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The effect of bad air quality on human health is a well-known risk. Annual health costs have significantly been increased in many countries due to adverse air quality. Therefore, forecasting air quality-measuring parameters in highly impacted areas is essential to enhance the quality of life. Though this forecasting is usual in many countries, Sri Lanka is far behind the state-of-the-art. The country has increasingly reported adverse air quality levels with ongoing industrialization in urban areas. Therefore, this research study, for the first time, mainly focuses on forecasting the PM10 values of the air quality for the two urbanized areas of Sri Lanka, Battaramulla (an urban area in Colombo), and Kandy. Twelve air quality parameters were used with five models, including extreme gradient boosting (XGBoost), CatBoost, light gradient-boosting machine (LightBGM), long short-term memory (LSTM), and gated recurrent unit (GRU) to forecast the PM10 levels. Several performance indices, including the coefficient of determination (R2), root mean squared error (RMSE), mean absolute error (MAE), mean squared error (MSE), mean absolute relative error (MARE), and the Nash–Sutcliffe efficiency (NSE), were used to test the forecasting models. It was identified that the LightBGM algorithm performed better in forecasting PM10 in Kandy (R2=0.99, MSE =0.02, MAE=0.002, RMSE =0.1225, MARE =1.0, and NSE=0.99). In contrast, the LightBGM achieved a higher performance (R2=0.99, MSE =0.002, MAE =0.012 , RMSE =1.051, MARE =0.00, and NSE=0.99) for the forecasting PM10 for the Battaramulla region. As per the results, it can be concluded that there is a necessity to develop forecasting models for different land areas. Moreover, it was concluded that the PM10 in Kandy and Battaramulla increased slightly with existing seasonal changes.

Background and ObjectiveA proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of marginal, short-term lung function changes in fHP on mortality.MethodsBaseline demographics were recorded for 145 consecutive patients with a Multi-Disciplinary Team diagnosis of fHP, as well as baseline and one year follow-up lung function, baseline echocardiographic findings, bronchoalveolar lavage (BAL) cellularity, and all-cause mortality. Marginal changes in FVC ≥5% and DLCO ≥10% at one year were calculated. Cox proportional hazards analysis was performed to test for associations with mortality.ResultsBaseline lung function severity (FVC, DLCO, and composite physiological index (CPI)), age, and PASP ≥40mm Hg on echocardiogram were associated with early mortality, while BAL lymphocytosis was associated with improved survival. A marginal decline at one year in FVC ≥5% (HR: 3.10, 95% CI: 2.00–4.81, p<0.001) and DLCO ≥10% (HR: 2.80 (95% CI: 1.78–4.42), p<0.001) were associated with markedly reduced survival on univariable analysis. Both of these associations remained significant on multivariable analysis correcting for demographic variables, disease severity (as each of: CPI, FVC, and DLCO), and treatment. The association of both measures of decline with early mortality were also maintained when, in separate models, PASP ≥40mm Hg on echocardiography, and BAL lymphocytosis thresholds of 20%, 30% and 40%, were included in addition to demographic variables, disease severity, and treatment.Abstract P145 Figure 1Survival according to decline in lung function at one yearConclusionsA marginal worsening in FVC of ≥5% and in DLCO of ≥10% at one year are predictive of markedly reduced survival in fHP.

BackgroundIdiopathic Pulmonary Fibrosis (IPF) is a progressive scarring lung disease. The antifibrotics pirfenidone and nintedanib are approved for IPF patients with a forced vital capacity% predicted (FVC%) between 50–80%, and either drug may be prescribed in the first instance. Both drugs reduce mortality risk, and disease progression as assessed by FVC% and transfer factor for carbon monoxide% predicted (TLCO%) over 12-months. The effectiveness of antifibrotics beyond 12-months is less established, furthermore there is limited real world data comparing pulmonary function and mortality between both drugs.AimsTo assess the effectiveness of antifibrotics on FVC% and TLCO% over 24-months. To identify if the current clinical rationale of offering either antifibrotic from the outset is appropriate through investigating FVC%, TLCO% and mortality outcomes in IPF patients receiving pirfenidone or nintedanib.MethodsWe carried out a retrospective analysis of IPF patients with an FVC% between 50–80% who commenced antifibrotic treatment between May 2012 and October 2019 at Royal Papworth Hospital (Cambridge, UK). Separate random coefficient regression models were used to assess FVC% and TLCO% at 0, 6, 12, 18 and 24-months. A Cox proportional hazards model was used to assess hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality in antifibrotic treated patients.Results194 patients were identified from our dataset. FVC% remained stable between 0 and 12-months (p=0.330) but declined between 12 and 24-months (p<0.001). TLCO% decreased between 0 and 12-months (p=0.003) and between 12 and 24-months (p<0.001). Over 24-months, FVC% was similar between pirfenidone and nintedanib (Figure 1) (p=0.495), while TLCO% was greater in pirfenidone treated patients (figure 1), albeit non-significant (p=0.054). No all-cause mortality difference was observed for nintedanib versus pirfenidone (HR = 0.80 [95% CI = 0.46–1.40]; p=0.434).Abstract P147 Figure 1Mean FVC% (Block lines) and TLCO% (Dotted lines) over 24-months in patients treated with pirfenidone (Circle) and nintedanib (Triangle). * Significant difference between nintedanib and pirfenidoneConclusionsData from our centre revealed a greater FVC% decline during the 2nd year of treatment compared to the 1st year of treatment. There appears to be no difference in pulmonary function parameters and all-cause mortality between pirfenidone and nintedanib. This supports the current clinical rationale that if there are no contraindications to either drug, patients should be offered the choice of antifibrotic at the outset.

Introduction and ObjectivesIdiopathic Pulmonary Fibrosis (IPF) has a median survival of ~ 2–3 years, but there is significant variability and hence difficulty in advising patients at a personal level. The full blood count (FBC) is readily accessible and gives a Red Cell Distribution Width (RDW), which describes the percentage variation in red cell size. The neutrophil and lymphocyte count can be used to calculate a ratio (NLR). Limited published work has evaluated the prognostic significance of these markers in IPF. Our aim was to assess longitudinal changes in RDW and NLR as potential prognosticators in IPF.MethodsPatients with IPF were identified from the Royal Devon and Exeter Hospital (2005–2019). Data collected: baseline characteristics, survival, PFTs and FBC <6 months from diagnosis and 6–18 months during follow-up. Patients with insufficient data were excluded. Blood parameters were stratified into quartiles for subsequent Kaplan-Meier survival analyses, Mann-Whitney U-test and Spearman’s rank correlation.Results131 patients were included in analysis. Median change/month for NLR (deltaNLR) and RDW (deltaRDW) were 0.17 and 0.02 respectively, indicating minimal longitudinal variation. Anti-fibrotic treatment did not modify deltaRDW or deltaNLR. However, stratifying by median deltaRDW significantly impacted on survival (median 33 months with deltaRDW>0.02 vs 59 months; P = 0.04). Median survival stratified on baseline RDW was 35 months (highest quartile) vs 47 months (1st-3rd quartiles) although this did not reach significance (P =0.1439). Median survival based on follow-up RDW was 25 months (highest quartile) vs 59 months (1st-3rd quartiles; P=0.0021) and this was negatively correlated with FVC (P=0.0056). Both baseline and follow-up NLR had significantly shorter median survival in the highest quartile (28 months; p<0.05) compared with 47 months (baseline 1st-3rd quartile) or 59 months (follow-up 1st-3rd quartile). FVC was negatively correlated to baseline NLR (P=0.0282).ConclusionsRDW and NLR demonstrated significant relationships with survival and correlations with FVC. Increasing RDW resulted in poorer outcomes. Although limited by the small retrospective cohort, this data indicates that readily available FBC may have utility in prognostication and progression monitoring in IPF, independent of antifibrotic treatment. RDW may be confounded by co-morbidities; further work to assess this is warranted.

Introduction and ObjectivesBTS guidelines suggest radiological follow up at 12 weeks for patients with COVID-19 associated pneumonia. It is suggested development of post-covid fibrotic changes is more prevalent with severity of illness.1 We compared illness severity based on maximal respiratory support with non-resolving changes on CT imaging at >12 weeks. Smoking status at time of admission was also collected.MethodsRetrospective analysis of COVID-19 patients surviving to follow up identified either by CVCX1 coded CXR or CVCX2 coded CXR and positive PCR between March 2020-January 2021. This identified 912 patients reviewed at 12 weeks with CXR ± CT imaging. 50/912 patients (5.5%) had evidence of either established fibrotic change or ongoing pneumonitis on CT. Imaging was reviewed by radiologist using suggested scoring system for Covid-19 follow-up 2 based on sum of 0–5 severity in 5 lobes (total 0–25) for markers of fibrosis/pneumonitis.ResultsComparison is shown in table 1. All patients requiring more than 60% oxygen therapy received advanced respiratory support. 10/50 patients (20%) required no supplementary oxygen and 6/10 were not admitted to hospital. Comparison mean fibrosis score; IPPV-18.6, CPAP/HFNO-9.23, RA- 8.5. There were no current smokers in the follow-up cohort, 24 ex-smokers.Abstract P131 Table 1 Max FiO2/Resp support 21 % ≤ 35 % 40% ≤ 60 % CPAP/HFNO IPPV No. patients 10 8 11 16 5 Age (mean) 62.1 71.6 62.5 62.7 51.6 Mean fibrosis score (0–25) 8.5 7.0 11.6 9.23 18.6 Mean pneumonitis score (0–25) 6.7 9.6 7.5 15.2 22.6 M: F ratio 7:3 3:5 6:5 10:6 4:1 Ex-smokers*% 50 75 64 33 20 Current smokers* 0 0 0 0 0 *smoking status at time of admission was available on 42/50 patientsConclusionsWe noted significant risk for developing post-Covid pneumonic fibrotic changes even in clinically mild cases. With SpO2 at times of peak incidence being main indicator for CXR and/or admission we surmise there may be a significant unrecognized population without an initial CXR to prompt follow-up. It is not clear whether these patients will develop significant symptoms to prompt future investigations and what impact this might have. No patients developing ongoing CT changes were current smokers- a topic we suggest for further study and correlation.ReferencesMcGroder CF, et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax29April 2021. doi:10.1136/thoraxjnl-2021-217031Xiaoyu Han, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology 2021;299:1, E177–E186.

Introduction and ObjectivesHealth inequalities are associated with worse outcomes of COVID-19 illness.1 Health deprivation and disability is one domain within the Index of Multiple Deprivation (IMD). We investigated potential correlation between health deprivation and development of new fibrosis in COVID-19 survivors within a mixed catchment area in NW England in which 35% of neighbourhoods are within the 10% most deprived decile for health and disability.MethodsRetrospective analysis of patients identified between March 2020 and January 2021 with either CVCX1 coded CXR or CVCX2 code with positive PCR test for COVID-19, who survived to follow-up at 3 months. Of 912 patients identified, 46 (5%) had new fibrotic changes on CT. Imaging was reviewed by a radiologist using suggested scoring system for COVID-19 follow-up 2 based on sum of 0–5 severity in 5 lobes (total 0–25) for markers of fibrosis. Deprivation decile was captured from patient postcode.Results42/46 (91%) lived in a neighbourhood within the 50% most deprived for health and disability in England; 20 (43%) within the 10% most deprived. Comparison is shown in table 1.Abstract P134 Table 1 10% most deprived Other Total 20 (43%) 26 (57%) Male sex 65% 54% Average age (years) 62.3 62.6 Maximal Fi02 < 0.6 13 (65%) 9 (35%) ITU admission 4 (20%) 10 (38%) T2DM 6 (30%) 3 (12%) Ex-smoker 13 (65%) 11 (42%) Average score fibrosis 10.06 10.14 ConclusionsWe have shown patients surviving COVID-19 who developed new fibrosis are significantly more likely to live within a deprived postcode. Patients within the 10% most deprived postcodes for health and disability are more likely to be male and ex-smokers. We also noted patients developing fibrotic changes on CT within lowest 10% for deprivation had lower rates of ITU admission and required lower FiO2 (indicating less severe disease) but with equivalent radiological findings to those within less deprived areas. Severe deprivation may in itself increase risk of developing long-term respiratory complications from COVID-19, propagating the ongoing cycle of health and deprivation.ReferencesMarmot M, et al. Build Back Fairer: The COVID-19 Marmot Review. The Pandemic, Socioeconomic and Health Inequalities in England. [Internet] London: Institute of Health Equity; 2020. Available from https://www.health.org.uk/sites/default/files/upload/publications/2020/Build-back-fairer-the-COVID-19-Marmot-review.pdfHan X, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology 2021 Jan 26;299(1):E177–E186.

IntroductionCOVID-19 follow up has become a high priority, with clear evidence that significant proportions of survivors continue to have symptoms at follow up. It has been demonstrated that 56% of those with severe COVID had lung diffusion (DLCO) impairment and more than 50% had radiographic abnormalities at 6 month follow up.1 However there is limited evidence at present how these abnormalities change over time beyond the first assessment.We present CT imaging results for patients discharged after COVID-19 infection, at various time points over the first year after discharge. Pulmonary function tests for this cohort are currently being analysed.Methods387 COVID-19 patients were followed up post discharge. There are 81 baseline CTs available for analysis, and of these 35 had a repeat CT thorax prior to second assessment based on clinical need.All the CT images were independently assessed by a Thoracic Radiologist using BSTI criteria2 and compared to subsequent CTs for the same patient. A higher proportion of those with PCVCT3 had repeat CT imaging as expected due to clinical need.DiscussionOn repeat assessment, all patients had significantly improved respiratory symptom scores (MRC and CAT score). Only 3 of 35 patients had progressive fibrosis on the second scan, all of whom had PCVCT3 on initial imaging. None of those who had PCVCT1 or 2 on initial imaging went on to develop fibrosis and all showed improvement on subsequent imaging.Abstract P132 Table 1Follow up symptoms and radiological findings at first and second assessment post discharge. Analysed by Wilcoxon Rank Sum, median (range) First timepoint Second timepoint P value Clinic assessment (months post discharge) 1.5 (1–3) 9 (6–12) CT scan (months post discharge) 2.5 (1–4) 8 (6–12) MRC score 3 (2–4) 1 (1–3) <0.0001 CAT score 12 (7–18) 6 (4–14) 0.002 Numbers of CT performed 81 35 Numbers of CTs performed for isolated ground glass abnormalities (PCVCT1+2) 47 13 Numbers of CTs performed for fibrosis plus ground glass changes (PCVCT3) 34 22 ConclusionThose patients found to have PCVCT3 changes on initial CT should receive long term follow up as a proportion (approximately 9%) of them may develop progressive fibrotic changes. However this is likely to only represent less than 1% of all COVID-19 patients discharged from hospital. Longer term follow up is needed to determine the ongoing trajectory of these interstitial changes. These patients may potentially benefit from clinical trials in the future for the use of antifibrotics.ReferencesHuang C, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220–32.BSTI. BSTI Post-COVID-19 CT Report Codes. BSTI 22-May-2020.

Introduction and ObjectiveLong COVID or ongoing symptoms post-acute COVID infection can affect up to 20% of patients.1 Dyspnoea can be a cardinal symptom and have a significant impact on patients’ quality of life and ability to function in society. NHS England devised a five-point plan for long COVID which included dedicated post COVID assessment clinics.2 We aimed to review whether duration of symptoms influenced the severity of perceived dyspnoea (using Borg score) and breathlessness (using MRC dyspnoea score).MethodsRetrospective analysis of patients assessed in the Cheshire and Merseyside long COVID assessment hub between 1 February and 30 April 2021. Data was split into three categories based on duration of symptoms: 3–6 months, 6–12 months and over 12 months. The data was analysed using an ANOVA and tukey’s multiple comparison test.Results332 patients were assessed, 7 were excluded from analysis.Of the 325:251 (75.7%) were femaleAge range 17–82 years, mean 47years31 (9.5%) patients received hospital treatment during initial illness305 (94%) patients reported exertional dyspnoeaAbstract P140 Table 1Results comparing mean Borg/MRC scores against length of time post covid infection Time assessed in clinic from acute infection (months) Mean Borg scale (±SD) Mean MRC score (±SD) 3–6 5.2 (2.0) 2.6 (0.8) 6–12 4.7 (1.9) 2.5 (0.9) >12 3.3 (2.2) 2.2 (0.9) ConclusionA significant difference was seen between Borg score in 3–6months and >12 (P<0.01), suggesting that perceived dyspnoea due to long COVID improves with time. No significant difference was found in MRC dyspnoea score between each group. The reason for this remains unclear though improvement in perceived dyspnoea with time may offer reassurance to many long Covid patients. Further research is needed to determine if pulmonary rehabilitation provides a greater reduction in perceived dyspnoea.ReferencesOns.gov.uk. 2021. The prevalence of long COVID symptoms and COVID-19 complications - Office for National Statistics. [online] Available at: [Accessed 22 June 2021]England N, 2021. NHS England » NHS to offer ‘long covid’ sufferers help at specialist centres. [online] England.nhs.uk. Available at: [Accessed 24 June 2021].

In recent years, statistical learning (SL) research has seen a growing interest in tracking individual performance in SL tasks, mainly as a predictor of linguistic abilities. We review studies from this line of research and outline three presuppositions underlying the experimental approach they employ: (i) that SL is a unified theoretical construct; (ii) that current SL tasks are interchangeable, and equally valid for assessing SL ability; and (iii) that performance in the standard forced-choice test in the task is a good proxy of SL ability. We argue that these three critical presuppositions are subject to a number of theoretical and empirical issues. First, SL shows patterns of modality- and informational-specificity, suggesting that SL cannot be treated as a unified construct. Second, different SL tasks may tap into separate sub-components of SL that are not necessarily interchangeable. Third, the commonly used forced-choice tests in most SL tasks are subject to inherent limitations and confounds. As a first step, we offer a methodological approach that explicitly spells out a potential set of different SL dimensions, allowing for better transparency in choosing a specific SL task as a predictor of a given linguistic outcome. We then offer possible methodological solutions for better tracking and measuring SL ability. Taken together, these discussions provide a novel theoretical and methodological approach for assessing individual differences in SL, with clear testable predictions. This article is part of the themed issue ‘New frontiers for statistical learning in the cognitive sciences’.