Indoor temperature and health: a global systematic review.

OBJECTIVES: The objective of this study was to identify and appraise evidence on the direct and indirect impacts of high indoor temperatures on health; the indoor temperature threshold at which the identified health impacts are observed; and to summarise the evidence for establishing a maximum indoor temperature threshold for health. STUDY DESIGN: This is a systematic literature review and narrative synthesis. METHODS: A review of the published literature using MEDLINE, EMBASE, Global Health, PsycINFO, Maternity and Infant Care, Cochrane Library, CINAHL and GreenFILE databases was conducted. The search criteria were kept broad to capture evidence from all countries and contexts; no date or study design limits were applied, except English language limits. We included studies that specifically measured indoor temperature and examined its effect on physical or mental health outcomes. Evidence was graded using the National Institutes of Health framework. RESULTS: Twenty-two articles were included in the review, including 11 observational, seven cross-sectional and three longitudinal cohort studies and one prospective case-control study. Eight main health effects were described: respiratory, blood pressure, core temperature, blood glucose, mental health and cognition, heat-health symptoms, physical functioning and influenza transmission. Five studies found respiratory symptoms worsened in warm indoor environments, with one reporting indoor temperatures higher than 26 °C, which was associated with increased respiratory distress calls being made to paramedics (odds ratio = 1.63, P = 0.056). Core symptoms of schizophrenia and dementia were found to be significantly exacerbated by indoor heat (the latter above a 26 °C cumulative exposure threshold). The absorption of insulin doses in people with type one diabetes was also significantly accelerated in hot indoor environments. Only five studies reported the temperatures at which health outcomes worsened, with thresholds ranging between 26 °C and 32 °C. However, owing to insufficient data and the heterogeneity of the included studies (design, population, setting, exposure measures, outcomes and location), meta-analysis and an upper threshold determination was not feasible. CONCLUSIONS: High indoor temperatures affect aspects of human health, with the strongest evidence for respiratory health, diabetes management and core schizophrenia and dementia symptoms. Exacerbation of symptoms in warm indoor environments has clinical relevance to at-risk groups and those caring for them. Care staff and facility managers need to be vigilant of high temperatures in care environments and should incorporate indoor overheating into their risk management and sustainability and/or climate change adaptation plans. The indoor temperature threshold at which adverse effects begin to occur remains unclear as studies seldom report the exposure-response relationship over a temperature continuum. Until there is extensive scientific data to support a maximum indoor temperature threshold, 26 °C may be the most suitable indoor temperature for at-risk groups in keeping with the existing guidance documents.

Deforestation for oil palm increases microclimate suitability for the development of the disease vector Aedes albopictus.

A major trade-off of land-use change is the potential for increased risk of infectious diseases, a.o. through impacting disease vector life-cycles. Evaluating the public health implications of land-use conversions requires spatially detailed modelling linking land-use to vector ecology. Here, we estimate the impact of deforestation for oil palm cultivation on the number of life-cycle completions of Aedes albopictus via its impact on local microclimates. We apply a recently developed mechanistic phenology model to a fine-scaled (50-m resolution) microclimate dataset that includes daily temperature, rainfall and evaporation. Results of this combined model indicate that the conversion from lowland rainforest to plantations increases suitability for A. albopictus development by 10.8%, moderated to 4.7% with oil palm growth to maturity. Deforestation followed by typical plantation planting-maturation-clearance-replanting cycles is predicted to create pulses of high development suitability. Our results highlight the need to explore sustainable land-use scenarios that resolve conflicts between agricultural and human health objectives.

Arteriovenous vascular malformations confined to the hand: an algorithm of management based on a new classification.

Management of arteriovenous malformations confined to the hand is diverse and ranges from conservative measures to amputation. This paper is a retrospective review of 13 patients with arteriovenous malformations of the hand who were managed using an algorithm of treatment which considered the clinical presentation and the anatomical structure of the lesion.

Cloning and characterization of a species-specific repetitive DNA sequence from Onchocerca armillata.

Two clones, pOA1 and pOA5, have been isolated from a genomic DNA library prepared from pools of Onchocerca armillata adults in the plasmid vector pUC12. In dot-blot hybridisations, these two clones do not cross-hybridise significantly with total genomic DNA from O. volvulus, O. gutturosa, O. ochengi, O. gibsoni, O. lienalis, bovine, human, Culicoides nubeculosus, Simulium species or Brugia pahangi, but do hybridise with as little as 100 pg of DNA from two separate geographic isolates of O. armillata. The sequence of pOA1 and pOA5 has been determined and found to contain a repetitive DNA sequence 147 bp in length. These clones can be used as specific and sensitive DNA probes for the identification of O. armillata capable of identifying a single L3 larva.

Stereotactic core needle biopsy and the workup of mammographic breast lesions.

OBJECTIVE: To evaluate the influence of stereotactic core needle biopsy (SCNB) as an alternative to wire localization biopsy (WLB) on the evaluation and workup of nonpalpable mammographic lesions. DESIGN: A 4-year retrospective clinical review. SETTING: University hospital and clinics. PATIENTS: All patients evaluated for nonpalpable mammographic lesions after screening, diagnostic mammography, or both during the 4-year period of the study were included. OUTCOME PARAMETERS: Changes in the number and types of mammograms and diagnostic biopsies and the histologic findings using each technique (SCNB vs WLB), including total number of cancers diagnosed. RESULTS: The number of screening mammograms and WLBs performed remained constant compared with a marked increase in the number of diagnostic mammograms and SCNBs. The rates of positive findings for each biopsy technique were consistent while the total number of cancers diagnosed increased dramatically. The percentage of biopsy specimens with positive results (ductal carcinoma in situ and invasive cancers) for SCNB was 13.3% compared with 26.2% for WLB specimens. There has also been an increase in the number of cancers found, from 22 in the first year to 54 in the fourth year. In the first year, 45% of these cancers were diagnosed by SCNB; in the fourth year, 83% of the cancers were diagnosed by SCNB. CONCLUSION: Stereotactic core needle biopsy has replaced WLB as the standard for the diagnostic biopsy of suspicious, nonpalpable mammographic lesions. Since adopting this technique, more patients have been examined and their conditions diagnosed as breast cancer in an efficient, cost-effective manner.

Postsurgical pain: zomepirac sodium, propoxyphene/-acetaminophen combination, and placebo.

Zomepirac sodium, a new, nonnarcotic analgesic agent, was compared with the combination of propoxyphene/acetaminophen in a placebo-controlled, double-blind, single-dose study in 196 hospitalized postsurgical patients with pain severe enough to require a prescription analgesic. Patients received 100 mg zomepirac sodium, 50 mg zomepirac sodium, 100 mg propoxyphene napsylate with 650 mg acetaminophen, or placebo. Total pain relief during the 6-hour observation period showed that 100 mg zomepirac sodium was significantly more effective than the propoxyphene combination. All active drugs were superior to placebo. Percentages of patients requiring remedication before the end of the study were: 77 per cent for placebo, 48 per cent for propoxyphene/acetaminophen, 43 per cent for 50 mg zomepirac sodium, and 29 per cent for 100 mg zomepirac sodium. The numbers of patients reporting side effects were not significantly different among the treatment groups. These results confirm those of other single-dose pain studies which showed 100 mg zomepirac sodium significantly more efficacious than the propoxyphene/acetaminophen combination.

An appraisal of codeine as an analgesic: single-dose analysis.

Codeine, a relatively weak oral narcotic agent, is the most frequently prescribed oral opiate drug. It is also frequently utilized as a control drug in comparative analgesic efficacy studies. These studies are often single dose analysis of pain relief following surgery or childbirth. We conducted a single dose, post-operative analysis of 116 patients who were randomly assigned to receive codeine 60 mg, acetaminophen 600 mg, the combination of codeine and acetaminophen at these doses, or a placebo. Only the combination agent was uniformly superior to placebo. Codeine 60 mg was not consistently superior to placebo in this post-operative single dose analysis. A review of the literature confirms the difficulty in unequivocally establishing the value of codeine as an analgesic, in acceptable oral doses, in the single dose setting. Previous reports, however, suggest that the multiple doses of codeine may afford adequate analgesia. Interpretation of single dose studies with extrapolation to repeated dosing in the practice setting is difficult.

Early leprosy with perineural proliferation.

A 62-year-old woman, who lived in an area of the United States nonendemic for leprosy, was seen for an enlarging anesthetic lesion that involved the entire left breast. Microscopic examination of skin biopsy specimens taken from the edge of the lesion disclosed chronic perineural inflammation and neural proliferation, with an acid-fast bacillus demonstrable in one nerve. Granulomas, giant cells, epithelioid cells, nerve abscesses, or other characteristics of tuberculoid leprosy were not seen. This woman had a skin lesion of leprosy in an atypical site. It appeared to be indeterminate on pathologic examination and was accompanied by an unusual degree of neural proliferation.

Predictors of mortality in pulmonary contusion.

BACKGROUND: Associated injuries and central nervous system (CNS) trauma are historically associated with poor outcome in patients with pulmonary contusions, but the value of specific factors reflecting shock, fluid resuscitation requirement and pulmonary parenchymal injury in predicting mortality in this population is not well established. METHODS: The medical records of 100 consecutive patients with pulmonary contusion, admitted over a 5-year period, were retrospectively reviewed. Survivors and nonsurvivors were compared in terms of age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), PaO2/FiO2 (oxygenation ratio), the severity and adequacy of shock resuscitation reflected in plasma lactate, resuscitation volume and transfusion requirements, using one-way ANOVA. To determine the contribution of individual, interdependent variables to mortality, the data were then analyzed using multivariable analysis. RESULTS: ISS and transfusion requirement were significantly higher, and GCS and PaO2/FiO2 at 24 and 48 hours after admission were significantly lower in nonsurvivors than in survivors. After multiple regression analysis, the factors most strongly associated with mortality included patient age, oxygenation ratio at 24 hours after admission, and resuscitation volume. CONCLUSIONS: Outcome in patients with pulmonary contusion is dependent upon a number of variables including the severity of pulmonary parenchymal injury as reflected in PaO2/FiO2 ratio.

Food stealing by young Norway rats (Rattus norvegicus).

Six experiments were undertaken to explore factors affecting young rats' (Rattus norvegicus) frequencies of stealing food from conspecifics when identical food is available in surplus. It was found that (a) rats would walk across a bed of pellets to steal the particular pellet a peer was eating, (b) frequency of stealing within a pair did not decrease over days, (c) rats stole unfamiliar foods more frequently than familiar foods, (d) younger rats stole from older rats more frequently than older rats stole from younger ones, (e) hungry rats stole more frequently than replete rats, and (f) rats that had stolen a pellet of unfamiliar food from an anesthetized conspecific subsequently exhibited an enhanced preference for that food. Results suggest that food stealing is a mode of active seeking of information about what foods to eat.

High-resolution computed tomography sampling for detection of asbestos-related lung disease.

RATIONALE AND OBJECTIVES: We determined whether a limited number of high-resolution computed tomography (HRCT) scans will effectively screen for interstitial lung disease (ILD) in a population of individuals exposed to asbestos. METHODS: We retrospectively reviewed the computed tomography studies of 49 patients exposed to asbestos. HRCT in the supine and prone positions had been performed at specifically preselected levels. Two teams of thoracic radiologists evaluated, on separate occasions: (1) all images, (2) prone images only, and (3) a single prone image through the lung bases for the presence of diffuse ILD. RESULTS: A relatively high level of accuracy was obtained with a single prone scan. However, improvement to 95% or better was found when additional prone images were used. CONCLUSION: A screening study for ILD, in this case patients exposed to asbestos, may be performed by preselected prone HRCT images only. The ease and decreased time of performing the procedure make screening relatively large patient groups for ILD more feasible.

Ethanol exposure in rats: studies on blood gas concentrations, pH and temperature.

The effects of different dosages of ethanol on respiration were determined by evaluating arterial blood PCO2, PO2 and pH in rats. Adult, male Sprague Dawley rats were treated per os with either 2, 4 or 6 g/kg of ethanol; controls received deionized water. Blood was sampled from an indwelling femoral artery catheter before treatment and 15, 30, 60, 120, 180 and 240 min posttreatment. Serum ethanol levels and body temperature was measured concurrently on all animals. This study demonstrates that ethanol ingestion results in a dose-dependent metabolic acidosis and hypothermia in rats. In addition, the highest dose of ethanol, 6 g/kg, resulted in hypoxia.

Microbiological quality of chilled beef carcasses in Northern Ireland: a baseline survey.

To standardize the assessment of the hygienic quality of beef carcasses in Northern Ireland (NI) abattoirs, swabbing techniques were evaluated. Six materials, including two commercially produced swabs, were compared for their ability to recover spoilage and pathogenic bacteria and for their ease of use as carcass swabs. A sponge retailed for domestic use was selected on the basis of efficiency of recovery of microorganisms, ease of use, and cost. On sample carcasses, 1,000 cm2 of the brisket was swabbed, since this site is normally readily contaminated. For 9 months, 420 carcasses in seven of the nine European Union-approved abattoirs in NI were sampled while in the chiller (24 to 48 h after kill). Total viable count (TVC), yeasts and molds, and Enterobacteriaceae were enumerated after incubation at 22 (48 h) and 37 degrees C (48 h), and the results were expressed as log CFU/cm2. The mean TVC results at 22 and 37 degrees C were 2.80+/-0.70 and 2.75+/-0.64, respectively. Although 63% of samples had yeasts that grew at 22 degrees C, only 35% were positive at 37 degrees C. The respective mean yeast counts were 1.12+/-0.59 and 0.46+/-0.51. Enterobacteriaceae were present in 15% of samples at 22 degrees C and 21% of samples at 37 degrees C. The mean counts for positive samples were 0.41+/-0.37 and 0.40+/-0.30, respectively. Molds were found in less than 4% of samples. Given that the brisket is normally one of the most heavily contaminated parts of the carcass, these results suggest that good hygienic practices are in operation in NI abattoirs. The results also enabled the abattoirs with the cleanest carcasses to be identified, hence permitting best practices to be found.

Prolonged life and improved quality for stored skin grafts.

This study is presented as both a follow-up and an extension of previous work on storage techniques for the preservation of skin by refrigeration. Rabbit skin grafts were used to compare the merits of various storage media. One of the media, McCoy's 5A plus serum, gave improved skin graft take and storage half-life. The ability to improve skin graft storage techniques is most beneficial to all aspects of plastic and reconstructive surgery where skin grafting is required. Prolonged graft viability and improved graft quality are of major clinical importance.

Radiographic imaging for treatment and follow-up of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is a spectrum of abnormalities that can range from a very mild disturbance to a very severe process that is incapacitating later in life. This article considers the causative factors and natural history of DDH, as well as anatomic abnormalities, physical examination findings, and both surgical and nonsurgical treatment options. The goal of this article is to place in perspective the use of advanced imaging techniques in the diagnosis and follow-up of patients with DDH. Ultrasound, computed tomography (CT), and magnetic resonance (MR) findings are reviewed with respect to the diagnosis of DDH, treatment complications, and long-term problems that may occur in treated and untreated patients.

The analysis of cremains: A case study involving the inappropriate disposal of mortuary remains.

Cremation as a method of body disposition has increased over the last two decades. Mishandling of the remains is bringing the analysis of cremains to the attention of forensic anthropologists. The destruction of skeletal components by heat, and mechanical reduction, make the analysis of cremains difficult. Three years after receiving cremains believed to be that of their mother, a family received a second set of cremains that were also purported to be those of their mother. Questioning whether which, if either, set of remains were the decedent, the family initiated an anthropological analysis of both sets of remains. The investigation focused on both osseous and nonosseous characteristics of each set. Total weight of the material and differences in both the osseous and nonosseous characteristics indicate that the cremains represent two individuals. These differences include the degree of color change due to heat, the amount of bone fragments vs. ash, and the lead and calcium content remaining in the fragments from each set. Differences in the nonosseous components of each set are related to coffin hardware, and medical and dental artifacts.

A test of the auricular surface aging technique.

A recently developed technique used in the estimation of age at death is based upon the metamorphosis of the auricular surface of the ilium. This technique was designed to be used in seriation to estimate the age distribution of a skeletal sample. However, the technique has also been used in forensic science cases, which must be analyzed on a case-by-case basis. The present study examines the use of the auricular surface technique as the single aging factor. Two hypotheses are tested using a sample of 189 individuals drawn from the Terry Collection, housed at the Smithsonian Institution. The hypotheses are (1) is the method equally applicable across race and sex, and (2) how well does the method perform as the single aging factor? The results indicate that the amount of degenerative change in the auricular surface is not dependent upon race or sex in any given age category. However, the rate of degenerative change is too variable to be used as a single criterion for the estimation of age; the range of estimation error is simply too large for forensic science purposes.

An isolated complex dorsal dislocation of the MP joint of the ring finger.

A rare case of isolated complex dorsal dislocation of the MP joint of the ring finger is described. Differences in the pathological findings between dislocations of the ring finger and other digits are discussed.

The arcade of Struthers: an anatomical study.

In an anatomical study of fresh cadavers, 25 arms were dissected. The arcade of Struthers was found to be present in 17 arms (68%). Atypical features of the arcade of Struthers were observed in seven specimens. The anatomical features and clinical implications of the variants are discussed.

Intrathoracic lymphoproliferative disorders and lymphoma.

The spectrum of lymphoproliferative disorders is truly a continuum from benign diseases to malignant aggressive lymphomas. Remarkable advances in laboratory techniques of monoclonal antibody production and molecular biology over the last decade allow more sophisticated analysis of these diseases. It is now apparent that some entities previously labeled "benign" are actually non-Hodgkin's lymphomas. We review the current knowledge of this spectrum including the histopathologic and clinical findings, as well as the radiographic characteristics. Understanding the diseases, treatment challenges, and follow-up requirements aids the radiologist in a more efficient and cost-effective evaluation of these patients.