24‐Hour,Weekly, and Annual Patterns in Traumatic and Non‐Traumatic Surgical Pediatric Emergencies

24 h patterns with high frequency components in the incidence of pediatric trauma were validated and quantified in one of our earlier studies. Herein, we further explored the temporal—high frequency, 24 h, weekly (7 d), hemi‐weekly (3.5 d), and annual – patterns in traumatic (1990–1997; n=15,110 events) and non‐traumatic pediatric surgical emergencies (PSE) (1992–2001; n=5,593 events) as well as automobile accidents (AA) (1990–1997; n=67,712) in the County of Vaud, Switzerland. The latter served as a reference system of human adult activity and risk. Two‐way ANOVA, χ2, correlation, and cosinor analyses were used as statistical tools. A 24 h pattern, reproducible from year to year, was validated in traumatic and non‐traumatic PSE and AA. The 24 h patterns were not correlated and differed from one another in terms of their acrophase (peak time) and amplitude. A gender‐related difference was found only in the non‐traumatic time series for weekly (7 d) and hemi‐weekly (3.5 d) patterns. The latter were detected in boys but not girls. No statistically significant difference was found in the acrophase and amplitude between boys and girls in the temporal patterns of other periods. An annual pattern was validated in automobile accidents (acrophase: 4th of September ±37 d (SD)) and pediatric trauma (acrophase: 14th of June ±10 d), but not in non‐traumatic PSE. These results suggest that environmental modulations differ between the incidence of traumatic and non‐traumatic PSE. Presumably, the two phenomena involve different aspects of the temporal organization and/or different levels of susceptibility of a set of biological rhythms to environmental factors.     

24-hour, weekly, and annual patterns in traumatic and non-traumatic surgical pediatric emergencies

24 h patterns with high frequency components in the incidence of pediatric trauma were validated and quantified in one of our earlier studies. Herein, we further explored the temporal—high frequency, 24 h, weekly (7 d), hemi-weekly (3.5 d), and annual - patterns in traumatic (1990-1997; n=15,110 events) and non-traumatic pediatric surgical emergencies (PSE) (1992-2001; n=5,593 events) as well as automobile accidents (AA) (1990-1997; n=67,712) in the County of Vaud, Switzerland. The latter served as a reference system of human adult activity and risk. Two-way ANOVA, χ2, correlation, and cosinor analyses were used as statistical tools. A 24 h pattern, reproducible from year to year, was validated in traumatic and non-traumatic PSE and AA. The 24 h patterns were not correlated and differed from one another in terms of their acrophase (peak time) and amplitude. A gender-related difference was found only in the non-traumatic time series for weekly (7 d) and hemi-weekly (3.5 d) patterns. The latter were detected in boys but not girls. No statistically significant difference was found in the acrophase and amplitude between boys and girls in the temporal patterns of other periods. An annual pattern was validated in automobile accidents (acrophase: 4th of September ±37 d (SD)) and pediatric trauma (acrophase: 14th of June ±10 d), but not in non-traumatic PSE. These results suggest that environmental modulations differ between the incidence of traumatic and non-traumatic PSE. Presumably, the two phenomena involve different aspects of the temporal organization and/or different levels of susceptibility of a set of biological rhythms to environmental factors.     

The Epidemiology and Prevention of Traffic Accidents Involving Child Pedestrians

A study of 713 motor vehicle accidents involving 749 children in the city of Vancouver is reported. A control group of 110 children who did not have accidents was included in the concurrent study. Factors investigated were the driver, the vehicle, the weather, the time of day, the day of week, the month, the width of roadway, the location of the accident, the child''s age, sex, personality, school record, and family background, the type of injury, and the ambulance and hospital service received. Boys were more commonly involved than girls, and most accidents occurred in the 3 to 7 year age group. Head injuries prevailed in the younger age groups and decreased steadily with the age of the child. Specific epidemic areas in the city were identified and selective enforcement was suggested as a possible countermeasure. Hospital records seldom provided a detailed history of the events leading up to the accident. In order to apply the preventive techniques of education and enforcement it was suggested that in each pedestrian traffic accident the driver should be required to accompany the victim to the site of medical care.     

Arachidonic Acid Metabolites and Their Orcadian Rhythm in Patients with Allergic Bronchial Asthma

The aim of this study was to investigate circadian variation in concentrations of arachidonic acid(AA) metabolites in relation to the circadian pattern in bronchial patency. Blood samples were obtained at 4-hr intervals from 2000 of 1 day until 1400 of the next from 12 diurnally active asthmatic and six diurnally active non-asthmatic patients. Bloods were analyzed for the prostanoids thromboxane A2 (measured as stable metabolite 6-keto-PGF_1a), PGE₂, and PGF_2a. Airways patency was assessed by self-measurement of peak expiratory flow (PEF). In asthmatics, circadian variation was detected in PEF as well as PGE₂ and TXB₂. The circadian trough of the PEF rhythm closely coincided with the circadian peak of the PGE₂ and TXB₂, rhythms. In the controls, the PEF was not circadian rhythmic. Of the AA metabolites only 6-keto-PGF_1a exhibited 24-hr bioperiodicity in the controls. The controls exhibited a significantly higher circadian mean of PEF (P < 0.001), while the asthmatics had a lower 24-hr average PGE₂ but greater mean TXB₂/PGE₂ ratio. The obstructive effect caused by the overall 24-hr deficiency of PGE₂ in asthmatics is possibly amplified by the increased of TXB₂ during the early morning hours. This dissociation of the temporal patterns in TXB, and PGE, levels over the 24 hr is discussed as a characteristic finding for asthmatics.     

Ultradian, circadian and seasonal variations of plasma progesterone and LH concentrations during the luteal phase

The circadian variations in plasma progesterone (P) and LH concentrations were investigated in six women, aged 23-40 years. All were studied in the mid-luteal phase (7 +/- 2 days after LH mid-cycle surge). Experiments were conducted in autumn and in spring. Blood samples were obtained every 15 min for 24 hr. Plasma P and LH concentrations were measured by RIA. Each subject's time-series was analysed using three methods; visual inspection (chronogram), spectral analysis to estimate component periods of rhythms (tau) and cosinor analysis to quantify the rhythms parameters. Marked temporal variations in plasma P concentration were observed in each subject. The maximal variations over a 24-hr period, ranged between 13-58.5 mmol/l. Differences related to sampling time were statistically validated by ANOVA (p less than 0.00001). Significant harmonic periods were detected by spectral analysis but differed among subjects. In all subjects but one, a circadian rhythm was detected. The acrophase location was similar (about 0700 hr) in the four subjects studied in autumn, but ranged from 1940 to 0320 hr in those studied in spring. An ultradian rhythm with tau = 8 hr was also validated in six time-series with similar acrophases (about 0200, 1000, and 1800 hr). Cosinor analysis of pooled data revealed that the 24-hr, 12-hr, and 8-hr rhythms were statistically significant (p = 0.001) in autumn. algebraic sum of these three cosine functions yielded a circadian waveform with peak-times occurring near 0300 and 1130 hr and a trough-time about 2200 hr. In spring, the circadian pattern appeared quite different, and peak-times were found near 0700 and 2000 hr, and trough-times near 0300 and 1500 hr. Furthermore, the 24-hr mean of P was higher in autumn (28.9 +/- 0.4 nmol/l) than in spring (17.2 +/- 0.4 nmol/l), p from ANOVA less than 0.00001. The evidence for a similar circadian LH pattern is not as strong. Seasonal, circadian and ultradian rhythms characterize the physiologic time structure of plasma P concentration in mid-luteal phase.     

Circadian rhythm of serotonin binding in rat brain--II. Influence of sleep deprivation and imipramine

Sleep deprivation (SD) modified the circadian rhythm of specific high affinity serotonin (5-HT) binding to rat brain membranes. In control rats a 24-hr rhythm was evident with a trough at 1000-1200 and a nadir at 0000. During the last 26 hr of a 49 hr SD period, trough and peak values were delayed by 4-6 hr. The 24-hr mean binding was significantly (P less than 0.001) different from that of controls. If sleep deprivation was followed by recovery sleep (RS), the normal rhythm of 5-HT binding was obtained already within 1 hr after SD. The effects of SD and RS were ascertained by plasma ACTH and corticosterone assay. No significant change in the hormone rhythms were observed through the mean plasma level of ACTH and corticosterone were enhanced to about 180 and 150%, respectively. Chronic treatment with the antidepressant imipramine resulted in a decrease of the 24-hr mean 5-HT binding by about 50% and a 2-hr delay of peak and trough values. Imipramine treatment decreased the peak value of 5-HT concentration at 1000 to about 65% and appears to abolish the rhythm of 5-HT concentration.     

PHOTOPERIOD IN XANTHIUM POPULATIONS FROM TEXAS AND MEXICO

Photoperiodic responses of Xanthium strumarium L. originating between 19° N in Mexico and 34° N in Texas varied among seedlings grown from seed under controlled conditions. The critical night lengths form a gradient from 9.5 hr in northern Texas to 10.75 hr in southern Texas and northeastern Mexico. Populations with critical night lengths of 9.5 and 9.75 hr showed a longer interval to flower bud formation under cooler temperatures (24 C day/15 C night) than under warmer temperatures (30 C day/24 C night). Three of four populations with a 10.75-hr critical night length showed a shorter interval under the cooler temperature regime. Although the Texas populations demonstrate a strong correlation of photoperiodic response with latitude, the Mexico populations show diverse photoperiodic timing from approximately the same latitude. The study emphasizes that a combination of critical night length and ripeness-to-flower (maturity) response forms the basis for reproductive adaptation in different climatic regimes in Texas and Mexico.     

Sleep related vehicle accidents.

OBJECTIVES--To assess the incidence, time of day, and driver morbidity associated with vehicle accidents where the most likely cause was the driver falling asleep at the wheel. DESIGN--Two surveys were undertaken, in southwest England and the midlands, by using police databases or on the spot interviews. SUBJECTS--Drivers involved in 679 sleep related vehicle accidents. RESULTS--Of all vehicle accidents to which the police were summoned, sleep related vehicle accidents comprised 16% on major roads in southwest England, and over 20% on midland motorways. During the 24 hour period there were three major peaks: at around 0200, 0600, and 1600. About half these drivers were men under 30 years; few such accidents involved women. CONCLUSIONS--Sleep related vehicle accidents are largely dependent on the time of day and account for a considerable proportion of vehicle accidents, especially those on motorways and other monotonous roads. As there are no norms for the United Kingdom on road use by age and sex for time of day with which to compare these data, we cannot determine what the hourly exposure v risk factors are for these subgroups. The findings are in close agreement with those from other countries.     

Case-control study of recidivist drivers involved in fatal highway accidents in Alberta in 1970-72.

A 3-year enpidemiologic study of fatal motor vehicle accidents was carried out by the Alberta Task Force on Highway Accidents. It was found that 11.1% of culpable drivers had been driving while impaired by alcohol on at least one occasion prior to the fatal accident, while only 3.3% of exonerated drivers had previous records. This significant difference led to a case-control study that demonstrated that the recidivist drivers (case group) differed significantly in a number of aspects from the innocent drivers (control group)--notably, age distribution, sex, whether drinking before the accident, blood alcohol concentration, ethnic distribution, class of accident and type of collision. Thus the recidivist driver is a greater threat to highway safety than the innocent driver and needs special attention by legislators and law enforcement agencies.     

Circadian Rhythm of Gastric Acid Secretion in Active Duodenal Ulcer: Chronobiological Statistical Characteristics and Comparison of Acid Secretory and Plasma Gastrin Patterns with Healthy Subjects and Post-Vagotomy and Pyloroplasty Patients

Twenty-one male patients with active duodenal ulcer underwent hourly 24-hr gastric acid collections under controlled, calorically deprived conditions. The 24-hr hourly acid secretory output for the group displayed a statistically significant (p < 0.001) rhythm, with peak rates occurring during the evening hours and low rates during the early morning hours, by population-mean cosinor statistical analysis. Population-mean cosinor analysis also verified the occurrence of a significant (p=0.034) circadian rhythm in unstimulated acid secretion in a group (N=14) of healthy male subjects similarly studied and reported previously. In contrast, population-mean cosinor analysis confirmed the absence of any detectable circadian rhythm in unstimulated acid secretion in a group (N=17) of post-vagotomy and pyloroplasty patients studied 2-11 years after surgery. Population-mean cosinor analysis of 4-hr plasma gastrin determinations, obtained in all groups during the 24-hr gastric acid collection, revealed an absence of any detectable circadian rhythm in plasma gastrin. This latter finding is compatible with the interpretation that the circadian rhythm of unstimulated gastric acid secretion, observed in the clinically healthy and active ulcer groups, is unrelated to changes in plasma gastrin levels. The employment of quantitative chronobiological inferential statistical techniques is important to the analysis of any time-dependent measurement in gastrointestinal function, of which gastric acidity is one example.     

Entrainment of A Free-Running Human with Bright Light?

The case of a 40-year-old sighted woman with free-running sleep-wake and melatonin rhythms is presented. The subject was studied for 102 days. During the pre-treatment period, both the sleep-wake and melatonin rhythms had a period of 25.1 hr, similar to the average period of humans living in temporal isolation. Treatment consisted of bright artifical light exposure (2500 lx Vita-Lite) for 2 hr each day upon awakening. Clock time of light exposure was held constant for 6 days and then slowly advanced until the subject was arising at her desired time of day. The subject continued the light treatment at home and was able to live on a 24-hr day for the 30-day follow-up study. While other factors may be operating in this situation, it is possible that the light treatment caused the stabilization of the free-running rhythms, advancement to a normal phase and entrainment to the 24-hr day. We suspect that the tendency to free-run was related to sleep onsets that were abnormally delayed relative to the circadian phase response curve for light. By scheduling a 2-hr pulse of bright light each morning, this tendency to delay would be counteracted by light-induced advances, resulting in normal entrainment.     

Traffic Deaths—A Preliminary Study of Urban and Rural Fatalities in California

An analysis by the California Department of Public Health of California Highway Patrol reports for 1961 showed that traffic accidents injured one and one-half times as many people per 1,000 population in rural California counties (under 50,000 people) as in urban counties (over 500,000 people), also persons injured in rural counties were almost four times as likely to die of their injuries as those injured in urban counties.A death certificate study was undertaken of 782 traffic deaths (excluding pedestrians) occurring in rural and urban California counties during 1961. Accidents occurring in rural counties tended to be single vehicle accidents which resulted in less severe injuries, while those in urban counties tended to be two vehicle and multiple vehicle accidents resulting in more serious injuries. The anatomic distribution of injuries was the same for both urban and rural accidents. However, people dying in rural accidents more frequently died at the scene of the accident, died sooner after injury, and died of less serious injuries than did those injured in urban accidents. For injuries where theoretically few lives should be salvaged by prompt emergency care, the time between injury and death was about the same in urban as in rural counties. Where such care should delay or prevent death because the injury was possibly or probably salvageable, those injured in rural counties died more quickly.Thirty-two per cent of fatalities in rural counties happened to urban and out-of-state residents, while only 12 per cent of fatalities in urban counties were to rural or out-of-state residents, suggesting that traffic accidents to non-residents may place an excessive load upon medical care resources in rural areas.     

Circannual Variation of Cell Proliferation in Lymphoid Organs and Bone Marrow of Dbf1 Male Mice on Three Lighting Regimens

The case of a 40-year-old sighted woman with free-running sleep-wake and melatonin rhythms is presented. The subject was studied for 102 days. During the pre-treatment period, both the sleep-wake and melatonin rhythms had a period of 25.1 hr, similar to the average period of humans living in temporal isolation. Treatment consisted of bright artifical light exposure (2500 lx Vita-Lite) for 2 hr each day upon awakening. Clock time of light exposure was held constant for 6 days and then slowly advanced until the subject was arising at her desired time of day. The subject continued the light treatment at home and was able to live on a 24-hr day for the 30-day follow-up study. While other factors may be operating in this situation, it is possible that the light treatment caused the stabilization of the free-running rhythms, advancement to a normal phase and entrainment to the 24-hr day. We suspect that the tendency to free-run was related to sleep onsets that were abnormally delayed relative to the circadian phase response curve for light. By scheduling a 2-hr pulse of bright light each morning, this tendency to delay would be counteracted by light-induced advances, resulting in normal entrainment.     

A chronobiological study of delta-amino levulinic acid urinary excretion

Determination of urinary delta-amino levulinic acid (ALA) is now systematically used in occupational health to detect an excessive exposure to lead in professionally exposed workers. However, to determine whether circadian changes of the urinary excretion of ALA alter the significance of the test, we quantified the ALA levels in the urine of 19 healthy young adults. Urine samples were taken every 3 hr between 0700 and 2300 hr and ALA levels were determined by a spectrocolorimetric method. The data indicated that the 24-hr mean ALA level was: 1.81 mg/g creatinine. The peak values (2.24 +/- 0.24) were obtained between 1400 and 1700 hr whereas the lowest ALA levels were found between 2200 and 0300 hr. Cosinor analysis revealed a significant circadian rhythm while no significant difference could be found according to sex. Possible explanations of our findings are discussed.     

Arachidonic acid metabolites and their circadian rhythm in patients with allergic bronchial asthma

The aim of this study was to investigate circadian variation in concentrations of arachidonic acid (AA) metabolites in relation to the circadian pattern in bronchial patency. Blood samples were obtained at 4-hr intervals from 2000 of 1 day until 1400 of the next from 12 diurnally active asthmatic and six diurnally active non-asthmatic patients. Bloods were analyzed for the prostanoids thromboxane A2 (measured as stable metabolite 6-keto-PGF1a), PGE2 and PGF2a. Airways patency was assessed by self-measurement of peak expiratory flow (PEF). In asthmatics, circadian variation was detected in PEF as well as PGE2 and TXB2. The circadian trough of the PEF rhythm closely coincided with the circadian peak of the PGE2 and TXB2 rhythms. In the controls, the PEF was not circadian rhythmic. Of the AA metabolites only 6-keto-PGF1a exhibited 24-hr bioperiodicity in the controls. The controls exhibited a significantly higher circadian mean of PEF (P less than 0.001), while the asthmatics had a lower 24-hr average PGE2 but greater mean TXB2/PGE2 ratio. The obstructive effect caused by the overall 24-hr deficiency of PGE2 in asthmatics is possibly amplified by the increased of TXB2 during the early morning hours. This dissociation of the temporal patterns in TXB2 and PGE2 levels over the 24 hr is discussed as a characteristic finding for asthmatics.     

CHILD PEDESTRIAN FATALITIES IN LOS ANGELES

In an analysis of information concerning 81 child pedestrians killed in traffic accidents in the city of Los Angeles during a recent five-year period it was observed that the majority of children were preschoolers playing near their residences but without adult supervision. In most instances the action of the child and not the driver of the vehicle was responsible for the accident. Among school age child fatalities, improper handling of a bicycle was commonly to blame.     

Effect of thyroidectomy on rhythmic gonadotropin release.

Nonstress blood samples were obtained from intact and thyroidectomized (TE) male rats at 3-hr intervals over a 24-hr period via rapid decapitation. The animals were thyroidectomized when 40 days old and used 6 weeks later. Intact animals showed periodicity in serum LH (P less than 0.01) and prolactin (P less than 0.01). Both gonadotropins began increasing after 8 PM and peak levels occurred at 11 PM. In contrast, 24-hr periodicity was not observed in serum FSH. Corticosterone levels in these same serum samples showed the expected circadian periodicity. After TE, the 24-hr pattern in all gonadotropins was altered significantly. Serum LH increased (P less than 0.01) and circadian periodicity appeared to be absent. FSH and prolactin levels were increased and decreased, respectively (P less than 0.01), with serum prolactin showing a 9-hr phase shift. Prolactin began increasing at 2 AM and reached a peak at 8 AM. Corticosterone in TE animals showed a 24-hr rhythm similar to that of intact rats. These findings confirm our previous observations that nonstress serum LH and prolactin levels fluctuate with a 24-hr periodicity and suggest that the level of, and the phase angle betweeen, these rhythms is markedly influenced by pituitary-thyroid activity.     

Circadian Rhythm of Serotonin Binding in Rat Brain—II. Influence of Sleep Deprivation and Imipramine

Sleep deprivation (SD) modified the circadian rhythm of specific high affinity serotonin (5-HT) binding to rat brain membranes. In control rats a 24-hr rhythm was evident with a trough at 1000-1200 and a nadir at 0000. During the last 26 hr of a 49 hr SD period, trough and peak values were delayed by 4-6 hr. The 24-hr mean binding was significantly (P < 0.001) different from that of controls. If sleep deprivation was followed by recovery sleep (RS), the normal rhythm of 5-HT binding was obtained already within 1 hr after SD. The effects of SD and RS were ascertained by plasma ACTH and corticosterone assay. No significant change in the hormone rhythms were observed though the mean plasma level of ACTH and corticosterone were enhanced to about 180 and 150%, respectively. Chronic treatment with the antidepressant imipramine resulted in a decrease of the 24-hr mean 5-HT binding by about 50% and a 2-hr delay of peak and trough values. Imipramine treatment decreased the peak valueof 5-HT concentration at 1000 to about 65% and appears to abolish the rhythm of 5-HT concentration.     

External exposure of the population living in areas of Russia contaminated due to the Chernobyl accident

An updated version of external dose modeling is presented with reference to the population in Russian areas contaminated due to the Chernobyl accident. An earlier version has been modified by applying a study time interval with a starting point immediately after radionuclide deposition (rather than 4 years after the accident as applied earlier) and by introducing an estimate of individual dose distributions. New input data to the model are the nuclide-specific composition of the deposit, additional data about migration of caesium in soil, time dependence of location factors and uncertainty distributions of all input parameters. Model results (i.e. effective dose-rates and accumulated effective doses) from external exposure for the rural and urban populations in contaminated areas of Russia during 100 years after the accident are presented. Radionuclide contributions to the dose during various time intervals after the accident have been estimated. The model has been validated by measurements of absorbed dose-rate in air during the first 30 days after the accident and by TLD measurements of individual external doses among inhabitants of contaminated rural settlements in the year 1993. Both the measurements and model show that the geometric mean of individual external doses is about 10% lower than the arithmetic mean and the upper bound of the 95% confidence range is larger by a factor of about 2.     

Chronobiologic perspectives of black time—Accident risk is greatest at night: An opinion paper

Simon Folkard in 1997 introduced the phrase black time to draw attention to the fact that the risk of driving accidents (DA) is greater during the night than day in usually diurnally active persons. The 24 h temporal pattern in DA entails circadian rhythms of fatigue and sleep propensity, cognitive and physical performance, and behavior that are controlled, at least in part, by endogenous clocks. This opinion paper extends the concept of black time to reports of excess nighttime accidents and injuries of workers and nocturnal occurrence of certain man-caused catastrophes. We explore the chronobiology of work-related black time accidents and injuries taking into account laboratory and field investigations describing, respectively, circadian rhythms in cognitive performance and errors and mistakes by employees in the conduct of routine occupational tasks. Additionally, we present results of studies pertaining to 24 h patterns of both the number and relative risk (number of events per h/number of workers exposed per h) of work-related accidents (WRA) and injuries (WRI) as well as indices of performance and alertness of a self-selected homogenous survivor cohort of French firefighters (FFs) to explore two possible explanations of black time, namely, 24 h variation in sleep propensity/drossiness characterized by a nocturnal peak and circadian rhythms in cognitive performance characterized by a nocturnal trough. We propose the 24 h pattern of WRA and WRI, particularly of FFs and other highly skilled self-selected cohorts, is more strongly linked to circadian rhythms of fatigue and sleepiness than cognitive performance. Other possible explanations –suppressed expression of circadian rhythms and/or unmasking of ultradian periodicities in cognitive performance in specific circumstances, e.g., highly stressful work, competitive, or life-threatening settings, are also discussed.