Systemic Analysis of Sudden Natural Deaths at Braithwaite Memorial Specialist Hospital Port Harcourt, Nigeria

Background: Many cases of sudden unexpected natural deaths occur in individuals without known medical diseases. Relatives of such victims and the law enforcement agents often designate those as sudden and unnatural deaths (SUD), and call for coroners inquests.Aims: To analyze the anatomic causes of sudden natural deaths investigated by the Coroner at Braithwaite Memorial Specialist Hospital (BMSH), and to classify them according to body systems and compare our findings with those of previous studies.Materials and methods: This is a nine-year retrospective study carried out in BMSH Port Harcourt, Nigeria. The reports of unlimited and standardized autopsies carried out on sudden and natural death victims were retrievedand analyzed. The causes of death were grouped according to the body systems involved. The cases were also analyzed according to age, sex, and circumstances of death.Results: Of the 9,164 bodies received, 2,415 (26.4%) were autopsied for varied reasons, out of which 249 (2.7%) were sudden natural deaths in persons without known significant medical history. Male: female ratio (MFR)was 2.2:1. The mean age was 39.7 years with a range of 3 weeks to 97 years. Peak age group was 30-39 years with 27.7%. Cardiovascular system pathologies were by far the commonest causes of death with 87.6%. The least cause of death was prematurity with 0.4%. Among the cardiovascular system pathologies, hypertensive heart disease was the commonest. All deathswere from natural causes.Conclusion: Cardiovascular system pathologies especially hypertensive heart disease remain the leading cause of sudden natural deaths in this study. Residents of Rivers state of Nigeria should be more conscious of their health and undergo regular medical check-ups for early detection and proper management of cardiovascular diseases especially systemic hypertension.Key Words: Sudden natural deaths, autopsy, coroner, hypertension, Port Harcourt

Sustainable flood risk and stormwater management in blue‐green cities; an interdisciplinary case study in Portland, Oregon

Blue-Green Infrastructure (BGI) is recognized as a viable strategy to manage stormwater and flood risk, and its multifunctionality may further enrich society through the provision of multiple cobenefits that extend far beyond the hydrosphere. Portland, Oregon, is an internationally renowned leader in the implementation of BGI and showcases many best practice examples. Nonetheless, a range of interdisciplinary barriers and uncertainties continue to cloud decision making and impede wider implementation of BGI. In this paper, we synthesize research conducted by the “Clean Water for All” (CWfA) research project and demonstrate that interdisciplinary evaluation of the benefits of Portland’s BGI, focusing on green street bioswales and the East Lents Floodplain Restoration Project, is essential to address biophysical and sociopolitical barriers. Effective interdisciplinary approaches require sustained interaction and collaboration to integrate disciplinary expertise toward a common problem-solving purpose, and strong leadership from researchers adapt at spanning disciplinary boundaries. While the disciplinary differences in methodologies were embraced in the CWfA project, and pivotal to providing evidence of the disparate benefits of multifunctional BGI, cross-disciplinary engagement, knowledge coproduction, and data exchanges during the research process were of paramount importance to reduce the potential for fragmentation and ensure research remained integrated. © 2020 The Authors. Journal of the American Water Resources Association published by Wiley Periodicals LLC on behalf of American Water Resources Associatio

Ischia island: strain field by GPS and Levelling data.

Geophysical Research Abstracts Vol. 13, EGU2011-13941-3, 2011 EGU General Assembly 2011 © Author(s) 2011 Ischia island: strain field by GPS and Levelling data. Francesco Obrizzo and the INGV (CNT-OV) Geodesy Team Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Vesuviano, Napoli, Italy In this paper, we discuss the results obtained by means high precision levelling and GPS surveys performed at Ischia island in June 2010. The levelling survey has been carried out on the whole network of the island. The compensated heights for each benchmark (bm), referred to bm 1 located at Ischia harbour, were compared to those obtained in the previous levelling survey performed during 2003. The GPS network operating on Ischia Island consists of 21 3D vertices homogeneously distributed on the island. Six different GPS surveys of the whole network were carried out since 1997, in order to investigate the subsidence phenomena. The comparison among the 1997, 1998, 1999, 2001, 2003 and 2010 surveys results show that some GPS points present significant horizontal displacements confirming slow but continuous deformations in the Southern and North West sectors of the island. The results show significant ground subsidence of various amplitude affecting different areas of the island. In addition, a further comparison with the measurements performed in 1987 confirms the existence of such differential movements characterised by subsidence velocity constant over time. Finally, we found a good agreement between levelling and GPS velocities, calculated in time span 1997-2010. Therefore, the integration of GPS and levelling data allowed to define the strain field on the island over the past 20 years

Decision Support Tool for energy-efficient, sustainable and integrated urban stormwater management

[EN] The use of Sustainable Drainage Systems (SUDS) to manage urban runoff and contribute to environmental and landscape improvement is now widely known, but its application is still limited in many regions, like in Mediterranean countries. In addition, there is a lack of Decision Support Tools that consider all their benefits in the decision making process in a clear and integrated holistic way. In this paper, the (ESTORMED)-S-2 Decision Support Tool is presented. This tool analyses the impact of stormwater management in the urban environment and introduces energetic and environmental criteria in the decision making process. Therefore, it aims to fill in the existing "gap" between SuDS manuals and guidelines and regional and local decision makers, since it quantifies SuDS benefits and includes them in the comparison of different stormwater scenarios. Finally, the results of applying this tool to compare drainage infrastructures in a real urban development are described. (C) 2016 Elsevier Ltd. All rights reserved.The E2STORMED project (Reference: 1C-MED12-14), within which the Decision Support Tool described in this paper has been developed, was funded by the MED Programme of the European Union. Authors would also like to express their gratitude to the E2STORMED project partners for their assistance and collaboration in this work.Morales Torres, A.; Escuder Bueno, I.; Andrés Doménech, I.; Perales Momparler, S. (2016). Decision Support Tool for energy-efficient, sustainable and integrated urban stormwater management. Environmental Modelling & Software. 84:518-528. doi:10.1016/j.envsoft.2016.07.019S5185288

Naproxen affects multiple organs in fish but is still an environmentally better alternative to diclofenac

The presence of diclofenac in the aquatic environment and the risks for aquatic wildlife, especially fish, have been raised in several studies. One way to manage risks without enforcing improved wastewater treatment would be to substitute diclofenac (when suitable from a clinical perspective) with another non-steroidal anti-inflammatory drug (NSAID) associated with less environmental risk. While there are many ecotoxicity-studies of different NSAIDs, they vary extensively in set-up, species studied, endpoints and reporting format, making direct comparisons difficult. We previously published a comprehensive study on the effects of diclofenac in the three-spined stickleback (Gasterosteus aculeatus). Our present aim was to generate relevant effect data for another NSAID (naproxen) using a very similar setup, which also allowed direct comparisons with diclofenac regarding hazards and risks. Sticklebacks were therefore exposed to naproxen in flow-through systems for 27 days. Triplicate aquaria with 20 fish per aquarium were used for each concentration (0, 18, 70, 299 or 1232 mu g/L). We investigated bioconcentration, hepatic gene expression, jaw lesions, kidney and liver histology. On day 21, mortalities in the highest exposure concentration group unexpectedly reached >= 25 % in all three replicate aquaria, leading us to terminate and sample that group the same day. On the last day (day 27), the mortality was also significantly increased in the second highest exposure concentration group. Increased renal hematopoietic hyperplasia was observed in fish exposed to 299 and 1232 mu g/L. This represents considerably higher concentrations than those expected in surface waters as a result of naproxen use. Such effects were observed already at 4.6 mu g/L in the experiment with diclofenac (lowest tested concentration). Similar to the responses to diclofenac, a concentration-dependent increase in both relative hepatic gene expression of c7 (complement component 7) and jaw lesions were observed, again at concentrations considerably higher than expected in surface waters. Naproxen bioconcentrated less than diclofenac, in line with the observed effect data. An analysis of recent sales data and reported concentrations in treated sewage effluent in Sweden suggest that despite higher dosages used for naproxen, a complete substitution would only be expected to double naproxen emissions. In summary, naproxen and diclofenac produce highly similar effects in fish but the environmental hazards and risks are clearly lower for naproxen. Hence, if there are concerns for environmental risks to fish with diclofenac, a substitution would be advisable when naproxen presents an adequate alternative from a clinical point-of-view

Impact of EU regulatory label changes for diclofenac in people with cardiovascular disease in four countries:interrupted time series regression analysis

Objective: Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. Method: Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. Results: The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark −0.08%, 95%CI −0.13, −0.03; England −0.09%, 95%CI −0.13 to −0.06%; the Netherlands −1.84%, 95%CI −2.51 to −1.17%; Scotland −0.34%, 95%CI −0.38 to −0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post-intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (−0.12%, 95%CI −0.19 to −0.04), PAD (−0.13%, 95%CI −0.22 to −0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (−0.01%, 95%CI −0.02 to −0.007%), IHD (−0.017, 95%CI −0.02, −0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. Conclusion: Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings

Human Clade 2.3.4.4 A/H5N6 Influenza Virus Lacks Mammalian Adaptation Markers and Does Not Transmit via the Airborne Route between Ferrets

Since their emergence in 1997, A/H5N1 influenza viruses of the A/goose/Guangdong/1/96 lineage have diversified in multiple genetic and antigenic clades upon continued circulation in poultry in several countries in Eurasia and Africa. Since 2009, reassortant viruses carrying clade 2.3.4.4 hemagglutinin (HA) and internal and neuraminidase (NA) genes of influenza A viruses of different avian origin have been detected, yielding various HA-NA combinations, such as A/H5N1, A/H5N2, A/H5N3, A/H5N5, A/H5N6, and A/H5N8. Previous studies reported on the low pathogenicity and lack of airborne transmission of A/H5N2 and A/H5N8 viruses in the ferret model. However, although A/H5N6 viruses are the only clade 2.3.4.4 viruses that crossed the species barrier and infected humans, the risk they pose for human health remains poorly characterized. Here, the characterization of A/H5N6 A/Guangzhou/39715/2014 virus in vitro and in ferrets is described. This A/H5N6 virus possessed high polymerase activity, mediated by the E627K substitution in the PB2 protein, which corresponds to only one biological trait out of the three that were previously shown to confer airborne transmissibility to A/H5N1 viruses between ferrets. This might explain its lack of airborne transmission between ferrets. After intranasal inoculation, A/H5N6 virus replicated to high titers in the respiratory tracts of ferrets and was excreted for at least 6 days. Moreover, A/H5N6 virus caused severe pneumonia in ferrets upon intratracheal inoculation. Thus, A/H5N6 virus causes a more severe disease in ferrets than previously investigated clade 2.3.4.4 viruses, but our results demonstrate that the risk from airborne spread is currently low. IMPORTANCE Avian influenza A viruses are a threat to human health, as they cross the species barrier and infect humans occasionally, often with severe outcome. The antigenic and genetic diversity of A/H5 viruses from the A/goose/Guangdong/1/96 lineage is increasing, due to continued circulation and reassortment in poultry, posing a constant risk for public health and requiring regular risk assessments. Here we performed an in-depth characterization of the properties of the newly emerged zoonotic A/H5N6 virus in vitro and in ferrets. The lack of airborne transmission in the ferret model indicates that A/H5N6 virus does not pose a direct public health threat, despite the fact that it can replicate to high titers throughout the respiratory tracts of ferrets and cause more severe disease than other clade 2.3.4.4 viruses.published_or_final_versio