Climate Change Adaptation: Prehospital Data Facilitate the Detection of Acute Heat Illness in India.

INTRODUCTION: Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors. METHODS: We enrolled 480 patients who presented to emergency medical services with chief complaints consistent with AHI in Ahmedabad, India, from April-June 2016 in a cross-sectional study. We evaluated AHI case definition test characteristics in reference to trained prehospital provider impressions, compared on-scene heat index measured by portable loggers to weather station measurements, and identified AHI behavioral and environmental risk factors using logistic regression. RESULTS: The case definition for heat exhaustion was 23.8% (12.1-39.5%) sensitive and 93.6% (90.9-95.7%) specific. The positive and negative predictive values were 33.5% (20.8-49.0%) and 90.1% (88.5-91.5%), respectively. Mean scene heat index was 6.7°C higher than the mean station heat index (P < 0.001), and station data systematically underestimated heat exposure, particularly for AHI cases. Heat exhaustion cases were associated with on-scene heat index ≥ 49°C (odds ratio [OR] 2.66 [1.13-6.25], P = 0.025) and a history of recent exertion (OR 3.66 [1.30-10.29], P = 0.014), while on-scene air conditioning was protective (OR 0.29 [0.10-0.85], P = 0.024). CONCLUSION: Systematic collection of prehospital data including recent activity history and presence of air conditioning can facilitate early AHI detection, timely intervention, and surveillance. Scene temperature data can be reliably collected and improve heat exposure and AHI risk assessment. Such data may be important elements of surveillance, clinical practice, and climate change adaptation.

Combating Climate Change-induced Heat Stress: Assessing Cool Roofs and Its Impact on the Indoor Ambient Temperature of the Households in the Urban Slums of Ahmedabad.

BACKGROUND: The rising global temperature and frequent heatwaves are the adverse effects of climate change. The causalities and ill impacts of the heat stress were higher among the slum dwellers because of the vulnerable household structures, which were made by heat-trapping materials like tin sheets, cement sheet (asbestos), plastic, and tarpaulin. The houses are not only dwellings but also a source of livelihood for many slum dwellers as they are involved in home-based work. The increase in the temperature of more than 40°C severely affects health and increases energy expenditures. OBJECTIVE: The present study conducted to identify the efficient cool roof technologies that reduce indoor temperature of the households and improve the heat resilience of dwellings located in the urban slums of Ahmedabad. METHODOLOGY: The performances of cool roof interventions were compared with the nonintervention - roof types, namely, tin, asbestos/cement sheet, and concrete. Relative humidity/temperature data loggers (Lascar EL-USB-2-LCD, Sweden) were used to measure the indoor ambient temperature and humidity. The questionnaire-based survey also has been conducted to understand the socioeconomic status and the perceptions related to roofing and health. RESULTS: The results revealed that selected cool roof technologies including Thermocol insulation, solar reflective white paint on the outer surface of the roof, and Modroof are effectively reducing the indoor temperature as compared to the nonintervention roofing. CONCLUSION: Cool roof technologies have a wider scope as number of informal settlements are increasing across the cities in India and other developing countries. The governments may not able to provide proper housing to all these inhabitants due to various reasons including the land tenure of the habitats. Validated cool roof technologies can be promoted as these structures are not requires legal sanctions and easily dismantled and installed in multiple places and safeguards the investment of urban poor.

Interleukin-7 improves in vitro maturation of ovine cumulus-oocyte complexes in a dose dependent manner.

Interleukin-7 (IL-7) mediated signals are linked to development, proliferation, survival and differentiation of cells. Recent evidences indicate its role in oocyte maturation process as well. Nevertheless, the underlying mechanisms of IL-7 involvement in oocyte maturation are not well characterized. In addition, currently no information is available on the effect of exogenous IL-7 on oocyte maturation in ovine or any other species. In this study, the effect of IL-7 supplementation during in vitro maturation (IVM) on the maturation rate, production of reactive oxygen species (ROS) and gene expression of ovine cumulus-oocyte complexes (COC) was assessed. IL-7 (0.5, 1, 2, 5 and 10 ng/ml) was supplemented in IVM medium at the beginning (0 h) and maturation rate of COC was assessed at the completion of IVM (24 h). The maturation rate (%) was found significantly (P = 0.000) greater with the 1 ng/ml of IL-7 supplementation (69.5) than control (60.0). In contrast, the maturation rate was reduced significantly (P = 0.000) with the 2 (47.1), 5 (39.2) and 10 ng/ml (39.1) of IL-7 as compared to the control. The level of intracellular ROS in the matured COC was found considerably higher with the 5 ng/ml of IL-7 followed by 1 ng/ml of IL-7 and control. It was evident that in the presence of superoxide dismutase-inhibitor, 1 ng/ml of IL-7 did not stimulate oocyte maturation. In contrast, oocyte maturation was improved with 5 ng/ml of IL-7 supplementation in the presence of NADPH-oxidase-inhibitor. IL-7 supplementation influenced gene expression in COC in a dose and time dependant manner. The expression of genes related to ROS production and apoptosis were upregulated and the genes associated with antioxidant mechanisms were downregulated noticeably with the supplementation of 5 ng/ml of IL-7. In conclusion, IL-7 at low concentration was beneficial for oocyte maturation, which was likely mediated through the favourable level of intracellular ROS and antioxidant mechanisms. In contrast, the detrimental effects of greater IL-7 concentrations on oocyte maturation were possibly arbitrated through the ROS-mediated oxidative stress, compromised antioxidant mechanism and stimulated apoptotic signalling.

Development of Ahmedabad's Air Information and Response (AIR) Plan to Protect Public Health.

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology’s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad’s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country’s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.

Effects of Occupational Heat Exposure on Traffic Police Workers in Ahmedabad, Gujarat.

One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.

Preparation of substituted quaternized arylfuran chitosan derivatives and their antimicrobial activity.

Heterocyclic modification of chitosan has been achieved through the formation of a Schiff base intermediate by the reaction of chitosan with substituted arylfurfural. The Schiff bases were further reacted with 10% sodium borohydride followed by reaction with methyl iodide to get the quaternized products. The formation of the Schiff bases and quaternized derivatives has been confirmed by elemental analysis, FTIR, (1)H NMR and UV-vis spectroscopy. The compounds are also characterized by thermo-gravimetric analysis. The parent compound and quaternized derivatives were compared for their antibacterial and antifungal activity. The results indicated that quaternized derivatives possess better inhibitory property than chitosan. Further this study confirms that heterocyclic aromatic substituent containing 'Cl' and 'NO2' are effective in enhancing the antimicrobial activity of Chitosan.

Indoor (222)Rn and (220)Rn concentrations and doses in Bangalore, India.

(222)Rn and (220)Rn levels have been measured using passive detector technique by employing time integrated solid-state nuclear track detector-based dosemeters in various types of houses at 10 different locations in and around Bangalore Metropolitan, India. The measured geometric mean concentration values of (222)Rn and (220)Rn levels in 200 dwellings of different types of construction were found to be 32.2±1.6 and 21.4±1.0 Bq m(-3), respectively. The dose rate received by the population of Bangalore ranged between 0.2 and 3.5 mSv y(-1) with an average and the geometric mean of 1.14±0.05 and 1.06 mSv y(-1), respectively. Overall, the result does not show much significant radiological risk for the inhabitants and the (222)Rn levels are well within the limits of global average concentration of 40 Bq m(-3). However, the (220)Rn levels observed were found to be higher than the global average of 10 Bq m(-3).

Nationwide indoor 222Rn and 220Rn map for India: a review.

Considering the role of radon in epidemiology, an attempt was made to make a nation-wide map of indoor (222)Rn and (220)Rn for India. More than 5000 measurements have been carried out in 1500 dwellings across the country comprising urban and nonurban locations. The solid state nuclear track detectors based twin cup (222)Rn/(220)Rn discrimination dosimeters were deployed for the measurement of indoor (222)Rn, (220)Rn and their progeny levels. The geometric means of estimated annual inhalation dose rate due to indoor (222)Rn, (220)Rn and their progeny in the dwellings was 0.94 mSvy(-1) (geometric standard deviation 2.5). It was observed that the major contribution to the indoor inhalation dose was due to indoor (222)Rn and its progeny. However, the contribution due to indoor (220)Rn and its progeny was not trivial as it was found to be about 20% of the total indoor inhalation dose rates. The indoor (222)Rn levels in dwellings was significantly different depending on the nature of walls and floorings.