Emerging Aquatic Contaminants: One Health Framework for Risk Assessment and Remediation in the Post COVID-19 Anthropocene

Emerging Aquatic Contaminants: One Health Framework for Risk Assessment and Remediation in the Post COVID-19 Anthropocene highlights various sources and pathways of emerging contamination, including their distribution, occurrence, and fate in the aquatic environment. The book provides detailed insight into emerging contaminants' mass flow and behavior in various spheres of the subsurface environment. Possible treatment strategies, including bioremediation and natural attenuation, are discussed. Ecotoxicity, relative environmental risk, human health risk, and current policies, guidelines, and regulations on emerging contaminants are analyzed. This book serves as a pillar for future studies, with the aim of bio-physical remediation and natural attenuation of biotic and abiotic pollution. © 2023 Elsevier Inc. All rights reserved.

Caring for the Seriously Ill and Dying in Inpatient Care

The initial situation of dying persons is described along the current ratio of places of death. A register of places of death is missing in Germany. It becomes clear that until today approx. 80% of all German citizens die in an inpatient setting. According to various experts, the Covid-19 pandemic has led to a loss of established quality of care. The outstanding importance of a valid patient living will for the terminal phase of life becomes apparent. In a project, the existing situation that 20-25% of dying nursing home residents are transferred to a hospital was chosen as the starting point to develop suitable solutions. Even within hospitals there are transfers of dying patients without, from the point of view of medicine, care and/or psycho-social aspects, indication. Both kinds of transfer affect approx. 150,000 patients and residents each year. 13 causal factors, some of which influence each other, were identified empirically and by factor analysis. Under the supervision of the Marburg Institute of the Association of the Scientific Medical Societies (AWMF), two structured consensus-based guidelines were developed and implemented in a nursing facility and a hospital. These were supplemented by decision-making aids, guidelines and management tools that supported the implementation. As a result, it could be demonstrated that there was not only a reduction in transfers but also an increase in labor satisfaction. The project members see the possibility of transferring the guidelines nationwide. The given project management, the adaptability of the instruments developed to regional conditions, the intersectoral, collaborative and communal approach make this possible. Copyright © 2022 MVS Medizinverlage Stuttgart. All rights reserved.

Intact Sense of Taste and Smell during COVID-19 Infection Is Associated with Absence of of SARS-CoV-2 Spike Protein Antibody Responses within 3 Months of Symptomatic Illness

Background. Although studies show most COVID-19 survivors have post-infection immunity against SARS-CoV-2 that could prevent re-infection, there is still a need to identify the breadth of antibody (Ab) responses associated with clinical phenotypes. We characterized Ab profiles at the estimated peak of Ab diversity among adults with recovered SARS-CoV-2 infections and determined their relationships with clinical factors. Methods. From April-June 2020, 41 health system employees with PCRconfirmed symptomatic COVID-19 infection enrolled 8-10 weeks after symptom onset. Symptom questionnaires including baseline demographics, COVID-19 symptoms, disease severity, and disease duration were collected and plasma samples were assayed using a custom Luminex Multiplex platform (Figure 1) to measure the antibody response against 20 COVID-19 related antigens (Figure 2). Differences in Ab profile titers among different groups were tested using nonparametric t test and Benjamini-Hochberg adjustment for multiplicity. Associations were considered significant at FDR< 0.05. Figure 1: Description of the Luminex Serology Assay Figure 2: List of the COVID-19 Related Antigens and Controls Measured Results. Mean age was 48 years (range 27-68), with 51% female, 37% White, 32% Black, 29% Asian, and 17% LatinX. Ab profiles (Figure 3) showed 100% cross-reactivity with related alpha and beta coronavirus, and 95% with SARS-CoV-1. 78% had Abs against SARS-CoV-2 nucleocapsid protein (NCP). However, 29% of patients had no immune response against the four spike protein epitopes. These participants also reported fewer symptoms, including no cases of anosmia/ageusia, suggesting mild illness. Anosmia/ageusia, fever, and cough associated significantly with higher Ab titers (Figure 4). Conclusion. Broad immune responses to various SARS-CoV-2 and related antigens were found among a heterogeneous patient population. However, less than 3 months after symptom onset, protective Ab responses to SARS-CoV-2 spike proteins were not detected in nearly one-third of recovered patients, primarily with mild infection. Intact sense of smell and taste demonstrated the greatest association with loss of seroprotective SARS-CoV-2 Ab responses, which may be clinically useful to predict post-infection immunity. Next steps include comparing the magnitude of Ab responses following full series completion with mRNA vaccination among this cohort.

Willingness to be vaccinated with a COVID‑19 vaccine—risk assessment, vaccination experiences and towards treatment procedures

Background: Globally, vaccination is an important preventive measure. A pronounced willingness to vaccinate is fundamental for the containment of the Coronavirus pandemic by means of vaccination coverage of society. Objectives: The willingness to be vaccinated with a COVID‑19 (coronavirus vaccine) vaccine and its influencing factors are investigated using a random sample of the total population in Germany. Materials and methods: The study is based on a random telephone sample and considers older and previously ill persons according to their proportion in population. The single-topic study on willingness to be vaccinated (n = 2014) was conducted in November/December 2020. Results: The willingness to be vaccinated in the sample is around 67%. Previous experience with vaccinations moderates the willingness to vaccinate. It increases with membership to a risk population. Belief in the efficacy of alternative healing methods and advocacy of alternative treatment procedures are associated with lower willingness to be vaccinated. Older people are more willing to be vaccinated, covarying with their assessment of higher risk in case of illness. Similarly, rejection of vaccination is associated with overestimation of side effects. Conclusions: Willingness to vaccinate is related to vaccination experiences and attitudes towards health care procedures in general. The overestimation of the frequency of serious side effects with vaccinations indicates widespread misinformation. © 2021, The Author(s).

Exposome and Immunity Training: How Pathogen Exposure Order Influences Innate Immune Cell Lineage Commitment and Function.

Immune memory is a defining characteristic of adaptive immunity, but recent work has shown that the activation of innate immunity can also improve responsiveness in subsequent exposures. This has been coined "trained immunity" and diverges with the perception that the innate immune system is primitive, non-specific, and reacts to novel and recurrent antigen exposures similarly. The "exposome" is the cumulative exposures (diet, exercise, environmental exposure, vaccination, genetics, etc.) an individual has experienced and provides a mechanism for the establishment of immune training or immunotolerance. It is becoming increasingly clear that trained immunity constitutes a delicate balance between the dose, duration, and order of exposures. Upon innate stimuli, trained immunity or tolerance is shaped by epigenetic and metabolic changes that alter hematopoietic stem cell lineage commitment and responses to infection. Due to the immunomodulatory role of the exposome, understanding innate immune training is critical for understanding why some individuals exhibit protective phenotypes while closely related individuals may experience immunotolerant effects (e.g., the order of exposure can result in completely divergent immune responses). Research on the exposome and trained immunity may be leveraged to identify key factors for improving vaccination development, altering inflammatory disease development, and introducing potential new prophylactic treatments, especially for diseases such as COVID-19, which is currently a major health issue for the world. Furthermore, continued exposome research may prevent many deleterious effects caused by immunotolerance that frequently result in host morbidity or mortality.