Social amplification of wildfire risk: the role of social interactions and information sources.

Wildfire is a persistent and growing threat across much of the western United States. Understanding how people living in fire-prone areas perceive this threat is essential to the design of effective risk management policies. Drawing on the social amplification of risk framework, we develop a conceptual model of wildfire risk perceptions that incorporates the social processes that likely shape how individuals in fire-prone areas come to understand this risk, highlighting the role of information sources and social interactions. We classify information sources as expert or nonexpert, and group social interactions according to two dimensions: formal versus informal, and generic versus fire-specific. Using survey data from two Colorado counties, we empirically examine how information sources and social interactions relate to the perceived probability and perceived consequences of a wildfire. Our results suggest that social amplification processes play a role in shaping how individuals in this area perceive wildfire risk. A key finding is that both "vertical" (i.e., expert information sources and formal social interactions) and "horizontal" (i.e., nonexpert information and informal interactions) interactions are associated with perceived risk of experiencing a wildfire. We also find evidence of perceived "risk interdependency"--that is, homeowners' perceptions of risk are higher when vegetation on neighboring properties is perceived to be dense. Incorporating social amplification processes into community-based wildfire education programs and evaluating these programs' effectiveness constitutes an area for future inquiry.

Trying not to get burned: understanding homeowners' wildfire risk-mitigation behaviors.

Three causes have been identified for the spiraling cost of wildfire suppression in the United States: climate change, fuel accumulation from past wildfire suppression, and development in fire-prone areas. Because little is likely to be performed to halt the effects of climate on wildfire risk, and because fuel-management budgets cannot keep pace with fuel accumulation let alone reverse it, changing the behaviors of existing and potential homeowners in fire-prone areas is the most promising approach to decreasing the cost of suppressing wildfires in the wildland-urban interface and increasing the odds of homes surviving wildfire events. Wildfire education efforts encourage homeowners to manage their property to decrease wildfire risk. Such programs may be more effective with a better understanding of the factors related to homeowners' decisions to undertake wildfire risk-reduction actions. In this study, we measured whether homeowners had implemented 12 wildfire risk-mitigation measures in 2 Colorado Front Range counties. We found that wildfire information received from local volunteer fire departments and county wildfire specialists, as well as talking with neighbors about wildfire, were positively associated with higher levels of mitigation. Firsthand experience in the form of preparing for or undertaking an evacuation was also associated with a higher level of mitigation. Finally, homeowners who perceived higher levels of wildfire risk on their property had undertaken higher levels of wildfire-risk mitigation on their property.

Postintubation Decline in Oxygen Saturation Index Predicts Mortality in COVID-19: A Retrospective Pilot Study.

BACKGROUND: Acute respiratory failure from COVID-19 pneumonia is a major cause of death after SARS-CoV-2 infection. We investigated whether PaO2/FiO2, oxygenation index (OI), SpO2/FiO2, and oxygen saturation index (OSI), commonly used to assess the severity of acute respiratory distress syndrome (ARDS), can predict mortality in mechanically ventilated COVID-19 patients. METHODS: In this single-centered retrospective pilot study, we enrolled 68 critically ill mechanically ventilated adult patients with confirmed COVID-19. Physiological variables were recorded on the day of intubation (day 0) and postintubation days 3 and 7. The association between physiological parameters, PaO2/FiO2, OI, SpO2/FiO2, and OSI with mortality was assessed using multiple variable logistic regression analysis. Receiver operating characteristic analysis was conducted to evaluate the performance of the predictive models. RESULTS: The ARDS severity indices were not statistically different on the day of intubation, suggesting similar baseline conditions in nonsurviving and surviving patients. However, these indices were significantly worse in the nonsurviving as compared to surviving patients on postintubation days 3 and 7. On intubation day 3, PaO2/FiO2 was 101.0 (61.4) in nonsurviving patients vs. 140.2 (109.6) in surviving patients, p=0.004, and on day 7 106.3 (94.2) vs. 178.0 (69.3), p < 0.001. OI was 135.0 (129.7) in nonsurviving vs. 84.8 (86.1) in surviving patients (p=0.003) on day 3 and 150.0 (118.4) vs. 61.5 (46.7) (p < 0.001) on day 7. OSI was 12.0 (11.7) vs. 8.0 (10.0) (p=0.006) on day 3 and 14.7 (13.2) vs. 6.5 (5.4) (p < 0.001) on day 7. Similarly, SpO2/FiO2 was 130 (90) vs. 210 (90) (p=0.003) on day 3 and 130 (90) vs. 230 (50) (p < 0.001) on day 7, while OSI was 12.0 (11.7) vs. 8.0 (10.0) (p=0.006) on day 3 and 14.7 (13.2) vs. 6.5 (5.4) (p < 0.001) on day 7 in the nonsurviving and surviving patients, respectively. All measures were independently associated with hospital mortality, with significantly greater odds ratios observed on day 7. The area under the receiver operating characteristic curve (AUC) for mortality prediction was greatest on intubation day 7 (AUC = 0.775, 0.808, and 0.828 for PaO2/FiO2, OI, SpO2/FiO2, and OSI, respectively). CONCLUSIONS: Decline in oxygenation indices after intubation is predictive of mortality in COVID-19 patients. This time window is critical to the outcome of these patients and a possible target for future interventions. Future large-scale studies to confirm the prognostic value of the indices in COVID-19 patients are warranted.

Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy.

PURPOSE: To report the clinical experience with an electromagnetic treatment target positioning and continuous monitoring system in patients with localized prostate cancer receiving external beam radiotherapy. METHODS AND MATERIALS: The Calypso System is a target positioning device that continuously monitors the location of three implanted electromagnetic transponders at a rate of 10 Hz. The system was used at five centers to position 41 patients over a full course of therapy. Electromagnetic positioning was compared to setup using skin marks and to stereoscopic X-ray localization of the transponders. Continuous monitoring was performed in 35 patients. RESULTS: The difference between skin mark vs. the Calypso System alignment was found to be >5 mm in vector length in more than 75% of fractions. Comparisons between the Calypso System and X-ray localization showed good agreement. Qualitatively, the continuous motion was unpredictable and varied from persistent drift to transient rapid movements. Displacements > or =3 and > or =5 mm for cumulative durations of at least 30 s were observed during 41% and 15% of sessions. In individual patients, the number of fractions with displacements > or =3 mm ranged from 3% to 87%; whereas the number of fractions with displacements > or =5 mm ranged from 0% to 56%. CONCLUSION: The Calypso System is a clinically efficient and objective localization method for positioning prostate patients undergoing radiotherapy. Initial treatment setup can be performed rapidly, accurately, and objectively before radiation delivery. The extent and frequency of prostate motion during radiotherapy delivery can be easily monitored and used for motion management.

Electrophysiological effects accompanying regression of left ventricular hypertrophy.

OBJECTIVE: The aim of this study was to investigate changes following regression of left ventricular hypertrophy (LVH). METHODS: Electrophysiolological changes were recorded in isolated guinea-pig myocardial preparations. LVH was induced by constriction of the thoracic aorta and regression was followed after removal of the constriction. Sham-operated animals served as controls. RESULTS: During 42 days constriction, heart/body weight ratio increased (3.19+/-0.49 vs. 3.85+/-0.83 g kg(-1)) and was accompanied by an increase of cell size. Forty-two days after clip removal, values had returned to control values. LVH increased action potential (AP) duration (mean 112% of control) and decreased conduction velocity (60.4+/-3.3 vs. 45.9+/-4.6 cm(-1)). These changes did not return to control after regression of LVH. The changes to condition velocity were attributed solely to increases of intracellular resistivity. The positive staircase response also decreased with LVH, but did recover upon regression. In isolated whole hearts, no changes to subepicardial action potential duration, QRS complex duration or AP refractory period were observed in LVH or its regression. During low-flow ischaemia AP duration shortened reversibly, the rate of shortening was more rapid in hypertrophied hearts but similar to control in regressed hearts. The incidence of ventricular tachyarrhythmias of fibrillation during low-flow ischaemia was similar in control, hypertrophied and regressed hearts. CONCLUSION: Morphological regression of LVH is not accompanied by reversal of electrophysiological changes measured in isolated preparations, whereas some aspects of contractile function to recover.

Ezetimibe + simvastatin (Merck/Schering-Plough).

Merck/Schering-Plough Pharmaceuticals has developed and launched ezetimibe + simvastatin (Vytorin), a fixed combination tablet of Schering-Plough's cholesterol absorption inhibitor ezetimebe (Zetia), and Merck's HMG CoA reductase inhibitor simvastatin (Zocor), for the treatment of hypercholesterolemia. The drug had been launched in Germany and Mexico by April 2004, and, in July 2004, was approved in the US, with expected launch late in 2004.

Pitavastatin Nissan/Kowa Yakuhin/Novartis/Sankyo.

Pitavastatin (nisvastatin) is an HMG CoA reductase inhibitor being developed jointly by Nissan, Kowa Kogyo, Novartis and Sankyo for the potential treatment of atherosclerosis and hyperlipidemia.

Prediction of intrafraction prostate motion: accuracy of pre- and post-treatment imaging and intermittent imaging.

PURPOSE: To evaluate whether pre- and post-treatment imaging (immediately before and after a radiation therapy treatment fraction) and intermittent imaging (at intervals during a treatment fraction) are accurate predictors of prostate motion during the delivery of radiation. METHODS AND MATERIALS: The Calypso 4D Localization System was used to continuously track the prostate during radiation delivery in 35 prostate cancer patients, for a total of 1,157 fractions (28-45 per patient). Predictions of prostate motion away from isocenter were modeled for a pre- and post-treatment imaging schedule and for multiple intermittent intrafraction imaging schedules and compared with the actual continuous tracking data. The endpoint was drift of the prostate beyond a certain radial displacement for a duration of more than 30 s, 1 min, and 2 min. Results were used to evaluate the sensitivity and specificity of these models as an evaluation of intrafraction prostate motion. RESULTS: The sensitivity of pre- and post-treatment imaging in determining 30 s of intrafraction prostate motion greater than 3, 5, or 7 mm for all fractions was low, with values of 53%, 49%, and 39%, respectively. The specificity of pre- and post-treatment imaging was high for all displacements. The sensitivity of intermittent imaging improved with increasing sampling rate. CONCLUSIONS: These results suggest that pre- and post-treatment imaging is not a sensitive method of assessing intrafraction prostate motion, and that intermittent imaging is sufficiently sensitive only at a high sampling rate. These findings support the value of continuous, real-time tracking in prostate cancer radiation therapy.