Recent Trends in Heat-Related Mortality in the United States: An Update Through 2018

Much research has shown a general decrease in the negative health response to extreme heat events in recent decades. With a society that is growing older, and a climate that is warming, whether this trend can continue is an open question. Using eight additional years of mortality data, we extend our previous research to explore trends in heat-related mortality across the United States. For the period 1975–2018, we examined the mortality associated with extreme-heat-event days across the 107 largest metropolitan areas. Mortality response was assessed over a cumulative 10-day lag period following events that were defined using thresholds of the excess heat factor, using a distributed-lag nonlinear model. We analyzed total mortality and subsets of age and sex. Our results show that in the past decade there is heterogeneity in the trends of heat-related human mortality. The decrease in heat vulnerability continues among those 65 and older across most of the country, which may be associated with improved messaging and increased awareness. These decreases are offset in many locations by an increase in mortality among men 45–64 (+1.3 deaths per year), particularly across parts of the southern and southwestern United States. As heat-warning messaging broadly identifies the elderly as the most vulnerable group, the results here suggest that differences in risk perception may play a role. Further, an increase in the number of heat events over the past decade across the United States may have contributed to the end of a decades-long downward trend in the estimated number of heat-related fatalities

Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury

OBJECTIVE: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. DESIGN: Prospective, observational cohort study. SETTING: Twelve PICUs in North Carolina. PATIENTS: All children 24 months old or younger with traumatic brain injury, admitted to an included PICU. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5-9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. CONCLUSION: Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old or younger with traumatic brain injury and a need for better evidence to support treatment recommendations for this group of children

Imaging Probes for Detecting Inflammation in the Mouse Model of Type 1 Diabetes

Non-invasive imaging of early signs of inflammation of endocrine pancreas is of importance due to a generally late clinical diagnosis of type 1 diabetes (T1D). Seventy-80% of insulin producing beta-cells could be already lost prior to the onset of clinical symptoms. Therefore, monitoring these early changes including increased vascular permeability of pancreas and activation of pro-inflammatory signaling pathways will aid in early diagnosis and timing of therapy. We have developed and tested superparamagnetic nanoparticles (NPs) with strong photoacoustic signal for detecting potential permeability changes in the pancreas of streptozotocin (STZ)- induced mouse model of T1D. These biocompatible gold/iron-oxide NPs enable application of multi-modality photoacoustic (PA) and magnetic resonance (MR) imaging to investigate the extent of NP accumulation in the pancreas. In addition, we have investigated the spatial distribution of nanoparticles in the endocrine and exocrine of pancreas using electron microscopy techniques. Our initial time-dependent histology results demonstrate the influx of macrophages and neutrophils as the first responders to pancreatic damage as well as activation of the NF-ҡB signaling pathway, which plays a central role in the inflammation of the islets. We recorded a significantly stronger PA signal in the pancreas of STZ-treated mice compared to control mice, which indicate higher accumulation of the NPs in mice with chemically induced diabetes. The potential use of a combination of clinically available imaging modality (MRI) and emerging high-resolution/high sensitivity PA makes this approach feasible for clinical translation. Furthermore, the safety of these imaging modalities makes them ideal for both initial diagnosis of diabetes in individuals at risk of T1D and for longer term noninvasive monitoring of the response to therapy

Seasonal Variations in Temperature–Suicide Associations across South Korea

South Korea has among the highest rates of suicide in the world, and previous research suggests that suicide frequency increases with anomalously high temperatures, possibly as a result of increased sunshine. However, it is unclear whether this temperature–suicide association exists throughout the entire year. Using distributed lag nonlinear modeling, which effectively controls for nonlinear and delayed effects, we examine temperature–suicide associations for both a warm season (April–September) and a cool season (October–March) for three cities across South Korea: Seoul, Daegu, and Busan. We find consistent, statistically significant, mostly linear relationships between relative risk of suicide and daily temperature in the cool season but few associations in the warm season. This seasonal signal of statistically significant temperature–suicide associations only in the cool season exists among all age segments, but especially for those 35 and older, along with both males and females. We further use distributed lag nonlinear modeling to examine cloud cover–suicide associations and find few significant relationships. This result suggests that that high daily temperatures in the cool season, and not exposure to sun, are responsible for the strong temperature–suicide associations found in South Korea

The ABCs of the Atypical Fam20 Secretory Pathway Kinases

The study of extracellular phosphorylation was initiated in late 19th century when the secreted milk protein, casein, and egg-yolk protein, phosvitin, were shown to be phosphorylated. However, it took more than a century to identify Fam20C, which phosphorylates both casein and phosvitin under physiological conditions. This kinase, along with its family members Fam20A and Fam20B, defined a new family with altered amino acid sequences highly atypical from the canonical 540 kinases comprising the kinome. Fam20B is a glycan kinase that phosphorylates xylose residues and triggers peptidoglycan biosynthesis, a role conserved from sponges to human. The protein kinase, Fam20C, conserved from nematodes to humans, phosphorylates well over 100 substrates in the secretory pathway with overall functions postulated to encompass endoplasmic reticulum homeostasis, nutrition, cardiac function, coagulation, and biomineralization. The preferred phosphorylation motif of Fam20C is SxE/pS, and structural studies revealed that related member Fam20A allosterically activates Fam20C by forming a heterodimeric/tetrameric complex. Fam20A, a pseudokinase, is observed only in vertebrates. Loss-of-function genetic alterations in the Fam20 family lead to human diseases such as amelogenesis imperfecta, nephrocalcinosis, lethal and nonlethal forms of Raine syndrome with major skeletal defects, and altered phosphate homeostasis. Together, these three members of the Fam20 family modulate a diverse network of secretory pathway components playing crucial roles in health and disease. The overarching theme of this review is to highlight the progress that has been made in the emerging field of extracellular phosphorylation and the key roles secretory pathway kinases play in an ever-expanding number of cellular processes

Heat/mortality sensitivities in Los Angeles during winter: A unique phenomenon in the United States

Background: Extreme heat is often associated with elevated levels of human mortality, particularly across the mid-latitudes. Los Angeles, CA exhibits a unique, highly variable winter climate, with brief periods of intense heat caused by downsloping winds commonly known as Santa Ana winds. The goal is to determine if Los Angeles County is susceptible to heat-related mortality during the winter season. This is the first study to specifically evaluate heat-related mortality during the winter for a U.S. city. Methods: Utilizing the Spatial Synoptic Classification system in Los Angeles County from 1979 through 2010, we first relate daily human mortality to synoptic air mass type during the winter season (December, January, February) using Welch\u27s t-tests. However, this methodology is only somewhat effective at controlling for important inter- and intra-annual trends in human mortality unrelated to heat such as influenza outbreaks. As a result, we use distributed lag nonlinear modeling (DLNM) to evaluate if the relative risk of human mortality increases during higher temperatures in Los Angeles, as the DLNM is more effective at controlling for variability at multiple temporal scales within the human mortality dataset. Results: Significantly higher human mortality is uncovered in winter when dry tropical air is present in Los Angeles, particularly among those 65 years and older (p \u3c 0.001). The DLNM reveals the relative risk of human mortality increases when above average temperatures are present. Results are especially pronounced for maximum and mean temperatures, along with total mortality and those 65 +. Conclusions: The discovery of heat-related mortality in winter is a unique finding in the United States, and we recommend stakeholders consider warning and intervention techniques to mitigate the role of winter heat on human health in the County

Direct observation of molecular cooperativity near the glass transition

We describe direct observations of molecular cooperativity near the glass transition in poly-vinyl-acetate (PVAc), through nanometer-scale probing of dielectric fluctuations. Molecular clusters switched spontaneously between two to four distinct configurations, producing complex random-telegraph-signals (RTS). Analysis of the RTS and their power spectra shows that individual clusters exhibit both transient dynamical heterogeneity and non-exponential kinetics.Comment: 14 pages pdf, need Acrobat Reade

Atmospheric Circulation of Eccentric Hot Neptune GJ436b

GJ436b is a unique member of the transiting extrasolar planet population being one of the smallest and least irradiated and possessing an eccentric orbit. Because of its size, mass and density, GJ436b could plausibly have an atmospheric metallicity similar to Neptune (20-60 times solar abundances), which makes it an ideal target to study the effects of atmospheric metallicity on dynamics and radiative transfer in an extrasolar planetary atmosphere. We present three-dimensional atmospheric circulation models that include realistic non-gray radiative transfer for 1, 3, 10, 30, and 50 times solar atmospheric metallicity cases of GJ436b. Low metallicity models (1 and 3 times solar) show little day/night temperature variation and strong high-latitude jets. In contrast, higher metallicity models (30 and 50 times solar) exhibit day/night temperature variations and a strong equatorial jet. Spectra and light curves produced from these simulations show strong orbital phase dependencies in the 50 times solar case and negligible variations with orbital phase in the 1 times solar case. Comparisons between the predicted planet/star flux ratio from these models and current secondary eclipse measurements support a high metallicity atmosphere (30-50 times solar abundances) with disequilibrium carbon chemistry at play for GJ436b. Regardless of the actual atmospheric composition of GJ436b, our models serve to illuminate how metallicity influences the atmospheric circulation for a broad range of warm extrasolar planets.Comment: 25 pages, 13 figure

Mass wasting triggered by seasonal CO₂ sublimation under Martian atmospheric conditions: Laboratory experiments

Sublimation is a recognized process by which planetary landscapes can be modified. However, interpretation of whether sublimation is involved in downslope movements on Mars and other bodies is restricted by a lack of empirical data to constrain this mechanism of sediment transport and its influence on landform morphology. Here we present the first set of laboratory experiments under Martian atmospheric conditions which demonstrate that the sublimation of CO2 ice from within the sediment body can trigger failure of unconsolidated, regolith slopes and can measurably alter the landscape. Previous theoretical studies required CO2 slab ice for movements, but we find that only frost is required. Hence, sediment transport by CO2 sublimation could be more widely applicable (in space and time) on Mars than previously thought. This supports recent work suggesting CO2 sublimation could be responsible for recent modification in Martian gullies