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The increase in evidence on the adverse health effects of air pollution has been possible thanks to the advances in technology for air pollution monitoring and personal exposure. In this context, air quality sensors present a huge potential for enhancing long-term personal exposure prediction. In order to prove the potential of air sensors for health research, a pilot study with patients suffering from chronic obstructive pulmonary diseases or Asthma was carried out in Stuttgart (Germany) in cooperation with the University Hospital Charité in Berlin, and an outpatient pulmonary practice in Stuttgart.Prior to the pilot study, we first tested several sensor models for PM and NO2 in the laboratory as well as in the field. The sensors with the best performance were selected to build two different sensor boxes for indoor and outdoor measurements. Temperature and relative humidity sensors were also included in the boxes. To avoid the overestimation of the PM readings due to hygroscopic growth, a low-cost dryer was designed and evaluated for the PM sensor of the outdoor boxes (Chacón-Mateos et al. 2022).The measurements inside and outside the houses were carried out over 30 days. Passive sampling of NO2 was done additionally for quality assurance of the NO2 measurements. Participants completed spirometry, a questionnaire assessing respiratory symptoms, and a protocol of activities on a daily basis. The calibration and validation of the sensors were conducted two weeks before the start of the measurements. To perform the quality assurance, the sensor boxes for indoors were collocated in the laboratory, and the sensor boxes for outdoors in the field, together with reference-grade instruments. The PM2.5 concentrations were corrected using univariate linear regression whereas multilinear regression and machine learning algorithms were tested and applied to correct the raw data of the NO2 sensors.The sensor validations have shown that measuring low concentrations of PM2.5 and NO2 has higher expanded uncertainty, but high concentrations can be measured with expanded uncertainties that fulfill the Data Quality Objectives (DQO) set by the Air Quality Directives for indicative measurements. However, we also found a high unit-to-unit variability which means that model coefficients cannot be transferred from one sensor to another. We also recommend collocating NO2 passive samples close to the sensor boxes to determine whether or not the sensor is measuring within the expected range as the signal of some NO2 sensors drifted unexpectedly during the measurements in the houses of the patients.In conclusion, air sensors are not yet to be recommended to quantify the effects of low-level air pollution but they are a promising tool to increase the ubiquity of epidemiological studies for low- and middle-income countries where high air pollution is expected. Moreover, it is important to consider that in order to get actionable data with air sensors, a significant amount of time in sensor calibration should be invested.References:Chacón-Mateos, M., Laquai, B., Vogt, U., and Stubenrauch, C.: Evaluation of a low-cost dryer for a low-cost optical particle counter, Atmos. Meas. Tech., 15, 7395–7410, https://doi.org/10.5194/amt-15-7395-2022, 2022

Background: Cytologic examination of specimens obtained from the respiratory tract is a lung cancer diagnostic procedure with high specificity but moderate sensitivity. The use of molecular biomarkers may enhance the sensitivity of cytologic examination in the detection of lung cancer.Methods: Complement factor H, a protein secreted by lung cancer cells, was quantified in a series of bronchoalveolar lavage supernatants from lung cancer patients and patients with nonmalignant respiratory diseases. Albumin, total protein content, and hemoglobin were also analyzed. Results were validated in independent sets of bronchoalveolar lavage and sputum supernatants.Results: There was a significantly higher concentration of factor H in bronchoalveolar lavage samples from lung cancer patients. The sensitivity and specificity of the factor H test was 82% and 77%, respectively. These results were validated in an independent set of patients with nearly identical results. Furthermore, 70% and 45% of bronchoalveolar lavage fluids from central and peripheral tumors, respectively, reported as cytologically negative, were classified as positive using this marker. Finally, the test was evaluated in a series of sputum supernatants from lung cancer patients and controls. The sensitivity and specificity of the factor H test in this series was 80% and 88%, respectively.Conclusion: Factor H is elevated in bronchoalveolar lavage and sputum from lung cancer patients.Impact: Measurement of molecular biomarkers, such as complement factor H, may be used in the future as an adjunct to cytology in the diagnosis of malignant pulmonary diseases. Cancer Epidemiol Biomarkers Prev; 19(10); 2665–72. ©2010 AACR.

Supplementary Table 1 from Complement Factor H Is Elevated in Bronchoalveolar Lavage Fluid and Sputum from Patients with Lung Cancer

Sauerstoff (O2) ist ein Arzneimittel mit spezifischen Eigenschaften, einem definierten Dosis-Wirkungs-Bereich und O2 hat unerwunschte Wirkungen. Im Jahr 2015 wurden 14 % einer Stichprobe von britischen Krankenhauspatienten mit Sauerstoff behandelt, davon hatten nur 42 % eine Verordnung. Gesundheitspersonal ist haufig unsicher uber die Relevanz einer Hypoxamie und es besteht ein eingeschranktes Bewusstsein fur die Risiken einer Hyperoxamie. In den letzten Jahren wurden zahlreiche randomisierte, kontrollierte Studien zur Sauerstofftherapie veroffentlicht. Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualitat erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert. Die Leitlinie enthalt 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Uberwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation fur Sauerstoff ist hauptsachlich die Hypoxamie. Hypoxamie und Hyperoxamie sollten aufgrund der Assoziation mit einer erhohten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsattigung fur die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhangig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Uberblick uber verfugbare Sauerstoffzufuhrsysteme und enthalt Empfehlungen fur deren Auswahl basierend auf Patientensicherheit und -komfort. Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff auserklinisch und stationar anwendet, und ist bis zum 30.06.2024 gultig.

Zusammenfassung Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen biochemischen und physiologischen Eigenschaften, einem definierten Dosis-Wirkungsbereich und mit unerwünschten Wirkungen. Im Jahr 2015 wurden 14 % von über 55 000 Krankenhauspatienten in Großbritannien mit O2 behandelt. Nur 42 % der Patienten hatten dabei eine O2-Verordnung. Gesundheitspersonal ist oft unsicher über die Relevanz einer Hypoxämie, und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte kontrollierte Studien zu Zielen der Sauerstofftherapie veröffentlicht. Eine nationale Leitlinie ist deswegen dringend erforderlich. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften eine S3-Leitlinie entwickelt und im Juni 2021 veröffentlicht. Bis zum 1. 2. 2021 wurde eine Literaturrecherche durchgeführt, um 10 Schlüsselfragen zu beantworten. Zur Klassifizierung von Studientypen hinsichtlich ihrer Validität wurde das Oxford Centre for Evidence-Based Medicine (CEBM) System („The Oxford 2011 Levels of Evidence“) verwendet. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wurde verwendet und zur Bewertung der Evidenzqualität und zur Einstufung von Leitlinienempfehlungen wurde ein formaler Konsensbildungsprozess durchgeführt. Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Hauptindikation für die O2-Therapie ist Hypoxämie. In der Akutmedizin sollten sowohl Hypoxämie als auch Hyperoxämie vermieden werden. Hyperoxämie scheint mit einer erhöhten Sterblichkeit verbunden zu sein, insbesondere bei Patienten mit Hyperkapnie. Die Leitlinie empfiehlt Zielsauerstoffsättigung für die Akuttherapie mit O2 ohne Differenzierung zwischen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet. Sie ist bis zum 30. 06. 2024 gültig.

Gunshot emissions contain toxic elements that can harm those frequently exposed, such as police officers. Several years ago, police indoor firing ranges were closed by the Berlin municipality in response to police officer health complaints, and an investigation was launched into the possible respiratory health risks of frequent gunshot emission exposure. We, therefore, conducted an exploratory cross-sectional study to investigate clinical and functional parameters of respiratory health as well as the burden of trace elements in policemen with long-term high exposure to indoor gunshot emissions, compared to low-exposure and control groups.We conducted lung function tests and collected blood and urine samples from Berlin police officers and government employees who were divided into three subject groups based on exposure to gunshot emissions: high exposure (n = 53), low exposure (n = 94) and no exposure (n = 76). Lung function was examined using body plethysmography. Blood and urine samples were tested via inductively coupled plasma mass spectrometry for the presence of common gunshot powder elements (antimony, lead and manganese). Exposure and symptoms were assessed using records as well as questionnaires.Higher exposure was associated with more respiratory symptoms during gun shooting practice (64% vs. 21%, P 0.001) compared to the low-exposure group. Headache, cough, discoloured mucous and shortness of breath were also more common as were some other symptoms. The cough symptomatology of the high-exposure group also persisted significantly longer (median: 0.67 vs. 0.01 days, range: 0 to 5 days, P = 0.029) compared to the low-exposure group. They also showed a lower forced expiratory volume in 1 s/forced vital capacity quotient (Tiffeneau index), P = 0.018 between the three groups and P = 0.005 for the high-exposure group, a possible marker of early, subclinical bronchial obstruction. We observed increased blood lead concentrations depending on subject's age (+1.2% per year, 95% confidence interval: 0.5-1.9%, P 0.001) and cumulative gunshot exposure (+0.34% per 100 000 shots, 0.02-0.66%, P = 0.037).These first results suggest that long-term exposure to indoor gunshot emissions induces bronchitic reactions due to repeated irritation of the airways. Higher levels of exposure lead to more negatively impacted lung function and higher blood lead levels with the possible reason that more frequent exposure may mean shorter regeneration phases for the respiratory mucous membrane. We recommend a reduction of exposure to gunshot emissions in order to decrease symptoms and avoid any-even small-deterioration in spirometry.

The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P, SCOPUS: ar.j, info:eu-repo/semantics/published

ZUSAMMENFASSUNGPatienten mit chronischen Lungenkrankheiten sind von den Auswirkungen zunehmender Hitzewellen besonders betroffen, da die Lunge als „Grenzorgan zur Umwelt“ wirkt. COPD- und Asthma-Patienten reagieren mit verstärkter Bronchokonstriktion und stärkerer Entzündungsreaktion der Bronchialschleimhaut auf Hitzestress, was zur Symptomzunahme bis hin zur Hospitalisierung führen kann. Dies führt auch zu einem Anstieg der Mortalität.Zur Prävention von Hitzestress im Krankenhaus können infrastrukturelle Anpassungen wie ein verbesserter Sonnenschutz oder das Anbringen von Kühldecken (konvektionsfreies Air Conditioning) vorgenommen werden. Ebenso können ein Monitoring der Flüssigkeitsaufnahme, körperliche Schonung und effektive Lüftungsregime Hitzestress abmildern. Im Falle Hitze-assoziierter Exazerbationen von COPD-Erkrankungen liegen erste Hinweise auf den therapeutischen Nutzen einer Krankenzimmer-Klimatisierung mit einer Raumtemperatur von 23° C vor. Hierfür bietet sich aufgrund energetischer und hygienischer Vorteile eine innovative Kühlung mithilfe konvektionsfreier Raumklimatisierung an. So könnte Patienten mit Hitze-assoziierter Krankheitsprogression ein ganzheitliches, über die traditionelle medikamentöse Therapie hinausgehendes, Behandlungskonzept angeboten werden.Bei zukünftig häufigerem und intensiverem Hitzestress wird die Notwendigkeit präventiver Maßnahmen für Patienten mit chronischen Atemwegs-Krankheiten steigen. Zusätzlich wird für besonders vulnerable Gruppen der Bedarf an Raumklimatisierung steigen.

ZUSAMMENFASSUNGDie gesundheitsschädigende Wirkung von Luftschadstoffen ist durch eine Vielzahl von Studien belegt. Eine erhöhte Konzentration von Feinstaubpartikeln (PM10 und PM2.5), Ozon und Stickoxiden triggern inflammatorische Prozesse an den Schleimhäuten der Atemwege und am Endothel. Diese kann zur Progression oder Exazerbation chronischer Krankheiten führen und akute respiratorische oder kardiovaskuläre Symptome auslösen. Die Exposition gegenüber Luftschadstoffen ist konzentrationsabhängig mit einem Anstieg der Mortalität und Morbidität assoziiert. Vulnerable Gruppen sind Säuglinge und Kleinkinder, aber auch ältere Personen und polymorbide Patienten. Diese Bevölkerungsgruppen sind vor allem in Metropolenregionen nicht nur den erhöhten Luftschadstoffen, sondern im Rahmen des Klimawandels auch zunehmender Hitzebelastung ausgesetzt.Die Stimme der Ärzte ist wichtig, um die Bevölkerung auf die gesundheitlichen Auswirkungen von Luftschadstoffen im Klimawandel hinzuweisen und fortschrittliche Lösungen zum Hitzeschutz auch in den Kliniken zu unterstützen.

Implications for the academic and interpersonal development of children and adolescents underpin a global political consensus to maintain in-classroom teaching during the ongoing COVID-19 pandemic. In support of this aim, the WHO and UNICEF have called for schools around the globe to be made safer from the risk of COVID-19 transmission. Detailed guidance is needed on how this goal can be successfully implemented in a wide variety of educational settings in order to effectively mitigate impacts on the health of students, staff, their families, and society. This review provides a comprehensive synthesis of current scientific evidence and emerging standards in relation to the use of layered prevention strategies (involving masks, distancing, and ventilation), setting out the basis for their implementation in the school environment. In the presence of increasingly infectious SARS-Cov-2 variants, in-classroom teaching can only be safely maintained through a layered strategy combining multiple protective measures. The precise measures that are needed at any point in time depend upon a number of dynamic factors, including the specific threat-level posed by the circulating variant, the level of community infection, and the political acceptability of the resultant risk. By consistently implementing appropriate prophylaxis measures, evidence shows that the risk of infection from in-classroom teaching can be dramatically reduced. Current studies indicate that wearing high-quality masks and regular testing are amongst the most important measures in preventing infection transmission; whilst effective natural and mechanical ventilation systems have been shown to reduce infection risks in classrooms by over 80%.

SummaryBackgroundThe public and scientific discourse on how to mitigate the COVID-19 pandemic is often focused on the impact of individual protective measures, in particular on vaccination. In view of changing virus variants and conditions, however, it seems not clear if vaccination or any other protective measure alone may suffice to contain the transmission of SARS-CoV-2.MethodsHere, we investigate the effectiveness and synergies of vaccination and non-pharmaceutical interventions like masking, distancing & ventilation, testing & isolation, and contact reduction as a function of compliance in the population. Our new analysis accounts for the practical compliance in the population and for both droplet transmission and aerosol transmission.FindingsFor realistic conditions, we find that it would be difficult to contain highly contagious SARS-CoV-2 variants by any individual measure. Instead, we show how multiple synergetic measures have to be combined to reduce the effective reproduction number (Re) below unity for different basic reproduction numbers ranging from the SARS-CoV-2 ancestral strain up to measles-like values (R0 = 3 to 18). For R0 = 5 as reported for the Delta variant and ∼70% vaccination rate, the synergies of masking and distancing & ventilation with compliances around 30% appear sufficient to keep Re < 1. In combination with 2-3 tests per week, this would work also at lower vaccination rates, e.g., in schools.InterpretationIf the Omicron variant were to reach R0 = 8, it could still be contained with the synergetic measures outlined above. In case of measles-like transmissibilities (R0 = 12 to 18), higher compliances and testing rates or additional measures like general contact reductions would be required. The presented findings and approach can be used to design and communicate efficient strategies for mitigating the COVID-19 pandemic.FundingMax Planck Society.Research in contextEvidence before this studyStudies on how to mitigate the COVID-19 pandemic are often focused on the impact of individual protective measures, in particular on vaccination. The effectiveness of non-pharmaceutical interventions (NPIs) like masking or distancing & ventilation are often under debate due to a lack of understanding of different transmission pathways (droplet versus aerosol transmission) and protective measures, in particular for the efficacy of masking and contrasting randomized trial results under different conditions (virus-limited vs. virus-rich) and at different levels of practical compliance. Thus, in view of more contagious variants such as Delta or Omicron, it is not clear if vaccination or any other protective measure alone may suffice to contain the transmission of SARS-CoV-2.Added value of this studyOur analysis explicitly accounts for both droplet and aerosol transmission as well as for practical compliance in the population, which is the main reason for divergent results on the effectiveness of the same NPIs in different regions. This was not fully considered before and may have led to misunderstandings and misinformation about the actual effects of preventive measures. For realistic conditions, we find that it would be difficult to contain highly contagious SARS-CoV-2 variants by any individual measure. Instead, we show that combining multiple synergetic measures with realistic compliances can reduce Re below unity without lockdown.Implications of all the available evidenceOur findings and the presented scientific approach can be used to design and communicate efficient strategies for mitigating the COVID-19 pandemic for specific environments like schools as well as on a population level.

There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector-borne disease incidence) health impacts of climate change. These impacts vary depending on vulnerability (i.e., existing diseases) and the international, economic, political, and environmental context. This unique review also expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and environmental justice and education. This scholarly resource explores these issues fully, linking them to global health in urban and rural settings in developed and developing countries. The review finishes with a practical discussion of action that health professionals around the world in our field can yet take.

Oxygen is a drug with specific properties, a defined dose-effect range and side effects. In 2015, in a sample of UK hospital patients, 14% were treated with oxygen, of which only 42% had a prescription. Health care workers are often uncertain about the relevance of hypoxemia, and there is limited awareness of the risks of hyperoxemia. Numerous randomized controlled trials on oxygen therapy have recently been published.As part of the guideline program of the Working Group of Scientific Medical Societies e. V. (AWMF), this S3 guideline was developed with the participation of 10 medical societies on the basis of a literature search up to 02/01/2021. The system of the Oxford Centre for Evidence-Based Medicine (CEBM) (The Oxford 2011 Levels of Evidence) was used to evaluate the literature. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE), and a formal consensus process of recommendations was performed.The guideline contains 34 evidence-based recommendations on the indication, prescription, monitoring, and discontinuation of oxygen therapy in acute care. The indication for oxygen is mainly hypoxemia. Hypoxemia and hyperoxemia should be avoided, since both increase mortality. The guideline recommends target ranges of oxygen saturation for acute oxygen therapy without differentiating between different diagnoses. Target areas depend on the risk for hypercapnia and ventilation status. The guideline provides an overview of available oxygen delivery systems and contains recommendations for their selection based on patient safety and comfort.This is the first German guideline on the use of oxygen in acute care. It is aimed at medical professionals who use oxygen in and outside hospitals and is valid until June 30th, 2024.HINTERGRUND: Sauerstoff (OIm Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualität erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert.Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation für Sauerstoff ist hauptsächlich die Hypoxämie. Hypoxämie und Hyperoxämie sollten aufgrund der Assoziation mit einer erhöhten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsättigung für die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort.Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet, und ist bis zum 30.06.2024 gültig.

Oxygen (O A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024. Sauerstoff (O Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften eine S3-Leitlinie entwickelt und im Juni 2021 veröffentlicht. Bis zum 1. 2. 2021 wurde eine Literaturrecherche durchgeführt, um 10 Schlüsselfragen zu beantworten. Zur Klassifizierung von Studientypen hinsichtlich ihrer Validität wurde das Oxford Centre for Evidence-Based Medicine (CEBM) System („The Oxford 2011 Levels of Evidence“) verwendet. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wurde verwendet und zur Bewertung der Evidenzqualität und zur Einstufung von Leitlinienempfehlungen wurde ein formaler Konsensbildungsprozess durchgeführt. Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Hauptindikation für die O Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet. Sie ist bis zum 30. 06. 2024 gültig.

Masking out air sharing The effectiveness of masks in preventing the transmission of severe acute respiratory syndrome coronavirus 2 has been debated since the beginning of the COVID-19 pandemic. One important question is whether masks are effective despite the forceful expulsion of respiratory matter during coughing and sneezing. Cheng et al. convincingly show that most people live in conditions in which the airborne virus load is low. The probability of infection changes nonlinearly with the amount of respiratory matter to which a person is exposed. If most people in the wider community wear even simple surgical masks, then the probability of an encounter with a virus particle is even further limited. In indoor settings, it is impossible to avoid breathing in air that someone else has exhaled, and in hospital situations where the virus concentration is the highest, even the best-performing masks used without other protective gear such as hazmat suits will not provide adequate protection. Science , abg6296, this issue p. 1439

The current COVID-19 pandemia affects health care systems worldwide, however, to a variable extent depending on the caseload in each country. We aimed to provide a cross-sectional overview of current limitations or adaptions in lung transplant programs in Germany in from January to May 2020 due to the COVID-19 pandemia caused by severe acute respiratory syndrome coronavirus 2. A cross-sectional survey assessing various aspects of lung transplant activity was sent to all active lung transplant programs (n = 12) in Germany. Eight centers (66%) responded to the survey within the requested time frame. Four centers (50%) reported their activity is not restricted at all and four centers (50%) reported on moderate general limitations. The overall lung transplant activity in Germany from January to May 2020 contains 128 bilateral and 11 single lung transplantations, which is similar to the same period in the year 2019 (126 bilateral transplantations and 12 single lung transplantations). The results suggest that the influence of the COVID-19 pandemia on lung transplantation activity in Germany has been moderate so far. Nevertheless, adaptions such as extensive testing of donors and recipients were introduced to reduce the likelihood of infections and increase patient safety. Alertness to changes in COVID-19 reproduction rates might be required until effective antiviral therapy or vaccination is available.

Aggregation of amyloid‐β (Aβ) that leads to the formation of plaques in Alzheimer's disease (AD) occurs through the stepwise formation of oligomers and fibrils. An earlier onset of aggregation is obtained upon intracerebral injection of Aβ‐containing brain homogenate into human APP transgenic mice that follows a prion‐like seeding mechanism. Immunoprecipitation of these brain extracts with anti‐Aβ oligomer antibodies or passive immunization of the recipient animals abrogated the observed seeding activity, although induced Aβ deposition was still evident. Here, we establish that, together with Aβ monomers, Aβ oligomers trigger the initial phase of Aβ seeding and that the depletion of oligomeric Aβ delays the aggregation process, leading to a transient reduction of seed‐induced Aβ deposits. This work extends the current knowledge about the role of Aβ oligomers beyond its cytotoxic nature by pointing to a role in the initiation of Aβ aggregation in vivo. We conclude that Aβ oligomers are important for the early initiation phase of the seeding process.

Objective The aim of the study was to examine trends in cold-related mortalities between 1995 and 2016. Study design This is a longitudinal mortality study. Methods For men and women aged 65–74 years or those older than 85 years in South East England, the relationship between daily mortality (deaths per million population) and outdoor temperatures below 18 °C, with allowance for influenza epidemics, was assessed by linear regression on an annual basis. The regression coefficients were expressed as a percentage of the mortality at 18 °C to adjust for changes in mortality through health care. Trends in ‘specific’ cold-related mortalities were then examined over two periods, 1977–1994 and 1995–2016. Results In contrast to the early period, annual trends in cold-related specific mortalities showed no decline between 1995 and 2016. ‘Specific’ cold-related mortality of women, but not men, in the age group older than 85 years showed a significant increase over the 1995–2016 period, which was different from the trend over the earlier period (P, Highlights • In contrast to 1977-94, a reduction of excess winter mortality from all causes did not take place between 1995 and 2016. • Similar trends are seen in mortality from ischaemic heart, cerebrovascular and respiratory diseases. • Excess winter mortality from all causes rose over this period in women older than 85 years.

Where there is limited access to COVID-19 tests, or where the results of such tests have been delayed or even invalidated (e.g., California and Utah), there is a need for scalable alternative approaches—such as a heuristic model or “pregnancy test for COVID-19” that can factor in the time denominator (i.e., duration of symptoms). This paper asks whether infection among these public health and safety agencies is a "canary in the coal mine," litmus test, or microcosm (pick your analogy) for the communities in which they operate. Can COVID-19 infection counts and rates be seen “moving around” communities by examining the virus’s effect on emergency responders themselves? The troubling question of emergency responders becoming “human indicator values” is relevant to maintaining the health of Mobile Medicine (EMS and Fire) personnel, as well as Police, who are an under-attended population, because without them our collective resiliency would crash. It has further implications for policies regarding, and investments, in exposure tracking and contact tracing, PPE acquisition, and mental and physical wellness. Design: We aggregated data from four (4) different EMS documentation systems across twelve (12) states using the MEDIVIEW BEACON Prehospital Health Information Exchange. We then outputted lists of charts containing critical ICD-10 values that had been identified by the WHO, the CDC, and the Los Angeles County Fire Dept. as inclusion criteria for possible signs, symptoms, and clinical impressions of COVID-19. Results: Three important results emergency from this study: (1) a demonstration of frequent exposure to possible COVID-19 infection among Mobile Medical (EMS & Fire) care providers in the states whose data were included; (2) a demonstration of the nervousness of the general population, given that calls for help due to possible COVID-19 based on symptomology exceeded the number of responses with a correlating “provider impression” after an informed clinical assessment; and (3) that this study was empowered by a public-private partnerships between a technology startup and numerous public health and public safety agencies, offers a template for success in rapidly implementing research and development collaborations. Limitations: This study incorporates data from only (a) twelve (12) states, and (b) four (4) Mobile Medical documentation systems. We sought to combat these limitations by ensuring that our sample crosses agencies types, geographies, population demographics, and municipal environments (i.e., rural vs. urban). Conclusions: Other studies have noted that EMS agencies are tasked with transporting the “sickest of the sick.” We found that PPE is particularly essential where the frequency of encounters between potentially—or actually—infected patients is high, because from Los Angeles County to rural Texas, without sufficient protection, public health and public safety agencies have become microcosms of the communities they are meant to protect. Indeed, data from the first six months of the pandemic in the U.S.A. show that intra-departmental spread is one of (if not the) riskiest sources of infection among Mobile Medical professionals.

Airborne transmission is an important transmission pathway for viruses, including SARS-CoV-2. Regions with a higher proportion of people wearing masks show better control of COVID-19, but the effectiveness of masks is still under debate due to their limited and variable efficiencies in removing respiratory particles. Here, we analyze experimental data and perform model calculations to show that this contrast can be explained by the different regimes of abundance of particles and viruses. Because of the large number of particles exhaled during human respiration and vocalization, indoor environments are usually in a particle-rich regime which means that masks cannot prevent the inhalation of large numbers of respiratory particles. Usually, however, only a small fraction of these particles contain viruses, which implies a virus-limited regime where masks can help to keep the number of inhaled viruses below the infectious dose. For SARS-CoV-2, the virus load in the respiratory tract of infectious individuals can vary by 3 to 4 orders of magnitude (5th to 95th percentile), leading to substantial variations in the abundance of airborne virus concentrations and infection risks. Nevertheless, we find that most environments are in a virus-limited regime where masks have a high efficacy in preventing the spread of COVID-19 by aerosol or droplet transmission during short-term exposure. The characteristic contrast between particle-rich and virus-limited regimes explains why face masks are highly efficient in most but not all environments, and why the largest benefits can be achieved by non-linear synergetic effects of combining masks with other preventive measures such as ventilation and social distancing to reduce airborne virus concentrations and the overall risk of infection.

Aims The risk of mortality from the coronavirus disease that emerged in 2019 (COVID-19) is increased by comorbidity from cardiovascular and pulmonary diseases. Air pollution also causes excess mortality from these conditions. Analysis of the first severe acute respiratory syndrome coronavirus (SARS-CoV-1) outcomes in 2003, and preliminary investigations of those for SARS-CoV-2 since 2019, provide evidence that the incidence and severity are related to ambient air pollution. We estimated the fraction of COVID-19 mortality that is attributable to the long-term exposure to ambient fine particulate air pollution. Methods and results We characterized global exposure to fine particulates based on satellite data, and calculated the anthropogenic fraction with an atmospheric chemistry model. The degree to which air pollution influences COVID-19 mortality was derived from epidemiological data in the USA and China. We estimate that particulate air pollution contributed ∼15% (95% confidence interval 7–33%) to COVID-19 mortality worldwide, 27% (13 – 46%) in East Asia, 19% (8–41%) in Europe, and 17% (6–39%) in North America. Globally, ∼50–60% of the attributable, anthropogenic fraction is related to fossil fuel use, up to 70–80% in Europe, West Asia, and North America. Conclusion Our results suggest that air pollution is an important cofactor increasing the risk of mortality from COVID-19. This provides extra motivation for combining ambitious policies to reduce air pollution with measures to control the transmission of COVID-19.