Neurological Disorders and Publication Abstracts Follow Elements of Social Network Patterns when Indexed Using Ontology Tree-Based Key Term Search

Disorders of the Central Nervous System (CNS) are worldwide causes of morbidity and mortality. In order to further investigate the nature of the CNS research, we generate from an initial reference a controlled vocabulary of CNS disorder-related terms and ontological tree structure for this vocabulary, and then apply the vocabulary in an analysis of the past ten years of abstracts (N = 10,488) from a major neuroscience journal. Using literal search methodology with our terminology tree, we find over 5,200 relationships between abstracts and clinical diagnostic topics. After generating a network graph of these document-topic relationships, we find that this network graph contains characteristics of document-author and other human social networks, including evidence of scale-free and power law-like node distributions. However, we also found qualitative evidence for Z-normal-type (albeit logarithmically skewed) distributions within disorder popularity. Lastly, we discuss potential consumer-centered as well as clinic-centered uses for our ontology and search methodology

Assessing the Current and Future Risk of Overheating in London’s Care Homes: The Effect of Passive Ventilation

The warming climate causes adverse effects on thermal comfort and health, especially for vulnerable older adults. This study assesses the current and future risk of summertime overheating in London’s care homes and explores the potential of passive ventilation on reducing these risks. Analysis is based on temperature monitoring of two care settings and on thermal simulation models of future conditions with and without passive ventilation strategies. Results show high overheating exposures for both care homes, with temperatures averaging 31-35 0C by 2050. Passive ventilation can substantially reduce these exposures, but a successful approach depends on time of day, duration and window characteristics. Dynamic window opening based on lower outdoor temperatures and indoor temperature exceedance of 22 0C is the most beneficial approach for both settings now and in the future. The study demonstrates the effectiveness of affordable building adaptations for reducing heat stress in senior care homes

Methods to estimate acclimatization to urban heat island effects on heat- and cold-related mortality

Background: Investigators have examined whether heat mortality risk is increased in neighborhoods subject to the urban heat island (UHI) effect but have not identified degrees of difference in susceptibility to heat and cold between cool and hot areas, which we call acclimatization to the UHI. Objectives: We developed methods to examine and quantify the degree of acclimatization to heat- and cold-related mortality in relation to UHI anomalies and applied these methods to London, UK. Methods: Case–crossover analyses were undertaken on 1993–2006 mortality data from London UHI decile groups defined by anomalies from the London average of modeled air temperature at a 1-km grid resolution. We estimated how UHI anomalies modified excess mortality on cold and hot days for London overall and displaced a fixed-shape temperature-mortality function (“shifted spline” model). We also compared the observed associations with those expected under no or full acclimatization to the UHI. Results: The relative risk of death on hot versus normal days differed very little across UHI decile groups. A 1°C UHI anomaly multiplied the risk of heat death by 1.004 (95% CI: 0.950, 1.061) (interaction rate ratio) compared with the expected value of 1.070 (1.057, 1.082) if there were no acclimatization. The corresponding UHI interaction for cold was 1.020 (0.979, 1.063) versus 1.030 (1.026, 1.034) (actual versus expected under no acclimatization, respectively). Fitted splines for heat shifted little across UHI decile groups, again suggesting acclimatization. For cold, the splines shifted somewhat in the direction of no acclimatization, but did not exclude acclimatization. Conclusions: We have proposed two analytical methods for estimating the degree of acclimatization to the heat- and cold-related mortality burdens associated with UHIs. The results for London suggest relatively complete acclimatization to the UHI effect on summer heat–related mortality, but less clear evidence for cold–related mortality

2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery

Authors/Task Force Members: Christa Boer (EACTA Chairperson)(Netherlands), Michael I. Meesters (Netherlands), Milan Milojevic (Netherlands), Umberto Benedetto (UK), Daniel Bolliger (Switzerland), Christian von Heymann (Germany), Anders Jeppsson (Sweden), Andreas Koster (Germany), Ruben L. Osnabrugge (Netherlands), Marco Ranucci (Italy), Hanne Berg Ravn (Denmark), Alexander B.A. Vonk (Netherlands), Alexander Wahba (Norway), Domenico Pagano (EACTS Chairperson)(UK),. Document Reviewers: Moritz W.V. Wyler von Ballmoos (USA), Mate Petricevic (Croatia), Arie Pieter Kappetein (Netherlands), Miguel Sousa-Uva (Portugal), Georg Trummer (Germany), Peter M. Rosseel (Netherlands), Michael Sander (Germany), Pascal Colson (France), Adrian Bauer (Germany)

Cognitive Development Respiratory Tract Illness and Effects of Exposure (Cortex) Project: Combining High Spatial Resolution Pollution Measurements With Individual Level Data, a Methodological Approach

Introduction The Secure Anonymised Information Linkage (SAIL) databank facilitated linkage of routinely collected health and education data, high spatial resolution pollution modelling and daily pollen measurements for 18,241 pupils in 7 cross-sectional cohorts across Cardiff city, UK, to investigate effects of air quality and respiratory health conditions on education attainment. Objectives and Approach An urban atmospheric dispersion and chemistry modelling system (ADMS-Urban) simulated modelled hourly concentrations of air pollutants: PM2.5, PM10, NO2 and ozone levels. These were summarised into minimum, average and maximum daily readings for 4 time periods (e.g. school hours 9am-3pm) for all home and school locations across Cardiff between 2009 and 2015. The combination of different pollutants, measurements and time-periods created a comprehensive multi-row dataset per location. We transformed the dimensionality of this high-resolution data to create one row of summarised data per pupil per cohort, in preparation for statistical analysis. Results 157,361 school and home locations across Cardiff were anonymised and household linkage fields were appended to combine pollution estimates at the household/school to individual health data. The pollution dataset contained 369 columns, 472,083 rows per year with one column per location, pollutant type, pollutant measurement, daily time-period, and day of year. Dataset transformation reduced algorithm computation by creating a single date column, producing a five column, 3,446,205,900-row matrix per year dataset. The algorithm adjusted for weekends, school/bank holidays and allowed location to vary 3pm-5pm on school days when pupil location was uncertain. The algorithm calculated tailored pollution exposures per pupil for revision and examination periods, creating one row per pupil and reducing 7 years of data and 24 billion rows to 18,241. Conclusion/Implications We successfully linked 95% of the cohorts’ household/school pollution data to their corresponding health and education data. This demonstrates data linking retrospective exposures for total populations using multiple daily locations, and extends our analysis platform for natural experiments to include daily exposure. Future work includes adding modelled route exposures

Are Children Who Are Treated for Asthma and Seasonal Allergic Rhinitis Disadvantaged in Their Educational Attainment When Acutely Exposed to Air Pollution and Pollen? A Feasibility Study

BACKGROUND: There is a lack of evidence of the adverse effects which air quality has on cognition for people with air quality-related health conditions, these are not widely documented in the literature. Educational attainment, as a proxy for cognition, may increase with improved air quality. OBJECTIVES: Prepare individual and household level linked environmental and health data for analysis within an anonymised safe haven; analyse the linked dataset for our study investigating: Cognition, Respiratory Tract illness and Effects of eXposure (CORTEX). METHODS: Anonymised, routinely collected health and education data were linked with high spatial resolution pollution measurements and daily pollen measurements to provide repeated cross-sectional cohorts (2009-2015) on 18,241 pupils across the city of Cardiff, using the SAIL databank. A fully adjusted multilevel linear regression analysis examined associations between health status and/or air quality. Cohort, school and individual level confounders were controlled for. We hope that using individual-level multi-location daily exposure assessment will help to clarify the role of traffic and prevent potential community-level confounding. Combined effects of air quality on variation in educational attainment between those treated for asthma and/or Severe Allergic Rhinitis (SAR), and those not treated, was also investigated. FINDINGS: Asthma was not associated with exam performance (p=0.7). However, SAR was positively associated with exam performance (p<0.001). Exposure to air pollution was negatively associated with educational attainment regardless of health status. CONCLUSIONS: Irrespective of health status, air quality was negatively associated with educational attainment. Treatment seeking behaviour may explain the positive association between SAR and educational attainment. For a more accurate reflection of health status, health outcomes not subject to treatment seeking behaviours, such as emergency hospital admission, should be investigated

Impact of concomitant aortic regurgitation on long-term outcome after surgical aortic valve replacement in patients with severe aortic stenosis

<p>Abstract</p> <p>Background</p> <p>Prognostic value of concomitant aprtic regurgitation (AR) in patients operated for severe aortic stenosis (AS) is not clarified. The aim of this study was to prospectively examine the impact of presence and severity of concomitant AR in patients operated for severe AS on long-term functional capacity, left ventricular (LV) function and mortality.</p> <p>Methods</p> <p>Study group consisted of 110 consecutive patients operated due to severe AS. The patients were divided into AS group (56 patients with AS without AR or with mild AR) and AS+AR group (54 patients with AS and moderate, severe or very severe AR). Follow-up included clinical examination, six minutes walk test (6MWT) and echocardiography 12 and 104 months after AVR.</p> <p>Results</p> <p>Patients in AS group had lower LV volume indices throughout the study than patients in AS+AR group. Patients in AS group did not have postoperative decrease in LV volume indices, whereas patients in AS+AR group experienced decrease in LV volume indices at 12 and 104 months. Unlike LV volume indices, LV mass index was significantly lower in both groups after 12 and 104 months as compared to preoperative values. Mean LVEF remained unchanged in both groups throughout the study. NYHA class was improved in both groups at 12 months, but at 104 months remained improved only in patients with AS. On the other hand, distance covered during 6MWT was longer at 104 months as compared to 12 months only in AS+AR group (p = 0,013), but patients in AS group walked longer at 12 months than patients in AS+AR group (p = 0,002). There were 30 deaths during study period, of which 13 (10 due to cardiovascular causes) in AS group and 17 (12 due to cardiovascular causes) in AS+AR group. Kaplan-Meier analysis showed that the survival probability was similar between the groups. Multivariate analysis identified diabetes mellitus (beta 1.78, p = 0.038) and LVEF < 45% (beta 1.92, p = 0.049) as the only independent predictor of long-term mortality.</p> <p>Conclusion</p> <p>Our data indicate that the preoperative presence and severity of concomitant AR has no influence on long-term postoperative outcome, LV function and functional capacity in patients undergoing AVR for severe AS.</p

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities

BACKGROUND: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. METHODS: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. FINDINGS: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. INTERPRETATION: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. FUNDING: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council

The challenges of transferring chronic illness patients to adult care: reflections from pediatric and adult rheumatology at a US academic center

<p>Abstract</p> <p>Background</p> <p>Little is known about the transfer of care process from pediatric to adult rheumatology for patients with chronic rheumatic disease. The purpose of this study is to examine changes in disease status, treatment and health care utilization among adolescents transferring to adult care at the University of California San Francisco (UCSF).</p> <p>Methods</p> <p>We identified 31 eligible subjects who transferred from pediatric to adult rheumatology care at UCSF between 1995–2005. Subject demographics, disease characteristics, disease activity and health care utilization were compared between the year prior to and the year following transfer of care.</p> <p>Results</p> <p>The mean age at the last pediatric rheumatology visit was 19.5 years (17.4–22.0). Subject diagnoses included systemic lupus erythematosus (52%), mixed connective tissue disease (16%), juvenile idiopathic arthritis (16%), antiphospholipid antibody syndrome (13%) and vasculitis (3%). Nearly 30% of subjects were hospitalized for disease treatment or management of flares in the year prior to transfer, and 58% had active disease at the time of transfer. In the post-transfer period, almost 30% of subjects had an increase in disease activity. One patient died in the post-transfer period. The median transfer time between the last pediatric and first adult rheumatology visit was 7.1 months (range 0.7–33.6 months). Missed appointments were common in the both the pre and post transfer period.</p> <p>Conclusion</p> <p>A significant percentage of patients who transfer from pediatric to adult rheumatology care at our center are likely to have active disease at the time of transfer, and disease flares are common during the transfer period. These findings highlight the importance of a seamless transfer of care between rheumatology providers.</p

Gender-specific associations of vision and hearing impairments with adverse health outcomes in older Japanese: a population-based cohort study

BACKGROUND: Several epidemiological studies have shown that self-reported vision and hearing impairments are associated with adverse health outcomes (AHOs) in older populations; however, few studies have used objective sensory measurements or investigated the role of gender in this association. Therefore, we examined the association of vision and hearing impairments (as measured by objective methods) with AHOs (dependence in activities of daily living or death), and whether this association differed by gender. METHODS: From 2005 to 2006, a total of 801 residents (337 men and 464 women) aged 65 years or older of Kurabuchi Town, Gunma, Japan, participated in a baseline examination that included vision and hearing assessments; they were followed up through September 2008. Vision impairment was defined as a corrected visual acuity of worse than 0.5 (logMAR = 0.3) in the better eye, and hearing impairment was defined as a failure to hear a 30 dB hearing level signal at 1 kHz in the better ear. Information on outcomes was obtained from the town hall and through face-to-face home visit interviews. We calculated the risk ratios (RRs) of AHOs for vision and hearing impairments according to gender. RESULTS: During a mean follow-up period of 3 years, 34 men (10.1%) and 52 women (11.3%) had AHOs. In both genders, vision impairment was related to an elevated risk of AHOs (multi-adjusted RR for men and women together = 1.60, 95% CI = 1.05-2.44), with no statistically significant interaction between the genders. In contrast, a significant association between hearing impairment and AHOs (multi-adjusted RR = 3.10, 95% CI = 1.43-6.72) was found only in the men. CONCLUSION: In this older Japanese population, sensory impairments were clearly associated with AHOs, and the association appeared to vary according to gender. Gender-specific associations between sensory impairments and AHOs warrant further investigation