Racial and ethnic differences in perceptions of campus climate related to sexual violence

Objective: To assess perceptions of university institutional climate related to sexual violence and whether these differed by race/ethnicity. Participants: Matriculated undergraduates > age 18 (n = 1028). Methods: Students were invited via campus email to participate in an online survey. Results: Overall, only 20% agreed that the university is creating an environment in which unwanted sexual experiences seemed common or normal, but these findings differed by race. Black students were more likely than their white peers to feel the university is creating an environment in which unwanted sexual experiences seem common or normal (37.3% vs. 19.7%, p < .001) and creating an environment in which such instances were more likely to occur (33.3% vs. 13.4%, p < .001). Conclusions: Data suggest that while students generally perceive that the university is working to create a positive and safe climate, these perceptions vary by race. Further investigation is necessary to better understand the concerns of students of color.

Impact of industrial air pollution on the quality of atmospheric water production

The atmospheric water generator (AWG) is a commercially available device that produces water from the air in large volumes over short times. This method can be applied in most regions of the world to solve chronic and acute drinking water scarcity. However, knowledge of the effects of air chemical composition on AWG-produced water quality is still very limited. In this study, a comprehensive survey of AWG-produced water quality was conducted in a heavily polluted industrial environment; 83 AWG water samples were analyzed for 99 different quality parameters, including organic, inorganic, and microbial contamination. Two parameters-nickel (15 samples) and dichloromethane (2 samples)-exceeded sporadically their drinking water standards of EPA, EU and IL. Ammonia was the only parameter consistently above standard limits of 0.5 mg/L (61% of samples, relevant to 47 countries) and even higher than 1.5 mg/L. Comparison to real air concentrations of volatile pollutants in the same environment did not reveal any significant correlations; while some pollutants were found at high concentrations in the air, this was not reflected by their presence in the produced water. The findings show that even in areas that are considered excessively polluted relative to the natural environment, the water produced from the air by AWG could be considered suitable for drinking, with careful attention to very specific contaminants.

A study on the cross-section data of 43,44m,46,47Sc isotopes via (d,x) reactions on natural abundance targets under the effects of deuteron optical models

Many studies have investigated the influence of theoretical models and factors involved in the acquisition of cross-section data of a nuclear reaction. The implications of different models of various variables such as level density, gamma strength function, and optical potentials on cross-section calculations whether used solo or jointly are investigated in a significant portion of the works conducted in this perspective. The aim of this particular study is to investigate the influence of different optical models on the cross-section calculations in production of several scandium isotopes, known for various medical uses, from several targets with natural abundances by (d,x) reactions. For this purpose, the cross-section calculations using five available deuteron optical models of TALYS code in ^natTi(d,x)⁴³Sc, ^natTi(d,x)^44mSc, ^natTi(d,x)⁴⁶Sc, ^natTi(d,x)⁴⁷Sc, ^natV(d,x)⁴⁷Sc and ^natCr(d,x)⁴⁷Sc reactions were performed and the obtained calculation results were compared with the experimental cross-section data gathered from the literature. To understand whether there is a significant and consistent relationship between the experimental data and the calculation results, both have been plotted together and analyzed with the naked-eye. In addition, the calculations of the mean standardized deviation, the mean relative deviation, the mean ratio and the mean square logarithmic deviation were performed in order to evaluate the results numerically.

Assessing Knee Stability in Adolescent Athletes with Osgood-Schlatter Disease Using the Y-Balance Test

PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.

Removal of carbamazepine, venlafaxine and iohexol from wastewater effluent using coupled microalgal-bacterial biofilm

We evaluated the removal capacity of a coupled microalgal-bacterial biofilm (CMBB) to eliminate three recalcitrant pharmaceuticals. The CMBB's efficiency, operating at different biofilm concentrations, with or without light, was compared and analyzed to correlate these parameters to pharmaceutical removal and their effect on the microorganism community. Removal rates changed with changing pharmaceutical and biofilm concentrations: higher biofilm concentrations presented higher removal. Removal of 82-94% venlafaxine and 18-51% carbamazepine was obtained with 5 days of CMBB treatment. No iohexol removal was observed. Light, microorganism composition, and dissolved oxygen concentration are essential parameters governing the removal of pharmaceuticals and ammonia. Chlorophyll concentration increased with time, even in the dark. Three bacterial phyla were dominant: Proteobacteria, Bacteroidetes and Firmicutes. The dominant eukaryotic supergroups were Archaeplastida, Excavata and SAR. A study of the microorganisms' community indicated that not only do the species in the biofilm play an important role; environment, concentration and interactions among them are also important. CMBB has the potential to provide low-cost and sustainable treatment for wastewater and recalcitrant pharmaceutical removal. The microenvironments on the biofilm created by the microalgae and bacteria improved treatment efficiency.

Strategic management to optimize response to cardiac resynchronization therapy registry

Background

Cardiac resynchronization therapy (CRT) is guideline-recommended for the treatment of symptomatic heart failure (HF) in patients (pts) with reduced LVEF and prolonged QRS. Clinical trials report Clinical Composite Score (CCS) response rates from 60 to 75%. However, patients with common comorbidities, such as atrial fibrillation, are often under-represented in clinical trials. The Strategic MAnagement to optimize response to cardiac Resynchronization Therapy (SMART) Registry (NCT03075215) was designed to examine outcomes in CRT patients in the real world.

Methods

The SMART Registry was a global, multicenter, prospective, clinical registry that enrolled subjects undergoing a de novo CRT-D implant or upgrade from pacemaker to CRT-D using a quadripolar LV lead. CCS was assessed at 12 months post-implant.

Results

For study design and CCS outcomes see Figure 1. CCS at 12 months showed that 58.8% of pts improved and 20.1% stabilized. Of the 21.1% of pts that worsened, 8.4% were due to death, 7.8% non-fatal heart failure event, and 5% worsening of NYHA or patient global assessment. Notably, this registry had a high prevalence of pts with NYHA I/II (51%), Non-LBBB (50%), AF (37%), diabetes (35%), and bradycardia (31%) at baseline. Age (&gt;65), diabetes, ischemia, non-LBBB, atrial fibrillation (AF) and renal dysfunction correlated with worsened CCS outcomes. NYHA III/IV patients had significantly higher HF hospitalization (HFH) rates than NYHA I/II (P-value &lt;0.001) (Figure 2a) and patients with AF had higher HFH rates than those without (P-value &lt;0.001) (Figure 2b). Similar effects of NYHA score and AF were seen on mortality. The use of ACE/ARB, or ARNI, and MRA correlated with better outcomes, whereas diuretics and anticoagulants correlated with poorer outcomes.

Conclusions

In this large registry, clinical outcomes across important sub-populations are in line with expectations, with older age, ischemia, renal dysfunction, AF, non-LBBB, and diabetes associated with a lower likelihood of response to CRT. By including these patients, this study provides a clearer picture of the effectiveness of CRT in the real world. Future studies should examine optimization approaches to facilitate CRT effectiveness in these under studied patient populations.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This registry was funded by Boston Scientific (BSC)

The effect of distinct dietary interventions on proximal aortic stiffness; the DIRECT-PLUS randomized controlled trial

Background

Proximal aortic stiffness (PAS) reflects arterial aging and is strongly associated with increased cardiovascular risk. Plant-rich, specifically Mediterranean-style, diets are associated with reduced cardiovascular risk. The effect of dietary interventions on PAS remains unclear.

Methods

We randomized participants with abdominal-obesity/dyslipidemia to healthy-dietary-guidelines (HDG), Mediterranean, or green-Mediterranean diets combined with physical activity (PA). Both Mediterranean diets were similarly hypocaloric and included 28g/day walnuts. The green-Mediterranean group also consumed green tea (3–4 cups/day) and a Wolffia-globosa (Mankai) plant green-shake. PAS was estimated based on aortic-arch pulse-wave-velocity using magnetic resonance imaging (MRI) at baseline and after 18-months.

Results

Among 294 participants [age=51±10.6 years, body-mass-index 31.3±4.0 kg/m2, PAS = 6.1±2.7 m/sec, retention rate = 89.8%], 281 had valid PAS measurements. Higher PAS was mostly associated with aging, hypertension, dyslipidemia, diabetes, and increased visceral adiposity (p&lt;0.05 for all). After 18-months of intervention, all diet groups significantly reduced their PAS ([HDG: −4.8% (interquartile-range [IQR]: −22.3 to 8.7); Mediterranean: −7.3%, IQR (−20.8 to 11.9); green-Mediterranean: −14.0%, IQR (−27.0 to 2.4); p&lt;0.05 for within-groups changes).

Green-Mediterranean dieters had significantly greater PAS reduction than HDG dieters (p=0.007), also after controlling for age, sex, baseline-PAS, and Δweight. Further adjustment to baseline dyslipidemia, diabetes, and hypertension also revealed significant differences in PAS reduction between green-Mediterranean and Mediterranean groups (p=0.027). Specifically, greater green tea consumption was associated with greater PAS regression (p=0.04). ΔPAS was significantly associated with improvements in Δlow-density-lipoprotein cholesterol and Δtotal-cholesterol (p&lt;0.05, multivariable models). All lifestyle intervention showed aortic age regression as compared to the expected (1.8±0.14 years vs.: HDG: −2.9±7.5 years; MED: −4.1±7.4 years; green-MED:-4.9±8.0 years; p&lt;0.001).

Conclusions

Higher PAS is strongly related to aging and is associated with traditional cardiovascular risk factors. Lifestyle intervention promotes PAS reduction. Green-Mediterranean diet may be associated with more remarkable aortic rejuvenation.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Deutsche Forschungsgemeinschaft (DFG, German Research Foundation); the Israel Ministry of Health

Serum uric acid levels significantly improve the accuracy of cardiovascular risk score models

Background

This study evaluated the impact of serum uric acid (sUA) on the accuracy of atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations (PCE) model, Systematic Coronary Risk Evaluation score 2 (SCORE2) and SCORE2-Older Persons (OP).

Methods

We evaluated 19,789 asymptomatic self-referred adults aged 40–79 years who were screened annually in a preventive healthcare setting. All subjects were free of cardiovascular disease and diabetes at baseline. sUA levels were expressed as a continuous as well as dichotomous variable (categorized into sex-specific tertiles, with the upper tertiles defined as high sUA). Mortality and cancer data were available for all subjects from nationwide registries. The primary endpoint was the composite of death, acute coronary syndrome and stroke, after excluding subjects diagnosed with lymphatic spread cancer during follow up.

Results

Mean age of study population was 50±8 years and 69% were men. During median follow up of 6 years [2.0–13.1], 1,658 (8%) subjects reached the study endpoint. ASCVD, SCORE2 risk and high sUA were all independently associated with the study endpoint in the multivariable Cox regression model (p&lt;0.001 for all). Continuous net reclassification improvement analysis showed an improvement of 13% in the accuracy of classification when high sUA was added to the PCE and SCORE2 models (p&lt;0.001 for both). sUA remained independently associated with the study endpoint among normal-weight subjects in the SCORE 2 model (HR 1.3, 95% CI 1.1–1.6) but not among overweight individuals (p for interaction = 0.01). Addition of sUA to the models in normal-weight subgroup (N=6,624) resulted in a significant 20% improvement in the model performance for both SCORE2 and ASCVD when sUA was incorporated as dichotomous variable (p&lt;0.001 for ASCVD and p=0.026 for SCORE2 model).

Conclusions

sUA significantly improves classification accuracy of PCE and SCORE 2 models. This effect is especially pronounced among normal weight subjects.

Funding Acknowledgement

Type of funding sources: None.

Decreasing albumin within normal range is associated with increased likelihood of ischemic heart disease

Background

Albumin (ALB) is a known biomarker of frailty, and cardiovascular disease and frailty are interdependent. Epidemiological evidence demonstrates that low serum albumin levels are linked to events of ischemic heart disease (IHD), venous thromboembolism, heart failure, atrial fibrillation, and stroke.

Purpose

We aimed to investigate the association of variations in ALB levels that are within normal range with IHD events among apparently healthy adults.

Methods

A case-control retrospective study of self-referred adults participating in an executive screening program between 2002 and 2017. All subjects were free of IHD and diabetes at baseline and had their ALB documented in each visit. Only subjects with at least two ALB measurements and whose ALB levels were within the normal range at all visits were included. Relationships between ALB trend and occurrence of IHD (acute coronary syndrome or percutaneous coronary intervention) within 2 years from the last visit were investigated.

Results

The final study cohort included 16,386 subjects. Median age was 53 (IQR 45–60), 11,461 (70%) were men. Analysis included a total of 99,127 visits. Median number of visits per subject was 5 (IQR 3–9, median inter-visit time 1.02 years) and median ALB level was 4.4 (IQR 4.2–4.6). IHD within 2 years was diagnosed in 545 (3%) subjects. Of those, only 36 were female and they tended to have lower variations in ALB throughout the years. Hence, we conducted an analysis of the 509 males only, and created an equal-size age-matched cohort of IHD-free subjects. Our analysis demonstrated a progressive and significant decrease in ALB levels among IHD cases, but not among controls (mean decrease of 0.021 g/DL vs. 0.004 g/DL per year, p&lt;0.01; OR [CI] = 0.82 [0.72–0.93]; Figure 1). Similar results were found among subjects with at least 3 or 4 visits (0.015 g/DL vs. 0.006 g/DL per year, p=0.027, and 0.009 g/DL vs. 0.003 g/DL per year, p=0.045, respectively).

Conclusions

Kinetics of ALB within the normal range can identify men at risk for IHD in preventive healthcare screening programs.

Funding Acknowledgement

Type of funding sources: None.

Effects of combining some theoretical models in the cross-section calculations of some alpha-induced reactions for natSb

In cases where it is not possible to obtain the cross-section values experimentally due to various factors, the importance of obtaining them with theoretical models has been explained in many studies available in the literature. In this context, the comparison of the cross-section values obtained by using the theoretical models with the experimental data will also be very beneficial for updating and developing these models. Existing studies, which also serve this purpose, have given inspiration to this study and it is aimed to examine the effects of the simultaneous use of the alpha optical model potentials and the level density models on the cross-section calculations for some alpha-particle-induced reactions on natural antimony. The effects of theoretical models on the cross-section calculations were investigated by comparing the obtained calculation results with the experimental data taken from the literature. The TALYS code, which is frequently preferred in the literature, was used in all calculations within the scope of this study. For the comparison of the calculated results with the experimental data, not only a visual analysis by graphing the outcomes, but also a mean-weighted-deviation calculation was used, and the findings were interpreted by accounting for both of them.

Incident cardiovascular events among middle-age men are associated with increased risk of subsequent prostate cancer diagnosis

Introduction

Prostate cancer is the second most common malignancy in men worldwide, but incidence is highly dependent on screening.

Purpose

We aimed to examine whether incident cardiovascular disease (CVD) events are associated with increased risk of future prostate cancer in middle-aged men.

Methods

We evaluated asymptomatic self-referred men who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.

Results

Final study population included 18,282 subjects. Median age was 47 years (Interquartile range [IQR] 41–54). During median follow up time of 12 years (IQR 4–17) 2,047 (11%) subjects developed CVD, 406 (2.2%) developed prostate cancer and 694 (4%) died. Compared with patients who were free of CVD or prostate cancer during follow up, risk of death was 4, 6 and 15 times higher for patients who developed CVD event, prostate cancer, or both during follow up, respectively (p &lt;.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 60% more likely to develop prostate cancer (95% Confidence Interval [CI] 1.2–2.1, p=.001). However, after multivariable adjustment, this association was no longer significant. Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in middle-aged men (age≤55 years; N=14,473) incident CVD was associated with a significant 70% increased risk of subsequent cancer diagnosis in multivariable model (95% CI 1.13–2.6, p=.011, p for interaction=.002). Exploratory analysis of men younger than 55 showed that independent association of incident CVD with subsequent cancer diagnosis was different among subjects with normal body mass index (BMI) (≤25 kg/m2) compared with those with increased BMI (HR 0.55; 95% CI [0.22–1.42]; p value=0.23 vs. 1.6; 95% CI [1.007–2.54]; p value=.047; p for interaction=.058, respectively).

Conclusion

Incident CVD is independently associated with increased risk of subsequent prostate cancer diagnosis among men ≤55 years. Routine prostate cancer surveillance should be considered after CVD event in this population.

Funding Acknowledgement

Type of funding sources: None.

Predictors of deterioration in cardiorespiratory fitness among healthy adults: the importance of sex and obesity

Introduction

Cardiorespiratory fitness (CRF) is associated with cardiovascular co-morbidities and is a strong predictor of adverse cardiovascular outcomes. However, data on the natural history of cardiorespiratory fitness among healthy subjects is limited.

Purpose

This study investigated what are the predictors of deterioration in CRF over time.

Methods

We investigated 36,239 men and women who were annually screened in a tertiary medical center and completed an exercise stress test in all visits, with a total of 175,596 annual visits. Subjects who failed to complete maximal exercise stress test according to the Bruce protocol at their first baseline visit were excluded. In addition, subjects with less than five visits to the center or those who developed ischemic heart disease during follow-up were excluded. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time. Change in CRF between the first baseline visit and the fifth visit was used to calculate fitness deterioration. The primary study endpoint was defined as the lower sex-specific quintile of change in metabolic equivalents (METS) between visits 1 and 5. Logistic regression models were applied.

Results

Final study population included 10,841 subjects. The mean age of the study population was 49±10 years, the mean BMI was 26±4, and 8107 (75%) were men. Median METS at baseline were 10.8 (IQR 9–12.6) and 11.1 (IQR 9.4–13) at the first and fifth visit, respectively (p&lt;0.001 for METS between visits). Overall, 2189 (20%) subjects met the study endpoint. CFR deterioration was higher among women as compared to men (p=0.023). Out of obesity, hypertension, fasting blood glucose, LDL, and HDL cholesterol, after adjustments for age, sex, and baseline CFR, only obesity was independently associated with fitness deterioration in the multivariate model (OR=1.4 95% CI 1.2–1.5, p&lt;0.001). The association of obesity with fitness deterioration was modified by sex such that the risk of CRF deterioration was more pronounced in women (OR=1.6 95% CI 1.3–2, p&lt;0.001) than in men (OR=1.3 95% CI 1.1–1.4, p&lt;0.001).

Conclusion

Obesity is an independent predictor of future CRF deterioration. The effect of obesity on future CRF deterioration is more pronounced among women as compared to men.

Funding Acknowledgement

Type of funding sources: None.

Incident cardiovascular events among healthy subjects are associated with increased risk of subsequent cancer diagnosis

Introduction

While Cardiovascular disease (CVD) and cancer share common risk factors, data on the temporal association between the occurrence of CVD and cancer is limited.

Purpose

This study investigated the association between incident CVD events future cancer among apparently healthy subjects.

Methods

We evaluated asymptomatic self-referred adults who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.

Results

Final study population included 26,574 subjects. Median age was 46 years (Interquartile range [IQR] 40–53) and 69% were men. During median follow up time of 10 years (IQR 3–16) 2,463 (9%) subjects developed CVD, 2,040 (8%) developed cancer and 869 (3%) died. Most common cancer types were prostate among men (N=406, 2.2%) and breast among women (N=283, 3.4%). Compared with patients who were free of CVD and cancer during follow up, risk of death was 5, 34 and 54 times higher for patients who developed CVD event, cancer, or both during follow up, respectively (p &lt;.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 50% more likely to develop cancer in a univariate model (95% Confidence Interval [CI] 1.3–1.7, p&lt;.001). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (≤52 years; N=19,052) incident CVD was associated with a significant 30% increased risk of subsequent cancer diagnosis (95% CI 1.03–1.67, p=.027) while in older subjects incident CVD was not associated with increased risk of cancer in the multivariable model (p for interaction =.018).

Conclusion

Incident CVD is independently associated with increased risk of subsequent cancer diagnosis among young adults. Active cancer surveillance should be considered among young patients recovering from a CVD event.

Funding Acknowledgement

Type of funding sources: None.

UV-LED Combined with Small Bioreactor Platform (SBP) for Degradation of 17α-Ethynylestradiol (EE2) at Very Short Hydraulic Retention Time

Degradation of 17α-ethynylestradiol (EE2) and estrogenicity were examined in a novel oxidative bioreactor (OBR) that combines small bioreactor platform (SBP) capsules and UV-LED (ultraviolet light emission diode) simultaneously, using enriched water and secondary effluent. Preliminary experiments examined three UV-LED wavelengths-267, 279, and 286 nm, with (indirect photolysis) and without (direct photolysis) H₂O₂. The major degradation wavelength for both direct and indirect photolysis was 279 nm, while the major removal gap for direct vs. indirect degradation was at 267 nm. Reduction of EE2 was observed together with reduction of estrogenicity and mineralization, indicating that the EE2 degradation products are not estrogens. Furthermore, slight mineralization occurred with direct photolysis and more significant mineralization with the indirect process. The physical-biological OBR process showed major improvement over other processes studied here, at a very short hydraulic retention time. The OBR can feasibly replace the advanced oxidation process of UV-LED radiation with catalyst in secondary sedimentation tanks with respect to reduction ratio, and with no residual H₂O₂. Further research into this OBR system is warranted, not only for EE2 degradation, but also to determine its capabilities for degrading mixtures of pharmaceuticals and pesticides, both of which have a significant impact on the environment and public health.

Arsenate reducing bacteria isolated from the marine sponge Theonella swinhoei: Bioremediation potential

Arsenic (As) contamination of freshwater resources constitutes a major environmental issue affecting over 200 million people worldwide. Although the use of microorganisms for the bioremediation of As has been well studied, only very few candidates have been identified to date. Here, we investigated bacteria associated with the Red Sea sponge Theonella swinhoei and their potential to reduce As in a low-salinity liquid medium. This Indo-Pacific common sponge has been shown to hyper-accumulate As, at an average concentration of 8600 mg/g^-1 in an environment uncontaminated by arsenic or barium. Four isolated strains of bacteria exhibited arsenic reduction potential by transforming inorganic As in the form of arsenate (iAs^V) to arsenite (iAs^III). Two of these isolates were identified as Alteromonas macleodii and Pseudovibrio ascidisceicola, and the other two isolates, both belonging to the same species, were identified as Pseudovibrio denitrificans. The four isolates were then cultured in a low-salinity iAs^V-rich medium (5 mM) and As concentration was measured over time using a specifically designed high-performance liquid chromatograph coupled to a mass spectrometer (HPLC-MS). Out of the four isolates, A. macleodii and P. ascidisceicola grew successfully in a low-salinity liquid medium and reduced As^V to As^III at an average rate of 0.094 and 0.083 mM/h, respectively, thereby demonstrating great potential for the bioremediation of As-contaminated groundwater.

Effects of deuteron optical models on the cross-section calculations of deuteron induced reactions on natural germanium

A common feature of scientific studies is that when experimental observation data are not available, theoretical calculations are used to obtain information about the subject under investigation. In this context, many parameters and theoretical models have been developed that can be used in nuclear physics studies just as it is in other branches of sciences. It is intended that by doing so, theoretical models can be improved using recent experimental data while also learning about outcomes where experimental data is unavailable or difficult to access. Among the many theoretical models available, there are also deuteron optical models whose effects are examined in this study. The objective of this study is to examine the effects of different deuteron optical models on the cross-section calculations of deuteron induced reactions on natural germanium. The cross-section values of ^natGe(d,x)⁷⁰As, ^natGe(d,x)⁷¹As, ^natGe(d,x)⁷²As, ^natGe(d,x)⁷³As, ^natGe(d,x)⁷⁴As and ^natGe(d,x)⁷⁶As reactions were calculated using five deuteron optical models in the TALYS code's v1.95 for this aim, and the results were compared to the experimental data available in the database known as Experimental Nuclear Reaction Data (EXFOR) library. Graphics and quantitative analyses were also used to present the findings and interpretations of the outcomes.

Metabolic determinants of proximal aortic stiffness among healthy people with abdominal obesity

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (1) the Deutsche Forschungsgemeinschaft; (2) Israel Ministry of Health

Background

Increased proximal aortic stiffness (PAS) is directly associated with cardiovascular risk. Likewise, metabolic syndrome (MS) and abdominal obesity are associated with cardiovascular risk. The direct association between MS determinants and PAS among a healthy population with abdominal obesity remains to be examined.

Purpose

To examine the association between MS determinants and PAS among healthy participants with abdominal obesity.

Methods

We utilized the cross-sectional baseline data of the DIRECT-PLUS study (clinicaltrials.gov NCT03020186), where we recruited healthy participants with abdominal obesity/dyslipidemia. Along with anthropometric measurements and blood tests, all participants underwent magnetic-resonance-imaging from which PAS we assessed by calculating the aortic arch pulse-wave-velocity (from the ascending to the descending aorta). We defined MS according to the NCEP-ATP-III criteria.

Results

Of 282 participants who had a valid PAS estimation [mean-age: 51.0, 88.3% male, mean-body-mass-index: 31.2kg/m2, mean-waist circumference (WC): 109.5cm] 171 (60.9%) had MS. PAS was mainly associated with age (r = 0.735, p &lt; 0.001). PAS was associated with an increased 10-year Framingham Risk Score (β=0.165,p = 0.008 after adjustment for age and gender). Participants with MS had higher PAS than non-MS participants (6.6m/sec vs. 5.4m/sec, p = 0.002 after adjusting for age and gender). PAS increased along with cumulative number of MS criteria (p-of-trend &lt; 0.001). In multivariate models, adjusted for gender, age, and dichotomous-components of the MS, worse PAS remained significantly associated with high-density lipoprotein cholesterol (HDL-c; β=0.-116,p = 0.007) and increased blood-pressure (β=0.165,p &lt; 0.001), but not with fasting-glucose, waist-circumference or plasma-triglycerides (p &gt; 0.05 for all). In models adjusted for age, gender, and continuous determinants of MS, worse PAS remained associated with mean-arterial pressure (β=0.218,p &lt; 0.001) and HDL-c (β=0.-126,p = 0.004).

Conclusions

Among a healthy population with abdominal obesity, reduced HDL-c levels and increased blood pressure might be the more dominant predictors of poor PAS state, out of the MS components.

Detection of N-nitrosodimethylamine (NDMA) and its formation potential in hospital wastewater

Hospital wastewaters contain high concentrations of pharmaceutical residues and other chemicals, and may present an important source for NDMA (N-nitrosodimethylamine) and its precursors in the aquatic environment. The present study evaluates the contribution of hospital wastewater to NDMA environmental load and identifies important sources within the hospital itself. For this purpose, wastewaters from five large hospitals in Israel were analyzed, and concentrations of NDMA were found in the range of 20.7-56.7 ng/L, which are similar to NDMA concentrations typically detected in domestic wastewater. The relative contribution of day surgery, oncology, laboratories, and central kitchen (in Sheba hospital) to the daily load of NDMA was calculated as 20.2%, 8.2%, 10%, and 43.2%, respectively. In addition, NDMA concentration in Sheba's mixed wastewater stream, measured throughout a complete working day, was highest at 14:00. This suggests the possible impact of lunchtime on NDMA concentration, and emphasizes the dominant contribution of central kitchen waste. Finally, formation potential of NDMA in the mixed stream was 7300 ng/L, in the upper range of domestic wastewater, but could be decreased by 70% during subsequent aerobic biological wastewater treatment.

Solid phase extraction based on trimethylsilyloxy silica aerogel

Solid-phase extraction (SPE) based on trimethylsilyloxy-modified silica aerogel was developed for extraction of chemotherapeutic drugs from water. The developed method is easy and affordable, can be performed in separating funnel and does not require a vacuum and SPE manifold. The extraction and recovery of cyclophosphamide (CYP), dexamethasone (DEX), and paclitaxel (TAX) by the aerogel from water were investigated. The factors governing the extraction efficiency such as sample pH, sample volume, volume of eluent and concentration of analytes were studied. The LOD and LOQ of the developed method were calculated and linearity was found in the range of 4–100 μg L⁻¹. The extraction efficiency of the aerogel was compared to that of other SPE cartridges, Oasis HLB, Strata-X-C, C18 and polymeric reversed phase, and the aerogel showed similar or better performance than the other commercial cartridges available on the market. The developed method was also used to extract chemotherapeutic drugs spiked in hospital wastewater.

Solid-phase extraction (SPE) based on trimethylsilyloxy-modified silica aerogel was developed for extraction of chemotherapeutic drugs from water.

Deep learning analysis provides accurate COVID-19 diagnosis on chest computed tomography

INTRODUCTION

Computed Tomography is an essential diagnostic tool in the management of COVID-19. Considering the large amount of examinations in high case-load scenarios, an automated tool could facilitate and save critical time in the diagnosis and risk stratification of the disease.

METHODS

A novel deep learning derived machine learning (ML) classifier was developed using a simplified programming approach and an open source dataset consisting of 6868 chest CT images from 418 patients which was split into training and validation subsets. The diagnostic performance was then evaluated and compared to experienced radiologists on an independent testing dataset. Diagnostic performance metrics were calculated using Receiver Operating Characteristics (ROC) analysis. Operating points with high positive (>10) and low negative (<0.01) likelihood ratios to stratify the risk of COVID-19 being present were identified and validated.

RESULTS

The model achieved an overall accuracy of 0.956 (AUC) on an independent testing dataset of 90 patients. Both rule-in and rule out thresholds were identified and tested. At the rule-in operating point, sensitivity and specificity were 84.4 % and 93.3 % and did not differ from both radiologists (p > 0.05). At the rule-out threshold, sensitivity (100 %) and specificity (60 %) differed significantly from the radiologists (p < 0.05). Likelihood ratios and a Fagan nomogram provide prevalence independent test performance estimates.

CONCLUSION

Accurate diagnosis of COVID-19 using a basic deep learning approach is feasible using open-source CT image data. In addition, the machine learning classifier provided validated rule-in and rule-out criteria could be used to stratify the risk of COVID-19 being present.

Assessing pharmaceutical contamination along the Mediterranean and Red Sea coasts of Israel: Ascidians (Chordata, Ascidiacea) as bioindicators

Global increase in the use of pharmaceutically-active compounds (PhACs), and their insufficient removal in wastewater treatment plants, have resulted in their continuous release into the marine environment. We investigated the use of the solitary ascidians Herdmania momus, Microcosmus exasperatus, and Styela plicata as bioindicators of three common PhACs in the Israeli coastal waters: Bezafibrate, carbamazepine and diclofenac. Both the Mediterranean and the Red-Sea coasts were found contaminated with PhACs, detected at all 11 sampling sites, with four sites contaminated with all three studied PhACs. Diclofenac was most frequent, present in nine of the 11 sites with concentrations reaching 51.9 ng/g of dry weight sample (dw). Bezafibrate and carbamazepine reached concentrations of 47.8 ng/g dw and 14.3 ng/g dw, respectively. The alarming detection of such high concentrations of PhACs in ascidians along Israel's coasts demonstrates both the extent of PhACs contamination in the region, and the potential of ascidians as bioindicators, and emphasizes the urgent need for additional research into PhAC contamination sources and effects.

Right ventricular strain for prediction of mortality in patients with preserved ejection fraction

Introduction

Right Ventricular (RV) dysfunction is highly prevalent and has major prognostic implication in patients with Heart Failure (HF) with Preserved Ejection Fraction (HFpEF). Different functional indices have been proposed to evaluate RV function, most common are TEI-index, TAPSE and RVFAC%. Recent works suggested that 2-dimensional speckle tracking echocardiography (2DSTE) for RV global longitudinal strain (RVGLS) and free wall strain (RVFWS) are more sensitive in evaluating RV (dys)function than other functional and hemodynamic parameters in specific populations, such as HF with reduced EF.

Purpose

We aimed to assess if endocardial RVGLS, RVFWS, and RV Septal Wall Strain (RVSWS), might have a prognostic and additive value (on top of the conventional measurements) on the outcome of patients with preserved EF.

Methods

Retrospective analysis of RV parameters including Peak and End Systolic Strain of RVGLS, RVFWS and RVSWS, RV functional indices (RVFAC% and Machine like TAPSE), Systolic Pulmonary Artery Pressure, in 375 consecutive patients with Preserved Ejection Fraction (EF ≥50%; age 69.1±19; 51% female; Co-morbidity Charlson index 1 (3)). Multivariate Cox regression hazards model was used to determine the association between RV strain parameters to all-cause mortality.

Results

RVFWS, RVSWS and RVFAC% were strong predictors of mortality in univariate analysis (HR 1.07 [1.03–1.1]; p≤0.0001, HR 1.08 [1.05–1.12]; p≤0.0001, HR 0.97 [0.95–0.99]; p≤0.0002, respectively). Moreover, after adjustment for clinical (age, gender, Charlson index) and echocardiographic parameters (LA volume, E/e' average, systolic pulmonary pressure), all three parameters remained statistically significant predictors of all-cause mortality (p=0.004, p=0.024, p=0.026, respectively).

The best strain univariate predictor of mortality was RVGLS (HR 1.09 [1.05–1.13]; p≤0.0001), being superior to other RV functional indices and systolic pulmonary pressure. Also, after multivariate analysis it remained a statistically significant predictor of mortality (p=0.007).

All measurements had good intra-observer and inter-observer reproducibility (Single Measures ICC = 0.90 and ICC = 0.88, respectively).

Conclusions

2DSTE of RVGLS, RVFWS, RVSWS provides significant prognostic value to predict overall mortality in patients with Preserved Ejection Fraction with excellent reproducibility, incremental to routine clinical, hemodynamic and diastolic parameters.

Moreover, the strain results of the septal wall showed to be significant, thereover challenging the known hypothesis that the septal wall is mainly influenced by LV function.

Figure 1

Funding Acknowledgement

Type of funding source: None

Photo-neutron cross-section calculations of 54,56Fe, 90,91,92,94Zr, 93Nb and 107Ag Isotopes with newly obtained Giant Dipole Resonance parameters

The knowledge of the interaction of photons with matter is of vital importance to investigate fundamental nuclear physics problems. Giant dipole resonance (GDR) mechanism is dominant up to 30 MeV at photo-absorption cross-section. The photo-absorption cross-section curve against the photon energy displays one or multi-peak Lorentzian functions according to the deformation of the nucleus. Theoretical photo-absorption cross-section calculations generally focus on the estimation of GDR parameters. Theoretical reaction codes use GDR parameters to reproduce photon-induced nuclear reactions. In this study, photo-neutron cross-section calculations of ^54,56Fe, ^90,91,92,94Zr, ⁹³Nb, and ¹⁰⁷Ag isotopes have been done with the TALYS 1.8 and EMPIRE 3.2.2 nuclear reaction codes in the GDR region. During these calculations, both codes were firstly operated by using the predefined and existing GDR parameters within the codes. Later on, a new set of GDR parameters have been obtained by running a Lorentzian model based code in where the available experimental data are also considered. Levenberg-Marquardt algorithm has been used with 10^-6 function tolerances and 400 iterations for optimization. These new obtained GDR parameters then replaced with the existing GDR parameters within the TALYS code and the photo-neutron cross-section calculations for the investigated isotopes have been repeated. Ultimately, in order to discuss the outcomes and the effects of using new GDR parameters, obtained results were analyzed by comparing them with the experimental data from the Experimental Nuclear Reaction Data (EXFOR) library.

Microbial and Viral Communities and Their Antibiotic Resistance Genes Throughout a Hospital Wastewater Treatment System

Antibiotic resistance poses a serious threat to global public health, and antibiotic resistance determinants can enter natural aquatic systems through discharge of wastewater effluents. Hospital wastewater in particular is expected to contain high abundances of antibiotic resistance genes (ARGs) compared to municipal wastewater because it contains human enteric bacteria that may include antibiotic-resistant organisms originating from hospital patients, and can also have high concentrations of antibiotics and antimicrobials relative to municipal wastewater. Viruses also play an important role in wastewater treatment systems since they can influence the bacterial community composition through killing bacteria, facilitating transduction of genetic material between organisms, and modifying the chromosomal content of bacteria as prophages. However, little is known about the fate and connections between ARGs, viruses, and their associated bacteria in hospital wastewater systems. To address this knowledge gap, we characterized the composition and persistence of ARGs, dsDNA viruses, and bacteria from influent to effluent in a pilot-scale hospital wastewater treatment system in Israel using shotgun metagenomics. Results showed that ARGs, including genes conferring resistance to antibiotics of high clinical relevance, were detected in all sampling locations throughout the pilot-scale system, with only 16% overall depletion of ARGs per genome equivalent between influent and effluent. The most common classes of ARGs detected throughout the system conferred resistance to aminoglycoside, cephalosporin, macrolide, penam, and tetracycline antibiotics. A greater proportion of total ARGs were associated with plasmid-associated genes in effluent compared to in influent. No strong associations between viral sequences and ARGs were identified in viral metagenomes from the system, suggesting that phage may not be a significant vector for ARG transfer in this system. The majority of viruses in the pilot-scale system belonged to the families Myoviridae, Podoviridae, and Siphoviridae. Gammaproteobacteria was the dominant class of bacteria harboring ARGs and the most common putative viral host in all samples, followed by Bacilli and Betaproteobacteria. In the total bacterial community, the dominant class was Betaproteobacteria for each sample. Overall, we found that a variety of different types of ARGs and viruses were persistent throughout this hospital wastewater treatment system, which can be released to the environment through effluent discharge.

Treatment of Diethyl Phthalate Leached from Plastic Products in Municipal Solid Waste Using an Ozone-Based Advanced Oxidation Process

Plastic products in municipal solid waste result in the extraction of phthalates in leachate that also contains large amounts of organic matter, such as humic substances, ammonia, metals, chlorinated organics, phenolic compounds, and pesticide residues. Phthalate esters are endocrine disruptors, categorized as a priority pollutant by the US Environmental Protection Agency (USEPA). Biological processes are inefficient at degrading phthalates due to their stability and toxic characteristics. In this study, the peroxone (ozone/hydrogen peroxide) process (O₃/H₂O₂), an O₃-based advanced oxidation process (AOP), was demonstrated for the removal of diethyl phthalate (DEP) in synthetic leachate simulating solid-waste leachate from an open dump. The impact of the O₃ dose during DEP degradation; the formation of ozonation intermediate by-products; and the effects of H₂O₂ dose, pH, and ultraviolet absorbance at 254 nm (UVC) were determined during ozonation. Removal of 99.9% of an initial 20 mg/L DEP was obtained via 120 min of ozonation (transferred O₃ dose = 4971 mg/L) with 40 mg/L H₂O₂ in a semi-batch O₃ system. Degradation mechanisms of DEP along with its intermediate products were also determined for the AOP treatment. Indirect OH radical exposure was determined by using a radical probe compound (pCBA) in the O₃ treatment.

Using solitary ascidians to assess microplastic and phthalate plasticizers pollution among marine biota: A case study of the Eastern Mediterranean and Red Sea

The interaction of microplastic (MP) with marine organisms is crucial for understanding the significant effect that MP and its additives may have on marine environments. However, knowledge regarding the magnitude of these pollutants in the Eastern Mediterranean Sea and the tropical Red Sea is still scarce. Here we examined the levels of phthalate acid esters (PAEs) and MP in Herdmania momus and Microcosmus exasperatus sampled along the Mediterranean and Red Sea coasts of Israel. High levels of dibutyl phthalate (DBP) and bis (2‑ethylhexyl) phthalate (DEHP) were found in ascidians at the majority of sampling sites, and MP particles were found in ascidians at all sites. As efficient filter-feeders and being widely-distributed, invasive ascidians present fundamental opportunities for the environmental monitoring of microplastic and its additives worldwide. The high levels of pollutants revealed emphasize the need for further research into the magnitude and effects of MP and PAEs in these regions.

Investigation of gamma strength functions and level density models effects on photon induced reaction cross-section calculations for the fusion structural materials 46,50Ti, 51V, 58Ni and 63Cu

Scientists have been focused on fusion reactor studies to overcome the increasing energy demand. The materials, which have the potential to be used in fusion reactors must be resistant to the harmful effects of radiation in the manner of material itself. Selection of the appropriate materials to be used in nuclear reactors has a crucial importance to achieve the maximum efficiency and security. Ti, V, Ni and Cu are known as some of the constructional fusion materials. Existence of many knowledge about those materials provides countless advantages to the researchers and one of them is the cross-section, which basically means the probability of a nuclear reaction's occurrence. In addition to the cross-section, there exist some other parameters, which could be pointed as gamma strength function and level density models that affect the theoretical calculations. In this study, photon induced reaction cross-sections of ^46,50Ti, ⁵¹V, ⁵⁸Ni and ⁶³Cu target isotopes have been calculated by using TALYS 1.8 code with different gamma strength functions in the giant dipole resonance region. For gamma strength functions Kopecky-Uhl generalised Lorentzian Model, Brink-Axel Lorentzian Model, Hartree-Fock BCS tables, Hartree-Fock-Bogolyubov tables and Goriely's Hybrid Model have been employed. To appoint the best gamma strength function model, the relative variance calculations have been performed. Also, reaction cross-sections have been recalculated by using the best gamma strength function models through the different level density options. Constant Temperature Fermi Gas Model, Back Shifted Fermi Gas Model and Generalised Super Fluid Model have been employed for level density calculations. Experimental data for the investigated reactions have been taken from EXFOR library and used for comparisons of the obtained calculation results.

The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria

This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

Graphene Oxide Sheets Combine into Conductive Coatings by Direct Oxidative Electropolymerization

New coatings are obtained when graphene oxide is further oxidized at moderate anodic potentials (≤~1.3 V vs. Ag/AgCl). Based on a variety of spectroscopic and electrochemical observations, the coatings are attributed to the direct electropolymerization of graphene oxide sheets via oxidation of the phenol edge groups on graphene. Depending on the applied potential, ether or carboxylic groups are formed. The coatings obtained via further oxidation are characterized by a lower O/C ratio due to decarboxylation and a higher content of C=C bonds. These bonds extend aromatic conjugation into the combined graphene oxide sheets and are responsible for the highly conductive nature of these coatings.

Surgical outcomes of a civil war in a neighbouring country

OBJECTIVES

The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey.

METHODS

159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring.

RESULTS

The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients).

CONCLUSIONS

In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Production cross–section calculations of medical 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment

In this study, production cross–section calculations of 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment produced by 30Si(d,γ)32P, 118Sn(γ,n)117Sn, 116Sn(n,γ)117Sn, 150Nd(α,n)153Sm, 154Sm(n,2n)153Sm, 152Sm(n,γ)153Sm, 186W(d,2n)186Re, 187Re(γ,n)186Re, 185Re(n,γ)186Re and 187Re(n,γ)188Re reactions have been investigated in the different incident energy range of 0.003–34 MeV. Two-component exciton and generalised superfluid models of the TALYS 1.6 and exciton and generalised superfluid models of the EMPIRE 3.1 computer codes have been used to pre-equilibrium (PEQ) reaction calculations. The calculated production cross–section results have been compared with available experimental results existing in the experimental nuclear reaction database (EXFOR). Except the 118Sn(γ,n)117Sn, 150Nd(α,n)153Sm and 185Re(n,γ)186Re reactions, the two-component exciton model calculations of TALYS 1.6 code exhibit generally good agreement with the experimental measurements for all reactions used in this present study.

Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria

This methods report describes the process of guideline development in detail. It is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS) and is published in Allergy 2014; 69:868-887.

The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update

This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).