National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial.

PURPOSE: Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS: A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS: 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION: From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.

Does Neoadjuvant Chemotherapy in Clinical T1-T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?

BACKGROUND: Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1-2N0 TNBC. METHODS: The National Cancer Database (NCDB) was queried for women with operable cT1-2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND. RESULTS: Overall, 55,624 women were included: 26.9% (n = 14,942) underwent NAC and 73.1% (n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p < 0.001) with more cT2 tumors (71.6% vs. 31.0%; p < 0.001), and had lower ALND rates (4.3% vs. 5.5%; p < 0.001). The upfront surgery cohort was more likely to have one to three pathologically positive nodes (12.1% vs. 6.5%; odds ratio [OR] 2.37, 95% confidence interval (CI) 2.17-2.58; p < 0.001) but there was no difference in the likelihood of ALND (OR 1.1, 95% CI 0.99-1.24; p = 0.08). CONCLUSION: Patients who underwent upfront surgery were more likely to be pN+; however, ALND rates were similar between the two cohorts. Thus, the use of NAC does not result in a higher odds of ALND and the decision for NAC should be individualized and based on modern guidelines and systemic therapy benefits.

Stakeholders' Experiences Using Videoconferencing for a Group-Based Stroke Intervention During COVID-19: A Thematic Analysis.

IMPORTANCE: Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software. OBJECTIVE: To explore stakeholders' experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom). DESIGN: Ad hoc exploratory thematic analysis. SETTING: Community-based telerehabilitation. PARTICIPANTS: Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4). INTERVENTION: Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation. OUTCOMES AND MEASURES: Semistructured interviews. RESULTS: Stakeholders included group members (ages 26-81 yr), group leaders (ages 32-71 yr), and study staff (ages 23-55 yr). Group members characterized ENGAGE as learning, doing, and connecting with others who shared their experience. Stakeholders identified social advantages and disadvantages to the videoconferencing environment. Attitudes toward technology, past technology experiences, the amount of time allotted for training, group size, physical environments, navigation of technology disruptions, and design of the intervention workbook were facilitators for some and barriers for others. Social support facilitated technology access and intervention engagement. Stakeholders recommended training structure and content. CONCLUSIONS AND RELEVANCE: Tailored training protocols may support stakeholders who are participating in telerehabilitation interventions using new software or devices. Future studies that identify specific tailoring variables will advance the development of telerehabilitation training protocols. What This Article Adds: These findings provide stakeholder-identified barriers and facilitators, in addition to stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

How the Human Brain Sleeps: Direct Cortical Recordings of Normal Brain Activity.

OBJECTIVE: Regional variations in oscillatory activity during human sleep remain unknown. Using the unique ability of intracranial electroencephalography to study in situ brain physiology, this study assesses regional variations of electroencephalographic sleep activity and creates the first atlas of human sleep using recordings from the first sleep cycle. METHODS: Intracerebral electroencephalographic recordings with channels displaying physiological activity from nonlesional tissue were selected from 91 patients of 3 tertiary epilepsy centers. Sections during non-rapid eye movement sleep (stages N2 and N3) and rapid eye movement sleep (stage R) were selected from the first sleep cycle for oscillatory and nonoscillatory signal analysis. Results of 1,468 channels were grouped into 38 regions covering all cortical areas. RESULTS: We found regional differences in the distribution of sleep transients and spectral content during all sleep stages. There was a caudorostral gradient, with more slow frequencies and fewer spindles in temporoparieto-occipital than in frontal cortex. Moreover, deep-seated structures showed spectral peaks differing from the baseline electroencephalogram. The regions with >60% of channels presenting significant rhythmic activity were either mesial or temporal basal structures that contribute minimally to the scalp electroencephalogram. Finally, during deeper sleep stages, electroencephalographic analysis revealed a more homogeneous spatial distribution, with increased coupling between high and low frequencies. INTERPRETATION: This study provides a better understanding of the regional variability of sleep, and establishes a baseline for human sleep in all cortical regions during the first sleep cycle. Furthermore, the open-access atlas will be a unique resource for research (https://mni-open-ieegatlas. RESEARCH: mcgill.ca). ANN NEUROL 2020;87:289-301.

High-Frequency Oscillations in the Normal Human Brain.

OBJECTIVE: High-frequency oscillations (HFOs) are a promising biomarker for the epileptogenic zone. It has not been possible, however, to differentiate physiological from pathological HFOs, and baseline rates of HFO occurrence vary substantially across brain regions. This project establishes region-specific normative values for physiological HFOs and high-frequency activity (HFA). METHODS: Intracerebral stereo-encephalographic recordings with channels displaying normal physiological activity from nonlesional tissue were selected from 2 tertiary epilepsy centers. Twenty-minute sections from N2/N3 sleep were selected for automatic detection of ripples (80-250Hz), fast ripples (>250Hz), and HFA defined as long-lasting activity > 80Hz. Normative values are provided for 17 brain regions. RESULTS: A total of 1,171 bipolar channels with normal physiological activity from 71 patients were analyzed. The highest rates of ripples were recorded in the occipital cortex, medial and basal temporal region, transverse temporal gyrus and planum temporale, pre- and postcentral gyri, and medial parietal lobe. The mean rate of fast ripples was very low (0.038/min). Only 5% of channels had a rate > 0.2/min HFA was observed in the medial occipital lobe, pre- and postcentral gyri, transverse temporal gyri and planum temporale, and lateral occipital lobe. INTERPRETATION: This multicenter atlas is the first to provide region-specific normative values for physiological HFO rates and HFA in common stereotactic space; rates above these can now be considered pathological. Physiological ripples are frequent in eloquent cortex. In contrast, physiological fast ripples are very rare, making fast ripples a good candidate for defining the epileptogenic zone. Ann Neurol 2018;84:374-385.

Association between fungal spore exposure in inner-city schools and asthma morbidity.

BACKGROUND: Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students. OBJECTIVE: To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma. METHODS: In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period. RESULTS: Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels. CONCLUSION: Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed. CLINICAL TRIAL REGISTRATION: Clinicaltrials.govNCT01756391.

Elevated CO2 boosts reproduction and alters selection in northern but not southern ecotypes of allergenic ragweed.

PREMISE OF THE STUDY: Many plants increase reproduction in response to rising levels of atmospheric CO2 . However, environmental and genetic variation across heterogeneous landscapes can lead to intraspecific differences in the partitioning of CO2 -induced carbon gains to reproductive tissue relative to growth. METHODS: We measured the effects of rising atmospheric CO2 on biomass allocation in the allergenic plant Ambrosia artemisiifolia (common ragweed) across a geographic climate gradient. We grew plants from three latitudes at 400, 600, and 800 µL·L-1 CO2 and analyzed biomass allocation and natural selection on flowering phenology and growth. KEY RESULTS: Both the latitude of origin and CO2 treatment had significant effects on allocation and on estimates of selection. Northern plants were under stronger selection than southern plants to flower quickly, and they produced larger seeds and more reproductive mass per unit of growth. Northern plants were under stronger selection than southern plants to flower quickly, and they produced larger seeds and more reproductive mass per unit of growth. While all plants grew larger and produced heavier seeds at higher CO2 , only northern plants increased male flower production. Both size and time to flowering were under selection, with a relaxation of the size-fitness function in northern ecotypes at high CO2 . CONCLUSIONS: Northern ecotypes allocate more CO2 -induced carbon gains to reproduction than do southern plants, pointing to a geographic gradient in future pollen and seed production by this species arising from local adaptation. Relaxed selection on size at elevated CO2 could amplify reproductive enhancements to northern ecotypes, although more growth and seed provisioning can be expected overall. Our results demonstrate potential for ecotypic divergence in ragweed responses to climate change.

OMEGA: The Open MEG Archive.

In contrast with other imaging modalities, there is presently a scarcity of fully open resources in magnetoencephalography (MEG) available to the neuroimaging community. Here we present a collaborative effort led by the McConnell Brain Imaging Centre of the Montreal Neurological Institute, and the Université de Montréal to build and share a centralised repository to curate MEG data in raw and processed form for open dissemination. The Open MEG Archive (OMEGA, omega.bic.mni.mcgill.ca) is bound to become a continuously expanding repository of multimodal data with a primary focus on MEG, in addition to storing anatomical MRI volumes, demographic participant data and questionnaires, and other forms of electrophysiological data such as EEG. The OMEGA initiative offers both the technological framework for multi-site MEG data aggregation, and serves as one of the largest freely available resting-state and eventually task-related MEG datasets presently available.

The MNI data-sharing and processing ecosystem.

Neuroimaging has been facing a data deluge characterized by the exponential growth of both raw and processed data. As a result, mining the massive quantities of digital data collected in these studies offers unprecedented opportunities and has become paramount for today's research. As the neuroimaging community enters the world of "Big Data", there has been a concerted push for enhanced sharing initiatives, whether within a multisite study, across studies, or federated and shared publicly. This article will focus on the database and processing ecosystem developed at the Montreal Neurological Institute (MNI) to support multicenter data acquisition both nationally and internationally, create database repositories, facilitate data-sharing initiatives, and leverage existing software toolkits for large-scale data processing.

Northern ragweed ecotypes flower earlier and longer in response to elevated CO2: what are you sneezing at?

Significant changes in plant phenology and flower production are predicted over the next century, but we know relatively little about geographic patterns of this response in many species, even those that potentially impact human wellbeing. We tested for variation in flowering responses of the allergenic plant, Ambrosia artemisiifolia (common ragweed). We grew plants originating from three latitudes in the Northeastern USA at experimental levels of CO2 (400, 600, and 800 µL L(-1)). We hypothesized that northern ecotypes adapted to shorter growing seasons would flower earlier than their southern counterparts, and thus disproportionately allocate carbon gains from CO2 to reproduction. As predicted, latitude of origin and carbon dioxide level significantly influenced the timing and magnitude of flowering. Reproductive onset occurred earlier with increasing latitude, with concurrent increases in the number of flowers produced. Elevated carbon dioxide resulted in earlier reproductive onset in all ecotypes, which was significantly more pronounced in the northern populations. We interpret our findings as evidence for ecotypic variation in ragweed flowering time, as well in responses to CO2. Thus, the ecological and human health implications of common ragweed's response to global change are likely to depend on latitude. We conclude that increased flower production, duration, and possibly pollen output, can be expected in Northeastern United States with rising levels of CO2. The effects are likely, however, to be most significant in northern parts of the region.

Malaria-related knowledge and prevention practices in four neighbourhoods in and around Mumbai, India: a cross-sectional study.

BACKGROUND: India accounts for the highest number of malaria cases outside of Africa. Eighty per cent of India's population lives in malaria-risk areas, with cases increasing in urban areas. Mumbai, India, one of the most populous cities in the world, has experienced such an increase. To be successful, many malaria control efforts require community participation, which in turn depends on individuals' knowledge and awareness of the disease. This study assessed the knowledge and prevention practices regarding malaria in residents of four different areas of Mumbai, India, around the time of a malaria outbreak and the start of a widespread awareness campaign. METHODS: A cross-sectional comparative study assessed malaria-related knowledge and prevention practices in four geographically and socio-demographically distinct areas of Mumbai, India. A structured interviewer-administered questionnaire was administered to a stratified random sample of 119 households between 16 December 2010 and 30 January 2011. Participant socio-demographic characteristics, malaria knowledge, malaria prevention practices, and household environmental factors were examined overall and compared across the four areas of Mumbai. RESULTS: Overall, respondents had excellent knowledge of the mosquito as the means of transmission of malaria, mosquito biting times and breeding sites, and fever as a symptom of malaria. However, many respondents also held misconceptions about malaria transmission and symptoms. Respondents generally knew that bed nets are an effective prevention strategy, but only 30% used them, and only 4% used insecticide-treated bed nets. Knowledge and prevention practices varied across the four areas of Mumbai. CONCLUSIONS: Although most residents know that bed nets are effective in preventing malaria, usage of bed nets is very low, and almost no residents use insecticide-treated bed nets. As the four areas of Mumbai differed in knowledge, prevention practices, and primary sources of information, malaria control campaigns should be tailored according to the knowledge gaps, practices, environments, resources, and preferences in different areas of the city, using the interpersonal and media channels most likely to reach the target audiences. Malaria control efforts involving bed nets should emphasize use of insecticide-treated bed nets.

Recent warming by latitude associated with increased length of ragweed pollen season in central North America.

A fundamental aspect of climate change is the potential shifts in flowering phenology and pollen initiation associated with milder winters and warmer seasonal air temperature. Earlier floral anthesis has been suggested, in turn, to have a role in human disease by increasing time of exposure to pollen that causes allergic rhinitis and related asthma. However, earlier floral initiation does not necessarily alter the temporal duration of the pollen season, and, to date, no consistent continental trend in pollen season length has been demonstrated. Here we report that duration of the ragweed (Ambrosia spp.) pollen season has been increasing in recent decades as a function of latitude in North America. Latitudinal effects on increasing season length were associated primarily with a delay in first frost of the fall season and lengthening of the frost free period. Overall, these data indicate a significant increase in the length of the ragweed pollen season by as much as 13-27 d at latitudes above ~44°N since 1995. This is consistent with recent Intergovernmental Panel on Climate Change projections regarding enhanced warming as a function of latitude. If similar warming trends accompany long-term climate change, greater exposure times to seasonal allergens may occur with subsequent effects on public health.

Immobilization of chromate in hyperalkaline waste streams by green rusts and zero-valent iron.

Zero-valent iron (ZVI) and green rusts can be used as reductants to convert chromium from soluble, highly toxic Cr(VI) to insoluble Cr(III). This study compared the reduction rates of Cr(VI) by ZVI and two carbonate green rust phases in alkaline/hyperalkaline solutions. Batch experiments were carried out with synthetic chromate solutions at pH 7.7-12.3 and a chromite ore processing residue (COPR) leachate (pH approximately 12.2). Green rust removes chromate from high pH solutions (pH 10-12.5) very rapidly (<400 s). Chromate reduction rates for both green rust phases were consistently higher than for ZVI throughout the pH range studied; the surface area normalized rate constants were two orders of magnitude higher in the COPR leachate solution at pH 12.2. The performances of both green rusts were unaffected by changes in pH. In contrast, ZVI exhibited a marked decline in reduction rate with increasing pH to become almost ineffective above pH12.

Protocol for a comparative cross-sectional study on characterisation of auditory impairment in sickle cell disease and sickle cell trait and its impact on health-related quality of life in Nigeria.

INTRODUCTION: Sickle cell disease (SCD) and sickle cell traits (SCT) are genetically inherited red blood cell disorders common among people of African descent. Nigeria has a high prevalence of SCD, with a prevalence of 2.28%-3% and SCT, 25%-30%. Poorly managed SCD and SCT can lead to sensorineural hearing loss and health-related quality of life (HRQoL) issues. This research aims to assess these possible complications of SCD and SCT in Nigeria. METHODS AND ANALYSIS: The study will use a comparative cross-sectional design at study power 80% to investigate the association between SCD/SCT, hearing impairment and HRQoL. Participants will be divided into two groups: a cohort and a control group. Hearing levels will be assessed through audiometric assessments and categorised by type and severity of hearing impairments using WHO classifications. HRQoL will also be assessed using WHO Disability Assessment Schedule 2.0. Statistical analyses will be performed using the SAS V.9.4, with parametric or non-parametric analysis depending on the distribution. Relationship between key variables will be determined via correlational tests, χ2, Fisher's exact test and multivariable logistic regression analyses. ETHICS AND DISSEMINATION: The proposal has been fully reviewed and registered by the University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee (HREC REF 228/2022) and the University of Abuja Teaching Hospital Human Research Ethics Committee (HREC/PR/2020/08/007). Information dissemination will be through conferences, peer-review publication and personal communications. The Strengthening the Reporting of Observational Studies in Epidemiology statement will be followed in writing the manuscript.

South African adolescents' lived experiences of acquired hearing loss following multidrug-resistant tuberculosis treatment.

Objective: The impact of acquiring hearing loss might be exacerbated during adolescence, as this normal transition from childhood to adulthood is characterised by identity construction and social intensity. This study aimed to describe the lived experiences of South African adolescents with acquired hearing loss following aminoglycoside treatment for multidrug resistant tuberculosis. Design: The study adopted a descriptive phenomenological design and in-depth, semi-structured interviews were conducted in English, isiZulu and Afrikaans. The data was managed and analysed according to a modified version of Hycner's framework. Study sample: Six participants aged 16-24 years with bilateral, mild to profound hearing loss acquired from aminoglycoside treatment were recruited from two South African provinces. Results: Three themes emerged which created a triple burden for participants. They endured socio-economic hardship encompassing limited economic and emotional support. Participants battled the consequences of life-threatening MDR-TB including illness, hospitalisation, stigma, and other challenges. Finally, participants were left with life-changing hearing loss. Conclusion: The findings indicate the necessity of holistic management of adolescents with aminoglycoside-related acquired hearing loss and serves as motivation to improve ototoxic monitoring practices and patient uptake of monitoring services and calls for the cessation, or at least cautious use, of aminoglycosides.

Outcomes and device use in children with bone-conduction hearing devices in South Africa.

BACKGROUND:  Bone-conduction hearing devices (BCHD) can provide hearing solutions in settings where middle ear pathology is rife. OBJECTIVES:  Describe functional hearing outcomes and device use of children fitted with BCHD. METHOD:  Retrospective review of 79 children fitted with BCHD between January 2017 and May 2022. Outcomes included device use and subjective reports measured with the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) and the Teachers' Evaluation of Aural/Oral Performance of Children (TEACH). Analysis of variance established association between mean data logging and type and degree of hearing loss. Thematic analyses were done for qualitative outcomes. RESULTS:  Average usage was 7.0 h/day (5.4 SD; range 0.1-24). PEACH ratings indicated 93.3% of children wore their BCHD 'always' or 'often', with 80% displaying Typical auditory performance at 1-month follow-up. TEACH ratings indicated 84.2% of children wore their BCHD 'always' or 'often', with 78.9% showing typical auditory behaviour. Increased usage was noted for conductive, mixed, moderate and severe hearing losses. There was a mean delay of 17.2 months (23.4 SD; range 0-90) between age of diagnosis and fitting. Thematic analyses identified two main themes: advantages and barriers to BCDH use. CONCLUSION:  Average device use fell short of the internationally recommended 10 h/day. Higher BCHD use was associated with higher functional listening performance scores. Long waiting times for medical or surgical intervention for conductive hearing losses can delay BCHD fitting.Contribution: Limited information is available to examine outcomes in children fitted with BCHD.

Exposures to molds in school classrooms of children with asthma.

BACKGROUND: Students spend a large portion of their day in classrooms which may be a source of mold exposure. We examined the diversity and concentrations of molds in inner-city schools and described differences between classrooms within the same school. METHODS: Classroom airborne mold spores, collected over a 2 day period, were measured twice during the school year by direct microscopy. RESULTS: There were 180 classroom air samples collected from 12 schools. Mold was present in 100% of classrooms. Classrooms within the same school had differing mold levels and mold diversity scores. The total mold per classroom was 176.6 ± 4.2 spores/m3 (geometric mean ± standard deviation) and ranged from 11.2 to 16,288.5 spores/m3. Mold diversity scores for classroom samples ranged from 1 to 19 (7.7 ± 3.5). The classroom accounted for the majority of variance (62%) in the total mold count, and for the majority of variance (56%) in the mold diversity score versus the school. The species with the highest concentrations and found most commonly included Cladosporium (29.3 ± 4.2 spores/m3), Penicillium/Aspergillus (15.0 ± 5.4 spores/m3), smut spores (12.6 ± 4.0 spores/m3), and basidiospores (6.6 ± 7.1 spores/m3). CONCLUSIONS: Our study found that the school is a source of mold exposure, but particularly the classroom microenvironment varies in quantity of spores and species among classrooms within the same school. We also verified that visible mold may be a predictor for higher mold spore counts. Further studies are needed to determine the clinical significance of mold exposure relative to asthma morbidity in sensitized and non-sensitized asthmatic children.

Ambient pollen concentrations and emergency department visits for asthma and wheeze.

BACKGROUND: Previous studies report associations between aeroallergen exposure and asthma exacerbations. Aeroallergen burdens and asthma prevalence are increasing worldwide and are projected to increase further with climate change, highlighting the importance of understanding population-level relationships between ambient pollen concentrations and asthma. OBJECTIVE: We sought to examine short-term associations between ambient concentrations of various pollen taxa and emergency department (ED) visits for asthma and wheeze in the Atlanta metropolitan area between 1993 and 2004. METHODS: We assessed associations between the 3-day moving average (lag 0-1-2) of Betulaceae (except Alnus species), Cupressaceae, Quercus species, Pinaceae (except Tsuga species), Poaceae, and Ambrosia species pollen concentrations and daily asthma and wheeze ED visit counts, controlling for covarying pollen taxa and ambient pollutant concentrations. RESULTS: We observed a 2% to 3% increase in asthma- and wheeze-related ED visits per SD increase in Quercus species and Poaceae pollen and a 10% to 15% increased risk on days with the highest concentrations (comparing the top 5% of days with the lowest 50% of days). An SD increase in Cupressaceae concentrations was associated with a 1% decrease in ED visits. The association for Quercus species pollen was strongest for children aged 5 to 17 years. Effects of Ambrosia species pollen on asthma exacerbations were difficult to assess in this large-scale temporal analysis because of possible confounding by the steep increase in circulating rhinoviruses every September. CONCLUSION: Poaceae and Quercus species pollen contribute to asthma morbidity in Atlanta. Altered Quercus species and Poaceae pollen production caused by climate change could affect allergen-induced asthma morbidity in the southeastern United States.

Nurses' perspectives on inpatient falls in a large academic hospital in South Africa.

BACKGROUND: Falls risk assessment tools, including the Morse Falls Scale, have been used for years, and yet falls remain key adverse events in hospitals. Nurses are key role players in falls prevention and can champion patient safety. OBJECTIVES: The aim of the study was to explore ward nurses' attitudes, knowledge and practices regarding the use of falls risk assessment tools, institutional falls policy and falls prevention. METHODS: A survey design was used. All permanent ward nurses were eligible to participate, and a convenience sample was used. RESULTS: Nurses endorsed the Morse Falls Scale, recommended by institutional policy, as effective in reducing falls and indicated that incident reporting measured progress on monitoring fall events. Falls prevention training was scanty; however, nurses were keen for further education of falls. CONCLUSION: Effective falls risk management needs to extend beyond promulgating policy and actively address nursing and patient education.Contribution: This study adds to the sparse literature regarding nursing practice and falls prevention in a developing country. Recommendations for change have been made.