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Exposure to ambient ozone (O3) O3 is associated with impacts on human health. O3 is a secondary pollutant whose concentrations are determined inter alia by emissions of precursors such as oxides of nitrogen (NOx) and volatile organic compounds (VOCs), and thus future health burdens depend on policies relating to climate and air quality. While emission controls are expected to reduce levels of PM2.5 and NO2 and their associated mortality burdens, for secondary pollutants like O3 the picture is less clear. Detailed assessments are necessary to provide quantitative estimates of future impacts to support decision-makers. We simulate future O3 across the UK using a high spatial resolution atmospheric chemistry model with current UK and European policy projections for 2030, 2040 and 2050, and use UK regional population-weighting and latest recommendations on health impact assessment to quantify respiratory emergency hospital admissions associated with short-term effects of O3. We estimate 60,488 admissions in 2018, increasing by 4.2%, 4.5% and 4.6% by 2030, 2040 and 2050 respectively (assuming a fixed population). Including future population growth, estimated emergency respiratory hospital admissions are 8.3%, 10.3% and 11.7% higher by 2030, 2040 and 2050 respectively. Increasing O3 concentrations in future are driven by reduced nitric oxide (NO) in urban areas due to reduced emissions, with increases in O3 mainly occurring in areas with lowest O3 concentrations currently. Meteorology influences episodes of O3 on a day-to-day basis, although a sensitivity study indicates that annual totals of hospital admissions are only slightly impacted by meteorological year. While reducing emissions results in overall benefits to population health (through reduced mortality due to long-term exposure to PM2.5 and NO2), due to the complex chemistry, as NO emissions reduce there are associated local increases in O3 close to population centres that may increase harms to health.

Air pollution is the greatest environmental risk to public health. Future air pollution concentrations are primarily determined by precursor emissions, which are driven by environmental policies relating to climate and air pollution. Detailed health impact assessments (HIA) are necessary to provide quantitative estimates of the impacts of future air pollution to support decision-makers developing environmental policy and targets. In this study we use high spatial resolution atmospheric chemistry modelling to simulate future air pollution concentrations across the UK for 2030, 2040 and 2050 based on current UK and European policy projections. We combine UK regional population-weighted concentrations with the latest epidemiological relationships to quantify mortality associated with changes in PM2.5 and NO2 air pollution. Our HIA suggests that by 2050, population-weighted exposure to PM2.5 will reduce by 28% to 36%, and for NO2 by 35% to 49%, depending on region. The HIA shows that for present day (2018), annual mortality attributable to the effects of long-term exposure to PM2.5 and NO2 is in the range 26,287 – 42,442, and that mortality burdens in future will be substantially reduced, being lower by 31%, 35%, and 37% in 2030, 2040 and 2050 respectively (relative to 2018) assuming no population changes. Including population projections (increases in all regions for 30+ years age group) slightly offsets these health benefits, resulting in reductions of 25%, 27%, and 26% in mortality burdens for 2030, 2040, 2050 respectively. Significant reductions in future mortality burdens are estimated and, importantly for public health, the majority of benefits are achieved early on in the future timeline simulated, though further efforts are likely needed to reduce impacts of air pollution to health.

Abstract Background Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced – (1) the ‘Failing Europe’ scenario (worst case/increasing inequalities), (2) the ‘Sustainable Prosperity’ scenario (best case/decreasing inequalities) and (3) the ‘Being Stuck’ scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.

A key and expensive part of coupled atmospheric chemistry–climate model simulations is the integration of gas-phase chemistry, which involves dozens of species and hundreds of reactions. These species and reactions form a highly coupled network of differential equations (DEs). There exist orders of magnitude variability in the lifetimes of the different species present in the atmosphere, and so solving these DEs to obtain robust numerical solutions poses a stiff problem. With newer models having more species and increased complexity, it is now becoming increasingly important to have chemistry solving schemes that reduce time but maintain accuracy. While a sound way to handle stiff systems is by using implicit DE solvers, the computational costs for such solvers are high due to internal iterative algorithms (e.g. Newton–Raphson methods). Here, we propose an approach for implicit DE solvers that improves their convergence speed and robustness with relatively small modification in the code. We achieve this by blending the existing Newton–Raphson (NR) method with quasi-Newton (QN) methods, whereby the QN routine is called only on selected iterations of the solver. We test our approach with numerical experiments on the UK Chemistry and Aerosol (UKCA) model, part of the UK Met Office Unified Model suite, run in both an idealised box-model environment and under realistic 3-D atmospheric conditions. The box-model tests reveal that the proposed method reduces the time spent in the solver routines significantly, with each QN call costing 27 % of a call to the full NR routine. A series of experiments over a range of chemical environments was conducted with the box model to find the optimal iteration steps to call the QN routine which result in the greatest reduction in the total number of NR iterations whilst minimising the chance of causing instabilities and maintaining solver accuracy. The 3-D simulations show that our moderate modification, by means of using a blended method for the chemistry solver, speeds up the chemistry routines by around 13 %, resulting in a net improvement in overall runtime of the full model by approximately 3 % with negligible loss in the accuracy. The blended QN method also improves the robustness of the solver, reducing the number of grid cells which fail to converge after 50 iterations by 40 %. The relative differences in chemical concentrations between the control run and that using the blended QN method are of order ∼  10−7 for longer-lived species, such as ozone, and below the threshold for solver convergence (10−4) almost everywhere for shorter-lived species such as the hydroxyl radical.

Mineral dust aerosols exert a significant effect on both solar and terrestrial radiation. By absorbing and scattering, the solar radiation aerosols reduce the amount of energy reaching the surface. In addition, aerosols enhance the greenhouse effect by absorbing and emitting outgoing longwave radiation. Desert dust forcing exhibits large regional and temporal variability due to its short lifetime and diverse optical properties, further complicating the quantification of the direct radiative effect (DRE). The complexity of the links and feedbacks of dust on radiative transfer indicate the need for an integrated approach in order to examine these impacts. In order to examine these feedbacks, the SKIRON limited area model has been upgraded to include the RRTMG (Rapid Radiative Transfer Model – GCM) radiative transfer model that takes into consideration the aerosol radiative effects. It was run for a 6 year period. Two sets of simulations were performed, one without the effects of dust and the other including the radiative feedback. The results were first evaluated using aerosol optical depth data to examine the capabilities of the system in describing the desert dust cycle. Then the aerosol feedback on radiative transfer was quantified and the links between dust and radiation were studied. The study has revealed a strong interaction between dust particles and solar and terrestrial radiation, with several implications on the energy budget of the atmosphere. A profound effect is the increased absorption (in the shortwave and longwave) in the lower troposphere and the induced modification of the atmospheric temperature profile. These feedbacks depend strongly on the spatial distribution of dust and have more profound effects where the number of particles is greater, such as near their source.

In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly overweight. Little data exist regarding the surgical challenges of obese children. This review study was designed to examine the relationship of obesity to surgical comorbidities, postoperative complications, and perioperative outcome in children, and to pediatric trauma. Obesity seems to be an independent risk factor in surgical-related pediatric morbidity and should be considered an important variable when looking at surgical outcomes in the pediatric population. Identification by and awareness among pediatric surgeons, of increased risk factors for peri/postoperative complications, will be crucial in optimizing the hospital stay and outcome of these children.

A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

The desert of Sahara is one of the major sources of mineral dust on Earth, producing around 2×108 tons/yr. Under certain weather conditions, dust particles from Saharan desert get transported over the Mediterranean Sea and most of Europe. The limiting values set by the directive EC/30/1999 of European Union can easily be exceeded by the transport of desert dust particles in the south European Region and especially in urban areas, where there is also significant contribution from anthropogenic sources. In this study, the effects of dust transport on air quality in several Greek urban areas are quantified. PM10 concentration values from stationary monitoring stations are compared to dust concentrations for the 4-year period 2003–2006. The dust concentration values in the Greek areas were estimated by the SKIRON modelling system coupled with embedded algorithms describing the dust cycle. The mean annual dust contribution to daily-averaged PM10 concentration values was found to be around or even greater than 10% in the urban areas throughout the years examined. Natural dust transport may contribute by more than 20% to the annual number of exceedances – PM10 values greater than EU limits – depending on the specific monitoring location. In a second stage of the study, the inhaled lung dose received by the residents in various Greek locations is calculated. The particle deposition efficiency of mineral dust at the different parts of the human respiratory tract is determined by applying a lung dosimetry numerical model, which incorporates inhalation dynamics and aerosol physical processes. The inhalation dose from mineral dust particles was greater in the upper respiratory system (extrathoracic region) and less significant in the lungs, especially in the sensitive alveolar region. However, in cases of dust episodes, the amounts of mineral dust deposited along the human lung are comparable to those received during exposure in heavily polluted urban or smoking areas.

A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO 2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO 2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO 2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO 2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population. Image 1 • We investigated NO 2 associations with socioeconomic indicators in 9 European cities. • Higher NO 2 was observed in areas with higher population density. • Higher NO 2 was observed in areas with higher population born outside EU. • Higher NO 2 was observed in areas with higher crime or unemployment rates. • Worse air quality is typically encountered in deprived European urban areas. [ABSTRACT FROM AUTHOR]

The estimated health effects of air pollution vary between studies, and this variation is caused by factors associated with the study location, hereafter termed regional heterogeneity. This heterogeneity raises a methodological question as to which studies should be used to estimate risks in a specific region in a health impact assessment. Should one use all studies across the world, or only those in the region of interest? The current study provides novel insight into this question in two ways. Firstly, it presents an up-to-date analysis examining the magnitude of continent-level regional heterogeneity in the short-term health effects of air pollution, using a database of studies collected by Orellano et al. (2020). Secondly, it provides in-depth simulation analyses examining whether existing meta-analyses are likely to be underpowered to identify statistically significant regional heterogeneity, as well as evaluating which meta-analytic technique is best for estimating region-specific estimates. The techniques considered include global and continent-specific (sub-group) random effects meta-analysis and meta-regression, with omnibus statistical tests used to quantify regional heterogeneity. We find statistically significant regional heterogeneity for 4 of the 8 pollutant-outcome pairs considered, comprising NO 2 , O 3 and PM 2.5 with all-cause mortality, and PM 2.5 with cardiovascular mortality. From the simulation analysis statistically significant regional heterogeneity is more likely to be identified as the number of studies increases (between 3 and 30 in each region were considered), between region heterogeneity increases and within region heterogeneity decreases. Finally, while a sub-group analysis using Cochran's Q test has a higher median power (0.71) than a test based on the moderators' coefficients from meta-regression (0.59) to identify regional heterogeneity, it also has an inflated type-1 error leading to more false positives (median errors of 0.15 compared to 0.09). [Display omitted] • Regional heterogeneity occurred between all-cause mortality and NO 2 , O 3 and PM 2.5. • Sub-group/meta-regression analyses are less biased than a global meta-analysis. • Meta-regression has good specificity but poor sensitivity to detect heterogeneity. [ABSTRACT FROM AUTHOR]

Summary: In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly overweight. Little data exist regarding the surgical challenges of obese children. This review study was designed to examine the relationship of obesity to surgical comorbidities, postoperative complications, and perioperative outcome in children, and to pediatric trauma. Obesity seems to be an independent risk factor in surgical-related pediatric morbidity and should be considered an important variable when looking at surgical outcomes in the pediatric population. Identification by and awareness among pediatric surgeons, of increased risk factors for peri/postoperative complications, will be crucial in optimizing the hospital stay and outcome of these children. [Copyright &y& Elsevier]

Summary: A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury. [ABSTRACT FROM AUTHOR]

Depleted uranium is a low-cost radioactive material that, in addition to other applications, is used by the military in kinetic energy weapons against armored vehicles. During the Gulf and Balkan conflicts concern has been raised about the potential health hazards arising from the toxic and radioactive material released. The aerosol produced during impact and combustion of depleted uranium munitions can potentially contaminate wide areas around the impact sites or can be inhaled by civilians and military personnel. Attempts to estimate the extent and magnitude of the dispersion were until now performed by complex modeling tools employing unclear assumptions and input parameters of high uncertainty. An analytical puff model accommodating diffusion with simultaneous deposition is developed, which can provide a reasonable estimation of the dispersion of the released depleted uranium aerosol. Furthermore, the period of the exposure for a given point downwind from the release can be estimated (as opposed to when using a plume model). The main result is that the depleted uranium mass is deposited very close to the release point. The deposition flux at a couple of kilometers from the release point is more than one order of magnitude lower than the one a few meters near the release point. The effects due to uncertainties in the key input variables are addressed. The most influential parameters are found to be atmospheric stability, height of release, and wind speed, whereas aerosol size distribution is less significant. The output from the analytical model developed was tested against the numerical model RPM-AERO. Results display satisfactory agreement between the two models. [ABSTRACT FROM AUTHOR]

The aim of this study is to estimate the mortality burden attributable to low temperature in Athens, Lisbon and London from 2002 to 2011 and to discuss related inequalities in socioeconomic conditions. We address a lack of quantitative estimates of cold-related mortality, particularly for the cities of Lisbon and Athens. To estimate the mortality burden attributable to low temperature, time-series regression analyses were carried out on daily mortality with respect to daily mean temperature for the three metropolitan areas to estimate the relative risk associated with a decrease in temperature. The number of cold-related deaths was estimated using the population Attributable Fraction. Lisbon presents higher relative risk (RR) than London and Athens; the RR for Athens is lower than for London. The coldrelated death rate is higher in Lisbon (53.2 deaths per 100,000 inhabitants) than in Athens (32.6) and London (37.6). The spatial heterogeneity between the three metropolitan areas in the risk estimates and cold-related mortality may result from the significant disparities in the built environment. Adequate public health planning and preventive measures in the built environment may help reduce cold-related deaths and decrease vulnerability to cold in European cities. • Cold has significant impacts on human health. • Cold-related death rate is higher in Lisbon than in Athens and London. • Spatial heterogeneity to cold may result from the built environment characteristics. • Preventive measures may help to reduce cold-related deaths and vulnerability. [ABSTRACT FROM AUTHOR]