Remarkable rates of lightning strike mortality in Malawi

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.     

Intense cold and mortality in Castile-La Mancha (Spain): study of mortality trigger thresholds from 1975 to 2003

Studies on temperature–mortality time trends especially address heat, so that any contribution on the subject of cold is necessarily of interest. This study describes the modification of the lagged effects of cold on mortality in Castile-La Mancha from 1975 to 2003, with the novelty of also approaching this aspect in terms of mortality trigger thresholds. Cross-correlation functions (CCFs) were thus established with 15 lags, after application of ARIMA models to the mortality data and minimum daily temperatures (from November to March), and the results for the periods 1975–1984, 1985–1994 and 1995–2003 were then compared. In addition, daily mortality residuals for the periods 1975–1989 and 1990–2003 were related to minimum temperatures grouped in 2°C intervals, with a cold threshold temperature being obtained in cases where such residuals increased significantly (p < 0.05) with respect to the mean for the study period. A cold-related mortality trigger threshold of −3°C was obtained for Ciudad Real for the period 1990–2003. The significant number of lags (p < 0.05) in the CCFs declined every 10 years in Toledo (5–2–0), Cuenca (4–2–0), Albacete (4–3–0) and Ciudad Real (3–2–1). This meant that, while the trend in cold-related mortality trigger thresholds in the region could not be ascertained, it was possible to establish a reduction in the lagged effects of cold on mortality, attributable to the improvement in socio-economic conditions over the study period. Evidence was shown of the effects of cold on mortality, a finding that renders the adoption of preventive measures advisable in any case where intense cold is forecast.     

Cervical cytology screening: experience of a general hospital.

At Henderson General Hospital, Hamilton, a program was introduced whereby cervical smears were taken routinely for cytologic study from all women admitted aged 17 years or older. The procedure was performed by a specially trained nurse. In a 5-year period 53% of eligible patients were screened. Of these, 32% had not had a cervical smear taken before. In 7681 smears nine instances of invasive disease were discovered: three of the cervix, three of the endometrium and three metastatic. There were 20 cases of carcinoma in situ and 2 of severe dysplasia. Evidence of infection was present in a high percentage of the smears. Hospital admission affords an excellent opportunity of applying this valuable screening procedure.     

Recent trends in neonatal mortality: the Canadian experience.

In Canada between 1958 and 1977 the neonatal mortality dropped by more than 50%. the decline was most prominent from 1963 and was almost entirely due to an improvement in neonatal birthweight-specific mortality, which suggests an improvement in perinatal medical care. The timing and pattern of the decline are similar to those reported for the United States. There was a transient increase in the incidence of low and very low birthweight in both countries in the late 1960s. The cause of this increase remains unexplained.     

"Infant mortality in Armenia 1992-2003": a comment.

The purpose of this comment is to counsel caution in some of the conclusions drawn in an otherwise fine article recently published in Economics and Human Biology on infant mortality in Armenia by Hakobyan, Mkrtchyan and Yepiskoposyan. These relate first, to the reliability of estimates and trends in infant mortality estimated from DHS data; second, to the interpretation of what the authors consider to be a 'low' infant mortality rate in former communist countries given their level of economic development; and third, to the role of the health care infrastructure in countries of the former Soviet Union in producing these 'low' infant mortality levels. This comment argues that trends in infant mortality in Armenia and other CIS countries, although probably declining, are perhaps less certain than the authors allow, that existing evidence does not suggest that they are uniformly low by global standards, or that the health care systems in CIS countries are uniformly effective in reducing infant deaths.     

Heat wave impacts on mortality in Shanghai, 1998 and 2003

A variety of research has linked extreme heat to heightened levels of daily mortality and, not surprisingly, heat waves both in 1998 and in 2003 all led to elevated mortality in Shanghai, China. While the heat waves in the two years were similar in meteorological character, elevated mortality was much more pronounced during the 1998 event, but it remains unclear why the human response was so varied. In order to explain the differences in human mortality between the two years’ heat waves, and to better understand how heat impacts human health, we examine a wide range of meteorological, pollution, and social variables in Shanghai during the summers (15 June to 15 September) of 1998 and 2003. Thus, the goal of this study is to determine what was responsible for the varying human health response during the two heat events. A multivariate analysis is used to investigate the relationships between mortality and heat wave intensity, duration, and timing within the summer season, along with levels of air pollution. It was found that for heat waves in both summers, mortality was strongly associated with the duration of the heat wave. In addition, while slightly higher than average, the air pollution levels for the two heat waves were similar and cannot fully explain the observed differences in human mortality. Finally, since the meteorological conditions and pollution levels for the two heat waves were alike, we conclude that improvements in living conditions in Shanghai, such as increased use of air conditioning, larger living areas, and increased urban green space, along with higher levels of heat awareness and the implementation of a heat warning system, were responsible for the lower levels of human mortality in 2003 compared to 1998.     

RNA interference against viruses: strike and counterstrike

RNA interference (RNAi) is a conserved sequence-specific, gene-silencing mechanism that is induced by double-stranded RNA. RNAi holds great promise as a novel nucleic acid-based therapeutic against a wide variety of diseases, including cancer, infectious diseases and genetic disorders. Antiviral RNAi strategies have received much attention and several compounds are currently being tested in clinical trials. Although induced RNAi is able to trigger profound and specific inhibition of virus replication, it is becoming clear that RNAi therapeutics are not as straightforward as we had initially hoped. Difficulties concerning toxicity and delivery to the right cells that earlier hampered the development of antisense-based therapeutics may also apply to RNAi. In addition, there are indications that viruses have evolved ways to escape from RNAi. Proper consideration of all of these issues will be necessary in the design of RNAi-based therapeutics for successful clinical intervention of human pathogenic viruses.     

Mass mortality in Northwestern Mediterranean rocky benthic communities: effects of the 2003 heat wave

Late in summer 2003, extensive mass mortality of at least 25 rocky benthic macro-invertebrate species (mainly gorgonians and sponges) was observed in the entire Northwestern (NW) Mediterranean region, affecting several thousand kilometers of coastline. We were able to characterize the mortality event by studying six areas covering the main regions of the NW Mediterranean basin. The degree of impact on each study area was quantified at 49 sites by estimating the proportion of colonies affected in populations of several gorgonian species compared with reference data obtained in years without mortality signs. According to these data, the western areas (Catalan coast and Balearic Islands) were the least affected, while the central areas (Provence coast and Corsica-Sardinia) showed a moderate impact. The northernmost and eastern areas (Gulf of Genoa and Gulf of Naples) displayed the highest impact, with almost 80% of gorgonian colonies affected. The heat wave of 2003 in Europe caused an anomalous warming of seawater, which reached the highest temperatures ever recorded in the studied regions, between 1 and 3 °C above the climatic values (mean and maximum). Because this exceptional warming was observed in the depth ranges most affected by the mortality, it seems likely that the 2003 anomalous temperature played a key role in the observed mortality event. A correlation analysis between temperature conditions and degree of impact seems to support this hypothesis. Under the present climate warming trend, new mass mortality events may occur in the near future, possibly driving a major biodiversity crisis in the Mediterranean Sea.     

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Background:

Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population.

Methods:

We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose–response relation.

Results:

A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07–1.12) for all-cause mortality and 1.08 (95% CI 1.06–1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60–80 beats/min had a relative risk of 1.12 (95% CI 1.07–1.17) for all-cause mortality and 1.08 (95% CI 0.99–1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34–1.57) for all-cause mortality and 1.33 (95% CI 1.19–1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected.

Interpretation:

Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population.Resting heart rate is a familiar, straightforward and inexpensive-to-measure clinical variable, and it can be modified by a number of factors, such as physical activity, psychologic stress, smoking, intake of omega-3 fatty acids and medications.^1–4 Higher heart rate has been linked to increased risks of cardiovascular disease and premature mortality through a multitude of actions, including its detrimental effects on progression of coronary atherosclerosis, on occurrence of myocardial ischemia and ventricular arrhythmia, on left ventricular function and on circulating levels of inflammatory markers.^5–7 However, measurement of resting heart rate has not been recommended in American and European guidelines on risk assessment of cardiovascular disease.^8,9 The major reasons for this may be that the magnitude of risk with each increment of higher resting heart rate has been inconsistent among studies, and that resting heart rate may not be an independent predictor because higher heart rate coexists with traditional risk factors of cardiovascular disease.^10–13 In addition, data are lacking on the dose–response relation between resting heart rate and all-cause and cardiovascular mortality,^5,9 although a previous review showed a continuous increase in risk with resting heart rate above 60 beats/min.⁵Therefore, we conducted a meta-analysis of prospective cohort studies involving the general population, following the MOOSE checklist,¹⁴ to assess the risk of all-cause and cardiovascular mortality associated with each increment of 10 beats/min; to evaluate the possible dose–response relation by restricted cubic spline functions and by pooling risks of all-cause and cardiovascular mortality for comparable categories of resting heart rate (60–80 beats/min and > 80 beats/min); and to evaluate the effect of traditional risk factors of cardiovascular disease on the association of resting heart rate with risk of all-cause and cardiovascular mortality.     

Informal complaints procedure in general practice: first year's experience.

OBJECTIVE--To evaluate the first year''s experience of an informal patient complaints system that encourages extensive patient participation. DESIGN--Audit of an informal complaints procedure. SETTING--The Marylebone Health Centre, London. SUBJECTS--39 complaints received over the audit period. MAIN OUTCOME MEASURES--Types of complaints (administrative, about doctors or medical care or both, staff about patients, mixed, other) and resolution of complaints (how complaints were dealt with and their resolution). RESULTS--37 of the 39 complaints were resolved within two weeks. Two complaints sent direct to the family health services authority were resolved (with patients'' agreement) by the informal complaints procedure. CONCLUSIONS--The informal complaints procedure was more cost effective than the family health services authority system and was comparatively straightforward to implement within the practice without major organisational restructuring. The two way process of the procedure ensured patients received a quick response to complaints and helped morale of health centre staff.     

Ebola and Marburg viruses: the humans strike back

Ebola and Marburg viruses are the causative agents of rapidly progressive hemorrhagic fevers with high mortality rates. Pre- or post-exposure treatments against the diseases are currently not available for human use. In the field, establishment of strict quarantine measures preventing further virus transmission are still the only way to fight the infections. However, our knowledge of Ebola and Marburg viruses has markedly increased as a result of two recent discoveries discussed in this review. Chandran et al. have elucidated the mechanism by which Ebola GP is converted to a fusion-active form. Infectivity of Ebola virus was shown to be dependent on the cleavage of GP by cellular endosomal proteases, cathepsin B and L, thus opening new therapeutic approaches options. As for Jones SM et al., they have successfully vaccinated monkeys with recombinant vesicular stomatitis virus expressing Ebola or Marburg virus surface glycoprotein GP, a promising vaccine approach.     

Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike

Forefoot strike is increasingly being adopted by runners because it can better attenuate impact than rearfoot strike. However, forefoot strike may overload the plantar fascia and alter the plantar fascia elasticity. This study aimed to use ultrasound elastography to investigate and compare shear wave elasticity of the plantar fascia between rearfoot strikers and forefoot strikers. A total of 35 participants (21 rearfoot strikers and 14 forefoot strikers), who were free of lower limb injuries and diseases, were recruited from a local running club. Individual foot strike patterns were identified through the measured plantar pressure during treadmill running. The B-Mode ultrasound images and shear wave elastographic images of the plantar fascia were collected from each runner. Two independent investigators reviewed the images and examined the plantar fascia qualitatively and quantitatively. The results demonstrated an overall good agreement between the investigators in the image review outcomes (ICC:0.96–0.98, κ: 0.89). There were no significant differences in the fascial thickness (p = 0.50) and hypoechogenicity on the gray-scale images (p = 0.54) between the two groups. Shear wave elastography showed that forefoot strikers exhibited reduced plantar fascia elasticity compared to rearfoot strikers (p = 0.01, Cohen’s d = 0.91). A less elastic fascial tissue was more easily strained under loading. Tissue overstrain is frequently related to the incidence of plantar fasciitis. While further study is needed for firm conclusions, runners using forefoot strike were encouraged to enhance their foot strength for better protection of the plantar fascia.     

Between Europe and the Balkans: Mapping Slovenia and Croatia's “Return to Europe” in the 1990s

This essay traces the ongoing discursive processes through which two former Yugoslav states — Croatia and Slovenia — framed their so-called “exit from the Balkans” and “return to Europe” throughout the 1990s. Applying Maria Todorova's framework of “Balkanism” to these two cases, the essay examines how leaders sought recognition as belonging to Europe, or Central Europe, by defining their respective national identities in opposition to Balkan or Yugoslav ones. What distinguishes Balkanism from other critical traditions such as Orientalism is that the Balkans are located in a distinctively liminal position: at the same time part of Europe as well as its antithetical periphery, the “other” within. This in-between position can often lead to contradictory identity constructions, whereby an insistence on concretizing one's Europeanness coincides with a certain awareness that this European status is never ontologically secure. The essay concludes by considering ways in which the Balkans can be re-imagined, reassembling diverse fragments of Balkan identity into a site for positive engagement and critique.