height, even after adjusting for sociodemographic characteristics [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.31-15.77]. Maternal obesity was associated with mortality, and children whose mothers were abdominally obese were at greater risk of dying in the neonatal period (OR 3.19, 95% CI 1.23-8.27). Children of mothers who were overweight or obese (BMI≥25kg/m(2)) were at greater risk of dying in the neonatal period (OR 2.41, 95% CI 1.12-5.16), and children of malnourished mothers (BMI<18.5kg/m(2)) were at greater risk of dying during the postneonatal period (OR 9.47, 95% CI 2.07-43.41). maternal obesity is a risk factor for neonatal death, maternal malnutrition is a risk factor for postneonatal death, and maternal short stature is a risk factor for mortality among Brazilian children. Copyright © 2015 Elsevier Ltd. All rights reserved.

Virulence comparisons of infectious hematopoietic necrosis virus U and M genogroups in sockeye salmon and rainbow trout

USGS Publications Warehouse

Garver, K.A.; Batts, W.N.; Kurath, G.

2006-01-01

Infectious hematopoietic necrosis virus (IHNV) is an aquatic rhabdovirus that infects salmonids in the Pacific Northwest of the United States, Europe, and Asia. Isolates of IHNV have been phylogenetically classified into three major viral genogroups, designated U, M, and L. To characterize virulence of IHNV in the context of these three viral genogroups, seven strains of IHNV (three U genogroup strains, three M strains, and one L strain) were compared for their pathogenicity in juvenile sockeye salmon Oncorhynchus nerka, kokanee (lacustrine sockeye salmon), and rainbow trout O. mykiss. Fish were waterborne-exposed to the different viral strains, and virulence was assessed by comparing mortality curves and final cumulative percent mortality (CPM) in both species of fish at 10??C and 15??C. In sockeye salmon and kokanee, the U genogroup virus types were extremely virulent, causing average CPMs of 69-100%, while the M genogroup virus types caused very little or no mortality (CPM = 0-4%). The endangered Redfish Lake sockeye salmon stock exhibited extreme differences in susceptibility to the U and M genogroups. Conversely, in two stocks of rainbow trout, the M genogroup virus types were more virulent, inducing average CPMs of 25-85%, while the U genogroup viruses caused lower mortality (CPM = 5-41%). In both fish species, the single L genogroup strain caused low to intermediate mortality (CPM = 13-53%). Viral glycoprotein sequence comparisons of the seven challenge strains revealed three amino acid sites (247, 256, and 270) that consistently differed between the U and M genogroups, possibly contributing to pathogenicity differences. ?? Copyright by the American Fisheries Society 2006.

Clinical Features of Non-clostridial Gas Gangrene and Risk Factors for In-hospital Mortality.

PubMed

Takazawa, Kensuke; Otsuka, Hiroyuki; Nakagawa, Yoshihide; Inokuchi, Sadaki

2015-09-20

To examine the clinical features of patients with non-clostridial gas gangrene (NCGG) at our hospital and identify risk factors for in-hospital mortality. This study included 24 patients with NCGG who were hospitalized in our medical facility from April 2005 to March 2015. The clinical features of NCGG were reviewed, and the characteristics of 6 patients who died in hospital and 18 who survived were compared to investigate risk factors. The median time from symptom onset to hospital arrival was 168 h. The causative agent was Klebsiella pneumoniae in 8.3% and mixed infection in 91.7%; 83.3% of patients had diabetes, and one patient had no obvious underlying disease. The site of infection was the neck in 4.2%, the thoracoabdominal wall and retroperitoneum in 12.5% each, the back in 33.3%, the buttocks in 25.0%, the perineum in 20.8%, and the extremities in 45.8%. Retroperitoneal infection, blood lactate ≥ 4.0 mmol/L, and Japanese Association for Acute Medicine disseminated intravascular coagulation (DIC) score ≥ 4 on emergency department (ED) arrival were significantly higher in non-survivors than in survivors. NCGG tends to develop in patients with diabetes, and in-hospital mortality rates are still high. Retroperitoneal infection, hyperlactatemia, and DIC on ED arrival are risk factors for in-hospital mortality.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

PubMed

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

A comparative analysis of heat waves and associated mortality in St. Louis, Missouri--1980 and 1995.

PubMed

Smoyer, K E

1998-08-01

This research investigates heat-related mortality during the 1980 and 1995 heat waves in St. Louis, Missouri. St. Louis has a long history of extreme summer weather, and heat-related mortality is a public health concern. Heat waves are defined as days with apparent temperatures exceeding 40.6 degrees C (105 degrees F). The study uses a multivariate analysis to investigate the relationship between mortality and heat wave intensity, duration, and timing within the summer season. The heat wave of 1980 was more severe and had higher associated mortality than that of 1995. To learn if changing population characteristics, in addition to weather conditions, contributed to this difference, changes in population vulnerability between 1980 and 1995 are evaluated under simulated heat wave conditions. The findings show that St. Louis remains at risk of heat wave mortality. In addition, there is evidence that vulnerability has increased despite increased air-conditioning penetration and public health interventions.

Patterns and causes of observed piñon pine mortality in the southwestern United States

USGS Publications Warehouse

Meddens, Arjan J.H.; Hicke, Jeff H.; Macalady, Alison K.; Buotte, P.C.; Cowles, T.R.; Allen, Craig D.

2015-01-01

Recently, widespread piñon pine die-off occurred in the southwestern United States. Here we synthesize observational studies of this event and compare findings to expected relationships with biotic and abiotic factors. Agreement exists on the occurrence of drought, presence of bark beetles and increased mortality of larger trees. However, studies disagree about the influences of stem density, elevation and other factors, perhaps related to study design, location and impact of extreme drought. Detailed information about bark beetles is seldom reported and their role is poorly understood. Our analysis reveals substantial limits to our knowledge regarding the processes that produce mortality patterns across space and time, indicating a poor ability to forecast mortality in response to expected increases in future droughts.

Identifying Population Vulnerable to Extreme Heat Events in San Jose, California.

NASA Astrophysics Data System (ADS)

Rivera, A. L.

2016-12-01

The extreme heat days not only make cities less comfortable for living but also they are associated with increased morbidity and mortality. Mapping studies have demonstrated spatial variability in heat vulnerability. A study conducted between 2000 and 2011 in New York City shows that deaths during heat waves was more likely to occur in black individuals, at home in census tracts which received greater public assistance. This map project intends to portray areas in San Jose California that are vulnerable to extreme heat events. The variables considered to build a vulnerability index are: land surface temperature, vegetated areas (NDVI), and people exposed to these area (population density).

Global mortality consequences of climate change accounting for adaptation costs and benefits

NASA Astrophysics Data System (ADS)

Rising, J. A.; Jina, A.; Carleton, T.; Hsiang, S. M.; Greenstone, M.

2017-12-01

Empirically-based and plausibly causal estimates of the damages of climate change are greatly needed to inform rapidly developing global and local climate policies. To accurately reflect the costs of climate change, it is essential to estimate how much populations will adapt to a changing climate, yet adaptation remains one of the least understood aspects of social responses to climate. In this paper, we develop and implement a novel methodology to estimate climate impacts on mortality rates. We assemble comprehensive sub-national panel data in 41 countries that account for 56% of the world's population, and combine them with high resolution daily climate data to flexibly estimate the causal effect of temperature on mortality. We find the impacts of temperature on mortality have a U-shaped response; both hot days and cold days cause excess mortality. However, this average response obscures substantial heterogeneity, as populations are differentially adapted to extreme temperatures. Our empirical model allows us to extrapolate response functions across the entire globe, as well as across time, using a range of economic, population, and climate change scenarios. We also develop a methodology to capture not only the benefits of adaptation, but also its costs. We combine these innovations to produce the first causal, micro-founded, global, empirically-derived climate damage function for human health. We project that by 2100, business-as-usual climate change is likely to incur mortality-only costs that amount to approximately 5% of global GDP for 5°C degrees of warming above pre-industrial levels. On average across model runs, we estimate that the upper bound on adaptation costs amounts to 55% of the total damages.

Dampening effects of long-term experimental drought on growth and mortality rates of a Holm oak forest.

PubMed

Barbeta, Adrià; Ogaya, Romà; Peñuelas, Josep

2013-10-01

Forests respond to increasing intensities and frequencies of drought by reducing growth and with higher tree mortality rates. Little is known, however, about the long-term consequences of generally drier conditions and more frequent extreme droughts. A Holm oak forest was exposed to experimental rainfall manipulation for 13 years to study the effect of increasing drought on growth and mortality of the dominant species Quercus ilex, Phillyrea latifolia, and Arbutus unedo. The drought treatment reduced stem growth of A. unedo (-66.5%) and Q. ilex (-17.5%), whereas P. latifolia remained unaffected. Higher stem mortality rates were noticeable in Q. ilex (+42.3%), but not in the other two species. Stem growth was a function of the drought index of early spring in the three species. Stem mortality rates depended on the drought index of winter and spring for Q. ilex and in spring and summer for P. latifolia, but showed no relation to climate in A. unedo. Following a long and intense drought (2005-2006), stem growth of Q. ilex and P. latifolia increased, whereas it decreased in A. unedo. Q. ilex also enhanced its survival after this period. Furthermore, the effect of drought treatment on stem growth in Q. ilex and A. unedo was attenuated as the study progressed. These results highlight the different vulnerabilities of Mediterranean species to more frequent and intense droughts, which may lead to partial species substitution and changes in forest structure and thus in carbon uptake. The response to drought, however, changed over time. Decreased intra- and interspecific competition after extreme events with high mortality, together with probable morphological and physiological acclimation to drought during the study period, may, at least in the short term, buffer forests against drier conditions. The long-term effects of drought consequently deserve more attention, because the ecosystemic responses are unlikely to be stable over time.Nontechnical summaryIn this study, we evaluate the effect of long-term (13 years) experimental drought on growth and mortality rates of three forest Mediterranean species, and their response to the different intensities and durations of natural drought. We provide evidence for species-specific responses to drought, what may eventually lead to a partial community shift favoring the more drought-resistant species. However, we also report a dampening of the treatment effect on the two drought-sensitive species, which may indicate a potential adaptation to drier conditions at the ecosystem or population level. These results are thus relevant to account for the stabilizing processes that would alter the initial response of ecosystem to drought through changes in plant physiology, morphology, and demography compensation. © 2013 John Wiley & Sons Ltd.

Temperature-dependent physiological and biochemical responses of the marine medaka Oryzias melastigma with consideration of both low and high thermal extremes.

PubMed

Li, Adela J; Leung, Priscilla T Y; Bao, Vivien W W; Lui, Gilbert C S; Leung, Kenneth M Y

2015-12-01

This study aimed to investigate temperature effect on physiological and biochemical responses of the marine medaka Oryzias melastigma larvae. The fish were subjected to a stepwise temperature change at a rate of 1 °C/h increasing or decreasing from 25 °C (the control) to six target temperatures (12, 13, 15, 20, 28 and 32 °C) respectively, followed by a 7-day thermal acclimation at each target temperature. The fish were fed ad libitum during the experiment. The results showed that cumulative mortalities were significantly increased at low temperatures (12 and 13 °C) and at the highest temperature (32 °C). For the survivors, their growth profile closely followed the left-skewed 'thermal performance curve'. Routine oxygen consumption rates of fish larvae were significantly elevated at 32 °C but suppressed at 13 and 15 °C (due to a high mortality, larvae from 12 °C were not examined). Levels of heat shock proteins and activities of malate dehydrogenase and lactate dehydrogenase were also measured in fish larvae exposed at 15, 25 and 32 °C. The activities of both enzymes were significantly increased at both 15 and 32 °C, where the fish larvae probably suffered from thermal discomfort and increased anaerobic components so as to compensate the mismatch of energy demand and supply at these thermal extremes. Coincidently, heat shock proteins were also up-regulated at both 15 and 32 °C, enabling cellular protection. Moreover, the critical thermal maxima and minima of fish larvae increased significantly with increasing acclimation temperature, implying that the fish could develop some degrees of thermal tolerance through temperature acclimation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer: A Meta-Analysis of Prospective Cohort Studies.

PubMed

Zong, Geng; Gao, Alisa; Hu, Frank B; Sun, Qi

2016-06-14

Current findings on associations between whole grain (WG) intake and mortality are inconsistent and have not been summarized by meta-analysis. We searched for prospective cohort studies reporting associations between WG intake and mortality from all causes, cardiovascular disease (CVD), and cancer through February 2016 in Medline, Embase, and clinicaltrials.gov, and we further included unpublished results from National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999 to 2004. Fourteen studies were eligible for analysis, which included 786 076 participants, 97 867 total deaths, 23 957 CVD deaths, and 37 492 cancer deaths. Pooled relative risks comparing extreme WG categories (high versus low) were 0.84 (95% confidence interval [CI], 0.80-0.88; P<0.001; I(2)=74%; Pheterogeneity<0.001) for total mortality, 0.82 (95% CI, 0.79-0.85; P<0.001; I(2)=0%; Pheterogeneity=0.53) for CVD mortality, and 0.88 (95% CI, 0.83-0.94; P<0.001; I(2)=54%; Pheterogeneity=0.02) for cancer mortality. Intakes of WG ingredients in dry weight were estimated among studies reporting relative risks for ≥3 quantitative WG categories, and they were <50 g/d among most study populations. The 2-stage dose-response random-effects meta-analysis showed monotonic associations between WG intake and mortality (Pnonlinearity>0.05). For each 16-g/d increase in WG (≈1 serving per d), relative risks of total, CVD, and cancer mortality were 0.93 (95% CI, 0.92-0.94; P<0.001), 0.91 (95% CI, 0.90-0.93; P<0.001), and 0.95 (95% CI, 0.94-0.96; P<0.001), respectively. Our meta-analysis demonstrated inverse associations of WG intake with total and cause-specific mortality, and findings were particularly strong and robust for CVD mortality. These findings further support current Dietary Guidelines for Americans, which recommends at least 3 servings per day of WG intake. © 2016 American Heart Association, Inc.

Viral replication rate regulates clinical outcome and CD8 T cell responses during highly pathogenic H5N1 influenza virus infection in mice.

PubMed

Hatta, Yasuko; Hershberger, Karen; Shinya, Kyoko; Proll, Sean C; Dubielzig, Richard R; Hatta, Masato; Katze, Michael G; Kawaoka, Yoshihiro; Suresh, M

2010-10-07

Since the first recorded infection of humans with H5N1 viruses of avian origin in 1997, sporadic human infections continue to occur with a staggering mortality rate of >60%. Although sustained human-to-human transmission has not occurred yet, there is a growing concern that these H5N1 viruses might acquire this trait and raise the specter of a pandemic. Despite progress in deciphering viral determinants of pathogenicity, we still lack crucial information on virus/immune system interactions pertaining to severe disease and high mortality associated with human H5N1 influenza virus infections. Using two human isolates of H5N1 viruses that differ in their pathogenicity in mice, we have defined mechanistic links among the rate of viral replication, mortality, CD8 T cell responses, and immunopathology. The extreme pathogenicity of H5N1 viruses was directly linked to the ability of the virus to replicate rapidly, and swiftly attain high steady-state titers in the lungs within 48 hours after infection. The remarkably high replication rate of the highly pathogenic H5N1 virus did not prevent the induction of IFN-β or activation of CD8 T cells, but the CD8 T cell response was ineffective in controlling viral replication in the lungs and CD8 T cell deficiency did not affect viral titers or mortality. Additionally, BIM deficiency ameliorated lung pathology and inhibited T cell apoptosis without affecting survival of mice. Therefore, rapidly replicating, highly lethal H5N1 viruses could simply outpace and overwhelm the adaptive immune responses, and kill the host by direct cytopathic effects. However, therapeutic suppression of early viral replication and the associated enhancement of CD8 T cell responses improved the survival of mice following a lethal H5N1 infection. These findings suggest that suppression of early H5N1 virus replication is key to the programming of an effective host response, which has implications in treatment of this infection in humans.

Growth and population dynamics during early stages of the mangrove Kandelia candel in Halong Bay, North Viet Nam

NASA Astrophysics Data System (ADS)

Thi Ha, Hoang; Duarte, Carlos M.; Tri, Nguyen Hoang; Terrados, Jorge; Borum, Jens

2003-11-01

Quantifying the dynamics of the early stages in the life cycle of mangroves is essential to predict the distribution, species composition and structure of mangrove forests, and their maintenance and recovery from perturbations. The growth and population dynamics of two stands of the mangrove Kandelia candel in Halong Bay (Viet Nam) were examined for 1 year. Growth was highly seasonal, with high growth rates and fast internode formation in the summer, dropping to extremely low growth during January-February, the coldest and driest months in the year. In addition, growth and internode formation rates showed important inter-annual variability during the last decade. The complete reproductive period required 7-8 months. Flower initiation was maximal in June and peak propagule maturity occurred in December-January. Only one mature propagule developed for every 67 and 127 inflorescence buds formed at Site 1 and Site 2, respectively. Kandelia candel propagules begun to sink 10 days after being released, and after 18 days all propagules had negative buoyancy. The propagules developed roots within 19-68 days, depending on whether they were held on the water or sediment, and were capable of long range dispersal, for 15-20% of them dispersed more than 100 m within 1 day. The median age of K. candel plants ranged between 8.7 and 5.6 years, with a density of 1900 and 470 plants ha -1, in Sites 1 and 2. Plant mortality was high, with 64 and 74% of the plants surviving after a year at Sites 1 and 2. Life expectancy (i.e. median age-at-death) of only 2.2 and 2.7 years at Sites 1 and 2, respectively, indicates that mortality of young K. candel plants was specially high. Recruitment occurred in early spring, and did not suffice to balance the mortality within the annual period examined. These results suggest that the K. candel stands in Halong Bay might be maintained by a few years of high recruitment which would compensate for generally high mortality rates.

Heat Death Associations with the built environment, social vulnerability and their interactions with rising temperature.

PubMed

Eisenman, David P; Wilhalme, Holly; Tseng, Chi-Hong; Chester, Mikhail; English, Paul; Pincetl, Stephanie; Fraser, Andrew; Vangala, Sitaram; Dhaliwal, Satvinder K

2016-09-01

In an extreme heat event, people can go to air-conditioned public facilities if residential air-conditioning is not available. Residences that heat slowly may also mitigate health effects, particularly in neighborhoods with social vulnerability. We explored the contributions of social vulnerability and these infrastructures to heat mortality in Maricopa County and whether these relationships are sensitive to temperature. Using Poisson regression modeling with heat-related mortality as the outcome, we assessed the interaction of increasing temperature with social vulnerability, access to publicly available air conditioned space, home air conditioning and the thermal properties of residences. As temperatures increase, mortality from heat-related illness increases less in census tracts with more publicly accessible cooled spaces. Mortality from all internal causes of death did not have this association. Building thermal protection was not associated with mortality. Social vulnerability was still associated with mortality after adjusting for the infrastructure variables. To reduce heat-related mortality, the use of public cooled spaces might be expanded to target the most vulnerable. Copyright © 2016 Elsevier Ltd. All rights reserved.

The mortality profile of black Seventh-Day Adventists residing in metropolitan Atlanta: a pilot study.

PubMed

Murphy, F G; Blumenthal, D S; Dickson-Smith, J; Peay, R P

1990-08-01

Mortality information was gathered for 110 Black Seventh-day Adventist members of seven churches in Metropolitan Atlanta, Georgia during the period 1980-87. Seventy-seven percent of the deaths were due to cardiovascular diseases; 8 percent due to cancer, the second leading cause of death. The cancer rate is extremely low in comparison to the proportion of deaths due to cardiovascular diseases. Subsequent research on this population will take into consideration lifestyle factors which could contribute to this finding.

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia

PubMed Central

Almashouq, Mohammad K.; Youssef, Amira M.; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N.

2017-01-01

Background Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Methods Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients’ files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. Results The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55–5.23) and 7.21 (5.70–8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Conclusions Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered. PMID:29176889

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia.

PubMed

Al-Rubeaan, Khalid; Almashouq, Mohammad K; Youssef, Amira M; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N

2017-01-01

Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients' files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55-5.23) and 7.21 (5.70-8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered.

Blow me down: A new perspective on Aloe dichotoma mortality from windthrow

PubMed Central

2014-01-01

Background Windthrow, the uprooting of trees during storms associated with strong winds, is a well-established cause of mortality in temperate regions of the world, often with large ecological consequences. However, this phenomenon has received little attention within arid regions and is not well documented in southern Africa. Slow rates of post-disturbance recovery and projected increases in extreme weather events in arid areas mean that windthrow could be more common and have bigger impacts on these ecosystems in the future. This is of concern due to slow rates of post-disturbance recovery in arid systems and projected increases in extreme weather events in these areas. This study investigated the spatial pattern, magnitude and likely causes of windthrown mortality in relation to other forms of mortality in Aloe dichotoma, an iconic arid-adapted arborescent succulent and southern Africa climate change indicator species. Results We found that windthrown mortality was greatest within the equatorward summer rainfall zone (SRZ) of its distribution (mean = 31%, n = 11), and was derived almost exclusively from the larger adult age class. A logistic modelling exercise indicated that windthrown mortality was strongly associated with greater amounts of warm season (summer) rainfall in the SRZ, higher wind speeds, and leptosols. A statistically significant interaction term between higher summer rainfall and wind speeds further increased the odds of being windthrown. While these results would benefit from improvements in the resolution of wind and substrate data, they do support the hypothesised mechanism for windthrow in A. dichotoma. This involves powerful storm gusts associated with either the current or subsequent rainfall event, heavy convective rainfall, and an associated increase in soil malleability. Shallow rooting depths in gravel-rich soils and an inflexible, top-heavy canopy structure make individuals especially prone to windthrown mortality during storms. Conclusions Results highlight the importance of this previously unrecognised form of mortality in A. dichotoma, especially since it seems to disproportionately affect reproductively mature adult individuals in an infrequently recruiting species. Smaller, more geographically isolated and adult dominated populations in the summer rainfall zone are likely to be more vulnerable to localised extinction due to windthrow events. PMID:24641794

Blow me down: a new perspective on Aloe dichotoma mortality from windthrow.

PubMed

Jack, Samuel Linton; Hoffman, Michael Timm; Rohde, Rick Frederick; Durbach, Ian; Archibald, Margaret

2014-03-18

Windthrow, the uprooting of trees during storms associated with strong winds, is a well-established cause of mortality in temperate regions of the world, often with large ecological consequences. However, this phenomenon has received little attention within arid regions and is not well documented in southern Africa. Slow rates of post-disturbance recovery and projected increases in extreme weather events in arid areas mean that windthrow could be more common and have bigger impacts on these ecosystems in the future. This is of concern due to slow rates of post-disturbance recovery in arid systems and projected increases in extreme weather events in these areas. This study investigated the spatial pattern, magnitude and likely causes of windthrown mortality in relation to other forms of mortality in Aloe dichotoma, an iconic arid-adapted arborescent succulent and southern Africa climate change indicator species. We found that windthrown mortality was greatest within the equatorward summer rainfall zone (SRZ) of its distribution (mean = 31%, n = 11), and was derived almost exclusively from the larger adult age class. A logistic modelling exercise indicated that windthrown mortality was strongly associated with greater amounts of warm season (summer) rainfall in the SRZ, higher wind speeds, and leptosols. A statistically significant interaction term between higher summer rainfall and wind speeds further increased the odds of being windthrown. While these results would benefit from improvements in the resolution of wind and substrate data, they do support the hypothesised mechanism for windthrow in A. dichotoma. This involves powerful storm gusts associated with either the current or subsequent rainfall event, heavy convective rainfall, and an associated increase in soil malleability. Shallow rooting depths in gravel-rich soils and an inflexible, top-heavy canopy structure make individuals especially prone to windthrown mortality during storms. Results highlight the importance of this previously unrecognised form of mortality in A. dichotoma, especially since it seems to disproportionately affect reproductively mature adult individuals in an infrequently recruiting species. Smaller, more geographically isolated and adult dominated populations in the summer rainfall zone are likely to be more vulnerable to localised extinction due to windthrow events.

Variation in embryonic mortality and maternal transcript expression among Atlantic cod (Gadus morhua) broodstock: a functional genomics study.

PubMed

Rise, Matthew L; Nash, Gordon W; Hall, Jennifer R; Booman, Marije; Hori, Tiago S; Trippel, Edward A; Gamperl, A Kurt

2014-12-01

Early life stage mortality is an important issue for Atlantic cod aquaculture, yet the impact of the cod maternal (egg) transcriptome on egg quality and mortality during embryonic development is poorly understood. In the present work, we studied embryonic mortality and maternal transcript expression using eggs from 15 females. Total mortality at 7days post-fertilization (7 dpf, segmentation stage) was used as an indice of egg quality. A 20,000 probe (20K) microarray experiment compared the 7hours post-fertilization (7 hpf, ~2-cell stage) egg transcriptome of the two lowest quality females (>90% mortality at 7 dpf) to that of the highest quality female (~16% mortality at 7 dpf). Forty-three microarray probes were consistently differentially expressed in both low versus high quality egg comparisons (25 higher expressed in low quality eggs, and 18 higher expressed in high quality eggs). The microarray experiment also identified many immune-relevant genes [e.g. interferon (IFN) pathway genes ifngr1 and ifrd1)] that were highly expressed in eggs of all 3 females regardless of quality. Twelve of the 43 candidate egg quality-associated genes, and ifngr1, ifrd1 and irf7, were included in a qPCR study with 7 hpf eggs from all 15 females. Then, the genes that were confirmed by qPCR to be greater than 2-fold differentially expressed between 7 hpf eggs from the lowest and highest quality females (dcbld1, ddc, and acy3 more highly expressed in the 2 lowest quality females; kpna7 and hacd1 more highly expressed in the highest quality female), and the 3 IFN pathway genes, were included in a second qPCR study with unfertilized eggs. While some maternal transcripts included in these qPCR studies were associated with extremes in egg quality, there was little correlation between egg quality and gene expression when all females were considered. Both dcbld1 and ddc showed greater than 100-fold differences in transcript expression between females and were potentially influenced by family. The Atlantic cod ddc (dopa decarboxylase) complete cDNA was characterized, and has a 1461bp open reading frame encoding a 486 amino acid protein that contains all eight residues of the conserved pyridoxal 5'-phosphate binding site including the catalytic lysine. This study provides valuable new information and resources related to the Atlantic cod egg transcriptome. Some of these microarray-identified, qPCR-confirmed, Atlantic cod egg transcripts (e.g. ddc, kpna7) play important roles during embryonic development of other vertebrate species, and may have similar functions in Atlantic cod. Copyright © 2014. Published by Elsevier B.V.

Forest responses to increasing aridity and warmth in the southwestern United States.

PubMed

Williams, A Park; Allen, Craig D; Millar, Constance I; Swetnam, Thomas W; Michaelsen, Joel; Still, Christopher J; Leavitt, Steven W

2010-12-14

In recent decades, intense droughts, insect outbreaks, and wildfires have led to decreasing tree growth and increasing mortality in many temperate forests. We compared annual tree-ring width data from 1,097 populations in the coterminous United States to climate data and evaluated site-specific tree responses to climate variations throughout the 20th century. For each population, we developed a climate-driven growth equation by using climate records to predict annual ring widths. Forests within the southwestern United States appear particularly sensitive to drought and warmth. We input 21st century climate projections to the equations to predict growth responses. Our results suggest that if temperature and aridity rise as they are projected to, southwestern trees will experience substantially reduced growth during this century. As tree growth declines, mortality rates may increase at many sites. Increases in wildfires and bark-beetle outbreaks in the most recent decade are likely related to extreme drought and high temperatures during this period. Using satellite imagery and aerial survey data, we conservatively calculate that ≈ 2.7% of southwestern forest and woodland area experienced substantial mortality due to wildfires from 1984 to 2006, and ≈ 7.6% experienced mortality associated with bark beetles from 1997 to 2008. We estimate that up to ≈ 18% of southwestern forest area (excluding woodlands) experienced mortality due to bark beetles or wildfire during this period. Expected climatic changes will alter future forest productivity, disturbance regimes, and species ranges throughout the Southwest. Emerging knowledge of these impending transitions informs efforts to adaptively manage southwestern forests.

Forest responses to increasing aridity and warmth in the southwestern United States

USGS Publications Warehouse

Williams, A.P.; Allen, Craig D.; Millar, C.I.; Swetnam, T.W.; Michaelsen, J.; Still, C.J.; Leavitt, Steven W.

2010-01-01

In recent decades, intense droughts, insect outbreaks, and wildfires have led to decreasing tree growth and increasing mortality in many temperate forests. We compared annual tree-ring width data from 1,097 populations in the coterminous United States to climate data and evaluated site-specific tree responses to climate variations throughout the 20th century. For each population, we developed a climate-driven growth equation by using climate records to predict annual ring widths. Forests within the southwestern United States appear particularly sensitive to drought and warmth. We input 21st century climate projections to the equations to predict growth responses. Our results suggest that if temperature and aridity rise as they are projected to, southwestern trees will experience substantially reduced growth during this century. As tree growth declines, mortality rates may increase at many sites. Increases in wildfires and bark-beetle outbreaks in the most recent decade are likely related to extreme drought and high temperatures during this period. Using satellite imagery and aerial survey data, we conservatively calculate that ≈2.7% of southwestern forest and woodland area experienced substantial mortality due to wildfires from 1984 to 2006, and ≈7.6% experienced mortality associated with bark beetles from 1997 to 2008. We estimate that up to ≈18% of southwestern forest area (excluding woodlands) experienced mortality due to bark beetles or wildfire during this period. Expected climatic changes will alter future forest productivity, disturbance regimes, and species ranges throughout the Southwest. Emerging knowledge of these impending transitions informs efforts to adaptively manage southwestern forests.

From many deaths to some few cases of drug-resistant tuberculosis: travelling with the systems quality improvement model in Lacs Health District, Togo

PubMed Central

Afanvi, Kossivi Agbelenko

2015-01-01

The ultimate goal of every tuberculosis (TB) treatment program is a high treatment success rate. Treatment success is extremely important because, when the rate is high, it significantly contributes to declining numbers of new cases by reducing the number and period of infectious cases, TB morbidity and mortality, and prevents the emergence of resistant strains. Our aim was to decrease TB mortality by increasing pulmonary TB patients’ treatment success rate to at least 85 % in Lacs Health District by end of July 2014. A systems and dialogic analysis of the public health system related to TB patients’ treatment revealed that it was not performing well; we found weak coverage and quality of TB services, a poorly-functioning TB health information system, poor-performing health workforce, poor availability of HIV tests and antiretroviral for TB patients, and low degree of patients’ participation in their care. We redesigned the system to correct those weaknesses. The effectiveness of these changes was monitored using plan, do, study, act (PDSA) cycles. We increased TB patient success rate from 80% to 95% between February 2012 and July 2014.The mortality rate dropped from 13% to 3% and the failure to follow-up rate dropped from 3% to 2%. In conclusion, district health systems performance depends on factors such as the closeness of services to population; skilled workforce; the ability to collect and analyze data and use information for action; population empowerment, and good management and improvement capabilities of management team especially the public health director. High TB patients’ success rate depends also on the availability of antiretroviral drugs. It is highly important that every district health management team member develops improvement capabilities. PMID:26734412

Alcohol in Greenland 1951-2010: consumption, mortality, prices.

PubMed

Aage, Hans

2012-01-01

Fluctuations in alcohol consumption in Greenland have been extreme since alcohol became available to the Greenland Inuit in the 1950s, increasing from low levels in the 1950s to very high levels in the 1980s - about twice as high as alcohol consumption in Denmark. Since then, consumption has declined, and current consumption is slightly below alcohol consumption in Denmark, while alcohol prices are far above Danish prices. Description of historical trends and possible causal connections of alcohol prices, alcohol consumption and alcohol-related mortality in Greenland 1951-2010 as a background for the evaluation of the impact of various types of policy. Time series for Greenland 1951-2010 for alcohol prices, consumption and mortality are compiled, and variation and correlations are discussed in relation to various policies aimed at limiting alcohol consumption. Corresponding time series for Denmark 1906-2010 are presented for comparison. The trends in alcohol prices and consumption followed each other rather closely until the 1990s in Greenland and the 1980s in Denmark. At this time, consumption stabilised while prices decreased further, but the effect of prices upon consumption is strong, also in recent years. A trend in Greenlandic mortality similar to consumption is discernible, but not significant. Among alcohol-related deaths cirrhosis of the liver is less prevalent whilst accidents are more prevalent than in Denmark. The effect of alcohol excise taxes and rationing upon consumption is evident. The stabilisation and subsequent decline in consumption since the mid-1990s, while alcohol prices decreased persistently, does not preclude continued effects of prices. On the contrary, price effects have been neutralised by other stronger causes. Whether these are government anti-alcohol campaigns or a cultural change is not clear.

Alcohol in Greenland 1951–2010: consumption, mortality, prices

PubMed Central

Aage, Hans

2012-01-01

Background Fluctuations in alcohol consumption in Greenland have been extreme since alcohol became available to the Greenland Inuit in the 1950s, increasing from low levels in the 1950s to very high levels in the 1980s – about twice as high as alcohol consumption in Denmark. Since then, consumption has declined, and current consumption is slightly below alcohol consumption in Denmark, while alcohol prices are far above Danish prices. Objective Description of historical trends and possible causal connections of alcohol prices, alcohol consumption and alcohol-related mortality in Greenland 1951–2010 as a background for the evaluation of the impact of various types of policy. Design Time series for Greenland 1951–2010 for alcohol prices, consumption and mortality are compiled, and variation and correlations are discussed in relation to various policies aimed at limiting alcohol consumption. Corresponding time series for Denmark 1906–2010 are presented for comparison. Results The trends in alcohol prices and consumption followed each other rather closely until the 1990s in Greenland and the 1980s in Denmark. At this time, consumption stabilised while prices decreased further, but the effect of prices upon consumption is strong, also in recent years. A trend in Greenlandic mortality similar to consumption is discernible, but not significant. Among alcohol-related deaths cirrhosis of the liver is less prevalent whilst accidents are more prevalent than in Denmark. Conclusions The effect of alcohol excise taxes and rationing upon consumption is evident. The stabilisation and subsequent decline in consumption since the mid-1990s, while alcohol prices decreased persistently, does not preclude continued effects of prices. On the contrary, price effects have been neutralised by other stronger causes. Whether these are government anti-alcohol campaigns or a cultural change is not clear. PMID:23256091

Aetiology and management of malnutrition in HIV-positive children

PubMed Central

Rose, Anna M; Hall, Charles S; Martinez-Alier, Nuria

2014-01-01

Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent. PMID:24406803

Cryptic disease-induced mortality may cause host extinction in an apparently stable host-parasite system.

PubMed

Valenzuela-Sánchez, Andrés; Schmidt, Benedikt R; Uribe-Rivera, David E; Costas, Francisco; Cunningham, Andrew A; Soto-Azat, Claudio

2017-09-27

The decline of wildlife populations due to emerging infectious disease often shows a common pattern: the parasite invades a naive host population, producing epidemic disease and a population decline, sometimes with extirpation. Some susceptible host populations can survive the epidemic phase and persist with endemic parasitic infection. Understanding host-parasite dynamics leading to persistence of the system is imperative to adequately inform conservation practice. Here we combine field data, statistical and mathematical modelling to explore the dynamics of the apparently stable Rhinoderma darwinii - Batrachochytrium dendrobatidis (Bd) system. Our results indicate that Bd-induced population extirpation may occur even in the absence of epidemics and where parasite prevalence is relatively low. These empirical findings are consistent with previous theoretical predictions showing that highly pathogenic parasites are able to regulate host populations even at extremely low prevalence, highlighting that disease threats should be investigated as a cause of population declines even in the absence of an overt increase in mortality. © 2017 The Author(s).

Extreme heat waves under 1.5 °C and 2 °C global warming

NASA Astrophysics Data System (ADS)

Dosio, Alessandro; Mentaschi, Lorenzo; Fischer, Erich M.; Wyser, Klaus

2018-05-01

Severe, extreme, and exceptional heat waves, such as those that occurred over the Balkans (2007), France (2003), or Russia (2010), are associated with increased mortality, human discomfort and reduced labour productivity. Based on the results of a very high-resolution global model, we show that, even at 1.5 °C warming, a significant increase in heat wave magnitude is expected over Africa, South America, and Southeast Asia. Compared to a 1.5 °C world, under 2 °C warming the frequency of extreme heat waves would double over most of the globe. In a 1.5 °C world, 13.8% of the world population will be exposed to severe heat waves at least once every 5 years. This fraction becomes nearly three times larger (36.9%) under 2 °C warming, i.e. a difference of around 1.7 billion people. Limiting global warming to 1.5 °C will also result in around 420 million fewer people being frequently exposed to extreme heat waves, and ~65 million to exceptional heat waves. Nearly 700 million people (9.0% of world population) will be exposed to extreme heat waves at least once every 20 years in a 1.5 °C world, but more than 2 billion people (28.2%) in a 2 °C world. With current emission trends threatening even the 2 °C target, our study is helpful to identify regions where limiting the warming to 1.5 °C would have the strongest benefits in reducing population exposure to extreme heat.

Relationship of Climatic and Forest Factors to Drought- and Heat-Induced Tree Mortality

PubMed Central

Zhang, Qingyin; Shao, Ming’an; Jia, Xiaoxu; Wei, Xiaorong

2017-01-01

Tree mortality due to warming and drought is a critical aspect of forest ecosystem in responding to climate change. Spatial patterns of tree mortality induced by drought and its influencing factors, however, have yet to be documented at the global scale. We collected observations from 248 sites globally where trees have died due to drought and then assessed the effects of climatic and forest factors on the rate of tree mortality. The global mean annual mortality rate was 5.5%. The rate of tree mortality was significantly and negatively correlated with mean annual precipitation (P < 0.01). Tree mortality was lowest in tropical rainforests with mean annual precipitation >2000 mm and was severe in regions with mean annual precipitation <1000 mm. Mortality rates varied amongst species. The global annual rate of mortality was much higher for gymnosperms (7.1%) than angiosperms (4.8%) but did not differ significantly between evergreen (6.2%) and deciduous (6.1%) species. Stand age and wood density affected the mortality rate. Saplings (4.6%) had a higher mortality rate than mature trees (3.2%), and mortality rates significantly decreased with increasing wood density for all species (P < 0.01). We therefore concluded that the tree mortality around the globe varied with climatic and forest factors. The differences between tree species, wood density, stand density, and stand age should be considered when evaluating tree mortality at a large spatial scale during future climatic extremes. PMID:28095437

Relationship of Climatic and Forest Factors to Drought- and Heat-Induced Tree Mortality.

PubMed

Zhang, Qingyin; Shao, Ming'an; Jia, Xiaoxu; Wei, Xiaorong

2017-01-01

Tree mortality due to warming and drought is a critical aspect of forest ecosystem in responding to climate change. Spatial patterns of tree mortality induced by drought and its influencing factors, however, have yet to be documented at the global scale. We collected observations from 248 sites globally where trees have died due to drought and then assessed the effects of climatic and forest factors on the rate of tree mortality. The global mean annual mortality rate was 5.5%. The rate of tree mortality was significantly and negatively correlated with mean annual precipitation (P < 0.01). Tree mortality was lowest in tropical rainforests with mean annual precipitation >2000 mm and was severe in regions with mean annual precipitation <1000 mm. Mortality rates varied amongst species. The global annual rate of mortality was much higher for gymnosperms (7.1%) than angiosperms (4.8%) but did not differ significantly between evergreen (6.2%) and deciduous (6.1%) species. Stand age and wood density affected the mortality rate. Saplings (4.6%) had a higher mortality rate than mature trees (3.2%), and mortality rates significantly decreased with increasing wood density for all species (P < 0.01). We therefore concluded that the tree mortality around the globe varied with climatic and forest factors. The differences between tree species, wood density, stand density, and stand age should be considered when evaluating tree mortality at a large spatial scale during future climatic extremes.

Post-fire reconstructions of fire intensity from fire severity data: quantifying the role of spatial variability of fire intensity on forest dynamics

NASA Astrophysics Data System (ADS)

Baker, Patrick; Oborne, Lisa

2015-04-01

Large, high-intensity fires have direct and long-lasting effects on forest ecosystems and present a serious threat to human life and property. However, even within the most catastrophic fires there is important variability in local-scale intensity that has important ramifications for forest mortality and regeneration. Quantifying this variability is difficult due to the rarity of catastrophic fire events, the extreme conditions at the time of the fires, and their large spatial extent. Instead fire severity is typically measured or estimated from observed patterns of vegetation mortality; however, differences in species- and size-specific responses to fires often makes fire severity a poor proxy for fire intensity. We developed a statistical method using simple, plot-based measurements of individual tree mortality to simultaneously estimate plot-level fire intensity and species-specific mortality patterns as a function of tree size. We applied our approach to an area of forest burned in the catastrophic Black Saturday fires that occurred near Melbourne, Australia, in February 2009. Despite being the most devastating fire in the past 70 years and our plots being located in the area that experienced some of the most intense fires in the 350,000 ha fire complex, we found that the estimated fire intensity was highly variable at multiple spatial scales. All eight tree species in our study differed in their susceptibility to fire-induced mortality, particularly among the largest size classes. We also found that seedling height and species richness of the post-fire seedling communities were both positively correlated with fire intensity. Spatial variability in disturbance intensity has important, but poorly understood, consequences for the short- and long-term dynamics of forests in the wake of catastrophic wildfires. Our study provides a tool to estimate fire intensity after a fire has passed, allowing new opportunities for linking spatial variability in fire intensity to forest ecosystem dynamics.

Delayed interval delivery in multiple gestations.

PubMed

Platt, J S; Rosa, C

1999-05-01

The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. Perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. Attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. Review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.

Emergency aortic valve replacement and Caesarian section in a primigravida with severe aortic stenosis: a case report.

PubMed

Kochhar, Puneet K; Zutshi, V; Shamsunder, S; Batra, S; Ghosh, P

2011-01-01

Congenital bicuspid aortic valve with severe aortic stenosis (AS) is a rare condition (3-6% of patients with congenital heart disease). Pregnancy in these patients carries a high risk of maternal and fetal mortality. With advancing gestational age, these women may develop cardiac failure due to increased cardiorespiratory requirements. When medical therapy proves insufficient, cardiac surgery becomes mandatory to save the patient's life. Balloon valvuloplasty is only palliative treatment, the duration of benefit being only 6 months. Valve replacement is thus recommended. Cardiopulmonary bypass (CPB) surgery with valve replacement has been reported to carry a lower risk of maternal mortality (1.5-13%) but a very high fetal risk (16-40%). This paper reports the case of a 30-year-old primigravida with severe AS with bicuspid aortic valve and pulmonary congestion clinically uncontrolled, in whom CPB surgery and aortic valve replacement was performed as an emergency procedure, along with a lower segment Caesarian section. The outcome of unrelieved severe symptomatic AS in pregnancy is poor. Multidisciplinary management is important to avoid deterioration in cardiac performance in parturients with severe AS. CPB during pregnancy carries a high risk to the fetus. Therefore, open heart surgery during pregnancy should be advised only in extreme emergencies (ie, heart failure refractory to conventional therapy).

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

PubMed Central

Nielsen, Travis B.; Bonomo, Robert A.; Pantapalangkoor, Paul; Luna, Brian; Spellberg, Brad

2016-01-01

SUMMARY Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)–Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed. PMID:27974412

Cervicofacial necrotizing fasciitis following periodontal abscess.

PubMed

Medeiros, Rui; Catunda, Ivson de Sousa; Queiroz, Isaac Vieira; de Morais, Hecio Henrique Araujo; Leao, Jair Carneiro; Gueiros, Luiz Alcino Monteiro

2012-01-01

Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

Subarachnoid and Intracerebral Hemorrhage in Patients with Churg-Strauss Syndrome: Two Case Reports

PubMed Central

Go, Myeong Hoon; Park, Jeong Un; Kang, Jae Gyu

2012-01-01

Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity. The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS. PMID:23210058

Can Diabetes Be Controlled by Lifestyle Activities?

PubMed

Reddy, P Hemachandra

2017-03-01

Diabetes is a complex disease that affects millions of people worldwide. Diabetes is a metabolic disease, in which increased blood glucose levels ultimately lead to heart disease, stroke, kidney failure, foot ulcers, and damage to the eyes. Current prevalence rates of diabetes are extremely high in countries throughout the world. Multiple forms of diabetes have been identified, including type 1, type 2, type 3, neonatal and gestational. The purpose of this article is to discuss recent developments in diabetes research, including prevalence, morbidity and mortality rates, and lifestyle factors that are associated with diabetes onset and progression. This article also discusses how lifestyle factors delay and/or prevent diabetes.

Establishment and performance of an experimental green roof under extreme climatic conditions.

PubMed

Klein, Petra M; Coffman, Reid

2015-04-15

Green roofs alter the surface energy balance and can help in mitigating urban heat islands. However, the cooling of green roofs due to evapotranspiration strongly depends on the climatic conditions, and vegetation type and density. In the Southern Central Plains of the United States, extreme weather events, such as high winds, heat waves and drought conditions pose challenges for successful implementation of green roofs, and likely alter their standard performance. The National Weather Center Experimental Green Roof, an interdisciplinary research site established in 2010 in Norman, OK, aimed to investigate the ecological performance and surface energy balance of green roof systems. Starting in May 2010, 26 months of vegetation studies were conducted and the radiation balance, air temperature, relative humidity, and buoyancy fluxes were monitored at two meteorological stations during April-October 2011. The establishment of a vegetative community trended towards prairie plant dominance. High mortality of succulents and low germination of grasses and herbaceous plants contributed to low vegetative coverage. In this condition succulent diversity declined. Bouteloua gracilis and Delosperma cooperi showed typological dominance in harsh climatic conditions, while Sedum species experienced high mortality. The plant community diversified through volunteers such as Euphorbia maculate and Portulaca maculate. Net radiation measured at a green-roof meteorological station was higher than at a control station over the original, light-colored roofing material. These findings indicate that the albedo of the green roof was lower than the albedo of the original roofing material. The low vegetative coverage during the heat and drought conditions in 2011, which resulted in the dark substrate used in the green roof containers being exposed, likely contributed to the low albedo values. Nevertheless, air temperatures and buoyancy fluxes were often lower over the green roof indicating that higher evapotranspiration rates compensated for the higher net radiation at the green roof. Copyright © 2015 Elsevier B.V. All rights reserved.

Winter Season Mortality: Will Climate Warming Bring Benefits?

PubMed

Kinney, Patrick L; Schwartz, Joel; Pascal, Mathilde; Petkova, Elisaveta; Tertre, Alain Le; Medina, Sylvia; Vautard, Robert

2015-06-01

Extreme heat events are associated with spikes in mortality, yet death rates are on average highest during the coldest months of the year. Under the assumption that most winter excess mortality is due to cold temperature, many previous studies have concluded that winter mortality will substantially decline in a warming climate. We analyzed whether and to what extent cold temperatures are associated with excess winter mortality across multiple cities and over multiple years within individual cities, using daily temperature and mortality data from 36 US cities (1985-2006) and 3 French cities (1971-2007). Comparing across cities, we found that excess winter mortality did not depend on seasonal temperature range, and was no lower in warmer vs. colder cities, suggesting that temperature is not a key driver of winter excess mortality. Using regression models within monthly strata, we found that variability in daily mortality within cities was not strongly influenced by winter temperature. Finally we found that inadequate control for seasonality in analyses of the effects of cold temperatures led to spuriously large assumed cold effects, and erroneous attribution of winter mortality to cold temperatures. Our findings suggest that reductions in cold-related mortality under warming climate may be much smaller than some have assumed. This should be of interest to researchers and policy makers concerned with projecting future health effects of climate change and developing relevant adaptation strategies.

Winter season mortality: will climate warming bring benefits?

NASA Astrophysics Data System (ADS)

Kinney, Patrick L.; Schwartz, Joel; Pascal, Mathilde; Petkova, Elisaveta; Le Tertre, Alain; Medina, Sylvia; Vautard, Robert

2015-06-01

Extreme heat events are associated with spikes in mortality, yet death rates are on average highest during the coldest months of the year. Under the assumption that most winter excess mortality is due to cold temperature, many previous studies have concluded that winter mortality will substantially decline in a warming climate. We analyzed whether and to what extent cold temperatures are associated with excess winter mortality across multiple cities and over multiple years within individual cities, using daily temperature and mortality data from 36 US cities (1985-2006) and 3 French cities (1971-2007). Comparing across cities, we found that excess winter mortality did not depend on seasonal temperature range, and was no lower in warmer vs. colder cities, suggesting that temperature is not a key driver of winter excess mortality. Using regression models within monthly strata, we found that variability in daily mortality within cities was not strongly influenced by winter temperature. Finally we found that inadequate control for seasonality in analyses of the effects of cold temperatures led to spuriously large assumed cold effects, and erroneous attribution of winter mortality to cold temperatures. Our findings suggest that reductions in cold-related mortality under warming climate may be much smaller than some have assumed. This should be of interest to researchers and policy makers concerned with projecting future health effects of climate change and developing relevant adaptation strategies.

Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess.

PubMed

Osterhoff, Georg; Scheyerer, Max J; Fritz, Yannick; Bouaicha, Samy; Wanner, Guido A; Simmen, Hans-Peter; Werner, Clément M L

2014-04-01

Radiology-based classifications of pelvic ring injuries and their relevance for the prognosis of morbidity and mortality are disputed in the literature. The purpose of this study was to evaluate potential differences between the pelvic ring injury classification systems by Tile and by Young and Burgess with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Two-hundred-and-eighty-five consecutive patients with pelvic ring fractures were analyzed for mortality within 30 days after admission, number of blood units and total volume of fluid infused during the first 24h after trauma, the Abbreviated Injury Severity (AIS) scores for head, chest, spine, abdomen and extremities as a function of the Tile and the Young-Burgess classifications. There was no significant relationship between occurrence of death and fracture pattern but a significant relationship between fracture pattern and need for blood units/total fluid volume for Tile (p<.001/p<.001) and Young-Burgess (p<.001/p<.001). In both classifications, open book fractures were associated with more fluid requirement and more severe injuries of the abdomen, spine and extremities (p<.05). When divided into the larger subgroups "partially stable" and "unstable", unstable fractures were associated with a higher mortality rate in the Young-Burgess system (p=.036). In both classifications, patients with unstable fractures required significantly more blood transfusions (p<.001) and total fluid infusion (p<.001) and higher AIS scores. In this first direct comparison of both classifications, we found no clinical relevant differences with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Shifts in historical streamflow extremes in the Colorado River Basin

DOE PAGES

Solander, Kurt C.; Bennett, Katrina Eleanor; Middleton, Richard Stephen

2017-07-10

The global phenomenon of climate change-induced shifts in precipitation leading to "wet regions getting wetter" and "dry regions getting drier" has been widely studied. However, the propagation of these changes in atmospheric moisture within stream channels is not a direct relationship due to differences in the timing of how changing precipitation patterns interact with various land surfaces. Streamflow is of particular interest in the Colorado River Basin (CRB) due to the region’s rapidly growing population, projected temperature increases that are expected to be higher than elsewhere in the contiguous United States, and subsequent climate-driven disturbances including drought, vegetation mortality, andmore » wildfire, which makes the region more vulnerable to changes in hydrologic extremes. Here in this study, we determine how streamflow extremes have shifted in the CRB using two statistical methods—the Mann-Kendall trend detection analysis and Generalized Extreme Value (GEV) theorem. We evaluate these changes in the context of key flow metrics that include high and low flow percentiles, maximum and minimum 7-day flows, and the center timing of streamflow using historical gage records representative of natural flows. Monthly results indicate declines of up to 41% for high and low flows during the June to July peak runoff season, while increases of up to 24% were observed earlier from March to April. Finally, our results highlight a key threshold elevation and latitude of 2300 m and 39° North, respectively, where there is a distinct shift in the trend. The spatiotemporal patterns observed are indicative of changing snowmelt patterns as a primary cause of the shifts. Identification of how this change varies spatially has consequences for improved land management strategies, as specific regions most vulnerable to threats can be prioritized for mitigation or adaptation as the climate warms.« less

Shifts in historical streamflow extremes in the Colorado River Basin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Solander, Kurt C.; Bennett, Katrina Eleanor; Middleton, Richard Stephen

The global phenomenon of climate change-induced shifts in precipitation leading to "wet regions getting wetter" and "dry regions getting drier" has been widely studied. However, the propagation of these changes in atmospheric moisture within stream channels is not a direct relationship due to differences in the timing of how changing precipitation patterns interact with various land surfaces. Streamflow is of particular interest in the Colorado River Basin (CRB) due to the region’s rapidly growing population, projected temperature increases that are expected to be higher than elsewhere in the contiguous United States, and subsequent climate-driven disturbances including drought, vegetation mortality, andmore » wildfire, which makes the region more vulnerable to changes in hydrologic extremes. Here in this study, we determine how streamflow extremes have shifted in the CRB using two statistical methods—the Mann-Kendall trend detection analysis and Generalized Extreme Value (GEV) theorem. We evaluate these changes in the context of key flow metrics that include high and low flow percentiles, maximum and minimum 7-day flows, and the center timing of streamflow using historical gage records representative of natural flows. Monthly results indicate declines of up to 41% for high and low flows during the June to July peak runoff season, while increases of up to 24% were observed earlier from March to April. Finally, our results highlight a key threshold elevation and latitude of 2300 m and 39° North, respectively, where there is a distinct shift in the trend. The spatiotemporal patterns observed are indicative of changing snowmelt patterns as a primary cause of the shifts. Identification of how this change varies spatially has consequences for improved land management strategies, as specific regions most vulnerable to threats can be prioritized for mitigation or adaptation as the climate warms.« less

[Will the climate change affect the mortality from prostate cancer?].

PubMed

Santos Arrontes, Daniel; García González, Jesús Isidro; Martín Muñoz, Manuel Pablo; Castro Pita, Miguel; Mañas Pelillo, Antonio; Paniagua Andrés, Pedro

2007-03-01

The global heating of the atmosphere, as well as the increase of the exposition to sunlight, will be associated with a decrease of the mortality from prostate cancer, due to an increase of the plasmatic levels of vitamin D. To evaluate if climatological factors (temperature, rainfall, and number of sunlight hours per year) may influence the mortality associated with prostate cancer over a five-year period. In this ecology type study we will evaluate the trends of prostate tumors associated mortality in the period between January 1st 1998 and December 31st 2002, in the geographic area of Spain (17 Autonomic communities-CA-and 2 Autonomic cities- Ceuta and Melilla-, 43 million inhabitants). Demographic and mortality data were obtained from the National Institute of Statistics (INE) and climatological data about temperature and rainfall were obtained from the National Institute of Meteorology (INM). The provinces were classified using the climatic index of Martonne (defined as the quotient between annual rainfall and mean annual temperature plus 10). Areas with a quotient below 5 ml/m2/o C are considered extremely arid zones; between 5 and 15 ml/m2/o C are considered arid zones, between 15 and 20 ml/m2/o C semiarid zones; between 20 and 30 ml/m2/o C subhumid zones; between 30 and 60 ml/m2/o C humid zones; and over 60 ml/m2/o C superhumid zones. We compared mortality rates between different climatic areas using the Jonckheere-Terpstra test for six independent samples following the index of Martonne. All calculations were performed using the SPSS v 13.0 for Windows software. A logistic regression model was performed to identify climate factors associated with prostate cancer mortality. A likeliness of the null hypotheses inferior to 0.05 was considered significant. Prostate cancer mortality presented statistically significant differences, being higher in provinces with higher Martonne index (p < 0.001) and lower in areas with a greater number of sunlight hours per year (p = 0.041). The adjusted mortality rate associated with extreme aridity regions and was 21.51 cases/100,000 males year, whereas in humid zones it was 35.87 cases/100,000 males years. Mortality associated with prostate cancer is significantly superior in regions with less exposition to the sunlight. The climate change may lead to a modification of the main epidemiologic patterns, and it may be associated with a modification of cancer mortality rates. Nevertheless, these results should be taken with caution and should be confirmed by prospective studies.

Mass Mortality Events in the NW Adriatic Sea: Phase Shift from Slow- to Fast-Growing Organisms.

PubMed

Di Camillo, Cristina Gioia; Cerrano, Carlo

2015-01-01

Massive outbreaks are increasing all over the world, which are likely related to climate change. The North Adriatic Sea, a sub-basin of the Mediterranean Sea, is a shallow semi-closed sea receiving high nutrients inputs from important rivers. These inputs sustain the highest productive basin of the Mediterranean Sea. Moreover, this area shows a high number of endemisms probably due to the high diversity of environmental conditions and the conspicuous food availability. Here, we documented two massive mortalities (2009 and 2011) and the pattern of recovery of the affected biocoenoses in the next two years. Results show an impressive and fast shift of the benthic assemblage from a biocoenosis mainly composed of slow-growing and long-lived species to a biocoenosis dominated by fast-growing and short-lived species. The sponge Chondrosia reniformis, one of the key species of this assemblage, which had never been involved in previous massive mortality events in the Mediterranean Sea, reduced its coverage by 70%, and only few small specimens survived. All the damaged sponges, together with many associated organisms, were detached by rough-sea conditions, leaving large bare areas on the rocky wall. Almost three years after the disease, the survived specimens of C. reniformis did not increase significantly in size, while the bare areas were colonized by fast-growing species such as stoloniferans, hydrozoans, mussels, algae, serpulids and bryozoans. Cnidarians were more resilient than massive sponges since they quickly recovered in less than one month. In the study area, the last two outbreaks caused a reduction in the filtration efficiency of the local benthic assemblage by over 60%. The analysis of the times series of wave heights and temperature revealed that the conditions in summer 2011 were not so extreme as to justify severe mass mortality, suggesting the occurrence of other factors which triggered the disease. The long-term observations of a benthic assemblage in the NW Adriatic Sea allowed us to monitor its dynamics before, during and after the mortality event. The N Adriatic Sea responds quickly to climatic anomalies and other environmental stresses because of the reduced dimension of the basin. The long-term consequences of frequent mass mortality episodes in this area could promote the shift from biocoenoses dominated by slow-growing and long-lived species to assemblages dominated by plastic and short life cycle species.

Time preference and its relationship with age, health, and survival probability

PubMed Central

Chao, Li-Wei; Szrek, Helena; Pereira, Nuno Sousa; Pauly, Mark V.

2009-01-01

Although theories from economics and evolutionary biology predict that one's age, health, and survival probability should be associated with one's subjective discount rate (SDR), few studies have empirically tested for these links. Our study analyzes in detail how the SDR is related to age, health, and survival probability, by surveying a sample of individuals in townships around Durban, South Africa. In contrast to previous studies, we find that age is not significantly related to the SDR, but both physical health and survival expectations have a U-shaped relationship with the SDR. Individuals in very poor health have high discount rates, and those in very good health also have high discount rates. Similarly, those with expected survival probability on the extremes have high discount rates. Therefore, health and survival probability, and not age, seem to be predictors of one's SDR in an area of the world with high morbidity and mortality. PMID:20376300

Summer Precipitation Predicts Spatial Distributions of Semiaquatic Mammals

PubMed Central

Ahlers, Adam A.; Cotner, Lisa A.; Wolff, Patrick J.; Mitchell, Mark A.; Heske, Edward J.; Schooley, Robert L.

2015-01-01

Climate change is predicted to increase the frequency of droughts and intensity of seasonal precipitation in many regions. Semiaquatic mammals should be vulnerable to this increased variability in precipitation, especially in human-modified landscapes where dispersal to suitable habitat or temporary refugia may be limited. Using six years of presence-absence data (2007–2012) spanning years of record-breaking drought and flood conditions, we evaluated regional occupancy dynamics of American mink (Neovison vison) and muskrats (Ondatra zibethicus) in a highly altered agroecosystem in Illinois, USA. We used noninvasive sign surveys and a multiseason occupancy modeling approach to estimate annual occupancy rates for both species and related these rates to summer precipitation. We also tracked radiomarked individuals to assess mortality risk for both species when moving in terrestrial areas. Annual model-averaged estimates of occupancy for mink and muskrat were correlated positively to summer precipitation. Mink and muskrats were widespread during a year (2008) with above-average precipitation. However, estimates of site occupancy declined substantially for mink (0.56) and especially muskrats (0.09) during the severe drought of 2012. Mink are generalist predators that probably use terrestrial habitat during droughts. However, mink had substantially greater risk of mortality away from streams. In comparison, muskrats are more restricted to aquatic habitats and likely suffered high mortality during the drought. Our patterns are striking, but a more mechanistic understanding is needed of how semiaquatic species in human-modified ecosystems will respond ecologically in situ to extreme weather events predicted by climate-change models. PMID:26284916

Summer Precipitation Predicts Spatial Distributions of Semiaquatic Mammals.

PubMed

Ahlers, Adam A; Cotner, Lisa A; Wolff, Patrick J; Mitchell, Mark A; Heske, Edward J; Schooley, Robert L

2015-01-01

Climate change is predicted to increase the frequency of droughts and intensity of seasonal precipitation in many regions. Semiaquatic mammals should be vulnerable to this increased variability in precipitation, especially in human-modified landscapes where dispersal to suitable habitat or temporary refugia may be limited. Using six years of presence-absence data (2007-2012) spanning years of record-breaking drought and flood conditions, we evaluated regional occupancy dynamics of American mink (Neovison vison) and muskrats (Ondatra zibethicus) in a highly altered agroecosystem in Illinois, USA. We used noninvasive sign surveys and a multiseason occupancy modeling approach to estimate annual occupancy rates for both species and related these rates to summer precipitation. We also tracked radiomarked individuals to assess mortality risk for both species when moving in terrestrial areas. Annual model-averaged estimates of occupancy for mink and muskrat were correlated positively to summer precipitation. Mink and muskrats were widespread during a year (2008) with above-average precipitation. However, estimates of site occupancy declined substantially for mink (0.56) and especially muskrats (0.09) during the severe drought of 2012. Mink are generalist predators that probably use terrestrial habitat during droughts. However, mink had substantially greater risk of mortality away from streams. In comparison, muskrats are more restricted to aquatic habitats and likely suffered high mortality during the drought. Our patterns are striking, but a more mechanistic understanding is needed of how semiaquatic species in human-modified ecosystems will respond ecologically in situ to extreme weather events predicted by climate-change models.

Acute kidney injury burden in different clinical units: Data from nationwide survey in China

PubMed Central

Yu, Shengqiang; Yang, Li; Mei, Changlin

2017-01-01

Background The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited. Methods We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records. Results The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients. Conclusions These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity of effective interventions in the high-risk patients in these departments. PMID:28152018

Legume consumption and risk of all-cause, cardiovascular, and cancer mortality in the PREDIMED study.

PubMed

Papandreou, Christopher; Becerra-Tomás, Nerea; Bulló, Mònica; Martínez-González, Miguel Ángel; Corella, Dolores; Estruch, Ramon; Ros, Emilio; Arós, Fernando; Schroder, Helmut; Fitó, Montserrat; Serra-Majem, Lluís; Lapetra, José; Fiol, Miquel; Ruiz-Canela, Miguel; Sorli, Jose V; Salas-Salvadó, Jordi

2018-01-09

Limited prospective studies have examined the association between legumes consumption and mortality, whereas scarce, if at all, previous studies have evaluated such associations taking into consideration specific grain legumes. We aimed to investigate the association between total legumes consumption and grain legumes species (dry beans, chickpeas, lentils, and fresh peas) with all-cause, cardiovascular disease (CVD), cancer and other-cause mortality among elderly Mediterranean individuals at high CVD risk. We prospectively assessed 7216 participants from the PREvención con DIeta MEDiterránea study. Dietary intake was assessed at baseline and yearly during follow-up by using a validated food frequency questionnaire. During a median follow-up of 6.0 years, 425 total deaths, 103 CVD deaths, 169 cancer deaths and 153 due to other-causes deaths occurred. Hazard ratios (HRs) [95% confidence interval (CI)] of CVD mortality were 1.52 (1.02-2.89) (P-trend = 0.034) and 2.23 (1.32-3.78) (P-trend = 0.002) for the 3rd tertile of total legumes and dry beans consumption, respectively, compared with the 1st tertile. When comparing extreme tertiles, higher total legumes and lentils consumption was associated with 49% (HR: 0.51; 95% CI: 0.31-0.84; P-trend = 0.009) and 37% (HR: 0.63; 95% CI: 0.40-0.98; P-trend = 0.049) lower risk of cancer mortality. Similar associations were observed for CVD death in males and for cancer death in males, obese and diabetic participants. These findings support the benefits of legumes consumption for cancer mortality prevention which may be counterbalanced by their higher risk for CVD mortality. The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

PubMed

Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

2011-01-03

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

Isohydric species are not necessarily more carbon limited than anisohydric species during drought.

PubMed

Garcia-Forner, N; Biel, C; Savé, R; Martínez-Vilalta, J

2017-04-01

Isohydry (i.e., strong regulation of leaf water potential, Ψl) is commonly associated with strict stomatal regulation of transpiration under drought, which in turn is believed to minimize hydraulic risk at the expense of reduced carbon assimilation. Hence, the iso/anisohydric classification has been widely used to assess drought resistance and mortality mechanisms across species, with isohydric species being hypothetically more prone to carbon starvation and anisohydric species more vulnerable to hydraulic failure. These hypotheses and their underlying assumptions, however, have rarely been tested under controlled, experimental conditions. Our objective is to assess the physiological mechanisms underlying drought resistance differences between two co-occurring Mediterranean forest species with contrasting drought responses: Phillyrea latifolia L. (anisohydric and more resistant to drought) and Quercus ilex L. (isohydric and less drought resistant). A total of 100 large saplings (50 per species) were subjected to repeated drought treatments for a period of 3 years, after which Q. ilex showed 18% mortality whereas no mortality was detected in P. latifolia. Relatively isohydric behavior was confirmed for Q. ilex, but higher vulnerability to cavitation in this species implied that estimated embolism levels were similar across species (12-52% in Q. ilex vs ~30% in P. latifolia). We also found similar seasonal patterns of stomatal conductance and assimilation between species. If anything, the anisohydric P. latifolia tended to show lower assimilation rates than Q. ilex under extreme drought. Similar growth rates and carbon reserves dynamics in both species also suggests that P. latifolia was as carbon-constrained as Q. ilex. Increasing carbon reserves under extreme drought stress in both species, concurrent with Q. ilex mortality, suggests that mortality in our study was not triggered by carbon starvation. Our results warn against making direct connections between Ψl regulation, stomatal behavior and the mechanisms of drought-induced mortality in plants. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Association of weather and air pollution interactions on daily mortality in 12 Canadian cities.

PubMed

Vanos, J K; Cakmak, S; Kalkstein, L S; Yagouti, Abderrahmane

It has been well established that both meteorological attributes and air pollution concentrations affect human health outcomes. We examined all cause nonaccident mortality relationships for 28 years (1981-2008) in relation to air pollution and synoptic weather type (encompassing air mass) data in 12 Canadian cities. This study first determines the likelihood of summertime extreme air pollution events within weather types using spatial synoptic classification. Second, it examines the modifying effect of weather types on the relative risk of mortality (RR) due to daily concentrations of air pollution (nitrogen dioxide, ozone, sulfur dioxide, and particulate matter <2.5 μm). We assess both single- and two-pollutant interactions to determine dependent and independent pollutant effects using the relatively new time series technique of distributed lag nonlinear modeling (DLNM). Results display dry tropical (DT) and moist tropical plus (MT+) weathers to result in a fourfold and twofold increased likelihood, respectively, of an extreme pollution event (top 5 % of pollution concentrations throughout the 28 years) occurring. We also demonstrate statistically significant effects of single-pollutant exposure on mortality ( p  < 0.05) to be dependent on summer weather type, where stronger results occur in dry moderate (fair weather) and DT or MT+ weather types. The overall average single-effect RR increases due to pollutant exposure within DT and MT+ weather types are 14.9 and 11.9 %, respectively. Adjusted exposures (two-way pollutant effect estimates) generally results in decreased RR estimates, indicating that the pollutants are not independent. Adjusting for ozone significantly lowers 67 % of the single-pollutant RR estimates and reduces model variability, which demonstrates that ozone significantly controls a portion of the mortality signal from the model. Our findings demonstrate the mortality risks of air pollution exposure to differ by weather type, with increased accuracy obtained when accounting for interactive effects through adjustment for dependent pollutants using a DLNM.

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study

PubMed Central

Lin, Hui-Jia; Du, Li-Zhong; Ma, Xiao-Lu; Shi, Li-Ping; Pan, Jia-Hua; Tong, Xiao-Mei; Li, Qiu-Ping; Zhou, Jian-Guo; Yi, Bing; Liu, Ling; Chen, Yun-Bing; Wei, Qiu-Fen; Wu, Hui-Qing; Li, Mei; Liu, Cui-Qing; Gao, Xi-Rong; Xia, Shi-Wen; Li, Wen-Bin; Yan, Chao-Ying; He, Ling; Liang, Kun; Zhou, Xiao-Yu; Han, Shu-Ping; Lyu, Qin; Qiu, Yin-Ping; Li, Wen; Chen, Dong-Mei; Lu, Hong-Ru; Liu, Xiao-Hong; Liu, Hong; Lin, Zhen-Lang; Liu, Li; Zhu, Jia-Jun; Xiong, Hong; Yue, Shao-Jie; Zhuang, Si-Qi

2015-01-01

Background: With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China. Methods: All infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors. Results: A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization. Conclusions: Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries. PMID:26481740

Preparing for Extreme Heat in India: Using High-Resolution Climate Models to Explore the Impact of Rising Temperatures on Human Health and Labor Productivity

NASA Astrophysics Data System (ADS)

Shaw, C.

2016-12-01

Globally, higher daily peak temperatures and longer, more intense heat waves are becoming increasingly frequent due to climate change. India, with relatively low GDP per capita, high population density, and tropical climate, is particularly vulnerable to these trends. In May 2015, one of the worst heat waves in world history hit the country, culminating in at least 2,300 officially-reported deaths as temperatures in some regions reached 48°C. As a result of climate change, heat waves in this region will last longer, be more extreme, and occur with greater frequency in the coming years. Impacts will be felt most acutely by vulnerable populations, which include not only those with frail health, but also populations otherwise considered healthy whose livelihood involves working under exposure to high temperatures. The problem is exacerbated by low levels of economic development, particularly in the under-provision of medical services, a higher proportion of weather-reliant income sources, and the inability to recover quickly from shocks. Responding to these challenges requires collaboration among the disciplines of climate science, public health, economics, and public policy. This project, presented as an online web application using Esri's ArcGIS Story Map, covers 1) the impact of extreme heat on human mortality, 2) the impact of combined heat and humidity (as measured by wet bulb globe temperature) on labor productivity, and 3) emerging best practices in adaptation planning by local municipalities and NGOs. The work is presented in a format that is designed to allow policymakers to take a deeper dive into the literature linking extreme temperature to human health and labor productivity, combined with interactive mapping tools that allow planners to drill down to data at the district level across the country of India. Further, the work presents a case study of heat adaptation planning efforts that have already been implemented in the city of Ahmedabad, allowing planners to understand what adaptations options might be available to mitigate the risk. Taken together, the tool provides a means to stimulate adaptation efforts, helping society's ability to prepare and cope with extreme heat events.

Estimating the effects of Cry1F Bt-maize pollen on non-target Lepidoptera using a mathematical model of exposure

PubMed Central

Perry, Joe N; Devos, Yann; Arpaia, Salvatore; Bartsch, Detlef; Ehlert, Christina; Gathmann, Achim; Hails, Rosemary S; Hendriksen, Niels B; Kiss, Jozsef; Messéan, Antoine; Mestdagh, Sylvie; Neemann, Gerd; Nuti, Marco; Sweet, Jeremy B; Tebbe, Christoph C

2012-01-01

In farmland biodiversity, a potential risk to the larvae of non-target Lepidoptera from genetically modified (GM) Bt-maize expressing insecticidal Cry1 proteins is the ingestion of harmful amounts of pollen deposited on their host plants. A previous mathematical model of exposure quantified this risk for Cry1Ab protein. We extend this model to quantify the risk for sensitive species exposed to pollen containing Cry1F protein from maize event 1507 and to provide recommendations for management to mitigate this risk. A 14-parameter mathematical model integrating small- and large-scale exposure was used to estimate the larval mortality of hypothetical species with a range of sensitivities, and under a range of simulated mitigation measures consisting of non-Bt maize strips of different widths placed around the field edge. The greatest source of variability in estimated mortality was species sensitivity. Before allowance for effects of large-scale exposure, with moderate within-crop host-plant density and with no mitigation, estimated mortality locally was <10% for species of average sensitivity. For the worst-case extreme sensitivity considered, estimated mortality locally was 99·6% with no mitigation, although this estimate was reduced to below 40% with mitigation of 24-m-wide strips of non-Bt maize. For highly sensitive species, a 12-m-wide strip reduced estimated local mortality under 1·5%, when within-crop host-plant density was zero. Allowance for large-scale exposure effects would reduce these estimates of local mortality by a highly variable amount, but typically of the order of 50-fold. Mitigation efficacy depended critically on assumed within-crop host-plant density; if this could be assumed negligible, then the estimated effect of mitigation would reduce local mortality below 1% even for very highly sensitive species. Synthesis and applications. Mitigation measures of risks of Bt-maize to sensitive larvae of non-target lepidopteran species can be effective, but depend on host-plant densities which are in turn affected by weed-management regimes. We discuss the relevance for management of maize events where cry1F is combined (stacked) with a herbicide-tolerance trait. This exemplifies how interactions between biota may occur when different traits are stacked irrespective of interactions between the proteins themselves and highlights the importance of accounting for crop management in the assessment of the ecological impact of GM plants. PMID:22496596

Cryptococcoma mimicking a brain tumor in an immunocompetent patient: case report of an extremely rare presentation.

PubMed

Paiva, Aline Lariessy Campos; Aguiar, Guilherme Brasileiro de; Lovato, Renan Maximilian; Zanetti, Arthus Vilar Deolindo; Panagopoulos, Alexandros Theodoros; Veiga, José Carlos Esteves

2017-11-06

Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.

Evaluating the Performance of the Pediatric Acute Lung Injury Consensus Conference Definition of Acute Respiratory Distress Syndrome.

PubMed

Parvathaneni, Kaushik; Belani, Sanjay; Leung, Dennis; Newth, Christopher J L; Khemani, Robinder G

2017-01-01

The Pediatric Acute Lung Injury Consensus Conference has developed a pediatric-specific definition of acute respiratory distress syndrome, which is a significant departure from both the Berlin and American European Consensus Conference definitions. We sought to test the external validity and potential impact of the Pediatric Acute Lung Injury Consensus Conference definition by comparing the number of cases of acute respiratory distress syndrome and mortality rates among children admitted to a multidisciplinary PICU when classified by Pediatric Acute Lung Injury Consensus Conference, Berlin, and American European Consensus Conference criteria. Retrospective cohort study. Tertiary care, university-affiliated PICU. All patients admitted between March 2009 and April 2013 who met inclusion criteria for acute respiratory distress syndrome. None. Of 4,764 patients admitted to the ICU, 278 (5.8%) met Pediatric Acute Lung Injury Consensus Conference pediatric acute respiratory distress syndrome criteria with a mortality rate of 22.7%. One hundred forty-three (32.2% mortality) met Berlin criteria, and 134 (30.6% mortality) met American European Consensus Conference criteria. All patients who met American European Consensus Conference criteria and 141 (98.6%) patients who met Berlin criteria also met Pediatric Acute Lung Injury Consensus Conference criteria. The 137 patients who met Pediatric Acute Lung Injury Consensus Conference but not Berlin criteria had an overall mortality rate of 13.1%, but 29 had severe acute respiratory distress syndrome with 31.0% mortality. At acute respiratory distress syndrome onset, there was minimal difference in mortality between mild or moderate acute respiratory distress syndrome by both Berlin (32.4% vs 25.0%, respectively) and Pediatric Acute Lung Injury Consensus Conference (16.7% vs 18.6%, respectively) criteria, but higher mortality for severe acute respiratory distress syndrome (Berlin, 43.6%; Pediatric Acute Lung Injury Consensus Conference, 37.0%). Twenty-four hours after acute respiratory distress syndrome onset, the presence of severe acute respiratory distress syndrome (using either Berlin or Pediatric Acute Lung Injury Consensus Conference) was associated with nearly 50% mortality. Applying the Pediatric Acute Lung Injury Consensus Conference definition of acute respiratory distress syndrome has the potential to significantly increase the number of acute respiratory distress syndrome patients identified, with a lower overall mortality rate. However, severe acute respiratory distress syndrome is associated with extremely high mortality, particularly if present at 24 hours after initial diagnosis.

Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis.

PubMed

Pavasini, Rita; Guralnik, Jack; Brown, Justin C; di Bari, Mauro; Cesari, Matteo; Landi, Francesco; Vaes, Bert; Legrand, Delphine; Verghese, Joe; Wang, Cuiling; Stenholm, Sari; Ferrucci, Luigi; Lai, Jennifer C; Bartes, Anna Arnau; Espaulella, Joan; Ferrer, Montserrat; Lim, Jae-Young; Ensrud, Kristine E; Cawthon, Peggy; Turusheva, Anna; Frolova, Elena; Rolland, Yves; Lauwers, Valerie; Corsonello, Andrea; Kirk, Gregory D; Ferrari, Roberto; Volpato, Stefano; Campo, Gianluca

2016-12-22

The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality. Articles were searched in MEDLINE, the Cochrane Library, Google Scholar, and BioMed Central between July and September 2015 and updated in January 2016. Inclusion criteria were observational studies; >50 participants; stratification of population according to SPPB value; data on all-cause mortality; English language publications. Twenty-four articles were selected from available evidence. Data of interest (i.e., clinical characteristics, information after stratification of the sample into four SPPB groups [0-3, 4-6, 7-9, 10-12]) were retrieved from the articles and/or obtained by the study authors. The odds ratio (OR) and/or hazard ratio (HR) was obtained for all-cause mortality according to SPPB category (with SPPB scores 10-12 considered as reference) with adjustment for age, sex, and body mass index. Standardized data were obtained for 17 studies (n = 16,534, mean age 76 ± 3 years). As compared to SPPB scores 10-12, values of 0-3 (OR 3.25, 95%CI 2.86-3.79), 4-6 (OR 2.14, 95%CI 1.92-2.39), and 7-9 (OR 1.50, 95%CI 1.32-1.71) were each associated with an increased risk of all-cause mortality. The association between poor performance on SPPB and all-cause mortality remained highly consistent independent of follow-up length, subsets of participants, geographic area, and age of the population. Random effects meta-regression showed that OR for all-cause mortality with SPPB values 7-9 was higher in the younger population, diabetics, and men. An SPPB score lower than 10 is predictive of all-cause mortality. The systematic implementation of the SPPB in clinical practice settings may provide useful prognostic information about the risk of all-cause mortality. Moreover, the SPPB could be used as a surrogate endpoint of all-cause mortality in trials needing to quantify benefit and health improvements of specific treatments or rehabilitation programs. The study protocol was published on PROSPERO (CRD42015024916).

Numerical experiments to explain multiscale hydrological responses to mountain pine beetle tree mortality in a headwater watershed

USGS Publications Warehouse

Penn, Colin A.; Bearup, Lindsay A.; Maxwell, Reed M.; Clow, David W.

2016-01-01

The effects of mountain pine beetle (MPB)-induced tree mortality on a headwater hydrologic system were investigated using an integrated physical modeling framework with a high-resolution computational grid. Simulations of MPB-affected and unaffected conditions, each with identical atmospheric forcing for a normal water year, were compared at multiple scales to evaluate the effects of scale on MPB-affected hydrologic systems. Individual locations within the larger model were shown to maintain hillslope-scale processes affecting snowpack dynamics, total evapotranspiration, and soil moisture that are comparable to several field-based studies and previous modeling work. Hillslope-scale analyses also highlight the influence of compensating changes in evapotranspiration and snow processes. Reduced transpiration in the Grey Phase of MPB-induced tree mortality was offset by increased late-summer evaporation, while overall snowpack dynamics were more dependent on elevation effects than MPB-induced tree mortality. At the watershed scale, unaffected areas obscured the magnitude of MPB effects. Annual water yield from the watershed increased during Grey Phase simulations by 11 percent; a difference that would be difficult to diagnose with long-term gage observations that are complicated by inter-annual climate variability. The effects on hydrology observed and simulated at the hillslope scale can be further damped at the watershed scale, which spans more life zones and a broader range of landscape properties. These scaling effects may change under extreme conditions, e.g., increased total MPB-affected area or a water year with above average snowpack.

Epidemiological characteristics and deaths of premature infants in a referral hospital for high-risk pregnancies

PubMed Central

de Freitas, Brunnella Alcantara Chagas; Sant'Ana, Luciana Ferreira da Rocha; Longo, Giana Zarbato; Siqueira-Batista, Rodrigo; Priore, Silvia Eloiza; Franceschin, Sylvia do Carmo Castro

2012-01-01

Objective To analyze the process of care provided to premature infants in a neonatal intensive care unit and the factors associated with their mortality. Methods Cross-sectional retrospective study of premature infants in an intensive care unit between 2008 and 2010. The characteristics of the mothers and premature infants were described, and a bivariate analysis was performed on the following characteristics: the study period and the "death" outcome (hospital, neonatal and early) using Pearson's chi-square test, Fisher's exact test or a chi-square test for linear trends. Bivariate and multivariable logistic regression analyses were performed using a stepwise backward logistic regression method between the variables with p<0.20 and the "death" outcome. A p value <0.05 was considered to be significant. Results In total, 293 preterm infants were studied. Increased access to complementary tests (transfontanellar ultrasound and Doppler echocardiogram) and breastfeeding rates were indicators of improving care. Mortality was concentrated in the neonatal period, especially in the early neonatal period, and was associated with extreme prematurity, small size for gestational age and an Apgar score <7 at 5 minutes after birth. The late-onset sepsis was also associated with a greater chance of neonatal death, and antenatal corticosteroids were protective against neonatal and early deaths. Conclusions Although these results are comparable to previous findings regarding mortality among premature infants in Brazil, the study emphasizes the need to implement strategies that promote breastfeeding and reduce neonatal mortality and its early component. PMID:23917938

Health status of alfalfa leafcutting bee larvae (Hymenoptera: Megachilidae) in United States alfalfa seed fields.

PubMed

James, R R; Pitts-Singer, T L

2013-12-01

We conducted a broad geographic survey in the northwestern United States to quantify production losses in the alfalfa leafcutting bee (Megachile rotundata (F.), Hymenoptera: Megachilidae), a solitary pollinator used extensively in alfalfa seed production. Viable larvae were found in only 47.1% of the nest cells collected at the end of the season. Most of the rest of the cells contained pollen balls (typified by a provision but no larva; 16.7%), unknown causes of mortality (15.5%), or larvae killed by chalkbrood (8.0%). Prevalence of pollen balls was correlated positively with bee release rates and negatively with alfalfa stand age. The unknown mortality was correlated with the U.S. Department of Agriculture-Plant Hardiness Zone, and thus, some of the mortality may be caused by high temperature extremes, although the nesting season degree-days were not correlated with this mortality. Chalkbrood prevalence was correlated with possible nesting-resource or crowding-related factors, such as the number of bees released per hectare and the number of shelters used, but not with nesting board disinfection practices. Vapona is used to control parasitoids when the parent bees are incubated before release, and use of this fumigant was associated with an increase in both chalkbrood and diapausing offspring, although any reason for these correlations are unknown. This survey quantifies the variation in the quality of alfalfa leafcutting bee cocoons produced across much of the U.S. alfalfa seed production area.

Inducing Cold-Sensitivity in the Frigophilic Fly Drosophila montana by RNAi

PubMed Central

Cook, Nicola; Tournière, Océane; Sneddon, Tanya; Ritchie, Michael G.

2016-01-01

Cold acclimation is a critical physiological adaptation for coping with seasonal cold. By increasing their cold tolerance individuals can remain active for longer at the onset of winter and can recover more quickly from a cold shock. In insects, despite many physiological studies, little is known about the genetic basis of cold acclimation. Recently, transcriptomic analyses in Drosophila virilis and D. montana revealed candidate genes for cold acclimation by identifying genes upregulated during exposure to cold. Here, we test the role of myo-inositol-1-phosphate synthase (Inos), in cold tolerance in D. montana using an RNAi approach. D. montana has a circumpolar distribution and overwinters as an adult in northern latitudes with extreme cold. We assessed cold tolerance of dsRNA knock-down flies using two metrics: chill-coma recovery time (CCRT) and mortality rate after cold acclimation. Injection of dsRNAInos did not alter CCRT, either overall or in interaction with the cold treatment, however it did induced cold-specific mortality, with high levels of mortality observed in injected flies acclimated at 5°C but not at 19°C. Overall, injection with dsRNAInos induced a temperature-sensitive mortality rate of over 60% in this normally cold-tolerant species. qPCR analysis confirmed that dsRNA injection successfully reduced gene expression of Inos. Thus, our results demonstrate the involvement of Inos in increasing cold tolerance in D. montana. The potential mechanisms involved by which Inos increases cold tolerance are also discussed. PMID:27832122

Human disease mortality kinetics are explored through a chain model embodying principles of extreme value theory and competing risks.

PubMed

Juckett, D A; Rosenberg, B

1992-04-21

The distributions for human disease-specific mortality exhibit two striking characteristics: survivorship curves that intersect near the longevity limit; and, the clustering of best-fitting Weibull shape parameter values into groups centered on integers. Correspondingly, we have hypothesized that the distribution intersections result from either competitive processes or population partitioning and the integral clustering in the shape parameter results from the occurrence of a small number of rare, rate-limiting events in disease progression. In this report we initiate a theoretical examination of these questions by exploring serial chain model dynamics and parameteric competing risks theory. The links in our chain models are composed of more than one bond, where the number of bonds in a link are denoted the link size and are the number of events necessary to break the link and, hence, the chain. We explored chains with all links of the same size or with segments of the chain composed of different size links (competition). Simulations showed that chain breakage dynamics depended on the weakest-link principle and followed kinetics of extreme-values which were very similar to human mortality kinetics. In particular, failure distributions for simple chains were Weibull-type extreme-value distributions with shape parameter values that were identifiable with the integral link size in the limit of infinite chain length. Furthermore, for chains composed of several segments of differing link size, the survival distributions for the various segments converged at a point in the S(t) tails indistinguishable from human data. This was also predicted by parameteric competing risks theory using Weibull underlying distributions. In both the competitive chain simulations and the parametric competing risks theory, however, the shape values for the intersecting distributions deviated from the integer values typical of human data. We conclude that rare events can be the source of integral shapes in human mortality, that convergence is a salient feature of multiple endpoints, but that pure competition may not be the best explanation for the exact type of convergence observable in human mortality. Finally, while the chain models were not motivated by any specific biological structures, interesting biological correlates to them may be useful in gerontological research.

Microhabitats reduce animal's exposure to climate extremes.

PubMed

Scheffers, Brett R; Edwards, David P; Diesmos, Arvin; Williams, Stephen E; Evans, Theodore A

2014-02-01

Extreme weather events, such as unusually hot or dry conditions, can cause death by exceeding physiological limits, and so cause loss of population. Survival will depend on whether or not susceptible organisms can find refuges that buffer extreme conditions. Microhabitats offer different microclimates to those found within the wider ecosystem, but do these microhabitats effectively buffer extreme climate events relative to the physiological requirements of the animals that frequent them? We collected temperature data from four common microhabitats (soil, tree holes, epiphytes, and vegetation) located from the ground to canopy in primary rainforests in the Philippines. Ambient temperatures were monitored from outside of each microhabitat and from the upper forest canopy, which represent our macrohabitat controls. We measured the critical thermal maxima (CTmax ) of frog and lizard species, which are thermally sensitive and inhabit our microhabitats. Microhabitats reduced mean temperature by 1-2 °C and reduced the duration of extreme temperature exposure by 14-31 times. Microhabitat temperatures were below the CTmax of inhabitant frogs and lizards, whereas macrohabitats consistently contained lethal temperatures. Microhabitat temperatures increased by 0.11-0.66 °C for every 1 °C increase in macrohabitat temperature, and this nonuniformity in temperature change influenced our forecasts of vulnerability for animal communities under climate change. Assuming uniform increases of 6 °C, microhabitats decreased the vulnerability of communities by up to 32-fold, whereas under nonuniform increases of 0.66 to 3.96 °C, microhabitats decreased the vulnerability of communities by up to 108-fold. Microhabitats have extraordinary potential to buffer climate and likely reduce mortality during extreme climate events. These results suggest that predicted changes in distribution due to mortality and habitat shifts that are derived from macroclimatic samples and that assume uniform changes in microclimates relative to macroclimates may be overly pessimistic. Nevertheless, even nonuniform temperature increases within buffered microhabitats would still threaten frogs and lizards. © 2013 John Wiley & Sons Ltd.

The lag effects and vulnerabilities of temperature effects on cardiovascular disease mortality in a subtropical climate zone in China.

PubMed

Huang, Jixia; Wang, Jinfeng; Yu, Weiwei

2014-04-11

This research quantifies the lag effects and vulnerabilities of temperature effects on cardiovascular disease in Changsha--a subtropical climate zone of China. A Poisson regression model within a distributed lag nonlinear models framework was used to examine the lag effects of cold- and heat-related CVD mortality. The lag effect for heat-related CVD mortality was just 0-3 days. In contrast, we observed a statistically significant association with 10-25 lag days for cold-related CVD mortality. Low temperatures with 0-2 lag days increased the mortality risk for those ≥65 years and females. For all ages, the cumulative effects of cold-related CVD mortality was 6.6% (95% CI: 5.2%-8.2%) for 30 lag days while that of heat-related CVD mortality was 4.9% (95% CI: 2.0%-7.9%) for 3 lag days. We found that in Changsha city, the lag effect of hot temperatures is short while the lag effect of cold temperatures is long. Females and older people were more sensitive to extreme hot and cold temperatures than males and younger people.

The Mechanisms of Alcohol Control

PubMed Central

Carpenter, Christopher S.; Dobkin, Carlos; Warman, Casey

2015-01-01

A substantial economics literature documents that tighter alcohol controls reduce alcohol-related harms, but far less is known about mechanisms. We use the universe of Canadian mortality records to document that Canada’s Minimum Legal Drinking Age (MLDA) significantly reduces mortality rates of young men but has much smaller effects on women. Using drinking data that are far more detailed than in prior work, we document that the MLDA substantially reduces ‘extreme’ drinking among men but not women. Our results suggest that alcohol control efforts targeting young adults should focus on reducing extreme drinking behavior. PMID:27127308

The mortality profile of black Seventh-Day Adventists residing in metropolitan Atlanta: a pilot study.

PubMed Central

Murphy, F G; Blumenthal, D S; Dickson-Smith, J; Peay, R P

1990-01-01

Mortality information was gathered for 110 Black Seventh-day Adventist members of seven churches in Metropolitan Atlanta, Georgia during the period 1980-87. Seventy-seven percent of the deaths were due to cardiovascular diseases; 8 percent due to cancer, the second leading cause of death. The cancer rate is extremely low in comparison to the proportion of deaths due to cardiovascular diseases. Subsequent research on this population will take into consideration lifestyle factors which could contribute to this finding. PMID:2368863

Assessment of extreme value distributions for maximum temperature in the Mediterranean area

NASA Astrophysics Data System (ADS)

Beck, Alexander; Hertig, Elke; Jacobeit, Jucundus

2015-04-01

Extreme maximum temperatures highly affect the natural as well as the societal environment Heat stress has great effects on flora, fauna and humans and culminates in heat related morbidity and mortality. Agriculture and different industries are severely affected by extreme air temperatures. Even more under climate change conditions, it is necessary to detect potential hazards which arise from changes in the distributional parameters of extreme values, and this is especially relevant for the Mediterranean region which is characterized as a climate change hot spot. Therefore statistical approaches are developed to estimate these parameters with a focus on non-stationarities emerging in the relationship between regional climate variables and their large-scale predictors like sea level pressure, geopotential heights, atmospheric temperatures and relative humidity. Gridded maximum temperature data from the daily E-OBS dataset (Haylock et al., 2008) with a spatial resolution of 0.25° x 0.25° from January 1950 until December 2012 are the predictands for the present analyses. A s-mode principal component analysis (PCA) has been performed in order to reduce data dimension and to retain different regions of similar maximum temperature variability. The grid box with the highest PC-loading represents the corresponding principal component. A central part of the analyses is the model development for temperature extremes under the use of extreme value statistics. A combined model is derived consisting of a Generalized Pareto Distribution (GPD) model and a quantile regression (QR) model which determines the GPD location parameters. The QR model as well as the scale parameters of the GPD model are conditioned by various large-scale predictor variables. In order to account for potential non-stationarities in the predictors-temperature relationships, a special calibration and validation scheme is applied, respectively. Haylock, M. R., N. Hofstra, A. M. G. Klein Tank, E. J. Klok, P. D. Jones, and M. New (2008), A European daily high-resolution gridded data set of surface temperature and precipitation for 1950 - 2006, J. Geophys. Res., 113, D20119, doi:10.1029/2008JD010201.

Mortality salience, martyrdom, and military might: the great satan versus the axis of evil.

PubMed

Pyszczynski, Tom; Abdollahi, Abdolhossein; Solomon, Sheldon; Greenberg, Jeff; Cohen, Florette; Weise, David

2006-04-01

Study 1 investigated the effect of mortality salience on support for martyrdom attacks among Iranian college students. Participants were randomly assigned to answer questions about either their own death or an aversive topic unrelated to death and then evaluated materials from fellow students who either supported or opposed martyrdom attacks against the United States. Whereas control participants preferred the student who opposed martyrdom, participants reminded of death preferred the student who supported martyrdom and indicated they were more likely to consider such activities themselves. Study 2 investigated the effect of mortality salience on American college students' support for extreme military interventions by American forces that could kill thousands of civilians. Mortality salience increased support for such measures among politically conservative but not politically liberal students. The roles of existential fear, cultural worldviews, and construing one's nation as pursing a heroic battle against evil in advocacy of violence were discussed.

Increased Risk of Mortality Due to Interpersonal Violence in Foreign-Born Women of Reproductive Age: A Swedish Register-Based Study.

PubMed

Fernbrant, Cecilia; Essén, Birgitta; Esscher, Annika; Östergren, Per-Olof; Cantor-Graae, Elizabeth

2016-10-01

Violence against women is an increasing public health concern, with assault leading to death as the most extreme outcome. Previous findings indicate that foreign-born women living in Sweden are more exposed to interpersonal violence than Swedish-born women. The current study investigates mortality due to interpersonal violence in comparison with other external causes of death among women of reproductive age in Sweden, with focus on country of birth. Foreign-born women and especially those from countries with low and very low gender equity levels had increased risk of mortality due to interpersonal violence, thus implicating lack of empowerment as a contributing factor. © The Author(s) 2016.

Relative sensitivity of five Hawaiian coral species to high temperature under high-pCO2 conditions

NASA Astrophysics Data System (ADS)

Bahr, Keisha D.; Jokiel, Paul L.; Rodgers, Ku'ulei S.

2016-06-01

Coral reef ecosystems are presently undergoing decline due to anthropogenic climate change. The chief detrimental factors are increased temperature and increased pCO2. The purpose of this study was to evaluate the effect of these two stressors operating independently and in unison on the biological response of common Hawaiian reef corals. Manipulative experiments were performed using five species ( Porites compressa, Pocillopora damicornis, Fungia scutaria, Montipora capitata, and Leptastrea purpurea) in a continuous-flow mesocosm system under natural sunlight conditions. Corals were grown together as a community under treatments of high temperature (2 °C above normal maximum summer temperature), high pCO2 (twice present-day conditions), and with both factors acting in unison. Control corals were grown under present-day pCO2 and at normal summer temperatures. Leptastrea purpurea proved to be an extremely hardy coral. No change in calcification or mortality occurred under treatments of high temperature, high pCO2, or combined high temperature-high pCO2. The remaining four species showed reduced calcification in the high-temperature treatment. Two species ( L. purpurea and M. capitata) showed no response to increased pCO2. Also, high pCO2 ameliorated the negative effect of high temperature on the calcification rates of P. damicornis. Mortality was driven primarily by high temperature, with a negative synergistic effect in P. compressa only in the high-pCO2-high-temperature treatment. Results support the observation that biological response to temperature and pCO2 elevation is highly species-specific, so generalizations based on response of a single species might not apply to a diverse and complex coral reef community.

Autophagy sustains the survival of human pancreatic cancer PANC-1 cells under extreme nutrient deprivation conditions.

PubMed

Kim, Sang Eun; Park, Hye-Jin; Jeong, Hye Kyoung; Kim, Mi-Jung; Kim, Minyeong; Bae, Ok-Nam; Baek, Seung-Hoon

2015-07-31

Pancreatic ductal adenocarcinomas are an extremely aggressive and devastating type of cancer with high mortality. Given the dense stroma and poor vascularization, accessibility to nutrients is limited in the tumor microenvironment. Here, we aimed to elucidate the role of autophagy in promoting the survival of human pancreatic cancer PANC-1 cells exposed to nutrient-deprived media (NDM) lacking glucose, amino acids, and serum. NDM inhibited Akt activity and phosphorylation of p70 S6K, and induced AMPK activation and mitochondrial depolarization. NDM also time-dependently increased LC3-II accumulation, number of GFP-LC3 puncta, and colocalization between GFP-LC3 and lysosomes. These results suggested that autophagy was progressively activated through Akt- and AMPK-mTOR pathway in nutrient-deficient PANC-1 cells. Autophagy inhibitors (chloroquine and wortmannin) or silencing of Atg5 augmented PANC-1 cell death in NDM. In cells exposed to NDM, chloroquine and wortmannin induced apoptosis and Z-VAD-fmk inhibited cytotoxicity of these inhibitors. These data demonstrate that autophagy is anti-apoptotic and sustains the survival of PANC-1 cells following extreme nutrient deprivation. Autophagy modulation may be a viable therapeutic option for cancer cells located in the core of solid tumors with a nutrient-deficient microenvironment. Copyright © 2015 Elsevier Inc. All rights reserved.

Responses of tree species to heat waves and extreme heat events.

PubMed

Teskey, Robert; Wertin, Timothy; Bauweraerts, Ingvar; Ameye, Maarten; McGuire, Mary Anne; Steppe, Kathy

2015-09-01

The number and intensity of heat waves has increased, and this trend is likely to continue throughout the 21st century. Often, heat waves are accompanied by drought conditions. It is projected that the global land area experiencing heat waves will double by 2020, and quadruple by 2040. Extreme heat events can impact a wide variety of tree functions. At the leaf level, photosynthesis is reduced, photooxidative stress increases, leaves abscise and the growth rate of remaining leaves decreases. In some species, stomatal conductance increases at high temperatures, which may be a mechanism for leaf cooling. At the whole plant level, heat stress can decrease growth and shift biomass allocation. When drought stress accompanies heat waves, the negative effects of heat stress are exacerbated and can lead to tree mortality. However, some species exhibit remarkable tolerance to thermal stress. Responses include changes that minimize stress on photosynthesis and reductions in dark respiration. Although there have been few studies to date, there is evidence of within-species genetic variation in thermal tolerance, which could be important to exploit in production forestry systems. Understanding the mechanisms of differing tree responses to extreme temperature events may be critically important for understanding how tree species will be affected by climate change. © 2014 John Wiley & Sons Ltd.

The Genetics of Extreme Longevity: Lessons from the New England Centenarian Study

PubMed Central

Sebastiani, Paola; Perls, Thomas T.

2012-01-01

The New England Centenarian Study (NECS) was founded in 1994 as a longitudinal study of centenarians to determine if centenarians could be a model of healthy human aging. Over time, the NECS along with other centenarian studies have demonstrated that the majority of centenarians markedly delay high mortality risk-associated diseases toward the ends of their lives, but many centenarians have a history of enduring more chronic age-related diseases for many years, women more so than men. However, the majority of centenarians seem to deal with these chronic diseases more effectively, not experiencing disability until well into their nineties. Unlike most centenarians who are less than 101 years old, people who live to the most extreme ages, e.g., 107+ years, are generally living proof of the compression of morbidity hypothesis. That is, they compress morbidity and disability to the very ends of their lives. Various studies have also demonstrated a strong familial component to extreme longevity and now evidence particularly from the NECS is revealing an increasingly important genetic component to survival to older and older ages beyond 100 years. It appears to us that this genetic component consists of many genetic modifiers each with modest effects, but as a group they can have a strong influence. PMID:23226160

All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review.

PubMed

Adams, Ted D; Mehta, Tapan S; Davidson, Lance E; Hunt, Steven C

2015-12-01

The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.

[Necrotizing fasciitis of the upper and lower extremities].

PubMed

Kückelhaus, M; Hirsch, T; Lehnhardt, M; Daigeler, A

2017-04-01

Necrotizing fasciitis is a potentially fatal soft tissue infection that may affect the upper and lower extremities, scrotum, perineum and abdominal wall. Typically, the infection demonstrates rapid spreading along the fascial planes leading to sepsis with mortality rates of 15-46%. Without adequate treatment, the mortality rate increases to close to 100%. There are four groups of pathogens that can lead to necrotizing fasciitis, namely beta-hemolytic group A streptococci, mixed infections with obligate and facultative anaerobes, clostridium species and fungal infections. Clinical signs may include erythema, edema and pain out of proportion in the early stages and soft tissue necrosis with bullae during the subsequent course. In some cases, only a deterioration of the general condition is evident and the aforementioned clinical symptoms are initially missing. The decision for treatment is based on the clinical diagnosis and surgical debridement is the cornerstone of treatment, accompanied by broad spectrum i.v. antibiotic treatment, e. g. with penicillin, ciprofloxacin and clindamycin.

Drought-induced mortality patterns and rapid biomass recovery in a terra firme forest in the Colombian Amazon.

PubMed

Zuleta, Daniel; Duque, Alvaro; Cardenas, Dairon; Muller-Landau, Helene C; Davies, Stuart J

2017-10-01

Extreme climatic events affecting the Amazon region are expected to become more frequent under ongoing climate change. In this study, we assessed the responses to the 2010 drought of over 14,000 trees ≥10 cm dbh in a 25 ha lowland forest plot in the Colombian Amazon and how these responses varied among topographically defined habitats, with tree size, and with species wood density. Tree mortality was significantly higher during the 2010-2013 period immediately after the drought than in 2007-2010. The post-drought increase in mortality was stronger for trees located in valleys (+243%) than for those located on slopes (+67%) and ridges (+57%). Tree-based generalized linear mixed models showed a significant negative effect of species wood density on mortality and no effect of tree size. Despite the elevated post-drought mortality, aboveground biomass increased from 2007 to 2013 by 1.62 Mg ha -1  yr -1 (95% CI 0.80-2.43 Mg ha -1  yr -1 ). Biomass change varied among habitats, with no significant increase on the slopes (1.05, 95% CI -0.76 to 2.85 Mg ha -1  yr -1 ), a significant increase in the valleys (1.33, 95% CI 0.37-2.34 Mg ha -1  yr -1 ), and a strong increase on the ridges (2.79, 95% CI 1.20-4.21 Mg ha -1  yr -1 ). These results indicate a high carbon resilience of this forest to the 2010 drought due to habitat-associated and interspecific heterogeneity in responses including directional changes in functional composition driven by enhanced performance of drought-tolerant species that inhabit the drier ridges. © 2017 by the Ecological Society of America.

Salt marsh dieback in coastal Louisiana: survey of plant and soil conditions in Barataria and Terrebonne basins, June 2000-September 2001

USGS Publications Warehouse

McKee, Karen L.; Mendelssohn, Irving A.; Materne, Michael D.

2006-01-01

Sudden and extensive dieback of the perennial marsh grass, Spartina alterniflora Loisel (smooth cordgrass), which dominates regularly flooded salt marshes along the Gulf of Mexico and Atlantic coastlines, occurred in the coastal zone of Louisiana. The objectives of this study were to assess soil and plant conditions in dieback areas of the Barataria-Terrebonne estuarine system as well as vegetative recovery during and after this dieback event. Multiple dieback sites were examined along 100 km of shoreline from the Atchafalaya River to the Mississippi River during the period from June 2000 through September 2001. The species primarily affected was S. alterniflora; sympatric species such as Avicennia germinans (L.) Stearn (black mangrove) and Juncus roemerianus Scheele (needlegrass rush) showed no visible signs of stress. The pattern of marsh dieback was distinctive with greatest mortality in the marsh interior, suggesting a correlation with local patterns of soil chemistry and/or hydrology. Little or no expansion of dieback occurred subsequent to the initial event, and areas with 50 percent or less mortality in the fall of 2000 had completely recovered by April 2001. Recovery was slower in interior marshes with 90 percent or greater mortality initially. However, regenerating plants in dieback areas showing some recovery were robust, and reproductive output was high, indicating that the causative agent was no longer present and that post-dieback soil conditions were actually promoting plant growth. Stands of other species within or near some dieback sites remained largely unchanged or expanded (A. germinans) into the dead salt marsh. The cause of the dieback is currently unknown. Biotic agents and excessive soil waterlogging/high sulfide were ruled out as primary causes of this acute event, although they could have contributed to overall plant stress and/or interacted with the primary agent to cause plant mortality. Our observations over the 15 month study specifically do not support the contention that dieback was caused by excessive grazing by Littoraria irrorata (marsh periwinkle). Instead, the data show that snails were responding to plant mortality and played an important role in rapid degradation of dead material in some areas. The dieback event was coincident with an extreme drought, low river discharge, and low sea level. These conditions could have caused plant mortality by directly decreasing water availability, increasing salinity, and/or causing oxidation and acidification of soils. The latter scenario was supported by findings of higher pyrite and acid-extractable aluminum and iron, higher acidification potential of dieback soils, and higher concentrations of aluminum and iron in dieback plant tissues (indicating uptake of potentially toxic metals) when compared to reference marshes showing no dieback. The implication of these findings is that periodic weather extremes may play a greater role in shaping coastal plant communities than has previously been recognized. Although such events may not be controlled directly, the resilience and recovery of the system may be altered by management. Such considerations will become increasingly important as global climate changes and human pressures in the coastal zone grow.

Mechanisms of plant survival and mortality during drought: Why do some plants survive while others succumb to drought?

USGS Publications Warehouse

McDowell, Nate G.; Pockman, William T.; Allen, Craig D.; Breshears, David D.; Cobb, Neil; Kolb, Thomas; Plaut, Jennifer; Sperry, John; West, Adam; Williams, David G.; Yepez, Enrico A.

2008-01-01

Severe droughts have been associated with regional-scale forest mortality worldwide. Climate change is expected to exacerbate regional mortality events; however, prediction remains difficult because the physiological mechanisms underlying drought survival and mortality are poorly understood. We developed a hydraulically based theory considering carbon balance and insect resistance that allowed development and examination of hypotheses regarding survival and mortality. Multiple mechanisms may cause mortality during drought. A common mechanism for plants with isohydric regulation of water status results from avoidance of drought-induced hydraulic failure via stomatal closure, resulting in carbon starvation and a cascade of downstream effects such as reduced resistance to biotic agents. Mortality by hydraulic failure per se may occur for isohydric seedlings or trees near their maximum height. Although anisohydric plants are relatively drought-tolerant, they are predisposed to hydraulic failure because they operate with narrower hydraulic safety margins during drought. Elevated temperatures should exacerbate carbon starvation and hydraulic failure. Biotic agents may amplify and be amplified by drought-induced plant stress. Wet multidecadal climate oscillations may increase plant susceptibility to drought-induced mortality by stimulating shifts in hydraulic architecture, effectively predisposing plants to water stress. Climate warming and increased frequency of extreme events will probably cause increased regional mortality episodes. Isohydric and anisohydric water potential regulation may partition species between survival and mortality, and, as such, incorporating this hydraulic framework may be effective for modeling plant survival and mortality under future climate conditions.

The 1994 heat wave in South Korea: mortality impacts and recurrence probability in a changing climate

NASA Astrophysics Data System (ADS)

Kysely, J.; Kim, J.

2010-03-01

The study deals with mortality impacts of the July-August 1994 heat wave in the population of South Korea, including the megacity of Seoul (with the population exceeding 10 million for the city and 20 million for the metropolitan area), and estimates recurrence probability of the heat wave in a changing climate in terms of simulations of daily temperature series with a stochastic model. The 1994 heat wave is found exceptional with respect to both climatological characteristics and the mortality effects: significantly elevated mortality occurred in all population groups, including children up to 14 years of age, and the total death toll exceeded 3000 in the Korean population, which ranks the 1994 heat wave among the worst weather-related disasters in East Asia. The estimate represents net excess mortality as no mortality displacement effect appeared. A comparison with other documented natural disasters shows that the death toll of the heat wave was much higher than those of the most disastrous floodings and typhoons over Korean Peninsula in the 20th century. The mortality response was stronger in males than females although males are found to be less vulnerable during average heat waves. A climatological analysis reveals that the July-August 1994 heat wave might be considered an extremely rare event with a return period in the order of hundreds of years if stationarity of temperature time series is assumed. However, under a more realistic assumption of gradual warming related to climate change, recurrence probability of an event analogous to the 1994 heat wave sharply rises for near-future time horizons. If warming of 0.04°C/year is assumed over 2001-2060, the recurrence interval of a very long spell of days with temperature exceeding a high threshold (as in the 1994 heat wave) is estimated to decrease to around 40 (10) years in the 2021-2030 (2041-2050) decade. This emphasizes the need for setting up an efficient heat-watch-warning system in this area in order to reduce human mortality impacts of heat waves.

Impact of an extreme climatic event on community assembly.

PubMed

Thibault, Katherine M; Brown, James H

2008-03-04

Extreme climatic events are predicted to increase in frequency and magnitude, but their ecological impacts are poorly understood. Such events are large, infrequent, stochastic perturbations that can change the outcome of entrained ecological processes. Here we show how an extreme flood event affected a desert rodent community that has been monitored for 30 years. The flood (i) caused catastrophic, species-specific mortality; (ii) eliminated the incumbency advantage of previously dominant species; (iii) reset long-term population and community trends; (iv) interacted with competitive and metapopulation dynamics; and (v) resulted in rapid, wholesale reorganization of the community. This and a previous extreme rainfall event were punctuational perturbations-they caused large, rapid population- and community-level changes that were superimposed on a background of more gradual trends driven by climate and vegetation change. Captured by chance through long-term monitoring, the impacts of such large, infrequent events provide unique insights into the processes that structure ecological communities.

Quantifying the influence of ambient temperature on dairy and beef cattle mortality in France from a time-series analysis.

PubMed

Morignat, Eric; Gay, Emilie; Vinard, Jean-Luc; Calavas, Didier; Hénaux, Viviane

2015-07-01

In the context of climate change, the frequency and severity of extreme weather events are expected to increase in temperate regions, and potentially have a severe impact on farmed cattle through production losses or deaths. In this study, we used distributed lag non-linear models to describe and quantify the relationship between a temperature-humidity index (THI) and cattle mortality in 12 areas in France. THI incorporates the effects of both temperature and relative humidity and was already used to quantify the degree of heat stress on dairy cattle because it does reflect physical stress deriving from extreme conditions better than air temperature alone. Relationships between daily THI and mortality were modeled separately for dairy and beef cattle during the 2003-2006 period. Our general approach was to first determine the shape of the THI-mortality relationship in each area by modeling THI with natural cubic splines. We then modeled each relationship assuming a three-piecewise linear function, to estimate the critical cold and heat THI thresholds, for each area, delimiting the thermoneutral zone (i.e. where the risk of death is at its minimum), and the cold and heat effects below and above these thresholds, respectively. Area-specific estimates of the cold or heat effects were then combined in a hierarchical Bayesian model to compute the pooled effects of THI increase or decrease on dairy and beef cattle mortality. A U-shaped relationship, indicating a mortality increase below the cold threshold and above the heat threshold was found in most of the study areas for dairy and beef cattle. The pooled estimate of the mortality risk associated with a 1°C decrease in THI below the cold threshold was 5.0% for dairy cattle [95% posterior interval: 4.4, 5.5] and 4.4% for beef cattle [2.0, 6.5]. The pooled mortality risk associated with a 1°C increase above the hot threshold was estimated to be 5.6% [5.0, 6.2] for dairy and 4.6% [0.9, 8.7] for beef cattle. Knowing the thermoneutral zone and temperature effects outside this zone is of primary interest for farmers because it can help determine when to implement appropriate preventive and mitigation measures. Copyright © 2015 Elsevier Inc. All rights reserved.

Widespread Amazon forest tree mortality from a single cross-basin squall line event

NASA Astrophysics Data System (ADS)

Negrón-Juárez, Robinson I.; Chambers, Jeffrey Q.; Guimaraes, Giuliano; Zeng, Hongcheng; Raupp, Carlos F. M.; Marra, Daniel M.; Ribeiro, Gabriel H. P. M.; Saatchi, Sassan S.; Nelson, Bruce W.; Higuchi, Niro

2010-08-01

Climate change is expected to increase the intensity of extreme precipitation events in Amazonia that in turn might produce more forest blowdowns associated with convective storms. Yet quantitative tree mortality associated with convective storms has never been reported across Amazonia, representing an important additional source of carbon to the atmosphere. Here we demonstrate that a single squall line (aligned cluster of convective storm cells) propagating across Amazonia in January, 2005, caused widespread forest tree mortality and may have contributed to the elevated mortality observed that year. Forest plot data demonstrated that the same year represented the second highest mortality rate over a 15-year annual monitoring interval. Over the Manaus region, disturbed forest patches generated by the squall followed a power-law distribution (scaling exponent α = 1.48) and produced a mortality of 0.3-0.5 million trees, equivalent to 30% of the observed annual deforestation reported in 2005 over the same area. Basin-wide, potential tree mortality from this one event was estimated at 542 ± 121 million trees, equivalent to 23% of the mean annual biomass accumulation estimated for these forests. Our results highlight the vulnerability of Amazon trees to wind-driven mortality associated with convective storms. Storm intensity is expected to increase with a warming climate, which would result in additional tree mortality and carbon release to the atmosphere, with the potential to further warm the climate system.

In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients.

PubMed

Aragón-Sánchez, Javier; Hernández-Herrero, Maria J; Lázaro-Martínez, Jose L; Quintana-Marrero, Yurena; Maynar-Moliner, Manuel; Rabellino, Martín; Cabrera-Galván, Juan J

2010-03-01

The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found.

Dust Storms in the United States are Associated with Increased Cardiovascular Mortality

EPA Science Inventory

Background: Extreme weather events such as dust storms are predicted to become more frequent as the global climate warms through the 21st century. Studies of Asian, Saharan, Arabian, and Australian dust storms have found associations with cardiovascular and total non-accidental...

Extreme biology: probing life at low water contents and temperatures

USDA-ARS?s Scientific Manuscript database

Germplasm that is dried or cryopreserved appears quiescent. However, changes occur in preserved germplasm, albeit slowly. Viability time courses follow a sigmoidal curve where there is a lag phase when changes can’t be detected, followed by a period of rapid mortality. Predicting longevity under...

[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].

PubMed

Nenezić, Dragoslav; Pandaitan, Simon; Ilijevski, Nenad; Matić, Predrag; Gajin, Predag; Radak, Dorde

2005-01-01

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.

[Role of multislice computed tomography in the diagnosis of acute rupture of the thoracic aorta and hepatic artery in a patient with severe concomitant injury].

PubMed

Muslimov, R Sh; Sharifullin, F A; Chernaia, N R; Novruzbekov, M S; Kokov, L S

2015-01-01

Acute traumatic aortic rupture is associated with extremely high mortality rates and requires emergency diagnosis and treatment. This clinical example shows the role of multislice spiral computed tomography in the emergency diagnosis of rupture of two large arterial vessels in severe concomitant injury. It presents the benefits of this rapid and noninvasive imaging technique, an algorithm of the study and the semiotics of injuries in patients with suspected traumatic aortic rupture. The paper also shows the importance of this method in defining treatment policy and then in the assessment of the results of the performed correction.

Necrotizing Fasciitis of the lower extremity: a case report and current concept of diagnosis and management

PubMed Central

Naqvi, GA; Malik, SA; Jan, W

2009-01-01

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge. PMID:19527519

Stenting for Acute Aortic Dissection with Malperfusion as “Bridge Therapy”

PubMed Central

Fujita, Wakako; Taniguchi, Satoshi; Daitoku, Kazuyuki; Fukuda, Ikuo

2010-01-01

The most common treatment of acute type A aortic dissection is immediate surgical repair. However, early surgery for acute dissections with peripheral vascular compromise carries a high mortality rate. Herein, we report a case in which we placed percutaneous endovascular stents in a type A dissection patient before proceeding with proximal aortic repair. Bare-metal stents were placed into the obliterated true channel of the abdominal aorta and the left external iliac artery. Endovascular stenting immediately relieved the lower-left-extremity ischemic symptoms, and the patient underwent hemi-arch replacement 7 days after the procedure. Stent placement for patients who have acute aortic dissection with malperfusion can be used as “bridge therapy.” PMID:21224949