Electrolysis products, reactive oxygen species and ATP loss contribute to cell death following irreversible electroporation with microsecond-long pulsed electric fields.

Membrane permeabilization and thermal injury are the major cause of cell death during irreversible electroporation (IRE) performed using high electric field strength (EFS) and small number of pulses. In this study, we explored cell death under conditions of reduced EFS and prolonged pulse application, identifying the contributions of electrolysis, reactive oxygen species (ROS) and ATP loss. We performed ablations with conventional high-voltage low pulse (HV-LP) and low-voltage high pulse (LV-HP) conditions in a 3D tumor mimic, finding equivalent ablation volumes when using 2000 V/cm 90 pulses or 1000 V/cm 900 pulses respectively. These results were confirmed by performing ablations in swine liver. In LV-HP treatment, ablation volume was found to increase proportionally with pulse numbers, without the substantial temperature increase seen with HV-LP parameters. Peri-electrode pH changes, ATP loss and ROS production were seen in both conditions, but LV-HP treatments were more sensitive to blocking of these forms of cell injury. Increases in current drawn during HV-LP was not observed during LV-HP condition where the total ablation volume correlated to the charge delivered into the tissue which was greater than HV-LP treatment. LV-HP treatment provides a new paradigm in using pulsed electric fields for tissue ablation with clinically relevant volumes.

Non-Contact Irreversible Electroporation in the Esophagus With a Wet Electrode Approach.

Our objective was to develop a technique for performing irreversible electroporation (IRE) of esophageal tumors while mitigating thermal damage to the healthy lumen wall. We investigated noncontact IRE using a wet electrode approach for tumor ablation in a human esophagus with finite element models for electric field distribution, joule heating, thermal flux, and metabolic heat generation. Simulation results indicated the feasibility of tumor ablation in the esophagus using an catheter mounted electrode immersed in diluted saline. The ablation size was clinically relevant, with substantially lesser thermal damage to the healthy esophageal wall when compared to IRE performed by placing a monopolar electrode directly into the tumor. Additional simulations were used to estimate ablation size and penetration during noncontact wet-electrode IRE (wIRE) in the healthy swine esophagus. A novel catheter electrode was manufactured and wIRE evaluated in seven pigs. wIRE was performed by securing the device in the esophagus and using diluted saline to isolate the electrode from the esophageal wall while providing electric contact. Computed tomography and fluoroscopy were performed post-treatment to document acute lumen patency. Animals were sacrificed within four hours following treatment for histologic analysis of the treated esophagus. The procedure was safely completed in all animals; post-treatment imaging revealed intact esophageal lumen. The ablations were visually distinct on gross pathology, demonstrating full thickness, circumferential regions of cell death (3.52 ± 0.89 mm depth). Acute histologic changes were not evident in nerves or extracellular matrix architecture within the treatment site. Catheter directed noncontact IRE is feasible for performing penetrative ablations in the esophagus while avoiding thermal damage.

Urban agrobiodiversity, health and city climate adaptation plans.

Objective: To identify the scope and nature of agricultural biodiversity actions within the climate adaptation plans of a sample of large world cities. Methods: I evaluated data from the 2021 Cities Climate Adaptation Actions database curated by the Carbon Disclosure Project. Cities with a population over 1 million and reporting at least one adaptation action were included. I identified actions involving agriculture and biodiversity using a framework consisting of five agrobiodiversity categories: urban and peri-urban land use and water management, and urban food supply chains, food availability and food environments. I also identified reported health co-benefits and health sector involvement. Findings: Of 141 cities reviewed, 61 cities reported actions on agricultural biodiversity, mostly supporting land use or water management. Key health outcomes addressed were illnesses linked to air pollution and excessive heat and vector-borne diseases, corresponding with cities' major health concerns. Greenhouse gas mitigation was also addressed by many cities. Fewer cities reported actions in food categories or concern for noncommunicable diseases or poor nutrition. Nearly two thirds of cities (40/61) reported health co-benefits or health-sector involvement for at least one intervention. A higher proportion of the 43 cities in low- and middle-income countries reported agrobiodiversity actions and health co-benefits than the 18 cities in high-income countries. Conclusion: Cities are key partners in achieving sustainable global agriculture that promotes health and supports climate and biodiversity goals. Cities can enhance this role through climate adaptation plans with strong health engagement, a focus on nature-based solutions and greater emphasis on food and nutrition.

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach.

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

2021 Climate and Health Review - Uncharted Territory: Extreme Weather Events and Morbidity.

Extreme weather events (EWEs) affected health in every world region during 2021, placing the planet in "uncharted territory." Portraying the human impacts of EWEs is part of a health frame that suggests public knowledge of these risks will spur support for needed policy change. The health frame has gained traction since the Paris COP21 (United Nations Climate Change Conference) and arguably helped to achieve modest progress at the Glasgow COP26. However, reporting rarely covers the full picture of health impacts from EWEs, instead focusing on cost of damages, mortality, and displacement. This review summarizes data for 30 major EWEs of 2021 and, based on the epidemiological literature, discusses morbidity-related exposures for four hazards that marked the year: wildfire smoke; extreme cold and power outages; extreme, precipitation-related flooding; and drought. A very large likely burden of morbidity was found, with particularly widespread exposure to risk of respiratory outcomes (including interactions with COVID-19) and mental illnesses. There is need for a well-disseminated global annual report on EWE morbidity, including affected population estimates and evolving science. In this way, the public health frame may be harnessed to bolster evidence for the broader and promising frame of "urgency and agency" for climate change action.

Taking Care of Friends: The Implementation Evaluation of a Peer-Focused School Program Using First Aid to Reduce Adolescent Risk-Taking and Injury.

Injury is a leading cause of adolescent deaths, with risk-taking associated with a sizeable proportion of injuries and many of those risks undertaken in the presence of peers or with peers' knowledge. Novel ways to promote safety are required and using the peer-relationship may be an important mechanism for prevention. This study reports on the implementation evaluation of the Skills for Preventing Injury in Youth (SPIY) program. SPIY is a high-school program designed to reduce injury by encouraging peers to look out for one another and prevent risk-taking, complemented by developing peer helping and first aid skills as well as school connectedness. 152 students and 12 teachers who delivered SPIY participated in separate 30 min focus groups and reported on students' understanding of peer protective behaviour and the program implementation (adherence, dose, quality of program delivery, and participant responsiveness). Students reported on many approaches to protecting friends and both students and teachers reported they found the program interesting, interactive, and able to be delivered. Peer protection messages were relevant and acceptable to teachers and students in a risk-taking harm reduction program to reduce adolescent injury.

Climate Change and Human Well-Being in the 2020s: Lessons From 2020.

Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year's newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead: (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

Piloting a city health adaptation typology with data from climate-engaged cities: Toward identification of an urban health adaptation gap.

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

First aid training in secondary schools: A comparative study and implementation considerations.

INTRODUCTION: School-based first aid training has benefits for adolescents with an opportunity to increase health and safety knowledge relating to injury and cardiac arrest. METHOD: Using a quasi-experimental design we evaluated differences among students (Mage = 13.46 years, 55% female) taught first aid through the Skills for Preventing Injury in Youth (SPIY) program (n = 1942), treatment-as-usual school-based first aid training (n = 675), and students who did not receive first aid training (n = 489). RESULTS: Results showed significant differences in self-reported knowledge scores at twelve-month follow-up (controlling for baseline knowledge). Students in the SPIY group and the treatment-as-usual first aid group had higher total scores than the control group. Teachers and students reported positive perceptions to first aid study, in particular the interactive delivery and scenarios for contextualizing information. Practical Applications: The study provides support for the retention of first aid knowledge up to 12-months and thus the inclusion and feasibility of first aid training in secondary school curriculum.

Early Warnings: The Lessons of COVID-19 for Public Health Climate Preparedness.

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems - governance, information, services, determinants, and capacity - to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

Understanding the Roles of Remoteness and Indigenous Status in Rural and Remote Road Trauma in North Queensland: Using a Mixed-Methods Approach.

Road trauma is a significant health problem in rural and remote regions of Australia, particularly for Indigenous communities. This study aims to identify and compare the circumstances leading to (proximal causation) and social determinants of (distal causation) crashes of Indigenous and non-Indigenous people in these regions and their relation to remoteness. This is a topic seriously under-researched in Australia. Modelled on an earlier study, 229 persons injured in crashes were recruited from local health facilities in rural and remote North Queensland and interviewed, mainly by telephone, according to a fixed protocol which included a detailed narrative of the circumstances of the crash. A qualitative analysis of these narratives identified several core themes, further explored statistically in this sample, supplemented by participants in the earlier study with compatible questionnaire data, designed to determine which factors were more closely associated with Indigenous status and which with remoteness. Indigenous participants were less often vehicle controllers, more likely to have recently been a drink driver or passenger thereof; to be unemployed, unlicensed, distracted or fatigued before the crash, alcohol dependent and have lower perceived social, but not personal, locus of control in a traffic crash than non-Indigenous persons. Differences between Indigenous and non-Indigenous participants are largely ascribable to hardship and transport disadvantage due to lack of access to licensing and associated limitations on employment opportunities. Based on these findings, a number of policy recommendations relating to educational, enforcement and engineering issues have been made.

Integrating Public Health into Climate Change Policy and Planning: State of Practice Update.

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: "Co-benefits" to health help underpin greenhouse gas reduction strategies, while safeguarding health-particularly of the most vulnerable-is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health's role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts-governance, implementation and adjustment-that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

The impact of changes to the NSW graduated driver licensing system on subsequent crash and offense experience.

INTRODUCTION: In mid-2007 the State of New South Wales (NSW) in Australia introduced modifications to the existing graduated driver licensing system, lengthening the mandatory number of supervised hours for learner drivers aged under 25 years from 50 to 120 and extending the minimum learner period from 6 to 12 months. Additional driving restrictions were also introduced for young drivers in the two provisional licensed periods, P1, P2. This paper aims to evaluate this change by comparing the crash and offense experiences of young learner drivers before and after it occurred. METHOD: From driver licensing files supplied by the NSW transport authority two cohorts of persons obtaining their initial learner's permits in the year prior to the changes and in the subsequent year were constructed with demographic data, dates of transition to the driving phases, dates of crashes, and dates and types of traffic offenses. Both cohorts comprised around 100,000 individuals. Crash rates per 100 years of person-time under observation post P1 with their standard errors were calculated. Using a survival-analytic approach the proportion of crashes of all types were graphed in three month periods post P1. Sexes were treated separately as were initial learner ages of 16, 17, 18-21, and 22-24 years. The distribution of traffic offense types during P1 and P2 phases were also compared. With such large numbers formal statistical testing was avoided. RESULTS: No meaningful differences in the crash or offense experiences of the two cohorts in either sex or at any age were observed. Delaying progress to unsupervised driving has road safety benefits. CONCLUSIONS: At least in conditions similar to those in NSW, requiring more than 50 h of supervised driving seems to have few road safety benefits. Practical applications: Licensing authorities should be cautious in extending the mandated number of supervised driving hours beyond 50.

Integrating Health into Local Climate Response: Lessons from the U.S. CDC Climate-Ready States and Cities Initiative.

SUMMARY: Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)'s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level. https://doi.org/10.1289/EHP1838.

Steering Clear of Driving After Drinking: a Tailored e-Health Intervention for Reducing Repeat Offending and Modifying Alcohol Use in a High-Risk Cohort.

PURPOSE: Digital interventions to reduce risk behaviours are emerging as effective public health measures; however, few have been applied to drink driving and associated alcohol use based on a harm reduction perspective. This paper reports on the design, development, and pilot of a novel intervention which aims to reduce repeat offending by first-time convicted drink driving offenders. It explores whether an online program is acceptable and user friendly and contains useful and relevant content, with a sample of first-time drink driving offenders recruited at the time of conviction. METHOD: Building upon existing research into interventions to reduce drink driving recidivism and problem alcohol use, a tailored program was designed to provide content specifically concerned with drink driving and with an additional component related to alcohol use. Following stakeholder and internal review, the 'Steering Clear First Offender Drink Driving Program' was subsequently piloted with 15 first-time drink driving offenders. Evaluative data was analysed both quantitatively and qualitatively. RESULTS: The pilot results indicate that the participants found the program to be user friendly, as demonstrated by high scores in relation to navigation, online delivery, engagement, avatar usage and straightforwardness. They reported that they found the content to be useful and relevant and that the key learning area was in relation to the consequences of drink driving. CONCLUSION: Online interventions for reducing risky behaviour such as drink driving may be useful and cost effective from a public health perspective. Potentially, they can directly address risky behaviours associated with alcohol use in high-risk cohorts that may not ordinarily receive intervention.

Self-Efficacy, Planning, and Drink Driving: Applying the Health Action Process Approach.

OBJECTIVE: This study examines the constructs from the health action process approach (HAPA) theoretical model (Schwarzer, 1992) on future drink driving avoidance by first time drink driving offenders. This research presents an advance in health related theory by the novel application of the health model to predict risk avoidance. METHOD: Baseline interviews were conducted with 198 first time drink driving offenders at the time of court appearance, and offenders were followed up 6-8 months following the offense date. The key outcome variables used in 3 stages were behavioral expectation, planning, and self-reported avoidance of drink driving at follow-up. RESULTS: Bivariate and multivariate analyses were conducted for each stage. High task self-efficacy and female gender were significantly related to having no behavioral expectation of future drink driving. High maintenance self-efficacy was significantly related to high levels of planning to avoid future drink driving. Those with higher planning scores at baseline had significantly higher odds of reporting that they had avoided drink driving at follow up. CONCLUSION: Planning plays an important role in drink driving rehabilitation and should be a focus of early intervention programs aimed at reducing drink driving recidivism following a first offense. Self-efficacy is an important construct to consider for the behavior and could strengthen a planning focused intervention. (PsycINFO Database Record

Trial of the Primary Care Practice Improvement Tool: building organisational performance in Australian general practice and primary health care.

OBJECTIVE: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities. DESIGN: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1-5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1-5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers' experiences and perceived support and resource needs to undertake organisational improvement in practice. RESULTS: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements. CONCLUSIONS: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs.

School-Based First Aid Training Programs: A Systematic Review.

BACKGROUND: This review examines the breadth of first aid training delivered to school students and the components that are age appropriate to adolescents. METHOD: Eligible studies included school-based first aid interventions targeting students aged between 10 and 18 years. Online databases were searched, for peer-reviewed publications available as at August 2014. RESULTS: A total of 20 journal articles were relevant to the review. Research supported programs with longer durations (3 hours or more). Most programs taught resuscitation alone and few included content that was context-specific and relevant to the target group. The training experience of the facilitator did not appear to impact on student outcomes. Incorporating both practical and didactic components was found to be an important factor in delivering material and facilitating the retention of knowledge. Educational resources and facilitator training were found to be common features of effective programs. CONCLUSIONS: The review supports first aid in school curriculum and provides details of key components pertinent to design of school-based first aid programs. The findings suggest that first aid training may have benefits wider than the uptake and retention of knowledge and skills. There is a need for future research, particularly randomized controlled trials to aid in identifying best practice approaches.

Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice.

BACKGROUND: Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions. OBJECTIVES: We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy. RESULTS AND DISCUSSION: We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10-21), and thoroughly addressed 13 of 22 (range 5-19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted. CONCLUSIONS: The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility.