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Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil: a small-area study
Aina Roca-Barceló ORCID: orcid.org/0000-0002-3681-65171,
Adelaide Nardocci2,
Breno Souza de Aguiar3,
Adeylson G. Ribeiro2,
Marcelo Antunes Failla3,
Anna L. Hansell4,
Maria Regina Cardoso5 &
Frédéric B. Piel1,6
Noise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo's Congonhas airport, Brazil during the period 2011–2016.
We selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution.
After accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting that road traffic air and noise pollution are potentially important confounders.
This study provides some evidence that aircraft noise is associated with increased risk of CVD and CHD mortality in a middle-income setting. More research is needed to validate these results in other LMIC settings and to further explore the influence of residual confounding and ecological bias. Remarkably, 60% of the study population living near the Congonhas airport (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), highlighting the need for public health interventions.
The health impact of noise pollution is a growing public health concern. Beyond the direct risk of noise to the auditory system, there is growing evidence of a wide range of physical and cognitive complications associated with the role of noise as a non-specific stressor [1–3]. An in-depth study conducted by the European Environmental Agency suggested that one in five Europeans were exposed to harmful noise levels and estimated that environmental noise was responsible for one million disability-adjusted life years (DALYs) in Europe only [4].
Noise levels are usually considered excessive when they exceed 65 dB (dB) during the day and 55 dB at night. A recent meta-analysis published to support the 2018 WHO Environmental Noise Guidelines for the European region [5] found sufficient and strong evidence linking road traffic noise to cardiovascular outcomes, particularly ischemic disease. Nonetheless, the quality of evidence for other noise sources, including aircraft noise, was found to be moderate to very low, accentuating the need for more and better quality evidence [6]. Accordingly, the WHO's guidelines were conservative, recommending levels below 45 dB and 40 dB for average daily noise (Ldn) and night-time exposure (Lnight), respectively for aircraft noise. To date, no such guidelines exist for non-European countries.
A recent systematic review summarizing current evidence on environmental noise and cardiovascular and metabolic effects [6] estimated aggregated relative risks of 1.05 (95% CI 0.95–1.17), 1.09 (95% CI: 1.04–1.15) and 1.14 (95% CI 1.03–1.25) per 10 dB LDEN for hypertension, ischemic heart disease and stroke in relation to aircraft noise. Again, most of the evidence identified came from studies conducted in European countries. For example, the HYpertension and Exposure to Noise near Airports (HYENA) study found a positive association between excess risk of hypertension and long term exposure to aircraft noise around six major European airports [7]. Evrard and colleagues found similar results for night noise around French airports where exposure-response relationship for hypertension was studied [8, 9]. In the UK, the Small Area Health Statistics Unit (SAHSU) conducted a small-area study of the risk of cardiovascular disease (CVD), stroke and coronary heart disease (CHD) associated with aircraft noise around Heathrow airport, the second busiest airport in the world by international passenger traffic [10], finding an association with CVD, CHD and stroke mortality and hospital admissions. Beyond Europe, Peters and colleagues reviewed evidence on aviation noise and cardiovascular health in the United States [11].
The issue of noise pollution in low- and middle-income countries (LMICs) has only recently started to gain more attention [12]. Assessing the health impact of aircraft noise in densely populated megacities in these countries would help quantifying the risks and the benefits of public health interventions to reduce exposure. It is of particular concern as large numbers of people with potential increased vulnerability to noise, including children, the elderly and individuals with chronic disease live in megacities [13, 14]. Additionally, those from deprived areas and from ethnic minority backgrounds, have been found to have higher exposures in European inner cities [14], which can contribute to further increases in health inequalities.
The city of São Paulo in Brazil provides a good example of the noise pollution challenges faced by megacities in LMICs. Congonhas airport - the second busiest airport in Brazil (22.7 million passengers in 2019) [15] - is located right in the middle of a densely populated area of São Paulo. Although studies have estimated exposure to aircraft noise pollution in São Paulo [16, 17], health impacts have so far not been assessed. According to the Brazilian Civil Aviation Regulation n° 161, areas with aircraft noise above 65 dB require restrictions in the land use and activities allowed, as well as the implementation of strategies to reduce ground noise levels [18].
This study aims to investigate the association between aircraft noise levels and CVD, stroke and CHD mortality risk among people living in the vicinities of the Congonhas airport, in São Paulo city, Brazil between 2011 and 2016.
Study methods
All procedures described here were approved by the ethics committee of the University of São Paulo (CAAE: 08337619.6.0000.5421) and conducted in accordance with Brazilian Law 13,709/2019 on protection of personal data.
Study area and population
We defined the study area based on existing noise contours for the Congonhas airport (see 2.3 below). We included 16 districts (171.8 km2) partially or entirely exposed to aircraft noise (Fig. 1a). Neighbourhoods were then defined using census tracts, the smallest geographic unit for which mortality and covariate data were available. Our study area covered 3259 census tracts (average: 542 inhabitants), excluding those with < 5 inhabitants or not populated, such as parks (Fig. 1b).
Study area (districts) and exposure bands based on area-weighted aircraft noise per census tract. a. Study area (dark grey) around Congonhas Airport (orange aircraft symbol) selected for being partially or entirely exposed to aircraft noise ≥50 dB. The light grey area represents the extent of the Municipality of São Paulo, Brazil. The boundaries shown are those of the districts; b. Area-weighted aircraft noise at census tract level across the study area. Hatched areas correspond to census tract with a population smaller than five individuals (e.g. parks), which have been excluded from the study
Population estimates at census tract level were not available for inter-censal years. Therefore, annual census-tract level population by age and sex were modelled from the official annual age- and sex-specific projected population data for administrative districts provided by the State-wise System for Data Analysis (SEADE) Foundation [19]. These estimates are sensitive enough to capture intra-urban variability [20], and therefore were considered adequate for our study area. For this purpose, we took the annual age- and sex-specific population change rate of each district and applied it to the 2010 census tracts' population as provided by the Brazilian Institute of Geography and Statistics (IBGE) [21]. This approach relies on the assumption that population changes at the census tract level followed similar trends to those at the district level. Given that our study area covered a densely populated area, substantial urban development and population growth were unlikely to have occurred. In the absence of more granular data, this was the best available approximation.
Outcome data
Data on deaths among population aged over 20 years old occurring between 2011 and 2016 in the study area were obtained from the Epidemiology and Information Department of the Municipal Health Secretariat of São Paulo (CEInfo/SMS-SP) [22]. Data were provided stratified by age, sex, year and underlying cause of death. For this study, we only considered the following underlying causes of death, as defined by the International Classification of Disease 10th edition (ICD-10) [23]: (i) CVD (ICD10: Chapter I); (ii) stroke (ICD10: I61, I63-I64), and (iii) CHD (ICD-10: I20-I25) [23]. Death certificates in Brazil are compulsory, and forms are filled in by physicians, with death causes coded according to the ICD-10. Health departments of each municipality collect information from the death certificates and record it periodically in the online national database, DATASUS [24]. Over recent years, the quality of death records in Brazil and São Paulo has improved remarkably providing the necessary information for defining specific underlying cause-of-death [25, 26].
Exposure data
Noise levels in Brazil are monitored and regulated by the Brazilian airport Infrastructure Company (INFRAERO, 2018). They are modelled using the integrated noise model (INM) version 7.0d developed by the US Federal Aviation Administration (FAA) and approved by the Brazilian National Civil Aviation Agency (ANAC) [27]. The model combines information on all aircrafts operating in 2017 including their flight patterns and times of arrival and departure as well as height, speed, and engine power. The modelled ground noise levels represented the day-night average sound level (Ldn); the average equivalent sound level during 24 h, with a penalty of + 10 dB for night-time noise (10 pm to 7 am) [28]. Flight restrictions are in place between 11 pm and 6 am in Congonhas airport, therefore reducing the number of night flights. Nonetheless, overnight flights still represented 8% of the total operating flights (~ 496 operations/day) and so, were included in the modelling.
INFRAERO data were available as Ldn contours categorized as follows: < 65, 65–70, 71–75, 76–80, 81–85, and > 85 dB (Fig. S1A, Additional File 1). As most of these bands fell within the perimeter of the airport, contours ≥65 dB were merged. To gain more granularity in lower noise contours, we used additional noise contours developed by Slama and colleagues using the same INM approach for 50, 51–55, 56–60, 61–65 and > 65 dB (Fig. S1B, Additional File 1). The contours, obtained directly from the authors (Slama, pers. com.), were based on flight information and supported by measurements taken at several monitoring stations around the airport. The INM software used to model noise has been accredited for use in national aircraft noise monitoring and used repeatedly in health impact assessments of exposed population [29] including in the landmark HYENA study [7]. The model validity was therefore considered strong enough to use its outputs in this epidemiological study.
Each of the contours represented a simplification of a continuous distribution of aircraft noise values across the contour area, where the upper and lower bands of the contour represented the minimum and maximum aircraft noise estimates in the distribution. We took the midpoint between the minimum and maximum values as a summary of the noise distribution for each band. As noise data are on a log scale (dB), we calculated the antilog values first.
We used an area weighting approach (Eq. 1) to harmonize the noise level at each census tract included in the study area for belonging to a district intersect any of our noise contours. Where AWnoisei is the area-weighted noise value for census tract i; areaij is the area of the census tract i intersecting the noise contour j; areai is the total area of census tract i, and antilog(noise)j is the antilog value of the noise for the contour j.
$$ {AWnoise}_i=\sum \limits_i^j\left(\left(\frac{area_{ij}}{area_i}\right)\times anti\log {(noise)}_j\right) $$
Firstly, we intersected the census tracts with the aircraft noise contours layer and estimated the area intersecting each contour. For a census tract, the proportion of area intersecting a given noise contour was used to weigh the contribution of that contour in the overall noise level for that census tract. Finally, weighted noise values were aggregated for each census tract and re-logged. The final output was an area-weighted annual average aircraft noise (dB) for each census tract. We classified these census tracts in the following 5 dB groups for congruency with the original contours categorization, i.e. ≤50 dB, > 50–55 dB, > 55–60 dB, > 60–65 dB, and > 65 dB.
We accounted for the following covariates in our modelling approach: area-level socioeconomic development, ethnic composition, area-level smoking, and noise and air pollution from road traffic. The spatial distributions of these covariates are shown in Fig. S2A-F, Additional File 1.
Socioeconomic development
To reflect the socioeconomic development of the census tracts in our study area, we used an adaptation of the Human Development Index (HDI), developed by the United Nations Development Program (UNDP) [30]. This synthetic measure of the degree of economic development and life quality across countries has been recurrently used to represent deprivation at finer spatial scales in Brazil, including municipalities (e.g. the Municipal Human Development Index, MHDI) [31] and census tracts in São Paulo [32]. It considers three dimensions: life expectancy, income and education, grouped by a geometric mean. As life expectancy is a health indicator, we have re-calculated the MHDI scores excluding that dimension, as a sensitivity analysis, using the same methodology. In addition to the continuous scores, we classified the census tracts in quintiles based on the distribution of the standard and modified MHDI scores across the study area. We evaluated the correlation between the standard and modified indicators using Pearson's correlation coefficient of their scores (0.9973, p-value< 0.005, Fig. S3, Additional File 1) and Spearman's rank order correlation for the quintile classification (0.9827, p-value< 0.005). The spatial distribution of both the continuous score and the quantile classification were also assessed (Fig. S4, Additional File 1), and showed similar patterns. Hence, we used the standard MHDI quantile classification to adjust the main model. The modified MHDI quantile classification was used in sensitivity analysis.
Ethnic composition
Census tract level ethnic composition was obtained from the 2010 census [21]. We calculated the proportion of Black (census term: Preto) and Mixed ethnicity (Pardo or Brown) groups combined, and the proportion of East Asians (Amarelo or Yellow) across our study area and in each census tract. No Indigenous (Indigeno) population was recorded in our study area. We then classified each census tract in one of three categories based on their deviance from the study area average using two different cut off points: the average (Black and Mixed population: 19.34%; Asian population: 4.09%) and two-fold the average proportion of each group. This resulted in three categories: (i) lower than the average, as an indicator of low prevalence of a certain ethnic group; (ii) between the average and twice the average, and (iii) higher than twice the study area's average, indicating a high concentration per area of people from the ethnic group under study.
Smoking prevalence
Data on individual smoking or prevalence of smoking across the study area were not available. However, over 90% of the lung cancer cases can be explained by cumulative smoking exposure [33]. Hence, lung cancer mortality (ICD-10: C33-C34) can be used as an indirect measure or proxy for cumulative smoking exposure. This approach has been used previously to estimate the global burden of mortality associated to tobacco [33, 34] and as an adjustment variable in epidemiological studies [10, 35]. Hence, we used smoothed lung cancer mortality (ICD-10: C33-C34) relative risk (RR) estimates between 2010 and 2016 modelled at the census tract level, as a proxy measure for area level smoking. We modelled this risk as a Poisson distribution using the Besag–York–Molliè (BYM) [36] model presented in Eq. 2.1 and 2.2. This modelling approach takes into account both structured and unstructured spatial dependencies. Where Oi is the number of observed and Ei the expected number of deaths at census tract i; λi is the risk of lung cancer death defined by ni and calculated as intercept (β0) added to the sum of the spatially structured residual (ui), modelled using the intrinsic conditional autoregressive (iCAR) specification coupled with an exchangeable random effect, and the unstructured residual (vi) modelled using exchangeability among all the census tracts.
$$ {\displaystyle \begin{array}{c}{O}_i\sim Poisson\left({\lambda}_i{E}_i\right)\\ {}{n}_i=\log \left({\lambda}_i\right)={\beta}_0+{u}_i+{v}_i\end{array}} $$
(S2.1)
Where ui and vi are modelled as follows:
$$ {\displaystyle \begin{array}{c}{u}_i\mid {u}_{-i}\sim Normal\left({\mu}_i+\frac{1}{\aleph_i}\sum \limits_{j=1}^n{a}_{ij}\left({u}_j-{\mu}_j\right),{s}_i^2\right)\\ {}{v}_i\sim Normal\left(0,{\sigma}_v^2\right)\end{array}} $$
The main assumption underlying this model is that the spatial distribution of smoking prevalence is highly associated to the spatial distribution of lung cancer mortality in our area of study. An exception to this assumption is the presence of one or more additional risk factors, which either (i) have a dissimilar spatial distribution to smoking, and/or (ii) are risk factors also for the outcome of interest in our main model (i.e. CVD, coronary disease and/or stroke). Both situations were deemed unlikely in our study area (see Discussion section for more detail).
Traffic noise and air pollution
To account for road traffic noise and air pollution levels, we used road traffic density as a proxy. Census tract road traffic density was defined as the sum of all vehicle counts per hour (vehicle/hour) along the length (meters) of all road segments (m2) falling within a given census tract. The dataset included routine data collected by the Traffic Engineering Company of São Paulo (CET) with additional traffic counts performed by the co-authors for a previous study using the same methodology [32] The streets were classified according to their function in traffic distribution as: expressway, arterial-1, arterial-2, arterial-3, collector-1, collector-2 and local. All traffic information was entered into a geo-coded street database. Traffic density was calculated for each census tract using the software ArcGIS ArcInfo 9.3 [37]. A full description of the methodology can be found elsewhere [32]. Data were categorized in quintiles based on the traffic density distribution across the study area, with the 5th quintile representing the highest road traffic density (Table 1).
Table 1 Census tract, population and cause-specific death counts (and %) per exposure and covariate levels
Correlations between covariates and noise exposure were assessed using Cramer's V-square test and bar plots (Figs. S5-S9, Additional File 1). In order to evaluate to risk of death from CVD, stroke and CHD associated with aircraft noise exposure, we fitted a Poisson regression model with a random effect term to account for over-dispersion and residual heterogeneity. For ease of interpretation, we used Ldn levels ≤50 dB as the reference category. The model was build using a forward stepwise regression approach, using the Akaike information criterion (AIC) for variable selection. The equation of the fully adjusted model is depicted in Eq.3.
$$ {\displaystyle \begin{array}{c}{O}_i\sim P\left({\lambda}_i{E}_i\right)\\ {}\log \left({\lambda}_i\right)={\beta}_0+{\beta}_1{noise}_i+{\beta}_2{Traffic}_i+{\beta}_3{Depriv}_i+{\beta}_4{Ethnos}_i+{\beta}_5{Smoking}_i+{e}_i\\ {}{e}_i\sim N\left(o,{\sigma}_e^2\right)\end{array}} $$
Oi number of deaths at census tracti.
Ei, expected number of deaths at census tracti, considering the control census tract year, age and sex-specific area population.
λi risk, mean number of deaths during the study period in census tracti.
β0 the intercept.
β1the regression coefficient (fixed effect) of the noise level effect (noisei) for census tracti.
β2the regression coefficient (fixed effect) of the total traffic air pollution quintile (Traffici) for census tracti.
β3 the regression coefficient (fixed effect) of the Index of Human Development quintiles (Deprivi) for census tracti.
β4 the regression coefficient (fixed effect) of the black and brown proportion variable (Ethnosi) for census tracti.
β5 the regression coefficient (fixed effect) of the quintiles of smothered lung cancer risk of death as a smoking proxy (Smokingi) for census tracti.
eij heterogeneity (level-1).
We compared our basic model (BM), adjusted only for age and sex (direct standardization), with our fully adjusted model (AM) which accounted for Black and Mixed ethnicity, standard MHDI 2010, our smoking proxy and road traffic density (Table 2, Fig. 2). In addition, we conducted six sensitivity analyses (SA) to test the following: the exclusion of road traffic density (SA1); the use of a modified version of the MHDI to exclude life expectancy (SA2); the incremental inclusion of covariates (SA3–4), and the inclusion of East Asian ethnicity in addition to Black and Mixed (SA5). AIC values for all models are shown in Table S1. We tested for linear trends across noise categories for the two main models (BM and AM) using linear regression. In addition, we estimated the risks per 10 dB increase to facilitate comparison with other studies using the WHO standard methodology (Table S2, Additional File 3).
Table 2 Relative risk (RR) and 95% confidence intervals (CI) for the association between CVD, stroke and CHD mortality and annual area-weighted average Ldn aircraft noise, between 2011 and 2016 around the Congonhas Airport in São Paulo, Brazil
Association between CHD, CVD, and stroke mortality and annual-population weighted average Ldn aircraft noise (relative to ≤50 dB) between 2011 and 2016. Adjusted model only shown. Black circles, relative risk estimates; solid likes, the 95%CI
Analyses were conducted separately for each cause of death considered. All analyses were conducted in STATA Software Version 13.1. and R software Version 3.6.3 .
Our study area was composed of 16 districts and 3259 census tracts, covering an area of 172km2. The average area of the census tracts within our study area was 50.8m2, with a standard deviation of 145.0m2 and an interquartile range of 38.42m2. We found that a total average population of 1,482,276 inhabitants (60% study population) were exposed to aircraft noise > 50 dB. Overall, 21,936 CVD related deaths were recorded in our study area between 2011 and 2016 (i.e. 3656 per year on average). These included 3601 deaths related to stroke and 8457 deaths related to CHD (Table 1). Approximately, 4.5% of the population were estimated to be exposed to the highest level (> 65 dB) of aircraft noise exposure.
According to the standard MHDI, 47.2% of our study area population lived in areas considered amongst the two lowest socioeconomic levels (24.2 and 22.9%, respectively). Deaths were more common in areas belonging to the second and third quintiles for all three causes. Mapping of the standard MHDI scores revealed an overall North-to-South gradient of development across the study area, with the North-Eastern areas being the most developed (Fig. S2A, Additional File 1). The standard and modified MHDI scores were highly correlated (Fig. S3, Additional File 1) and showed a similar spatial distribution (Fig. S4, Additional File 1). A total of 1388 census tracts, representing 49.1% of the population, had a proportion of Black and Mixed population over the average for the study area. Amongst these, 62.9% exceeded 2-fold the average. These areas were located mainly in the southernmost part of our study area (Fig. S2B, Additional File 1). The average road traffic density was 139.8 (interquartile range (IQR): 50.0; 145.8) vehicles/hour/m2 within our study area. The total traffic density was the highest in the centre and northern part of our study area (Fig. S2D, Additional File 1). Finally, most of the census tracts showed a smoothed lung cancer mortality risk between 0.95 and 1.05. Finally, Figs. S2E and S2F (Additional File 1) depict the residual relative risk of lung cancer mortality and its uncertainty. The highest risks (> 1.15) seemed to cluster, with low uncertainty, in the centre and south of our study area; whereas low risk areas (< 0.85) were concentrated in the northern part of our study area, albeit with high uncertainty.
Correlations between covariates are shown in Figs. S5-S9, Additional File 1. All the correlations with aircraft noise levels were weak, with V-Cramer estimates always under ≤0.12.Between covariate variables, we observed a relatively high correlation (V-Cramer = 0.70) between categories of Black and Mixed ethnicity population and MHDI 2010 quintiles, with census tracts with a high Black and Mixed ethnicity population percentage often coinciding with the poorest areas (i.e. 1th quintile MHDI 2010). The percentage of East Asians was negatively correlated with the proportion of Black and Mixed ethnicity (V-Cramer = 0.59) and positively correlated with the quintiles of MHDI 2010 (V-Cramer = 0.54) so that, areas with a high proportion of East Asians had lower Black and Mixed ethnicity population percentage, and higher quintiles of MHDI 2010. Correlations among other covariates were weaker (V-Cramer < 0.50).
The AIC values and description of the different models fitted in our forward stepwise model approach can be found in Table S1, Additional File 2. The best fit was for the fully adjusted model - AM (AICCVD = 17,838, AICstroke = 8778, and AICCHD = 12,627). Excluding road traffic density from the model (SA1) led to a worsening of the model's fit. Adjusting for the modified MHDI 2010 index (excl. Life expectancy) (SA2) also worsened the model fit (AICCVD = 17,853, AICstroke = 8783, and AICCHD = 12,639). Models only adjusting for age, sex and MHDI (SA3) or for age, sex, MHDI and smoking (SA4) also performed less well. The addition of the East Asian population covariate (SA5) did not explain much of the residual variability (AICCVD = 17,840, AICstroke = 8778, and AICCHD = 12,632).
The RRs associated with Ldn noise exposure for the four models presented are shown in Table 2. The results of the age- and sex-adjusted model only (BM) for CVD and CHD indicated risk estimates oscillating above and below 1 and wide confidence intervals. No significant linear trend was observed (p-trendCVD = 0.939, and p-trendCHD = 0.300). For stroke, risk estimates showed a reduction with increasing noise exposure, only significant for the second to highest level (RR> 60-65dB = 0.84, 95%CI: 0.70;0.99), and a non-significant test for trend (p-trendstroke = 0.096).
After adjusting for all the covariates considered (AM), the risk estimates for CVD and CHD were mostly above 1 and the confidence intervals narrowed slightly (Table 2, Fig. 2). Despite none of the risk estimates being statistically significant, we found clear and statistically significant positive trends with increasing noise exposure for CVD and CHD (p-trendCVD = 0.043, and p-trendCHD = 0.005). Risk estimates for stroke also increased after adjustment, yet they remained below one and showed wider confidence intervals. After removing road traffic density, the model (SA1) showed marginally higher risk estimates with slightly broader confidence intervals. The test for trend remained statistically significant for CHD (p-trendCHD = 0.020) but not for CVD (p-trendCVD = 0.087), suggesting that failing to adjust for road traffic related air and noise pollution (here captured through road traffic density) can lead to residual confounding or effect modification by background noise or synergistic/antagonistic effects, Fig. 2. This is further supported by the smaller AIC value obtained for SA1. Finally, adjusting for the modified MHDI (excl. Life expectancy, SA2) slightly reduced the effect size, yet it did not modify the overall direction and significance of the effect. Finally, we calculated the risk of death for each outcome per 10 dB increase to facilitate comparisons with other studies (Table S2, Additional File 3). Given that the noise exposure was modelled to capture 5 dB intervals we present the categorical models as our main analysis.
In this cross-sectional small-area study, covering a population of 3,5 million people living near the international Congonhas Airport in São Paulo, Brazil, we show that 60% of the study population (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), and provide suggestive evidence of a small dose-response association for CVD and CHD after adjustment for major confounders, with a statistically significant trend for both diseases, but not for stroke. This adds to the growing body evidence of the impact of noise pollution on the health of urban citizens and, to our knowledge, represents the first study to evaluate the effects of aircraft noise on the health of the population living around a major airport in Brazil, or even in a LMIC.
High levels of background noise pollution have previously been reported for São Paulo [38], including in areas surrounding the Congonhas Airport [16]. Noise has been recognised as a risk to human health, primarily based on available occupational and community level evidence [39–41]. The RRs identified in the present study for noise exposures > 65 dB for CVD (1.06, 95%CI: 0.94–1.20) and CHD (1.11, 95%CI: 0.96–1.27) were not statistically significant but consistent with RRs of 1.04 (95%CI: 0.98–1.11) per 10 dB for CHD published in a meta-analysis conducted by the WHO-European region [6], and later updated to 1.03 (95%CI: 0.98–1.09) by Vienneau et al. [42]. If we compare our estimates with specific studies, there exists a large variability in the risk estimates [10, 11, 43–45]. For example, our risks were lower than those found in Hansell et al's [10] earlier study which reported a RR of death of 1.16 (95%CI: 1.04; 1.29) for CVD, and 1.15 (1.02 to 1.30) for CHD in population living near Heathrow Airport in London, UK, although confidence intervals overlap. Other studies have found no evidence for CVD or CHD but a slight increased risk per 10 dB for stroke and heart failure (HRstroke:1.056 and HRHeart failure:1.027) [43] while, we did not find any association or statistically significant trend between aircraft noise and stroke in the present study.
The differences observed between our study and others in the literature can be attributed to multiple factors. It is possible that the level of risk relates to the number of noisy events, in which case the lower number of flights and volume of passengers transiting in Congonhas airport (21 million in 2019) compared to other studied airports, such as the Heathrow airport (75 million in 2018) in Hansell et al. [10], may partly explain these differences. It could also be due to the limited levels of aircraft noise around Congonhas airport during the night, because of local restrictions on night time flights. Results from recent large case-crossover study of CVD around Zürich Airport suggested that night-time aircraft noise may trigger acute cardiovascular mortality [44]. The risk of stroke is closely linked with age with incidence doubling with each decade after the age of 45 years. Over 70% of all strokes occur above the age of 65 [46]. As the population of Brazil (median age in 2018: 32.6 years) is much younger than the European population (median age in 2018 in the UK: 40.5), the smaller number of stroke deaths could possibly explain the lack of association observed in our study. Differences in the statistical approach and exposure assessment used, setting-specific conditions such as individual exposure determinants (e.g. housing, occupational exposure, individual risk factors), and residual confounding may also add to the variability observed in the risk estimates found in the literature.
The positive association between noise levels and CVD and CHD mortality has to be considered in the context of biological plausibility. Noise exposure has been repeatedly shown to increase blood pressure and elevate the risk of hypertension, a major risk factor for heart disease. According to the WHO review from 2019, there exists a 1.05 (95%CI: 0.95–1.17) relative risk of hypertension per 10 dB of aircraft noise [6]. Mechanisms involved in such physiological changes include both direct and indirect physiological changes involving the activation of the neuroendocrine system and increased production of stress hormones [47].
Despite growing evidence of the negative health effects of noise exposure, some methodological questions remain, in particular in relation to disentangling exposure levels and health impacts of source-specific noise levels [48]. Road traffic noise is a major source of noise and air pollution in São Paulo, with noise often exceeding the standard regulations [38]. When evaluating the effects of aircraft noise on health, extreme background noise levels could prevail over aircraft noise, raising concerns of confounding. To evaluate the contribution of each source in the total noise levels surrounding the Congonhas Airport, Scatolini and Pinto Alves (2015) measured noise levels uninterruptedly for 168 h between May and October 2009 in 15 sites around the airport [16]. They showed, that despite the high levels of background noise, aircraft noise was still an important contributor to the total noise. Héritier et al. investigated the effects of three major transportation noise sources—i.e. road, railway and aircraft—with cardiovascular mortality among 4.41 million participants of the Swiss National Cohort [43]. They observed a consistent association of all noise sources with myocardial infractions, particularly high for aircraft noise, demonstrating the independent impact of source-specific noise exposure. Another common co-pollutant is air pollution. In a follow up study, Héritier and colleagues [45] investigated the confounding effect of NO2 and PM2.5 on the same source-specific noise exposures, and vice versa. They found that the health effects of the air pollutants decreased upon adjustment for noise pollution. Again, this supports the independent effect of source-specific noise exposure and highlights the importance of correct confounder adjustment in epidemiological analyses. The inclusion of road traffic density in our analysis aimed to account for the potential confounding between different sources of noise and air pollution present in our study area. Our sensitivity analyses excluding road traffic density, suggest that road traffic related pollution is an important contributor to the mortality effects observed. However, it is important to bear in mind that traffic density is an unspecific indicator and also shows a slight spatial correlation with aircraft noise, which could lead to bias. Moreover, this approach only considers the effect of traffic noise and air pollution as a confounder and does consider the possibility of it acting synergistically or as an effect modifier as it has been suggested elsewhere [49, 50].
Our results were particularly affected by adjustment for Black and Mixed ethnicity and area-level deprivation. Evidence supporting the higher risk of CVD mortality among Black and Mixed ethnicity is unclear. The high spatial correlation with deprivation may partially explain the high contribution of this variable in our models, yet it deserves further investigation. Conversely, deprivation is a major health determinant and often positively correlated with mortality and exposure levels. In area-level epidemiological studies, it is common practise to use composite index, often developed for non-research purposes and so, its adequacy should be considered critically. In our case, the MHDI included as a component life expectancy which is directly associated to our outcomes. Nonetheless, our sensitivity analysis excluding life expectancy from the MHDI score showed almost identical results.
One remarkable finding of this study is that 60% of the study population living in the vicinities of the Congonhas Airport in São Paulo, Brazil, approximately 1.5million, was exposed to aircraft noise levels > 50 dB which is well above the WHO guideline recommendation of 45dBLdn [5]. Of these, 4% lived in areas exposed to > 65 dB, classified by the Brazilian Civil Aviation Regulation n° 161 as areas that should have restricted residential and land use due to serious health concerns [18]. This puts into evidence the failure to control noise levels around airports and to set living and land use standards within the recommended noise guidelines, stressing the urgency for action. Communities' concerns over this issue are visible and require urgent addressing. Concurrent to this study, in May 2019, São Paulo regulated the elaboration of its first road traffic noise map, the Urban Noise Map [51, 52], based on a large civil society movement, with public sectors, academic and technical bodies support. The results of the pilot study, evaluating a busy central area in the city, are now available online (http://www.mapaderuidosp.org.br/). It is aimed to act as a decision support tool for urban planning and ordering to support noise management in the city and help identify priority areas for noise reduction and preservation of areas with appropriate sound levels. Our findings highlight the importance of including aircraft noise in such evaluation tools. Failure to do so, could result in an underestimation of the areas and population affected by exceeding noise levels.
Finally, we recognize several limitations of our approach. Firstly, the exposure assessment was based on limited noise measurements and an acoustic model for 2017, combining both daytime and night-time noise. Personal exposure to noise levels is different at night-time and so, our model fails to distinguish such differences. Moreover, disruptions of the night cycle, either actively (i.e. conscious disruption of sleep) or passively, have been shown to have a larger impact on health, by causing a more pronounced increase in levels of stress hormones and vascular oxidative stress [53, 54]. However, only few flights take place overnight at Congonhas airport (approx. 8%) since flight restrictions are in place between 11 pm and 6 am. And so, we would expect its effects to be small. Secondly, the use of 5 dB categories is not standard which may hinder comparability with other studies and affect the power to detect associations. To facilitate international comparison, we estimated risk associated to 10 dB increases in noise exposure, which showed similar trends (yet not significant). Thirdly, other sources of noise and presence of co-pollutants such as air pollution may also affect our results. We incorporated data on road traffic density to address the confounding effect of noise and air pollution from road traffic. Finally, we did not account for other confounders including housing characteristics (e.g. construction type, window glazing, presence of air conditioning) or individual level covariates, including lifestyle factors such as smoking, and morbidity, as they were not available. Although we believe that the use of lung cancer as a proxy for smoking is appropriate in the absence of tobacco data – supported for example by the strong correlation identified between spatial smoking patterns from survey data with lung mortality smoothed estimates in a Swiss study [55] - the strength of this association in a large city such as São Paulo should be further investigated.
Overall, we believe our study adds to the existing knowledge in the field of noise exposure epidemiology and adds a new perspective on a LMIC setting. It also is the first study of the health impact of aircraft noise exposure in Brazil. It covers a large study population of 3.5 million residents with good exposure contrast and high-quality death records. We have been able to adjust for major covariates such as socioeconomic development, ethnic composition, smoking and road traffic density, albeit at small-area level rather than at the individual level. By using small geographies, such as census tracts, the small-area design attempts to provide a closer estimation to individual-level risks and to minimise the ecological fallacy [56]. Although the presence of residual confounding and ecological bias need to be considered further, small-area studies therefore offer a valuable epidemiological approach to assess health risks posed by environmental pollutants such as aircraft noise, as previously demonstrated in a study of the health impact of aircraft noise near Heathrow airport, London, UK [10].
In conclusion, our small-area study, conducted in a South American megacity, provided suggestive evidence that exposure to aircraft noise is associated with increased risk of CVD and CHD deaths. Aircraft noise pollution around the Congonhas airport is much higher in areas near the airport than WHO recommendations and public health measures to reduce exposure would nevertheless help reducing potential health impacts in local populations. In light of our findings, we recommend future noise models to include multiple noise sources to create comprehensive population noise exposure profiles of the city. As an example, we suggest to expand the municipality-wide Urban Noise Map currently in development stages to include aircraft noise. Such a tool would prove extremely useful for research purposes, for the evaluation of urban interventions, and for the formulation of public policies necessary to guarantee people health that live in areas exposed to high-level decibels.
Outcome data. The health data that support the findings of this study are not publicly available due the need of protection of individual information. Aggregated data by larger areas are however available from the Epidemiology and Information Department of the Municipal Health Secretariat of São Paulo (CEInfo/SMS-SP), https://www.prefeitura.sp.gov.br/cidade/secretarias/saude/epidemiologia_e_informacao/ [20].
Noise data. The noise exposure data that support the findings of this study are available from the Brazilian airport Infrastructure Company and by direct communications with Prof. Slama, but restrictions may apply to the availability of these data. Data are however available from the authors upon reasonable request and with permission of the Brazilian airport Infrastructure Company and Prof. Slama.
Population data. The age- and sex-specific population data for census tracts in our study area and modelled by the co-authors, are available from the corresponding author on reasonable request. The district-level age- and sex specific population projections and the total census tract population counts used to estimate this, are available from the State-wise System for Data Analysis (SEADE) Foundation Projecoes Populacionais, http://produtos.seade.gov.br/produtos/projpop [18], and from the 2010 Census Tract Population repository provided by the Brazilian Institute of Geography and Statistics (IBGE),https://www.ibge.gov.br/en/statistics/social/population/22836-2020-census-censo4.html?=&t=o-que-e [19], respectively.
Ethnic composition. The dataset analyzed during the current study is available in the 2010 Brazilian Population Census repository, https://www.ibge.gov.br/en/statistics/social/population/22836-2020-census-censo4.html?=&t=o-que-e [19].
Smoking proxy and traffic density. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
AIC:
Akaike information criterion
ANAC:
Brazilian national civil aviation agency
BCR:
Biomedical research centre
BYM:
Besag-York-Molliè
CEInfo/SMS-SP:
Epidemiology and information department of the municipal health secretariat of São Paulo
CET:
Companhia de Engenharia de Tráfego
CHD:
Coronary heart diseases
CVD:
DEM:
Departamento de Engenharia Mecânica
FAA:
FAPESP:
Fundação de Amparo à Pesquisa do Estado de São Paulo
HDI:
Human development index
HYENA:
HYpertension and exposure to noise near airports
IBGE:
Brazilian institute of geography and statistics
iCAR:
Intrinsic conditional autoregressive
ICD-10:
International classification of diseases 10th edition
INFRAERO:
Brazilian airport infrastructure company
IQR:
Interquartile range
Ldn:
Day-night average noise level
LMIC:
Low and middle-income countries
MHDI:
Municipal human development index
MRC:
Medical research council
NIHR:
National institute for health research
RR:
Relative risk
SAHSU:
Small area health statistics unit
SEADE:
State-wide system for data analysis
São Paulo researchers in international collaboration
UNDP:
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The authors would like to thank Professor Jules G. Slama, Departamento de Engenharia Mecânica (DEM), Federal University of Rio de Janeiro for sharing unpublished noise contours with us.
This study was supported by a São Paulo Researchers in International Collaboration (SPRINT) grant to Fred B. Piel (2017/50189–3) funded jointly by Imperial College London and the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). This work was also partly supported by the MRC Centre for Environment and Health, which is funded by the Medical Research Council (MRC/S019669/1, 2019–2024) and by the National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Exposures and Health, a partnership between Public Health England (PHE) and Imperial College. Infrastructure support for the Department of Epidemiology and Biostatistics was provided by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC). Anna L. Hansell acknowledges funding from the NIHR Health Protection Research Unit in Environmental Exposures and Health, a partnership between Public Health England, the Health and Safety Executive and the University of Leicester. The views expressed are those of the authors and not necessarily those of the NIHR, Public Health England, the Health and Safety Executive or the Department of Health and Social Care.
UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
Aina Roca-Barceló & Frédéric B. Piel
Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
Adelaide Nardocci & Adeylson G. Ribeiro
Epidemiology and Information Department, Municipal Health Secretariat of São Paulo, São Paulo, Brazil
Breno Souza de Aguiar & Marcelo Antunes Failla
Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
Anna L. Hansell
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
Maria Regina Cardoso
National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Exposures and Health, London, UK
Frédéric B. Piel
Aina Roca-Barceló
Adelaide Nardocci
Breno Souza de Aguiar
Adeylson G. Ribeiro
Marcelo Antunes Failla
ARB: Conceptualization, Methodology, Formal analysis, Data curation, Writing – Original draft, Visualization. AN: Conceptualization, Methodology, Formal analysis, Writing – Review & Editing, Funding acquisition. BSA: Data curation, Writing – Review & Editing. AGR: Writing – Review & Editing MAF: Data curation, Writing – Review & Editing. ALH: Conceptualization, Writing – Review & Editing. MRC: Conceptualization, Methodology, Writing – Review & Editing, Funding acquisition. FBP: Conceptualization, Methodology, Formal analysis, Writing – Review & Editing, Visualization, Supervision, Project administration, Funding acquisition. All authors read and approved the final manuscript.
Correspondence to Aina Roca-Barceló.
Additional file 1: Fig. S1.
Noise contours. A. Ldn noise contours > 65 dB as provided by the Brazilian Airport Infrastructure Company (INFRAERO) for Congonhas airport, São Paulo, Brazil. B. Noise contours (yellow) as estimated by Prof. Jules G. Slama (personal communication). Districts selected for being partially or entirely exposed to noise levels are shown in dark blue. The grey outline illustrates the boundaries of the Municipality of São Paulo. Fig. S2. Maps of covariates within our study area, São Paulo, Brazil. Spatial distribution of: A. the quintiles of the Index of Human Development (IHD); B. Proportion of Black and Mixed population; C. proportion of East Asian population; D. Quintiles of total traffic density as a proxy for air pollution E. Smoothed lung mortality risk; and F. Posterior probability of lung mortality risk. Fig. S3. Scatter plot between the standard MHDI 2010 score and the modified MHDI 2010. The modified MHDI was re-calculated excluding the life expectancy indicator using a geometric mean. The red line, the fitted linear regression. Fig. S4. Spatial distribution the standard and modified MHDI 2010. The standard (left) and modified (right) MHDI for both the continuous score (top) and quintiles classification (bottom). Fig. S5-S9. Correlations between covariates. The correlation coefficient and p-value of the Cramer's V-square test are shown. V Cramer = 1 denotes strong association and V Cramer = 0 denotes weak association. Bar plots indicate the number of census tracts belonging to each category for a given covariate against each of the other covariates.
Additional file 2: Table S1.
Model selection. Information regarding the forward stepwise regression models fitted including model name, description and Akaike information criterion (AIC) for cardiovascular diseases (CVD), stroke and coronary disease. Shaded those presented in the manuscript. Bolded the model with the best fit; shaded, models fully presented in the full text.
Relative risk (RR) and 95% confidence intervals (CI) for the association between CVD, stroke and CHD with 10 dB increase in noise. Adjusted model only (i.e. Adjusted for age and sex (standardization) + smoking proxy + IDHM 2010 + Black and Mixed ethnicity + road traffic density). Trends estimated using WHO standard methods, i.e. generalized least square estimation.
Roca-Barceló, A., Nardocci, A., de Aguiar, B.S. et al. Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil: a small-area study. Environ Health 20, 59 (2021). https://doi.org/10.1186/s12940-021-00746-7
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Nestled on Saba Island's Troy Hill in the Netherlands Antilles, this all-suite resort offers stunning views of the Caribbean Sea as well as luxurious spa services and enjoyable facilities. Queens Garden Resort features suites with flat-screen TVs and iPod docking stations. Guests can relax with a drink from the minibar while using the free wireless internet access. Select suites offer a private hot tub with views of the ocean. After working out in the 24-hour fitness center, guests can relax with massage in the full-service spa. Guests can also spend the day beside the outdoor pool, after taking an on-site yoga class. The restaurant at the Queens Garden serves the freshest seafood, finest meats and organic vegetable and herbs, which are grown in the resort's garden. After a delicious meal, guests can relax with a cocktail at the outdoor lounge bar.


Storage Insurance for your goods - added protection and peace of mind.
Plan for the unexpected that may occur to your valuables. Self-Storage facility operators do not insure against their damage or loss. It is your responsibility to insure your goods. Although many policies do, do not assume that your homeowner's policy provides you with full or partial coverage for items in storage. Please contact your insurance agent or broker for coverage details for off-site insurance of your valuables. Please contact us for more information.


Very nice mensual cup. Started used few months back. 1st month it was difficult to get adjusted and from 2nd month had issues only 1-2 days and now I'm so comfortable with it that I hate wearing pads. No rashes and it's so comfortable. Pls avoid pads as they harm the environment and also get you rashes.
5.0 out of 5 starsEvery girl/woman SHOULD buy this..!!!!
One of the best things that happened to my menstrual life😄....i cant go back to pads now.!!! Even if want to. I can write page long essay on the ease and the comfort and all the better things you get to feel with this.!!! I wish there was more insight and more marketing on this product so that the number of users will increase.. its not only about a different method of using .but also about environment ans how much waste you are stopping by shifting from pads to cup.!!!!
Perfect replacement for the She cup I used for 4 years and misplaced. No complains whatsoever.
Loved the product. Am not going back to sanitary napkins.
A bit disappointed with the packaging. The cup did not come in a sealed pack which made me very skeptical tp use it.
I was hesitant about ordering this costly cup but want to go for it as I have heard very good reviews about it..and yes it's really good, no leaks easy to use and comes with cloth bag to keep when not in use.
Takes time getting use to.
A little difficult to insert and remove initially. But once y get a technic shudnt be a problem.
Be the silicon could be a little soft.
Will definitely recommend it to everyone. Soap strips were missing but is replaced with a soap bar. Would definitely prefer soap stripes over soap bar.
4.0 out of 5 starsI am happy with the product.
Very good product. Using from 4months. Very much comfortable, easy to use, clean and tension free. Value for money product. Don't need to buy sanitary pads anymore. I am happy with Rustic art menstrual cup.
The cup is a revolutionary product, no doubt. After 1-2 days of using a cup for the first time, i am totally comfortable with it. No leakage, no worries on waste mangement, no irritation and wet days. It's super cool!


There are many additional regulations about relocating, catching and handling the possums, so hiring a possum control professional is the safest bet for you. Book the Fantastic wildlife handlers and make sure the issue is properly taken care of .... The Maribyrnong River Main (MRM) carries sewage from six major City West Water catchment areas to the Western Treatment Plant. To protect the integrity of the pipe and reduce the risk of the sewer failing in the future, Melbourne Water needs to reline this sewer main.
dead animal removal melbourne A common occurrence in the colder months is for animals such as possums, rats and mice to venture into our homes in search of a suitable location to live. Our subfloors, walls and roof voids provide perfect harbourage for these pests.
There are many additional regulations about relocating, catching and handling the possums, so hiring a possum control professional is the safest bet for you. Book the Fantastic wildlife handlers and make sure the issue is properly taken care of .
The Edway Traffic Control training course RIIWHS205D provides the required Vic Roads competency for persons involved in controlling traffic using a stop-slow bat. Traffic Management Melbourne VIC Roads training requirements, all field personnel responsible for setting out, implementing and/or monitoring a Traffic Guidance Scheme must have taken a course in Traffic Guidance Scheme implementation.


text:
Tyrone Roberts, né le  à Grafton, est un joueur de rugby à XIII australien évoluant au poste de demi de mêlée, de demi d'ouverture, de talonneur ou d'arrière dans les années 2010.

Il fait ses débuts en National Rugby League lors de la saison 2014 avec les Knights de Newcastle où il y devient titulaire. Il rejoint en 2016 les Titans de Gold Coast.

Biographie

Palmarès

 Collectif :
 Finaliste de la Super League : 2018 (Warrington)
 Finaliste de la Challenge Cup : 2018 (Warrington).

En club

Statistiques

Notes et références

Lien externe

Joueur australien de rugby à XIII
Naissance en juin 1991
Naissance en Nouvelle-Galles du Sud

redpajama_set_name: RedPajamaWikipedia


text:
Hluchov är en ort i Tjeckien.   Den ligger i regionen Olomouc, i den östra delen av landet,  km öster om huvudstaden Prag. Hluchov ligger  meter över havet och antalet invånare är .

Terrängen runt Hluchov är platt åt nordost, men åt sydväst är den kuperad. Terrängen runt Hluchov sluttar brant österut. Den högsta punkten i närheten är  meter över havet,  km väster om Hluchov. Runt Hluchov är det tätbefolkat, med  invånare per kvadratkilometer. Närmaste större samhälle är Olomouc,  km öster om Hluchov. Trakten runt Hluchov består till största delen av jordbruksmark.

Trakten ingår i den hemiboreala klimatzonen. Årsmedeltemperaturen i trakten är  °C. Den varmaste månaden är juli, då medeltemperaturen är  °C, och den kallaste är december, med  °C. Genomsnittlig årsnederbörd är  millimeter. Den regnigaste månaden är juni, med i genomsnitt  mm nederbörd, och den torraste är mars, med  mm nederbörd.

Kommentarer

Källor

Externa länkar

Orter i Olomouc (region)


Water Wizards Irrigation, LLC was founded in 2003 by Jack Barry. Water Wizards Irrigation LLC is a family owned and operated company that specializes in residential and commercial lawn irrigation and water features. Water Wizards Irrigation LLC offers every aspect of lawn sprinkler service. Spring activations, routine maintenance, repair, winterization and Connecticut-licensed backflow testing. We also offer design and new installation of lawn sprinkler systems, lawn sprinkler system components and water features, such as ponds, waterfalls and other various water features.
Healthy green grass is the goal. Homeowners that have sprinkler systems know this. In summers where this is little rain and warm temps, grass turns brown and sometime dies. Having your own irrigation system stops this, keeps the dust down and improves the value of your home. It's more efficient than dragging the hose around and waste less water in the process. Automatic wireless rain sensors are installed to control unwanted watering and over watering. Irrigation systems promote healthy root systems and keep weeds under control, along with regular weed and pest control applications.
What are some of the basic options that people have when it comes to irrigation design?
Design of your sprinkler system is done by our professional design staff based on what the homeowner's needs are. We will make professional recommendations based on prior experience and careful overview of your yard. There are many options such as remote controls, WiFi systems, pest and fertilization control right through your sprinkler system. Stainless steel sprinklers that are heavy-duty drip systems for your delicate flowers and gardens, and micro drip for those hanging plants.
It's not as expensive as you think! An automatic sprinkler system can actually save you money on your water bill. Also, it does very little damage to your lawn upon installation.
What kind of maintenance do lawn and garden irrigation systems need after they're installed?
Your basic routine maintenance is spring activation, winterization and backflow testing, which is required by the state of Connecticut and most others. Custom maintenance plans are available to suit your needs.
Do you have any tips to help maintain healthy, green grass (or a thriving garden) without an overly expensive water bill?
Water deeply, not frequently. The longer and harder your water cycle is, the better. Everyday short water cycles don't help with root penetration. Water your delicate plants from below where it counts. No wasted water on plant or tree tops. Have a professional tune up your system to maintain perfect adjustments and matched precipitation.
If you need to have one of the best solution http://fixwindows10connections.com by which you can smoothly know how to fix connections for bluetooth audio devices and wireless displays in windows 10.


Last edited by Nat! on Wed Sep 15, 2004 12:53 am, edited 1 time in total.
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Fixed. Thanks for the hint.
You write in regard to the standard dyld stub: "I think this could be done a whole lot better".
I agree, but can it be done without breaking binary compatibility? The guy who designed DYLD wasn't an expert on position-independent code, and this stub has already been improved at least once prior to the current version you dissect in the article. But, it's embedded in the file format.
whitenoise wrote: I agree, but can it be done without breaking binary compatibility?
I think it should be possible to define a bit in the flags of the mach-o header, to alert that this is a new kind of object file. Or one could also use a different filetype. This would be only upward compatible, but the different filetype could preclude launches on not-supported platforms.
Well, I don't think I will really write a whole article on the subject. The topic is too narrow and I would actually have to do some serious coding, for which I am too lazy.
It would be twice as fast and it is half the size.
If the dynamic linker can generate a table with addresses it could also just generate or patch that code. Incidentally that code just takes 16 bytes, which means proper alignment (see below) for free without waste.
Because of prebinding the linked addresses wouldn't usually change, so this could be set already at link time and it usually wouldn't be necessary to change the stub code at all. Therefore there shouldn't be any penalty compared to the current state of affairs.
Now shared libraries can be relocated and therefore addresses can change. To accomodate that it would be required that the stubcodes reside on their own page(s), then map a fresh page at that address and write in the required new stubs. Finally clear the instruction cache and maybe fiddle with page protection and I think it should work.
There is a problem that just bit me now, in a NSArray mapping method. I have an array mixed with objects that implement a certain method (lets say it's @selector( name)) directly and some, that implement them indirectly via forwarding (@selector( forwardInvocation:) -> forwarding it to another object).
If a class does not implement a method, then class_lookupMethod will return _objc_msgForward. This will in turn do the forwarding steps.
Unfortunately it is either the case that _objc_msgForward is written in a way, that it expects objc_msgSend to be called beforehand (setting the r11 register properly) or the gcc compiler 4.0 does not emit proper function pointer call code, because it does not set the r11 register then. I am undecided, but leaning towards the first conclusion.
Performance with forwarding ain't so great anyway, so the loss in that case should be acceptable.


Creating a premium events site for your members, like Meetup.com, Ticketmaster or EventBrite, isn't out of reach with WordPress – and is easily done when you pair our Events+ and Membership 2 Pro plugins.
Integrating these plugins allows you to create a site – or network – where visitors can sign up to view event information and buy tickets. You could even create a premium membership subscription for members who want to create their own events, and let free members upgrade to a premium subscription to access this feature.
In this article, I'll walk you through how to create a member's only events site on a single or Multisite installation. I'll also go through our Events+ and Membership 2 Pro plugins in a bit more depth, and show you how to create free and premium memberships, how to limit features for free accounts, and how to make them available to premium members only.
You can create and manage all your events with Events+.
With Events+, you can create and manage events on your WordPress site and sell tickets for them, too.
You can also create stunning events pages that match your branding and seamlessly blend in with the look and feel of your site.
You can share events on your single or Multisite install and update your visitors on what's happening. You can even earn extra income by selling tickets.
Create a profitable membership site with Membership 2 Pro.
What is Membership 2 Pro?
With Membership 2 Pro you can build a scalable subscription-based membership site – and everything you need to run it is included.
You can create just about any kind of membership site you want with standard, free, guest, and drip content membership types.
You can limit the Read More section of posts, offer digital reading subscriptions just like the New York Times, or create a full-blown social media site.
Membership 2 Pro is great on its own for limiting any content you want to certain members, but when you integrate Events+, you can create a complete solution for a premium events site.
First, install and activate the Events+ and Membership 2 Pro plugins. You can install them on a single site, network-wide or site-by-site in your network. It all depends on the setup you're trying to achieve.
For more details on how to install and activate plugins in WordPress, check out our guides Installing WordPress Plugins and Activating WordPress Plugins Network Wide.
Configure your memberships and set up the ones you need for your site. For details on how to do this, check out Build an Online Community With WordPress and Membership 2 Pro.
You can create both free and premium memberships and limit creating events to premium members only while allowing both types of accounts to purchase tickets. You can also add other premium features as you see fit.
It all starts with setting up the Events+ plugin.
Go to Events > Settings in your admin dashboard and enter the slug where you want events displayed. For example, if you enter concerts, new events will be displayed at www.your-site.com/concerts/new-concert and if you were to go to www.your-site.com/concerts, you would see an archived list of all the events that have been created to date.
Enter the slug where you want your events to be located.
Also, check the first box so you can accept payments and, depending on your needs, check the boxes to enable Facebook and Twitter logins as well as public RSVPs. If you enable this last option, members can click a button to let you or the event organizer know whether they are or aren't able to attend the event.
When you're happy with your selections, click Save Changes at the bottom of the page, then go to the next menu item to enter the appearance settings where you can choose an optional style template. If you chose to allow Facebook and Twitter logins, you can enter the API settings for those social media sites on the API Settings tab.
You can get more information on setting up this plugin by checking out the Events+ plugin's usage guide.
Next, enter your PayPal email address on the Payment Settings page to be able to accept ticket payments. You can also integrate the MarketPress eCommerce plugin to be able to access many more payment gateways.
If you want your members to be able to get event tickets for free when they sign up for a free or premium account, you can skip the payment settings.
You can activate many of the over 40 add-ons.
Now, go to the Add-ons tab and activate the Capabilities and Front-End Editing extensions. Keep in mind that both of these add-ons are optional.
The Capabilities add-on lets you edit the default WordPress user roles to include access to event features.
The Front-end editing add-on provides the option of creating and editing events on the front-end, rather than in the dashboard.
You can edit the user roles through the Capabilities add-on or through Membership 2 Pro so choosing which method you use to manage your membership features all depends on how you want your members to access the features you enable, how you want to organize the back-end, and where you are most comfortable managing these features in the future. No matter which option you choose, the end result should be similar.
You can also enable the Events Maps Options add-on to display maps for events if you also install and activate our Google Maps plugin. There are many more add-ons for you to choose from as well that majorly extend the functionality of Events+, so don't be too quick to pass them over without taking a good look first.
Next, go to Events > Shortcodes to see the list of available shortcodes and options you can use on your posts or pages or anywhere else they can fit with your site's design. For example, you could use the [eab_calendar] shortcode on a page you create to display a calendar of all the current events that are open to selling or reserving tickets.
When you're happy with the settings you've entered, you can use the Membership 2 Pro settings to protect the event pages and anything else you would like by protecting the URL or by making use of the other protection settings. If you're not sure how to do this, you can check out the Membership 2 Pro usage guide.
When you've protected all the content you need for your specific situation, you can change the user roles for your memberships so that only premium users can create events. There are also three ways you can accomplish this so you can go ahead and choose the method that works best for your site.
Enable the Capabilities add-on under Events > Settings > Add-ons if you haven't already and click the new Event Capabilities tab that's displayed. Choose the role you want to edit to reveal a list of options.
You can edit user role capabilities to include event features.
The subscriber role is the default role that's given to members when they sign up so you could keep the settings as-is without adding additional capabilities. Instead, you could add features to the contributor role since the default settings aren't set as high as editors or administrators. though, it's up to you and what you need for your site.
There's also a checkbox toward the bottom of the page to restrict the media files to the author only and you can check it if you want to let only the person who uploaded event media to be able to use and edit the content.
When you're done making your selections, click the Save Changes button on the bottom right and go to Membership 2 > Add-ons. Find the Member Capabilities add-on and click the toggle button to enable it.
Then, go to Membership 2 > Protection Rules > User Roles and hover over the user role you edited in the Events+ settings. Click the Modify Access link that appears, then select the membership level you want to apply to the adjusted user role.
You can choose a user role to be applied to a membership of your choice.
Your changes are saved automatically and once completed, all visitors who sign up for the membership you selected should be assigned the user role you picked. This means that these members have access to the events features you selected for the user role you edited.
If you prefer to keep all the user role settings in one place, you can adjust them all within the Membership 2 Pro plugin settings.
Instead of activating the Capabilities add-on in the Events+ settings, go to Membership 2 > Add-ons and click the toggle button on the Admin Side Protection extension.
Adding Advanced Capabilities gives you more options to protect.
You can enable the Member Capabilities add-on and click the Details link to display an additional option. Enable the option for Advanced Capability Protection.
Go to Membership 2 > Protection Rules > Admin Side and scroll to the events links that are displayed in the dashboard.
Hover over the event pages you want to protect and click the Modify Access link, then choose the membership whose members you want to have access to this page.
You can protect the Events+ pages that appear in the dashboard.
You can also add other user role capabilities to your memberships by going to Membership 2 > Protection Rules > Capabilities. Hover over the capability you want to make available to users and click the Modify Access link, then choose the membership where you want to add the access.
You can choose to assign advanced capabilities to memberships.
It's important to note that you need to be fully aware of what each of these advanced capabilities actually does to your site and network. It's possible to give too much access or not enough to your members. You could end up giving access to features you don't want users to be able to change, such as your site's theme or page editing to name a few since all the capabilities to your site are listed on this settings page.
You may also accidentally give too few features to a membership which could severely cripple your users' ability to get around and use your site so be sure the changes you choose are in fact the ones you need before applying them.
Once you're done, your visitors who sign up for a membership on your site should have access to the features you selected.
It's possible to enable event editing and creation on the front-end so your users don't need to have access to your site's dashboard in order to take part in managing events on your site.
Go to Events > Add-ons and activate the Front-end editing option. You can also go to the Events > Shortcodes page to find the [eab_event_editor] shortcode and all the additional options that are available to add front-end event management to your site.
Create a new page and include the [eab_event_editor] shortcode in it with any options you would like to add. Publish the page, then protect it with the settings in the page editor or under Membership 2 > Protection Rules > Pages.
Your new fron-end event managing page should have all the features your members need to create events while being styled to fit your site's design so it fits seamlessly with your business.
The front-end editing add-on enabled on the TwentySixteen default theme.
As long as you grant access to the event managing page to your premium membership type, your free members won't be able to access this page, but your premium members will and they can easily create events on their own.
Integrating our Events+ and Membership 2 Pro plugins lets you create a scalable premium events site so you can give your members special access to event creation tools while earning extra income from enabling this exclusive feature.
You can even use these plugins to edit the default WordPress user roles and capabilities to further customize your memberships and give access to advanced features for your premium members.
For more information on user roles and capabilities and how to edit them with code, check out one of our other posts WordPress Roles and Capabilities Explained (Plus Code-Based Tweaks).
Now that you have everything you need to create your own events site, what features and capabilities do you want to add to your site or network? What are your plans for these plugins and your membership site? Feel free to share your thoughts in the comments below.
Your feature request has already been logged from your other comments so you don't have to worry about letting us know you need this feature. We're reviewing it and seeing what we can do about it.
Thanks for letting us know this is so important to you! We really appreciate the feedback!
Congrats for the article! Very completed and well explained.


Your home is an investment, and ensuring that it's well-maintained and cared for is a large part of protecting that investment. Whether you're building a new home, remodeling an old home, changing the style of your home, or need repairs, at A-Team Construction and Remodeling, we want to be your siding company of choice to help make and keep your home beautiful. As insurance approved siding contractors in Blaine, Minnesota, we work with insurance companies to negotiate pricing and file claims so that the most you have to worry about is choosing your siding and making sure we're giving you the service you want and deserve.
Any form of home repair is unwelcome, and siding is no different. Though siding repairs might not sound or seem as serious as roofing repairs, your siding helps keep your home protected from the elements in addition to making it look beautiful, and when your siding is compromised, your home is at risk, as well. To make sure you don't leave your home unprotected, if you have trouble with your siding, you should have it checked out as soon as possible – especially at this time of year, when moisture can build up beneath siding and when siding can be ripped away and broken by winter storms.
Whether you need us to match your current siding or replace it, let us know, and we'll be happy to tell you about the benefits and disadvantages of every type of siding so that you can make the best choice about siding for your home and your budget.


Can I get an Amen? It happens to all of us. I'll explain why it happens in a moment, but for now, let's just take a quick look at what transpired in that conversation.
You, the leader, hired someone to do a job. You hired them in order to create leverage (or else you'd be doing that job) and you did that by delegating that work to them.
They ran into a problem that was their responsibility to solve. Rather than coming up with a solution to a problem that was/is their responsibility to solve, they came to you for help.
The moment you offered to help and said, "Let me think about it (or let me make a call) and I'll get back to you," is the moment the reverse delegation was completed. Why? Because in that moment, your roles changed. No longer are they responsible, you are. No longer are they reporting back to you, you're reporting back to them. No longer are they working on a solution, they're waiting for you to get back to them. That's why this is called reverse delegation. You delegated a task. They ran into a problem. Then they gave it back to you and now they're waiting on you. Everything about that whole scenario is wrong.
So, how can you turn this around and eliminate reverse delegation from occurring?
The first step to fixing anything is to own that you're the problem. So, why do so many of us allow reverse delegation to occur? Well, here are a few different reasons.
We like solving problems. For many of us, we get excited about solving problems because it's an intellectual challenge (i.e. a puzzle to be solved).
We like to feel needed. For some of us, we get an emotional high from helping another person who has a problem. This is especially true when the person is doing a job we used to do.
We like to help people. For some of us, helping others is a part of our ethical makeup, it's who we are.
We like to be the hero. If we're honest, some of us like being "superman." We like being the hero who rushes in at the last moment and against all odds, saves the world (okay, at least our employee).
We don't like people in pain. For some of us, our make up is such that we don't like watching others suffer. So, if we can relieve their pain (the problem they can't solve), we feel better about us.
There's always a reason why we do what we do. And, if you take a look at that list, you should quickly realize that all of those reasons are about us, not our employees. Our actions are driven by us wanting something for us (and frequently to breathe life into our own self-esteem).
So, why do you allow reverse delegation to occur? Unless you deal honestly with the reason why, you'll probably find yourself falling victim to it over and over again.
As a leader, your job is to create leverage. It's not to get work done, it's to deliver results through leveraging the time, talents, treasures, intellectual property and resources of other people. When you allow reverse delegation to occur, you're undercutting yourself as a leader. Instead of creating leverage, you're adding more work to your already overcrowded to do list while simultaneously removing the responsibility for taking action from your delegatee.
The moment you agree to "help" the monkey has left their back and is now firmly on yours. They become the leader checking on you and you become the delegatee.
Ugh! That hurts just reading it, doesn't it?
This is why you must never allow reverse delegation to happen. It strips you of being the leader.
Moreover, it strips your employee of responsibility and learning to solve problems on their own (i.e. it creates a dysfunctional system where you're needed and they're ineffective). In addition, it holds back growth and progress for your business because not only are they not making progress, you're dragged into their problem which means you're not working on the big picture issues you should be working on.
At every level, reverse delegation is wrong.
So, my question for you is, are you committed to not allowing it to happen again on your watch?
If you're wondering, "Okay, but what do I do? They have a problem and it still needs to be solved," here are a few ideas to help you move forward.
1. Let Out Your Inner Socrates.
Socrates assumed that people had the answers within themselves, they just didn't know it. So, he would ask a series of questions to help them see what was already inside of them. In your case, it would be to ask your employee a series of questions that would elicit out of them some potential solutions. Remember, if you don't want your employees to be co-dependent on you, you can't be the "answer man" all the time.
The one thing you never want to do is to allow them to leave the conversation thinking that they're now waiting on your for something. You should always be waiting on them, not the reverse.
So, there you have it. If you want to regain more of your time back, develop more resourceful and responsible employees, and create better leverage and faster growth for your business, make sure you refuse to allow reverse delegation to happen on your watch.
P.S. If you're reading this by RSS or email, click here >> to add comments to the conversation.
P.P.S. If you want to learn how to be a better delegator, I've decided to run a flash sale this week only (ends Friday at midnight EST) for my course on Delegation Mastery: How to Stop Dumping and Start Delegating Like A Pro. Save 30% and regain some of your life!