Search

Per- and polyfluoroalkyl substances (PFAS) and pesticides are widespread environmental contaminants linked to adverse health outcomes; yet, their impact on lung function-individually and as mixtures-remains poorly understood. This study analyzed data from 381 adolescents in a longitudinal cohort in Ecuador, measuring serum levels of three PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], and perfluorononanoic acid [PFNA]) and urinary levels of three pesticides (glyphosate, 2,4-dichlorophenoxyacetic acid [2,4-D], and ethylene thiourea [ETU]). Spirometric lung function was assessed in 2016 and 2022. We evaluated associations between individual chemical levels and lung measures in log-log models estimated via ordinary least squares regression. We used quantile g-computation to assess the association of the mixture of PFAS and pesticides with lung function outcomes. After accounting for multiple hypothesis testing, and in a range of socioeconomic, geographic variables, and tobacco exposure, no statistically significant associations were observed for individual or combined exposures with lung function outcomes, after correcting for multiple hypothesis testing. Slight, non-significant increases in FEV1/FVC were noted for PFOA, glyphosate, and ETU levels between 2016 and 2022. Our findings suggest that PFAS and pesticides, either individually or in combination, may not have substantial effects on adolescent lung function in this mid-to-high-altitude agricultural population. Further research is needed to assess these relationships in larger cohorts and over longer exposure periods., (Copyright © 2025 Elsevier GmbH. All rights reserved.)

Aerobiology in the tropics is still a science in development, where very little about their dynamics is known. Airborne pollen concentrations in the city of Medellín (Colombia) were measured using a Hirst-type sampler and correlated with meteorological parameters (relative humidity, rainfall, temperature, wind speed, and wind direction, this last analyzed by using circular statistics). Sampling was conducted over three years (2019-2022), and pollen grains were detected on all days of sampling, at higher concentrations than expected for tropical conditions. The highest pollen concentrations were observed from December to January and July-August, corresponding to the months with the lowest rainfall, which sheds light about how La Niña phenomena influenced pollen concentrations during the sampling period. The Main Pollen Season (MPS) ranged in length from 277 to 342 days. The highest intra-diurnal peaks pollen concentrations occurred around noon, whilst something very different and rarely reported occurs with Cecropia, which is much more abundant at night, from 20:00 to 1:00 h. Circular statistics revealed statistically significant wind direction patterns from SW, matching the same intra-diurnal pollen variations. This work helps to complete the blurred situation of the Aerobiology in the Neotropics and the dynamics of particles in the tropical atmosphere, being a first step towards the construction of pollen calendars to help pollen sufferers to mitigate symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study estimates agricultural soil variables using a non-parametric machine learning technique based on Lipschitz interpolation. This method is adapted for the first time to learn spatio-temporal dynamics, accounting for two-dimensional spatial and one temporal coordinate inputs separately. The estimator is validated on real agricultural data, addressing challenges like measurement noise and quantization. The experimental setup, including an edge layer with measurement devices and a cloud layer for data storage and processing, is detailed. Despite its simplicity, the method presents a compelling alternative to Gaussian processes and neural networks., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Luis Orihuela reports financial support was provided by Agencia Española de Cooperación Internacional al Desarrollo. Luis Orihuela reports financial support was provided by Agencia Estatal de Investigación. Luis Orihuela reports financial support was provided by Junta de Andalucía., (Copyright © 2024 International Society of Automation. Published by Elsevier Ltd. All rights reserved.)

Introduction: Despite advances in the diagnosis and therapeutics strategies for pulmonary hypertension (PH) in patients with end-stage liver disease (ESLD), the impact of hemodynamic patterns among ESLD patients identified through right heart catheterization (RHC) on clinical outcomes remains poorly understood., Methods: This single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan-Meier with log-rank test was employed to generate survival curves., Results: We identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52-66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19-36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups ( P  < 0.001)., Conclusion: We observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice., (© 2024 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Per- and polyfluoroalkyl substances (PFASs) and pesticides are ubiquitous environmental exposures with increasingly recognized adverse health outcomes; however, their impact on lung function, particularly in combination, remains poorly understood. We included 381 adolescent participants from a prospective cohort study in Ecuador who underwent measurements of serum PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS] and perfluorononanoic acid [PFNA]) and urinary herbicides (glyphosate, 2,4D) and fungicides (ethylene thiourea) and had spirometric measurements in either 2016 or 2022. We characterized the association between each PFAS or pesticide and each lung function measure in log-log models estimated via ordinary least squares regression. We used quantile g-computation to assess the association of the mixture of PFAS and pesticides with lung function outcomes. After accounting for multiple hypothesis testing, and in models adjusting for household income, parental education, and exposure to tobacco, we found that, individually, PFOA, glyphosate, and ETU were associated with slight increases in FEV 1 /FVC between 2016 and 2022. No other individual associations were significant. In mixtures analyses, a one quartile increase in all PFASs and pesticides simultaneously was also not associated with statistically significant changes in lung function outcomes after accounting for multiple hypothesis testing. In large part, we do not provide evidence for associations of PFAS and herbicide and fungicide pesticides with lung function among adolescents in moderate-to-high-altitude agricultural communities in Ecuador.

Competing Interests: Declaration of competing interest There is no conflict of interest.

Pulmonary hypertension (PH) is a prevalent complication among patients with chronic kidney disease (CKD). In these patients, pulmonary vasodilators may be useful but are underused. We describe a group of patients with precapillary PH and advanced CKD treated with pulmonary vasodilators. This was a case series of patients with CKD stage 4 and 5 and precapillary PH (isolated or combined) based on right heart catheterization (RHC) treated with pulmonary vasodilators from 2018 to 2023. Of 263 patients with isolated precapillary or combined PH and advanced CKD, only 17 (6%) were treated with pulmonary vasodilators; 53% ( n  = 9) with precapillary PH and 47% ( n  = 8) with combined PH. Most patients (94%, n  = 16) received phosphodiesterase-5 antagonists, while 12% ( n  = 2) received endothelin receptor antagonists. Adverse clinical outcomes were seen in 35% of patients within a year. The use of pulmonary vasodilator did not prevent adverse outcomes in patients with precapillary PH and advanced CKD., Competing Interests: Given the adherence to ethical and institutional guidelines and the main incentive of academic growth without monetary incentive for the development of this study, the authors declare no conflicts of interest present in this study., (© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Purpose: Immune checkpoint inhibitor-related pneumonitis (ICI-P) is a condition associated with high mortality, necessitating prompt recognition and treatment initiation. This study aimed to assess the impact of implementing a clinical care pathway algorithm on reducing the time to treatment for ICI-P., Methods: Patients with lung cancer and suspected ICI-P were enrolled, and a multimodal intervention promoting algorithm use was implemented in two phases. Pre- and post-intervention analyses were conducted to evaluate the primary outcome of time from ICI-P diagnosis to treatment initiation., Results: Of the 82 patients admitted with suspected ICI-P, 73.17% were confirmed to have ICI-P, predominantly associated with non-small cell lung cancer (91.67%) and stage IV disease (95%). Pembrolizumab was the most commonly used immune checkpoint inhibitor (55%). The mean times to treatment were 2.37 days in the pre-intervention phase, 3.07 days (p = 0.46), and 1.27 days (p = 0.40) in the post-intervention phases 1 and 2, respectively. Utilization of the immunotoxicity order set significantly increased from 0 to 27.27% (p = 0.04) after phase 2. While there were no significant changes in ICU admissions or inpatient mortality, outpatient pulmonology follow-ups increased statistically significantly, demonstrating enhanced continuity of care. The overall mortality for patients with ICI-P was 22%, underscoring the urgency of optimizing management strategies. Notably, all patients discharged on high-dose corticosteroids received appropriate gastrointestinal prophylaxis and prophylaxis against Pneumocystis jirovecii pneumonia infections at the end of phase 2., Conclusion: Implementing a clinical care pathway algorithm for managing severe ICI-P in hospitalized lung cancer patients standardizes practices, reducing variability in management., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This case demonstrated the rare "shark fin" ECG pattern, an ST-segment elevation typically seen in acute myocardial infarction. We reported a case of takotsubo cardiomyopathy secondary to influenza A infection with multiple organ failure, showing the shark fin sign and resulting in in-patient mortality and various complication., Competing Interests: There are no conflicts of interest to declare., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

This study examines the influence of meteorological factors and air pollutants on the performance of automatic pollen monitoring devices, as part of the EUMETNET Autopollen COST ADOPT-intercomparison campaign held in Munich, Germany, during the 2021 pollen season. The campaign offered a unique opportunity to compare all automatic monitors available at the time, a Plair Rapid-E, a Hund-Wetzlar BAA500, an OPC Alphasense, a KH-3000 Yamatronics, three Swisens Polenos, a PollenSense APS, a FLIR IBAC2, a DMT WIBS-5, an Aerotape Sextant, to the average of four manual Hirst traps, under the same environmental conditions. The investigation aimed to elucidate how meteorological factors and air pollution impact particle capture and identification efficiency. The analysis showed coherent results for most devices regarding the correlation between environmental conditions and pollen concentrations. This reflects on one hand, a significant correlation between weather and airborne pollen concentration, and on the other hand the capability of devices to provide meaningful data under the conditions under which measurements were taken. However, correlation strength varied among devices, reflecting differences in design, algorithms, or sensors used. Additionally, it was observed that different algorithms applied to the same dataset resulted in different concentration outputs, highlighting the role of algorithm design in these systems (monitor + algorithm). Notably, no significant influence from air pollutants on the pollen concentrations was observed, suggesting that any potential difference in effect on the systems might require higher air pollution concentrations or more complex interactions. However, results from some monitors were affected to a minor degree by specific weather variables. Our findings suggest that the application of real-time devices in urban environments should focus on the associated algorithm that classifies pollen taxa. The impact of air pollution, although not to be excluded, is of secondary concern as long as the pollution levels are similar to a large European city like Munich., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Pulmonary hypertension (PH) is associated with adverse outcomes in chronic kidney disease (CKD) patients. Our study suggests mildly elevated pulmonary vascular resistance ( > 2 to ≤ 3) is independently associated with major adverse cardiovascular events at 1-year follow-up. Early diagnosis of precapillary PH in CKD patients can potentially improve clinical outcomes., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Purpose: Immune checkpoint inhibitors (ICI) have become standard of care for some types of lung cancer. Along with expanding usage comes the emergence of immune-related adverse events (irAEs), including ICI-related pneumonitis (ICI-P). Treatment guidelines for managing irAEs have been developed; however, how clinicians manage irAEs in the real-world setting is less well known. We aimed to describe the outcomes and care patterns of grade ≥ 3 ICI-P in an onco-hospitalist service., Patients and Methods: We included patients with lung cancer treated with ICI who were admitted to an oncology hospitalist service with a suspicion of ICI-P. We described the hospitalization characteristics, treatment patterns, discharge practices, and clinical outcomes of patients with confirmed ICI-P. The primary outcome was time to start treatment for ICI-P., Results: Among 49 patients admitted with a suspicion of ICI-P, 31 patients were confirmed to have ICI-P and subsequently received ICI-P directed treatment. Pulmonology was consulted in 97% of patients. Median time to start treatment for ICI-P was 1 day (IQR 0-3.5 days). All 31 patients received corticosteroids. Inpatient mortality was 32%. Majority of patients discharged with steroids were prescribed prophylaxis for gastritis and opportunistic infections. Thirty-eight percent of patients were seen by pulmonology and 86% were seen by the oncology team post-discharge., Conclusion: Our study confirms prior findings of high mortality among patients with high-grade ICI-P. Early diagnosis and treatment are key to improving clinical outcomes. Understanding the care patterns and adherence to treatment guidelines of clinicians caring for this patient population may help identify ways to further standardize management practices and improve patient outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Paper mulberry pollen, declared a pest in several countries including Pakistan, can trigger severe allergies and cause asthma attacks. We aimed to develop an algorithm that could accurately predict high pollen days to underpin an alert system that would allow patients to take timely precautionary measures. We developed and validated two prediction models that take historical pollen and weather data as their input to predict the start date and peak date of the pollen season in Islamabad, the capital city of Pakistan. The first model is based on linear regression and the second one is based on phenological modelling. We tested our models on an original and comprehensive dataset from Islamabad. The mean absolute errors (MAEs) for the start day are 2.3 and 3.7 days for the linear and phenological models, respectively, while for the peak day, the MAEs are 3.3 and 4.0 days, respectively. These encouraging results could be used in a website or app to notify patients and healthcare providers to start preparing for the paper mulberry pollen season. Timely action could reduce the burden of symptoms, mitigate the risk of acute attacks and potentially prevent deaths due to acute pollen-induced allergy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kakakhail et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ornamental trees can reduce some of the negative impacts of urbanization on citizens but some species, such as Platanus spp., produce pollen with high allergenic potential. This can exacerbate the symptomatology in allergic patients, being a public health problem. Therefore, it would be relevant to determine the environmental conditions regulating the flowering onset of the Platanus species. The aims of this study were to use aerobiological records for modelling the thermal requirements of Platanus flowering and to make future projections based on the effects that climate change could have on it under several possible future scenarios. This study was conducted in Badajoz and Malaga, two Western Mediterranean cities with different climate conditions. In the first step, several main pollen season definitions were applied to the aerobiological data and their onset dates were compared with in situ phenological observations. The main pollen season definition that best fitted the Platanus flowering onset was based on the 4th derivative of a logistic function. This definition was used as a proxy to model the thermal requirements of the Platanus flowering onset by applying the PhenoFlex statistical framework. The errors obtained by this model during the external validation were 3.2 days on average, so it was fed with future temperature estimations to determine possible future trends. According to the different models, the flowering onset of Platanus in Badajoz will show heterogeneous responses in the short and medium term due to different balances in the chilling-forcing compensation, while it will clearly delay in Malaga due to a significant delay in the chilling requirement fulfilment. This may increase the chances of cross-reactivity episodes with other pollen types in the future, increasing its impact on public health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population., (Copyright © 2023 the American College of Medical Quality.)

Pollen is a major issue globally, causing as much as 40 % of the population to suffer from hay fever and other allergic conditions. Current techniques for monitoring pollen are either laborious and slow, or expensive, thus alternative methods are needed to provide timely and more localised information on airborne pollen concentrations. We have demonstrated previously that low-cost Optical Particle Counter (OPC) sensors can be used to estimate pollen concentrations when machine learning methods are used to process the data and learn the relationships between OPC output data and conventionally measured pollen concentrations. This study demonstrates how methodical hyperparameter tuning can be employed to significantly improve model performance. We present the results of a range of models based on tuned hyperparameter configurations trained to predict Poaceae (Barnhart), Quercus (L.), Betula (L.), Pinus (L.) and total pollen concentrations. The results achieved here are a significant improvement on results we previously reported: the average R2 scores for the total pollen models have at least doubled compared to using previous parameter settings. Furthermore, we employ the explainable Artificial Intelligence (XAI) technique, SHAP, to interpret the models and understand how each of the input features (i.e. particle sizes) affect the estimated output concentration for each pollen type. In particular, we found that Quercus pollen has a strong positive correlation with particles of optical diameter 1.7-2.3 μm, which distinguishes it from other pollen types such as Poaceae and may suggest that type-specific subpollen particles are present in this size range. There is much further work to be done, especially in training and testing models on data obtained across different environments to evaluate the extent of generalisability. Nevertheless, this work demonstrates the potential this method can offer for low-cost monitoring of pollen and the valuable insight we can gain from what the model has learned., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The level of environmental exposure throughout life may contribute to the prevalence of allergic sensitization and allergic disease. The alpine climate has been considered a healthy climate with little allergen exposure and pollution. We conducted a cross-sectional study to investigate local environmental exposure and concomitant prevalence of allergic sensitization among local school children born and raised in an alpine environment., Methods: Clinical and demographic data were collected with a questionnaire. Allergen content was assessed in residential settled dust samples, lifetime exposure to pollen and air pollution was calculated using data from national pollen and air pollution monitoring stations, and the allergic sensitization profile was determined with component resolved diagnostics (ISAC®). Univariate and multivariate regression models were used to estimate the relation between exposure and sensitization., Results: In a cohort of children born and raised in an alpine environment, sensitization to aeroallergens is quite common (38%), especially to grass (33%) and cat (16%). House dust mite allergen was detected in up to 38% of residential dust samples, but sensitization to HDM was low (2.5%). Pollutant levels were low, but an increasing trend was observed in the amount of ozone and PM 10 . Living close to a busy road was associated with increased odds OR (95% CI) for being sensitized to any allergen 2.7 (1.0-7.2), to outdoor allergens 2.8 (1.1-7.1) and being sensitized plus reporting symptoms of rhinoconjunctivitis 4.4 (1.3-14.8) and asthma 5.5 (1.4-21). Indoor living conditions, including the presence of visible mold, increased the odds of being sensitized to indoor allergens (1.9 (1.1-3.2) and being sensitized plus reporting symptoms of rhinoconjunctivitis 1.9 (1.0-3.6) and asthma 2.1 (1.0-4.1)., Conclusion: In a healthy alpine environment, pollution might still be an important factor contributing to allergic sensitization., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

In Central Europe the most common allergies are provoked by grass or birch pollen allergens. We determined the intra-daily behavior of airborne pollen grains of grasses (Poaceae) and birch (Betula ssp.) in Central Europe, based on data obtained from a network of automatic pollen monitors over Europe (www.pollenscience.eu). Our aim was to determine the time of day when the lowest concentrations occur, to provide allergic individuals the optimal time to ventilate their homes. The study was carried out in three Central European capitals, Berlin (Germany), Paris-Saclay (France), and Luxembourg (Luxembourg), as well as in eight stations in Germany (Altötting, Feucht, Garmisch-Partenkirchen, Hof, Marktheidenfeld, Mindelheim, Munich and Viechtach). The diurnal rhythm of these eleven locations was analyzed for either the complete, first week, peak week, peak day and last week of the pollen season. The data studied were reported as pollen/m 3 measured in 3 h periods. Stations were classified as city, semi-populated or countryside areas using land-use and population density criteria. Grass pollen has a more pronounced diurnal rhythm than birch pollen concentrations. A significant difference was observed when comparing day (6-21 h) versus night (21-6 h) for all stations. No difference was detected between city and countryside for both pollen types, although for Poaceae a longer period of maximum concentrations was observed in big cities and higher day/night-time differences were registered in the countryside (6.4) than in cities (3.0). The highest pollen concentrations were observed between 9 and 18 h for grass, but the rhythm was less pronounced for birch pollen. For allergic individuals who want to bring in fresh air in their homes, we recommend opening windows after 21 h, but even better early in the morning between 6 and 9 h before pollinations (re)starts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: Sclerosing mesenteritis (SM), a fibroinflammatory process of the mesentery, can rarely occur after immune checkpoint inhibitor (ICI) therapy; however, its clinical significance and optimal management are unclear. We aimed to assess the characteristics and disease course of patients who developed SM following ICI therapy at a single tertiary cancer center., Methods: We retrospectively identified 12 eligible adult cancer patients between 05/2011 and 05/2022. Patients' clinical data were evaluated and summarized., Results: The median patient age was 71.5 years. The most common cancer types were gastrointestinal, hematologic, and skin. Eight patients (67%) received anti-PD-1/L1 monotherapy, 2 (17%) received anti-CTLA-4 monotherapy, and 2 (17%) received combination therapy. SM occurred after a median duration of 8.6 months from the first ICI dose. Most patients (75%) were asymptomatic on diagnosis. Three patients (25%) reported abdominal pain, nausea, and fever and received inpatient care and corticosteroid treatment with symptom resolution. No patients experienced SM recurrence after the completion of corticosteroids. Seven patients (58%) experienced resolution of SM on imaging. Seven patients (58%) resumed ICI therapy after the diagnosis of SM., Conclusions: SM represents an immune-related adverse event that may occur after initiation of ICI therapy. The clinical significance and optimal management of SM following ICI therapy remains uncertain. While most cases were asymptomatic and did not require active management or ICI termination, medical intervention was needed in select symptomatic cases. Further large-scale studies are needed to clarify the association of SM with ICI therapy., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In prior studies, central pulmonary embolism (PE) was associated with high clot burden and was considered an independent predictor for thrombolysis. Further information about predictors of adverse outcomes in these patients is needed for better risk stratification. The objective is to describe independent predictors of adverse clinical outcomes in patients with central PE., Methods: Large retrospective, observational, and single-center study of hospitalized patients with central PE. Data were gathered on demographics, comorbidities, clinical features on admission, imaging, treatments, and outcomes. Multivariable standard and Least Absolute Shrinkage and Selection Operator (LASSO) machine learning logistic regressions and sensitivity analyses were used to analyze factors associated with a composite of adverse clinical outcomes, including vasopressor use, mechanical ventilation, and inpatient mortality., Results: A total of 654 patients had central PE. The mean age was 63.1 years, 59% were women, and 82% were African American. The composite adverse outcome was observed in 18% (n = 115) of patients. Serum creatinine elevation (odds ratio [OR] = 1.37, 95% CI = 1.20-1.57; p = 0.0001), white blood cell (WBC) count elevation (OR = 1.10, 95% CI = 1.05-1.15; p < 0.001), higher simplified pulmonary embolism severity index (sPESI) score (OR = 1.47, 95% CI = 1.18-1.84; p = 0.001), serum troponin elevation (OR = 1.26, 95% CI 1.02-1.56; p = 0.03), and respiratory rate increase (OR = 1.03, 95% CI = 1.0-1.05; p = 0.02) were independent predictors of adverse clinical outcomes., Conclusion: Among patients with central PE, higher sPESI score, WBC count elevation, serum creatinine elevation, serum troponin elevation, and respiratory rate increase were independent predictors of adverse clinical outcomes. Right ventricular dysfunction on imaging and saddle PE location did not predict adverse outcomes., Competing Interests: Declaration of competing interest The authors have no competing interest to disclose. None declared., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Hydralazine is rarely associated with antineutrophilic cytoplasmic antibody (ANCA) vasculitis. In the appropriate clinical scenario, such as in a patient with pulmonary, renal, or cutaneous manifestations, finding antibodies against nuclear and cytoplasmic neutrophil antigens may suggest drug-induced vasculitis after exposure to hydralazine. We present the case of an elderly man diagnosed with focal alveolar hemorrhage with elevated concentrations of anti-myeloperoxidase antibody, anti-proteinase-3 antibody, and antinuclear antibodies in the setting of prolonged hydralazine therapy. We observed a rapid clinical improvement with hydralazine discontinuation and systemic corticosteroids. We did not observe further disease activity while on mycophenolate mofetil six months later., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Martinez Manzano et al.)

Background: Given the heterogeneity of predisposing factors associated with pulmonary infarction (PI) and the lack of clinically relevant outcomes among patients with acute pulmonary embolism (PE) complicated by PI, further investigation is required., Methods: Retrospective study of patients with central PE in an 11-year period. Data were stratified according to the diagnosis of PI. Multivariable logistic regression analysis was used to analyze factors associated with PI development and determine if PI was associated with severe hypoxemic respiratory failure and mechanical ventilation use., Results: Of 645 patients with central PE, 24% ( n  = 156) had PI. After adjusting for demographics, comorbidities, and clinical features on admission, only age (OR 0.98, CI 0.96-0.99; p  = 0.008) was independently associated with PI. Regarding outcomes, 35% ( n  = 55) had severe hypoxemic respiratory failure, and 19% ( n  = 29) required mechanical ventilation. After adjusting for demographics, PE severity, and right ventricular dysfunction, PI was independently associated with severe hypoxemic respiratory failure (OR 1.78; CI 1.18-2.69, p  = 0.005) and mechanical ventilation (OR 1.92; CI 1.14-3.22, p  = 0.013)., Conclusions: Aging is a protective factor against PI. In acute central PE, subjects with PI had higher odds of developing severe hypoxemic respiratory failure and requiring mechanical ventilation.

Introduction: Right heart thrombus (RHT), also known as clot in transit, is an uncommon finding in pulmonary embolism (PE) that is associated with increased inpatient mortality. To date, there is no consensus on the management of RHT. Therefore, we aim to describe the clinical features, treatments, and outcomes of patients with simultaneous RHT and PE., Methods: This is a retrospective, cross-sectional, and single-center study of hospitalized patients with central PE who had RHT visualized on transthoracic echocardiography (TTE) from January 2012 to May 2022. We use descriptive statistics to describe their clinical features, treatments, and outcomes, including mechanical ventilation, major bleeding, inpatient mortality, length of hospital stay, and recurrent PE on follow-up., Results: Of 433 patients with central PE who underwent TTE, nine patients (2%) had RHT. The median age was 63 years (range 29-87), most were African American (6/9), and females (5/9). All patients had evidence of RV dysfunction and received therapeutic anticoagulation. Eight patients received RHT-directed interventions, including systemic thrombolysis (2/9), catheter-directed suction embolectomy (4/9), and surgical embolectomy (2/9). Regarding outcomes, 4/9 patients were hemodynamically unstable, 8/9 were hypoxemic, and 2/9 were mechanically ventilated. The median length of hospital stay was six days (range 1-16). One patient died during hospital admission, and two patients had recurrent PE., Conclusion: We described the different therapeutic approaches and outcomes of patients with RHT treated in our institution. Our study adds valuable information to the literature, as there is no consensus on the treatment of RHT., Highlights: Right heart thrombus (RHT) was a rare finding in central pulmonary embolism. Most patients with RHT had evidence of RV dysfunction and pulmonary hypertension. Most patients received RHT-directed therapies in addition to therapeutic anticoagulation., (© 2023 Wiley Periodicals LLC.)

Pollen allergies affect a significant proportion of the global population, and this is expected to worsen in years to come. There is demand for the development of automated pollen monitoring systems. Low-cost Optical Particle Counters (OPCs) measure particulate matter and have attractive advantages of real-time high time resolution data and affordable costs. This study asks whether low-cost OPC sensors can be used for meaningful monitoring of airborne pollen. We employ a variety of methods, including supervised machine learning techniques, to construct pollen proxies from hourly-average OPC data and evaluate their performance, holding out 40 % of observations to test the proxies. The most successful methods are supervised machine learning Neural Network (NN) and Random Forest (RF) methods, trained from pollen concentrations collected from a Hirst-type sampler. These perform significantly better than using a simple particle size-filtered proxy or a Positive Matrix Factorisation (PMF) source apportionment pollen proxy. Twelve NN and RF models were developed to construct a pollen proxy, each varying by model type, input features and target variable. The results show that such models can construct useful information on pollen from OPC data. The best metrics achieved (Spearman correlation coefficient = 0.85, coefficient of determination = 0.67) were for the NN model constructing a Poaceae (grass) pollen proxy, based on particle size information, temperature, and relative humidity. Ability to distinguish high pollen events was evaluated using F1 Scores, a score reflecting the fraction of true positives with respect to false positives and false negatives, with promising results (F1 ≤ 0.83). Model-constructed proxies demonstrated the ability to follow monthly and diurnal trends in pollen. We discuss the suitability of OPCs for monitoring pollen and offer advice for future progress. We demonstrate an attractive alternative for automated pollen monitoring that could provide valuable and timely information to the benefit of pollen allergy sufferers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

To benefit allergy patients and the medical practitioners, pollen information should be available in both a reliable and timely manner; the latter is only recently possible due to automatic monitoring. To evaluate the performance of all currently available automatic instruments, an international intercomparison campaign was jointly organised by the EUMETNET AutoPollen Programme and the ADOPT COST Action in Munich, Germany (March-July 2021). The automatic systems (hardware plus identification algorithms) were compared with manual Hirst-type traps. Measurements were aggregated into 3-hourly or daily values to allow comparison across all devices. We report results for total pollen as well as for Betula, Fraxinus, Poaceae, and Quercus, for all instruments that provided these data. The results for daily averages compared better with Hirst observations than the 3-hourly values. For total pollen, there was a considerable spread among systems, with some reaching R 2 > 0.6 (3 h) and R 2 > 0.75 (daily) compared with Hirst-type traps, whilst other systems were not suitable to sample total pollen efficiently (R 2 < 0.3). For individual pollen types, results similar to the Hirst were frequently shown by a small group of systems. For Betula, almost all systems performed well (R 2 > 0.75 for 9 systems for 3-hourly data). Results for Fraxinus and Quercus were not as good for most systems, while for Poaceae (with some exceptions), the performance was weakest. For all pollen types and for most measurement systems, false positive classifications were observed outside of the main pollen season. Different algorithms applied to the same device also showed different results, highlighting the importance of this aspect of the measurement system. Overall, given the 30 % error on daily concentrations that is currently accepted for Hirst-type traps, several automatic systems are currently capable of being used operationally to provide real-time observations at high temporal resolutions. They provide distinct advantages compared to the manual Hirst-type measurements., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jeroen Buters, Jose M. Maya Manzano, Carsten B. Schmidt-Weber and Marina Triviño report financial support, administrative support, equipment, drugs, or supplies, and travel were provided by Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) and EUMETNET. Carsten Skjoth reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by COST Action CA18226 ADOPT – New approaches in detection of pathogens and aeroallergens. Bernard Clot and Fiona Tummon report financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by European Meteorological Society and the EUMETNET AutoPollen Programme. Branko Sikoparija and Predrag Matavulj report financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by BREATHE project from the Science Fund of the Republic of Serbia PROMIS program, under grant agreement no. 6039613 and by the Ministry of Education, Science and Technological Development of the Republic of Serbia (grant agreement number 451–03-68/2022–14/200358). Evgeny Kadantsev and Julia Palamarchuk report financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by Academy of Finland PS4A (grant 318,194). Mikhail Sofiev reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by Academy of Finland project ALL-Impress (grant 329,215). Mikhail Sofiev reports financial support, administrative support, article publishing charges, equipment, drugs, or supplies, and travel were provided by European Social Fund (project no. 09.3.3-LMT-K-712-01-0066) and Research Council of Lithuania (LMTLT). Nathan Allan, Landon Bunderson, Richard W. Lucas (Pollen science TM), Jorg Haus, Stefan Schaefer, Martin Schnitzler and Tom Stemmler (Helmut Hund Wetzlar), Reto Abt, Elias Graf, Erny Niederberger and Yanick Zeder (Swisens AG) report a relationship with Pollen science TM, Helmut Hund Wetzlar and Swisens AG respectively, that includes: board membership, employment, and travel reimbursement. The investigations were carried out in compliance with good scientific practices and the support provided by these companies in terms of instrumentation had no effect on the results presented., (Copyright © 2023 Elsevier B.V. All rights reserved.)

COVID-19 lockdown measures have impacted the environment with both positive and negative effects. However, how human populations have perceived such changes in the natural environment and how they may have changed their daily habits have not been yet thoroughly evaluated. The objectives of this work were to investigate (1) the social perception of the environmental changes produced by the COVID-19 pandemic lockdown and the derived change in habits in relation to i) waste management, energy saving, and sustainable consumption, ii) mobility, iii) social inequalities, iv) generation of noise, v) utilization of natural spaces, and, vi) human population perception towards the future, and (2) the associations of these potential new habits with various socio-demographic variables. First, a SWOT analysis identified strengths (S), weaknesses (W), opportunities (O), and threats (T) generated by the pandemic lockdown measures. Second, a survey based on the aspects of the SWOT was administered among 2370 adults from 37 countries during the period from February to September 2021. We found that the short-term positive impacts on the natural environment were generally well recognized. In contrast, longer-term negative effects arise, but they were often not reported by the survey participants, such as greater production of plastic waste derived from health safety measures, and the increase in e-commerce use, which can displace small storefront businesses. We were able to capture a mismatch between perceptions and the reported data related to visits to natural areas, and generation of waste. We found that age and country of residence were major contributors in shaping the survey participants ´answers, which highlights the importance of government management strategies to address current and future environmental problems. Enhanced positive perceptions of the environment and ecosystems, combined with the understanding that livelihood sustainability, needs to be prioritized and would reinforce environmental protection policies to create greener cities. Moreover, new sustainable jobs in combination with more sustainable human habits represent an opportunity to reinforce environmental policy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Inc. All rights reserved.)

Although Alternaria spores are well-known allergenic fungal spores, automatic bioaerosol recognition systems have not been trained to recognize these particles until now. Here we report the development of a new algorithm able to classify Alternaria spores with BAA500 automatic bioaerosol monitors. The best validation score was obtained when the model was trained on both data from the original dataset and artificially generated images, with a validation unweighted mean Intersection over Union (IoU), also called Jaccard Index, of 0.95. Data augmentation techniques were applied to the training set. While some particles were not recognized (false negatives), false positives were few. The results correlated well with manual counts (mean of four Hirst-type traps), with R 2 = 0.78. Counts from BAA500 were 1.92 times lower than with Hirst-type traps. The algorithm was then used to re-analyze the historical automatic pollen monitoring network (ePIN) dataset (2018-2022), which lacked Alternaria spore counts. Re-analysis of past data showed that Alternaria spore exposure in Bavaria was very variable, with the highest counts in the North (Marktheidenfeld, 154 m a.s.l.), and the lowest values close to the mountains in the South (Garmisch-Partenkirchen, 735 m a.s.l.). This approach shows that in our network future algorithms can be run on past datasets. Over time, the use of different algorithms could lead to misinterpretations as stemming from climate change or other phenological causes. Our approach enables consistent, homogeneous treatment of long-term series, thus preventing variability in particle counts owing to changes in the algorithms., Competing Interests: Declaration of competing interest The authors report no conflict of interest. Tom Stemmler is currently working at Helmut Hund Gmbh., however this had no effect on the results presented as the investigations were carried out in compliance with good scientific practices., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The drivers affecting the Pollen Allergen Potency (PAP, amount of allergen released per pollen) are sparsely known. Betula and Poaceae airborne pollen are the two main allergenic pollen in the World. Airborne pollen and their allergens Bet v 1 and Phl p 5 were simultaneously measured from 2010 to 2015 in Davos (Switzerland) and Munich (Germany) by using volumetric traps and ChemVol cascade impactors. Daily variations in PAP were analysed in PM >10 and PM 2.5-10 air fractions and generalized additive models were created to explain which factors determine PAP, including meteorological parameters and inorganic pollutants. 87.1 ± 13.9% of Bet v 1 and 88.8 ± 15.5% of Phl p 5 was detected in the fraction PM >10 where most pollen grains were collected. Significantly higher PAP for grasses (3.5 ± 1.9 pg Phl p 5/pollen grain) were observed in Munich than in Davos (2.4 ± 1.5 pg/pollen grain, p < 0.001), but not for Betula (2.5 ± 1.6 pg Bet v 1/pollen grain in Munich and 2.3 ± 1.7 in Davos, N.S.). PAP varied between days, years and location, and increased along the pollen season for Poaceae, but remaining constant for Betula. Free allergens (allergens observed in the fraction with limited pollen, PM 2.5- 10 ) were recorded mostly at the beginning or at the end of the pollen season, being linked to higher humidity and rainy days. Also, PAP was higher when the airborne pollen concentrations increased rapidly after one day of low/moderate levels. Our findings show that pollen exposure explains allergen exposure only to a limited extend, and that day in the season, geographic location and some weather conditions need to be considered also to explain symptoms of allergic individuals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: Several studies have confirmed increased mortality among patients with both COVID-19 and cancer. It remains important to continue to report observations of morbidity and mortality from COVID-19 in this vulnerable population. The purpose of this study is to describe the hospitalization characteristics and outcomes of patients with both cancer and COVID-19 admitted to our comprehensive cancer center., Methods: This was a descriptive study of the first COVID-19-related hospitalization among adult patients with cancer admitted to our institution. Descriptive statistics were used to summarize patient demographics, clinical as well as hospitalization characteristics. Overall survival (OS) was estimated using the Kaplan-Meier method., Results: A total of 212 patients were included in our cohort with a mean age of 59 years. Fifty-four percent of patients had history of solid tumor malignancy and 46% had hematologic malignancies. Eighty-five percent of our cohort had active malignancy. The mean length of stay (LOS) for hospitalization was 11.2 days (median LOS of 6 days). Twenty-five percent had severe disease and 10.8% died during their initial hospitalization. Those who had severe disease had worse survival at the end of the observation period., Conclusions: COVID-19 among cancer patients causes significant morbidity and mortality as well as repeat hospitalizations. Continued study of COVID-19 in this vulnerable population is essential in order to better inform evolving treatment algorithms, public health policies, and infection control protocols, especially for institutions caring for patients with cancer., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Rationale: Few case series have described the simultaneous development of angioedema in patients with coronavirus 19 disease (COVID-19). Most of these reports were described in at-risk patients for developing bradykinin angioedema. Therefore, we aim to describe 5 African American patients who developed simultaneous COVID-19 and angioedema., Methods: This was a case series of hospitalized patients with simultaneous angioedema and COVID-19 infection in a single center from May 2020 to February 2022. We used descriptive statistics. The study was approved by the institutional review board., Results: Their median age was 55 years (range 28-66); all patients were African American, and 3/5 were males. All patients developed angioedema within a week of hospitalization. Two subjects had prior history of ACEI-related angioedema but were not exposed to ACEI recently, whereas 1 subject was on chronic lisinopril therapy for the last 3 years. All patients had orofacial involvement; the most common locations were lips (5/5) and tongue (3/5). None had histaminergic features of angioedema (either skin rash or peripheral eosinophilia). 4/5 subjects had respiratory symptoms and chest imaging features of COVID-19 pneumonia, whereas 3/5 subjects developed severe COVID-19 infection. Most patients were treated with standard combination of H1 and H2 blockers, and corticosteroids. A total of 2/5 subjects were intubated; one patient developed refractory tongue swelling, received tracheostomy for extubation, and died due to COVID-19 pneumonia. The median length of angioedema improvement was 44 hours (range 20-168 hours). The median length of hospital stay was 15 days (range 1-49)., Conclusion: We described 5 cases of angioedema in COVID-19 patients that shared risk factors and features of bradykinin-related angioedema., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Inc.)

This study evaluated the utility and performance of the LACE index and HOSPITAL score with consideration of the type of diagnoses and assessed the accuracy of these models for predicting readmission risks in patient cohorts from 2 large academic medical centers. Admissions to 2 hospitals from 2011 to 2015, derived from the Vizient Clinical Data Base and regional health information exchange, were included in this study (291 886 encounters). Models were assessed using Bayesian information criterion and area under the receiver operating characteristic curve. They were compared in CMS diagnosis-based cohorts and in 2 non-CMS cancer diagnosis-based cohorts. Overall, both models for readmission risk performed well, with LACE performing slightly better (area under the receiver operating characteristic curve 0.73 versus 0.69; P ≤ 0.001). HOSPITAL consistently outperformed LACE among 4 CMS target diagnoses, lung cancer, and colon cancer. Both LACE and HOSPITAL predict readmission risks well in the overall population, but performance varies by salient, diagnosis-based risk factors., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Medical Quality.)

Background: Indoor allergens (i.e. from mite, cat and dog) are carried by airborne particulate matter. Thus, removal of particles would reduce allergen exposure. This work aims to assess the performance of air filtration on particulate matter and thus allergen removal in 22 bedrooms., Methods: Indoor air was sampled (with and without air filtration) with a cascade impactor and allergens were measured using enzyme-linked immunosorbent assay (ELISA). Particulate matter (including ultrafine particles) was also monitored., Results: The median of allergen reduction was 75.2% for Der f 1 ( p  < 0.001, n  = 20), 65.5% for Der p 1 ( p  = 0.066, n  = 4), 76.6% for Fel d 1 ( p  < 0.01, n  = 21) and 89.3% for Can f 1 ( p  < 0.01, n  = 10). For size fractions, reductions were statistically significant for Der f 1 (all p  < 0.001), Can f 1 (PM >10 and PM 2.5-10 , p  < 0.01) and Fel d 1 (PM 2.5-10 , p  < 0.01), but not for Der p 1 (all p  > 0.05). PM was reduced in all fractions ( p  < 0.001). The allergens were found in all particle size fractions, higher mite allergens in the PM >10 and for pet allergens in the PM 2.5-10 ., Conclusions: Air filtration was effective in removing mites, cat and dog allergens and also particulate matter from ambient indoor air, offering a fast and simple solution to mitigate allergen exposome., Competing Interests: Michael Scheja is employee in Philips. The investigations were carried out in compliance with good scientific practices. Support provided by Philips had no effect on the results presented., (© 2022 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Respiratory allergies triggered by pollen allergens represent a significant health concern to the Irish public. Up to now, Ireland has largely refrained from participating in long-term aerobiological studies. Recently, pollen monitoring has commenced in several sampling locations around Ireland. The first results of the pollen monitoring campaigns for Dublin (urban) and Carlow (rural) concerning the period 2017-2019 and 2018-2019, respectively, are presented herein. Additional unpublished pollen data from 1978-1980 and, 2010-2011 were also incorporated in creating the first pollen calendar for Dublin. During the monitoring period over 60 pollen types were identified with an average Annual Pollen Integral (APIn) of 32,217 Pollen × day/m 3 for Dublin and 78,411 Pollen × day/m 3 for Carlow. The most prevalent pollen types in Dublin were: Poaceae (32%), Urticaceae (29%), Cupressaceae/Taxaceae (11%), Betula (10%), Quercus (4%), Pinus (3%), Fraxinus (2%), Alnus (2%) and Platanus (1%). The predominant pollen types in Carlow were identified as Poaceae (70%), Urticaceae (12%) , Betula (10%), Quercus (2%), Fraxinus (1%) and Pinus (1%). These prevalent pollen types increased in annual pollen concentration in both locations from 2018 to 2019 except for Fraxinus. Although higher pollen concentrations were observed for the Carlow (rural) site a greater variety of pollen types were identified for the Dublin (urban) site. The general annual trend in the pollen season began with the release of tree pollen in early spring, followed by the release of grass and herbaceous pollen which dominated the summer months with the annual pollen season coming to an end in October. This behaviour was illustrated for 21 different pollen types in the Dublin pollen calendar. The correlation between ambient pollen concentration and meteorological parameters was also examined and differed greatly depending on the location and study year. A striking feature was a substantial fraction of the recorded pollen sampled in Dublin did not correlate with the prevailing wind directions. However, using non-parametric wind regression, specific source regions could be determined such as Alnus originating from the Southeast, Betula originating from the East and Poaceae originating from the Southwest., Supplementary Information: The online version contains supplementary material available at 10.1007/s10453-022-09751-w., Competing Interests: Conflict of interestThe authors declare the following financial/non-financial interests that could be considered as potential competing interests., (© The Author(s) 2022.)

Purpose: Readmissions for the medical treatment of cancer have traditionally been excluded from readmission measures under the Hospital Readmissions Reduction Program. Patients with cancer often have higher readmission rates and may need heightened support to ensure effective care transitions after hospitalization. Estimating readmission risk before discharge may assist in discharge planning efforts and help promote care coordination at time of discharge., Patients and Methods: We developed and validated a readmission risk scoring system among a cohort of adult cancer patients with solid tumor admitted at a comprehensive cancer center. Multivariate logistic regression analysis was used to develop the model. The model's discriminative capacity was evaluated through a receiver operating characteristic curve analysis. We further compared the performance of the developed score with existing risk scores for 30-day readmission., Results: The 30-day unplanned readmission rate in the total cohort was 16.0% (n = 1,078 of 6,720). After multivariate analysis, Cancer site, Recent emergency room visit within 30 days, non-English primary language, Anemia defined as hemoglobin < 10 g/dL, > 4 Days length of stay during the index admission, unmarried Marital status, Increased white blood cell count > 11 × 10 9 /L, and distant Tumor spread were significantly associated with risk of unplanned 30-day readmission. The derived score, which we call the Cancer READMIT score, had modest discriminatory performance in predicting readmissions (area under the curve for the model receiver operating characteristic curve = 0.647)., Conclusion: The Cancer READMIT score was able to predict 30-day unplanned readmissions to our institution with fairly modest performance. External validation of our derived risk scoring system is recommended.

Background: Given the heterogeneity of etiologies, pathophysiology, and presentation of angioedema, variations in clinical outcomes, such as intubation and hospital readmissions, need further clarification., Objective: To determine the factors associated with intubation and hospital readmissions in patients with angioedema., Methods: Retrospective study of patients evaluated with a diagnosis of angioedema in a 6-year period. Demographic and clinical data, such as medication use, family history, comorbidities, and symptoms, were recorded. Multivariable logistic regression was used to analyze factors associated with intubation, whereas Cox regression was used to analyze readmissions., Results: Of 636 patients, the most common cause of angioedema was that induced by angiotensin-converting enzyme inhibitor (ACEI) at 58%. The overall mortality was 0.5%. After adjusting for sex, race, comorbidities, and type of angioedema, smoking (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.10-2.93; P = .02), calcium channel blocker therapy (OR, 1.91; 95% CI, 1.18-3.10; P = .009), histaminergic symptoms (OR, 3.21; 95% CI, 1.93-5.33; P < .001), and age (OR, 1.02; 95% CI, 1.00-1.04; P = .02) were independently associated with increased odds of intubation. Involvement of either the pharynx, larynx, or tongue was associated with higher odds of intubation (OR, 20.96; 95% CI, 10.63-41.33; P < .001). A total of 10% of the patients had a readmission for angioedema within 90 days, and 75% occurred within 30 days. After multivariable Cox regression analysis, only chronic obstructive pulmonary disease and asthma (OR, 2.13; 95% CI, 1.12-4.07; P = .02) and ACEI-related angioedema (OR, 2.93; 95% CI, 1.33-6.47; P = .008) were significantly associated with readmissions., Conclusion: Smoking, calcium channel blocker use, histaminergic symptoms, age, and upper airway involvement were markedly associated with intubation. The presence of chronic obstructive pulmonary disease, asthma and ACEI-related angioedema were independently associated with increased odds of readmission., (Copyright © 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Climate change impacts on the structure and function of ecosystems will worsen public health issues like allergic diseases. Birch trees (Betula spp.) are important sources of aeroallergens in Central and Northern Europe. Birches are vulnerable to climate change as these trees are sensitive to increased temperatures and summer droughts. This study aims to examine the effect of climate change on airborne birch pollen concentrations in Central Europe using Bavaria in Southern Germany as a case study. Pollen data from 28 monitoring stations in Bavaria were used in this study, with time series of up 30 years long. An integrative approach was used to model airborne birch pollen concentrations taking into account drivers influencing birch tree abundance and birch pollen production and projections made according to different climate change and socioeconomic scenarios. Birch tree abundance is projected to decrease in parts of Bavaria at different rates, depending on the climate scenario, particularly in current centres of the species distribution. Climate change is expected to result in initial increases in pollen load but, due to the reduction in birch trees, the amount of airborne birch pollen will decrease at lower altitudes. Conversely, higher altitude areas will experience expansions in birch tree distribution and subsequent increases in airborne birch pollen in the future. Even considering restrictions for migration rates, increases in pollen load are likely in Southwestern areas, where positive trends have already been detected during the last three decades. Integrating models for the distribution and abundance of pollen sources and the drivers that control birch pollen production allowed us to model airborne birch pollen concentrations in the future. The magnitude of changes depends on location and climate change scenario., (© 2021 John Wiley & Sons Ltd.)

Screening for pulmonary fibrosis may help to identify early stages of the disease. We assessed the psychological impact of screening undiagnosed first-degree relatives of patients with pulmonary fibrosis by administering two validated measures after participants received their results: the Decisional Regret Scale and the Feelings About genomiC Testing Results Questionnaire. More than 90% of relatives reported either no or mild decisional regret. Increased measures of decisional regret and negative feelings were present in those found to have a low diffusion capacity of carbon monoxide or interstitial lung abnormalities. Results of telomere length and genetic testing did not significantly impact regret., Competing Interests: Competing interests: HH reports grants and personal fees from Canon Medical Systems Inc, grants from Konica-Minolta Inc, and personal fees from Mitsubishi Chemical Co outside the submitted work. IOR reports grants from Roche/Genentech during the conduct of the study, grants and personal fees from Genentech and personal fees from Boehringer and Bristol Myers Squibb outside the submitted work. GMH reports personal fees from Boehringer-Ingelheim, Gerson Lehrman Group and Mitsubishi Chemical outside the submitted work., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Bioinformatics clustering application for mining of a large set of olive pollen aerobiological data to describe the daily distribution of Olea pollen concentration. The study was performed with hourly pollen concentrations measured during 8 years (2011-2018) in Extremadura (Spain). Olea pollen season by quartiles of the pollen integral in preseason (Q1: 0%-25%), in-season (Q2 and Q3: 25%-75%) and postseason (Q4: 75%-100%). Days with pollen concentrations above 100 grains/m 3 were clustered according to the daily distribution of the concentrations. The factors affecting the prevalence of the different clusters were analyzed: distance to olive groves and the moment during the pollen season and the meteorology. During the season, the highest hourly concentrations during the day where between 12:00 and 14:00, while during the preseason the highest hourly concentrations were detected in the afternoon and evening hours. In the postseason the pollen concentrations were more homogeneously distributed during 9-16 h. The representation shows a well-defined hourly pattern during the season, but a more heterogeneous distribution during the preseason and postseason. The cluster dendrogram shows that all the days could be clustered in 6 groups: most of the clusters shows the daily peaks between 11:00 and 15:00 with a smooth curve (Cluster 1 and 3) or with a strong peak (2 and 5). Days included in cluster 9 shows an earlier peak in the morning (before 9:00). On the other hand, cluster 6 shows a peak in the afternoon, after 15:00. Hourly concentrations show a sharper pattern during the season, with the peak during the hours close to the emission. Out of the season, when pollen is expected to come from farther distances, the hourly peak is located later from the emission time of the trees. Significant factors for predicting the hourly pattern were wind speed and direction and the distance to the olive groves., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Rationale: Although relatives of patients with familial pulmonary fibrosis (FPF) are at an increased risk for interstitial lung disease (ILD), the risk among relatives of sporadic idiopathic pulmonary fibrosis (IPF) is not known. Objectives: To identify the prevalence of interstitial lung abnormalities (ILA) and ILD among relatives of patients with FPF and sporadic IPF. Methods: Undiagnosed first-degree relatives of patients with pulmonary fibrosis (PF) consented to participate in a screening study that included the completion of questionnaires, pulmonary function testing, chest computed tomography, a blood sample collection for immunophenotyping, telomere length assessments, and genetic testing. Measurements and Main Results: Of the 105 relatives in the study, 33 (31%) had ILA, whereas 72 (69%) were either indeterminate or had no ILA. Of the 33 relatives with ILA, 19 (58%) had further evidence for ILD (defined by the combination of imaging findings and pulmonary function testing decrements). There was no evidence in multivariable analyses that the prevalence of either ILA or ILD differed between the 46 relatives with FPF and the 59 relatives with sporadic IPF. Relatives with decrements in either total lung or diffusion capacity had a greater than 9-fold increase in their odds of having ILA (odds ratio, 9.6; 95% confidence interval, 3.1-29.8; P  < 0.001). Conclusions: An undiagnosed form of ILD may be present in greater than 1 in 6 older first-degree relatives of patients with PF. First-degree relatives of patients with both familial and sporadic IPF appear to be at similar risk. Our findings suggest that screening for PF in relatives might be warranted.

Ornamental trees bring benefits for human health, including reducing urban pollution. However, some species, such as plane trees (Platanus sp.), produce allergenic pollen. Consequently, urban maps are a valuable tool for allergic patients and allergists, but they often fail to include variables that contribute to the "building downwash effect", such as the width and shape of streets and the height of buildings. Other factors that directly influence pollen dispersion (slopes and other geographical features) also have not traditionally been discussed. The LiDAR (Laser Imaging Detection and Ranging) technique enables one to consider these variables with high accuracy. This work proposes an Aerobiological Index to create Risk maps for Ornamental Trees (AIROT) and the establishment of potential areas of risk of exposure to Platanus pollen. LiDAR data from five urban areas were used to create the DEM and DSM (Digital Elevation and Surface Models) needed to perform further analysis. GIS software was used to map the points for each city and to create risk maps by Kriging, with stable (3 cases) and exponential function (2 cases) as the optimal models. In short, the AIROT index was a useful tool to map possible biological risks in cities. Since AIROT allows each city to consider its own characteristics, including geographical specifications, by using remote sensing and geostatistics techniques, the establishment of risk maps and healthy itineraries is valuable for allergic patients, allergists, architects and urban planners. This new aerobiological index provides a new decision-making tool related to urban planning and allergenicity assessment., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Although various interventions targeted at reducing hospital readmissions have been identified in the literature, little is known about actual operationalization of such evidence-based interventions. This study conducted a systematic review and a survey of key informants in 2 leading hospitals, Houston Methodist (HM) and MD Anderson Cancer Center (MDACC), to compare and contrast the most cited evidence-based interventions in the current literature with interventions reported by those hospitals. The authors found that both hospitals followed evidence-based practices reported as successful in the literature. Both hospitals have implemented interventions for inpatient settings, and the timing of interventions was very similar. Major implementation differences observed for post-discharge interventions focused on collaboration. It also was found that HM was more likely than MDACC to use medication reconciliation in outpatient ( P = .018) and discharge planning for community/home patients ( P = .032). Results will provide hospital professionals with insights for implementing the most effective interventions to reduce readmissions.

Techniques of remote sensing are being used to develop phenological studies. Our goal is to study the correlation among the Normalized Difference Vegetation Index (NDVI) related with oak trees included in three set data polygons (15, 25 and 50 km to aerobiological sampling point as NDVI-15, 25 and 50), and oak (Quercus) daily average pollen counts from 1994 to 2013. The study was developed in the SW Mediterranean region with continuous pollen recording within the mean pollen season of each studied year. These pollen concentrations were compared with NDVI values in the locations containing the vegetation under a study based on two cartographic sources: the Extremadura Forest Map (MFEx) of Spain and the Fifth National Forest Inventory (IFN5) from Portugal. The importance of this work is to propose the relationship among data related in space and time by Spearman and Granger causality tests. 9 out of 20 studied years have shown significant results with the Granger causality test between NDVI and pollen concentration, and in 12 years, significant values were obtained by Spearman test. The distances of influence on the contribution of Quercus pollen to the sampler showed statistically significant results depending on the year. Moreover, a predictive model by using Artificial Neural Network (ANN) was applied with better results in NDVI25 than for NDVI15 or NDVI50. The addition of NDVI25 with the lag of 5 days and some weather parameters in the model was applied with a RMSE of 4.26 (Spearman coefficient r = 0.77) between observed and predicted values. Based on these results, NDVI seems to be a useful parameter to predict airborne pollen., (Copyright © 2019. Published by Elsevier B.V.)

Purpose: Readmission within 30 days has been used as a metric for quality of care received at hospitals for certain diagnoses. In the era of accountability, value-based care, and increasing cancer costs, policymakers are looking into cancer readmissions as well. It is important to describe the readmission profile of patients with cancer in the most clinically relevant approach to inform policy and health care delivery that can positively impact patient outcomes., Patients and Methods: We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data. We included elderly Texas residents diagnosed with GI cancer and identified risk factors for unplanned readmission using generalized estimating equations, comparing medical with surgical cancer-related hospitalizations., Results: We analyzed 69,693 hospitalizations from 31,736 patients. The unplanned readmission rate was higher after medical hospitalizations than after surgical hospitalizations (21.6% v 13.4%, respectively). Shared risk factors for readmission after medical and surgical hospitalizations included advanced disease stage, high comorbidity index, and emergency room visit and radiation therapy within 30 days before index hospitalization. Several other associated factors and reasons for readmission were noted to be unique to medical or surgical hospitalizations alone., Conclusion: Unplanned readmissions among elderly patients with GI cancer are more common after medical hospitalizations compared with surgical hospitalizations. There are shared risk factors and unique risk factors for these hospitalizations that can inform policy, health care delivery, and interventions to reduce readmissions. Other findings underscore the importance of care coordination and comorbidity management in this patient population.

Urban parks play a key role in the provision of ecosystem services, actively participating in improving the quality of life and welfare of local residents. This paper reports on the application of an index designed to quantify the allergenicity of urban parks in a number of Spanish cities. The index, which records biological and biometric parameters for the tree species growing there, classifies parks in terms of the risk they pose for allergy sufferers, graded as null, low, moderate or high. In this initial phase, the index was applied to 26 green areas in 24 Spanish cities; green areas varied in type (urban park, historical or modern garden, boulevard, square or urban forest), size 1-100 ha), geographical location, species richness, number of trees and tree density (number of trees / ha.). The data obtained were used to calculate the percentage of allergenic species in each park, which varied between 17-67%; density ranged from 100 to 300 trees/ha. The index values recorded ranged from a minimum of .07 to a maximum of .87; a significant correlation was found between index value and both number of trees and tree density. Taking an index value of .30 as the threshold considered sufficient to trigger allergy symptoms in the sensitive population, 12 of the parks studied may be regarded as unhealthy at any time of the year. Corrective measures to mitigate the impact of pollen emissions include the implementation of nature-based solutions at various levels: planning and design, handling and management, and strengthening of urban green-infrastructure elements. The index proved to be a useful tool for environmental analysis, and complies with the principles of portability and scalability central to current and horizon scientific research., (Copyright © 2017 Elsevier Inc. All rights reserved.)