Hot Topic: A Systematic Review and Content Analysis of Heat-Related Messages During the 2021 Heat Dome in Canada.

CONTEXT: During the summer of 2021, western Canada experienced a deadly heat event. From the first heat alert to postevent reporting, thousands of media articles were published that reference the heat event. However, a gap remains in understanding how this communication chain-from the release of a public heat alert to information shared through media outlets to the public-currently operates to disseminate heat-related messaging across Canada. OBJECTIVE: To understand the role of digital media in delivering heat-health messaging during an extreme heat event in Canada. DESIGN: A qualitative content analysis was conducted using Canadian news articles published on the 2021 Heat Dome between June 2021 and February 2022 (n = 2909). The coding frame was designed to align with the basic framework for information gathering used in journalism (who, what, where, when, and how) and included both concept-driven and data-driven codes. RESULTS: Overall, 2909 unique media articles discussing the 2021 Heat Dome were identified, with the majority (74%) published by online news agencies (how). The highest article count was on June 29, 2021 (n = 159), representing 5% of the total data set (n = 2909) spanning 260 days (when); 57% of the identified locations were in British Columbia (where). Although we found that the top voices providing media-based heat-health messages are government officials (who), only 23% of articles included heat-health messaging that aligns with the government health alert bulletins released during extreme heat. In addition, heat-health messaging frequently included contradictory content, inconsistent language, or incorrect advice (what). CONCLUSION: The findings demonstrate clear opportunities to improve health communication related to extreme heat, perhaps most importantly, including updates to mass media messaging educating the public on heat-protective behaviors.

Minimizing Lung Injury During Laparoscopy in Head-Down Tilt: A Physiological Cohort Study.

BACKGROUND: Increased intra-abdominal pressure during laparoscopy induces atelectasis. Positive end-expiratory pressure (PEEP) can alleviate atelectasis but may cause hyperinflation. Cyclic opening of collapsed alveoli and hyperinflation can lead to ventilator-induced lung injury and postoperative pulmonary complications. We aimed to study the effect of PEEP on atelectasis, lung stress, and hyperinflation during laparoscopy in the head-down (Trendelenburg) position. METHODS: An open-label, repeated-measures, interventional, physiological cohort trial was designed. All participants were recruited from a single tertiary Belgian university hospital. Twenty-three nonobese patients scheduled for laparoscopy in the Trendelenburg position were recruited.We applied a decremental PEEP protocol: 15 (high), 10 and 5 (low) cm H 2 O. Atelectasis was studied with the lung ultrasound score, the end-expiratory transpulmonary pressure, the arterial oxygen partial pressure to fraction of inspired oxygen concentration (P ao2 /Fi o2 ) ratio, and the dynamic respiratory system compliance. Global hyperinflation was evaluated by dead space volume, and regional ventilation was evaluated by lung ultrasound. Lung stress was estimated using the transpulmonary driving pressure and dynamic compliance. Data are reported as medians (25th-75th percentile). RESULTS: At 15, 10, and 5 cm H 2 O PEEP, the respective measurements were: lung ultrasound scores (%) 11 (0-22), 27 (11-39), and 53 (42-61) ( P < .001); end-expiratory transpulmonary pressures (cm H 2 O) 0.9 (-0.6 to 1.7), -0.3 (-2.0 to 0.7), and -1.9 (-4.6 to -0.9) ( P < .001); P ao2 /Fi o2 ratios (mm Hg) 471 (435-538), 458 (410-537), and 431 (358-492) ( P < .001); dynamic respiratory system compliances (mL/cm H 2 O) 32 (26-36), 30 (25-34), and 27 (22-30) ( P < .001); driving pressures (cm H 2 O) 8.2 (7.5-9.5), 9.3 (8.5-11.1), and 11.0 (10.3-12.2) ( P < .001); and alveolar dead space ventilation fractions (%) 10 (9-12), 10 (9-12), and 9 (8-12) ( P = .23). The lung ultrasound score was similar between apical and basal lung regions at each PEEP level ( P = .76, .37, and .76, respectively). CONCLUSIONS: Higher PEEP levels during laparoscopy in the head-down position facilitate lung-protective ventilation. Atelectasis and lung stress are reduced in the absence of global alveolar hyperinflation.

Reoperation for bleeding after cardiac surgery.

BACKGROUND: Postoperative cardio-surgical haemostatic management is centre-specific and experience-based, which leads to a variability in patient care. This study aimed to identify which postoperative haemostatic interventions may reduce the need for reoperation after cardiac surgery in adults. METHODS: A retrospective case-control study in a tertiary centre. Adult, elective, primary cardiac surgical patients were selected (n = 2098); cases (n = 42) were patients who underwent reoperation within 72 h after the initial surgery. Interventions administered to control surgical bleeding were compared for the need to re-operate using multiple logistic regression. RESULTS: Rate of cardiac surgical reoperation was 2% in the study population. Three variables were found to be associated with cardiac reoperation: preoperative administration of fresh frozen plasma (OR 5.45, CI 2.34-12.35), cumulative volume of chest tube drainage and cumulative count of packed red blood cells transfusion on ICU (OR 1.98, CI 1.56-2.51). CONCLUSION: No significant difference among specific types of postoperative haemostatic interventions was found between patients who needed reoperation and those who did not. Perioperative transfusion of fresh frozen plasma, postoperative transfusion of packed cells and cumulative volume of chest tube drainage were associated with reoperation after cardiac surgery. These variables could help predict the need for reoperation.

Reflections on a Century of Extreme Heat Event-Related Mortality Reporting in Canada.

Climate change is causing more frequent and severe extreme heat events (EHEs) in Canada, resulting in significant loss of life. However, patterns across mortality reporting for historical EHEs have not been analyzed. To address this gap, we studied deaths in Canadian EHEs from 1936 to 2021, identifying trends and challenges. Our analysis revealed inconsistencies in mortality data, discrepancies between vulnerable populations identified, difficulties in determining the cause of death, and inconsistent reporting on social vulnerability indicators. We provide some observations that could help inform solutions to address the gaps and challenges, by moving toward more consistent and comprehensive reporting to ensure no population is overlooked. Accurately accounting for affected populations could help better target evidence-based interventions, and reduce vulnerability to extreme heat.

The Intersection of the COVID-19 Pandemic and the 2021 Heat Dome in Canadian Digital News Media: A Content Analysis.

During the 2021 Heat Dome, 619 people in British Columbia died due to the heat. This public health disaster was made worse by the ongoing COVID-19 pandemic. Few studies have explored the intersection of heat with COVID-19, and none in Canada. Considering that climate change is expected to increase the frequency of extreme heat events, it is important to improve our understanding of intersecting public health crises. Thus, this study aimed to explore media-based public health communication in Canada during the COVID-19 pandemic and the 2021 Heat Dome. A qualitative content analysis was conducted on a subset of media articles (n = 520) related to the COVID-19 pandemic which were identified through a previous media analysis on the 2021 Heat Dome (n = 2909). Many of the articles provided conflicting health messages that may have confused the public about which health protective actions to take. The articles also showed how the COVID-19 pandemic may have exacerbated the health impacts of the 2021 Heat Dome, as pandemic-related public health measures may have deterred people away from protecting themselves from heat. This study, which provides novel insight into the prioritization of public health messaging when an extreme heat event occurs concurrently with a pandemic, supports the need for consistent heat health guidance.

Chronic Diseases Associated With Mortality in British Columbia, Canada During the 2021 Western North America Extreme Heat Event.

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.

Reimagining spaces where children play: developing guidance for thermally comfortable playgrounds in Canada.

SETTING: Planning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children's playground equipment and surfacing standard. INTERVENTION: The project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds. OUTCOMES: A group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds. IMPLICATIONS: Both the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada's playgrounds are designed to minimize environmental health risks for children.

RéSUMé: CONTEXTE: À l'ère des changements climatiques, le confort thermique n'a jamais été si important pour la planification et l'aménagement d'espaces extérieurs, surtout car les enfants sont plus sensibles que les adultes aux chaleurs brûlantes. Cependant, les normes qui encadrent actuellement les aires de jeu s'articulent autour d'une logique de prévention de traumatismes. Elles portent donc principalement sur les équipements et leurs revêtements plutôt que sur les conséquences des canicules, des malaises liés à la chaleur et des insolations. L'objectif du présent projet est de rédiger un projet de directives pour favoriser le confort thermique des aires de jeu au Canada et d'intégrer ces directives à la norme CAN/CSA-Z614 Aires et équipements de jeu. INTERVENTION: Les origines du projet remontent à une action municipale à Windsor, en Ontario. Celle-ci avait pour but d'augmenter la quantité de zones d'ombres, de végétation et de jeux d'eau dans les parcs et les aires de jeu en vue de favoriser le confort thermique vu la fréquence croissante des canicules (≥30°C). Le constat de lacunes d'informations autour de la gestion des conditions écologiques a suscité une concertation pour créer des ressources et faire rayonner des pratiques d'aménagement optimales pour l'amélioration du confort thermique des aires de jeu. RéSULTATS: Une équipe transversale d'experts a rédigé des directives techniques pour améliorer le confort thermique des aires de jeu, ainsi qu'une annexe de six pages sur la question qui a été intégrée à une norme nationale. Dans le cadre d'un concours, des écoles canadiennes se sont servies de l'annexe comme référentiel pour penser et aménager des aires de jeu vertes. IMPLICATIONS: Le rapport technique et l'annexe mettent en valeur le besoin d'encadrer la gestion des facteurs environnementaux des aires de jeu. L'amélioration du confort thermique de ces espaces et la réduction des risques environnementaux permettent de protéger la santé des enfants au Canada.

Urban Trees and Human Health: A Scoping Review.

The urban forest is a green infrastructure system that delivers multiple environmental, economic, social and health services, and functions in cities. Environmental benefits of urban trees are well understood, but no review to date has examined how urban trees affect human health. This review provides a comprehensive summary of existing literature on the health impacts of urban trees that can inform future research, policy, and nature-based public health interventions. A systematic search used keywords representing human health, environmental health, and urban forestry. Following screening and appraisal of several thousand articles, 201 studies were conceptually sorted into a three-part framework. Reducing Harm, representing 41% of studies, includes topics such as air pollution, ultraviolet radiation, heat exposure, and pollen. Restoring Capacities, at 31%, includes attention restoration, mental health, stress reduction, and clinical outcomes. Building Capacities, at 28%, includes topics such as birth outcomes, active living, and weight status. The studies that were reviewed show substantial heterogeneity in purpose and method yet indicate important health outcomes associated with people's exposure to trees. This review will help inform future research and practice, and demonstrates why urban forest planning and management should strategically promote trees as a social determinant of public health.

Developing a harmonized heat warning and information system for Ontario: a case study in collaboration.

BACKGROUND: Heat wave early warning systems help alert decision-makers and the public to prepare for hot weather and implement preventive actions to protect health. Prior to harmonization, public health units across Ontario either used independent systems with varying methodologies for triggering and issuing public heat warnings or did not use any system. The federal government also issued heat warnings based on different criteria. During heat events, adjacent public health units in Ontario and the federal government would routinely call heat warnings at different times with separate public messages, leading to confusion. This article describes the collaborative process and key steps in developing a harmonized Heat Warning and Information System (HWIS) for Ontario. SETTING: Public health units across Ontario, Canada, collaborated with the federal and provincial government to develop the harmonized HWIS for Ontario. INTERVENTION: In 2011, stakeholders identified the need to develop a harmonized system across Ontario to improve heat warning services, warning criteria, and health messaging. Through a 5-year process facilitated by a non-governmental organization, the three levels of government collaborated to establish the Ontario HWIS. OUTCOMES: The province-wide HWIS was implemented in 2016 with the Ontario Ministry of Health and Long-Term Care's release of the harmonized HWIS Standard Operating Practice, which outlined the notification and warning process. IMPLICATIONS: The lessons learned could help spur action in other provinces and jurisdictions internationally in the development of similar health evidence-based warning systems, including in particular those for protecting public health during extreme heat events.

Establishing Heat Alert Thresholds for the Varied Climatic Regions of British Columbia, Canada.

Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation to extreme heat in greater Vancouver, but no other parts of BC were covered by HARS. The objective of this study was to identify evidence-based heat alert thresholds for the Southwest, Southeast, Northwest, and Northeast regions to facilitate the introduction of HARS across BC. This was done based on a national approach that considers high temperatures on two consecutive days and the intervening overnight low, referred to as the high-low-high approach. Daily forecast and observed air temperatures and daily mortality counts for May through September of 2004 through 2016 were obtained. For each date (dayt), dayt-2 forecasts were used to assign high temperatures for dayt and dayt+1 and the overnight low. A range of high-low-high threshold combinations was assessed for each region by finding associations with daily mortality using time-series models and other considerations. The following thresholds were established: 29-16-29 °C in the Southwest; 35-18-35 °C in the Southeast; 28-13-28 °C in the Northwest; and 29-14-29 °C in the Northeast. Heat alert thresholds for all regions in BC provide health authorities with information on dangerously hot temperature conditions and inform the activation of protective public health interventions.

Animal models of atherosclerosis.

An ideal animal model of atherosclerosis resembles human anatomy and pathophysiology and has the potential to be used in medical and pharmaceutical research to obtain results that can be extrapolated to human medicine. Moreover, it must be easy to acquire, can be maintained at a reasonable cost, is easy to handle and shares the topography of the lesions with humans. In general, animal models of atherosclerosis are based on accelerated plaque formation due to a cholesterol-rich/Western-type diet, manipulation of genes involved in the cholesterol metabolism, and the introduction of additional risk factors for atherosclerosis. Mouse and rabbit models have been mostly used, followed by pigs and non-human primates. Each of these models has its advantages and limitations. The mouse has become the predominant species to study experimental atherosclerosis because of its rapid reproduction, ease of genetic manipulation and its ability to monitor atherogenesis in a reasonable time frame. Both Apolipoprotein E deficient (ApoE-/-) and LDL-receptor (LDLr) knockout mice have been frequently used, but also ApoE/LDLr double-knockout, ApoE3-Leiden and PCSK9-AAV mice are valuable tools in atherosclerosis research. However, a great challenge was the development of a model in which intra-plaque microvessels, haemorrhages, spontaneous atherosclerotic plaque ruptures, myocardial infarction and sudden death occur consistently. These features are present in ApoE-/-Fbn1C1039G+/- mice, which can be used as a validated model in pre-clinical studies to evaluate novel plaque-stabilizing drugs.

Isolation from porcine antral mucosa of a hexapeptide corresponding to the C-terminal sequence of gastrin.

The present studies were undertaken to confirm reports of high concentrations of the C-terminal tetrapeptide of gastrin in hog antral mucosa. A method was developed whereby synthetic tetrapeptide added to boiling water extracts of hog antral mucosa could be purified to homogeneity by adsorption to Amberlite XAD2 resin, ion exchange chromatography on DEAE cellulose, and reverse phase HPLC. The product had the amino acid composition of gastrin tetrapeptide. When the same method was used on antral mucosa without prior addition of synthetic G4, several small peaks of material with C-terminal immunoreactivity could be found in DEAE column eluates but none could be unequivocally identified as the tetrapeptide. In the same column runs there was a relatively large peak of immunoreactivity eluting later than the tetrapeptide. This material was purified to homogeneity by HPLC and on the basis of its amino acid composition and sequence was identified as the C-terminal hexapeptide of gastrin.

Heterogeneity of the gastrins in blood and tissue.

The forms of gastrin which have been isolated from antral mucosa or Zollinger-Ellison tumour tissue (or both) and characterized chemically are as follows: little gastrin (G17) (LG); big gastrin (G34) (BG); minigastrin (G13); the NH2-terminal 1-13 fragment of G17. All these exist as pairs of peptides which have an identical amino acid sequence and differ solely in that the single tyrosyl residue present may be sulphated. The proportions of the pairs of each peptide show species variation where isolation has been accomplished (e.g. from hog, dog, cat, cow, sheep and man in the case of LG, and hog and man for BG). All these forms of the hormone have been identified immunologically in serum; LG and BG have been identified in duodenal mucosa. Two larger forms of the hormone have been identified immunologically in serum; component I (CI) and 'big big gastrin' (BBG). Material corresponding in size to BBG and CI has been identified in extracts of antral and jejunal mucosa and Zollinger-Ellison tumour. Neither BBG nor CI has been characterized chemically to date and their physiological significance is uncertain. Recent studies suggest that the heterogeneity of gastrins in serum and tissues may be considerably greater than is indicated by the list of components given above.

Relations between neuropeptides and gut hormones.

Certain peptides have a dual distribution in brain and in neurons or endocrine cells, or both, in the gut. Substance P, neurotensin and somatostatin have been isolated from brain and gut (or pancreas); cholecystokinin has been isolated from intestine as peptides of 33 and 39 residues and their active C-terminal octapeptide has been isolated from brain, which suggests differences between biosynthetic processing pathways for cholecystokinin in neurons and those in endocrine cells. Identification of other peptides (vasoactive intestinal peptide, bombesin, enkephalin etc.) rests in part on immunochemical evidence and needs to be confirmed by isolation. The combined evidence of immunochemical and physiological studies suggests that gut target cells can receive peptides in at last four ways: (1) as hormones in the blood; (2) from intrinsic neurons in the enteric plexuses; (3) from extrinsic nerves like the vagus; (4) by local (paracrine) release from mucosal endocrine-like cells, possibly by basal axon-like processes.

Isolation of two minigastrins from Zollinger-Ellison tumour tissue.

A pair of gastrin tridecapeptides (;minigastrins') have been isolated from Zollinger-Ellison tumour tissue; they correspond to the fragment 5-17 of the heptadecapeptides isolated from the same source. In one (type II) the tyrosine residue present is sulphated, in the other (type I) it is not. The proportion of types I and II is approximately 2:1 similar to that for the ;big' gastrins and the heptadecapeptides isolated from the same source and from human antral mucosa. Both minigastrins are potent stimulants of gastric acid secretion. Immunological evidence exists to indicate that both are present as circulating forms of the hormone gastrin in patients with the Zollinger-Ellison syndrome and in fed normal subjects.