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Short term physician visits and medication prescriptions for allergic disease associated with seasonal tree, grass, and weed pollen exposure across the United States

While year-round exposure to pollen is linked to a large burden of allergic diseases, location-specific risk information on pollen types and allergy outcomes are limited. We characterize the relationship between acute exposure to tree, grass and weed pollen taxa and two allergy outcomes (allergic rhinitis physician visit and prescription allergy medication fill) across 28 metropolitan statistical areas (MSA) in the United States.

We obtained daily pollen data from National Allergy Bureau (NAB) monitors at these 28 MSAs for 2008–2015. We revised the NAB guidelines to classify taxa-specific pollen severity each day. Daily information on allergic rhinitis and prescribed allergy medications for individuals with employer-based health insurance from the IBM MarketScan Research database for these MSAs. We combined the daily pollen and health data for each MSA into a longitudinal dataset. We conducted a MSA-specific conditional quasi-Poisson regression analysis to assess how different levels of pollen concentration impact the health outcomes, controlling for local air pollution, meteorology and Influenza-like illness (ILI). We used a random effects meta-analysis to produce an overall risk estimate for each pollen type and health outcome.

The seasonal distribution of pollen taxa and associated health impacts varied across the MSAs. Relative risk of allergic rhinitis visits increased as concentrations increased for all pollen types; relative risk of medication fills increased for tree and weed pollen only. We observed an increase in health risk even on days with moderate levels of pollen concentration. 7-day average concentration of pollen had stronger association with the health outcomes compared to the same-day measure. Controlling for air pollution and ILI had little impact on effect estimates.

This analysis expands the catalogue of associations between different pollen taxa and allergy-related outcomes across multiple MSAs. The effect estimates we present can be used to project the burden of allergic disease in specific locations in the future as well inform patients with allergies on impending pollen exposure.

Peer Review reports

Allergies related to pollen exposure are widespread and occur throughout the year in many locations. While the global burden of disease related to aeroallergens is elusive, prevalence of allergic rhinitis, the most common form of pollenosis, is estimated to be approximately 20% [1] and pollen allergy prevalence has increased significantly in recent years [2, 3]. Pollen seasons in the northern hemisphere have lengthened as a result of anthropogenic climate change [4], and worsening disease burdens have been attributed to climate change in certain regions [5, 6]. Several studies have projected substantial increases in aeroallergen exposure and associated burden of disease in the US [7] and Europe [8], and there is concern that other atmospheric changes in the Anthropocene will amplify the impacts of increased pollen exposure [9].

Sensitivity to pollen tends to develop after pollen exposure early in life [10] and sensitization at a young age is strongly predictive of symptoms during childhood and later in life [11]. Sensitized individuals commonly have allergies to multiple types of plant pollens [12]. A relatively small number of wind-pollinated plants, including approximately ten tree taxa [13, 14] as well as several grasses [15] and weeds [16], appear to be responsible for the majority of pollenosis. Short-term exposure to allergenic pollens immediately drives symptomatic disease in sensitized individuals [17] and can result in health complications several days after exposure [18].

Direct medical cost related to allergic rhinitis in the United States is estimated to be around 3.4 billion dollars, with prescription medications being the largest component [19]. It is common to manage pollen allergies with over-the-counter (OTC) medications [20] and OTC medication purchases are commonly used as indicators of allergic disease [13, 21]. Approximately 80% of allergic rhinitis symptoms can be managed successfully with inhaled corticosteroids and other medications [20]. However, patients with moderate to severe symptoms seek medical care – 12.3% in the US in one study [22] – and receive prescription medications [23]. Thus, medication use and physician visits are important health indicators to track allergic disease exacerbation. Emergency department (ED) visits for allergic rhinitis are relatively rare [22], unlike for patients with allergic asthma that has been linked to increase in exposure to pollen [13, 24].

Prior assessments of adverse health impacts associated with pollen have several limitations. Many are limited by geography, focusing only on few specific locations [13, 25], inclusion of a few pollen types [13, 24], or examine a limited number of health outcomes [21]. The objective of our study is to broaden the characterization of the relationship between acute exposure to a wide range of allergenic pollens prevalent in the continental United States and health outcomes related to allergic rhinitis and allergy medication fills. We use the existing National Allergy Bureau (NAB) guidelines as a benchmark to inform risk communication efforts across the pollen seasons and multiple locations. We control for other potential exposures like air pollution [13], and influenza-like illness (ILI) known to cause upper respiratory symptoms like rhinitis (

Pollen data

We obtained daily pollen data for 2008–2015 from 28 monitors that are part of the NAB network of the American Academy of Allergy, Asthma, and Immunology (AAAAI) (See Supplemental figure SF1). We geocoded the physical address of these locations to identify the Metropolitan Statistical Area (MSA) in which these monitors reside. The selection of these monitoring stations was based on our assessment of completeness of the pollen data as well as availability of the health data for those specific locations. The monitors were all located in urban areas.

Identification of pollen season start and end dates: We use a novel approach to determine the start and end of the pollen season for each monitor [26]. For taxa with annual total counts above 2,000 pollen grain*day/m3, we define the start date as the day when the cumulative sum over that pollen year reaches a threshold of 50 pollen grain*day/m3. For taxa with lower annual total counts, we define the start date as the date on which cumulative sum reached a threshold of 2.5% of the historical mean total count, with the intent of creating a functionally equivalent threshold. The start date of the pollen season is computed for each pollen taxa at each station location for every year, and days with missing data do not contribute. The end date is calculated in a similar manner to the start date. For taxa with high mean total counts (> 2,000 pollen grain*day/m3), the end date is defined as the date at which the cumulative sum from that date to the end of the pollen year is less than 50 pollen grain*day/m3. If the historical mean total count is low, then the end date threshold is calculated as the date at which accumulated pollen concentration reaches 97.5% of the historical mean total count for the season. The overall pollen season is defined as the earliest start date and the latest end date for any taxa in a year for each monitor. While the reported pollen data vary substantially by taxa across stations, the common taxa that were included in the tree, grass and weed pollen are available in the study used to define the pollen season [26].

Pollen exposure characterization: We used the pollen thresholds published by the NAB as the benchmark ( to characterize pollen concentrations each day. These guidelines are currently widely used to communicate health risks from pollen exposure. Since a scan of the literature revealed a wide range of pollen levels deemed adverse to health [27,28,29], we modified the NAB thresholds to examine health effects at relatively low levels of pollen instead of solely focusing on days with extremely high concentrations [26]. For each type of pollen, we defined five categories as ‘low’, ‘moderate’, ‘moderately high’, ‘high’ and ‘very high’ based on the following concentration ranges (by grain*day/m3—(tree pollen: < 15, 15–90, 90–250, 250–1500, > 1500; grass pollen: < 4, 4–19, 19–50, 50–100, > 100; weed pollen: < 9, 9–50, 50–100, 100–250, > 250) (Supplemental table ST1 for more details). NAB uses a broad range of pollen concentrations to define the ‘high’ category. We broke it into two categories – ‘moderately high’ and ‘high’. For grass and weed, we also lowered the NAB threshold to define ‘very high’ as few locations reported grass and weed pollen at such extremely high levels. We linearly interpolated pollen data by tree, grass, and weed within their specific seasons each year to account for missing data when pollen was not measured (e.g. most stations do not measure pollen over the weekends). We used the imputed pollen concentrations to classify each day in the study period into the five pollen categories for tree, grass and weed respectively. This was the main pollen exposure variable of interest. We conducted a series of sensitivity analyses to compare the results with percentile-based definition of pollen concentration and consecutive days of exposure. We calculated the 25th, 50th and 75th percentile values for tree, grass and weed pollen based on the daily distribution from 2008–2015 for each site [30, 31]. Each day was then assigned to one of the four percentile-based categories with values between 0-25th percentile being ‘low’ and above 75th percentile being ‘high’. We compare the effect estimates using same day pollen concentrations with those averaged over 7 days from date of the health episode to check if consistently high levels of pollen over consecutive days was associated with a higher health risk.

Health data

For the years 2008–2015, we obtained health data from the Truven Health MarketScan® Research database (Commercial Claims and Encounters (CCAE)). The database is a large convenience sample from the US population with employer-based health insurance. The database provides information on healthcare encounters of active employees, dependents and early retirees who used a fee-for-service, capitated or partially capitated health insurance plan. While the coverage varies across years, the database provides healthcare information for around 40 million individuals each year. The large sample size provides information on healthcare use across different parts of US. The database captures de-identified patient-level healthcare outcomes with age, gender, date of healthcare service, MSA of patient residence and a list of diagnoses codes based on the ninth revision of the International Classification of Diseases (ICD-9-CM). Patients were included in the study with either (i) a fill of prescribed allergy medications related to steroids and antihistamines (see Supplemental table ST2 for details) or, (ii) a physician visit with a diagnosis of allergic rhinitis (AR) (ICD-9-CM = 477.0). We calculated a daily count of medication fills (MF) by MSA based on the day of the fill. Since many AR patients require multiple follow-up physician visits following initial symptom development from exposure to pollen, we estimated two different daily counts of AR visits based on a patient’s first visit in a calendar year, as well as all visits through the year. The results presented focuses only on the count of first physician visits during the year.

We collected data on Influenza-like Illness (ILI) from the Centers for Disease Control (CDC) Fluview website. For each of the ten Health and Human Services (HHS) Regions in the country, weekly information on an index for ILI was collected for the 2008–2015 time period.

Environmental data

For this analysis, we created daily MSA-level estimates of environmental variables such as daily measures of temperatures, relative humidity, and air pollutants. The daily measures of maximum temperature and humidity were derived using predictions from the North American Land Data Assimilation System Phase 2 (NLDAS) model, available at 0.125 degrees (approximately 14 km × 14 km) spatial resolution [32]. The grid-level predictions were first converted to county-level estimates and then to MSA-level estimates of temperature in Fahrenheit (°F) and relative humidity (%), using a population weighted approach [33, 34].The daily measures of air pollutants, such as daily maximum 8-h average ozone concentrations in parts per billion (ppb) Ozone (O3), and daily 24-h average Particulate Matter (PM2.5) (micrograms/m3) were available from the Bayesian space–time Downscaler (DS) fusion modelling framework that was developed by EPA and its partners. This generates predictions of ozone and PM2.5 by U.S. Census tracts [35]. These tract-level air pollutant predictions were averaged, using tract populations as spatial weights, to generate MSA-level estimates of O3 and PM2.5.

Data linkage

We identified the MSA where each of the pollen monitors were located. We linked the daily data on pollen, health and environmental variables by MSA. Based on the HHS region that each MSA belonged to, we linked the ILI information to this dataset such that each day of the week was assigned the same ILI index value.

Statistical analyses

The dependent variables in our analyses were daily counts of allergy medication fills (MF) and physician visits with a diagnosis of allergic rhinitis (AR). We adopted a Conditional Quasi-Poisson framework to assess how these counts varied across days with different categories of pollen exposure, controlling for ‘overdispersion’ and the day of week [36] for each location. The base model contained categorical variables based on daily tree, grass, and weed pollen concentrations. Since we observed overlap in the temporal distribution of the three pollen types, we included all three pollen indicators in the same model. We compared the risk estimates for each pollen category to see how the health risks increased with increase in pollen concentrations. We sequentially added variables for ILI, air pollution and meteorological factors to check if they affected the association between pollen categories and the health outcomes. We used a random effects meta-analysis approach to produce one representative effect estimate across all locations included in the study. The meteorological and air pollution factors were included in the model as continuous variables and their associations modeled as linear. All analyses was conducted in R software (Version 4.0.3). We present the relative risk estimates from the meta analyses in the manuscript and the location-specific risk estimates for all pollen categories in the Supplemental material. To display the variation in risk estimates across locations and pollen types, we use the relative risk for ‘high’ pollen days, as only a small number of days were classified as ‘very high’ based on the pollen data we had for all locations.

We conducted a series of sensitivity analyses. For AR visits, our main outcome of interest were daily counts based on a patient’s first visit in a calendar year. As a sensitivity analysis, we also examined daily counts based on all AR visits through the pollen season. For medication fills, we divided the medications into antihistamines and steroids to compare differences in risk estimates for the two types. We conducted a sensitivity analysis based on definition of pollen exposure (comparison of modified NAB thresholds with percentile-based pollen categories), duration of exposure (comparison of same-day pollen exposure with a 7-day average), and linear interpolation of pollen data (comparison of pollen categories using the daily imputed pollen concentrations with the raw data with missing observations)..

The 28 MSAs included in the analysis are shown in Supplemental Figure SF1. In Table 1, we show the distribution of different types of pollen by location. The average length of the entire pollen season varies by location. Many stations reported missing pollen data for a large percentage of days within the study period, providing a rationale to impute the missing values and avoid reducing the statistical power of the analysis. The distribution across the ‘moderately high’, ‘high’ and ‘very high’ pollen levels varied noticeably across locations and pollen types. For example, Atlanta shows a large number of days with tree pollen, but relatively few for weed pollen and even less for grass. We observed a relatively small number of days in the ‘very high’ pollen category across the three types of pollen in most locations during the study period. The higher number of days across the ‘moderate’ to ‘high’ pollen categories were more relevant in terms of assessing the health risks from exposure to pollen across entire seasons. For stations where any of the pollen types had 5 percent or less days in the ‘high’ pollen category for the study period, we excluded that pollen type in the health risk analysis. We thus estimate risk estimates for 28 MSAs for tree pollen, 18 for grass pollen and 19 for weed pollen. The distribution of the health outcomes by gender and age groups are presented in Supplemental table ST3. The cases of MF and AR comprised of individuals from 0–65 years. For the study, we analyzed 5.6 million cases of medication fills of which 52% were for females and 13% were for children (0-17 years); 1.1 million allergic rhinitis related physician visits (first visit of the season) of which 51% were for females and 24% were for children (0–17 years).

Table 1 Descriptive statistics of pollen distribution from 2008–2015; Average annual season length and range based on all three types of pollen combined; a missing pollen days calculated based on days within the entire pollen season; b Total number of days over the entire study period in ‘low’ (L), ‘moderate’ (M), ‘moderately high’ (MH), ‘high’ (H) and ‘very high’ (VH) categories are based on daily pollen concentrations (grains/m3): (tree pollen: 90–250, 250–1500, > 1500; grass pollen: 19–50, 50–100, > 100; weed pollen: 50–100, 100–250, > 250). Table cells in grey indicate very low prevalence of the type of pollen if number of days in ‘high’ pollen category were <  = 10 days during the entire study period

In Table 2, we provide the relative risk (RR) estimates for MF and AR associated with all pollen categories and the three pollen types from the meta analyses. We observe a dose–response relationship between the pollen categories and health outcomes for all types of pollen. While the ‘very high’ pollen category was consistently associated with the highest RR, the larger confidence interval around these estimates compared to other pollen categories were due to the small number of days classified as ‘very high’. For ‘high’ pollen days, we see a significant increase in risk of MF for tree [RR = 1.11; 95%CI = 1.09, 1.14] and weed [RR = 1.08; 95%CI = 1.06, 1.10] pollen, with grass pollen being marginally insignificant [RR = 1.03; 95%CI = 0.99, 1.07]. For ‘high’ pollen days, we observe a statistically significant increase in risk of AR for tree [RR = 1.20; 95%CI = 1.10, 1.31], grass [RR = 1.29; 95%CI = 1.15, 1.42] and weed [RR = 1.31; 95%CI = 1.15, 1.47] pollen. We observe statistically significant increase in RR of MF and AR even on days with ‘moderate’ levels of pollen. This finding is particularly important for AR outcomes, as days with ‘moderate’ pollen levels show an increase in RR of a physician visit by 7%, 17% and 12% for tree, grass and weed pollen respectively. The location specific RR for MF and AR across all five pollen categories are provided in Supplementary tables ST4 and ST5 respectively.

Table 2 Meta-analyzed relative risk estimates of allergy medication fills and allergic rhinitis physician visits (first visit in calendar year) on days with different categories for tree, grass and weed pollen. Same-day pollen concentrations are used to define the pollen categories. Relative risk estimates derived from models with weekly ILI index, air pollution measures (daily PM2.5 and Ozone) and meteorological factors (daily maximum temperature, total precipitation, and average wind speed) as covariates

We observed that the RR estimates varied by location and pollen types. In Fig. 1, we show the relative risk (RR) of MF on ‘high’ pollen days (instead of ‘very high’ pollen days which were very small in number) compared to ‘low’ pollen days. In these models, we considered same day pollen values, and included all the environmental covariates and ILI index. Besides the RR from the meta analyses that is shown at the top for comparison, the figure shows the variation in risk across locations for specific pollen types, as well as how the risk changes in each location by pollen season. We found statistical significance of the RR of MF in 24 out of 28 locations for tree pollen, 3 out of 18 locations for grass pollen, and 10 out of 19 for weed pollen. For sensitivity analyses, we examined if the RR for medication fills were different between antihistamines and steroid prescriptions. The RR for antihistamine fill on a ‘high’ tree pollen day was 1.13 [95% CI = 1.10, 1.16] compared to RR for steroid 1.09 [95% CI = 1.05, 1.14]. The differences in RR for antihistamines and steroids were similarly small for grass pollen, but the pattern was reversed for weed pollen – on ‘high’ pollen days the RR for antihistamines was 1.05 [95% CI = 1.02, 1.09] and RR for steroids was 1.11 [95% CI = 1.06, 1.15]. These results are presented in Supplemental table ST6.

Fig. 1

Location-specific relative risk of prescription medication fills on days when the (same day) pollen concentration is in the ‘high’ category compared to the ‘low’ category.’High’ pollen level is defined by pollen concentrations (grains/m3) – 250 < Tree < 1500; 50 < grass < 100, 100 < weed < 250. Relative risk estimates derived from models with weekly ILI index, air pollution measures (daily PM2.5 and Ozone) and meteorological factors (daily maximum temperature, total precipitation, and average wind speed) as covariates

In Fig. 2, we show the RR of first AR physician visit during the pollen season on ‘high’ pollen days using the model with all covariates. We found statistical significance of the RR of AR in 13 out of 28 locations for tree pollen, 11 out of 18 locations for grass pollen, and 10 out of 19 locations for weed pollen. As a sensitivity analysis, we observed much weaker associations between pollen levels and any AR visit that happened during the pollen season. For example, the RR of the first physician visit for allergic rhinitis on a ‘high’ tree pollen day was 1.20 [95% CI = 1.10, 1.31] compared to RR of all AR visits 1.10 [95% CI = 1.03, 1.18]. This pattern persisted for grass and weed pollen.

Fig. 2

Location-specific relative risk of physician visits for Allergic Rhinitis on days when the (same day) pollen concentration is in the ‘high’ category compared to the ‘low’ category. Only the first visit during the pollen season is considered.’High’ pollen level is defined by pollen concentrations (grains/m3) – 250 < Tree < 1500; 50 < grass < 100, 100 < weed < 250. Relative risk estimates derived from models with weekly ILI index, air pollution measures (daily PM2.5 and Ozone) and meteorological factors (daily maximum temperature, total precipitation, and average wind speed) as covariates

In Table 3, we show how the RR estimates are sensitive to four different measures of pollen – (i) ‘high’ pollen level based on same day imputed concentration, (ii) ‘high’ pollen level based on a 7-day average of imputed concentration, and (iii) ‘high’ pollen level based on same day non-imputed concentration, and (iv) days in the 75th percentile values of the pollen distribution during the study period in each location. The RR corresponding to 7-day average pollen measure were consistently higher than the RR corresponding to the same day pollen measure. The differences were more apparent for AR – the RR associated with the 7-day average tree pollen measure was 1.31 [95% CI = 1.13, 1.49] compared to the RR associated with same day tree pollen measure of 1.20 [95%CI = 1.10, 1.31]. We observed similar patterns for grass and weed pollen as well. This indicates that persistently high levels of pollen exposure likely increase the risk of AR visits. The risk estimates for MF and AR did not differ when we compared the imputed vis-à-vis the raw daily values with missing values. We saw that RR associated with the same-day and 75th percentile-based measures were similar for MF, but the latter was lower for AR.

Table 3 Meta-analyzed relative risk estimates of allergy medication fills and allergic rhinitis physician visits (first visit in calendar year) on days designated as – (i) ‘high’ pollen level based on same day imputed values, (ii) ‘high’ pollen based on 7-day average of imputed values; (iii) ‘high’ pollen based on same day non-imputed values of pollen (with missing pollen observations), (iv) days with pollen concentrations >=75th percentile of the pollen distribution during the study period. ’High’ pollen level is defined by pollen concentrations (grains/m3) – 250 < Tree < 1500; 50 < grass < 100, 100 < weed < 250. Relative risk estimates derived from models with weekly ILI index, air pollution measures (daily PM2.5 and Ozone) and meteorological factors (daily maximum temperature, total precipitation, and average wind speed) as covariates

We did not observe any pattern in the association of the weekly ILI index, air pollution measures (daily PM2.5 and Ozone) and meteorological factors (daily maximum temperature, total precipitation, and average wind speed) to the estimated RR of MF and AR. The RR estimates were not sensitive to the inclusion of these variables in the models either. The ILI index showed inconsistent results. For the models on medication fills, it was statistically significant in only seven locations, out of which only two showed an increased risk, and there was no apparent spatial or temporal pattern that plausibly explained the observed associations. For the analysis on allergic rhinitis, it was significant in seventeen locations, out of which ten showed an increases risk, and seven showed a reduction in risk. In the models for medication refills, daily average 8-h maximum ozone concentrations increased the risk in 11 locations (at the 95% significance level). In our analyses, we observe very weak association between PM2.5 and ozone with allergic rhinitis visits. In the models for medication fills, daily average precipitation reduced the risk in only five locations (at the 95% significance level), while daily maximum temperature reduced the risk in 11 locations and increased the risk in two locations (at the 95% significance level).

Aeroallergen exposure is a major source of morbidity and appears to be on the rise globally as the climate warms. Developing a broad range of exposure-outcome associations, controlled for potential confounders, is an essential step in estimating disease burden associated with aeroallergen exposure. Our study adds to the literature on the health impacts of pollen by (i) examining two health outcomes –prescription medication fills and allergic rhinitis physician visits, that are relatively understudied; (ii) providing estimates of health risks for three broad categories of pollen (tree, grass, and weed), thus covering the entire pollen season; (iii) covering 28 locations across the United States; (iv) controlling for potential environmental factors (like air pollution, temperature, precipitation) and potential biases that could arise from seasonal influenza-like illness. We conduct a series of sensitivity analyses to examine how these associations vary by different constructs of pollen exposure (based on concentrations and temporal lags) and health outcomes. We observe a statistically significant increase in risk of allergic disease even at moderate levels of pollen as defined by the National Allergy Bureau. Given the high burden of allergic disease in the country, these location-specific results could inform recalibrating the risk communication strategy to issue alerts before the high pollen levels are reached.

We refrain from comparing the effect estimates from our study with other studies due to the different approaches used to measure pollen and health outcomes. Yet, it is useful to highlight a few studies that show results qualitatively similar to our study. In France, same day grass pollen count was associated to a binary indicator of severe allergic rhinitis cases [RR 1.08 95%CI = 1.01, 1.14] [15]. Studies in France [23] and Belgium [37] have found a strong association between increases in tree and grass pollen and increases in anti-allergic medication use using claims data. The risk estimates for medication fills in the Belgian study for tree and grass pollen are comparable to the estimates we derived. A study in New York City showed strong association between over-the-counter (OTC) allergy medication sales and increase in tree pollen season [13].

We found that the inclusion of the environmental variables had little impact on the magnitude of the risk estimates for medication fills and allergic rhinitis. While a study in Korea observed positive association between temperature and tree-pollen related hospital admissions [38], meteorological conditions had no impact on medication sales during the tree pollen season in New York City, NY [13] and Bridgeport, CT [39]. Studies have reported contrasting associations between OTC medications with air pollution [13, 25]. Similarly, the impact of air pollution on allergic rhinitis cases are inconclusive [15, 40,41,42].

There is quite a bit of variation in the lagged associations of pollen concentration and health outcomes in the literature. For example, the temporal association between high tree pollen and over-the-counter medication sales were found to last for 0–3 days in New York City [13]. The effects on allergy medication use were concentrated on the present-day tree pollens but remained significant until 3 days lag time in the case of grass pollens [23]. In our meta-analysis, we notice that the risk of the first allergic rhinitis visit of the season is strongly correlated with a 7-day average of pollen exposure for all three type of pollen, though there are variations across the locations. We do not observe such strong effects of longer lags for the risk of medication fills.

Overall, this work provides helpful new insights for risk assessment and other aspects of public health practice related to aeroallergens. Specifically, the significant increase in risk of allergic complications even on days with moderate levels of pollen concentrations suggest that risk communication should focus on early warning even at moderate exposure levels. These findings have implications for ongoing surveillance, estimations of disease exacerbation risk associated with pollen among sensitized individuals, and projections of pollen-related disease burden related to climate change, as widespread shifts in allergenic plant distribution [43] and pollen phenology [4] have been observed. The findings provide additional support for using medication fills as a surveillance indicator for allergic rhinitis, the management of which is principally via outpatient ambulatory care [23]. This could also facilitate surveillance of allergy symptoms in regions without pollen observations. The findings also have implications for land use and climate change adaptation and mitigation activities that include widespread tree planting to reduce urban heat islands and promote carbon fixation [44], which can inadvertently result in increased exposure to allergenic pollens [45], allowing for more comprehensive health impact assessment and comprehensive synthesis of environmental information in health protection [46].

The study has some limitations to note. Assignment of pollen data from a single monitoring location to health data obtained for those living in a large metropolitan area raises concerns for exposure misclassification. Different instruments (Rotorod and Burkard) and manual inspections to count pollen could introduce unknown biases in the measurements that we are unable to control for. The pollen monitors are located in urban areas that prevented us from estimating the health risks in rural areas. The health dataset only contains information on individuals who have employer-based health insurance that limits the generalizability of the results to the wider population. The health data only provides information on medication fills and not how individuals used the medication. As a result, we could not assess how medication use was associated with increase in pollen exposure. Location-specific information of the specific plant species that contribute to relatively high levels of pollen and thus to increase in allergic complications would be most useful for designing pollen early warning systems to provide timely information for susceptible individuals. Future analysis will focus on the identification of the most allergenic species in these locations and consider a wider range of respiratory health impacts. Another topic of interest will be to assess potential variation in the impact of pollen exposure on individuals with different levels of susceptibility to pollen.

Our results also suggest several additional avenues for further exploration. The relationship between pollen exposure and incidence of sensitization has been characterized for relatively few populations and is important to estimating overall disease burden related to allergic disease. The question of whether certain species within the general categories of trees, weeds, and grasses may be driving the observed relationships also remains unanswered. Lastly, while there are several markers of morbidity associated with pollen allergy, there are as yet no standardized estimates of disability such as disability adjusted life year estimates to associate with the disease, complicating standardized estimates of disease burden in the US and elsewhere. As pollen exposure, sensitization, and related allergic disease burden grow, these questions are likely to become increasingly pressing.

Aeroallergens are a significant source of morbidity worldwide, and exposure is increasing as the climate warms. Despite the large disease burden, risk assessment and risk reduction activities have suffered from limited information regarding exposure-outcome associations for a wide range of pollens, potential confounders of observed associations, and knowledge of exposure thresholds for symptom development in sensitized individuals. Our findings confirm known exposure outcome associations for a number of pollens while controlling for a larger range of potential confounders than prior research and extending the findings to cover much of the contiguous United States and extending the catalogue to several other pollen categories. Our findings highlight the significance of even moderate levels of pollen exposure and have implications for future efforts at estimating disease burden associated with aeroallergen exposure in a warming world and for guiding efforts to minimize harms related to climate change adaptation and mitigation activities.

Availability of data and materials

The health data that support the findings of this study are available from IBM Truven, and the pollen data are available through the National Allergy Bureau. These datasets are proprietary and were used under license for the current study. Restrictions apply to the availability of these data, which and so are not publicly available.

National Allergy Bureau

Influenza-like illness

Over the counter

Emergency department

American Academy of Allergy, Asthma, and Immunology

Metropolitan Statistical Area

Commercial Claims and Encounters

International Classification of Diseases

Allergic Rhinitis

Medication refill

Centers for Disease Control

Health and Human Services

North American Land Data Assimilation System

Relative risk

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The pollen data used in this analysis were provided by the National Allergy Bureau (NAB) of the American Academy of Asthma, Allergy, and Immunology (AAAAI). The authors would like to acknowledge the following members of the NAB for their provision of pollen data for this work: Stanley M Fineman, MD MBA FAAAAI, Atlanta Allergy and Asthma Clinic, Marietta (Atlanta), GA; Sheila Amar, MD, FAAAAI, FACAAI, Allergy & Asthma Center of Georgetown, Austin, TX; Jonathon Matz, MD, FAAAAI, & David Golden, MD, FAAAAI, Baltimore, MD; Linda Ford, MD, FAAAAI, The Asthma and Allergy Center, PC, Bellevue, NE David Weldon, MD, FAAAAI, FACAAI, Scott & White Clinic, College Station, TX; Robert Nathan, MD, FAAAAI, & Daniel Soteres, MD, MPH, FAAAAI, Asthma and Allergy Associates, PC, Colorado Springs, CO; Donald Pulver, MD, FAAAAI, Allergy, Asthma & Immunology of Rochester, Rochester, NY; Andy Roth, RAPCA, Dayton, OH; Duane Harris, MD, FAAAAI, Intermountain Allergy & Asthma Clinic, Draper, UT; Philip Gallagher, MD, FAAAAI, Allergy & Asthma Associates of Northeastern Pennsylvania, Erie, PA; Kraig Jacobson, MD, FAAAAI, Allergy & Asthma Research Group, Eugene, OR; Neil Kao, MD, FAAAAI, Allergic Disease and Asthma Center, Greenville, SC; Tony Huynh, City of Houston, Houston, TX; Jay Portnoy, MD, FAAAAI, Children’s Mercy Hospital, Kansas City, MO; James Anderson, MLT, OSHTECH, London, ON; James Sublett, MD, FAAAAI, Family Allergy & Asthma, Louisville, KY; Robert Bush, MD, FAAAAI, University of Wisconsin Medical School, Madison, WI; Joseph Leija, MD, FAAAAI, Melrose Park, IL; Harold Kaiser, MD, FAAAAI, Clinical Research Institute, Minneapolis, MN; Warren Filley, MD, FAAAAI, OK Allergy Asthma Clinic, Inc., Oklahoma City, OK; Martha Tarpay, MD, Allergy & Asthma Center, Oklahoma City, OK; Donald W. Pulver, MD FAAAAI, Allergy, Asthma & Immunology of Rochester, Rochester, NY; Wayne Wilhelm, Saint Louis County Health Department, St. Louis, MO; Robert Gomez, Wiford Hall Ambulatory Surgical Center, San Antonio, TX; Alan Goldsobel, MD, FAAAAI, & James Wolfe, MD, FAAAAI, Allergy and Asthma Associates of Northern California, San Jose, CA; Frank Virant, MD, FAAAAI, Northwest Asthma & Allergy Center, Seattle, WA; Rhizza Adams, Springfield-Greene County Health Department, Springfield, MO; James Love, Jr., MD, PhD, FAAAAI, Allergy Clinic of Tulsa, Tulsa, OK; Richard Henry, MD, Asthma & Allergy of Idaho, Twin Falls, ID; Pramila K. Daftary, MD, FAAAAI, Allergy & Asthma Care of Waco, Waco, TX; Susan E. Kosisky, MHA, US Army Garrison-Forest Glen, Silver Spring, MD (Washington D.C.); Christopher Randolf, MD, FAAAAI, Waterbury, CT; Michael Nickels, MD, PhD, Allergy and Asthma Consultants, Inc., York, PA.

This work was supported by the National Aeronautics and Space Administration (NASA) grant 15-HAQST15-0025, Research Opportunities in Space and Earth Science (ROSES-2015), Program Element A.46: Health and Air Quality Applied Sciences Team.

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Project conceptualizing: SS, JH; Data analysis: SS, AV, FL; Literature review: SS, CB, JH; Manuscript preparation: SS, AV, FL, CB, JH. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shubhayu Saha.

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Saha, S., Vaidyanathan, A., Lo, F. et al. Short term physician visits and medication prescriptions for allergic disease associated with seasonal tree, grass, and weed pollen exposure across the United States. Environ Health 20, 85 (2021).

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  • Pollen
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Ireland Wiki

The Eighteenth Amendment of the Constitution of Ireland permitted the state to ratify the Amsterdam Treaty. It was effected by the Eighteenth Amendment of the Constitution Act, 1998, which was approved by referendum on 22 May 1998 and signed into law on the 3 June of the same year.

Changes to the text[]

  • Insertion of new Article 29.4.5:
The State may ratify the Treaty of Amsterdam amending the Treaty on European Union, the Treaties establishing the European Communities and certain related Acts signed at Amsterdam on the 2nd day of October, 1997.
  • Insertion of new Article 29.4.6:
The State may exercise the options or discretions provided by or under Articles 1.11, 2.5 and 2.15 of the Treaty referred to in subsection 5° of this section and the second and fourth Protocols set out in the said Treaty but any such exercise shall be subject to the prior approval of both Houses of the Oireachtas.
  • (Existing subsections 5 and 6 of Article 29.4 are retained but renumbered as subsections 7 and 8 respectively)

The Eighteenth Amendment of the Constitution was one of a number of amendments that have been made to expressly permit the state to ratify changes to the founding treaties of the European Union (others have been the Tenth, Eleventh and Twenty-sixth Amendments). These amendments have all been adopted in response to the 1987 ruling of the Supreme Court, in the case of Crotty v. An Taoiseach, that major changes to the treaties are unconstitutional unless accompanied by an amendment. However it has been a matter of scholarly dispute as to whether or not every one of these treaties has been sufficiently far-reaching as to actually necessitate a constitutional amendment. The Treaty of Amsterdam contained a number of optional protocols that member-states could activate at a later time after its adoption. The Eighteenth Amendment permitted the Republic to choose to exercise these options, provided it had the support of the Oireachtas (parliament). While the changes shown above are those made to the English-language version of the constitution, constitutionally it is the Irish text that takes precedence.

The Eighteenth Amendment was introduced by the Fianna FáilProgressive Democrats coalition government of Bertie Ahern and was also supported by Fine Gael and the Labour Party (the two major opposition parties). The referendum on the amendment occurred on the same day as the referendum on the Nineteenth Amendment, which related to the Good Friday Agreement. The Eighteenth Amendment was approved by 932,632 (61.7%) votes in favour to 578,070 (38.3%) against, a narrower margin than in previous referendums on the European Union

Eighteenth Amendment of the Constitution of Ireland referendum
Choice Votes Percentage
Referendum passed Yes 932,632 61.74%
No 578,070 38.26%
Valid votes 1,510,702 97.85%
Invalid or blank votes 33,228 2.15%
Total votes 1,543,930 100.00%
Voter turnout 56.20%
Electorate 2,747,088

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PowerDirector – Video Editor APK

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text:
Sonology workshop “the circle of sound”

Sitting in circle of sharing, the participants play the instrument they chose in all the singing bowls, chimes, and others at their disposal.

They learn to bring out the best of it, to harmonize themselves in group, to master the moments of silents and the particularities of their “tool”.

Each seance is different as it depends on everyone’s condition ont the moment, and the instrument they chose, and the also on the theme if there is one.

The music soften the mores… silence is golden….
Let’s take the opportunity to stimulate our letting go and our relaxation, and let’s create.


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text:
Six Weeks to Yehidah

Title: Six Weeks to Yehidah
A bestselling novel and winner of the Forward National Literature Award for Middle Grade Chapter Books.

Author: Melissa Studdard
Publisher: All Things That Matter Press
ISBN: 9780984651702
Release Date: August 2nd 2011
Pages: 170
Genre: Middle grade chapter book
Format: ebook
Source: Tourz de Codex for review

Review on GoodReads:
Move over, C.S. Lewis; Melissa Studdard is here! Annalise of the Verdant Hills is one of the most delightful protagonists to skip through the pages of literature since Dorothy landed in Oz. Join Annalise and her two walking, talking wondersheep as they travel to ever more outlandish places and meet outrageous and enlightening folk on their journey to discover interconnectedness in a seemingly disconnected world. Discover with them how just one person can be the start of the change we all strive for. A book for all ages, for all time: wonderful, wacky, and bursting with truth!

My Review:
This is a fascinating, well written story for early readers. I agree with the Goodread’s review, very similar to C S Lewis. Six Weeks to Yehidah is the story of Annalise, a young girl who enters a wondrous dreamscape. Like all children, she accepts that it is all real and is not surprised when her companions, her two sheep, can suddenly talk. It full of wonder and adventure, but also contains wonderful lessons about the difference between truth and make-believe. It makes you think about what goes on around you. It will enchant any child who believes in fairies (or would like to). It is must read for the young and young at heart. The author says that the book is in many ways, “about tolerance and acceptance of ourselves and others. It was also important to me to share certain wisdom traditions with children, and I absolutely knew that the best way to do this was through narrative.” This is evident all through the story.

Author Interview

Describe your book in five words or less.
Magical, Mythical, Mystical

How did the ideas for your books come to you?
I get ideas so many different ways – from talking to people, observing the world, and reading other books. My favourite and most frequent way is through dreams . For a long time, I’ve been fascinated by the mechanisms of the unconscious mind, and in the years preceding the composition of Six Weeks to Yehidah I’d done an intensive study of dreams, meditation, visualization, and so forth. I kept a dream journal and meditated regularly. I listened to guided meditations, which are rich with imagery. In the end, it was a combination of dreaming and waking imagination that birthed the scenes in this book

Is there a message in your novel that you want readers to grasp?
Six Weeks to Yehidah is about love, tolerance, acceptance of ourselves and others, and finding purpose in life. I want readers to understand that to a large extent we create our own realities and circumstances and that we can all live magical, meaningful lives if we approach them with mindfulness, authenticity, and love.

What is the hardest part of writing for you? What’s the easiest?
I wear a lot of hats. I’m a single mom, an editor, a radio show host, a professor. Finding time has to be the hardest part. If I could, I would write several hours a day, at least five days a week. Right now, my life doesn’t allow for that. That kills me because I feel ideas slip by, and I fear sometimes I’ll never get them back.
The easiest part is making things up. I love making things up. Thank goodness I’m a writer. Otherwise I might be a pathological liar. Haha.

What’s next for you? Are you currently working on or have plans for future projects?
I’m currently putting together a book based on the radio interview program, Tiferet Talk, which I host for the literary journal Tiferet. The publisher, Donna Baier Stein, has started a press associated with the journal, and the first book will be a compilation of the first year of Tiferet Talk interviews. It’s filled with insight and wisdom about spirituality and writing. I was fortunate enough to interview people such as Julia Cameron, Robert Pinsky, Marc Allen, and Jeffrey Davis. They had so much to share. I can’t wait to see it all collected together as one book!

Why did you choose to write for specific genre?
I write in many genres, but I think the genre for this particular book chose me. I was in a wonderful critique and writing group in which we took turns assigning prompts each month. One woman asked us to read The Oxford Book of Modern Fairy Tales and write our own short tale. It turned out that I was so compelled by the voice and characters I’d created that I kept writing and writing until I realized I was actually writing a novel.

What’s it like hearing that readers are eagerly awaiting your book’s release date?
Lovely. The positive response to Six Weeks to Yehidah has been overwhelming, and I wake up filled with gratitude every single day.

What is one question that you’ve always wanted to be asked in an interview? How would you answer that question?
What a wonderful question. Earlier, you asked me if there was a message I wanted readers to grasp (another wonderful question), and I’d like to elaborate on that a bit and discuss what the book can do for the reader. Sure I wrote it to be fun, exciting, entertaining, and so forth, but I also had a deeper purpose beyond entertainment and beyond even the message. That purpose was to inspire people—especially children—to create lives of meaning, connection, purpose, love, and joy. Six Weeks to Yehidah models the potential for this kind of life through the adventures and choices of the main character, Annalise. The companion book, My Yehidah, directly engages readers’ own experiences, feelings, thoughts, and dreams by asking them to journal about the themes most prevalent in the novel and in their own lives.

What was your road to publications like?
Surprisingly, it wasn’t that difficult. Rather than flooding the industry with submissions of my book, I chose a few presses that I admired, and which I knew were publishing books like the one I had written. The research – finding the right places to send it – was the hardest part. Once I targeted a specific small group and got my book to the right people, the acceptance came rather quickly.

Author Bio:
I’m a professor, a book reviewer at-large for The National Poetry Review, a contributing editor for both Tiferet Journal and The Criterion, and the host of the radio interview program Tiferet Talk. As well, I am a member of many literary organizations, including the National Book Critics Circle and the Society of Childrens Book Writers and Illustrators. I am the author of the bestselling novel Six Weeks to Yehidah, which also won the Forward National Literature Award for Middle Grade Chapter Books, and the newly released My Yehidah.

I love anything related to writing and reading, whether it’s sitting alone with a book and a cup of hot tea, or attending a large poetry reading or literary festival. I also love travelling, meditating, going for walks, bicycling, practicing yoga, and spending time with family.

I currently reside in Texas with my wonderful daughter and our four sweet but mischievous cats.

Author Website

This new Australian story is a must read for 9 to 90

Gunnedah Hero – By Clancy Tucker

Fourteen-year-old Gunnedah ‘Gunnie’ Danson is despondent because he has an assignment on the drought. As a ‘Townie’ he knows nothing about the affects of this blight on the rural industry; but that is about to change. When he returns home from school he receives a surprise gift.

    His late grandfather has left him a box containing a manuscript. It was written by Gunnie’s great-great-grandfather, Smokey ‘Gun’ Danson after his journey up the long paddock as a fourteen-year-old drover;  during a harsh drought in 1910. At the back of the manuscript is an envelope. It’s NOT to be opened until Gunnie has read the entire story.
    Gunnie spends the weekend at Wiralee Station; a cattle station that’s been in the family since 1848. There, he reads the awesome manuscript and learns of Smokey’s adventurous journey. But while he is at Wiralee, he learns more than he bargained for. The family cattle station is under threat. Will the contents of the mysterious envelope save it?

Review: This story is so good it gave me goosebumps. It is a wonderful coming of age story for boys. It is set in the Australian bush and parallels the lives of two boys – one a present day lad of 14, and the other, his great-great-grandfather at the same age. The story is based on a manuscript left to the present day lad that tells the story of his great-great-grandfather’s heroic journey to save the family’s cattle property during the 1910 drought. It is cleverly written and is a heart warming and enjoyable read that will appeal to more than the young adult audience it is targeting. I loved editing and formatting it. I laughed and cried; and for hours, I was totally lost in the bush setting and the lives of the two main protagonists. It was ‘Highly Commended’ in the FAW Jim Hamilton Award – 2007 National Literary Awards, and has been favourably acclaimed by many notable people.

eBook now available for immediate download on Smashwords:

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HBS 011: The TRUE Fast Track to Massive Online Income

Everyone who starts an online business with the hope of creating income has a goal. Some are happy with just a few hundred a month in extra income, others are seeking what we could call “massive online income”. Let’s define that as income in the five-figure per month range. Just a couple days ago, I …Read More

Relationships – The True FAST TRACK to Massive Income!

I want to share what I received in an email from Joel Therien today. Joel is the founder of Pure Leverage, and a very accomplished entrepreneur and online marketer. I know a lot of times, people want to make big money online just hiding behind their computer during the wee hours of the night, posting …Read More


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CBS News, and most other news organizations, have this story.

The Las Vegas headquarters of the nation’s largest grassroots community organization for low-income people was raided today by Nevada state authorities as part of a voter-fraud probe.

The raid was initiated by Nevada’s Secretary of State, Ross Miller, after a series of accusations that the Association of Community Organizations for Reform Now, also known as ACORN, was submitting voter registration lists to the state that contained false or duplicate names of voters.

“When we got [to the headquarters], no one was there so, there were no arrests,” Secretary of State spokesman Bob Walsh told CBS News. But, he added “agents did seize lots of records.”

CBS News has learned that the state’s investigation is focusing on the conduct of ACORN’s work force. Critics allege that ACORN hires workers “off the street” to sign up new voters, paying them by the number of voters registered – sometimes resulting in false and duplicate names. But an ACORN spokesman dismisses this allegation and told CBS News that workers are paid “by the hour” and “not by the number of people they sign up.”

The Las Vegas paper reported that ACORN staff registered the starting lineup of the Dallas Cowboys.

What makes this story so troubling is that ACORN has had this problem in other occasions over the last 5 years.  I did a quick Lexis search and found cases of indictments or convictions of ACORN workers in Missouri in April of 2008, Washington State, Wisconsin, and other places.   Moreover, these sort of registration problems are the fodder for election fraud claims and are used by those who support stringent voter identification at the polls and more stringent voter registration identification requirements.


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Episode 18: The Happiest Day Of A Girl’s Life

Black Comedy

By Michael G. Glab

© 2013

— Eighteen —

[What’s the difference between a wedding and a riot? We’ll find out in the next few installments of the serial e-novel, “Black Comedy.”]

It’s still hot on Saturday, April 6, 1968, even though the temperature at the time of Anna Dudek and Anthony Pontone’s wedding at St. Giles Roman Catholic Church is only 49 degrees. A cool front passed through the Chicago area early this morning, well before the sun rose. But, yeah, it’s hot.

In the morning, for instance, snipers engage the cops in a shoot out at the Cabrini-Green highrises. Dozens of cops crouch behind squadrols and private cars, exchanging gunfire with dozens of snipers up on the balconies. For some moments, the area around Larrabee and Division streets sounds like the worst of the news film footage from Vietnam.

The Balconies At Cabrini-Green

The cooler air temps may have led to a slight easing of the madness on the West Side. The setting of fires, for one thing, seems to have ceased although most of the more than 200 buildings torched within the last 36 hours still are smoldering. Nearly a thousand people have been made homeless so far. Ten have lost their lives — again, so far. And the running count of people arrested in the riot zone now stands at 2500, give or take a few hundred which, when it comes to the Chicago Police Department counting bad things happening to black human beings, is about as accurate as things will get.

More than 22,000 fully-armed personnel have fanned out over the battle zone. Ten thousand five hundred Chicago Police officers in riot gear are working twelve-hour shifts. Governor Samuel Shapiro has sent in sixty seven hundred Illinois National Guardsmen. And President Lyndon Johnson has ordered 5000 regular U.S. Army troops into Chicago. The Army is setting up camp in Washington Park on the South Side. Convoys of armored personnel carriers and tanks are shuttling back and forth between the south and west sides.

Mayor Daley has been flying over the riot zone in a helicopter with Fire Commissioner Robert Quinn. The Mayor is shaking his head and saying, repeatedly, “I never thought this would happen here.” Commissioner Quinn, for his part, continually points out young black kids running into and out of Madison Street stores with shattered front windows, carrying radios and and TVs. “Look at that,” Quinn says. “Look. Look. You see that?” Quinn, the school snitch, and Daley, the flustered principal.

It is during one of these flyovers that Daley notices cops seemingly doing nothing to stop the kids from looting. “Why aren’t the policemen doing anything about it?” he wonders. He says the word policemen in his own version of Chicagoese: p’leess-minn. Quinn shrugs his shoulders, an innocent look on his face. Quinn thanks his holy God that Police Commissioner James Conlisk will bear the brunt of Daley’s wrath. Just to make sure, he points out a few more looters.

Mayor Daley

“How Could This Happen Here?”

It’s at this moment that Richard J. Daley, the democratically elected mayor of the nation’s second largest city, declares war on his own constituents. Daley carried some of the precincts in these West Side wards by 10-1 margins in the 1967 election. These are his most loyal voters. It is now that Daley first articulates his order for police to shoot to maim looters and shoot to kill anyone with a Molotov cocktail in his hand.

Meanwhile, Governor Shapiro declares the residents of the West Side to be in a state of insurrection, thereby giving his National Guard soldiers license to fire upon them at will.

Chicago, like much of the nation today, is at war with itself.

Lyndon Johnson

“Mr. President?”

“Yes, Dick?”

“We’re In Trouble. We Need Some Help.”

Anna and Anthony’s wedding might very well be the only one celebrated in the city today. That is, if one can actually celebrate anything while tanks and armored personnel carriers are rolling through Chicago’s streets. But God forbid anyone would even consider postponing these nuptials. Tree, for instance. She wants the whole thing over and done with as soon as possible. And Al, of course, has never been one to let distractions like civil warfare move him off his planned course.

And what of Anna? Shouldn’t she expect Saturday, April 6, 1968, to be the most exciting day of her young life?

Father Jerome will perform the ceremony at St. Giles. The pews on the bride’s side of the aisle are packed. None of Al Dudek’s family, friends, and associates are about to let those pozzo coloreds stop them from going about their business. Anthony’s side is even more populated. And, for the first time in the long history of Mob scions’ weddings in Chicago, a passel of scraggly hippies and — Madonna! — a couple of Negroes are among the guests.

When the two Negroes first climbed the front steps of St. Giles church, Anthony Pontone’s driver reflexively reached inside his suit jacket and fingered the handle of his holstered .38.

Now, the two Negroes march into the church with every single eye upon them as if they are the bride and groom. They take their seats on Anthony’s side and act as though the other nearly 500 guests aren’t staring at them with mouths agape.

St. Giles

St. Giles

Fr. Jerome climbs up to the lectern to give his sermon. He peers out over the assembled multitude and when his eyes land upon the two Negroes, his own jaw drops. He stands there staring for what seems an eternity. He stares so long that a murmur arises from the congregation. Like a character in a sitcom, Fr. Jerome finally shakes the cobwebs out and says, “Ahem, well then….”

The congregation has to wait another uncomfortable few moments for him to even remember what the hell he’s going to talk about, so shaken is he. Fr. Jerome is a big one for incorporating current events into his sermons. Say, for example, this wedding is taking place on a Saturday in December and the Bears are about to about to face, oh, the Green Bay Packers in an important game the next day. Half to three quarters of his sermon will be about the game. Then there was the time, just a little over a year ago, the Sunday after McCormick Place had burned to the ground, when his entire sermon resembled nothing so much as an arson investigator’s report. He commented that the fire had forced the cancellation of the Four Seasons show at the Arie Crown Theater. He even held up his tickets and said, crestfallen, “The Lord works in mysterious ways”!

The Four Seasons

Poor Fr. Jerome — He Missed The Four Seasons

The Dudeks’ neighbors, Charlie Solari and his wife Josie were here that Sunday. They’re here today. Charlie Solari, a firefighter stationed at the Chinatown firehouse, actually battled the McCormick Place blaze. It turned out to be the most profitable working day of his life. Anna will explain this all later, when she points out each of the guests to Anthony at the reception.

So, Fr. Jerome is up on his current events.

Today, though, he makes absolutely no mention of the mayhem on the West Side and more than a hundred other cities around the country, nor does he refer to the death of the nation’s most prominent black leader that started it all. No, today Fr. Jerome falls back on that old wedding sermon chestnut, the marriage at Cana. Fr. Jerome hurtles himself into a feverish rapture by recounting Jesus’ first miracle. He is thrusting his fist into the air and nearly shouting as he gets to the part about the jugs of water being transformed into wine. For God’s sake, the guests might be excused for thinking Fr. Jerome is recounting the final touchdown in a Bears’ miraculous comeback victory over those Packers. Perhaps he hopes his histrionics will make the congregation forget the riots and the assassination. And he’s right. By the time he finishes even Al is asleep.

The reception is being held at Nuovo Mondo Italian Restaurant & Banquets on Division Street, a block east of Austin Boulevard. Nuovo Mondo is a mere 200 yards from the border of Oak Park. Even though the rioting is taking place some two and a half miles to the east, there is an Oak Park police squad car blocking every major entry street to make sure marauding bands of Negroes don’t invade the leafy suburb. The Oak Park cops needn’t have bothered — there’s been plenty to burn and loot in the West Side ghetto.

Nuovo Mondo is part-owned by Tony the Fist Pontone. He is providing the reception hall free of charge in exchange for a healthy discount on all his meats from Al’s company for the remainder of the the year. That healthy discount amounts to a simple four words uttered by Al when Tony’s kitchen manager calls him up to inquire about his bill: “Doan worry about it.”

Black limousines pull up the the front entrance of Nuovo Mondo, disgorging their occupants: the newlyweds, of course; the rest of the wedding party; Anna’s parents; and Tony himself and his bride, Marlena.

An all-star cast arrives in lesser — but still pricey and shiny — vehicles. Mickey Finnin and his wife pull up in their brown Lincoln Continental. Alderman Rocco Bianco — a confirmed bachelor (some have whispered that he’s a swish) — pulls up in his rakish red Corvette. State’s Attorney Eddie Halloran and his wife Kathleen get out of their burgundy Oldsmobile Toronado. A slew of Buick Electra 225s of varying hues lets out the likes of State Senator Renaldo Nitti and his wife, Meat Cutters & Boners Union local president Tommy DeMio and his lovely bride, Teamsters local boss Jerry Piombino, restaurant mogul Andy Silverberg, auto dealer partners Nicky Capizzi and Mort Aronson, and a raft of lesser lights. Even Harry Aleman and Tony Spilotro are here.

(And, irony of ironies, when Anna was making out her seating arrangements, she placed Aleman and Spilotro at the same table as the widow Eva Mondi. One of Tony the Fist’s boys caught the gaff as he walked around the hall prior to the reception, sweeping for bugs planted by the G. He simply switched the two place cards with two from another table. He was, after all, concerned that the two hit men might be a tad uncomfortable sitting with the woman whose husband they’d assassinated not six months ago. He obviously didn’t know Aleman and Spilotro well.)

Nuovo Mondo’s red-vested parking valets are having the day of their year, their pockets bulging with fins and ten-spots. They’re running like track stars trying to keep up with with the big-tipping connected guys and pesci grandi.* And then a clunky little beige Ford Falcon splutters up to the curb. The woman on the passenger side opens her own door because none of the valets has dashed up to do so. Her door makes an excruciating, rusty squeak. The driver, a man, gets out and waits for a valet to approach to collect his keys. He waits and waits and waits until finally the valet with the least seniority slowly ambles up as if attached to a large rubber band and holds his palm open six inches below the man’s hand — the valet clearly does not want his skin to graze the man’s. The man lowers his hand to bring it nearer the valet’s so as to make the exchange of keys easier but the valet maintains the six-inch space. Finally, the man grasps what’s going and on simply drops the keys into the valet’s hand.

Ford Falcon

A Lump Of Coal In A Parking Lot Full Of Diamonds

The man from the Falcon does not dig into his pocket to slip the valet a fin or a ten-spot. He has no fins or ten-spots in his pocket. In fact, he is carrying precisely $2.63 on his person, as much as he carries on some days and more than on most. “Psh,” one of the other valets stage whispers to his colleagues, “whaddya expect from a shine?” The man from the Falcon pretends not to hear this comment.

He and the woman, the same couple who drew unabashed stares in St. Giles, enter the lobby of Nuovo Mondo. They both pretend that they’re not being gaped at openly yet again. It’s unheard of for a black couple to enter the lobby of Nuovo Mondo. It’s bordering on madness for one to do so today.

There is still the hint of smoke in the air outside the banquet hall.

Now the guests are taking their seats. Joey, who has already begun sneaking gulps from wine bottles — not Chianti this time but Côtes du Rhône and Châteauneuf-du-Pape. He stumbles up to the wedding party’s dais and puts his arms around Anthony and Anna. “Yer married,” he says as if he’s breaking the news to them. Anna smiles at her brother. “Yes we are. Thank you, Joey,” she says. Anthony is about to thank him when Joey expels a monumental belch. “Sorry,” Joey says, and he stumbles off to find another unattended bottle of fine wine to slurp.

Anthony, of course, has been absent from the neighborhood for several years, learning to become a journalist, and then, consecutively, a dissenter, a radical, and finally a revolutionary. He leans nearer to Anna. “Who are all these people?” he whispers.

“Okay now,” Anna says, “pay attention.”

To be continued

A Helpful Glossary

  • Pesci Grandi: Pronounced PESH-ee GRAHN-dee, literally big fish, used to describe men of accomplishment and status.
  • The G: FBI agents or representatives from the US Attorney’s office. Short for government.

Join us Monday for the next installment of “Black Comedy.”

All fictional characters, descriptions, and situations are the property of the author.

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Space Marine Land Speeder Storm Product Description

A Land Speeder Storm can be used as a mobile firebase, assault transport or stealth insertion craft as the combat objective dictates. This box set contains one multi-part plastic Space Marine Land Speeder Storm and six multi-part plastic Space Marine Scouts. This 99-piece set includes: a Cerberus launcher, a heavy bolter and a range of head, weapon and arm options for the Scout crew. Also included are a host of accessories including: pouches, grenades, scopes, packs and knives. Model supplied with a large flying base.
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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A-Z Listings Contact Us

'Flattening the Curve' Saves More Lives Than Thought

MONDAY, Sept. 14, 2020 (HealthDay News) -- Failure to "flatten the coronavirus curve" in the United States could lead to even more deaths than previously believed, a new study claims.

The researchers concluded that every six additional intensive care unit (ICU) beds or seven additional non-ICU beds filled by COVID-19 patients leads to one additional COVID-19 death over the following week.

"A spike in hospitalization naturally leads to more deaths, but these deaths may not only come from those who are hospitalized, but also from those who should have been hospitalized but were not," explained study co-author Anirban Basu. He's a professor of health economics at the University of Washington in Seattle.

The results match previous research showing that death rates rise as ICUs handle more COVID-19 patients, but the finding about non-ICU beds is new, according to the study authors.

U.S. Centers for Disease Control and Prevention data suggest that for every additional seven patients in non-ICU beds, about 0.5 deaths would be expected over the next seven days. But this study found that the number is higher.

"This may indicate that constraints in available capacity of non-ICU beds may have a spillover effect to non-hospitalized patients. In fact, the study found that the effect of non-ICU beds rises steadily as more and more non-ICU beds are occupied by COVID-19 patients," Basu said.

For example, when 20% of non-ICU beds are occupied by COVID-19 patients, an additional seven COVID-19 admissions to non-ICU beds will result in two additional COVID-19 deaths over the next seven days.

"Even when, say, 80% of non-ICU beds are still available, a further increase in COVID-19 admissions leads to significantly more numbers of deaths than what we would expect from only the hospitalized patients. This may be because the health care delivery within a hospital is not only driven by hospital beds but also personnel and COVID-specific supplies, which may be stretched thin," Basu said.

The findings show that efforts to flatten the curve through measures such as physical distancing and mask use are more important than keeping hospitals from becoming overwhelmed with COVID-19 patients, according to Basu.

Failure to flatten the curve before hospitals reach capacity kills more people than just those who end up in hospital beds, he said in a university news release.

"These results have very important implications as large numbers of students head back to schools and colleges across the nation, and resistance to public health measures continues to stymie efforts to reduce the number of infected," Basu said.

The study was published recently in the Journal of General Internal Medicine.

"Our study quantifies the relationship between COVID-19 deaths and COVID-19 hospitalizations using actual data," the study authors wrote in the report. "These estimates provide a better understanding of the projections of the COVID-19 pandemic in the USA, especially when states are gearing up to restart economic activities and provide important practice insights for hospitals in terms of assessment of hospital bed and ICU bed capacity and preparedness."

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19 protection.

SOURCE: University of Washington, news release, Aug. 20, 2020

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