Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database.

OBJECTIVE: To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution. DESIGN: Case-crossover study. SETTING: England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. PARTICIPANTS: 24,861 hospital admissions for myocardial infarction occurring in 11 conurbations during the warmest months (June to August) of the years 2003-09. MAIN OUTCOME MEASURE: Odds ratio of myocardial infarction for a 1 °C increase in temperature. RESULTS: Strong evidence was found for an effect of heat acting 1-6 hours after exposure to temperatures above an estimated threshold of 20 °C (95% confidence interval 16 °C to 25 °C). For each 1 °C increase in temperature above this threshold, the risk of myocardial infarction increased by 1.9% (0.5% to 3.3%, P=0.009). Later reductions in risk seemed to offset early increases in risk: the cumulative effect of a 1 °C rise in temperature above the threshold was 0.2% (-2.1% to 2.5%) by the end of the third day after exposure. CONCLUSIONS: Higher ambient temperatures above a threshold of 20 °C seem to be associated with a transiently increased risk of myocardial infarction 1-6 hours after exposure. Reductions in risk at longer lags are consistent with heat triggering myocardial infarctions early in highly vulnerable people who would otherwise have had a myocardial infarction some time later ("short term displacement"). Policies aimed at reducing the health effects of hot weather should include consideration of effects operating at sub-daily timescales

Mental health impacts of flooding: a controlled interrupted time series analysis of prescribing data in England.

BACKGROUND: There is emerging evidence that people affected by flooding suffer adverse impacts on their mental well-being, mostly based on self-reports. METHODS: We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011-2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre-post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10 km of a flood. RESULTS: After control for deprivation and population density, there was an increase of 0.59% (95% CI 0.24 to 0.94) prescriptions in the postflood year among practices located within 1 km of a flood over and above the change observed in the furthest distance band. The increase was greater in more deprived areas. CONCLUSIONS: This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. The degree to which the increase is actually concentrated in those flooded can only be determined by more detailed linkage studies

The effects of hourly differences in air pollution on the risk of myocardial infarction: case crossover analysis of the MINAP database.

OBJECTIVES: To investigate associations between air pollution levels and myocardial infarction (MI) on short timescales, with data at an hourly temporal resolution. DESIGN: Time stratified case crossover study linking clinical data from the Myocardial Ischaemia National Audit Project (MINAP) with PM(10), ozone, CO, NO(2), and SO(2) data from the UK National Air Quality Archive. Pollution effects were investigated with delays (lags) of 1-6, 7-12, 13-18, 19-24, and 25-72 hours in both single and multi-pollutant models, adjusted for ambient temperature, relative humidity, circulating levels of influenza and respiratory syncytial virus, day of week, holidays, and residual seasonality within calendar month strata. SETTING: Population based study in 15 conurbations in England and Wales. SUBJECTS: 79,288 diagnoses of myocardial infarction recorded over the period 2003-6. MAIN OUTCOME MEASURES: Excess risk of myocardial infarction per 10 µg/m(3) increase in pollutant level. RESULTS: In single pollutant models, PM(10) and NO(2) levels were associated with a very short term increase in risk of myocardial infarction 1-6 hours later (excess risks 1.2% (95% confidence interval 0.3 to 2.1) and 1.1% (0.3 to 1.8) respectively per 10 μg/m(3) increase); the effects persisted in multi-pollutant models, though with only weak evidence of an independent PM(10) effect (P = 0.05). The immediate risk increases were followed by reductions in risk at longer lags: we found no evidence of any net excess risk associated with the five pollutants studied over a 72 hour period after exposure. CONCLUSIONS: Higher levels of PM(10) and NO(2), which are typically markers of traffic related pollution, seem to be associated with transiently increased risk of myocardial infarction 1-6 hours after exposure, but later reductions in risk suggest that air pollution may be associated with bringing events forward in time ("short-term displacement") rather than increasing overall risk. The well established effect of air pollution on cardiorespiratory mortality may not be mediated through increasing the acute risk of myocardial infarction, but through another mechanism

Adiabatic theorem for non-hermitian time-dependent open systems

In the conventional quantum mechanics (i.e., hermitian QM) the adia- batic theorem for systems subjected to time periodic fields holds only for bound systems and not for open ones (where ionization and dissociation take place) [D. W. Hone, R. Ketzmerik, and W. Kohn, Phys. Rev. A 56, 4045 (1997)]. Here with the help of the (t,t') formalism combined with the complex scaling method we derive an adiabatic theorem for open systems and provide an analytical criteria for the validity of the adiabatic limit. The use of the complex scaling transformation plays a key role in our derivation. As a numerical example we apply the adiabatic theorem we derived to a 1D model Hamiltonian of Xe atom which interacts with strong, monochromatic sine-square laser pulses. We show that the gener- ation of odd-order harmonics and the absence of hyper-Raman lines, even when the pulses are extremely short, can be explained with the help of the adiabatic theorem we derived

Withholding and withdrawing life-sustaining treatment in a patient's best interests: Australian judicial deliberations

•Intractable disputes about withholding and withdrawing life-sustaining treatment from adults who lack capacity are rare but challenging. Judicial resolution may be needed in some of these cases. •A central concept for judicial (and clinical) decision making in this area is a patient's “best interests”. Yet what this term means is contested. •There is an emerging Supreme Court jurisprudence that sheds light on when life-sustaining treatment will, or will not, be judged to be in a patient's best interests. •Treatment that is either futile or overly burdensome is not in a patient's best interests. Although courts will consider patient and family wishes, they have generally deferred to the views of medical practitioners about treatment decisions

The avifauna of the Barito Ulu region. Central Kalimantan

As part of the more general studies of the Barito Ulu Project, a detailed study was made of the avifauna in July-September 1989. The survey area, which lies at the geographical centre of the island of Borneo, consists mainly of primary forest in hilly terrain, and this Is the first detailed study that has been made In the hills of Kalimantan for many decades. A week was also spent in montane forest at 800-1000 m. An appendix lists 226 species that were recorded. The avifauna includes 15 Bornean endemics, and extensions to known range are made for Spizaetus alboniger, Arborophila hyperythra and Megalaima eximia. Data are provided also on 20 species for which there are no recent Kalimantan records. While species described as 'slope specialists' predominated, the presence of some 26 'extreme lowland specialists' may have significance for conservation, for example Lophura erythrophthalma, Melanoperdix nigra. Pitta baudi, Malacopteron albogulare and Pityriasis gymnocephala

Effect of 20 mph traffic speed zones on road injuries in London, 1986-2006: controlled interrupted time series analysis

Objective To quantify the effect of the introduction of 20 mph (32 km an hour) traffic speed zones on road collisions, injuries, and fatalities in London

What is the functional/organic distinction actually doing in psychiatry and neurology? [version 1; peer review: 3 approved]

The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms ‘functional’ and ‘organic’ varies considerably by context. Techniques for differentially diagnosing ‘functional’ and ‘organic’ diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of ‘zero sum’ causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note ‘functional’ and ‘organic’ have loaded social meanings, creating the potential for social disempowerment. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other in neuropsychiatric thinking. We also note that the contribution of people who experience the interaction between ‘functional’ and ‘organic’ factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority

Nano-scale behavior of irradiated nano-structured alloys

Future fast neutron fusion and fission nuclear systems will be subjected to levels of radiation damage from fast neutrons which is significantly higher than the current generation of nuclear power stations. This will require innovative materials solutions to allow long term mechanical stability of reactors. One proposed class of materials are nanostructured alloys where the large number of interfaces allow for recombination defects and reduce the degree of radiation hardening seen. However their response under irradiation has not thoroughly been studied. In this work, two irradiated nanostructured alloys have been studied W-5%Re in both a nanostructured and annealed variant and a novel Hf-Ti-Ta-V-Zr high entropy alloy. I will outline the benefits nanostructured materials offer under irradiation and some of the problems and challenges in measuring their mechanical properties after irradiation and relating this to the nano-structure using XRD, TEM, HR-EBSD and atom probe tomography. Rolled tungsten 5 wt% rhenium sheet was studied in two microstructural variants: (a) as received with a high dislocation density (mean value of 1.4×1014lines/m2), measured using HR-EBSD, and pancake shaped grains with a thickness of≈200nm and (b) annealed at 1400oC for 24 hours to produce equiaxed grains with average grain size of ≈90 µm and low dislocation density (with a mean value of 4.8×1013 lines/m2). Both materials were ion implanted with 2MeV W+ ions at 300oC to damage levels from 0.07, to 33 displacements per atom (dpa). Nanoindentation was used to measure the change in hardness after implantations. Irradiation induced hardening saturated in the as-received material at an increase of 0.4dpa from the unimplanted hardness of 8GPa at 0.4dpa. In the annealed material saturation does not occur by 13dpa and the hardness change of 1.3GPa from the unimplanted hardness of 6.2GPa was over four times higher. At 33dpa both material types showed a further increase in hardening. In these samples Atom probe tomography showed clustering of Re in ≈4nm precipitates with a rhenium concentration of ≈11%. In both cases the number density and volume fraction are similar at ≈3100 x1000/µm3 and volume fraction of ≈13%. These differences in radiation response are likely to be due to the high damage sink density in the as-received microstructure in the form of dislocation networks, as even in the as-received material the average grain size is too large to provide sufficient sinks. Initially this provides a large sink network for radiation damage resulting in less hardening in the rolled material. However at 33dpa the formation of rhenium clusters occurs at similar levels in both material conditions. These dominate the hardening mechanisms and result in secondary hardening at high damage levels. The difficulties in extracting hardness values from 200nm deep ion implanted layers will be discussed, with reference to minimizing the influence of the substrate material and how changes in pile up effects in irradiated materials can change mechanical responses, and proposed methods to minimize these. High entropy alloys have been proposed as potential nuclear materials as high configurational entropy may provide resistance to radiation damage. We have produced a novel high entropy alloy (Hf-Ti-Ta-V-Zr) in which is single phase on casting but two high entropy phases (one bcc and one hcp) are produced during heat treatment. This material then has a nano-lamella structure with an average lamella thickness of 200nm. Samples of the as cast single phase material, the dual phase high entropy alloy and single crystal vanadium were ion irradiated with V+ ions at 300oC to a dose of 5e14 ions/cm2. In the vanadium control samples the hardness as measured using CSM-nanoindentation was seen to increase from 2GPa in the unimplanted condition to 3.5GPa in the ion irradiated condition. The high entropy alloy in both the as cast and heat treated condition showed no increase in hardness after irradiation, demonstrating the intrinsic resistance to radiation damage of HEA’s. These studies show the ability of nanostructured alloys to have improved irradiation hardening resistance over conventional alloys. However challenges still remain in the production of large scale engineering components in such materials