Urban heat stress: novel survey suggests health and fitness as future avenue for research and adaptation strategies

Extreme heat has tremendous adverse effects on human health. Heat stress is expected to further increase due to urbanization, an aging population, and global warming. Previous research has identified correlations between extreme heat and mortality. However, the underlying physical, behavioral, environmental, and social risk factors remain largely unknown and comprehensive quantitative investigation on an individual level is lacking. We conducted a new cross-sectional household questionnaire survey to analyze individual heat impairment (self-assessed and reported symptoms) and a large set of potential risk factors in the city of Berlin, Germany. This unique dataset (n = 474) allows for the investigation of new relationships, especially between health/fitness and urban heat stress. Our analysis found previously undocumented associations, leading us to generate new hypotheses for future research: various health/fitness variables returned the strongest associations with individual heat stress. Our primary hypothesis is that age, the most commonly used risk factor, is outperformed by health/fitness as a dominant risk factor. Related variables seem to more accurately represent humans' cardiovascular capacity to handle elevated temperature. Among them, active travel was associated with reduced heat stress. We observed statistical associations for heat exposure regarding the individual living space but not for the neighborhood environment. Heat stress research should further investigate individual risk factors of heat stress using quantitative methodologies. It should focus more on health and fitness and systematically explore their role in adaptation strategies. The potential of health and fitness to reduce urban heat stress risk means that encouraging active travel could be an effective adaptation strategy. Through reduced CO2 emissions from urban transport, societies could reap double rewards by addressing two root causes of urban heat stress: population health and global warming.Deutsche Forschungsgemeinschaft 10.13039/501100001659Peer Reviewe

A different point of view: the evaluation of motor imagery perspectives in patients with sensorimotor impairments in a longitudinal study

BACKGROUND: Motor imagery (MI) has been successfully applied in neurological rehabilitation. Little is known about the spontaneous selection of the MI perspectives in patients with sensorimotor impairments. What perspective is selected: internal (first-person view), or external (third-person view)? The aim was to evaluate the MI perspective preference in patients with sensorimotor impairments. METHODS: In a longitudinal study including four measurement sessions, 55 patients (25 stroke, 25 multiple sclerosis, 5 Parkinson’s disease; 25 females; mean age 58 ± 14 years) were included. MI ability and perspective preference in both visual and kinaesthetic imagery modalities were assessed using the Kinaesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), the body rotation task (BRT), and mental chronometry (MC). Additionally, patients’ activity level was assessed. Descriptive analyses were performed regarding different age- ( 64), activity levels (inactive, partially active, active), and KVIQ-20 movement classifications (axial, proximal, distal, upper and lower limb). A mixed-effects model was used to investiage the relationship between the primary outcome (MI perspective: internal, external) with the explanatory variables age, MI modality (visual, kinaesthetic), movement type (axial, proximal, distal), activity levels and the different assessments (KVIQ-20, BRT, MC). RESULTS: Imagery modality was not a significant predictor of perspective preference. Over the four measurement sessions, patients tended to become more consistent in their perspective selection, however, time point was not a significant predictor. Movement type was a significant predictor: imagination of distal vs. axial and proximal vs. axial movements were both associated with preference for external perspective. Patients with increased physical activity level tend to use internal imagery, however, this effect was borderline not statistically significant. Age was neither a significant precictor. Regarding the MI assessments, the KVIQ- 20 score was a significant predictor. The patients with higher test scores tend to use the external perspective. CONCLUSION: It is recommended to evaluate the spontaneous MI perspective selection to design patient-specific MI training interventions. Distal movements (foot, finger) may be an indicator when evaluating the consistency of the MI perspective in patients with sensorimotor impairments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-021-02266-w

Urban heat stress: novel survey suggests health and fitness as future avenue for research and adaptation strategies

Extreme heat has tremendous adverse effects on human health. Heat stress is expected to further increase due to urbanization, an aging population, and global warming. Previous research has identified correlations between extreme heat and mortality. However, the underlying physical, behavioral, environmental, and social risk factors remain largely unknown and comprehensive quantitative investigation on an individual level is lacking. We conducted a new cross-sectional household questionnaire survey to analyze individual heat impairment (self-assessed and reported symptoms) and a large set of potential risk factors in the city of Berlin, Germany. This unique dataset (n = 474) allows for the investigation of new relationships, especially between health/fitness and urban heat stress. Our analysis found previously undocumented associations, leading us to generate new hypotheses for future research: various health/fitness variables returned the strongest associations with individual heat stress. Our primary hypothesis is that age, the most commonly used risk factor, is outperformed by health/fitness as a dominant risk factor. Related variables seem to more accurately represent humans’ cardiovascular capacity to handle elevated temperature. Among them, active travel was associated with reduced heat stress. We observed statistical associations for heat exposure regarding the individual living space but not for the neighborhood environment. Heat stress research should further investigate individual risk factors of heat stress using quantitative methodologies. It should focus more on health and fitness and systematically explore their role in adaptation strategies. The potential of health and fitness to reduce urban heat stress risk means that encouraging active travel could be an effective adaptation strategy. Through reduced CO2 emissions from urban transport, societies could reap double rewards by addressing two root causes of urban heat stress: population health and global warming

Perfluoroalkyl acids and their precursors in indoor air sampled in children's bedrooms

The contamination levels and patterns of perfluoroallcyl acids (PFAAs) and their precursors in indoor air of children's bedrooms in Finland, Northern Europe, were investigated. Our study is among the most comprehensive indoor air monitoring studies (n = 57) and to our knowledge the first one to analyse air in children's bedrooms for PFASs (17 PFAAs and 9 precursors, including two acrylates, 6:2 FTAC and 6:2 FTMAC). The most frequently detected compound was 8:2 fluorotelomer alcohol (8:2 FTOH) with the highest median concentration (3570 pg/m(3)). FTOH concentrations were generally similar to previous studies, indicating that in 2014/2015 the impact of the industrial transition had been minor on FTOH levels in indoor air. However, in contrast to earlier studies (with one exception), median concentrations of 6:2 FTOH were higher than 10:2 FTOH. The C8 PFAAs are still the most abundant acids, even though they have now been phased out by major manufacturers. The mean concentrations of FOSE/As, especially MeFOSE (89.9 pg/m(3)), were at least an order of magnitude lower compared to previous studies. Collectively the comparison of FTOHs, PFAAs and FOSE/FOSAs with previous studies indicates that indoor air levels of PFASs display a time lag to changes in production of several years. This is the first indoor air study investigating 6:2 FTMAC, which was frequently detected (58%) and displayed some of the highest maximum concentrations (13 000 pg/m(3)). There were several statistically significant correlations between particular house and room characteristics and PFAS concentrations, most interestingly higher EtFOSE air concentrations in rooms with plastic floors compared to wood or laminate. (C) 2016 Published by Elsevier Ltd.Peer reviewe

The TOMPs network:continuous data on the UK air quality for 20 years

The Toxic Organic Micro Pollutants (TOMPs) Network, which has operated since 1991, currently collects ambient air samples at six sites across England and Scotland, using high-volume active air samplers. Lancaster University has been operating this UK Department of Environment, Food and Rural Affairs (Defra) funded network from its inception, delivering long-term ambient air trend data for a range of Persistent Organic Pollutants (POPs) at both urban and rural locations. Data from the network provides Defra with valuable information on emission/source controls and on the effectiveness of international chemicals regulation. It is also used to demonstrate UK compliance with its obligations under the 2001 Stockholm Convention on Persistent Organic Pollutants and the 1998 UN/ECE Long-Range Atmospheric Transport Protocol. Moreover, long-term analysis of air pollutants at trace levels allows detailed studies on atmospheric fate and behaviour processes of persistent chemicals and is the inevitable basis of their successful modelling. The target chemicals of TOMPs have been polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and, since 2010, polybrominated diphenyl ethers (PBDEs). PCBs, PCDDs, PCDFs, and selected PBDEs are all listed under the Stockholm Convention. The continuous monitoring of these compounds has demonstrated the constant decline in their UK air concentrations over the last decades. The concentrations of all compounds are generally significantly higher at urban compared to semi-rural and rural sites, with estimated clearance rates between 2 and 9 years for PCBs at all sites, 2 to 4 years for PBDEs at urban and semi-rural sites, and 4 to 5 years for PCDDs and PCDFs at urban sites. All these data are in good agreement with emission estimates. Additionally, an archive is maintained, which can be used for analysing emerging chemicals, such as alternative flame retardants, pesticides, and further substances of interest as soon as they have been identified

Indigenous 14C-phenanthrene biodegradation in “pristine” woodland and grassland soils from Norway and the United Kingdom.

In this study, the indigenous microbial mineralisation of 14C-phenanthrene in seven background soils (four from Norwegian woodland and three from the UK (two grasslands and one woodland)) was investigated. ∑PAHs ranged from 16.39 to 285.54 ng g−1 dw soil. Lag phases (time before 14C-phenanthrene mineralisation reached 5%) were longer in all of the Norwegian soils and correlated positively with TOC, but negatively with ∑PAHs and phenanthrene degraders for all soils. 14C-phenanthrene mineralisation in the soils varied due to physicochemical properties. The results show that indigenous microorganisms can adapt to 14C-phenanthrene mineralisation following diffuse PAH contamination. Considering the potential of soil as a secondary PAH source, these findings highlight the important role of indigenous microflora in the processing of PAHs in the environment.N/

The challenge of measuring physiological parameters during motor imagery engagement in patients after a stroke

Introduction: It is suggested that eye movement recordings could be used as an objective evaluation method of motor imagery (MI) engagement. Our investigation aimed to evaluate MI engagement in patients after stroke (PaS) compared with physical execution (PE) of a clinically relevant unilateral upper limb movement task of the patients' affected body side. Methods: In total, 21 PaS fulfilled the MI ability evaluation [Kinaesthetic and Visual Imagery Questionnaire (KVIQ-10), body rotation task (BRT), and mental chronometry task (MC)]. During the experiment, PaS moved a cup to distinct fields while wearing smart eyeglasses (SE) with electrooculography electrodes integrated into the nose pads and electrodes for conventional electrooculography (EOG). To verify MI engagement, heart rate (HR) and oxygen saturation (SpO2) were recorded, simultaneously with electroencephalography (EEG). Eye movements were recorded during MI, PE, and rest in two measurement sessions to compare the SE performance between conditions and SE's psychometric properties. Results: MI and PE correlation of SE signals varied between r = 0.12 and r = 0.76. Validity (cross-correlation with EOG signals) was calculated for MI (r = 0.53) and PE (r = 0.57). The SE showed moderate test–retest reliability (intraclass correlation coefficient) with r = 0.51 (95% CI 0.26–0.80) for MI and with r = 0.53 (95% CI 0.29 – 0.76) for PE. Event-related desynchronization and event-related synchronization changes of EEG showed a large variability. HR and SpO2 recordings showed similar values during MI and PE. The linear mixed model to examine HR and SpO2 between conditions (MI, PE, rest) revealed a significant difference in HR between rest and MI, and between rest and PE but not for SpO2. A Pearson correlation between MI ability assessments (KVIQ, BRT, MC) and physiological parameters showed no association between MI ability and HR and SpO2. Conclusion: The objective assessment of MI engagement in PaS remains challenging in clinical settings. However, HR was confirmed as a reliable parameter to assess MI engagement in PaS. Eye movements measured with the SE during MI did not resemble those during PE, which is presumably due to the demanding task. A re-evaluation with task adaptation is suggested

Prevalence of depression and anxiety among participants with glaucoma in a population-based cohort study : the Gutenberg Health Study

Background To investigate the prevalence of depression and anxiety among subjects with self-reported glaucoma and the association between self-reported glaucoma and depression respectively anxiety in a European cohort. Methods A study sample of 14,657 participants aged 35 to 74 years was investigated in a population-based cohort study. All participants reported presence or absence of glaucoma. Ophthalmological examinations were carried out in all participants and demographic and disease related information were obtained by interview. Depression was assessed with the Patient Health Questionnaire (PHQ-9), and generalized anxiety with the two screening items (GAD-2) of the short form of the GAD-7 (Generalized Anxiety Disorder-7 Scale). Prevalence of depression and generalized anxiety were investigated for subjects with and without self-reported glaucoma. Logistic regression analyses with depression, respectively anxiety as dependent variable and self-reported glaucoma as independent variable were conducted and adjusted for socio-demographic factors, systemic comorbidities (arterial hypertension, myocardial infarction, stroke, diabetes mellitus, chronic obstructive pulmonary disease, cancer), ocular diseases (cataract, macular degeneration, corneal diseases, diabetic retinopathy), visual acuity, intraocular pressure, antiglaucoma eye drops (sympathomimetics, parasympathomimetics, carbonic anhydrase inhibitors, beta-blockers, prostaglandins) and general health status. Results 293 participants (49.5% female) reported having glaucoma. Prevalence of depression among participants with and without self-reported glaucoma was 6.6% (95%-CI 4.1–10.3) respectively 7.7% (95%-CI 7.3–8.2), and for anxiety 5.3% (95%-CI 3.1–8.7) respectively 6.6% (95%-CI 6.2–7.1). Glaucoma was not associated with depression (Odds ratio 1.10, 95%-CI 0.50–2.38, p = 0.80) or anxiety (1.48, 95%-CI 0.63–3.30, p = 0.35) after adjustment for socio-demographic factors, ocular/systemic diseases, ocular parameters, antiglaucoma drugs and general health status. A restriction to self-reported glaucoma cases either taking topical antiglaucoma medications or having a history of glaucoma surgery did not alter the result. Conclusions This is the first study analyzing both depression and anxiety among glaucoma patients in a European cohort. Subjects with and without self-reported glaucoma had a similar prevalence of depression and anxiety in our population-based sample. Self-reported glaucoma was not associated with depression or anxiety. A lack of a burden of depressive symptoms may result from recruitment from a population-based sample as compared to previous study groups predominantly recruited from tertiary care hospitals

GAPS-megacities: A new global platform for investigating persistent organic pollutants and chemicals of emerging concern in urban air

A pilot study was initiated in 2018 under the Global Atmospheric Passive Sampling (GAPS) Network named GAPS-Megacities. This study included 20 megacities/major cities across the globe with the goal of better understanding and comparing ambient air levels of persistent organic pollutants and other chemicals of emerging concern, to which humans residing in large cities are exposed. The first results from the initial period of sampling are reported for 19 cities for several classes of flame retardants (FRs) including organophosphate esters (OPEs), polybrominated diphenyl ethers (PBDEs), and halogenated flame retardants (HFRs) including new flame retardants (NFRs), tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCDD). The two cities, New York (USA) and London (UK) stood out with ∼3.5 to 30 times higher total FR concentrations as compared to other major cities, with total concentrations of OPEs of 15,100 and 14,100 pg/m3, respectively. Atmospheric concentrations of OPEs significantly dominated the FR profile at all sites, with total concentrations in air that were 2-5 orders of magnitude higher compared to other targeted chemical classes. A moderately strong and significant correlation (r = 0.625, p < 0.001) was observed for Gross Domestic Product index of the cities with total OPEs levels. Although large differences in FR levels were observed between some cities, when averaged across the five United Nations regions, the FR classes were more evenly distributed and varied by less than a factor of five. Results for Toronto, which is a "reference city" for this study, agreed well with a more in-depth investigation of the level of FRs over different seasons and across eight sites representing different urban source sectors (e.g. traffic, industrial, residential and background). Future sampling periods under this project will investigate trace metals and other contaminant classes, linkages to toxicology, non-targeted analysis, and eventually temporal trends. The study provides a unique urban platform for evaluating global exposome.Fil: Saini, Amandeep. Environment and Climate Change; CanadáFil: Harner, Tom. Environment and Climate Change; CanadáFil: Chinnadhurai, Sita. Environment and Climate Change; CanadáFil: Schuster, Jasmin K.. Environment and Climate Change; CanadáFil: Yates, Alan. Environment and Climate Change; CanadáFil: Sweetman, Andrew. Lancaster Environment Centre; Reino UnidoFil: Aristizabal Zuluaga, Beatriz H.. Universidad Nacional de Colombia; ColombiaFil: Jiménez, Begoña. Consejo Superior de Investigaciones Científicas; EspañaFil: Manzano, Carlos A.. Universidad de Chile; ChileFil: Gaga, Eftade O.. Eskisehir Technical University; TurquíaFil: Stevenson, Gavin. National Measurement Institute; AustraliaFil: Falandysz, Jerzy. Uniwersytet Gdanski; PoloniaFil: Ma, Jianmin. Peking University; ChinaFil: Miglioranza, Karina Silvia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Kannan, Kurunthachalam. Nyu Grossman School Of Medicine; Estados UnidosFil: Tominaga, Maria. Sao Paulo State Environmental Company; BrasilFil: Jariyasopit, Narumol. No especifíca;Fil: Rojas, Nestor Y.. Universidad Nacional de Colombia; ColombiaFil: Amador-Muñoz, Omar. Universidad Nacional Autónoma de México; MéxicoFil: Sinha, Ravindra. Patna University; IndiaFil: Alani, Rose. University of Lagos; NigeriaFil: Suresh, R.. No especifíca;Fil: Nishino, Takahiro. Tokyo Metropolitan Research Institute for Environmental Protection; JapónFil: Shoeib, Tamer. American University In Cairo; Egipt

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707