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Species of Tricholoma sections Genuina and Megatricholoma are characterized by having pilei that are some shade of brown, and by white or yellow lamellae that also discolor some shade of brown. From Costa Rica in sect. Genuina, we describe as new T. luteopallidum, T. cacumense, and T. talamancense, and confirm the occurrence of Tricholoma stans, and from the United States describe as new Tricholoma brunneoluteum. Tricholoma roseoacerbum from sect. Megatricholoma is con-firmed for Costa Rica. Morphology as well as ITS sequences are employed to confirm the species’ identifications or circumscription of the new species.

Introduction: Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. Objectives: This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. Methods: A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. Setting: Multinational, multi-institutional, tertiary pediatric hospitals. Results: Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. Conclusion: The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation. Keywords: Atypical mycobacteria; Cervical lymphadenitis; Consensus recommendations; Non-tuberculous mycobacteria.

Springtime road dust is a common air quality concern for northern latitudes communities. Traction material, brake wear, tire wear, and other particles entrained in snow during winter become re-suspended into the air as the snow melts. Characterization of within-season variability of road dust composition and weather conditions is critical to understanding its acute health impacts. Sixty 24-hour samples of PM10 were collected with a high-volume sampler at a near-road site in Prince George, British Columbia. Near-road samples were collected intermittently in winter and daily in spring. All samples were analyzed for 18 trace elements. We used data from a nearby regulatory monitor to estimate daily coarse fraction (PM10–2.5). Proportion of PM10–2.5 in PM10 was used to classify days as high or low road dust based on a threshold of 65% PM10–2.5. We identified clusters of near-road samples based on weather parameters and PM10 components using Bayesian profile regression (BPR). Twenty-one near-road PM10 samples were classified as high road dust days and 34 as low road dust days. Concentrations of total trace elements and specific trace elements were significantly higher on high road dust days (aluminum, chromium, iron, lead, tin, vanadium, and zinc). High road dust days also had low relative humidity and precipitation and higher temperature and air pressure. We identified five clusters of near-road PM10 mixtures that suggested an interaction between temperature and humidity for road dust impacts. Samples from a near-road site indicated days highly affected by springtime road dust are distinct from other days based on particulate mixtures and meteorological factors. Higher loading of trace element mixtures in PM10 on high road dust days has important implications for acute toxicity of road dust. Relationships between road dust and weather may facilitate further research into health effects of road dust as the climate changes. Implications: Non-tailpipe emissions driven by springtime road dust in northern latitude communities is increasing in importance for air pollution control and improving our understanding of the health effects of chemical mixtures from particulate matter exposure. High-volume samples from a near-road site indicated that days affected by springtime road dust are substantively different from other days with respect to particulate matter mixture composition and meteorological drivers. The high load of trace elements in PM10 on high road dust days has important implications for the acute toxicity of inhaled air and subsequent health effects. The complex relationships between road dust and weather identified in this study may facilitate further research on the health effects of chemical mixtures related to road dust while also highlighting potential changes in this unique form of air pollution as the climate changes.

Objectives To assess the safety of paediatric tonsillectomy procedures conducted in NHS hospitals in England between 2008 and 2019. Design Retrospective observational cohort study using Hospital Episode Statistics (HES) data. Setting Acute NHS trusts in England conducting paediatric tonsillectomy procedures. Participants Children (≤16 years old) undergoing bilateral tonsillectomy. Main outcome measures Number of tonsillectomies performed per year by procedural method. In‐hospital complications including return to theatre for arrest of haemorrhage. Readmission within 28 days, including those for pain, haemorrhage and surgical arrest of haemorrhage. Long‐term outcomes: all‐cause mortality, revision tonsillectomy. Results A total of 318 453 paediatric tonsillectomies were performed from 2008 to 2019:278,772 dissection (87.5%) and 39 681 coblation (12.5%). The proportion of tonsillectomy performed using coblation increased from 7% in 2008/9 to 27% in 2018/9. Five patients died in hospital (including 4 due to respiratory complications). In‐hospital complications occurred in 4202 children (1.3%), with the most frequent being haemorrhage. Within 28 days of tonsillectomy, 28 170 patients (8.8%) were readmitted and 7 deaths occurred. Readmission rates for haemorrhage and pain have increased since 2008. The proportion of children undergoing revision tonsillectomy procedures within 5 years following coblation tonsillectomy (1.4%) was approximately double that of dissection (0.6%). Conclusions Clinical practice of paediatric tonsillectomy has changed in England over the past 11 years. The overall mortality rate associated with the procedure is 0.0037%. Differences in outcomes have been identified for different procedural methods. However, routine administrative data are limited in differentiating procedural detail (eg we are unable to differentiate intra or extra‐capsular techniques from current clinical coding of tonsillectomy procedures). Therefore, prospective national data collection or more granular clinical coding is essential to capture relative outcomes of the different tonsillectomy methods and techniques being used in the NHS.

OBJECTIVE To determine whether (1) initial baseline scores are significantly better for those who have valid (initial valid) versus invalid scores (initial invalid) on their concussion baseline testing, (2) retesting results in significantly improved baseline scores, and (3) there is a significant difference in scores between those who have valid scores on their initial attempt and those who retook baseline tests (retest valid). DESIGN Prospective, repeated-measures. SETTING Two years of collegiate preparticipation concussion baseline testing. PARTICIPANTS Five hundred forty-seven male and female Division I collegiate athletes (19.02 ± 1.31 years, female = 217). INDEPENDENT VARIABLES Participants were divided into initial valid and initial invalid. The retest group was further divided into their initial (initial invalid) and final valid attempt (retest valid). MAIN OUTCOME MEASURES Data were analyzed to determine the relationship between the 3 groups and overall initial and final scores on 28 individual items: total symptoms score, coordination, near-point convergence, CNS Vital Signs (CNSVS), Senaptec Sensory Station, and Neurocom Sensory Organization Test (SOT). RESULTS The initial valid group scored significantly better than the initial invalid group on 8 CNSVS items and 5 Senaptec items (P < 0.002). The retest valid scores were significantly better compared with the initial invalid scores on 17 items (P < 0.002). CONCLUSIONS Retesting is recommended for individuals who score below acceptable ranges. This is important because athletes may experience a learning effect and are highly motivated during postinjury testing, so accurate baseline scores are imperative for athlete safety. Completion time for the coordination test may be a more informative option.