Urban Heat Island and Future Climate Change-Implications for Delhi's Heat.

UrbClim, the urban climate model, is used for short- and long-term projections of climate for Delhi. The projections are performed for RCP8.5 using an ensemble of 11 GCM model outputs. Various heat stress indices were employed to understand the role of urban heat island (UHI) in influencing the present and future urban climate of the city. UHI intensity based on 5% warmest nights (TNp95) was 4.1 °C and exhibits negligible change over time. However, the impact of UHI on other heat stress indices is very strong. Combined hot days and tropical nights (CHT) that influenced 58-70% of the reference time frame are expected to rise to 68-77% in near-future and to 91-97% in far-future time periods. For reference time period, urban areas experience 2.3 more number of heat wave days (NHWD) than rural areas per summer season. This difference increases to 7.1 in short-term and 13.8 in long-term projections. Similar to this trend, frequency of heat waves (FHW) for urban areas is also expected to increase from 0.8 each summer season in reference time frame to 2.1 and 5.1 in short- and long-term projections. The urban-rural difference for duration of heat waves (DHW) appears to increase from 1.7 days in past to 2.3 and 2.2 days in future, illustrating that DHW for cities will be higher than non-urban areas at least by 2 days. The intensity of heat wave (IHW) for urban land uses increases from 40 °C in reference time frame to 45 °C in short-term projection to 49 °C in far future. These values for non-urban land use were 33 °C during the baseline time period and are expected to increase to 42 °C and 46 °C in near- and far-future time frames. The results clearly indicate the contribution of UHI effects in intensifying the impacts of extreme heat and heat stress in the city.

Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania).

INTRODUCTION: Direct health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. METHODS: We modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009-2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030-2045) and one in the far future (2085-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009-2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. RESULTS: During the sample period 2009-2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4-38.4) in the near future and to 46 deaths/year (95% CI: 16.4-74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009-2015, we observed increased mortality on days on which the minimum daily temperature fell below - 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8-7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1-0.8). Assuming a "middle ground" between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. CONCLUSION: Thermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception.

Projected heat-related mortality under climate change in the metropolitan area of Skopje.

BACKGROUND: Excessive summer heat is a serious environmental health problem in Skopje, the capital and largest city of the former Yugoslav Republic of Macedonia. This paper attempts to forecast the impact of heat on mortality in Skopje in two future periods under climate change and compare it with a historical baseline period. METHODS: After ascertaining the relationship between daily mean ambient air temperature and daily mortality in Skopje, we modelled the evolution of ambient temperatures in the city under a Representative Concentration Pathway scenario (RCP8.5) and the evolution of the city population in two future time periods: 2026-2045 and 2081-2100, and in a past time period (1986-2005) to serve as baseline for comparison. We then calculated the projected average annual mortality attributable to heat in the absence of adaptation or acclimatization during those time windows, and evaluated the contribution of each source of uncertainty on the final impact. RESULTS: Our estimates suggest that, compared to the baseline period (1986-2005), heat-related mortality in Skopje would more than double in 2026-2045, and more than quadruple in 2081-2100. When considering the impact in 2081-2100, sampling variability around the heat-mortality relationship and climate model explained 40.3 and 46.6 % of total variability. CONCLUSION: These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate.

Heat wave hazard classification and risk assessment using artificial intelligence fuzzy logic.

The average summer temperatures as well as the frequency and intensity of hot days and heat waves are expected to increase due to climate change. Motivated by this consequence, we propose a methodology to evaluate the monthly heat wave hazard and risk and its spatial distribution within large cities. A simple urban climate model with assimilated satellite-derived land surface temperature images was used to generate a historic database of urban air temperature fields. Heat wave hazard was then estimated from the analysis of these hourly air temperatures distributed at a 1-km grid over Athens, Greece, by identifying the areas that are more likely to suffer higher temperatures in the case of a heat wave event. Innovation lies in the artificial intelligence fuzzy logic model that was used to classify the heat waves from mild to extreme by taking into consideration their duration, intensity and time of occurrence. The monthly hazard was subsequently estimated as the cumulative effect from the individual heat waves that occurred at each grid cell during a month. Finally, monthly heat wave risk maps were produced integrating geospatial information on the population vulnerability to heat waves calculated from socio-economic variables.

Urban heat in Johannesburg and Ekurhuleni, South Africa: A meter-scale assessment and vulnerability analysis.

Heat stress is an important threat for human health and urban areas are affected at higher rates compared to rural environments. Additionally, climate change will increase the vulnerability towards urban heat stress in the future. Current high-resolution urban heat stress assessments are limited in time and space due to the high computational costs. In this paper, the UrbClim numerical model is used to simulate urban heat accurately at a fast rate and high spatial resolution for the cities of Johannesburg and Ekurhuleni, South Africa. Using detailed terrain information, (future) urban heat stress assessments are provided at 30 m resolution for both city agglomerations, while meter-scale simulations are executed for a selection of neighborhoods. These model simulations are evaluated using an extensive monitoring campaign in which the local community was heavily engaged. Distinct spatial differences in the urban heat island effect are observed, with greatest heat stress in areas with high building densities and low vegetation numbers. These areas are often characterized by lower socio-economic living conditions. The meter-scale analysis further shows the importance of shade provided by vegetation to lower heat stress in both present and future climate. These assessments offer assistance in the design of climate-resilient urban planning strategies.

Resection of calcaneonavicular bar with interposition of extensor digitorum brevis. A questionnaire review.

The purpose of this study was to review the clinical outcome of teenagers who had a resection of a symptomatic calcaneonavicular bar with interposition of the extensor digitorum brevis muscle. After a mean follow-up of almost 5 years, 22 patients were assessed symptomatically and functionally by means of a questionnaire. More than 95% were satisfied with the operation.

Air-quality modelling in the Lake Baikal region.

In this paper, we assess the status of the air quality in the Lake Baikal region which is strongly influenced by the presence of anthropogenic pollution sources. We combined the local data, with global databases, remote sensing imagery and modelling tools. This approach allows to inventorise the air-polluting sources and to quantify the air-quality concentration levels in the Lake Baikal region to a reasonable level, despite the fact that local data are scarcely available. In the simulations, we focus on the month of July 2003, as for this period, validation data are available for a number of ground-based measurement stations within the Lake Baikal region.

A rare cause of acute compartment syndrome in the thigh: a case report.

Acute compartment syndrome (ACS) is an orthopaedic emergency that requires urgent fasciotomy and decompression to avoid significant morbidity. It is most commonly caused by a fracture or crush injury. We present a case of a patient who developed ACS of the posterior compartment of the thigh secondary to a low energy fall and avulsion of sclerotic arterioles. There was no fracture and the patient was not anti-coagulated. They had fasciotomy and embolization of responsible vessels. This case demonstrates the need for high clinical suspicion needed for ACS and the morbidity associated with a delayed fasciotomy. A literature research demonstrated no case reports of a patient developing ACS with no fracture, no crush injury and no history of anti-coagulation.

Distal metaphyseal radius fractures in children: reduction with or without pinning.

We retrospectively reviewed 39 distal metaphyseal radius fractures in children. This study compares the results of closed reduction with or without percutaneous pinning. Twenty-four fractures were treated by closed reduction and above-elbow cast immobilisation. Re-displacement was noted after one week in three patients, for which they were revised with reduction and pinning. Fifteen patients were initially treated by closed reduction and pinning. In these patients we saw no redisplacement after six weeks immobilisation in a forearm cast. We recommend closed reduction and pinning as a predictable and safe alternative for unstable distal metaphyseal radius fractures.

Flexible intramedullary nailing in the treatment of diaphyseal fractures of the femur in preschool children.

Femur fractures in preschool children are mostly treated in a conservative way, by means of spica cast immobilisation or skin traction. In school age children the use of flexible intramedullary nails (FIN) is widely used and promoted. We performed intramedullary nailing in 9 preschool children aged 1.5-6 years. The mean length of postoperative hospital stay was 4 days (range: 3 to 6). The mean time to solid callus formation was 2.5 months (range: 2 to 3). Follow-up was available in all 9 children for a mean period of 18.9 months (range: 3 to 38). No complications were noted. Flexible intramedullary nailing of femur fractures is a valuable technique in this particular age group. However, further study and long-term follow-up are needed.

Heat and health in Antwerp under climate change: Projected impacts and implications for prevention.

BACKGROUND: Excessive summer heat is a serious environmental health problem in several European cities. Heat-related mortality and morbidity is likely to increase under climate change scenarios without adequate prevention based on locally relevant evidence. METHODS: We modelled the urban climate of Antwerp for the summer season during the period 1986-2015, and projected summer daily temperatures for two periods, one in the near (2026-2045) and one in the far future (2081-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the relationship between temperature and mortality, as well as with hospital admissions for the period 2009-2013, and estimated the projected mortality in the near future and far future periods under changing climate and population, assuming alternatively no acclimatization and acclimatization based on a constant threshold percentile temperature. RESULTS: During the sample period 2009-2013 we observed an increase in daily mortality from a maximum daily temperature of 26°C, or the 89th percentile of the maximum daily temperature series. The annual average heat-related mortality in this period was 13.4 persons (95% CI: 3.8-23.4). No effect of heat was observed in the case of hospital admissions due to cardiorespiratory causes. Under a no acclimatization scenario, annual average heat-related mortality is multiplied by a factor of 1.7 in the near future (24.1deaths/year CI 95%: 6.78-41.94) and by a factor of 4.5 in the far future (60.38deaths/year CI 95%: 17.00-105.11). Under a heat acclimatization scenario, mortality does not increase significantly in the near or in the far future. CONCLUSION: These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate, and the calibration of existing prevention activities in light of locally relevant evidence.

Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments.

OBJECTIVES: To compare the abilities of four different screening tools to predict return visits of older persons after they have been discharged from the emergency department (ED). METHODS: We assessed 83 short-term (discharged within 24 h) patients (aged 65 years and above) who visited the ED of the University Hospitals Leuven, Belgium, from 15 October 2005 to 24 December 2005. The Identification of Seniors at Risk (ISAR), the Triage Risk Screening Tool (TRST), the eight-item questionnaire of Runciman, and the seven-item questionnaire of Rowland were administered at admission to screen the patients for risk factors of future ED readmission. By telephone follow-up 14, 30, and 90 days after discharge from the ED, we asked the patients (or their families) whether readmission had occurred since their initial discharge from the ED. RESULTS: Readmission rates were 10%, 15.8%, and 32.5% after 14, 30, and 90 days, respectively. When using three or more positive answers as the cutoff scores, the Rowland questionnaire proved to be the most accurate predictive tool with a sensitivity of 88%, specificity of 72%, and negative predictive value of 98% at 14 days after discharge. Thirty days after discharge, the sensitivity was 73%, specificity was 75%, and negative predictive value was 92%. CONCLUSION: Repeat visits in older persons admitted to an ED seemed to be most accurately predicted by using the Rowland questionnaire, with an acceptable number of false positives. This instrument can be easily integrated into the standard nursing assessment.