Forest Fire Smoke Exposures and Out-of-Hospital Cardiac Arrests in Melbourne,Australia: A Case-Crossover Study

Background

Millions of people can potentially be exposed to smoke from forest fires, making this an important public health problem in many countries.

Objective

In this study we aimed to measure the association between out-of-hospital cardiac arrest (OHCA) and forest fire smoke exposures in a large city during a severe forest fire season, and estimate the number of excess OHCAs due to the fire smoke.

Methods

We investigated the association between particulate matter (PM) and other air pollutants and OHCA using a case-crossover study of adults (≥ 35 years of age) in Melbourne, Australia. Conditional logistic regression models were used to derive estimates of the percent change in the rate of OHCA associated with an interquartile range (IQR) increase in exposure. From July 2006 through June 2007, OHCA data were collected from the Victorian Ambulance Cardiac Arrest Registry. Hourly air pollution concentrations and meteorological data were obtained from a central monitoring site.

Results

There were 2,046 OHCAs with presumed cardiac etiology during our study period. Among men during the fire season, greater increases in OHCA were observed with IQR increases in the 48-hr lagged PM with diameter ≤ 2.5 μm (PM_2.5) (8.05%; 95% CI: 2.30, 14.13%; IQR = 6.1 μg/m³) or ≤ 10 μm (PM₁₀) (11.1%; 95% CI: 1.55, 21.48%; IQR = 13.7 μg/m³) and carbon monoxide (35.7%; 95% CI: 8.98, 68.92%; IQR = 0.3 ppm). There was no significant association between the rate of OHCA and air pollutants among women. One hundred seventy-four “fire-hours” (i.e., hours in which Melbourne’s air quality was affected by forest fire smoke) were identified during 12 days of the 2006/2007 fire season, and 23.9 (95% CI: 3.1, 40.2) excess OHCAs were estimated to occur due to elevations in PM_2.5 during these fire-hours.

Conclusions

This study found an association between exposure to forest fire smoke and an increase in the rate of OHCA. These findings have implications for public health messages to raise community awareness and for planning of emergency services during forest fire seasons.

Citation

Dennekamp M, Straney LD, Erbas B, Abramson MJ, Keywood M, Smith K, Sim MR, Glass DC, Del Monaco A, Haikerwal A, Tonkin AM. 2015. Forest fire smoke exposures and out-of-hospital cardiac arrests in Melbourne, Australia: a case-crossover study. Environ Health Perspect 123:959–964; http://dx.doi.org/10.1289/ehp.1408436     

End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population

Objective

To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.

Management of dyspepsia—The role of the ED Observation unit to optimize patient outcomes

Background

Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit.

Characterization of in vitro metabolites of cudratricusxanthone A in human liver microsomes

Cudratricusxanthone A (CTXA), isolated from the roots of Cudrania tricuspidata, exhibits several biological activities; however, metabolic biotransformation was not investigated. Therefore, metabolites of CTXA were investigated and the major metabolic enzymes engaged in human liver microsomes (HLMs) were characterized using liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). CTXA was incubated with HLMs or human recombinant CYPs and UGTs, and analysed by an LC‐MS/MS equipped electrospray ionization (ESI) to qualify and quantify its metabolites. In total, eight metabolites were identified: M1–M4 were identified as mono‐hydroxylated metabolites during Phase I, and M5–M8 were identified as O‐glucuronidated metabolites during Phase II in HLMs. Moreover, these metabolite structures and a metabolic pathway were identified by elucidation of MSⁿ fragments and formation by human recombinant enzymes. M1 was formed by CYP2D6, and M2–M4 were generated by CYP1A2 and CYP3A4. M5–M8 were mainly formed by UGT1A1, respectively. While investigating the biotransformation of CTXA, eight metabolites of CTXA were identified by CYPs and UGTs; these data will be valuable for understanding the in vivo metabolism of CTXA. Copyright © 2015 John Wiley & Sons, Ltd.     

A III-nitride nanowire solar cell fabricated using a hybrid coaxial and uniaxial InGaN/GaN multi quantum well nanostructure

III-Nitride nanowires are currently considered as next generation photovoltaic materials due to their excellent physical properties together with reduced dislocation densities, increased surface area and thus enhanced light absorption and direct path for carrier transport. Here, we investigate the photovoltaic characteristics of a solar cell fabricated from a novel hybrid nanostructure comprising uniaxial and coaxial InGaN/GaN multi-quantum wells (MQWs) along with an InGaN nano-cap layer. Various characterization methods were employed to study the optical and structural properties of the hybrid nanostructure. Transmission electron microscopy images revealed the hybrid nanostructure consists of distinct uniaxial and coaxial InGaN/GaN MQWs along with the InGaN nano-cap layer. The InGaN/GaN MQW architectures have a significant effect on the performance of the photovoltaic device. The solar cell fabricated with the hybrid nanostructure exhibits superior photovoltaic performance compared to the uniaxial as well as the coaxial InGaN/GaN nanowire MQW structures. The improved photovoltaic characteristic is primarily attributed to the considerably larger InGaN active area grown in the hybrid nanostructure. A conversion efficiency of 1.16% along with a fill factor of 70% was obtained for the device fabricated with the hybrid nanostructure. This study provides an experimental demonstration of the improvement of III-nitride nanowire based solar cells incorporating uniaxial and coaxial InGaN/GaN MQWs.

Solar cells fabricated with hybrid nanowires comprising InGaN/GaN uniaxial and coaxial multi-quantum wells with an InGaN nano-cap layer.     

Impact of catheter ablation versus medical therapy on cognitive function in atrial fibrillation: a systematic review

Journal of Interventional Cardiac Electrophysiology - Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether the restoration of sinus rhythm with...     

Evaluating elderly patients with syncope

Age-related physiologic changes together with high prevalence of chronic illness and the use of multiple medications predispose older adults to syncope. The causes of many of these patients' syncope are unexplained and most remained symptomatic. A thoughtful diagnostic strategy is essential to pinpoint the cause in each patient. The initial assessment includes a comprehensive medical history, preferably with an eye witness account, and a thorough physical examination. The decision for further diagnostic tests often depends on whether there is evidence of underlying structural heart disease. In the absence of heart disease, tilt table testing and the related autonomic function testing are usually most productive. Various cardiac studies will be more appropriate for those with suspected structural heart disease. A cause of syncope can only be concluded if there is a sufficiently strong correlation between syncopal symptoms and the detected abnormalities on investigations. A strategic evaluation of syncope of the elderly subjects should allow a correct diagnosis and appropriate management.     

Antinucleosome antibodies may help predict development of systemic lupus erythematosus in patients with primary antiphospholipid syndrome

Patients with primary antiphospholipid syndrome (PAPS) may evolve to systemic lupus erythematosus (SLE), even many years later. This makes differentiation between primary and secondary antiphospholipid syndrome a difficult task. Studies in murine models of lupus have shown that the development of antinucleosome (anti-NCS) antibodies may occur from the early stages of life. We therefore hypothesize that anti-NCS antibodies could help predict development of SLE in patients with PAPS. We studied anti-NCS antibodies in 18 PAPS patients (15 female, three male), followed for a mean of 11 years to evaluate the potential development of SLE. When PAPS was diagnosed, nine patients were positive for anti-NCS antibodies. Six of them developed clinical manifestations of SLE. In contrast, none of the patients who were negative to anti-NCS antibodies developed it. These findings suggest that anti-NCS antibodies could help predict which patients with PAPS may eventually develop SLE.