Search

Abstract Background In 2006, the Canadian Cardiovascular Society (CCS) Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR). The objectives of the current study were to: (1) describe cardiac patient perceptions of actual and ideal CR wait times, (2) describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3) investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate), and 92 CR programs (61.7% response rate). Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days), while their ideal median wait time was 28 days. Most patients (91.5%) considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.

Abstract Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories. These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed. Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment.

Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard-mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries., Competing Interests: Declaration of interests YTEL was funded by a University of Bristol fellowship in Climate and Health. EB was funded by Policy Bristol. CR is funded by a UKRI Future Leaders Fellowship (MR/V021672). NSF received support of H2020 MSCA IF (grant ID 846824). AG was supported by the Medical Research Council-UK (MR/V034162/1). All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The United Kingdom experienced its most extreme heatwave to date during late July 2022, with maximum air temperatures exceeding 40 °C recorded for the first time in history on July 19th. High ambient temperatures have been statistically shown to lead to increased mortality. Higher nighttime temperatures that occur in more urbanised areas, called the urban heat island (UHI), may contribute to the mortality burden of heat. In this study, we applied health impact assessment methods with advanced urban climate modelling to estimate what contribution the UHI had on the mortality impact of the 10-25 July 2022 heatwave in Greater London. Estimated mortality due to heat and due to the UHI were compared with estimated mortality due to air pollution in the same period, based on monitored concentrations. We estimate that of the 1773 deaths in Greater London in this period 370 (95% confidence interval 328-410) could be attributed to heat. We estimate that 38% of these heat-related deaths could be attributed to the UHI. In the same period is estimate deaths attributable to PM2.5 were 20.6 (10.4-30.8) and to ozone were 52.3 (95% confidence interval 18.6-85.2). Despite not contributing to the record-breaking maximum air temperature observed during this period, the UHI may have contributed to the heatwave's mortality burden through raised nighttime temperature. While air pollutant concentrations were elevated during the period, deaths attributable to air pollution were relatively few compared to deaths attributable to heat., (© 2024 The Author(s). Published by IOP Publishing Ltd.)

The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK. We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation. We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess associations between housing characteristics and risk of hospital admissions related to falls on/from stairs in children, to help inform prevention measures., Study Design: An existing dataset of birth records linked to hospital admissions up to age 5 for a cohort of 3 925 737 children born in England between 2008 and 2014, was linked to postcode-level housing data from Energy Performance Certificates. Association between housing construction age, tenure (eg, owner occupied), and built form and risk of stair fall-related hospital admissions was estimated using Poisson regression. We stratified by age (<1 and 1-4 years), and adjusted for geographic region, Index of Multiple Deprivation, and maternal age., Results: The incidence was higher in both age strata for children in neighborhoods with homes built before 1900 compared with homes built in 2003 or later (incidence rate ratio [IRR], 1.40; 95% CI, 1.10-1.77 [age <1 year], 1.20; 95% CI, 1.05-1.36 [age 1-4 years]). For those aged 1-4 years, the incidence was higher for those in neighborhoods with housing built between 1900 and 1929, compared with 2003 or later (IRR, 1.26; 95% CI, 1.13-1.41), or with predominantly social-rented homes compared with owner occupied (IRR, 1.21; 95% CI, 1.13-1.29). Neighborhoods with predominantly houses compared with flats had higher incidence (IRR, 1.24; 95% CI, 1.08-1.42 [<1 year] and IRR 1.16; 95% CI, 1.08-1.25 [1-4 years])., Conclusions: Changes in building regulations may explain the lower fall incidence in newer homes compared with older homes. Fall prevention campaigns should consider targeting neighborhoods with older or social-rented housing. Future analyses would benefit from data linkage to individual homes, as opposed to local area level., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. Funding provided by the UCL Health of the Public and Wellcome Trust. The funders had no role in study design, data collection, analysis, interpretation, writing, or decision to submit for publication., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Personal weather stations (PWS) can provide useful data on urban climates by densifying the number of weather measurements across major cities. They do so at a lower cost than official weather stations by national meteorological services. Despite the increasing use of PWS data, little attention has yet been paid to the underlying socio-economic and environmental inequalities in PWS coverage. Using social deprivation, demographic, and environmental indicators in England and Wales, we characterize existing inequalities in the current coverage of PWS. We find that there are fewer PWS in more deprived areas which also observe higher proportions of ethnic minorities, lower vegetation coverage, higher building height and building surface fraction, and lower proportions of inhabitants under 65 years old. This implies that data on urban climate may be less reliable or more uncertain in particular areas, which may limit the potential for climate adaptation and empowerment in those communities., (© 2024. The Author(s).)

Irrigation and urban greening can mitigate extreme temperatures and reduce adverse health impacts from heat. However, some recent studies suggest these interventions could actually exacerbate heat stress by increasing humidity. These studies use different heat stress indices (HSIs), hindering intercomparisons of the relative roles of temperature and humidity. Our method uses calculus of variations to compare the sensitivity of HSIs to temperature and humidity, independent of HSI units. We explain the properties of different HSIs and identify conditions under which they disagree. We highlight recent studies where the use of different HSIs could have led to opposite conclusions. Our findings have significant implications for the evaluation of irrigation and urban greening as adaptive responses to overheating and climate adaptation measures in general. We urge researchers to be critical in their choice of HSIs, especially in relation to health outcomes; our method provides a useful tool for making informed comparisons., Competing Interests: Competing Interests The authors declare no competing interests.

Cardiac ischemia or myocardial infarction after pit viper envenomation is rare. Few case reports have been published, none describing cases reported after crotaline snake envenomation in the United States. We report a case of ST-segment elevation myocardial infarction (STEMI) occurring in a 73-year-old man after an envenomation by a juvenile canebrake rattlesnake (Crotalus horridus). The man was bitten on the left index finger and subsequently developed localized edema followed by hypotension, chest pain, and altered mental status. His initial electrocardiogram revealed ST-segment elevation in the inferior and lateral leads. His hospital course included emergent left heart catheterization with thrombectomy and cardiac stent placement. This case captures the unique medical situation involving the approach to treatment and management of a patient with a severe crotaline envenomation complicated by a STEMI., (Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Sources of particulate matter (PM) air pollution are generally inferred from PM chemical constituent concentrations using source apportionment models. Concentrations of PM constituents are often censored below minimum detection limits (MDL) and most source apportionment models cannot handle these censored data. Frequently, censored data are first substituted by a constant proportion of the MDL or are removed to create a truncated dataset before sources are estimated. When estimating the complete data distribution, these commonly applied methods to adjust censored data perform poorly compared with model-based imputation methods. Model-based imputation has not been used in source apportionment and may lead to better source estimation. However if the censored chemical constituents are not important for estimating sources, censoring adjustment methods may have little impact on source estimation. We focus on two source apportionment models applied in the literature and provide a comprehensive assessment of how censoring adjustment methods, including model-based imputation, impact source estimation. A review of censoring adjustment methods critically informs how censored data should be handled in these source apportionment models. In a simulation study, we demonstrated that model-based multiple imputation frequently leads to better source estimation compared with commonly used censoring adjustment methods. We estimated sources of PM in New York City and found estimated source distributions differed by censoring adjustment method. In this study, we provide guidance for adjusting censored PM constituent data in common source apportionment models, which is necessary for estimation of PM sources and their subsequent health effects.

Purpose: To evaluate the shear bond strengths of "one-bottle" adhesives to dentin when used with self-cured composite., Materials and Methods: 100 bovine teeth were ground to expose superficial dentin, which was polished to 600-grit. The dentin was etched for 15 s with 35% phosphoric acid, rinsed, and blotted with tissue paper. The surface remained visibly moist for all specimens. The following adhesives were applied to the etched dentin according to manufacturers' directions: Scotchbond Multi-Purpose (in its visible light-cured [VLC] and self-cure modes) as a control, One-Step (VLC only), OptiBond Solo Plus (VLC only), Prime & Bond NT (VLC) and Prime & Bond NT Dual-Cure. For each adhesive, specimens were bonded with a self-cure composite, while 10 were bonded with a VLC composite as a control. After 24 hrs water storage, shear bond strengths were determined using an Instron universal testing machine. Data were analyzed using two-way ANOVA, Tukey's test, and Student's t-tests., Results: Using the light-cured composite, mean bond strengths ranged from 11.0 MPa for light-cured Prime & Bond NT to 26.3 MPa for OptiBond Solo Plus. Using the self-cure composite, mean bond strengths ranged from 0.0 for light-cured Prime & Bond NT to 21.4 MPa for One-Step. Two adhesives, light-cured Prime & Bond NT and OptiBond Solo Plus, had significantly lower bond strengths when used with the self-cure composite., Clinical Significance: Some "one-bottle" dentin adhesives may not provide acceptable bonding to tooth structure when they are used with self-cure composites.

A colorimetric method for the determination of serum iron and total iron-binding capacity (TIBC) has been adapted to an IL Multistat III Centrifugal Analyzer. The correlation to an ESA Ferrochem, Model 3050, which measures iron by coulometry, is acceptable (IL Multistat = 1.08 ESA--5.05). The intra-run precision gave an average C.V. of less than 5%. The day-to-day precision was between 2% and 7% and the average analytical recovery was 102%. This method requires only 150 microliters of sample for both iron and TIBC which is a significant advantage over many existing methods in terms of sample volume, especially when a pediatric population is considered. Both iron and TIBC may be analyzed at the same time on the same rotor. The approximate analysis time is 30 minutes for seven iron and TIBC samples, four controls and one standard. The cost is low, being approximately $0.08 per iron assay and $0.83 per TIBC assay.