Validation Parameters of Patient-Generated Data for Digitally Recorded Allergic Rhinitis Symptom and Medication Scores in the @IT.2020 Project: Exploratory Study

Background: Mobile health technologies enable allergists to monitor disease trends by collecting daily patient-reported outcomes of allergic rhinitis. To this end, patients with allergies are usually required to enter their symptoms and medication repetitively over long time periods, which may present a risk to data completeness and quality in the case of insufficient effort reporting. Completeness of patient’s recording is easily measured. In contrast, the intrinsic quality and accuracy of the data entered by the patients are more elusive. Objective: The aim of this study was to explore the association of adherence to digital symptom recording with a predefined set of parameters of the patient-generated symptom and medication scores and to identify parameters that may serve as proxy measure of the quality and reliability of the information recorded by the patient. Methods: The @IT.2020 project investigates the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In its pilot phase, 101 children with seasonal allergic rhinitis were recruited in Rome and instructed to record their symptoms, medication intake, and general conditions daily via a mobile app (AllergyMonitor) during the relevant pollen season. We measured adherence to daily recording as the percentage of days with data recording in the observation period. We examined the patient’s trajectories of 3 disease indices (Rhinoconjunctivitis Total Symptom Score [RTSS], Combined Symptom and Medication Score [CSMS], and Visual Analogue Scale [VAS]) as putative proxies of data quality with the following 4 parameters: (1) intravariation index, (2) percentage of zero values, (3) coefficient of variation, and (4) percentage of changes in trend. Lastly, we examined the relationship between adherence to recording and each of the 4 proxy measures. Results: Adherence to recording ranged from 20% (11/56) to 100% (56/56), with 64.4% (65/101) and 35.6% (36/101) of the patients’ values above (highly adherent patients) or below (low adherent patients) the threshold of 80%, respectively. The percentage of zero values, the coefficient of variation, and the intravariation index did not significantly change with the adherence to recording. By contrast, the proportion of changes in trend was significantly higher among highly adherent patients, independently from the analyzed score (RTSS, CSMS, and VAS). Conclusions: The percentage of changes in the trend of RTSS, CSMS, and VAS is a valuable candidate to validate the quality and accuracy of the data recorded by patients with allergic rhinitis during the pollen season. The performance of this parameter must be further investigated in real-life conditions before it can be recommended for routine use in apps and electronic diaries devoted to the management of patients with allergic rhinitis

Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study

Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=-0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone. Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts

Trapianti di briofite acquatiche per il biomonitoraggio dei metalli in traccia: risultati e prospettive della tecnica dei moss bags dopo 10 anni di studi fra Veneto e Friuli-Venezia Giulia

Fra gli obiettivi del monitoraggio chimico delle acque previsto dalla Direttiva Quadro 2000/60/CE vi \ue8 la sorveglianza delle sostanze prioritarie, fra le quali si annoverano alcuni metalli pesanti che spesso generano forme d\u2019inquinamento sporadiche o intermittenti. Ci\uf2, sommato alla promiscuit\ue0 dell\u2019utilizzo del territorio, all\u2019inadeguatezza della rete fognaria o degli impianti di trattamento ed all\u2019impossibilit\ue0 di controllare le sorgenti puntiformi, pu\uf2 determinare situazioni che generano rischi ambientali particolarmente insidiosi. Il monitoraggio biologico ed anche quello chimico basato sul campionamento dell\u2019acqua non possono procurare informazioni rappresentative sulla reale presenza di metalli nell\u2019ambiente, n\ue9 sulla loro disponibilit\ue0 biologica. L\u2019utilizzo di accumulatori, soprattutto quelli biologici come le briofite, consente invece di ottenere stime sensibili ed integrate del livello di alterazione ambientale da metalli nella sola frazione biodisponibile. Le briofite acquatiche sono utilizzate con successo da oltre 40 anni nei pi\uf9 svariati contesti ambientali d\u2019Europa e si configurano come i migliori strumenti oggi a disposizione per il monitoraggio dei metalli. Il Dipartimento di Scienze della Vita dell\u2019Universit\ue0 di Trieste \ue8 impegnato da circa dieci anni in attivit\ue0 di studio, calibrazione ed applicazione dei trapianti di muschio (moss bags) sul territorio veneto e friulano. Questa metodica semplice ed efficace \ue8 gi\ue0 a disposizione degli Enti locali grazie alla collaborazione con le Agenzie Regionali per la Protezione Ambientale ed attende ora di essere standardizzata attraverso un progetto nazionale patrocinato dall\u2019ISPRA

Development of a standard protocol for monitoring trace elements in continental waters with moss bags: inter- and intraspecific differences

8noThis paper is a contribution for validating a standard method for trace element monitoring based on transplants and analysis of aquatic bryophytes, in the framework of the EC Directive 2000/60. It presents the results of an experiment carried out to assess significant differences in the amount and variability of As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn in three moss species (Cinclidotus aquaticus, Fontinalis antipyretica, Platyhypnidium riparioides) and two different parts of the moss (whole plant vs apical tips). Mosses were caged in bags made of a plastic net and transplanted for 2 weeks to an irrigation canal impacted by a waste water treatment plant. Trace element concentrations were measured by inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS) before and after exposure to the experimental and control sites in five samples. Enrichment factors >>2 were found for Cu, Ni, Mn, Pb and Zn in all moss species, lower in C. aquaticus, intermediate in F. antipyretica and higher in P. riparioides (the species we recommend to use). The analysis of apical tips after exposure instead of the whole plant led to (I) lower concentrations of As, Co, Cr, Fe and Zn in C. aquaticus (−7 to −30 %) and of Fe and Pb (−13, −18 %) in P. riparioides, (II) higher concentrations of Cu, Ni and Zn (+14 to +18 %) in P. riparioides, while (III) no significant difference (p > 0.05) in F. antipyretica. Data variability after exposure was generally lower in apical tips, especially in C. aquaticus and in F. antipyretica, less in P. riparioides. In the aim of standardizing the moss-bag technique, the analysis of apical tips is recommended.reservedmixedCesa, Mattia; Bertossi, Alberto; Cherubini, Giovanni; Gava, Emanuele; Mazzilis, Denis; Piccoli, Elisa; Verardo, Pierluigi; Nimis, Pier LuigiCesa, Mattia; Bertossi, Alberto; Cherubini, Giovanni; Gava, Emanuele; Mazzilis, Denis; Piccoli, Elisa; Verardo, Pierluigi; Nimis, Pierluig

Historical overview of the presence of common ragweed airborne pollen since 2000 in Northern Italy

The aim of this study is to investigate the spatial and temporal changes of Ambrosia pollen in the geographical area of Northern Italy during the last 23 years. Ambrosia sp., also referred to as ragweed, is considered an invasive alien species in Europe. Originally native to North America, this annual plant prefers mostly anthropogenic habitats and can tolerate different climatic conditions. This geographical variety, from habitats in the Po Plain to alpine locations, characterizes the regions of Northern Italy, considered in this study. In addition to its broad ecological niche, the common ragweed causes health, environmental, and agronomical problems in many parts of the world. To evaluate the potential risk to human health due to the exposure levels to this highly allergenic pollen, investigating the change in pollen concentrations over time can be relevant. Furthermore, this study gains insight into the trend of the concentration of ragweed pollen during the new century in Italy. Considering the time interval 2000-2023, Ambrosia pollen data were collected at 34 aerobiological monitoring sites in North Italy; all sites had at least 12 years of daily pollen concentration ( P*m-3) data. 31 out of 34 monitoring sites belong to the Italian pollen network POLLnet. All stations performed the aerobiological monitoring using a volumetric Hirst sampler and adopting a common method consistent with UNI EN 16868:2019 EU standard procedure. The dataset has been checked for completeness. Referring to the flowering period of Ambrosia (i.e., July-October), 3% of the yearly data series were excluded since the completeness was lower than 80%. Ambrosia pollen concentrations were analyzed to verify if changes occurred in the study area regarding pollen amounts (i.e., Seasonal Pollen Integral, SPIn, the sum of daily concentrations in the July-October period) and seasonality. Firstly, considering the SPIn values averaged over the entire 2000-2023 study period, results show a large spatial variability, from the lowest values in Brunico (BZ) (9 P*m-3*day) to the highest values in Magenta (MI) site (3667 P*m-3*day). This confirms previous results, evidencing in the Milan area mean SPIn values above 2000 P*m&#x2;3*day, while the seven stations in the Alpine and pre-Alpine area display on average values below 100 P*m-3*day; eastern stations show intermediate values ranging from 100 to 500 P*m&#x2;3*day. Referring to the first occurrence in Italy of Ophraella communa verified in 2013, the comparison (Mann-Whitney U Test) of mean APIn values registered before (i.e., in 2000-2012 period) and after (i.e., 2013-2023 period) displays a significant decrease only for Legnano, Magenta, Rho, Piacenza (p&lt;0.001), Omegna, Novara (p&lt;0.01), and Bolzano (p&lt;0.05). Further analyses will include the pollen seasonality and the spatial distribution with thematic map production. Considering the spatial and temporal variation of Ambrosia pollen amounts, it is of crucial importance to continuously monitor this invasive plant and its pollen, for human health and environment protection, in a large and inclusive One Health perspective. The findings of this study can build the base to improve the current management measures, by adding new ones, which are increasingly comprehensive and can be used as supportive information for decision makers for future handling steps of this invasive speci

Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study

Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording.Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach.Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season.Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, &gt;= 1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman rho=0.75; P&lt;.001; Pordenone: rho=0.81; P&lt;.001) the overall patient adherence to recording and was inversely related to postponed reporting (rho=-0.55; P&lt;.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone.Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts

DNA metabarcoding uncovers fungal diversity of mixed airborne samples in Italy

<div><p>Fungal spores and mycelium fragments are particles which become and remain airborne and have been subjects of aerobiological studies. The presence and the abundance of taxa in aerobiological samples can be very variable and impaired by changeable climatic conditions. Because many fungi produce mycotoxins and both their mycelium fragments and spores are potential allergens, monitoring the presence of these taxa is of key importance. So far data on exposure and sensitization to fungal allergens are mainly based on the assessment of few, easily identifiable taxa and focused only on certain environments. The microscopic method used to analyze aerobiological samples and the inconspicuous fungal characters do not allow a in depth taxonomical identification. Here, we present a first assessment of fungal diversity from airborne samples using a DNA metabarcoding analysis. The nuclear ITS2 region was selected as barcode to catch fungal diversity in mixed airborne samples gathered during two weeks in four sites of North-Eastern and Central Italy. We assessed the taxonomic composition and diversity within and among the sampled sites and compared the molecular data with those obtained by traditional microscopy. The molecular analyses provide a tenfold more comprehensive determination of the taxa than the traditional morphological inspections. Our results prove that the metabarcoding analysis is a promising approach to increases quality and sensitivity of the aerobiological monitoring. The laboratory and bioinformatic workflow implemented here is now suitable for routine, high-throughput, regional analyses of airborne fungi.</p></div

Doughnut charts showing fungal taxonomic composition at division (A) and class (B) level in the four sampling sites.

<p>Relative abundances of taxa are reported in percentage. “Unidentified fungi” comprehends Fungi sp. and fungi with no blast hit. Taxa accounting for <0.1% of reads are grouped as “other”.</p

DNA metabarcoding uncovers fungal diversity of mixed airborne samples in Italy - Fig 5

<p>A) Bar charts showing the taxonomic composition at genus level in the four sampling sites. Abundances of taxa are reported with the percentage values of reads. Taxa accounting for <0.1% of reads are grouped as “Other”. B) Venn diagram shows the number of unique and shared taxa identified at the genus level among sites (as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0194489#pone.0194489.s006" target="_blank">S2 Table</a>).</p