Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China : a time-stratified case-crossover study

Background: A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension. ---------- Methods: Daily data on emergency hospital visits (EHVs) for hypertension were collected from the Peking University Third Hospital. Daily data on gaseous air pollutants (sulfur dioxide (SO2) and nitrogen dioxide (NO2)) and particulate matter less than 10 μm in aerodynamic diameter (PM10) were collected from the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was conducted to evaluate the relationship between urban gaseous air pollution and EHVs for hypertension. Temperature and relative humidity were controlled for. ---------- Results: In the single air pollutant models, a 10 μg/m3 increase in SO2 and NO2 were significantly associated with EHVs for hypertension. The odds ratios (ORs) were 1.037 (95% confidence interval (CI): 1.004-1.071) for SO2 at lag 0 day, and 1.101 (95% CI: 1.038-1.168) for NO2 at lag 3 day. After controlling for PM10, the ORs associated with SO2 and NO2 were 1.025 (95% CI: 0.987-1.065) and 1.114 (95% CI: 1.037-1.195), respectively.---------- Conclusion: Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing, China.

Caveat Anicula! Beware of the Quiet Little Old Ladies : Demographics, Pharmacotherapy, Survival and Readmissions in a 10 Year Cohort of Heart Failure Patients with Preserved Systolic Function

Objective--To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). Design and setting--A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital.Main outcome measures-- Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival.Results--Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912). Conclusions--Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.

The prevalence and characteristics of self-reported dangerous driving behaviours among a young cohort

Background: Young motorists engaging in anti-social and often dangerous driving manoeuvres (which is often referred to as “hooning” within Australia) is an increasing road safety problem. While anecdotal evidence suggests that such behaviour is positively linked with crash involvement, researchers have yet to examine whether younger drivers who deliberately break road rules and drive in an erratic manner (usually with peers) are in fact over represented in crash statistics. This paper outlines research that aimed to identify the characteristics of individuals most likely to engaging in hooning behaviours, as well as examine the frequency of such driving behaviours and if such activity is linked with self-reported crash involvement.---------- Methods: A total of 717 young drivers in Queensland voluntarily completed a questionnaire to investigate their driving behaviour and crash history.---------- Results: Quantitative analysis of the data revealed that almost half the sample reported engaging in some form of “hooning” behaviour at least once in their lifetime, although only 4% indicated heavy participation in the behaviour e.g., >50 times. Street racing was the most common activity reported by participants followed by “drifting” and then “burnouts”. Logistic regression analysis indicated that being younger and a male was predictive of reporting such anti-social driving behaviours, and importantly, a trend was identified between such behaviour and self-reported crash involvement.---------- Conclusions: This research provides preliminary evidence that younger male drivers are more likely to engage in dangerous driving behaviours, which ultimately may prove to increase their overall risk of becoming involved in a crash. This paper will further outline the study findings in regards to current enforcement efforts to deter such driving activity as well as provide direction for future research efforts in this area.---------- Research highlights: ► The self-reported driving behaviours of 717 younger Queensland drivers were examined to investigate the relationship between deliberately breaking road rules and self-reported crash involvement. ► Younger male drivers were most likely to engage in such aberrant driving behaviours and a trend was identified between such behaviour and self-reported crash involvement.

Synthesis and characterisation of cobalt hydroxy carbonate Co2CO3(OH)2 Nanomaterials

In an attempt to make nanofibres based upon cobalt oxides, a novel compound a hydrated cobalt hydroxy carbonate was formed. This compound is related to the minerals of the rosasite mineral group. X-ray diffraction showed that the formed compound was a cobalt hydroxy carbonate and SEM displayed bundles of fibres on the micron scale in length and nanoscale in width. The morphology was compared with that of the rosasite mineral group. XPS proved two bond energies for cobalt and three for oxygen in the compound. The compound was characterised by vibrational spectroscopy and the spectra related to minerals of the rosasite mineral group. The stability of the synthetic mineral was limited to temperatures below 200°C.

Are Active Australia physical activity questions valid for older adults?

Objective The Active Australia Survey (AAS) is used for physical activity (PA) surveillance in the general Australian adult population, but its validity in older adults has not been evaluated. Our aim was to examine the convergent validity of the AAS questions in older adults. Design The AAS was validated against pedometer step counts as an objective measure of PA, self-reported physical function, and a step-test to assess cardiorespiratory fitness. Method Participants were community-dwelling adults, aged 65-89 y, with the ability to walk 100 m. They completed a self-administered AAS and the step-test in one interview. One week earlier, they completed the Short Form-36 physical function subscale. Between these two interviews, they each wore a YAMAX Digiwalker SW200 pedometer and recorded daily steps. Using the AAS data, daily walking minutes and total PA minutes (walking, moderate-intensity PA and vigorous-intensity PA) were compared with the validity measures using Spearman rank-order correlations. Fifty-three adults completed the study. Results Median daily walking minutes were 34.2 (interquartile range [IQR] 17.1, 60.0), and median daily total PA minutes were 68.6 (IQR 31.4, 113.6). Walking and total PA minutes were both moderately correlated with pedometer steps (Spearman correlation r=0.42, p=0.003, for each) but not with step-test seconds to completion (r=-0.11, p=0.44; r=-0.25, p=0.08, respectively). Total PA minutes were significantly correlated with physical function scores (r=0.39, p=0.004), but walking minutes were not (r=0.15, p=0.29). Conclusions This initial examination of the psychometric properties of the AAS for older adults suggests that this surveillance tool has acceptable convergent validity for ambulatory, community-dwelling older adults.

Time-dependent analysis of length of stay and mortality due urinary tract infections in ten developing countries : INICC findings

Catheter associated urinary tract infections (CAUTI) are a worldwide problem that may lead to increased patient morbidity, cost and mortality.1e3 The literature is divided on whether there are real effects from CAUTI on length of stay or mortality. Platt4 found the costs and mortality risks to be largeyetGraves et al found the opposite.5 A reviewof the published estimates of the extra length of stay showed results between zero and 30 days.6 The differences in estimates may have been caused by the different epidemiological methods applied. Accurately estimating the effects of CAUTI is difficult because it is a time-dependent exposure. This means that standard statistical techniques, such asmatched case-control studies, tend to overestimate the increased hospital stay and mortality risk due to infection. The aim of the study was to estimate excess length of stay andmortality in an intensive care unit (ICU) due to a CAUTI, using a statistical model that accounts for the timing of infection. Data collected from ICU units in lower and middle income countries were used for this analysis.7,8 There has been little research for these settings, hence the need for this paper.

Executive function effects and numerical development in children : behavioural and ERP evidence from a numerical Stroop paradigm

Most research on numerical development in children is behavioural, focusing on accuracy and response time in different problem formats. However, Temple and Posner (1998) used ERPs and the numerical distance task with 5-year-olds to show that the development of numerical representations is difficult to disentangle from the development of the executive components of response organization and execution. Here we use the numerical Stroop paradigm (NSP) and ERPs to study possible executive interference in numerical processing tasks in 6–8-year-old children. In the NSP, the numerical magnitude of the digits is task-relevant and the physical size of the digits is task-irrelevant. We show that younger children are highly susceptible to interference from irrelevant physical information such as digit size, but that access to the numerical representation is almost as fast in young children as in adults. We argue that the developmental trajectories for executive function and numerical processing may act together to determine numerical development in young children.

Intake of isoflavone and lignan phytoestrogens and associated demographic and lifestyle factors in older Australian women

The purpose was to determine intake of phytoestrogens in a sample of older Australian women, and to investigate associated lifestyle factors. Subjects were an age-stratified sample of 511 women aged 40-80 y, randomly selected from the electoral roll and participating in the Longitudinal Assessment of Ageing in Women at the Royal Brisbane and Women’s Hospital. A cross-sectional study was conducted to assess isoflavone and lignan intake over the past month from food and supplements using a 112-item phytoestrogen frequency questionnaire. Data were also collected on nutrient intakes, physical activity, smoking, alcohol, non-prescription supplements, hormone therapy, education and occupation. Logistic regression was used to evaluate associations between demographic and lifestyle variables and soy/linseed consumption while controlling for age. Isoflavone intakes were significantly higher in the younger compared to older age groups (p<0.001); there were no age-related differences in lignan intake. Forty-five percent of women consumed at least one serve of a soy and/or linseed item and were defined as a soy/linseed consumer. Median (range) intakes by consumers for isoflavones and lignans (3.9 (0-172) mg/d and 2.4 (0.1-33) mg/d) were higher than intakes by non-consumers (0.004 (0-2.6) mg/d and 1.57 (0.44-4.7) mg/d), respectively (p<0.001). Consumers had higher intakes of dietary fibre (p=0.003), energy (p=0.04) and polyunsaturated fat (p=0.004), and higher levels of physical activity (p=0.006), socio-economic position (p<0.001), education (p<0.001) and supplement use (p<0.001). Women who consumed soy or linseed foods differed in lifestyle and demographic characteristics suggesting these factors should be considered when investigating associations with chronic disease outcomes.

Perturbation solutions for flow through symmetrical hoppers with inserts and asymmetrical wedge hoppers

Under certain circumstances, an industrial hopper which operates under the "funnel-flow" regime can be converted to the "mass-flow" regime with the addition of a flow-corrective insert. This paper is concerned with calculating granular flow patterns near the outlet of hoppers that incorporate a particular type of insert, the cone-in-cone insert. The flow is considered to be quasi-static, and governed by the Coulomb-Mohr yield condition together with the non-dilatant double-shearing theory. In two dimensions, the hoppers are wedge-shaped, and as such the formulation for the wedge-in-wedge hopper also includes the case of asymmetrical hoppers. A perturbation approach, valid for high angles of internal friction, is used for both two-dimensional and axially symmetric flows, with analytic results possible for both leading order and correction terms. This perturbation scheme is compared with numerical solutions to the governing equations, and is shown to work very well for angles of internal friction in excess of 45 degree.

Definition of an airworthiness certification framework for civil unmanned aircraft systems

The development of effective safety regulations for unmanned aircraft systems (UAS) is an issue of paramount concern for industry. The development of this framework is a prerequisite for greater UAS access to civil airspace and, subsequently, the continued growth of the UAS industry. The direct use of the existing conventionally piloted aircraft (CPA) airworthiness certification framework for the regulation of UAS has a number of limitations. The objective of this paper is to present one possible approach for the structuring of airworthiness regulations for civilian UAS. The proposed approach facilitates a more systematic, objective and justifiable method for managing the spectrum of risk associated with the diversity of UAS and their potential operations. A risk matrix is used to guide the development of an airworthiness certification matrix (ACM). The ACM provides a structured categorisation that facilitates the future tailoring of regulations proportionate to the levels of risk associated with the operation of the UAS. As a result, an objective and traceable link may be established between mandated regulations and the overarching objective for an equivalent level of safety to CPA. The ACM also facilitates the systematic consideration of a range of technical and operational mitigation strategies. For these reasons, the ACM is proposed as a suitable method for the structuring of an airworthiness certification framework for civil or commercially operated UAS (i.e., the UAS equivalent in function to the Part 21 regulations for civil CPA) and for the further structuring of requirements on the operation of UAS in un-segregated airspace.

HapMap tag-SNP analysis confirms a role for COMT in schizophrenia risk and reveals a novel association

Catechol-O-methyl transferase (COMT) encodes an enzyme involved in the metabolism of dopamine and maps to a commonly deleted region that increases schizophrenia risk. A non-synonymous polymorphism (rs4680) in COMT has been previously found to be associated with schizophrenia and results in altered activity levels of COMT. Using a haplotype block-based gene-tagging approach we conducted an association study of seven COMT single nucleotide polymorphisms (SNPs) in 160 patients with a DSM-IV diagnosis of schizophrenia and 250 controls in an Australian population. Two polymorphisms including rs4680 and rs165774 were found to be significantly associated with schizophrenia. The rs4680 results in a Val/Met substitution but the strongest association was shown by the novel SNP, rs165774, which may still be functional even though it is located in intron five. Individuals with schizophrenia were more than twice as likely to carry the GG genotype compared to the AA genotype for both the rs165774 and rs4680 SNPs. This association was slightly improved when males were analysed separately possibly indicating a degree of sexual dimorphism. Our results confirm that COMT is a good candidate for schizophrenia risk, by replicating the association with rs4680 and identifying a novel SNP association.

The effects of ambulance ramping on Emergency Department length of stay and mortality

Background: Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes. ----- ----- Methods: A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality. ----- ----- Results: The median ramp time for all 1857 patients was 11 (IQR 6—21) min. Compared to nonramped patients, ramped patients had significantly longer wait time to be triaged (10 min vs. 4 min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2%vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06—1.70, p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p < 0.0001). ----- ----- Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers.

The relative impact of work-related stress, life stress and driving environment stress on driving outcomes

Previous research has shown the association between stress and crash involvement. The impact of stress on road safety may also be mediated by behaviours including cognitive lapses, errors, and intentional traffic violations. This study aimed to provide a further understanding of the impact that stress from different sources may have upon driving behaviour and road safety. It is asserted that both stress extraneous to the driving environment and stress directly elicited by driving must be considered part of a dynamic system that may have a negative impact on driving behaviours. Two hundred and forty-seven public sector employees from Queensland, Australia, completed self-report measures examining demographics, subjective work-related stress, daily hassles, and aspects of general mental health. Additionally, the Driver Behaviour Questionnaire (DBQ) and the Driver Stress Inventory (DSI) were administered. All participants drove for work purposes regularly, however the study did not specifically focus on full-time professional drivers. Confirmatory factor analysis of the predictor variables revealed three factors: DSI negative affect; DSI risk taking; and extraneous influences (daily hassles, work-related stress, and general mental health). Moderate intercorrelations were found between each of these factors confirming the ‘spillover’ effect. That is, driver stress is reciprocally related to stress in other domains including work and domestic life. Structural equation modelling (SEM) showed that the DSI negative affect factor influenced both lapses and errors, whereas the DSI risk-taking factor was the strongest influence on violations. The SEMs also confirmed that daily hassles extraneous to the driving environment may influence DBQ lapses and violations independently. Accordingly, interventions may be developed to increase driver awareness of the dangers of excessive emotional responses to both driving events and daily hassles (e.g. driving fast to ‘blow off steam’ after an argument). They may also train more effective strategies for self-regulation of emotion and coping when encountering stressful situations on the road.

Using GIS to visualise and evaluate student travel behaviour

Using GIS to evaluate travel behaviour is an important technique to increase our understanding of the relationship between accessibility and transport demand. In this paper, the activity space concept was used to identify the nature of participation in activities (or lack of it) amongst a group of students using a 2 day travel-activity diary. Three different indicators such as the number of unique locations visited, average daily distance travelled, and average daily activity duration were used to measure the size of activity spaces. These indicators reflect levels of accessibility, personal mobility, and the extent of participation respectively. Multiple regression analyses were used to assess the impacts of students socio-economic status and the spatial characteristics of home location. Although no differences were found in the levels of accessibility and the extent of participation measures, home location with respect to a demand responsive transport (DRT) service was found to be the most important determinant of their mobility patterns. Despite being able to travel longer distances, students who live outside of the DRT service area were found to be temporally excluded from some opportunities. Student activity spaces were also visualised within a GIS environment and a spatial analysis was conducted to underpin the evaluation of the performance of the DRT. This approach was also used to identify the activity spaces of individuals that are geographically excluded from the service. Evaluation of these results indicated that although the service currently covers areas of high demand, 90% of the activity spaces remained un-served by the DRT service. Using this data six new routes were designed to meet the coverage goal of public transport based on a measure of network impedance based on inverse activity density. Following assessment of public transport service coverage, the study was extended using a Spatial Multi Criteria Evaluation (SMCE) technique to assess the effect of service provision on patronage.

Participation index : a measure to identify rural transport disadvantage?

This paper develops a composite participation index (PI) to identify patterns of transport disadvantage in space and time. It is operationalised using 157 weekly activity-travel diaries data collected from three case study areas in rural Northern Ireland. A review of activity space and travel behaviour research found that six dimensional indicators of activity spaces were typically used including the number of unique locations visited, distance travelled, area of activity spaces, frequency of activity participation, types of activity participated in, and duration of participation in order to identify transport disadvantage. A combined measure using six individual indices were developed based on the six dimensional indicators of activity spaces, by taking into account the relativity of the measures for weekdays, weekends, and for a week. Factor analyses were conducted to derive weights of these indices to form the PI measure. Multivariate analysis using general linear models of the different indicators/indices identified new patterns of transport disadvantage. The research found that: indicator based measures and index based measures are complement each other; interactions between different factors generated new patterns of transport disadvantage; and that these patterns vary in space and time. The analysis also indicates that the transport needs of different disadvantaged groups are varied.