Identifying dominant factors of waterlogging events in metropolitan coastal cities: The case study of Guangzhou, China.

Urban waterlogging disasters are affected by environmental conditions and human activities. Previous studies had explored the effect of land-use type on waterlogging in relatively small watersheds. Few, however, have comprehensively revealed the relative contributions of the environmental and anthropogenic factors to urban waterlogging concerning different scales of analysis. Indeed what is less known, are the dominant factors and the appropriate scale of analysis. To overcome this limitation, a novel method that integrates the stepwise regression model with hierarchical partitioning analysis is presented. The purpose is to investigate the complex mechanism of urban waterlogging by identifying the relative contribution of each environmental and anthropogenic factor and the stability linking waterlogging to influencing factors at multiple scales of analysis (i.e. 1 km, 2 km, 3 km, 4 km, and 5 km). We consider waterlogging events in the central urban districts of Guangzhou (PR China) from 2009 to 2015 as a case study. The results show that the spatial distribution of waterlogging events in the central urban area presents a strong agglomeration pattern. The waterlogging hot spots are mainly concentrated in the historical area of Guangzhou. Under all analysis scales, we find that the percent cover of urban green spaces (44.74%), percent cover of residential area (41.03%), and slope.std (36.85%) both have a dominant contribution to urban waterlogging, which suggests the importance of land cover composition in determining urban waterlogging. However, the relative contribution and dominant factors of waterlogging varied across different analysis scales, presenting a strong scale effect. Under a small analysis scale (1 km), the topography factors (slope.std and relative elevation) are confirmed as the dominant variables; however, with the increase of analysis scale, the influence of land cover composition (greenspace, residence area, grassland) and land cover spatial configuration (LPI, AI, Cohesion index) on waterlogging magnitude is greater than other factors. This finding provides additional insights that the urban waterlogging can be alleviated by balancing the relative composition of land cover features as well as by optimizing their spatial configuration. Since the optimal statistical scale for urban waterlogging studies only worked for specific influencing factors, the appropriate analysis scale for urban waterlogging study should be determined by the characteristics of study areas. This study has the capability to extend our scientific understanding of the complex mechanisms of waterlogging in the highly urbanized coastal city, providing useful support for the prevention and management of urban waterlogging.

The Lombardia Stroke Unit Registry: 1-year experience of a web-based hospital stroke registry.

This paper presents methodological aspects of the Lombardia Stroke Registry. At the registry start-up, 36 recruiting centres were identified according to a regional survey. The registry recruits consecutive patients with acute stroke or transient ischaemic attacks (TIAs). A 3-month follow-up was planned to correlate acute care with outcomes. On 31st December 2007, data concerning 6,181 patients discharged alive were available. The registry aims at measuring performance parameters, identifying guidelines non-compliance and analysing care processes. In this first phase, 30% of the Lombardia acute stroke and 10% of TIA patients have been enrolled, thus the sample can be considered informative for the disease care in the region. The proportion of completed data items is very high with very small differences among items. The following critical points were highlighted: (1) lack of data input staff for 30% of centres, and (2) difficulty of obtaining the informed consent for post-discharge follow-up.

[The network for the management of acute coronary syndromes in Milan: results of a four-year experience and perspectives of the prehospital and interhospital cardiological network]. / La rete per la gestione delle sindromi coronariche acute della Città di Milano: risultati di quattro anni di esperienza e prospettive del network cardiologico preospedaliero e interospedaliero.

In patients with acute ST-elevation myocardial infarction (STEMI), in order to shorten the time to definitive treatment, it is essential to coordinate the intervention between the local healthcare system and the hospitals. In 1999, a Working Group for Prehospital Emergency in Cardiology was established in Milan, and a network for 12-lead ECG transmission between advances life support (ALS) ambulances, the headquarter of 118 Rescue Service and the Coronary Care Units (CCU) or Divisions of Cardiology was developed: between February 1, 2001 and May 1, 2005, 6821 patients with suspected heart attack were rescued and their ECG recorded and transmitted (177 patients/month, 20% of them with an ST-segment shift, 11% ST-segment elevation, 9% non-ST-segment elevation, 24% with normal ECG). The rate of false positive automatic diagnosis of acute myocardial infarction was 0.3%, the rate of false negative was 0.8%. Forty-six patients with ventricular fibrillation underwent DC-shock. After May 1, 2004, clinical data of patients with STEMI transferred to the hospitals by ALS ambulances were reported in a database: 82% of the 89 patients were treated with primary angioplasty. The time (median, interquartile ranges) between ECG arrival to the CCU and the ECG report was 2 min (1-5), between ECG arrival to the CCU and patient arrival to the hospital was 34 min (24-42), between ECG arrival to the CCU and primary angioplasty was 69 min (50-93); the door-to-balloon time was 33 min (22-60). The telephone ECG transmission has been demonstrated to be a useful and rapid tool, easy to use; the automatic ECG diagnosis was accurate. In patients with STEMI the telephone ECG transmission shortened the time of delivery of therapy, helped to recover arrhythmic complications, allowed both the coordination between the 118 System and the Divisions of Cardiology and the implementation of the triage for primary angioplasty. Increasing the technological level of the service will be the next step of the program: the protocol will be upgraded in order to increase the number of patients rescued, to shorten the time of operation and to administer prehospital fibrinolytic therapy in selected patients.

Trends in drug prescriptions to diabetic patients from 2000 to 2008 in Italy's Lombardy Region: a large population-based study.

OBJECTIVE: To analyze the prescribing patterns of antidiabetic and cardiovascular medications among diabetics in the most highly populated Italian Region, from 2000 to 2008. METHODS: Data were obtained from the Lombardy Region administrative health databases. The standardized prevalence of antidiabetic and cardiovascular drugs use was calculated within each study year. The prescription trends of initial treatment with antidiabetic drugs were also analyzed. RESULTS: From 2000 to 2008 there was an increase in the proportion of patients treated with biguanides (from 53.4% to 66.5%; p<0.0001) while those receiving sulfonylurea decreased (from 78.6% to 56.4%; p<0.0001). A sharp increase of metformin (as monotherapy) as initial treatment was also observed (from 15.2% to 48.8%; p<0.0001). The percentage of patients receiving renin-angiotensin system inhibitors, lipid-lowering drugs and antiplatelets increased between 2000 and 2008, from respectively 45.1% to 63.3%, 13.6% to 43.2% and 21.6% to 40.9 (p<0.0001). Multivariate analyses indicated that changes in prescriptions were statistically significant for both antidiabetic and cardiovascular drugs. CONCLUSION: This study documents progressive changes in the prescription of antidiabetic and cardiovascular drugs in accordance with guidelines. However, the use of metformin as first line therapy was still suboptimal and cardiovascular preventive strategies were only partially implemented in community practice.

Emergency Medical System response to out-of-hospital cardiac arrest in Milan, Italy.

The objective of this study was to investigate how rapidly the Emergency Medical System provides life support to patients suffering out-of-hospital cardiac arrest in Milan, Italy. The study population included 1426 consecutive participants with out-of-hospital cardiac arrest between January 2007 and October 2008. The mean age was 72.7 years. The incidence of ventricular tachycardia/ventricular fibrillation as the presenting rhythm was 12.7%. Eighty percent of out-of-hospital cardiac arrests occurred at home and bystander cardiopulmonary resuscitation (CPR) was in progress in 11.1% of all cases. The mean time interval from collapse-to-first shock was 18.67+/-5.37 min. The mean Emergency Medical System unit response time interval was 7.07+/-3.14 min; time elapsed from arrival-to-first CPR was 7.75+/-4.32 min. In conclusions, the dispatch to arrival and dispatch to CPR intervals are comparable with those reported in other large urban areas, but the time from arrival-to-first CPR was longer than recommended by current guidelines.

[Cardiological emergency network in Lombardy]. / Le reti dell'emergenza in Cardiologia: i'esperienza lombarda.

AIMS: To achieve a reduction of time to reperfusion through the organization of an interhospital network and the involvement of the Regional Health Authority. METHODS: Four major endpoints were identified: institutional governance action, clinical management of acute ST-elevation myocardial infarction (STEMI), priority actions for cardiac arrest and early defibrillation, actions to avoid the delay related to decision-making, and logistic factors. Since 2001 in the urban area of Milan a network has been operating among 23 coronary care units, the 118 Dispatch Center (national free number for medical emergencies) and the Health Country Government Agency named Group for Prehospital Cardiac Emergency. In order to monitor the network activity and time to treatment and clinical outcomes a periodic monthly survey, called MOMI (One Month Monitoring Myocardial Infarction), was undertaken and repeated twice yearly. Data were evaluated according to hospital admission modality. RESULTS: Global times are: symptom onset to first medical contact 116 min (interquartile range [IQR] 189), time to first ECG 7 min (IQR 12), door-to-balloon time 77 min (IQR 81.7). Non-parametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. The shortest one (49.5 min) was that of patients transported by means of advanced rescue units with 12-lead ECG teletransmission and activation of a fast track directly to the cath lab. CONCLUSIONS: Our data show how in a complex urban area the organization of an interhospital network and the availability of ECG teletransmission are effective in reducing time to reperfusion, in the treatment of major arrhythmias and in pre-alert of coronary care units and cath labs in case of confirmed STEMI. This experience also stimulated an improvement in technological equipment of rescue units with extension of 12-lead teletransmission to basic life support units. Through the Health Country Government Agency and the Scientific Societies we carry on with our job to create a regional network for cardiac emergency involving all the hospitals.