Quantification and evaluation of intra-urban heat-stress variability in Seoul, Korea.

This study quantifies heat-stress hazard (air temperature), vulnerability (heat vulnerability index and age score), and risk (heat-related mortality) on the district scale in Seoul, Korea, for a comprehensive heat-stress impact assessment. Moreover, the heat-stress impact assessment is evaluated by checking the spatial consistency between heat-stress hazard, vulnerability, and risk, which was rarely done before. We applied numerical and geo-empirical models to simulate the spatial pattern of heat-stress hazard. For heat-stress vulnerability, we used demographic and socioeconomic factors. Heat-related mortality was estimated based on an event-based heat-stress risk analysis. Results are that heat-stress hazard, vulnerability, and risk are spatially variable in Seoul. The highest heat-stress hazard was detected in the districts Mapo, Yeongdeungpo, and Yangcheon, the highest vulnerability in Jongno and the highest risk in Jongno and Yangcheon. The different components (heat-stress hazard, vulnerability, and risk) and variables (heat vulnerability index and percentage of seniors) showed different spatial patterns. Knowledge about the causes of higher heat-stress risk, either the hazard or vulnerability, is helpful to design tailored adaptation measures that focus on the reduction of thermal loads or on the preparation of the vulnerable population. The evaluation showed that heat-stress vulnerability and hazard explain the spatial pattern of risk only partly. This highlights the need to evaluate heat-stress impact assessment systems to produce reliable urban heat-stress maps.

Heat stress is associated with reduced health status in pulmonary arterial hypertension: a prospective study cohort.

BACKGROUND: Summer heat waves with temperature extremes are becoming more frequent with growing numbers in morbidity and mortality in patients with respiratory diseases. The aim of this study was to evaluate the ramifications of heat stress (temperature >25 °C) on the health status of patients with pulmonary arterial hypertension (PAH). METHODS: Fifteen patients with PAH (mean age = 66.7 ± 5.2 years) continuously wore an accelerometer from April 1 to September 30, 2011, and their daily step count was recorded. In addition, patients kept a diary to record data on seven standardized questions regarding their daily symptoms. Echocardiography, 6-minute walk test, NTproBNP, and Modified Medical Research Council Scale (MMRC) were assessed at baseline and at the end of the study after 6 months. RESULTS: On heat-stress days, patients showed significantly more symptoms and lower total steps/day compared to thermal comfort days (3,995 ± 2,013 steps/day vs. 5,567 ± 2,434 steps/day, respectively; P < 0.001). There was a significant negative correlation between total steps/day and Temp(max) (R = -0.47; P < 0.001) and humidity (R = -0.34; P < 0.001). A significant positive correlation was found between daily symptoms and Temp(max) (R = +0.79; P < 0.001) and humidity (R = +0.23; P < 0.001). CONCLUSIONS: Heat stress is associated with a compromised clinical status in patients with PAH. Adaptation strategies must be implemented to prevent heart-related morbidity, including therapeutic adjustments and adequate room cooling in the patient's home and at the hospital.

Tele-monitoring reduces exacerbation of COPD in the context of climate change--a randomized controlled trial.

BACKGROUND: A home based tele-monitoring system was developed to assess the effects of heat stress (days > 25°C) on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty-two COPD patients (GOLD II-IV) were randomized into a tele-monitoring Group (TG, N = 32) or Control Group (CG, N = 30). Tele-monitoring included 1) daily clinical status (COPD Assessment Test-CAT), 2) daily lung function and 3) weekly 6-minute walk test (6MWT). Duration of monitoring lasted a total of nine months (9 M). RESULTS: From June 1st-August 31st 2012, 32 days with heat stress (29.0 ± 2.5°C) were recorded and matched with 32 thermal comfort days (21.0 ± 2.9°C). During heat stress, the TG showed a significant reduction in lung function and exercise capacity (FEV1% predicted: 51.1 ± 7.2 vs. 57.7 ± 5.0%; P <0.001 and 6MWT performance: 452 ± 85 vs. 600 ± 76 steps; P <0.001) and increase in CAT scores (19.2 ± 7.9 vs. 16.2 ± 7.2; P <0.001).Over summer, significantly fewer TG patients suffered exacerbation of COPD compared to CG patients (3 vs. 14; P = 0.006). Over entire 9 M follow-up, the TG group had fewer exacerbations compared to CG (7 vs. 22; P = 0.012), shorter cumulative hospital stay (34 vs. 97 days) and 43% fewer specialist consultations (24. vs. 42; P = 0.04). CONCLUSION: Heat stress affects clinical and functional status in COPD. Tele-monitoring reduces exacerbation frequency and health care utilization during heat stress and other periods of the year. TRIAL REGISTRATION DRKS-ID: DRK00000705.

Ammonia emissions from a broiler farm: spatial variability of airborne concentrations in the vicinity and impact on adjacent woodland.

Agricultural NH(3) emissions affect air quality and influence the nitrogen cycle. In the subject study, NH(3) emissions from a broiler farm and the resulting atmospheric concentrations in the immediate vicinity during three growing cycles have been quantified. Additionally, vegetation along a transect in an adjacent woodland was analysed. The emissions were as high as 10 kg NH(3) h(-1) and the atmospheric concentrations ranged between 33 and 124 µg NH(3) m(-3) per week in the immediate vicinity. Measurements of the atmospheric concentrations over 7 weeks showed a substantial decline of mean concentrations (based on a 3-week average) from ∼13 to <3 µg NH(3) m(-3), at 45- and 415-m distance from the farm. Vegetation surveys showed that nitrophilous species flourished when they grew closest to the farm (their occurrence sank proportionately with distance). A clearly visible damage of pine trees was observed within 200 m of the farm; this illustrated the significant impact of NH(3) emissions from agricultural sources on the sensitive ecosystem.

Significant reduction of ultrafine particle emission fluxes to the urban atmosphere during the COVID-19 lockdown.

The worldwide restrictions of social contacts that were implemented in spring 2020 to slow down infection rates of the SARS-CoV-2 virus resulted in significant modifications in mobility behaviour of urban residents. We used three-year eddy covariance measurements of size-resolved particle number fluxes from an urban site in Berlin to estimate the effects of reduced traffic intensity on particle fluxes. Similar observations of urban surface-atmosphere exchange of size-resolved particles that focus on COVID-19 lockdown-related effects are not available, yet. Although the site remained a net emission source for ultrafine particles (UFP, Dp < 100 nm), the median upward flux of ultrafine particles (FUFP) decreased from 8.78 × 107 m-2 s-1 in the reference period to 5.44 × 107 m-2 s-1 during the lockdown. This was equivalent to a relative reduction of -38 % for median FUFP, which was similar to -35 % decrease of road traffic intensity in the flux source area during that period. The size-resolved analysis demonstrated that, on average, net deposition of UFP occurred only during night when particle emission source strength by traffic was at its minimum, whereas accumulation mode particles (100 nm < Dp < 200 nm) showed net deposition also during daytime. The results indicate the benefits of traffic reductions as a mitigation strategy to reduce UFP emissions to the urban atmosphere.

Direct observations of CO2 emission reductions due to COVID-19 lockdown across European urban districts.

The measures taken to contain the spread of COVID-19 in 2020 included restrictions of people's mobility and reductions in economic activities. These drastic changes in daily life, enforced through national lockdowns, led to abrupt reductions of anthropogenic CO2 emissions in urbanized areas all over the world. To examine the effect of social restrictions on local emissions of CO2, we analysed district level CO2 fluxes measured by the eddy-covariance technique from 13 stations in 11 European cities. The data span several years before the pandemic until October 2020 (six months after the pandemic began in Europe). All sites showed a reduction in CO2 emissions during the national lockdowns. The magnitude of these reductions varies in time and space, from city to city as well as between different areas of the same city. We found that, during the first lockdowns, urban CO2 emissions were cut with respect to the same period in previous years by 5% to 87% across the analysed districts, mainly as a result of limitations on mobility. However, as the restrictions were lifted in the following months, emissions quickly rebounded to their pre-COVID levels in the majority of sites.

Effects of ethylene oxide chain length on crystallization of polysorbate 80 and its related compounds.

As a result of the synthesis protocol polyoxyethylene sorbitan monooleate (polysorbate 80, PS80) is a highly complex mixture of compounds. PS80 was therefore separated into its main constituents, e.g. polyoxyethylene isosorbide esters and polyoxyethylene esters, as well as mono- di- and polyesters using preparative high-performance liquid chromatography. In this comprehensive study the individual components and their ethoxylation level were verified by matrix assisted laser desorption/ionization time-of-flight and their thermotropic behavior was analyzed using differential scanning calorimetry and X-ray diffraction. A distinct correlation was found between the average length of the ethylene oxide (EO) chains in the headgroup and the individual compounds' ability to crystallize. Importantly, a critical number of EO units required for crystallization of the headgroup was determined (6 EO units per chain or 24 per molecule). The investigation also revealed that the hydrocarbon tails only crystallize for polyoxyethylene sorbitan esters if saturated. PS80 is synthesized by reacting with approximately 20 mol of EO per mole of sorbitol, however, the number of EO units in the sorbitan ester in commercial PS80 products is higher than the expected 20 (5 EO units per chain). The complex behavior of all tested compounds revealed that if the amount of several of the linear by-products is reduced, the number of EO units in the chains will stay below the critical number and the product will not be able to crystallize by the EO chains.

Interactions of Perfluorohexyloctane With Polyethylene and Polypropylene Pharmaceutical Packaging Materials.

Semifluorinated alkanes (SFAs) are aprotic solvents, which may be used as drug solvents for topical ocular applications, for instance, in dry eye syndrome. Their physical properties suggest that they might be prone to interaction with plastic materials, such as, polyethylene (PE) and polypropylene (PP), which are commonly used as packaging materials for pharmaceutical products. In this study, we investigate interactions of PE and PP with a liquid SFA perfluorohexyloctane (PFHO) using differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and cross-polarized light microscopy. Binary phase diagrams of PFHO-PE and PFHO-PP systems demonstrating interactions of PFHO with the polymeric materials were constructed based on DSC data. According to this data, PFHO tends to lower the melting temperatures of PE and PP. The equilibrium values of solubilities of the polymers in PFHO and PFHO in the polymers were obtained by extrapolation of melting enthalpy data. Absorption of PFHO by PE and PP materials at ambient conditions after 4 weeks of equilibration was also studied by TGA. From the presented results, it may be concluded that thorough studies of interactions of PE or PP with SFAs are required when these materials are used as packaging components in SFA-based formulations.

Semifluorinated alkane based systems for enhanced corneal penetration of poorly soluble drugs.

Semifluorinated alkanes (SFAs) are amphiphilic liquids that can dissolve hydrophobic drugs to form clear solutions. This study evaluated the potential of two SFAs to act as vehicle for topical ocular drug delivery. After confirming ocular safety, an ex vivo corneal penetration model was developed to determine drug distribution and corneal bioavailability. Hydrophobic dye distribution in the different corneal layers was visualised under a confocal microscope. Corneal bioavailability of cyclosporine A (CsA) dissolved in perfluorobutylpentane (F4H5) or perfluorohexyloctane (F6H8) was compared to commercially available CsA ophthalmic emulsions, Restasis® and Ikervis®. Precorneal residence of the four test vehicles containing the hydrophobic dye was also compared using an ex vivo corneal tissue model. Preferential accumulation of the hydrophobic dye in the corneal epithelium was observed with higher amounts detectable when delivered via the SFAs compared to Restasis or Ikervis. A significant improvement in corneal CsA penetration was observed after application of a single dose of 0.05% CsA in F4H5 and F6H8 when compared to Restasis with the area under curve over 4 h (AUC(0-4h)) being at least 8-fold greater for both SFAs (p < .0001). Moreover, the AUC(0-4h) of 0.1% CsA in F4H5 was almost 5-fold greater than Ikervis (p < .0001). Finally, the precorneal residence time of both SFA solutions was significantly longer than that of the commercial emulsions with the AUC(0-60min) being 2- to 11-fold greater. This study demonstrated that SFAs can significantly improve the local bioavailability of hydrophobic drugs by increasing corneal penetration as well as prolonging precorneal residence. They therefore offer a promising new platform for topical drug delivery to the eye.

Modification of Heat-Related Mortality in an Elderly Urban Population by Vegetation (Urban Green) and Proximity to Water (Urban Blue): Evidence from Lisbon, Portugal.

BACKGROUND: Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status. OBJECTIVES: We investigated the influence of urban green and urban blue, that is, urban vegetation and water bodies, on heat-related excess mortality in the elderly > 65 years old in Lisbon, Portugal, between 1998 and 2008. METHODS: We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to bodies of water (the Atlantic Ocean and the Tagus Estuary). Poisson generalized additive models were fitted, allowing for the interaction between equivalent temperature [universal thermal climate index (UTCI)] and quartiles of urban greenness [classified using the Normalized Difference Vegetation Index (NDVI)] and proximity to water (≤ 4 km vs. > 4 km), while adjusting for potential confounders. RESULTS: The association between mortality and a 1°C increase in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than for areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4 km from water, a 1°C increase in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%). CONCLUSIONS: Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water. CITATION: Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. 2016. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect 124:927-934; http://dx.doi.org/10.1289/ehp.1409529.

The Effects of Climate Change on Patients With Chronic Lung Disease. A Systematic Literature Review.

BACKGROUND: Ever since higher overall mortality rates due to heat stress were reported during the European heat waves of 2003 and 2006, the relation between heat waves and disease-specific events has been an object of scientific study. The effects of heat waves on the morbidity and mortality of persons with chronic lung disease remain unclear. METHODS: We conducted a systematic search using PubMed, the Cochrane Library, and Google Advanced Search to identify relevant studies published between 1990 and 2015. The reference lists of the primarily included articles were searched for further pertinent articles. All articles were selected according to the PRISMA guidelines. The heat-wave-related relative excess mortality was descriptively expressed as a mean daily rate ratio ([incidence 1]/[incidence 2]), and the cumulative excess risk (CER) was expressed in percent. RESULTS: 33 studies with evaluable raw data concerning the effect of heat waves on patients with chronic lung disease (chronic obstructive pulmonary disease, bronchial asthma, pulmonary arterial hypertension, and idiopathic pulmonary fibrosis) were analyzed in this review. By deriving statistics from the overall data set, we arrived at the conclusion that future heat waves will-with at least 90% probability-result in a mean daily excess mortality (expressed as a rate ratio) of at least 1.018, and-with 50% probability-in a mean daily excess mortality of at least 1.028. These figures correspond, respectively, to 1.8% and 2.8% rises in the daily risk of death. CONCLUSION: Heat waves significantly increase morbidity and mortality in patients with chronic lung disease. The argument that the excess mortality during heat waves is compensated for by a decrease in mortality in the subsequent weeks/months (mortality displacement) should not be used as an excuse for delay in implementing adaptive strategies to protect lung patients from this risk to their health.

Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease--A Prospective, Multicenter Noninterventional Study.

PURPOSE: Evaporation of the tear film is heavily discussed as one core reason for dry eye disease (DED). Subsequently, new artificial tear products are developed that specifically target this pathomechanism. Perfluorohexyloctane (F6H8, NovaTears(®)) from the family of semifluorinated alkanes is a novel substance that has been approved as a medical device, as a nonblurring wetting agent for the ocular surface. METHODS: Thirty patients with hyperevaporative dry eye received F6H8 during a prospective, multicenter, observational 6-week study. Patients were advised to apply 1 drop 4 times daily in both eyes. Parameters assessed included best corrected visual acuity, intraocular pressure, Schirmer I test, tear fluid, tear film breakup time (TFBUT), corneal staining, meibum secretion, and Ocular Surface Disease Index (OSDI(©)). RESULTS: From the 30 patients recruited, 25 completed the trial per protocol. Four patients discontinued F6H8 and 1 patient did not present for follow-up. F6H8 treatment led to significant reduction of corneal staining and significant increase of Schirmer I and TFBUT. In addition, OSDI score dropped significantly from a mean of 55 (± 23.0) to 34 (± 22.4). Visual acuity and ocular pressure did not change. CONCLUSIONS: This prospective observational study shows significant beneficial effects in patients suffering from evaporative DED, using F6H8 in all the relevant parameters tested. The decrease of the OSDI by a mean of 21 points was particularly remarkable and clearly exceeds minimal, clinical important differences for mild or moderate and severe disease. Overall, F6H8 (NovaTears) seems to be safe and effective in treating mild to moderate hyperevaporative DED.

IVIVC for fenofibrate immediate release tablets using solubility and permeability as in vitro predictors for pharmacokinetics.

The goal of this study was to investigate the in vitro-in vivo correlation (IVIVC) for fenofibrate immediate release (IR) tablet formulations based on MeltDose-technique. The in vitro determined drug solubility and permeability data were related to the C(max) values observed from two in vivo human studies. Solubility and permeation studies of fenofibrate were conducted in medium simulating the fasted state conditions in the upper jejunum, containing the surfactant compositions of the six formulations at different concentrations. The behavior of all surfactant compositions was characterized by surface tension, dynamic light scattering, and cryo-TEM. The obtained solubility and permeation data were combined and compared with the C(max) values for the fenofibrate formulations, assuming a 50 mL in vivo dissolution volume. A good IVIVC was observed for five fenofibrate formulations (R(2) = 0.94). The in vitro studies revealed that the formulation compositions containing sodium lauryl sulfate (SLS) interfered with the vesicular drug solubilizing system of the biorelevant medium and antagonized its solubilization capacity. The opposing interaction of surfactants with the emulsifying physiological constituents in intestinal juice should be taken into consideration in order to prevent unsatisfactory in vivo performance of orally administered formulations with low soluble active pharmaceutical ingredients.

Donor-acceptor oligoenes with a locked all-trans conformation: synthesis and linear and nonlinear optical properties.

A general synthetic approach to variously polarised merocyanines and a cyanine with enhanced thermal and (photo)chemical stability by a locked all-trans conformation (derived from a rigidified hexatriene unit and a variety of common donor and acceptor groups) is presented as well as a systematic study of their (non)linear optical properties. Apart from the UV/Vis absorption and fluorescence behaviour, the ground- and excited-state dipoles, the first-, second- and third-order molecular polarisabilities were determined by electro-optical absorption measurements (EOAM) and degenerate four-wave mixing (DFWM) techniques in solution. Large values for the second- and third-order polarisability up to beta(0)=461x10(-50) C V(-2) m(3) (1242x10(-30) esu) and [gamma(LL)]=183x10(-60) C V(-3) m(4) (15x10(-34) esu) were found. The linear and nonlinear optical properties were related to the ground-state polarisation and the resonance structure of the chromophores. In order to reveal the influence of the length of the polymethinic chain (number of pi electrons within the chromophore), some lower homologues shortened by one C=C (double) bond were also taken into account. The unexpectedly high gamma values of some of the merocyanines cannot be explained by a two-level model. Molecular vibrational third- order polarisabilities (calculated from absolute Raman intensities in solution) were qualitatively correlated to the DFWM results. Furthermore, the dependence of the (13)C NMR chemical shifts of the polymethinic carbons within the merocyanines upon ground-state polarisation was investigated and compared to those within a corresponding cyanine.