Laceration of the Iliac Vein in a Patient with a Femoral Catheter for Hemodialysis

Although catheters are an ideal therapeutic treatment for all patients who need hemodialysis, their placement, use may be followed by certain complications. We present a case of iliac vein lacerations in the projection of the tip of a femoral catheter for hemodialysis in a 55-year-old patient

Lifelong exposure to air pollution and cognitive development in young children: the UK Millennium Cohort Study

Background. Evidence about the impact of air pollution on cognitive development of children has been growing but remains inconclusive. Objectives. To investigate the association of air pollution exposure and the cognitive development of children in the UK Millennium Cohort Study. Methods. Longitudinal study of a nationally representative sample of 13,058-14,614 singleton births, 2000-2002, analysed at age 3, 5 and 7 years for associations between exposure from birth to selected air pollutants and cognitive scores for: School Readiness, Naming Vocabulary (age 3 and 5), Picture Similarity, Pattern Construction (age 5 and 7), Number Skills and Word Reading. Multivariable regression models took account of design stratum, clustering and sampling and attrition weights with adjustment for major risk factors, including age, gender, ethnicity, region, household income, parents' education, language, siblings and second-hand tobacco smoke. Results: In fully adjusted models, no associations were observed between pollutant exposures and cognitive scores at age 3. At age 5, particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulphur dioxide (SO2) and carbon monoxide (CO) were associated with lower scores for Naming Vocabulary but no other outcome except for SO2 and Picture Similarity. At age 7, PM2.5, PM10 and NO2 were associated with lower scores for Pattern Construction, SO2 with lower Number Skills and SO2 and ozone with poorer Word Reading scores, but PM2.5, PM10 and NO2 were associated with higher Word Reading scores. Adverse effects of air pollutants represented a deficit of up to around 4 percentile points in Naming Vocabulary at age 5 for an interquartile range increase in pollutant concentration, which is smaller than the impact of various social determinants of cognitive development. Conclusions: In a study of multiple pollutants and outcomes, we found mixed evidence from this UK-wide cohort study for association between lifetime exposure to neighbourhood air pollutants and cognitive development to age 7 years

Assessing heat vulnerability in London care settings: case studies of adaptation to climate change

This pilot study aims at testing methods to assess heat vulnerability in London care homes and develop overheating reduction strategies to mitigate temperature exposure and the associated negative health impacts under the warming climate, with a view to scaling up the project on a national scale. It undertakes feasibility work to identify possible causes of overheating across a range of care home types and evaluate the current and future potential of indicative passive solutions. The summertime thermal environments of five case study care homes were monitored and their physical, technical and occupancy profiles were established through surveys. The data was inputed in the EnergyPlus V8.9 dynamic thermal simulations via the DesignBuilder Graphical User Interface. Future overheating risks and their reduction potential through the use of passive strategies were tested under a set of representative climate change scenarios, during a five-day heatwave period. The dynamic thermal simulation analysis indicated that older buildings with higher heat loss and thermal mass capacities are likely to benefit more from the application of high albedo materials rather than external shading methods, whereas newer and highly insulated buildings seem to benefit more from higher ventilation rates and appropriate external shading systems. Night ventilation emerged as the single most impactful passive technique for all building types. This feasibility work has developed novel methods, knowledge and insights that will be helpful in understanding how to enable care settings in the UK to become resilient to rising heat stress. This is one of the first systematic attempts to build a set of dynamic thermal models of care homes in the UK

Myocardial infarction, ST-elevation and non-ST-elevation myocardial infarction and modelled daily pollution concentrations; a case-crossover analysis of MINAP data

Objectives: To investigate associations between daily concentrations of air pollution and myocardial infarction (MI), ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Methods: Modelled daily ground-level gaseous, total and speciated particulate pollutant concentrations and ground-level daily mean temperature, all at 5 km x 5 km horizontal resolution, were linked to 202,550 STEMI and 322,198 NSTEMI events recorded on the England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. The study period was 2003-2010. A case-crossover design was used, stratified by year, month, and day of the week. Data were analysed using conditional logistic regression, with pollutants modelled as unconstrained distributed lags 0-2 days. Results are presented as percentage change in risk per 10 µg/m3 increase in the pollutant relevant metric, having adjusted for daily mean temperature, public holidays, weekly flu consultation rates, and a sine-cosine annual cycle. Results: There was no evidence of an association between MI or STEMI and any of O3, NO2, PM2.5, PM10 or selected PM2.5 components (sulphate and elemental carbon). For NSTEMI there was a positive association with daily maximum 1-hour NO2 (0.27% (95% CI: 0.01 to 0.54)), which persisted following adjustment for O3 and adjustment for PM2.5. The association appeared to be confined to the midland and southern regions of England and Wales. Conclusions: The study found no evidence of an association between the modelled pollutants (including components) investigated and STEMI but did find some evidence of a positive association between NO2 and NSTEMI. Confirmation of this association in other studies is required

Air Pollution, housing and respiratory tract Infections in Children: NatIonal birth Cohort study (PICNIC) - study protocol

INTRODUCTION: Respiratory tract infections (RTIs) are the most common reason for hospital admission among children <5 years in the UK. The relative contribution of ambient air pollution exposure and adverse housing conditions to RTI admissions in young children is unclear and has not been assessed in a UK context. METHODS AND ANALYSIS: The aim of the PICNIC study (Air Pollution, housing and respiratory tract Infections in Children: NatIonal birth Cohort Study) is to quantify the extent to which in-utero, infant and childhood exposures to ambient air pollution and adverse housing conditions are associated with risk of RTI admissions in children <5 years old. We will use national administrative data birth cohorts, including data from all children born in England in 2005-2014 and in Scotland in 1997-2020, created via linkage between civil registration, maternity and hospital admission data sets. We will further enhance these cohorts via linkage to census data on housing conditions and socioeconomic position and small area-level data on ambient air pollution and building characteristics. We will use time-to-event analyses to examine the association between air pollution, housing characteristics and the risk of RTI admissions in children, calculate population attributable fractions for ambient air pollution and housing characteristics, and use causal mediation analyses to explore the mechanisms through which housing and air pollution influence the risk of infant RTI admission. ETHICS, EXPECTED IMPACT AND DISSEMINATION: To date, we have obtained approval from six ethics and information governance committees in England and two in Scotland. Our results will inform parents, national and local governments, the National Health Service and voluntary sector organisations of the relative contribution of adverse housing conditions and air pollution to RTI admissions in young children. We will publish our results in open-access journals and present our results to the public via parent groups and social media and on the PICNIC website. Code and metadata will be published on GitHub

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