Minimum indoor temperature threshold recommendations for English homes in winter - A systematic review.

OBJECTIVES: To identify and assess the available evidence on the impacts of cold indoor temperature thresholds on human health and make evidence-based recommendations for English homes. STUDY DESIGN: Systematic literature review. METHODS: A systematic search of peer-reviewed published literature from the UK and countries with similar climates, and grading of the evidence using the National Institute of Health (NIH) framework was followed by a discussion with experts and formulation of recommendations. RESULTS: Twenty papers were included. Studies were included if they were conducted outside England but were from countries considered to have similar climates. Studies included two small randomised controlled trials, two cohort studies and one case control study; other studies were cross-sectional, largely laboratory-based studies. Health effects in the general population start to occur at around 18 °C. Effects in older people are more profound than in younger adults. Older people are less able to perceive low temperatures. DISCUSSION: Although evidence was limited, a strong argument for setting thresholds remains. The effects observed on the general population and the effects on those more vulnerable makes a case for a recommended minimum temperature for all. Health messages should be clear and simple, allowing informed choices to be made. A threshold of 18 °C was considered the evidence based and practical minimum temperature at which a home should be kept during winter in England. CONCLUSION: There is limited evidence available on minimum temperature thresholds for homes. However a recommendation of at least 18 °C for the whole population with nuancing of messages for those more vulnerable to the effects of cold can be made from the results of the retrieved studies. RECOMMENDATION: Heating homes to at least 18 °C (65 °F) in winter poses minimal risk to the health of a sedentary person, wearing suitable clothing.

Evaluation of the utility of the Vigileo FloTrac(™) , LiDCO(™) , USCOM and CardioQ(™) to detect hypovolaemia in conscious volunteers: a proof of concept study.

It is important to detect and treat hypovolaemia; however, detection is particularly challenging in the conscious, spontaneously breathing patient. Eight healthy male volunteers were monitored using four minimally invasive monitors: Vigileo FloTrac(™) ; LiDCOrapid(™) ; USCOM 1A; and CardioQ(™) oesophageal Doppler. Monitor output and clinical signs were recorded during incremental venesection of 2.5% estimated blood volume aliquots to a total of 20% blood volume removed. A statistically significant difference from baseline stroke volume was detected after 2.5% blood loss using the LiDCO (p = 0.007), 7.5% blood loss using the USCOM (p = 0.019), and 12.5% blood loss using the CardioQ (p = 0.046) and the FloTrac (p = 0.028). Receiver operator characteristic curves for predicting > 10% blood loss had areas under the curve of 0.68-0.82. The minimally invasive cardiac output devices tested can detect blood loss by a reduction in stroke volume in awake volunteers, and may have a role in guiding fluid replacement in conscious patients with suspected hypovolaemia.

Electrochemical detection of commercial silver nanoparticles: identification, sizing and detection in environmental media.

The electrochemistry of silver nanoparticles contained in a consumer product has been studied. The redox properties of silver particles in a commercially available disinfectant cleaning spray were investigated via cyclic voltammetry before particle-impact voltammetry was used to detect single particles in both a typical aqueous electrolyte and authentic seawater media. We show that particle-impact voltammetry is a promising method for the detection of nanoparticles that have leached into the environment from consumer products, which is an important development for the determination of risks associated with the incorporation of nanotechnology into everyday products.

Stress responses of Calluna vulgaris to reduced and oxidised N applied under 'real world conditions'.

Effects and implications of reduced and oxidised N, applied under 'real world' conditions, since May 2002, are reported for Calluna growing on an ombrotrophic bog. Ammonia has been released from a 10 m line source generating monthly concentrations of 180-6 microg m(-3), while ammonium chloride and sodium nitrate are applied in rainwater at nitrate and ammonium concentrations below 4mM and providing up to 56 kg N ha(-1) year(-1) above a background deposition of 10 kg N ha(-1) year(-1). Ammonia concentrations, >8 microg m(-3) have significantly enhanced foliar N concentrations, increased sensitivity to drought, frost and winter desiccation, spring frost damage and increased the incidence of pathogen outbreaks. The mature Calluna bushes nearest the NH3 source have turned bleached and moribund. By comparison the Calluna receiving reduced and oxidised N in rain has shown no significant visible or stress related effects with no significant increase in N status.

Effects of nitrogen with and without acidified sulphur on an ectomycorrhizal community in a Sitka spruce (Picea sitchensis Bong. Carr) forest.

This preliminary study investigated the effects of enhanced nitrogen (NH4NO3 at 48 kg ha(-1) y(-1)), sulphur (Na2SO4 at 50 kg ha(-1) y(-1)), acidified nitrogen and sulphur (H2SO4 + NH4NO3) at pre-stated doses (pH 2.5), and acidified nitrogen and sulphur deposition at double these doses on the ectomycorrhizal community associated with a 13-year-old Sitka spruce (Picea sitchensis) forest. Sulphur deposition had little impact on below ground ectomycorrhizal diversity, but stimulated sporocarp production. Nitrogen inputs increased below ground colonisation compared to acidified nitrogen and sulphur, largely due to an increase in Tylospora fibrillosa colonisation. Sporocarp production and ectomycorrhizal root colonisation by Lactarius rufus were reduced in the nitrogen treated plots. These observations suggest that nitrogen deposition to a young plantation may suppress ectomycorrhizal fungi producing large sporocarps. It is proposed that enhanced nitrogen deposition increases ectomycorrhizal nitrogen assimilation, consuming more carbon and leaving less for extrametrical mycelium and sporocarp development.

The effect of an inhibitory factor from the bovine retractor penis on the gastro-intestinal tract and gall bladder of the guinea-pig.

1 The effect of a smooth muscle inhibitory factor extracted from the bovine retractor penis has been examined on a variety of in vitro smooth muscle preparations from the guinea-pig alimentary canal and on the guinea-pig gall bladder. 2 The inhibitory factor caused relaxation of spontaneous and carbachol-induced tone in the taenia coli, the stomach fundal strip and the duodenum and colon. There was little effect on the ileum. Sensitivity was highest in the taenia coli where the response to the inhibitory factor mimicked the response to stimulation of the non-adrenergic, non-cholinergic (NANC) inhibitory nerves. 3 In the taenia coli the inhibitory response to stimulation of the NANC nerves and to ATP was abolished by apamin 5 x 10(-8) M, whereas this or higher concentrations had no effect on the response to the inhibitory factor. This makes it unlikely that the latter is the neurotransmitter in these NANC nerves. 4 The inhibitory factor had no effect on the gall bladder. Inhibitory responses to field stimulation were obtained in this tissue but these were insensitive to tetrodotoxin in concentrations greater than those needed to block the motor cholinergic nerves.

Effects of interferon-alpha therapy on immune parameters in immune thrombocytopenic purpura.

Interferon-alpha (IFN alpha) has been shown to increase platelet numbers in patients with immune thrombocytopenic purpura (ITP), but the basis for this effect is not known. In this study changes in immune function were monitored following administration of IFN alpha to seven patients whose ITP had proved refractory to conventional therapy. Patients' peripheral blood mononuclear cells were cultured with phytohaemagglutinin and culture supernatants assayed for cytokine production. Production of the Th1 cytokines IL-2 and IFN-gamma was low in patients compared to healthy controls, and amounts of these tended to increase after IFN alpha therapy. In two patients high levels of IL-10 were detectable in culture, and these were reduced after IFN alpha. In patients who had high serum concentrations of IL-4 or IL-10, these were also decreased following therapy. Natural killer cell activity, which was low in the patients prior to therapy, was increased following administration of IFN alpha. In those patients with detectable platelet-associated autoantibody to gpIIb/IIIa, the amounts were reduced after treatment. Two patients had an unusually high percentage of T cells expressing the gamma delta T cell receptor, which decreased after therapy. The findings are consistent with an increase in Th 1 activity and a decrease in autoantibody production following IFN alpha therapy, which may be related to the beneficial effects of this cytokine.

The ultrastructure of a pheromone-secreting gland in the male scorpion-fly Harpobittacus Australis (Bittacidae: Mecoptera).

The eversible vesicles of the sex pheromone glands consist of three cell types, secreting the cuticle, the duct and the pheromone, respectively. Each pheromone-secreting cell has an end apparatus, bounded by microvilli and lined by a granular mass, that is penetrated by remarkable elongate filaments extending far up into the secretory duct. Vesicles containing secretion or secretion precursors abound. The possible role is discussed of the various organelles in the elaboration and transport of the pheromone.

The ultrastructure of the osmeterium and the nature of its secretion in Papilio larvae (lepidoptera).

Two main cell types constitute the defensive osmeterium gland of Papilio larvae. Ellipsoid gland cells have an extensively infolded basal plasma membrane, abundant ribosomes and whorls of smooth endoplasmic reticulum. The apical plasma membrane bears long microvilli extending into a mass of granular material containing electron-lucid cavities. Tangential slits occur in the epicuticle. Tubular arm cells contain heterogeneous, electron-dense inclusions, extensively-branched nuclei and large mitochondria sometimes distended with electron-dense material. The apical plasma membrane bears short microvilli. The inner, dense epicuticle forms a complex ramifying system. The two-phase defensive fluid consists mainly of water, 2-methyl propionic acid, and 2-methyl butyric acid.

Hormonal control of morphogenetic cell death of the wing hypodermis in Lucilia cuprina.

1. Cytoplasmic fragments in the haemolymph of newly emerged flies derive from the degenerating wing hypodermis. 2. At the time of eclosion, dorsal and ventral cell layers of the wing are connected by processes containing bundles of microtubules and microfilaments. Cytoplasmic fragments contain similar bundles of microtubules but few microfilaments. 3. Extensive vacuolation marks the onset of hormonally initiated fragmentation of the wing hypodermal cells. Haemocytes containing lysosomes are present in the wing at this time, but do not invade the fragmenting hypodermis.

Pollution in the upland environment.

As part of a study on the effects of pollutants on forests, a long-term monitoring programme has been operating at two sites (602 and 275 m above sea level (a.s.l.)) in Glentress Forest, south-east Scotland, since June 1987. At these sites, equipment has been recording 20-min data for weather parameters, and cloud and rain event frequency, duration and intensity. The chemical composition of bulk cloud and rainwater has been measured. Cloudwater detection and collection has been made using passive 'Harp wire' gauges (with a cross-sectional area of 0.047 m2) strung with polypropylene filament and having a typical collection efficiency of 29% when compared with independent measurements of windspeed and liquid water content. During 1988, the annual rainfall at the upper site was 1213 mm, occurring over 1776 h. The equivalent cloudwater deposition to a forest with a drag coefficient of 0.06 was estimated to be 375 mm over 1936 h. A 'typical cloud event' lasted 4.5 h and would deposit to forests at a rate of 0.2 mm h(-1). There were significantly higher loadings of suspended particulate material (> 0.2 microm) in cloudwater (mean 18.42, max. 94.5 mg litre(-1)) compared with rainwater (mean 2.6, max. 25.6 mg litre(-1)). There were similar differences in ion concentrations, e.g. for H+ in cloudwater (mean 163, max. 1259 microm) and in rainwater (mean 33, max. 262 microM). It is concluded that cloudwater deposition represents a major pathway for pollutant transfer to the upland environment, especially where the surface vegetation is efficient at capturing cloudwater, i.e. forests. The consequences of this increased pollutant loading to forests and water catchments are yet to be assessed.

Particulate and dissolved organic carbon in cloud water in southern Scotland.

Total particulate carbon (TPC), which includes both elemental carbon and particulate organic carbon, total suspended particulate matter (TSP) and dissolved organic carbon (DOC) were measured in 53 cloud water samples collected using a passive 'Harp-wire' cloud collector at weekly intervals at a hill-top site in southern Scotland (Dunslair Heights, 602 m above sea level) between December 1990 and April 1992. The concentrations of TPC, TSP and DOC were in the range 0.03-6.9 mg 1(-1) (median 1.05 mg l(-1)), 2.6-51.6 mg l(-1) (median 13.6 mg l(-1)) and 0.-14 mg l(-1) (median 3.6 mg l(-1)), respectively. The concentrations of TPC, TSP and DOC were greatest in winter (December-February), up to 6.9, 42 and 4.6 mg l(-1) respectively in 1990-1991 and up to 6.0, 51 and 14 mg l(-1), respectively, in 1991-1992. Particulate carbon in cloud water samples comprised 1-47% of the TSP. Concentrations of major anions (Cl(-), NO(-)(3), SO(2-)(4)) and pH were measured on the same water samples. Estimates of cloud liquid water content from January to April 1992 were derived from measured wind speeds and volumes of water collected. These estimates suggested that the air contained up to 1.2 microg TPC m(-3), 16 microg TSP m(-3) and 2.3 microg DOC m(-3), which are typical of concentrations to be expected in rural air. There was no correlation between concentrations of DOC in cloud water and either TPC or TSP, indicating that the sources and partitioning of DOC and TPC in the atmosphere are different. The largest concentrations of TPC coincided with the largest concentrations of non-marine sulphate, and although there was a significant linear correlation between the two sets of data, the log-transformed data were not correlated. Concentrations of TPC were significantly correlated with concentrations of other particulate matter (TSP-TPC), suggesting that similar sources and/or partitioning processes were involved in determining concentrations in cloud. Concentrations of DOC in cloud were significantly correlated (p < 0.02) with concentrations of nitrate, suggesting that sources of DOC were related to the emission and chemistry of nitrogen oxides. The very large concentrations of particulate carbon, especially in winter, indicate that carbon-catalysed oxidation of sulphur dioxide by molecular oxygen in cloud water may be a significant pathway when concentrations of hydrogen peroxide are small.

Orographic enhancement of snowfall.

Field studies have been conducted at a hill site in Scotland to measure the variation with altitude of wet deposition by snowfall. The results showed that, due to wind drift effects, snowflakes were captured very inefficiently by snow collectors. It was therefore not possible to measure an increase in precipitation with altitude. The average concentrations of principal ions dissolved in the snow water were calculated over a two-month period. The results showed that the concentrations increased by factors of between 1.4 and 1.9 with an altitude rise of 400 m. A model of the orographic enhancement of snowfall by the seeder-feeder effect showed that the orographic enhancements of precipitation and pollutant deposition were significantly greater for snowfall than for rainfall. The wind drift of snow crystals and the evaporation of precipitation in dry valley air were important in determining the patterns of deposition.

Stem growth reduction in mature Sitka spruce trees exposed to acid mist.

An eighteen-year-old clone of Sitka spruce (Picea sitchensis (Bong.) Carr) growing in the field was used to evaluate the whole tree response of 'mature' Sitka spruce to acid mist treatment. The mist, an equimolar mixture of H(2)SO(4) and NH(4)NO(3) at pH 2.5 with or without particles (soda glass ballotini < 20 microm diameter), was applied twice weekly (equivalent to 4 mm precipitation week(-1)) throughout the growing season, May-November 1990-1992. The annual dose of S, N, H applied as mist (at 51, 48 and 3.3 kg ha(-1), respectively) was 2.5 times that measured in the Scottish uplands. Throughout the experiment there was no evidence of visible injury symptoms, yet there was a highly significant reduction (p < 0.02) in the stem-area increment relative to the stem area at the start, measured using vernier dendrometer bands. There was no significant difference between the (acid mist + particle) and the acid mist only treatments. The mean relative stem-area increment over two complete growing seasons (1991-1992) was 65% for control trees, but only 53% for acid-misted trees.

Throughfall chemistry and canopy interactions in a Sitka spruce plantation sprayed with six different simulated polluted mist treatments.

Throughfall chemistry was studied in a mature Sitka spruce plantation in order to investigate canopy interactions, such as nitrogen absorption, cation leaching, and neutralization of rainfall passing through the canopy. The plantation had been exposed to six different simulated mist treatments including N (NH(4)NO(3)) and S (H(2)SO(4) at pH 2.5) in four replicated blocks since 1996. Throughfall and rainfall were collected from May to September 2000. The results showed that 30-35% of the applied N was retained by the canopy. There were linear relationships between the loss of H(+) and increased K(+), Mg(2+) and Ca(2+) deposition through the canopy. However these increases in K(+), Mg(2+) and Ca(2+) deposition accounted for only about 50% of total neutralization of the acidity. The relationship between the anion deficits in throughfall and the loss of H(+) implied that weak organic acid anions were involved in the neutralization of the acidity in throughfall.

Experimental field estimation of organic nitrogen formation in tree canopies.

The content of organic N has been shown in many studies to increase during the passage of rain water through forest canopies. The source of this organic N is unknown, but generally assumed to come from canopy processing of wet or dry-deposited inorganic N. There have been very few experimental studies in the field to address the canopy formation or loss of organic N. We report two studies: a Scots pine canopy exposed to ammonia gas, and a Sitka spruce canopy exposed to ammonium and nitrate as wet deposition. In both cases, organic N deposition in throughfall was increased, but only represented a small fraction (<10%) of the additional inorganic N supplied, suggesting a limited capacity for net organic N production, similar in both conifer canopies under Scottish summertime conditions, of less than 1.6 mmol N m(-2) mth(-1) (equivalent to 3 kg N ha(-1) y(-1)).

Six months of shivering in a district general hospital.

Of 2595 patients admitted to a recovery room in Derbyshire Royal Infirmary over a 6-month period, 164 (6.3%) shivered postoperatively. Data regarding the anaesthetic techniques to which these patients had been subjected were gathered from the Derby Anaesthetic Audit System. Subsequent analysis demonstrated the importance of a number of factors that led to shivering, including male gender, anaesthetic techniques involving spontaneous ventilation, and anticholinergic premedication. The administration of pethidine, alfentanil or morphine intra-operatively reduced the incidence of shivering postoperatively.

Postoperative shivering.

Shivering is common during recovery from anaesthesia. Factors in the aetiology include the use of volatile anaesthetic agents, prolonged anaesthesia, gender and age. The relationship between postoperative shivering and thermoregulation is not clear. Management should include measurement of the patient's temperature.