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RVF is very active and sensitive to climate and other environmental as well as socioeconomic changes, such as occurred with the Nasser Dam in the 1970s

However, in acute intensive care unit (ICU) settings, where patients require mechanical respiratory support, a multitude of factors including infection, accumulation of inflammatory cells, airway dehydration, reduced cough reflexes, supra-normal oxygenation, and mechanical stress from ventilation can lead to changes in mucus characteristics and increased mechanical impedance to mucociliary clearance

Flemming and Wingender, 2010

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The best available procedure to confirm non-celiac gluten sensitivity is a double-blind, placebo-controlled gluten challenge that demonstrates that gluten-related symptoms are relieved by a gluten-free diet (Volta 2013