El Nino and Health Risks from Landscape Fire Emissions in Southeast Asia

Emissions from landscape fires affect both climate and air quality. Here, we combine satellite-derived fire estimates and atmospheric modelling to quantify health effects from fire emissions in southeast Asia from 1997 to 2006. This region has large interannual variability in fire activity owing to coupling between El Nino-induced droughts and anthropogenic land-use change. We show that during strong El Nino years, fires contribute up to 200 micrograms per cubic meter and 50 ppb in annual average fine particulate matter (PM2.5) and ozone surface concentrations near fire sources, respectively. This corresponds to a fire contribution of 200 additional days per year that exceed the World Health Organization 50 micrograms per cubic metre 24-hr PM(sub 2.5) interim target and an estimated 10,800 (6,800-14,300)-person (approximately 2 percent) annual increase in regional adult cardiovascular mortality. Our results indicate that reducing regional deforestation and degradation fires would improve public health along with widely established benefits from reducing carbon emissions, preserving biodiversity and maintaining ecosystem services

Use of patients’ classification instruments: analysis of the brazilian production of knowledge

Objective To analyze the production of scientific knowledge about the use of patients’ classification instruments in care and management practice in Brazil. Method Integrative literature review with databases search in: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS, between January 2002 through December 2013. Results 1,194 studies were found, 31 met the inclusion criteria. We observed a higher number of studies in the category care plans and workload (n=15), followed by the category evaluation of psychometric properties (n=14). Conclusion Brazilian knowledge production has not yet investigated some purposes of using instruments for classifying patients in professional nursing practice. The identification of unexplored areas can guide future research on the topic

Probabilistic fire spread forecast as a management tool in an operational setting

Background: An approach to predict fire growth in an operational setting, with the potential to be used as a decision-support tool for fire management, is described and evaluated. The operational use of fire behaviour models has mostly followed a deterministic approach, however, the uncertainty associated with model predictions needs to be quantified and included in wildfire planning and decision-making process during fire suppression activities. We use FARSITE to simulate the growth of a large wildfire. Probabilistic simulations of fire spread are performed, accounting for the uncertainty of some model inputs and parameters. Deterministic simulations were performed for comparison. We also assess the degree to which fire spread modelling and satellite active fire data can be combined, to forecast fire spread during large wildfires events. Results: Uncertainty was propagated through the FARSITE fire spread modelling system by randomly defining 100 different combinations of the independent input variables and parameters, and running the correspondent fire spread simulations in order to produce fire spread probability maps. Simulations were initialized with the reported ignition location and with satellite active fires. The probabilistic fire spread predictions show great potential to be used as a fire management tool in an operational setting, providing valuable information regarding the spatial–temporal distribution of burn probabilities. The advantage of probabilistic over deterministic simulations is clear when both are compared. Re-initializing simulations with satellite active fires did not improve simulations as expected. Conclusion: This information can be useful to anticipate the growth of wildfires through the landscape with an associated probability of occurrence. The additional information regarding when, where and with what probability the fire might be in the next few hours can ultimately help minimize the negative environmental, social and economic impacts of these firesinfo:eu-repo/semantics/publishedVersio

Indirizzi operativi per la sorveglianza clinica e ambientale della legionellosi nelle strutture sanitarie e assistenziali della Regione Puglia

La prima epidemia di legionellosi, verificatasi nel luglio del 1976 durante l'American Legion Annua/ Convention a Philadelphia, fece registrare oltre 200 casi con 34 decessi. Solo un anno più tardi, nei laboratori dei Centers far Disease Contrai and Prevention (CDC) dì Atlanta , fu isolato e identificato il microrganismo che, in memoria della prima epidemia, fu chiamato Legionella pneumophila. la sorgente dell' infezione fu individuata nell' impianto di aria condizionata presente nell'hotel. La scoperta suscitò un grande interesse, tale da incoraggiare alcuni studiosi ad effettuare indagini sierologiche retrospettive su campioni di siero provenienti da soggetti affetti da polmonite di origine sconosciuta. Fu possibile in tal modo risalire ad altri episodi epidemici, quali gli eventi accaduti nel 1965 tra i pazienti dell'Ospedale Psichiatrico St. Elisabeth di Washington e nel 1968 tra coloro che lavoravano nel Servizio di Sanità Pubblica di Pontiac (in Michigan). In seguito, si verificarono altre epidemie che hanno contribuito ad approfondire le conoscenze scientifiche non solo sull'etiologia, patogenesi, diagnosi e terapia della legionellosi, ma anche sulle caratteristiche biochimiche, morfologiche e immunologiche dell'agente patogeno, compreso il suo habitat natura le. In Italia, il primo focolaio epidemico risale al 1978 sul Lago di Garda ed interessò 10 soggetti. Da allora le segnalazioni di casi, sia sporadici sia epidemici , sono diventate sempre più frequ enti, anche se è difficile stabilire se questo incremento sia dovuto ad un reale aumento dell' incidenza, al perfezionam ento delle tecniche diagnostiche o ad una maggiore att enzione alla diagnosi e segnalazione dei casi. Nel Sud Italia, la Puglia è tra le regioni con il maggior numero di casi di legionellosi notificati [Notiziar io ISS 2017]. I fattori che rendono diff icile il controllo e la gestione del probl ema sono la disomogeneità nelle procedure di campionamento, le difformità negli intervent i di bonif ica, la scarsa esperienza nella gestione del rischio associato alle diverse concentrazioni di Legionella rilevate nelle reti idriche. L'entità del problema, per la sua complessità, richiede sempre piu un'accurata attenzione a causa delle pesanti conseguenze legali e di immagine che possono coinvolgere sia le strutture sanitarie sia quelle turistico-ricettive, pertanto la Giunta regionale ha approvato nel 2012 il documento Indirizzi per l'Adozione di un Sistema per la sorveglianza e il controllo delle infezioni da Legionella in Puglia, con il quale ha istituito un sistema di rete regionale formato da due livelli organizzativi: uno centrale e l'altro periferico [D.G.R. n. 2261/2012] . Il livello organizzativo centrale è rappresentato da un apposito Nucleo di Riferimento Regionale che definisce percorsi comun i e codificati nell'ambito delle attività di prevenzione e controllo della malattia ed esercita funzioni chiave per la governance del sistema . Il mandato strategico è quello di assumere l'impegno di "regolare" la rete, attraverso un ruolo di att ivazione, sviluppo e manutenzione di procedure codificate tra i componenti della rete stessa. Il livello organizzativo periferico , costituito dal Nucleo Operativo Territo riale presso ogni Azienda Sanitaria Locale, è incaricato delle attività in materia di prevenzione e controllo della legionellosi e rappresenta, a livello aziendale, il momento d'incontro e condivisione tra il Dipartimento di Prevenzione, la Direzione Sanitaria, i reparti di ricovero, i laborato ri di analisi aziendali, oltre che di coordinamento e collaborazione con l'Agenzia Regionale per la Prevenzione e la Protezione dell'Ambiente (ARPA) provinciale. I punti deboli di ogni strategia di controllo della legionellosi sono riportabili alla mancanza di una chiara correlazione dose-effetto e di una soglia limi te ben definita , ancora oggi associate all'impossibilità di bonificare il sistema idrico in maniera definitiva. Per ridurre il rischio e il numero dei casi di malattia , il presente documento si propone di pianificare un iter omogeneo di procedure da applicare per il controllo e la prevenzione della legionellosi, ponendosi nella linea della prevenzione primaria piuttosto che in quella dell'intervento al verificarsi dei casi. - Il presente documento è rivolto a tutte le strutture sanitarie e assistenziali della Regione Puglia e fornisce indicazioni su: 1. metodi più appropriati per lo screening e la diagnosi della legionellosi; 2. modalità di campionamento per la ricerca di Legionella negli impianti idrici e aeraulici; 3. sistemi efficaci per la sorveglianza e il controllo delle reti idriche; 4. procedure e mezzi per la bonifica e la ridu zione del rischio; 5. attività di comunicaz ione e formazione degli operatori sanitari e degli addetti al controllo; 6. responsabilità medico-legali connesse al verificarsi di casi di malattia associati alle strutture coinvolte

Fresh-blood-free diet for rearing malaria mosquito vectors

Mosquito breeding depends on the supply of fresh vertebrate blood, a major bottleneck for large-scale production of Anopheles spp. Feeding alternatives to fresh blood are thus a priority for research, outdoor large-cage trials and control interventions. Several artificial meal compositions were tested and Anopheles oogenesis, egg laying and development into the next generation of adult mosquitoes were followed. We identified blood-substitute-diets that supported ovarian development, egg maturation and fertility as well as, low progeny larval mortality, and normal development of offspring into adult mosquitoes. The formulated diet is an effective artificial meal, free of fresh blood that mimics a vertebrate blood meal and represents an important advance for the sustainability of Anopheles mosquito rearing in captivity.Agência financiadora / Número do subsídio Bill and Melinda Gates Foundation OPP1138841 Fundacao para a Ciencia e Tecnologia GHTM - UID/Multi/04413/201 CCMAR - UID/Multi/04326/2013 UID/Multi/04326/2013 RF SFRH/BPD/89811/2012 FAPEAM, Brazil 19716.UNI472.2459.20022014info:eu-repo/semantics/publishedVersio

Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

BACKGROUND: Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an "intrinsic" parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. METHODS: Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling). Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's "K" value. RESULTS: Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. CONCLUSIONS: Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct brushing in the detection of malignant diseases (p < 0.01)

A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma

<p/> <p>Background</p> <p>Osteoporosis could be associated with the hormone therapy for metastatic prostate carcinoma (PCa) and with PCa <it>per se</it>. The objective of this review is to determine the incidence of bone loss and osteoporosis in patients with PCa who are or are not treated with hormone therapy (ADT).</p> <p>Methods</p> <p>The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published studies on prostate cancer and bone metabolism. The outcomes assessed were: fracture, osteoporosis and osteopenia.</p> <p>Results</p> <p>Thirty-two articles (116,911 participants) were included in the meta-analysis. PCa patients under ADT had a higher risk of osteoporosis (RR, 1.30; <it>p </it>< 0.00001) and a higher risk of fractures (RR, 1.17; <it>p </it>< 0.00001) as compared to patients not under ADT. The total bone mineral density was lower in patients under ADT when compared with patients not under ADT (<it>p </it>= 0.031) but it was similar to bone mineral density found in healthy controls (<it>p </it>= 0.895). The time of androgen deprivation therapy correlated negatively with lumbar spine and total hip bone mineral density (Spearman's rho = -0.490 and -0.773; <it>p </it>= 0.028 and 0.001, respectively) and with total hip <it>t </it>score (Spearman's rho = -0.900; <it>p </it>= 0.037).</p> <p>Conclusion</p> <p>We found consistent evidence that the use of androgen deprivation therapy in patients with PCa reduces bone mineral density, increasing the risk of fractures in these patients.</p

Effective Rheology of Bubbles Moving in a Capillary Tube

We calculate the average volumetric flux versus pressure drop of bubbles moving in a single capillary tube with varying diameter, finding a square-root relation from mapping the flow equations onto that of a driven overdamped pendulum. The calculation is based on a derivation of the equation of motion of a bubble train from considering the capillary forces and the entropy production associated with the viscous flow. We also calculate the configurational probability of the positions of the bubbles.Comment: 4 pages, 1 figur