CLINICALLY APPLIED MEDICAL GEOGRAPHY: ITS ROLE IN TRAVEL MEDICINE

Medical geography frequently contributes to public health, but rarely are medical geographic concepts applied in clinical settings. This article describes the application of medical geographic concepts to an academic travel and tropical medicine clinical service at University Hospital in Seattle, and reviews the role of a medical geographer in this particular clinical setting. Applied concepts of medical geography improve the quality of patient care for overseas travellers and recent immigrants to the United States.     

The structure of Neptune's upper atmosphere: The stellar occultation of 24 May 1981

Observations of the 24 May 1981 occultation of an uncatalogued star by Neptune made at the Cerro Tololo Inter-American Observatory have been analyzed to yield temperature profiles of Neptune's upper atmosphere for number densities near 5 × 10¹³ cm^?3. The mean temperatures at immersion (latitude ?56°) and emersion (latitude ?16°) obtained by numerical inversion were 140 ± 10°K and 154 ± 10°K, respectively. The immersion and emersion profiles are remarkably similar in overall shape, suggestive of global atmospheric layering. From the astrometry of the event, precise relative positions of Neptune and the occulted were obtained.     

Us public and private regulation of LNG transport

The authors examine the propositions that the private banking sector is capable of assuring that liquefied natural gas (LNG) projects are economically viable and that the insurance sector is capable of rating the relative risks of LNG projects to assure their operations are as safe as possible. If the markets could assure these outcomes, government regulation of LNG projects could be reduced. Reviews of public and private regulation of safety and economic viability suggest that the private sector cannot serve these functions adequately. Unless private financial and insurance enterprises are induced by government regulations to smooth their own operating cycles, private self-regulation of major new developments is unlikely to be effective. In the case of LNG, the red tape of governmental bureaucracy may have prevented the large-scale development of costly, potentially hazardous, white elephants, but for all the wrong reasons.     

Constraints on spatial variability in soft-sediment communities affected by contamination from an Antarctic waste disposal site

A small-scale (<500 m length) transect-based survey was conducted in December 1998 to examine the spatial distribution of soft-sediment communities and of concentrations of heavy metals and hydrocarbons in sediments in Brown Bay, adjacent to an abandoned waste dump, at Casey Station, Antarctica. Samples were taken along three transects at increasing distances (nine stations) from the shore-line waste dump. A gradient of contamination was detected, but concentrations of contaminants were very variable with "hotspots" or high levels of contaminants at some stations. Multivariate analysis revealed that the distribution of soft-sediment communities was distinctly different between the inner, middle and outer stations. Abundances of most taxa were very variable with few patterns apparent, but some fauna displayed an abundance gradient from the inner to the outer part of the bay. Many taxa had maximum abundances at outer stations and minimum at inner stations. Multivariate correlations between environmental variables and soft-sediment communities indicated that combinations of some metals (Cd, Cu, Sn, Pb) and grain size (mainly finer fractions, fine sands and coarse silts) were the variables that best "matched" the community patterns within Brown Bay. This study indicated that there were significant correlations between the presence of contaminants and the distribution and composition of soft-sediment communities over very small spatial scales.     

Tidal currents,energy flux and bottom boundary layer thickness in the Clyde Sea and North Channel of the Irish Sea

A high-resolution three-dimensional model of the Clyde Sea and the adjacent North Channel of the Irish Sea is used to compute the major diurnal and semidiurnal tides in the region, the associated energy fluxes and thickness of the bottom boundary layer. Initially, the accuracy of the model is assessed by performing a detailed comparison of computed tidal elevations and currents in the region, against an extensive database that exists for the M₂, S₂, N₂, K₁ and O₁ tides. Subsequently, the model is used to compute the tidal energy flux vectors in the region. These show that the major energy flux is confined to the North Channel region, with little energy flux into the Clyde Sea. Comparison with the observed energy flux in the North Channel shows that its across-channel distribution and its magnitude are particularly sensitive to the phase difference between elevation and current. Consequently, small changes in the computed values of these parameters due to slight changes of the order of the uncertainty in the open-boundary values to the model, can significantly influence the computed energy flux. The thickness of the bottom boundary layer in the region is computed using a number of formulations. Depending upon the definition adopted, the empirical coefficient C used to determine its thickness varies over the range 0.1 to 0.3, in good agreement with values found in the literature. In the North Channel, the boundary layer thickness occupies the whole water depth, and hence tidal turbulence produced at the sea bed keeps the region well mixed. In the Clyde Sea, the boundary layer thickness is a small fraction of the depth, and hence the region stratifies.Responsible Editor: Phil Dyke     

The impact of extreme heat on morbidity in Milwaukee, Wisconsin

Given predictions of increased intensity and frequency of heat waves, it is important to study the effect of high temperatures on human mortality and morbidity. Many studies focus on heat wave-related mortality; however, heat-related morbidity is often overlooked. The goals of this study are to examine the historical observed relationship between temperature and morbidity (illness), and explore the extent to which observed historical relationships could be used to generate future projections of morbidity under climate change. We collected meteorological, air pollution, and hospital admissions data in Milwaukee, Wisconsin, for the years 1989–2005, and employed a generalized additive model (GAM) to quantify the relationship between morbidity (as measured by hospital admissions) and high temperatures with adjustment for the effects of potential confounders. We also estimated temperature threshold values for different causes of hospital admissions and then quantified the associated percent increase of admissions per degree above the threshold. Finally, the future impact of higher temperatures on admissions for the years 2059–2075 was examined. Our results show that five causes of admission (endocrine, genitourinary, renal, accidental, and self-harm) and three age groups (15–64, 75–84, >85 years) were affected by high temperatures. Future projections indicate a larger number of days above the current temperature threshold leading to an increase in admissions. Our results indicate that climate change may increase heat-related hospital admissions in the US urban mid-West and that health systems should include heat wave planning.     

Non-uniform interhemispheric temperature trends over the past 550 years

The warming trend over the last century in the northern hemisphere (NH) was interrupted by cooling from ad 1940 to 1975, a period during which the southern hemisphere experienced pronounced warming. The cause of these departures from steady warming at multidecadal timescales are unclear; the prevailing explanation is that they are driven by non-uniformity in external forcings but recent models suggest internal climate drivers may play a key role. Paleoclimate datasets can help provide a long-term perspective. Here we use tree-rings to reconstruct New Zealand mean annual temperature over the last 550 years and demonstrate that this has frequently cycled out-of-phase with NH mean annual temperature at a periodicity of around 30–60 years. Hence, observed multidecadal fluctuations around the recent warming trend have precedents in the past, strongly implicating natural climate variation as their cause. We consider the implications of these changes in understanding and modelling future climate change.