Performance of the cobas EBV and cobas BKV assays: multi-site comparison of standardized quantitation.

Guidelines recommend monitoring of Epstein-Barr virus (EBV) and BK virus (BKV) in solid organ and hematopoietic stem cell transplant patients. The majority of quantitative DNA testing for EBV and BKV employs unstandardized individual laboratory-developed testing solutions (LDTs), with implications for accuracy, reproducibility, and comparability between laboratories. The performance of the cobas EBV and cobas BKV assays was assessed across five laboratories, using the World Health Organization International Standards (WHO IS) for EBV and BKV, and the National Institute of Standards and Technology Quantitative Standard for BKV, and results were compared with the LDTs in use at the time. Methods were also compared using locally sourced clinical specimens. Variation was high when laboratories reported EBV or BKV DNA values using LDTs, where quantitative values were observed to differ by up to 1.5 log10 unit/mL between sites. Conversely, results from the cobas EBV and cobas BKV assays were accurate and reproducible across sites and on different testing days. Adjustment of LDTs using the international standards led to closer alignment between the assays; however, day-to-day reproducibility of LDTs remained high. In addition, BKV continued to show bias, indicating challenges with the commutability of the BKV International Standard. The cobas EBV and cobas BKV assays are automated, aligned to the WHO IS, and have the potential to reduce the variability in viral load testing introduced by differences in LDTs. Standardization of reporting values may eventually allow different centers to compare data to allow clinical decision thresholds to be established supporting improvements in patient management.IMPORTANCEThe application of center-specific cut-offs for clinical decisions and the variability of LDTs often hinder interpretation; thus, the findings reported here support the need for standardization in the field of post-transplant monitoring of EBV and BKV to improve patient management. Alongside the choice of assay, it is also important to consider which standard to use when deciding upon a testing methodology. This is a call to action for standardization, as treatment for EBV and BKV is driven by viral load test results, and the more accurate and comparable the test results are across institutions, the more informed and better the treatment decisions can be.

COVID-19 Vaccination Before Initiating Rituximab Treatment Induces Strong Serological Response in Autoimmune Rheumatic Disease, Reducing Post-Pandemic Concerns About the Impact of Rituximab.

OBJECTIVE: Rituximab (RTX)-treated patients exhibit suboptimal responses to COVID-19 vaccines. However, existing research primarily involves patients already receiving RTX when vaccines were introduced, failing to account for the current landscape where patients are vaccinated before initiating RTX. Our objective was to compare the serological response to COVID-19 vaccines in patients vaccinated before or after RTX initiation. METHODS: We included 254 RTX-treated patients with autoimmune inflammatory rheumatic diseases (AIIRDs) and 113 blood donors (BDs) in a retrospective, observational cohort study. Patients were categorized based on the timing of RTX treatment relative to primary COVID-19 vaccination. Serological vaccine responses were assessed using three immunoassays, and logistic regression analysis was used to identify predictors of serological response. RESULTS: Patients vaccinated before initiating RTX treatment had significantly higher seroconversion rates of SARS-CoV-2 immunoglobulin G (87%) and neutralizing antibodies (91%) compared with those receiving RTX before and after vaccination (n = 132) (61% and 65%, respectively). In the logistic regression analysis, a positive serological response was associated with the number of vaccines administered >9 months after the last RTX treatment. Patients receiving the highest number of vaccines with >9 months after RTX showed a response comparable to that of the BDs. CONCLUSION: Vaccinating before RTX initiation yields a robust serological response in patients with AIIRDs. Furthermore, we highlight the reversibility of antibody impairment after RTX treatment cessation, provided that adequate vaccinations occur within a minimum of 9 months after RTX. Our findings offer essential insights for clinical decision-making regarding COVID-19 vaccination and RTX treatment, alleviating concerns about future RTX use.

Consumers' willingness to buy meat and seafood products close to the expiry date: an exploratory study from Denmark.

Introduction: Meat- and seafood products close to their expiry date (MSPCED) are one of the significant contributors to the growing food waste. Therefore, this study aims to investigate consumers' attitudes and willingness to buy MSPCED. Methods: An online questionnaire was used to collect data from 400 Danish consumers. Results and discussion: Three consumer segments were identified based on their willingness to buy MSPCED: 39.8% of the participants showed a high willingness to buy MSPCED close to their expiry date ("All High"), 34.5% were selective with a high willingness to buy meat close to their expiry date but not seafood ("High meat, low seafood"), while 25.7% showed a low willingness to buy MSPCED ("All Low"). Consumers' willingness to buy MSPCED is influenced by the perceived quality of the products, food safety, social acceptability, and price. Consumers were willing to pay a higher price for minced beef close to the expiry date when compared to cod fillets, pork cuts, and chicken breasts. However, consumers were willing to buy cod fillets with the lowest discount percentage when compared to pork cuts, minced beef, and chicken breast. The findings suggest that price reduction and discount percentage can have varying effects in influencing willingness to pay for MSPCED. This study provides valuable insights, for food waste practitioners in the retail sector, to develop effective strategies for reducing food waste by influencing consumer willingness to buy and pay for perishable products like meat and seafood.

Gonorrhoea on the rise in Denmark since 2022: distinct clones drive increase in heterosexual individuals.

A surge in gonorrhoea in Denmark has occurred since 2022, a 46% increase from 2021. National surveillance, leveraging mandatory reporting and epidemiological data, highlights three distinct clades linked to heterosexual transmission. Despite the rise, these exhibit high susceptibility, contrasting MSM-associated strains. Geographical hotspots and age-specific patterns further illuminate transmission dynamics. The combination of genomic and epidemiological data provides novel insights into the evolving landscape of gonorrhoea, indicating potential shifts in infection dynamics and transmissibility.

Revaccination of patients with systemic lupus erythematosus or rheumatoid arthritis without an initial COVID-19 vaccine response elicits seroconversion in half of the patients.

OBJECTIVES: To investigate the effect of COVID-19 mRNA revaccination (two doses) on the antibody response in patients with rheumatic diseases (RD) who were initial vaccine non-responders. Further, to examine if B-cell levels or T-cell responses before revaccination predicted seroconversion. METHODS: From a RD cohort vaccinated with the standard two-dose COVID-19 vaccinations, we enrolled cases without detectable antibody responses (n=17) and controls with detectable antibody response (n=29). Blood donors (n=32) were included as additional controls. Samples were collected before and six weeks after completed revaccination. Total antibodies and specific IgG, IgA, and IgM against SARS-CoV-2 spike protein, SARS-CoV-2 neutralising antibodies, and SARS-CoV-2 reacting CD4+ and CD8+ T-cells were measured before and after revaccination. B-cells (CD19+CD45+) were quantified before revaccination. RESULTS: Forty-seven percent of cases had detectable neutralising antibodies after revaccination. However, antibody levels were significantly lower than in controls and blood donors. Revaccination induced an antibody class switch in cases with a decrease in IgM and increase in IgG. No significant difference was observed in T-cell responses before and after revaccination between the three groups. Only 29% of cases had measurable B-cells compared to 100% of controls and blood donors. Fifty percent of revaccinated cases who seroconverted had measurable B-cells before revaccination. CONCLUSIONS: Forty-seven percent of initial non-responders seroconverted after two-dose revaccination but still had lower levels of SARS-CoV-2 antibodies compared with controls and blood donors. RD patients without a detectable serological response after the initial COVID-19 mRNA vaccine had a T-cell response similar to immunocompetent controls and blood donors.

Nudging Toward Sustainable Food Consumption at University Canteens: A Systematic Review and Meta-Analysis.

INTRODUCTION: This systematic literature review and meta-analysis investigated the effectiveness of the nudging approach toward sustainable food consumption in the university canteen context. METHODS: The systematic literature search was carried out in 5 databases, Web of Science, PubMed, Scopus, ProQuest, and the Royal Library, identifying 14 eligible studies and selecting 9 articles containing adequate information for meta-analysis. The nudging strategies were classified using the typology of interventions in the proximal physical microenvironments framework that resulted in 5 different intervention types: availability, position, size, presentation, and information that belonged to either intervention class-altering properties or placement. RESULTS: The study identified presentation, availability, and information as the most promising nudge intervention for achieving sustainable food consumption at the university canteen or similar settings. Nudging by altering the properties had a small effect size (d = 0.16), and nudging by altering placement showed a medium effect size (d = 0.21). DISCUSSION: Nudging interventions implemented after understanding consumers' current behavior showed positive effectiveness toward sustainable food consumption rather than implementing random nudges. CONCLUSIONS AND IMPLICATIONS: It is important that future studies aim to achieve sustainable food consumption by understanding canteen user food preferences and food choice motives before designing a nudging strategy.

Potential Energy and Environmental Footprint Savings from Reducing Food Loss and Waste in Europe: A Scenario-Based Multiregional Input-Output Analysis.

Food loss and waste (FLW) contribute significantly to the global food system's economic and environmental burdens, including substantial greenhouse gas (GHG) emissions, resource depletion, and waste management challenges. In alignment with the European Commission's sustainability objectives and U.N. Sustainable Development Goal 12.3, this study explores the potential energy and environmental footprint savings achievable by halving FLW in Europe by 2030. Using a multiregional input-output model, we estimated the total global energy and environmental footprint savings across all stages of the food supply chain, considering industry-specific FLW rates and proportion weights. The findings reveal substantial environmental savings across Europe, with aggregate savings potentially reaching 51 Mt CO2e (0.09 t CO2e/p), 4,620 Mm3 (8 m3/p) of blue water, 106,446 km2 (179 m2/p) of cropland, 55,523 km2 (93 m2/p) of grassland, and 0.47 EJ (0.54 TJ/p) of energy. The greatest potential for savings was found in Western Europe, specifically in France, Germany, Belgium, and The Netherlands. However, countries with a lower per capita GDP, such as Greece, Croatia, Bulgaria, and Romania, also demonstrate significant per capita savings potential, indicating that wealth does not necessarily correlate with higher environmental savings. Agricultural production emerged as the stage with the highest footprint reduction potential for GHG and resource footprints across Europe, while the foodservice and institutional stages offer the greatest energy-saving potential. Geographical disparities underscore the need for region-specific policies. These results challenge the wealth-sustainability correlation and advocate for adaptable policies that transcend national wealth and accommodate regional disparities, underlining the pivotal roles of the agricultural production and consumption stages in footprint savings.

A prospective evaluation of the diagnostic potential of EBV-DNA in plasma and whole blood.

BACKGROUND: Quantitative polymerase chain reaction (qPCR) for Epstein-Barr virus (EBV)-DNA is an important diagnostic tool for EBV-associated disease, but interpretation of its clinical significance is challenging. OBJECTIVES: We assessed the diagnostic and clinical performance of WHO-standardised qPCR for EBV-DNA (WHO EBV-qPCR) in plasma and whole blood (WB) for proven EBV disease in a prospectively accrued patient cohort. STUDY DESIGN: Central Denmark Region patients, tested with WHO EBV-qPCR from November 2017 to March 2019, were screened for EBV disease. Incidence (IR) was estimated by Poisson regression. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for EBV-qPCR in plasma and WB. Risk of diagnostic latency was compared between patients with EBV-positive and EBV-negative lymphomas. RESULTS: EBV disease was diagnosed in 95 of 1484 participants (IR: 16.3 per 1000 patientyears 95%CI; 13.3-19.9). Sensitivity and specificity of WHO EBV-qPCR in plasma was 82.4% (95% CI; 74.2-90.7%) and 87.8% (95% CI; 85.6-90%), yielding a PPV of 32.2% (95% CI; 24.9-39.5%) and NPV of 98.6% (95% CI; 97.7-99.5%) for proven EBV disease. Sensitivity and NPV were comparable in WB, while specificity and PPV decreased to 66.9% (95% CI; 60.6-73.1%) and 18.1% (95% CI; 7.5-28.7%). Risk of diagnostic latency was 2.3-fold (95% CI 1.4-4.1) higher for patients with EBV-positive compared with EBV-negative lymphomas. CONCLUSIONS: WHO EBV-qPCR in plasma and WB have a low PPV but a high NPV for proven EBV disease. Implementation of WHO EBV-qPCR could improve interpretation and facilitate EBV-positive lymphoma diagnosis.

Sampling from upper and/or lower respiratory tract when diagnosing coronavirus disease 2019 (COVID-19) - results from a Danish cohort study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can replicate in the upper and lower respiratory tract. We aimed to evaluate whether symptom characteristics and symptom duration prior to sampling are associated with test positivity in upper or lower respiratory tract samples. METHODS: We conducted a retrospective cohort study in the Central Denmark Region from 14 April 2020 to 2 November 2020 including hospitalised patients with SARS-CoV-2 reverse transcriptase-polymerase chain reaction samples from both the upper and lower respiratory tract within 48 h and at least one positive test result. RESULTS: Of 122 patients, 101 were positive in both samples (83%), 7 (5%) were positive only in the upper respiratory tract sample, and 14 (11%) were only positive in the lower respiratory tract sample. The median number of symptoms was 4 (IQR 3, 5.75) and 5 (IQR 3, 7), respectively, in patients with only a positive upper respiratory tract sample and in concordant positive patients; while 1 (IQR 1, 3) in patients with only a positive upper respiratory tract sample. 98% (120/122) of patients would have been diagnosed with coronavirus disease 2019 if supplemental sampling from the lower respiratory tract was guided by lower respiratory tract symptoms. No substantial difference in the duration of symptoms was observed across the three patient groups. CONCLUSIONS: The presence of lower respiratory tract symptoms could have been used to determine whether supplemental sampling from the lower respiratory tract was necessary. Symptom duration was not associated with test positivity in the upper or lower respiratory tract.

Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study.

OBJECTIVE: To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections. DESIGN: A nationwide population-based cohort study. SETTING: All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019. PATIENTS: Neonates aged 0-28 days with HSV infection. MAIN OUTCOME MEASURES: The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI. RESULTS: Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0-3, 4-7 and 8-14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively. CONCLUSIONS: The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.

Who Buys Surplus Meals? An Exploratory Survey in Danish Canteens.

Food waste has received increasing attention over the last decade, owing to its economic, environmental, and social impacts. Much of the existing research has investigated consumers' buying behaviour towards sub-optimal and upcycle food, but surplus meal buying behaviours are poorly understood. Thus, this study performed consumer segmentation through a modular food-related lifestyle (MFRL) instrument and determined consumers' buying behaviour towards surplus meals in canteens employing the theory of reasoned action (TRA). A survey was conducted using a validated questionnaire from a convenient sample of 460 Danish canteen users. Four food-related lifestyle consumer segments were identified by employing k-means segmentation: Conservative (28%), Adventurous (15%), Uninvolved (12%), and Eco-moderate (45%). The Partial Least Square Structural Equation Modelling (PLS-SEM) analysis indicated that attitudes and subjective norms were significantly influencing surplus meal buying intention to further influence buying behaviour. Environmental objective knowledge was significantly influencing environmental concerns to further influence attitudes and behavioural intention. However, environmental objective knowledge had no significant influence on attitude towards surplus meals. Male consumers with higher education, those having higher food responsibility and lower food involvement, and convenience scores had higher surplus food buying behaviour. The results can be used to inform policymakers, marketers, business professionals, and practitioners to promote surplus meals in canteens or similar settings.

Rituximab-treated rheumatic patients: B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders.

OBJECTIVES: To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 weeks apart) on the antibody response to the COVID-19 mRNA vaccines in patients with rheumatic disease (RD) treated with rituximab (RTX) who had not produced vaccine-reactive antibodies after the initial two vaccine doses. Further, to examine if B cell levels in peripheral blood predicted seroconversion. METHODS: We included 91 RTX-treated RD patients previously vaccinated against COVID-19. Patients were offered revaccination or a single booster vaccination with an mRNA vaccine. Serum total antibodies against SARS-CoV-2 spike protein were measured before and 6 weeks after the last vaccine dose. B cells (CD19+CD45+) were measured by flow cytometry at inclusion. RESULTS: Of RD patients with undetectable SARS-CoV-2 antibody levels before inclusion, seroconversion was seen in 38% 6 weeks after the booster dose and 32% after revaccination. Patients receiving revaccination had significantly higher antibody levels than patients receiving a booster dose (P < 0.001). In both univariate and multivariate logistic regression analysis, only B cells higher than 10/µl before boost or revaccination were associated with seroconversion (P = 0.009 and P = 0.01, respectively). Seroconversion was independent of age, gender, diagnosis, cumulative RTX dose, RTX treatment time and time since last RTX treatment. CONCLUSION: Continuously impaired humoral response to mRNA vaccines was found in most RTX-treated patients after a booster dose or revaccination. Seroconversion was observed in approximately one-third of the patients. Measurable B cells before boosting or revaccination was the strongest predictor of antibody response after boost or revaccination.

SARS-CoV-2 Infection Rates Following Use of Regular Compared With Defective Respirators When Caring for COVID-19 Patients: A Retrospective Follow-up Study.

BACKGROUND: There is strong observational evidence that respirators are highly effective in protecting the users from being infected with Middle East respiratory syndrome and severe acute respiratory syndrome coronavirus (SARS-CoV), but the evidence for SARS-CoV-2 during daily work is limited. This study utilized a subset of healthcare workers' temporary use of a new brand respirator with frequent defects when caring for coronavirus disease 2019 (COVID-19) patients to assess the protective effect of regular respirators against SARS-CoV-2 infection. METHODS: We retrospectively followed 463 participants wearing a regular respirator and 168 wearing the new brand respirator day-by-day when caring for COVID-19 patients until testing polymerase chain reaction positive for SARS-CoV-2 between 27th December 2020 and 14th January 2021. RESULTS: We observed seven and eight incident SARS-CoV-2-infected cases. This corresponded with daily infection rates of 0.2 and 0.5%, an incidence rate ratio of 0.4 [95% confidence interval (CI) 0.1; 1.0], and an incidence rate difference of 0.3% (95% CI -0.1; 0.8) when comparing a regular with the new brand respirator. DISCUSSION: We regard the new brand respirator a sham intervention, and this study thus provides further evidence for the protective effect of respirators when exposed to SARS-CoV-2 virus.

COVID-19 vaccination in patients with rheumatic diseases leads to a high seroconversion rate and reduced self-imposed isolation and shielding behaviour.

OBJECTIVES: We investigated the effect of a two-dose messenger ribonucleic acid (mRNA) vaccine on antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and patient behaviour and shielding concerning fear of coronavirus disease 2019 (COVID-19) in patients with systemic lupus erythematosus or rheumatoid arthritis. METHODS: Three hundred and three patients and 44 blood donors were included. All patients received two doses of an mRNA vaccine and had total antibodies against SARS-CoV-2 measured before vaccination and 2 and 9 weeks after the second vaccination. Further, patients answered an electronic questionnaire before and after vaccination concerning behaviour, anxiety, and symptoms of depression (Patient Health Questionnaire-9). RESULTS: Significantly fewer patients (90%) had measurable antibodies against SARS-CoV-2 compared to blood donors (100%) after the second vaccination (P < .001). Treatment with rituximab was the strongest predictor of an unfavourable vaccine response, as only 27% had measurable antibodies. Nearly all patients (97%) not treated with rituximab experienced seroconversion. Prednisone and methotrexate had a negative effect on seroconversion, but no effect of age or comorbidity was observed. Patients experienced significant improvement after vaccination in 10 out of 12 questions regarding behaviour and fear of COVID-19, while no change in Patient Health Questionnaire-9 or anxiety was observed. CONCLUSION: We find a very high seroconversion rate among rheumatic patients and reduced self-imposed isolation and shielding after COVID-19 vaccination.

Risk of hospitalisation associated with infection with SARS-CoV-2 omicron variant versus delta variant in Denmark: an observational cohort study.

BACKGROUND: Estimates of the severity of the SARS-CoV-2 omicron variant (B.1.1.529) are crucial to assess the public health impact associated with its rapid global dissemination. We estimated the risk of SARS-CoV-2-related hospitalisations after infection with omicron compared with the delta variant (B.1.617.2) in Denmark, a country with high mRNA vaccination coverage and extensive free-of-charge PCR testing capacity. METHODS: In this observational cohort study, we included all RT-PCR-confirmed cases of SARS-CoV-2 infection in Denmark, with samples taken between Nov 21 (date of first omicron-positive sample) and Dec 19, 2021. Individuals were identified in the national COVID-19 surveillance system database, which included results of a variant-specific RT-PCR that detected omicron cases, and data on SARS-CoV-2-related hospitalisations (primary outcome of the study). We calculated the risk ratio (RR) of hospitalisation after infection with omicron compared with delta, overall and stratified by vaccination status, in a Poisson regression model with robust SEs, adjusted a priori for reinfection status, sex, age, region, comorbidities, and time period. FINDINGS: Between Nov 21 and Dec 19, 2021, among the 188 980 individuals with SARS-CoV-2 infection, 38 669 (20·5%) had the omicron variant. SARS-CoV-2-related hospitalisations and omicron cases increased during the study period. Overall, 124 313 (65·8%) of 188 980 individuals were vaccinated, and vaccination was associated with a lower risk of hospitalisation (adjusted RR 0·24, 95% CI 0·22-0·26) compared with cases with no doses or only one dose of vaccine. Compared with delta infection, omicron infection was associated with an adjusted RR of hospitalisation of 0·64 (95% CI 0·56-0·75; 222 [0·6%] of 38 669 omicron cases admitted to hospital vs 2213 [1·5%] of 150 311 delta cases). For a similar comparison by vaccination status, the RR of hospitalisation was 0·57 (0·44-0·75) among cases with no or only one dose of vaccine, 0·71 (0·60-0·86) among those who received two doses, and 0·50 (0·32-0·76) among those who received three doses. INTERPRETATION: We found a significantly lower risk of hospitalisation with omicron infection compared with delta infection among both vaccinated and unvaccinated individuals, suggesting an inherent reduced severity of omicron. Our results could guide modelling of the effect of the ongoing global omicron wave and thus health-care system preparedness. FUNDING: None.

Time Since Rituximab Treatment Is Essential for Developing a Humoral Response to COVID-19 mRNA Vaccines in Patients With Rheumatic Diseases.

OBJECTIVE: We aimed to investigate (1) whether patients with rheumatic disease (RD) treated with rituximab (RTX) raise a serological response toward the coronavirus disease 2019 (COVID-19) mRNA vaccines, and (2) to elucidate the influence of time since the last RTX dose before vaccination on this response. METHODS: We identified and included 201 patients with RDs followed at the outpatient clinic at the Department of Rheumatology, Aarhus University Hospital, who had been treated with RTX in the period 2017-2021 and who had completed their 2-dose vaccination series with a COVID-19 mRNA vaccine. Total antibodies against the SARS-CoV-2 spike protein were measured on all patients and 44 blood donors as reference. RESULTS: We observed a time-dependent increase in antibody response as the interval from the last RTX treatment to vaccination increased. Only 17.3% of patients developed a detectable antibody response after receiving their vaccination ≤ 6 months after their previous RTX treatment. Positive antibody response increased to 66.7% in patients who had RTX 9-12 months before vaccination. All blood donors (100%) had detectable antibodies after vaccination. CONCLUSION: Patients with RDs treated with RTX have a severely impaired serological response toward COVID-19 mRNA vaccines. Our data suggest that the current recommendations of a 6-month interval between RTX treatment and vaccination should be reevaluated.

A Comparison of Pharyngeal Swabs and Tracheal Secretions for the Diagnosing of COVID-19.

The aim of this study was to compare the test results from patients who, within a short timescale, have been tested for COVID-19 using both a pharyngeal swab and tracheal secretion. Data were collected from the database of AUH, from patients hospitalized between 1 March 2020 and 1 March 2021 who, due to symptoms of COVID-19, were tested by a pharyngeal swab and by tracheal secretion. We found great agreement between oropharyngeal swab and tracheal secretion RT-PCR testing for the diagnosis of COVID-19, with 98.5% of double tests being concordant and only 1.5% being discordant. This finding may advocate a single-test strategy being either an oropharyngeal swab RT-PCR testing or tracheal secretion, although this study revealed 15.9% false negative oropharyngeal swabs.

Life cycle assessment of digestate post-treatment and utilization.

Three digestate utilization scenarios for bio-fertilizer production are evaluated with life cycle assessment. The aim is to determine the environmental performance of the digestate post-treatment with the goal to decrease the loss of nitrogen and phosphorus, support circular nutrient management, and increase the substitution of mineral fertilizers. The functional unit (FU) of the study is the utilization of 1 kg dry matter raw digestate, in three scenario designs. Scenario 1 (S1) describes a system where the raw digestate is directly spread on soil. In scenario 2 (S2) the raw digestate is processed by centrifugation with two recovered phases (liquid and solid digestate), which are spread on agricultural soil. In scenario 3 (S3) a more advanced post-treatment system is modelled, where the raw digestate is phase separated with centrifugation followed by drying of the solid digestate and further processing of the liquid digestate with a membrane filtration and a reverse osmosis unit. The studied scenarios show a global warming potential ranging from -0.14 (S3) to -0.36 (S1) kg CO2 eq per FU. The fossil resource depletion per FU was decreased in scenario 1 (-0.053 kg oil eq) and scenario 2 (-0.049 kg oil eq) but increased in scenario 3 (0.002 kg oil eq). The terrestrial acidification potential ranges from 0.09 (S3) to 0.18 (S1) kg SO2 per FU. The digestate post-treatment is a sustainable solution able to tackle the problem of excess nutrients and their management in agricultural areas. It could replace conventional nitrogen removal processes (aerobic biological treatment) by a valorization chain keeping the nutrients in closed loop.

Circular bioeconomy: Life cycle assessment of scaled-up cascading production from orange peel waste under current and future electricity mixes.

Orange peel waste (OPW) is present in large quantities both locally and globally, which makes them feasible input into the circular bioeconomy. However, due to their antimicrobial and anti-nutritional activity, they are problematic biomass, and proper waste management is yet to be determined. This life cycle assessment (LCA) quantifies the environmental performance of biorefinery producing limonene, citric acid, and animal feed from OPW generated from juice factories. Only previously assessed sustainable technologies were considered (cold press, microwave extraction, solid-state fermentation). The life cycle inventories were refined by a scale-up procedure to reflect industrial production at i) 0.5 t, ii) 100 t, and iii) 1000 t of OPW weekly. The data were translated per functional unit of 1 tonne OPW. Three electricity mixes and both attributional (average) and consequential (marginal) inventories were compared. Results showed that the environmental performance, in particular for climate change, was essentially dependent upon the electricity input, with 4388 CO2 eq for current electricity mix, 2404 CO2 eq using renewable, and 594 CO2 eq using electricity from wind. Business-as-usual scenarios for OPW (incineration and animal feed) showed better performance in most scenarios, representing -150 CO2 eq (animal feed) and -135 CO2 eq (incineration) in the climate change. Lower impacts are reached due to avoided impacts of fossil fuel use and conventional feed cultivation. Renewable energy had better environmental performance than the current electricity mix, except for eutrophication, due to digestate spreading associated with biogas use, calling for mitigation action. Our results suggest that stopping the biorefinery processes immediately after the recovery of limonene via solvent-free microwave extraction process, with subsequent use of the dried OPW as animal feed, is the most environmentally performant option. This represents a feasible strategy for the circular bioeconomy and is in line with the updated food waste hierarchy.

Advances in microalgal research for valorization of industrial wastewater.

This review article focuses on recent updates on remediation of industrial wastewater (IWW) through microalgae cultivation. These include how adding additional supplements of nutrient to some specific IWWs lacking adequate nutrients improving the microalgae growth and remediation simultaneously. Various pretreatments strategy recently employed for IWWs treatment other than dealing with microalgae was discussed. Various nutrient-rich IWW could be utilized directly with additional dilution, supplement of nutrients and without any pretreatment. Recent advances in various approaches and new tools used for cultivation of microalgae on IWW such as two-step cultivation, pre-acclimatization, novel microalgal-bioelectrical systems, integrated catalytic intense pulse-light process, sequencing batch reactor, use of old stabilized algal-bacterial consortium, immobilized microalgae cells, microalgal bacterial membrane photobioreactor, low-intensity magnetic field, BIO_ALGAE simulation tool, etc. are discussed. In addition, biorefinery of microalgal biomass grown on IWW and its end-use applications are reviewed.