Multi-decade changes in pollen season onset, duration, and intensity: a concern for public health?

Longitudinal shifts in pollen onset, duration, and intensity are public health concerns for the growing number of individuals with pollen sensitization. National analyses of long-term pollen changes are influenced by how a plant's main pollen season (MPS) is defined. Prior Swiss studies have inconsistently applied MPS definitions, leading to heterogeneous conclusions regarding the magnitude, directionality, and significance of multi-decade pollen trends. We examined national pollen data in Switzerland between 1990 and 2020, applying six MPS definitions (2 percentage-based and 4 threshold-based) to twelve relevant allergenic plants. We analyzed changes in pollen season using both linear regression and locally estimated scatterplot smoothing (LOESS). For 4 of the 12 plant species, there is unanimity between definitions regarding earlier onset of pollen season (p < 0.05), with magnitude of 31-year change dependent on specific MPS definition (hazel: 9-18 days; oak: 5-13 days; grasses: 8-25 days; and nettle/hemp: 6-25 days). There is also consensus (p < 0.05) for modified MPS duration among hazel (21-104% longer), nettle/hemp (8-52% longer), and ash (18-38% shorter). Between-definition agreement is highest for MPS intensity analysis, with consensus for significant increases in seasonal pollen quantity (p < 0.05) among hazel, birch, oak, beech, and nettle/hemp. The largest relative intensification is noted for hazel (110-146%) and beech (162-237%). LOESS analysis indicates that these multi-decade pollen changes are typically nonlinear. The robustness of MPS definitions is highly dependent on annual pollen accumulation, with definition choice particularly influential for long-term analysis of low-pollen plants such as ragweed. We identify systematic differences between MPS definitions and suggest future aerobiologic studies apply multiple definitions to minimize bias. In summary, national pollen onset, duration, and intensity have shifted for some plants in Switzerland, with MPS definition choice affecting magnitude and significance of these variations. Future public health research can determine whether these temporal and quantitative pollen changes correlate with longitudinal differences in population pollen sensitization

Ground Motion Relations While TBM Drilling in Unconsolidated Sediments

The induced ground motions due to the tunnel boring machine (TBM), which has been used for the drilling of the urban metro tunnel in Karlsruhe (SW Germany), has been studied using the continuous recordings of seven seismological monitoring stations. The drilling has been undertaken in unconsolidated sediments of the Rhine River system, relatively close to the surface at 6–20 m depth and in the vicinity of many historic buildings. Compared to the reference values of DIN 4150-3 (1–80 Hz), no exceedance of the recommended peak ground velocity (PGV) limits (3–5 mm/s) was observed at the single recording site locations on building basements during the observation period between October 2014 and February 2015. Detailed analyses in the time and frequency domains helped with the detection of the sources of several specific shaking signals in the recorded time series and with the comparison of the aforementioned TBM-induced signals. The amplitude analysis allowed for the determination of a PGV attenuation relation (quality factor Q ~ 30–50) and the comparison of the TBM-induced ground motion with other artificially induced and natural ground motions of similar amplitudes

De novo undifferentiated pleomorphic sarcoma arising from a renal allograft: A case report

To the best of our knowledge, this is the first report of an undifferentiated pleomorphic sarcoma arising from a renal graft. Transplantectomy was performed in a 47-year old woman presenting to the emergency room because of general weakness. Preoperative workup revealed a 5.5 cm malignant mass of the graft which was not present on routine ultrasound performed 12 months earlier. Following transplantectomy, local recurrence developed despite complete tumor resection and interruption of immunosuppression. Despite radiation therapy, the outcome was ultimately fatal. Genetic analysis revealed that the tumor had arisen from donor tissue. Annual ultrasound surveillance might not be enough effective to screen for these rare high grade neoplasms

The Influence of Large-Scale Airborne Particle Decline and Traffic-Related Exposure on Children’s Lung Function

Between 1991 and 2000, ambient air pollution in East Germany changed to resemble West German pollution levels: The concentration of total suspended particles (TSPs) decreased on a broad scale while traffic increased. During that time, we analyzed total lung capacity (TLC) and airway resistance (R(aw)) of East and West German children. We tested children 5–7 years of age (n = 2,574) with cooperation-independent body plethysmography in repeated cross sections. We used random-effect models to determine the mutually adjusted association between lung function and short-term and chronic particle exposure and its interaction with living near a busy road. Annual averages of TSPs declined from 77 to 44 μg/m(3); averages on the day of investigation declined from 133 to 30 μg/m(3). Differences in lung function between East and West German children vanished during the investigation time. The association of TSPs with R(aw) and TLC was stronger in children living > 50 m away from busy roads. East German children from this group had an R(aw) 2.5% higher [95% confidence interval (CI), 0.0–5.1%] per 40-μg/m(3) increase of daily TSP averages. TLC decreased by 6.2% (95% CI, 0.04–11.6%) per 40-μg/m(3) increase in annual mean TSPs, and this effect was equally pronounced in East and West Germany. TSP exposure decreased on a broad scale between 1991 and 2000. Lower concentrations of TSPs were associated with better measures of lung function in 6-year-old children. For children living near busy roads, this effect was diminished

Referral patterns between high- and low-volume centers and associations with uterine cancer treatment and survival: a population-based study of Medicare, Medicaid, and privately insured women

High-volume (HV) center surgery and gynecologic oncology care are associated with improved outcomes for women with uterine cancer. Referral patterns, from biopsy through to chemotherapy, may have patients interacting with HV centers for all, a portion, or none of their care. The relative frequency, the underlying factors that contribute to referral, and the potential impact of these referral patterns on treatment outcomes are unknown

Information sharing and credit : firm-level evidence from transition countries

We investigate whether information sharing among banks has affected credit market performance in the transition countries of Eastern Europe and the former Soviet Union, using a large sample of firm-level data. Our estimates show that information sharing is associated with improved availability and lower cost of credit to firms. This correlation is stronger for opaque firms than transparent ones and stronger in countries with weak legal environments than in those with strong legal environments. In cross-sectional estimates, we control for variation in country-level aggregate variables that may affect credit, by examining the differential impact of information sharing across firm types. In panel estimates, we also control for the presence of unobserved heterogeneity at the firm level, as well as for changes in macroeconomic variables and the legal environment

Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

Many low-income patients enroll in Medicaid at the time of cancer diagnosis, which improves survival outcomes. Medicaid enrollment before cancer diagnosis may confer additional benefits. Our objective was to compare stage at diagnosis and overall mortality between women with and without Medicaid enrollment before gynecologic cancer diagnosis

Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias

PURPOSE: Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative. METHODS: In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months. RESULTS: The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients. CONCLUSIONS: LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement