Chaoborus spp. Transport CH4 from the Sediments to the Surface Waters of a Eutrophic Reservoir, But Their Contribution to Water Column CH4 Concentrations and Diffusive Efflux Is Minor.

Chaoborus spp. (midge larvae) live in the anoxic sediments and hypolimnia of freshwater lakes and reservoirs during the day and migrate to the surface waters at night to feed on plankton. It has recently been proposed that Chaoborus take up methane (CH4) from the sediments in their tracheal gas sacs, use this acquired buoyancy to ascend into the surface waters, and then release the CH4, thereby serving as a CH4 "pump" to the atmosphere. We tested this hypothesis using diel surveys and seasonal monitoring, as well as incubations of Chaoborus to measure CH4 transport in their gas sacs at different depths and times in a eutrophic reservoir. We found that Chaoborus transported CH4 from the hypolimnion to the lower epilimnion at dusk, but the overall rate of CH4 transport was minor, and incubations revealed substantial variability in CH4 transport over space and time. We calculated that Chaoborus transport ∼0.1 mmol CH4 m-2 yr-1 to the epilimnion in our study reservoir, a very low proportion (<1%) of total CH4 diffusive flux during the summer stratified period. Our data further indicate that CH4 transport by Chaoborus is sensitive to water column mixing, Chaoborus density, and Chaoborus species identity.

Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic.

BACKGROUND: The novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease. METHODS: We conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients. RESULTS: The majority of respondents were female (83.9%), 41-60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it. CONCLUSION: We found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients' health behaviors related to COVID-19.

Dissecting cellulitis of the scalp associated with peripheral and axial spondyloarthritis: report of a case and review of the literature.

Dissecting cellulitis of the scalp (DCS) is a rare, primary neutrophilic cicatricial alopecia of unknown etiology. The disease follows a chronic, relapsing, and remitting course which may ultimately lead to scar formation and alopecia. The association of seronegative peripheral and/or axial spondyloarthritis in patients with hidradenitis suppurativa (HS) and acne conglobata (AC) is well established. However, the occurrence of spondyloarthropathy in patients with either isolated or combined DCS is relatively rare and therefore underrecognized by clinicians. We report a patient with DCS with inflammatory peripheral arthritis and asymptomatic radiographic sacroiliitis. Using PubMed, Ovid, and Google scholar, we searched for case reports of inflammatory arthritis in HS, AC, and DCS in the English literature from 1982 to present. We identified 12 patients with DCS who had associated spondyloarthropathy with adequate clinical details for a systematic analysis. We outline key clinical features, radiographic findings, and treatment utilized for these patients. Seronegative axial and peripheral spondyloarthritis may occur in the setting of isolated DCS as well with concomitant HS and AC. The inflammatory arthritis often develops during acute flares of the cutaneous disease. Choosing optimal drug therapy may be challenging. Current options include anti-TNF-α medications, which have been reported to be effective for both the cutaneous lesions and the associated spondyloarthritis. The complex pathophysiology of the conditions that comprise the follicular occlusion triad warrants further research into the potential role of additional biologic agents.

Challenges of caring for homeless patients with inflammatory arthritis: 12-month follow-up observations and identification of certain barriers to care.

Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived "greatest need" included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived "greatest needs" went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.

Cardiac Manifestations of Systemic Lupus Erythematous: An Overview of the Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology and Treatment Options.

Systemic lupus erythematosus (SLE) is a complex connective tissue disease that can potentially affect every organ of the human body. In some cases, SLE may present with diverse cardiac manifestations including pericarditis, myocarditis, valvular disease, atherosclerosis, thrombosis, and arrhythmias. Heart disease in SLE is associated with increased morbidity and mortality. It is unclear whether traditional treatments for coronary artery disease significantly impact mortality in this population. Current therapeutic agents for SLE include glucocorticoids, hydroxychloroquine, mycophenolate mofetil, azathioprine, methotrexate, cyclophosphamide, and B cell-directed therapies. This article will provide a comprehensive review and update on this important disease state.

Integrating fast and slow processes is essential for simulating human-freshwater interactions.

Integrated modeling is a critical tool to evaluate the behavior of coupled human-freshwater systems. However, models that do not consider both fast and slow processes may not accurately reflect the feedbacks that define complex systems. We evaluated current coupled human-freshwater system modeling approaches in the literature with a focus on categorizing feedback loops as including economic and/or socio-cultural processes and identifying the simulation of fast and slow processes in human and biophysical systems. Fast human and fast biophysical processes are well represented in the literature, but very few studies incorporate slow human and slow biophysical system processes. Challenges in simulating coupled human-freshwater systems can be overcome by quantifying various monetary and non-monetary ecosystem values and by using data aggregation techniques. Studies that incorporate both fast and slow processes have the potential to improve complex system understanding and inform more sustainable decision-making that targets effective leverage points for system change.