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Wu WJ, Hutton J, Zordan R, Ranse J, Crilly J, Tutticci N, English T, Currie J. Review article: Scoping review of the characteristics and outcomes of adults presenting to the emergency department during heatwaves. Emerg Med Australas 2023; 35:903-920. [PMID: 37788821 DOI: 10.1111/1742-6723.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
As a result of climate change heatwaves are expected to increase in frequency and intensity and will have detrimental impacts on human health globally. EDs are often the critical point of care for acute heat illnesses and other conditions associated with heat exposure. Existing literature has focused on heatwave-related hospitalisation and mortality. This scoping review aimed to identify, evaluate and summarise current literature regarding patient characteristics and outcomes of ED admissions from heatwaves. A scoping review of the literature was conducted using six databases: Medline, EMBASE, EMCARE, CINAHL, PsycINFO, and Scopus, using MeSH terms and keywords related to 'heatwave' and 'Emergency Department'. Articles were included if they were: published in English from January 2000 to August 2021, related to ED, and examined high temperature periods consistent with heatwave criteria. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). Thirty-one studies were included, mostly from the United States, Australia, and France. The study designs include retrospective case analysis, case-control, and time-series analysis. Eight studies examined known heatwaves, 21 used different criteria to identify heatwave occurrence, and two focused on heat-related illness. The selected articles display a moderate-high quality on MMAT. ED admissions for both heat-related illnesses and other conditions increased during heatwaves, with up to 18.5 times risk increase. The risk was elevated for all population groups, and substantially in the elderly, male patients with certain comorbidities, medications, or lower socioeconomic status. Outcomes including hospitalisation and mortality rates after ED admissions showed positive associations with heatwaves. The heatwaves resulting from climate change will place increasing demands on EDs providing care for increasingly susceptible populations. Significant public heatwave planning across multiple sectors is required to reduce the risk of overwhelming EDs with these patients.
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Affiliation(s)
- Wendy Jingyi Wu
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Rachel Zordan
- Education and Learning, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Naomi Tutticci
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Timothy English
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Currie
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Sampath V, Shalakhti O, Veidis E, Efobi JAI, Shamji MH, Agache I, Skevaki C, Renz H, Nadeau KC. Acute and chronic impacts of heat stress on planetary health. Allergy 2023; 78:2109-2120. [PMID: 36883412 DOI: 10.1111/all.15702] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Heat waves are increasing in intensity, frequency, and duration causing significant heat stress in all living organisms. Heat stress has multiple negative effects on plants affecting photosynthesis, respiration, growth, development, and reproduction. It also impacts animals leading to physiological and behavioral alterations, such as reduced caloric intake, increased water intake, and decreased reproduction and growth. In humans, epidemiological studies have shown that heat waves are associated with increased morbidity and mortality. There are many biological effects of heat stress (structural changes, enzyme function disruption, damage through reactive oxygen or nitrogen species). While plants and animals can mitigate some of these effects through adaptive mechanisms such as the generation of heat shock proteins, antioxidants, stress granules, and others, these mechanisms may likely be inadequate with further global warming. This review summarizes the effects of heat stress on plants and animals and the adaptative mechanisms that have evolved to counteract this stress.
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Affiliation(s)
- Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, California, Stanford, USA
| | - Omar Shalakhti
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, California, Stanford, USA
| | - Erika Veidis
- Center for Innovation in Global Health, Stanford University, California, Stanford, USA
| | - Jo Ann Ifeoma Efobi
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, California, Stanford, USA
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), Philipps-University Marburg, Marburg, Germany
- German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
| | - Harald Renz
- Institute of Laboratory Medicine, Member of the German Center for Lung Research (DZL), Philipps-University Marburg, Marburg, Germany
- German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Kari C Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Stowell JD, Sun Y, Spangler KR, Milando CW, Bernstein A, Weinberger KR, Sun S, Wellenius GA. Warm-season temperatures and emergency department visits among children with health insurance. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:015002. [PMID: 36337257 PMCID: PMC9623446 DOI: 10.1088/2752-5309/ac78fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Aaron Bernstein
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
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Huang Y, Song H, Cheng Y, Bi P, Li Y, Yao X. Heatwave and urinary hospital admissions in China: Disease burden and associated economic loss, 2014 to 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 857:159565. [PMID: 36265638 DOI: 10.1016/j.scitotenv.2022.159565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions. OBJECTIVES To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019. METHODS Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype. RESULTS A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk. CONCLUSION Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.
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Affiliation(s)
- Yushu Huang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hejia Song
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yibin Cheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Bi
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Yonghong Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiaoyuan Yao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Bhojak NP, Modi A, Patel JD, Patel M. Measuring patient satisfaction in emergency department: An empirical test using structural equation modeling. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2112440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nimesh P. Bhojak
- Department of Hospital Management, Hemchandracharya North Gujarat University, Patan, India
| | - Ashwin Modi
- Department of Commerce and Management, Hemchandracharya North Gujarat University, Patan, India
| | - Jayesh D. Patel
- Ganpat University - V. M. Patel Institute of Management, Mehsana, Gujarat, India
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Romaszko J, Dragańska E, Jalali R, Cymes I, Glińska-Lewczuk K. Universal Climate Thermal Index as a prognostic tool in medical science in the context of climate change: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 828:154492. [PMID: 35278561 DOI: 10.1016/j.scitotenv.2022.154492] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/17/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
The assessment of the impact of meteorological factors on the epidemiology of various diseases and on human pathophysiology and physiology requires a comprehensive approach and new tools independent of currently occurring climate change. The thermal comfort index, i.e., Universal Climate Thermal Index (UTCI), is gaining more and more recognition from researchers interested in such assessments. This index facilitates the evaluation of the impact of cold stress and heat stress on the human organism and the assessment of the incidence of weather-related diseases. This work aims at identifying those areas of medical science for which the UTCI was applied for scientific research as well as its popularization among clinicians, epidemiologists, and specialists in public health management. This is a systematic review of literature found in Pubmed, Sciencedirect and Web of Science databases from which, consistent with PRISMA guidelines, original papers employing the UTCI in studies related to health, physiological parameters, and epidemiologic applications were extracted. Out of the total number of 367 papers identified in the databases, 33 original works were included in the analysis. The selected publications were analyzed in terms of determining the areas of medical science in which the UTCI was applied. The majority of studies were devoted to the broadly understood mortality, cardiac events, and emergency medicine. A significant disproportion between publications discussing heat stress and those utilizing the UTCI for its assessment was revealed.
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Affiliation(s)
- Jerzy Romaszko
- Department of Family Medicine and Infectious Diseases, School of Medicine, University of Warmia and Mazury in Olsztyn, Poland.
| | - Ewa Dragańska
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Poland
| | - Rakesh Jalali
- School of Medicine, Department of Emergency Medicine, University of Warmia and Mazury in Olsztyn, Poland
| | - Iwona Cymes
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Poland
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Liu J, Varghese BM, Hansen A, Borg MA, Zhang Y, Driscoll T, Morgan G, Dear K, Gourley M, Capon A, Bi P. Hot weather as a risk factor for kidney disease outcomes: A systematic review and meta-analysis of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 801:149806. [PMID: 34467930 DOI: 10.1016/j.scitotenv.2021.149806] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. METHODS Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. RESULTS Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. CONCLUSIONS High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
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Affiliation(s)
- Jingwen Liu
- School of Public Health, The University of Adelaide, Australia
| | | | - Alana Hansen
- School of Public Health, The University of Adelaide, Australia
| | - Matthew A Borg
- School of Public Health, The University of Adelaide, Australia
| | - Ying Zhang
- Sydney School of Public Health, The University of Sydney, Australia
| | - Timothy Driscoll
- Sydney School of Public Health, The University of Sydney, Australia
| | - Geoffrey Morgan
- Sydney School of Public Health, The University of Sydney, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Australia
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Australia.
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Davis RE, Markle ES, Windoloski S, Houck ME, Enfield KB, Kang H, Balling RC, Kuehl DR, Burton JH, Farthing W, Rubio ER, Novicoff WM. A comparison of the effect of weather and climate on emergency department visitation in Roanoke and Charlottesville, Virginia. ENVIRONMENTAL RESEARCH 2020; 191:110065. [PMID: 32827524 PMCID: PMC7658034 DOI: 10.1016/j.envres.2020.110065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Compared with mortality, the impact of weather and climate on human morbidity is less well understood, especially in the cold season. We examined the relationships between weather and emergency department (ED) visitation at hospitals in Roanoke and Charlottesville, Virginia, two locations with similar climates and population demographic profiles. Using patient-level data obtained from electronic medical records, each patient who visited the ED was linked to that day's weather from one of 8 weather stations in the region based on each patient's ZIP code of residence. The resulting 2010-2017 daily ED visit time series were examined using a distributed lag non-linear model to account for the concurrent and lagged effects of weather. Total ED visits were modeled separately for each location along with subsets based on gender, race, and age. The relationship between the relative risk of ED visitation and temperature or apparent temperature over lags of one week was positive and approximately linear at both locations. The relative risk increased about 5% on warm, humid days in both cities (lag 0 or lag 1). Cold conditions had a protective effect, with up to a 15% decline on cold days, but ED visits increased by 4% from 2 to 5 days after the cold event. The effect of thermal extremes tended to be larger for non-whites and the elderly, and there was some evidence of a greater lagged response for non-whites in Roanoke. Females in Roanoke were more impacted by winter cold conditions than males, who were more likely to show a lagged response at high temperatures. In Charlottesville, males sought ED attention at lower temperatures than did females. The similarities in the ED response patterns between these two hospitals suggest that certain aspects of the response may be generalizable to other locations that have similar climates and demographic profiles.
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Affiliation(s)
- Robert E Davis
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Erin S Markle
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Sara Windoloski
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Margaret E Houck
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Kyle B Enfield
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
| | - Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois, Champaign-Urbana, IL, USA.
| | - Robert C Balling
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA.
| | - Damon R Kuehl
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - John H Burton
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Wilson Farthing
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Edmundo R Rubio
- Section of Pulmonology, Critical Care, Sleep and Environmental Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Wendy M Novicoff
- Departments of Public Health Sciences and Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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