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Purpose: Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome. Methods: Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)—36 (worst) was assigned to each patient. LUS findings were compared with clinical data. Results: The median baseline total LUS score was 15, IQR [7–20]. Baseline LUS score was 0–18 in 80 (67%) patients, and 19–36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0–18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02–1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05–1.2], p = 0.0008. Conclusion: Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients' management strategies, as well as resource allocation in case of surge capacity. [ABSTRACT FROM AUTHOR]

Background: Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel.Methods: Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to 'outdoor gyms' located in parks.Results: Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to 'outdoor gyms' and variance of greenness had the largest estimates of mediation.Conclusion: This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations. [ABSTRACT FROM AUTHOR]

Increased awareness of the environmental complexities of coastal cities has led to a variety of management strategies. However, there is still a knowledge gap in how global strategies are locally implemented, and how tensions between stakeholders affect outcome. The author, the CEO of the municipal corporation managing the development and planning of the Tel Aviv-Yafo coastline, explores the historical development of coastal policies over time and frames the Israeli context. The important impacts of globalization and the variety of different tools used to manage the coastline are illustrated with global examples of spatial plans and projects that are compared and critiqued. With this framework in mind, this paper introduced a decision-making model for coastal cities. This is an important topic for municipal stakeholders given ever increasing coastal pressures, and the necessity of finding a sustainable balance between societal and ecological needs. [ABSTRACT FROM AUTHOR]

This study classifies urban environments into types characterized by different exposure to environmental risk factors measured by general sense of discomfort and Heart Rate Variability (HRV). We hypothesize that a set of environmental factors (micro-climatic, CO, noise and individual heart rate) that were measured simultaneously in random locations can provide a better understanding of the distribution of human exposure to environmental loads throughout the urban space than results calculated based on measurements from close fixed stations. We measured micro-climatic and thermal load, CO and noise, individual Heart Rate, Subjective Social Load and Sense of Discomfort (SD) were tested by questionnaire survey. The results demonstrate significant differences in exposure to environmental factors among 8 types of urban environments. It appears that noise and social load are the more significant environmental factors to enhance health risks and general sense of discomfort. [ABSTRACT FROM AUTHOR]

Few longitudinal studies evaluated the beneficial associations between cumulative residential greenness and site-specific cancer. Our objective was to evaluate the associations between cumulative residential greenness exposure and site-specific cancer incidence (lung, bladder, breast, prostate, and skin cancer) within a registry-based cohort study. This study was based on 144,427 participants who lived in the Tel Aviv district during 1995–2015. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure, based on the mean Normalized Difference Vegetation Index (NDVI) in the residential area and the duration of the residence in this area. Cox regression models were used to evaluate the unadjusted and adjusted associations between exposure to greenness and cancer incidence during 1998–2015 (Hazard Ratios (HRs) and 95% Confidence Intervals (CIs)). Covariates included in adjusted models were selected based on prior knowledge and directed acyclic graphs. We imputed missing data and further sensitivity analyses were conducted. After adjustments, beneficial associations between exposure to greenness and cancer incidence were observed. An interquartile range (IQR) increase in NDVI was associated with a lower HRs for lung cancer (HR adj. = 0.75 95% CI: 0.66–0.85), bladder cancer (HR adj. = 0.71, 95% CI: 0.62–0.82), breast cancer (HR adj. = 0.81, 95% CI: 0.74–0.88), prostate cancer (HR adj. = 0.77, 95% CI: 0.70–0.86) and skin cancer (HR adj. = 0.78, 95% CI: 0.69–0.88). Generally, the patterns of associations were consistent between complete-case models and imputed models, when estimated for participants aged 16 years or 40 years and older at baseline, when stratified by area level socioeconomic status, when evaluated for non-movers participants and after further adjustment to social determinants of health. Residential greenness may reduce the risk for lung, bladder, breast, prostate, and skin cancers. If our observations will be replicated, it may present a useful avenue for public-health intervention to reduce cancer burden. • Few cohorts evaluated the associations between residential greenness and cancer. • Information on site-specific cancer incidence is limited. • Few considered individual cumulative exposure to greenness. • Linear beneficial associations with greenness were observed. • These associations were observed for lung, bladder, breast, prostate and skin cancers. [ABSTRACT FROM AUTHOR]

This paper examines how the first urban plan of Tel-Aviv (the Geddes Plan of 1925) [18] affected outdoor human thermal comfort in two periods: at the time of its implementation (1920–1930s) and in the present day (2010s). Additionally, this paper questions which of the two – shade or wind velocity – has greater influence on outdoor thermal sensation in the urban areas along the Israeli Mediterranean seashore. In order to examine the thermal sensation at street level during the 1920s and 1930s, a series of summer and winter climatological measurements were taken in the years 2010–2013 and compared to historical climatic data from the 1920s–1930s. The historical city structure was then reconstructed virtually and the climatological measurements for 2010–2013 were fed into the RayMan model to produce thermal comfort information (PET, Physiologically Equivalent Temperature). A main finding of the study is that in summer the duration of “hot” and “very hot” heat stress was double in eastwest oriented streets compared to north–south ones. Furthermore, in the winter, higher H/W ratios can increase cold thermal sensation in streets with the same orientation by up to 10 °C PET, due to shading. Finally, the results show that solar radiation has a greater effect on thermal sensation than wind velocity both in summer and winter seasons. Consequently, the Geddes Plan created improved thermal sensation in the main streets of Tel-Aviv, which are north–south oriented, and provided for greatly improved micro-climate conditions, in spite of the critique that Tel-Aviv “turned its back to the sea”. [ABSTRACT FROM AUTHOR]

Short-term personal exposure of passengers in different types of motor vehicles to carbon monoxide was investigated in an intensively used main road in Israel's Tel Aviv metropolitan area. According to monitoring stations of the Ministry for Environmental Protection (MEP), concentrations of carbon monoxide (CO) along the road, at a height of 3 m above pedestrian level, in the Tel Aviv metropolitan area, are currently very low. However, these measurements do not reflect the actual exposure of commuters, which were the main objective of this study. Four vehicle types/travel modes were investigated: private cars with closed windows, private cars with open windows, motorcycles, and buses. The commuter CO average exposure was the accumulative exposure divided by the duration of the sampling taken along the route, for each type of vehicles. The results showed that commuters in cars with closed windows were exposed to the highest mean CO level, 27.2 ppm, for a period of 38 min; those in a car with open windows, to 19.7 ppm for 38 min; motorcycle riders, to 12.8 ppm, for 17 min; and bus users were exposed to the lowest mean pollution level, of only 3.6 ppm, for 25 min. Thus, CO values of 1 to 3 ppm, as measured at an MEP adjacent monitoring station, may indicate the exposure to CO pollution of area residents, but do not represent the actual exposure of commuters on the congested main road. [ABSTRACT FROM AUTHOR]

Allergic disorders have been described in a variety of connective tissue disorders. Although an association between allergy and primary Sjögren's syndrome has been suggested, it has not been well documented. The purpose of this study was to analyze the prevalence of several types of allergic disorders in a cohort of primary Sjögren's syndrome patients. The presence of an allergic disorder was evaluated by a specific questionnaire in 65 randomly selected primary Sjögren's syndrome patients and was compared to control groups of 67 rheumatoid arthritis patients, 53 patients with rheumatoid arthritis and sicca symptoms, and 31 patients with osteoarthritis. At least one type of allergic manifestation was reported by 42 of the 65 Sjögren's syndrome patients (65%). This rate was significantly higher than each of the three control groups (p < 0.01). Only drug allergy and skin contact allergy were found to be more prevalent in Sjögren's syndrome patients than in the control groups (p< 0.05). Allergic reactions were more common in Sjögren's syndrome patients who were anti-Ro positive (p < 0.05). As drug and skin contact allergies are a frequent finding in Sjögren's syndrome patients, obtaining a careful history is needed before prescribing drugs in these patients. [ABSTRACT FROM AUTHOR]

Abstract: The impact of human exposure to environmental factors on Heart Rate Variability (HRV) was examined in the urban space of Tel-Aviv-Jaffa. Four environmental factors were investigated: thermal and social loads; CO concentrations and noise. Levels of HRV are explained mainly by subjective social stresses, noise and CO. The most interesting result is the fact that while subjective social stress and noise increase HRV, low levels of CO are reducing HRV to some extent moderating the impact of subjective social stress and noise. Beyond the poisoning effect of CO and the fact that extremely low levels of HRV associated with high dozes of CO increase risk for life, low levels of CO may have a narcotic effect, as it is measured by HRV. The effects of thermal loads on HRV are negligible probably due to the use of behavioral means in order to neutralize heat and cold effects. [Copyright &y& Elsevier]

The article presents a research study that tested the feasibility of immunochemical fecal occult blood test (FIT) compared to guaiac fecal occult blood test (G-FOBT) in a large urban population in Tel Aviv, Israel. The advantages and disadvantages of G-FOBT are presented along with the reasons for the development of FIT. Materials and methods applied in the study are discussed together with the results involving the excluded and the included patients, compliance with performing FOBT, and test results and positivity rate.

The article presents a study which examines the significance of microclimate formation in urban planning in terms of built-up morphology and urban shade trees city climate. Green Cluster Thermal Time Constant (CTTC) model was used to analyzed the thermal effect of situation based on cooling attributes and geometric built-up parameters of three urban tree species in gardens and street in Tel Aviv, Israel. It shows that urban trees alleviate heat island effect on hot and humid summer season.

Objectives: On 1 November 2004 a suicide bomber detonated himself in Tel Aviv, in a crowded open market space, resulting in 3 dead victims and 34 casualties. This event in a central urban area was handled quickly by experienced emergency medical service (EMS) teams. We analysed evacuation destinations of urgent casualties in order to learn whether severe casualties should all be evacuated to the closest trauma centre. Alternatively, they might be distributed to all nearby hospitals, both trauma and non‐trauma centres. A third possibility is directing urgent casualties only to trauma centres, dividing them between the close trauma centre and a ‘second cycle’ distant level A trauma centre. Methods: Data were collected from formal debriefings carried out after the event in the Ministry of Health, in the Israeli Defense Forces Medical Corps (IDF MCs) and in the Home Front Command (HFC). Other debriefings, in which we took part, were those of the EMS and participating hospitals. We analysed these data to learn about the timetable of the event, the number of EMS ambulances and medical personnel involved in the event, the number of casualties evacuated to each hospital (both primary and secondary evacuation), and the major medical problems (resuscitations, operations) encountered by EMS and by the hospital personnel. Results: Casualties were rapidly treated and evacuated: within 25 minutes of the blast (19 minutes after the arrival of the first ambulance), all urgent casualties had been administered airway and haemorrhage control and evacuated from the site. Seven of eight urgent casualties were evacuated to the closest trauma centre. Reviewing the trauma centre ER work found no bottlenecks either outside or inside the ER. All seven ‘immediate’ victims were treated simultaneously at the emergency department (ED). Two casualties arrived at the ED while being ventilated manually with a bag‐valve‐mask device, and required urgent tracheal intubation. Two urgent laparotomies and two orthopaedic operations were performed. The only immediate victim who was referred to the smaller nearby hospital needed secondary evacuation to a neurosurgical centre. Conclusion: The decision to send almost all severely injured patients to the nearest level A trauma centre, using a ‘save and run’ mode of evacuation, was life‐saving in this event. As this is a study of a single case, further analysis of multiple similar events is needed, to examine whether the PHTLS guidelines regarding preferable evacuation to level A trauma centres can also be applied to small‐scale multi‐casualty incidents in an urban setting. [ABSTRACT FROM AUTHOR]

Alternative new technologies are urgently needed to overcome the rapidly increasing global water scarcity. Atmospheric dew water is a potential source of potable water, as the earth's atmosphere contains billions of tons of fresh water (98% in a vapor state). The atmospheric water generator (AWG) converts water vapor into liquid water and is a promising solution for water scarcity. We provide the first comprehensive analysis of the chemical profiles of water produced for several months by an AWG in the city of Tel Aviv, Israel. Metals, inorganic ions, volatile organic compounds (VOCs), and semi-VOCs were analyzed in the dew water. The main elements found were ammonium, calcium, sulfate, and nitrate. Location of the sampling site in an urban residential area, between major traffic routes, likely affected the chemical composition of the produced dew water. Nevertheless, the produced water nearly always (day and night in different seasons) met the WHO and Israeli drinking water standards. Thus, even in a highly developed urban environment, the AWG offers an excellent alternative source of safe drinking water throughout the year. [ABSTRACT FROM AUTHOR]

The global supply of vaccines against mpox (previously called monkeypox virus infection) was significantly lower than the demand. Therefore, evidence-based vaccine prioritization criteria, based on risk assessment were needed. Our objective was therefore to identify the characteristics of individuals at the highest risk for mpox. This population-based cohort study included all Clalit Health Services (CHS) subjects assumed to be at risk for mpox. The eligibility criteria for inclusion were determined based on known characteristics of people with infection worldwide and insights of lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) -specialized CHS clinicians. Cox hazards models were used to identify the risk factors for mpox within the study cohort. The study commenced on 6 June 2022, the date of the first known mpox in CHS members, until 31 July 2022, when the mpox vaccination campaign started. A total of 8088 individuals of 4.7 million CHS members (0.18%) were identified according to the study inclusion criteria. Of those, 69 (0.85%) developed infection during the study period. Risk factors for mpox were birth in 1980 or later (hazard ratio, 5.04; 95% CI, 2.11–12.02), history of syphilis (2.62; 1.58–4.35), registration to primary healthcare clinics in the Tel Aviv district (2.82; 1.44–5.54), HIV–pre-exposure prophylaxis medication use (3.96; 2.14–7.31), PDE5 inhibitors use (2.92; 1.77–4.84), and recent sexually transmitted infections (STIs) within the last 18 months (2.27; 1.35–3.82). No infections were observed in individuals with none of the factors. Individuals with three or more risk factors had a 20.30-fold (10.39–39.69) higher risk for mpox compared with those with 0–2, with 85.5% (75.0–92.8%) sensitivity and 77.8% (76.9–78.7%) specificity. Weighting individuals' risk levels based on validated risk factors against vaccine availability can assist health systems in the equitable prioritization of vaccine allocation in various future outbreaks, given supply-demand gaps. [ABSTRACT FROM AUTHOR]