This article presents the first panel-data evidence of a human health externality from the air pollution generated by surface coal mining. In West Virginia, a standard deviation increase in a ...county's exposure to surface coal mining is associated with 9.85 more asthma hospitalizations per 100,000 residents in a given quarter. Interpreted causally, this suggests over $11 million in hospitalization costs over the 6-year study period. The study builds on earlier cross-sectional research by controlling for unobserved county-level heterogeneity, and by defining more accurate measures of exposure. Both methods are shown to reduce the bias associated with earlier estimates of coal mining's effect on health. Young and elderly women demonstrate the largest sensitivities to surface mining. Falsification tests reveal that neither hernias nor bone fractures demonstrate any relationship with surface mining activity.
INTRODUCTION: Mental health promotion apps can promote youth mental health but fail to engage young people. Fit to young people’s media preferences is known to mediate engagement. OBJECTIVES: To ...explore the fit of existing youth mental health apps with young people’s media preferences. METHODS: A workshop with 60 youth psychologists elicits designs of digital mental health interventions. A review of 29 youth mental health apps unpacks their modality strategies. We then compare modality strategies from literature on youth mental health, media preferences and engagement, and from the experts, with strategies in current mental health apps to identify potential fit problems. RESULTS: There is a mismatch between young people’s modality preferences and how youth mental health apps deliver their content. CONCLUSION: There is a need to make youth mental health promotion apps more interactive and tailorable, featuring dynamic visuals and social connectivity, to better engage youth.
Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying ...admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time.
A 52-year-old female presented to Integrated Health Options Clinic in October 2014 with a history of relapsed acute myeloid leukaemia (AML, diagnosed in 2009 and relapsed in 2014). Intravenous(IV) ...vitamin C therapy was initiated (in 2014) following completion of chemotherapy as an alternative to haematopoietic stem cell transplantation. IV vitamin C was administered twice weekly at a dose of 70 g/infusion. Within 4 weeks of initiation of IV vitamin C therapy, there was a dramatic improvement in the patient's blood indices with platelet cell counts increasing from 25 × 10⁸/L to 196 × 10⁸/L and white blood cell counts increasing from 0.29 × 10⁸/L to 4.0 × 10⁸/L, with further improvements observed over the next 18 months. Furthermore, there was a clear and sustained improvement in the patient's health-related quality of life scores assessed using a validated questionnaire. She has remained healthy and in complete remission until the present day. This case study highlights the benefits of IV vitamin C as a supportive therapy for previously relapsed AML.
Extreme rainfall is expected to increase under climate change, carrying potential socioeconomic risks. However, the magnitude of increase is uncertain. Over recent decades, extreme storms over the ...West African Sahel have increased in frequency, with increased vertical wind shear shown to be a cause. Drier midlevels, stronger cold pools, and increased storm organization have also been observed. Global models do not capture the potential effects of lower- to midtropospheric wind shear or cold pools on storm organization since they parameterize convection. Here we use the first convection-permitting simulations of African climate change to understand how changes in thermodynamics and storm dynamics affect future extreme Sahelian rainfall. The model, which simulates warming associated with representative concentration pathway 8.5 (RCP8.5) until the end of the twenty-first century, projects a 28% increase of the extreme rain rate of MCSs. The Sahel moisture change on average follows Clausius–Clapeyron scaling, but has regional heterogeneity. Rain rates scale with the product of time-of-storm total column water (TCW) and in-storm vertical velocity. Additionally, prestorm wind shear and convective available potential energy both modulate in-storm vertical velocity. Although wind shear affects cloud-top temperatures within our model, it has no direct correlation with precipitation rates. In our model, projected future increase in TCW is the primary explanation for increased rain rates. Finally, although colder cold pools are modeled in the future climate, we see no significant change in near-surface winds, highlighting avenues for future research on convection-permitting modeling of storm dynamics.
Background
Self-poisoning accounts for up to 10 % of hospital admissions, some of whom require admission to ICU. Few studies have looked at the epidemiology of these patients in an Irish setting.
...Aims
To quantify the proportion of ICU admissions attributable to self-poisoning, to examine the characteristics and outcome of these patients, and to assess their ICU resource utilisation.
Methods
Retrospective review of ICU admissions from 2006 to 2010. Data were collected on patient age, sex, admission diagnosis, substances involved, APACHE II score, length of stay, organ support, and outcome.
Results
There were 80 admissions to ICU following self-poisoning accounting for 3.8 % of ICU admissions and 13 % of all hospital admissions for self-poisoning. M:F ratio was 0.9:1. Mean age 35 (range 16–75), APACHE II score 14 (2–36). Commonest substances involved were benzodiazepines, opioids, tricycle antidepressants. Median ICU stay was 2 days (IQR 0.96–4.5). 84 % of patients were ventilated, 27.5 % required inotropic support, 14 % renal replacement therapy. When opioids were involved requirement for inotropes and CRRT were higher. ICU mortality was 6.3 %. These patients consumed 280 bed days.
Conclusion
Self-poisoning accounted for 3.8 % of ICU admissions. Patients tend to require a short period of ventilation, with a minority requiring additional organ support. The cost of ICU care is calculated based on previously published methodology to be €7,717 per patient. Extrapolated nationally the annual cost for ICU care for self-poisoning is estimated to be in the order of €5 m.
Immune-related disorders of the oral cavity may occur as primary disease process, secondary to systemic disease or neoplasm, or as a reaction to medications and other agents. The entities represented ...within this group may vary significantly by severity, clinical presentation, microscopic presentation, and special testing results. The selected immune-related conditions of the oral cavity in this article are categorized and presented by their prototypical tissue reaction patterns: vesiculobullous, including acantholytic and subepithelial separation; psoriasiform; spongiotic; and lichenoid reaction patterns.
Projected changes in the intensity of severe rain events over the North African Sahel—falling from large mesoscale convective systems—cannot be directly assessed from global climate models due to ...their inadequate resolution and parameterization of convection. Instead, the large-scale atmospheric drivers of these storms must be analyzed. Here we study changes in meridional lower-tropospheric temperature gradient across the Sahel (ΔT
Grad), which affect storm development via zonal vertical wind shear and Saharan air layer characteristics. Projected changes in ΔT
Grad vary substantially among models, adversely affecting planning decisions that need to be resilient to adverse risks, such as increased flooding. This study seeks to understand the causes of these projection uncertainties and finds three key drivers. The first is intermodel variability in remote warming, which has strongest impact on the eastern Sahel, decaying toward the west. Second, and most important, a warming–advection–circulation feedback in a narrow band along the southern Sahara varies in strength between models. Third, variations in southern Saharan evaporative anomalies weakly affect ΔT
Grad, although for an outlier model these are sufficiently substantive to reduce warming here to below that of the global mean. Together these uncertain mechanisms lead to uncertain southern Saharan/northern Sahelian warming, causing the bulk of large intermodel variations in ΔT
Grad. In the southern Sahel, a local negative feedback limits the contribution to uncertainties in ΔT
Grad. This new knowledge of ΔT
Grad projection uncertainties provides understanding that can be used, in combination with further research, to constrain projections of severe Sahelian storm activity.
Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33% (138/419) of primary admissions discharged as EVD negative (not a ...case). Fifteen of these were readmitted within 21 days, nine of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.
Current space‐based observations of terrestrial gamma ray flashes (TGFs) are capable of identifying only TGFs that exceed a lower brightness threshold. Observationally, dim TGFs that fall below this ...threshold are consequently difficult to find using photon‐only search algorithms. Such TGFs are a potentially important part of the overall global TGF rate, and information on their occurrence rate would give important insight into TGF generation mechanisms. We describe and implement a lightning‐based search for TGFs that uses the location and time of National Lightning Detection Network reported positive polarity, in‐cloud (+IC) discharges of the type known to be directly associated with TGFs. These events identify a 200 μs search window when any associated TGF photons would have been detected. We show that this approach can detect TGFs without requiring a lower threshold on the detected photon brightness of the event, and thus is capable, in principle, of finding a population of weak TGFs. We find that TGFs occur at a rate between 1 in 40 and 1 in 500 of in‐cloud lightning events that meet our study's criteria. The distribution of gamma ray counts in the search windows exhibits a statistically significant lack of nearby dim TGFs below the GBM search threshold. The data favor a brightness distribution in which nearby observationally dim TGFs are rare.
Key Points
We developed a method to identify TGFs with no lower limit on fluence
The fraction of strong in‐cloud lightning that produces TGFs is estimated to be around 1 in 100
Dim TGFs are likely rarer than expected from extrapolation of the known rate of brighter TGFs
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