A retrospective cohort study of stroke onset: implications for characterizing short term effects from ambient air pollution

<p>Abstract</p> <p>Background</p> <p>Case-crossover studies used to investigate associations between an environmental exposure and an acute health response, such as stroke, will often use the day an individual presents to an emergency department (ED) or is admitted to hospital to infer when the stroke occurred. Similarly, they will use patient's place of residence to assign exposure. The validity of using these two data elements, typically extracted from administrative databases or patient charts, to define the time of stroke onset and to assign exposure are critical in this field of research as air pollutant concentrations are temporally and spatially variable. Our a priori hypotheses were that date of presentation differs from the date of stroke onset for a substantial number of patients, and that assigning exposure to ambient pollution using place of residence introduces an important source of exposure measurement error. The objective of this study was to improve our understanding on how these sources of errors influence risk estimates derived using a case-crossover study design.</p> <p>Methods</p> <p>We sought to collect survey data from stroke patients presenting to hospital EDs in Edmonton, Canada on the date, time, location and nature of activities at onset of stroke symptoms. The daily mean ambient concentrations of NO₂and PM_2.5on the self-reported day of stroke onset was estimated from continuous fixed-site monitoring stations.</p> <p>Results</p> <p>Of the 336 participating patients, 241 were able to recall when their stroke started and 72.6% (95% confidence interval [CI]: 66.9 - 78.3%) experienced stroke onset the same day they presented to the ED. For subjects whose day of stroke onset differed from the day of presentation to the ED, this difference ranged from 1 to 12 days (mean = 1.8; median = 1). In these subjects, there were no systematic differences in assigned pollution levels for either NO₂or PM_2.5when day of presentation rather than day of stroke onset was used. At the time of stroke onset, 89.9% (95% CI: 86.6 - 93.1%) reported that they were inside, while 84.5% (95% CI: 80.6 - 88.4%) reported that for most of the day they were within a 15 minute drive from home. We estimated that due to the mis-specification of the day of stroke onset, the risk of hospitalization for stroke would be understated by 15% and 20%, for NO₂and PM_2.5, respectively.</p> <p>Conclusions</p> <p>Our data suggest that day of presentation and residential location data obtained from administrative records reasonably captures the time and location of stroke onset for most patients. Under these conditions, any associated errors are unlikely to be an important source of bias when estimating air pollution risks in this population.</p

Unexplained variability among spatial replicates in transient elasticity: implications for evolutionary ecology and management of invasive species

Understanding actual and potential selection on traits of invasive species requires an assessment of the sources of variation in demographic rates. While some of this variation is assignable to environmental, biotic or historical factors, unexplained demographic variation also may play an important role. Even when sites and populations are chosen as replicates, the residual variation in demographic rates can lead to unexplained divergence of asymptotic and transient population dynamics. This kind of divergence could be important for understanding long- and short- term differences among populations of invasive species, but little is known about it. We investigated the demography of a small invasive tree Psidium cattleianum Sabine in the rainforest of Hawaiʻi at four sites chosen for their ecological similarity. Specifically, we parameterized and analyzed integral projection models (IPM) to investigate projected variability among replicate populations in: (1) total population size and annual per capita population growth rate during the transient and asymptotic periods; (2) population structure initially and asymptotically; (3) three key parameters that characterize transient dynamics (the weighted distance of the structure at each time step from the asymptotic structure, the strength of the sub-dominant relative to the dominant dynamics, and inherent cyclicity in the subdominant); and (4) proportional sensitivity (elasticity) of population growth rates (both asymptotic and transient) to perturbations of various components of the life cycle. We found substantial variability among replicate populations in all these aspects of the dynamics. We discuss potential consequences of variability across ecologically similar sites for management and evolutionary ecology in the exotic range of invasive species

Spatial analysis of urban growth in Spain, 1900–2001

Convergence, Urban growth, Spatial autocorrelation, Spatial SUR models, Markov chains, C14, C21, O18,

A Prediction Model of Drug Exposure in Cirrhotic Patients According to Child–Pugh Classification

International audienc