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• A large patient cohort was tested with qPCR for EBV-DNA in plasma and whole blood. • Primary infection, T-cell and Hodgkin lymphomas were predominant EBV diseases. • WHO qPCR for EBV-DNA had a low positive predictive value for proven EBV disease. • The analysis had an excellent negative predictive value for proven EBV disease. • The risk of diagnostic latency was high for patients with EBV-positive lymphoma. 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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Offshore cultivation of seaweed provides an innovative feedstock for biobased products supporting blue growth in northern Europe. This paper analyzes two alternative exploitation pathways: energy and protein production. The first pathway is based on anaerobic digestion of seaweed which is converted into biogas, for production of electricity and heat, and digestate, used as fertilizer; the second pathway uses seaweed hydrolysate as a substrate for cultivation of heterotrophic microalgae. As a result the seaweed sugars are consumed while new proteins are produced enhancing the total output. We performed a comparative Life Cycle Assessment of five scenarios identifying the critical features affecting resource efficiency and environmental performance of the systems with the aim of providing decision support for the design of future industrial scale production processes. The results show that all scenarios provide environmental benefits in terms of mitigation of climate change, with biogas production from dried Laminaria digitata being the most favorable scenario, quantified as -18.7*102 kg CO2 eq./ha. This scenario presents also the lowest consumption of total cumulative energy demand, 1.7*104 MJ/ha, and even resulting in a net reduction of the fossil energy fraction, -1.9*104 MJ/ha compared to a situation without seaweed cultivation. All scenarios provide mitigation of marine eutrophication thanks to bioextraction of nitrogen and phosphorus during seaweed growth. The material consumption for seeded lines has 2-20 times higher impact on human toxicity (cancer) than the reduction achieved by energy and protein substitution. However, minor changes in cultivation design, i.e. use of stones instead of iron as ballast to weight the seeded lines, dramatically reduces human toxicity (cancer). Externalities from the use of digestate as fertilizer affect human toxicity (non-cancer) due to transfer of arsenic from aquatic environment to agricultural soil. However concentration of heavy metals in digestate does not exceed the limit established by Danish regulation. The assessment identifies seaweed productivity as the key parameter to further improve the performance of the production systems which are a promising service provider of environmental restoration and climate change mitigation. [ABSTRACT FROM AUTHOR]

For the last ten years, the notion of a green economy has become increasingly attractive to policy makers. However, green economy covers a lot of diverse concepts and its links with sustainability are not always clear. In this article, we focus on definitions of green economy and related concepts and an evaluation of these concepts against the criterion of strong and weak sustainability. The article serves three purposes: Firstly, we identify and describe diverse theories, concepts, approaches and tools related to a “green economy”. Among these are the theories of environmental economics and ecological economics, the concepts and approaches of cleaner production, waste hierarchy, bio-economy, industrial ecology, circular economy, nature-based solutions, and dematerialization through product-servicizing, and tools like life cycle assessment, and cost-benefit analysis. Secondly, we develop a framework that shows the capacity of the green economy concepts, approaches and tools to support the transition towards sustainability. Such a framework can serve as a heuristic to embed diverse concepts and approaches into a green economy framework. Thirdly, we briefly discuss green economy concepts with respect to their impact on strong and weak sustainability. Depending on the different concepts, approaches and tools identified in the green economy framework, different degrees of substitutability and trade-offs between environmental and economic benefits are allowed, and more or less structural changes of our modes of living are required. By discussing the notion of green economy and related concepts, approaches and tools we seek to make a contribution to their definitions and relationships as a prerequisite for operationalizing green economy. [ABSTRACT FROM AUTHOR]

Background: During a 27 month period, we detected four incidents of penicillin-resistant (PR) Streptococcus dysgalactiae subsp. equisimilis (SDSE) isolated from blood cultures of three patients.Methods: The 4 PR-SDSE were compared phenotypically and molecularly (using WGS) with 36 penicillin-susceptible SDSE from blood cultures obtained in the same catchment area and time period.Results: Phylogenetic analysis showed that the four PR-SDSE belonged to a single clone and a possible epidemiological link between the three patients was identified to be a dermatology department. MICs of penicillin were determined to be 0.5-2 mg/L using Etest and 0.5 mg/L when tested by a broth microdilution method. The four PR-SDSE were unrelated to the 36 penicillin-susceptible isolates, which could suggest that they did not evolve locally from a susceptible clone, but have been introduced into the region. In silico genome-based resistome analysis revealed identical PBP mutations in all four isolates. We detected mutations in multiple PBPs, including two amino acid substitutions within the active sites of the transpeptidase domain of PBP2x (T341P and Q555E), which have also been detected in other PR streptococci. The remaining mutations were, however, all located outside the active-site motifs of the transpeptidase domain.Conclusions: To the best of our knowledge, this is the first description and characterization of invasive PR-SDSE. The resistant isolates had several amino acid changes in various PBPs compared with penicillin-susceptible SDSE. The observation that SDSE also can become PR emphasizes the importance of performing antimicrobial susceptibility testing. [ABSTRACT FROM AUTHOR]

Seaweed is a key biomass for the development of a biobased economy because it contains valuable components such as proteins, sugars, nitrogen and phosphorus. This paper analyses innovative offshore seaweed cultivation for the production of biorefinery feedstock. The biomass is converted into three products: bioethanol, liquid fertilizer and protein-rich ingredient for fish feed. We performed comparative life cycle assessment of a base case and six alternative production scenarios in order to maximize the benefits and minimize the trade-offs in environmental performance of future macroalgal biorefineries (MABs). The results show that the base case provides a net reduction in climate change factors, i.e. −0.1·10 2 kg CO 2 eq. per ha of sea cultivated despite a cumulative net energy demand of 3.9·10 4 MJ/ha, 13% of which originates from fossil sources. Regarding the environmental performance of the system, we obtained a reduction in marine eutrophication of −16.3 kg N eq./ha, thanks to bioextraction of nitrogen. For the base case the net impact on human toxicity (carcinogenic effects) was 2.1·10 −4 comparative toxic units per ha of cultivation. The increase in human toxicity is seven times greater than the system can deal with, however reduction of materials for the cultivation lines, i.e. iron ballast, reduces human toxicity to 0.2·10 −5 comparative toxic units. Externalities from the use of biofertilizer affect the non-carcinogenic effects of the system, resulting in 20.3·10 −4 comparative toxic units per ha. Hotspots in the value chain show that biomass productivity is the main constraint against being competitive with other energy and protein producing technologies. Minor changes in plant design, i.e. use of stones instead of iron as ballast to weight the seeded lines, dramatically reduces human toxicity (cancer). Including engineered ecosystem services in the LCA significantly improves the results. As such, an increase in soil carbon stock represents 15% of the climate change mitigation provided by the MAB system. The study shows that MABs can contribute to a regenerative circular economy through environmental restoration and climate mitigation. [ABSTRACT FROM AUTHOR]

The aim of the study is to assess the efficacy of seaweed for circular nutrient management to reduce eutrophication levels in the aquatic environment. We performed a comparative Life Cycle Assessment (LCA) of two reference waste management systems treating seaweed as biowaste, i.e. landfill disposal and combustion, and an alternative scenario using the seaweed Saccharina latissima as a resource for biobased fertilizer production. Life Cycle Impact Assessment (LCIA) methods were improved by using a cradle-to-cradle approach, quantifying fate factors for nitrogen and phosphorus loss from fertilized agriculture to the aquatic environment. We also differentiated between nitrogen- and phosphorus-limited marine water to improve the traditional freshwater impact category, making this indicator suitable for decision support in relation to coastal water management schemes. Offshore cultivation of Saccharina latissima with an average productivity of 150 Mg/km 2 in Danish waters in 2014 was applied to a cultivation scenario of 208 km 2 . The bioresource scenario performs better than conventional biowaste management systems, delivering a net reduction in aquatic eutrophication levels of 32.29 kg N eq. and 16.58 kg PO 4 3 − eq. per Mg (dry weight) of seaweed, quantified by the ReCiPe and CML impact assessment methods, respectively. Seaweed cultivation, harvest and reuse of excess nutrients from the aquatic environment is a promising approach for sustainable resource cycling in a future regenerative economy that exploits manmade emissions as a resource for closed loop biobased production while significantly reducing eutrophication levels in 3 out of 7 Danish river basin districts. We obtained at least 10% bioextraction of phosphorus manmade emissions (10%, 89% and > 100%) and contributed significantly to local nitrogen reduction goals according to the Water Framework Directive (23%, 78% and > 100% of the target). [ABSTRACT FROM AUTHOR]

Rathe M, Kristensen L, Ellermann-Eriksen S, Thomsen MK, Schumacher H. Vancomycin-resistant Enterococcus spp.: validation of susceptibility testing and in vitro activity of vancomycin, linezolid, tigecycline and daptomycin. APMIS 2010; 118: 66–73. Vancomycin-resistant enterococci (VRE) have emerged to become a significant nosocomial pathogen. However, detection may be challenging and treatment possibilities are limited. Reports of resistance to linezolide, daptomycin and tigecycline underline the need for reliable susceptibility testing with respect to these compounds. We evaluated the in vitro activity of vancomycin, linezolid, daptomycin and tigecycline against a panel of VRE and vancomycin-susceptible enterococci by broth microdilution (BMD). Etest for determination of minimum inhibitory concentration of these four antibiotics and two disc diffusion assays for detecting VRE and for susceptibility testing against tigecycline and linezolid were evaluated. Before susceptibility testing, all isolates were classified by polymerase chain reaction as vanA or vanB gene positive or vanA/B gene negative. Linezolid, daptomycin and tigecycline had excellent in vitro activity towards all isolates. For daptomycin and tigecycline, the overall agreement between BMD and Etest was suboptimal. For both disc diffusion assays, use of current break points was inadequate to detect vancomycin resistance for isolates carrying the vanB gene. Inspection of the inhibition zone for a diffuse edge, as recommended, accurately predicted presence of the vanB gene. [ABSTRACT FROM AUTHOR]

[Display omitted] • Industrial wastewater (IWW) serve as ideal nutrient growth media for microalgae. • IWW requires specific pretreatments and optimization before microalgae cultivation. • Recent advances of IWW treatments through microalgae cultivation are explored. • Microalgal biomass grown on IWWs must be valorized to value-added products. 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. [ABSTRACT FROM AUTHOR]

Food production and consumption have been recognized as a major source of environmental impacts. To ensure food security and a sustainable food system, dietary changes have been identified as one of the valuable strategies to reduce impacts on the environment while promoting human health. The vast majority of scientific literature has been focused on the effects of food consumption on climate change while neglecting to assess the degree of water scarcity impacts due to water consumption embodied in food. The research paper investigates the nexus between food consumption and impacts on water consumption adding important findings to a more recent growing body of studies estimating the water footprint (WF) of different dietary scenarios. This study uses the Water Footprint Network methodology and the AWARE (Available Water REmaining) characterization model to assess both the WF and the blue WSF (water scarcity footprint), respectively, of four Danish diets: standard, carnivore, vegetarian and vegan. In order to make them comparable, a total intake of 2000 kcal person−1 day−1 was set as energetic reference for all the diet scenarios considered. Using detailed trade and production data of agri-foods, we were able to assess the location of primary production and consequently to reveal countries mainly affected by water scarcity associated with import to satisfy Danish diets consumption. We found that while the vegan scenario scored the best environmental profile requiring 1489 L/cap/day calculated with the volumetric WF approach, it has the largest potential impacts on blue WSF of 10,477 L H20-eq /cap/day. This study has shown that more than 90% of impacts on water consumption occur outside the national borders, as a consequence of large quantities of fruits and nuts imported by countries already threatened by high water scarcity conditions such as USA and Mediterranean regions. This methodological approach may be used to compare environmental performances of recommended dietary guidelines and to assess impact scenarios of new trade policies, protecting local water scarcity levels. • Volumetric and impact-oriented WF assessment of Danish diets was performed. • Shifting to plant-based diets increased total water scarcity footprint. • Danish food consumption relies on imports from water stressed countries. • Almond, fruits and vegetables contributed most to the water scarcity footprint. • New trade policies should consider local water availability. [ABSTRACT FROM AUTHOR]

Food production is a major driver of global warming, water scarcity and biodiversity loss. Denmark has set ambitious targets to lower its territorial carbon emissions in the next decades. In 2019, the Danish Agriculture and Food Council announced a strategy to make Denmark's food production systems climate-neutral by 2050. Therefore, detailed information concerning Denmark's food consumption's environmental impacts is required to implement effective climate mitigation and resource conservation policies that lead to positive local to global results. Using an environmentally extended multi-regional input-output (EE MRIO) analysis and the EXIOBASE v3.4 database, we evaluate Denmark's global food-related consumption-based (CB) greenhouse gas emissions (GHG) and resource (land and water use) accounts from 1995 to 2014. Although Denmark's CB food-related blue water use remained relatively stable during the studied period, its food-related CB GHG emissions (excluding land-use change emissions) decreased continuously by 30%. Also, Denmark's cropland and grassland footprints for food declined by 16% (3555 km2) and 27% (621 km2), respectively. Almost two-fifths of Denmark's food consumption was produced abroad in 2014, corresponding to 51% of Denmark's food-related CB GHG emissions and land use apiece and 84% of its food-related blue water use. Whereas animal-based foods accounted for the largest share of Denmark's food-related CB GHG emissions, plant-based diets were responsible for the bulk of Denmark's CB land and blue water use. Dietary changes towards plant-based foods are essential to mitigating Denmark's food-related climate impacts. We recommend that Denmark transfers its sustainable food production technologies to its pollution-and-resource intensive food-exporting trade partners to enhance global climate change mitigation and resource use efficiency. [Display omitted] • About 49% of Denmark's food-related CB GHG emissions and land use occur in Denmark. • Denmark's GHG and land footprints for food decreased by 30% and 17%, respectively. • Denmark is a net importer of food-related blue water and grassland footprint. • GHG emissions and cropland embodied in Danish food exports increased by 11% and 47%, respectively. • Almost two-fifths of Denmark's GHG and cropland footprints are embodied in imports from other European countries and Asia. [ABSTRACT FROM AUTHOR]

This study presents a critical overview of reported essential oil (EO) extractions from citrus peel wastes (CPW), including harmonized data on the various citrus species and cultivars. Harmonization is vital to enable sustainable management practices. The review only includes eco-efficient extraction techniques. In total, the review contains 66 quantified examples using i) mechanical cold press ii) thermal extraction with water or steam media iii) thermal microwave-assisted extraction iv) other innovative methods (such as ultrasound). The technologies were assessed for their potential use in cascading production to achieve economies of scope, particularly considering the use of extraction residues for subsequent fermentation to produce various products from energy carriers to enzymes. Two techniques were found insufficient for direct use in fermentation. Cold press extracts an inadequate amount of EO (average yield 2.85% DW) to ensure suitable fermentation, while solvent extraction contaminates the residues for its subsequent use. Extractions using water media, such as hydrodistillation and microwave-assisted hydrodistillation (average EO yield 2.87% DW), are feasible for the liquid-based fermentation processes, such as submerged fermentation. Steam extraction is feasible for any type of fermentation. Our review highlighted solvent-free microwave extraction (average EO yield 5.29% DW) as the most effective method, which provides a high yield in a short extraction time. We also uncovered and discussed several inconsistencies in existing yields and energy consumption published data. Image 1 • We report 66 quantified extractions via green chemistry technologies. • Technologies were assessed for possible use of residues in subsequent fermentation. • Solvent-free microwave extraction has been identified as the most effective method. • Data harmonization expressed per mass unit are strongly advised. [ABSTRACT FROM AUTHOR]

Bioaccumulation of heavy metals (HMs) in the food supply chain is a crucial environmental and health issue in need of urgent risk reduction action plans. This study assesses the daily intake of four HMs, i.e. cadmium, mercury, lead and arsenic, and four minerals; chromium, nickel, selenium and zinc. 456 Danish food items were grouped in six food categories (grains , fruits and vegetables , oils and condiments , food rich in fats , sugar and alcohol , milk and dairy and protein-rich). A model of four different Danish diets (standard, carnivore, vegetarian and vegan) is presented. The probability of exceeding the provisional tolerable daily intake (PTDI) of HMs and minerals for the four different Danish diets were calculated applying a Monte Carlo approach. While the sources to the total intake differ, there is no significant differences in the risk of exceeding the PTDI across the four dietary profiles. The risk of exceeding the PTDI across the four dietary profiles was on average 60%, 17% and 16% for cadmium, mercury and lead respectively. For total arsenic the risk of exceeding the provisional daily intake was 33%. Concerning minerals, the average probability of exceeding the recommended daily intake was 29% for chromium, 80% for selenium, 73% for nickel and 0% for zinc. Regarding the toxic limit value the probability was 12% for chromium, 17% for selenium, 52% for nickel and 0% for zinc. The results of our study emphasize the importance of implementing measures to reduce the risk cycle of HMs threatening environmental health and food safety. • The probability of exceeding the EFSA regulatory limit for Cd is 60%. • The food category grains is a main source to Cd exposure for all dietary profiles. • Food rich in sugar, fats and alcohol is a main source to Pb exposure. • Protein-rich food dominates the Hg, total As, and Cr intake for carnivore profile. • Of protein-rich foods, fish contains higher levels of heavy metals compared to meat. [ABSTRACT FROM AUTHOR]

Phthalate exposure from Vegetables grown in Plastic Greenhouses (VPGs) represents an important source of total daily phthalate exposure in China. However, quantified health risks of phthalates attributable to VPG intake have not been documented. To fill this gap, this study estimates phthalate exposure from VPG intake in western China and calculates the first assessment of the disease burden associated with phthalate exposure from VPG intake in China based on a simple steady-state exposure model and a linear dose-response function between human bio-monitoring phthalates and Type 2 Diabetes (T2D) prevalence. What we present in this paper is a problem identification and screening level risk assessment. We chose Shaanxi province as the research field site due to its large contribution to the total vegetable yield and consumption in western China. Phthalate concentration in VPG samples, phthalate exposure levels from VPG intake, and the T2D burden caused by phthalate attributable to VPG intake for adults were measured or calculated. Di-2-ethylhexyl phthalate (DEHP) was found to represent over 55% of the total phthalate concentration in VPGs, followed by di-n-butyl phthalate (DnBP) and di-isobutyl phthalate (DiBP). Phthalate exposure from VPG intake for urban adults was higher than the level for rural adults. The share of DEHP exposure from VPG intake to urinary total DEHP metabolites were nearly 8% and 15%, and the share of DnBP exposure caused by VPG intake to total daily DnBP metabolites were nearly 4% and 7%, for rural and urban adult populations in Shaanxi, respectively. The adult population with T2D attributable to phthalate exposure from VPG intake was 2561, nearly 6.4% to the T2D burden attributable to total phthalate exposure, and 0.4% to the total adult population with T2D in Shaanxi. The authors recommend policy interventions to protect populations from future risk of phthalate exposure. Unlabelled Image • DEHP was over 55% of the total phthalate concentration in VPGs, followed by DnBP. • Urban adults have higher phthalate exposure from VPG intake than rural adults have. • Urinary DEHP from VPG intake was 15% to total daily DEHP exposure in urban adults. • MBP from VPG intake was 7% to total daily DnBP exposure in urban adults. • T2D burdens associated to phthalate from VPG intake was 0.4% of the total T2D adults. [ABSTRACT FROM AUTHOR]

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 log 10 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., Competing Interests: L.M., P.J., M.K.T., S.Y., and G.C. declare no potential conflicts of interest. Outside of the submitted work, M.H. declares personal fees from Roche Diagnostics (speaker's honoraria). J.A.C. is an employee of Roche Molecular Systems, Inc. D.J. is an employee of Roche Molecular Systems, Inc. and participates in Roche Connect.

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., (© 2024 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pandey, Bohl, Favari, Mora, Phuyal, Sojková, Budhathoki and Thomsen.)

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.

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.

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

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 CO 2 e (0.09 t CO 2 e/p), 4,620 Mm 3 (8 m 3 /p) of blue water, 106,446 km 2 (179 m 2 /p) of cropland, 55,523 km 2 (93 m 2 /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.

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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., (© Japan College of Rheumatology 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

Objective: Patients with chronic rheumatic diseases (CRDs), such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), require special attention during the COVID-19 pandemic as they are considered at risk of severe infections. Our objective was to assess the seroprevalence of SARS-CoV-2 in patients with SLE and RA and to assess patient behavior, disease-related symptoms, and mental health., Methods: More than 900 participants were included: 405 patients with RA or SLE (CRD patients) and 513 blood donors. All participants had blood SARS-CoV-2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (Patient Health Questionnaire 9). The CRD patients were further asked about physical activity, adherence to medication, and disease-related symptoms., Results: CRD patients had a significantly lower seroprevalence of SARS-CoV-2 antibodies (n = 1 of 365, 0.3%) compared to blood donors (n = 10 of 513, 1.9%; P = 0.03). Almost 60% of patients were unable to exercise as usual, and increased pain and disease activity was experienced by 34% and 24% of patients, respectively. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6.8% of blood donors (P < 0.001)., Conclusion: Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS-CoV-2. However, this mitigation appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side effects and for further studies to investigate the possible long-term consequences., (© 2021 American College of Rheumatology.)

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., (Copyright © 2022 by the Journal of Rheumatology.)

Agricultural plastic greenhouse (PG) production can extend the growing season of crops to satisfy domestic consumption in countries such as China. Workers in PGs have potential higher phthalate exposure risks than the general population as phthalate accumulation has been observed in greenhouse soil, air, and crops. To date, biomonitoring tests of phthalates for the working population have not been carried out. To address this shortage, we conducted a pilot study in Shaanxi Province, China, among 35 healthy PG workers by follow-up recording their seasonal dietary habits and work activities and urine sample collection and measurement between 2018 and 2019. The objectives were to uncover the association between phthalate metabolites and the population characteristics, seasonal and diurnal variations and causes, and to estimate exposure risks and contributions of exposure pathways from PG production systems. A total of 13 phthalate metabolite concentrations (Σ 13 phthalate metabolites) ranged from 102 to 781 (5th-95th) ng/mL (median: 300 ng/mL). Mono-n-butyl phthalate (MNBP) made up 51.3% of Σ 13 phthalate metabolites, followed by the sum of four di-2-ethylhexyl phthalate (DEHP) metabolites (24.2%), mono-2-isobutyl phthalate (MIBP) (13.4%), and mono-ethyl phthalate (MEP) (9.8%). The concentrations of MNBP and MIBP in summer were significantly higher than the levels in winter (p < 0.0001). A total of 62.3% of the PG worker population was shown to have exposure risks, and the proportion was as high as 79.4% in summer. Phthalate exposure of the workers from PG production systems constituted over 20% of the total creatinine-based daily intake, and consuming vegetables and fruit planted in PGs and inhalation in PGs were the two largest exposure pathways. Our findings demonstrate that it is important to protect workers in PGs from phthalate exposure risks, and phasing out the use of plastic materials containing phthalates in PGs is imperative, to guarantee food safety in PGs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: With a vaccine effectiveness of 95% for preventing coronavirus disease 2019 (COVID-19), Pfizer-BioNTech BNT162b2 (BNT162b2) was the first vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to be approved. However, immunosuppressive therapy was an exclusion criterion in the phase 3 trial that led to approval. Thus, extrapolation of the trial results to patients with rheumatic diseases treated with immunosuppressive drugs warrants caution., Methods: Patients with systemic lupus erythematosus (SLE; n = 61) and rheumatoid arthritis (RA; n = 73) were included from the COPANARD (Corona Pandemic Autoimmune Rheumatic Disease) cohort, followed since the beginning of the COVID-19 pandemic. Patients received the BNT162b2 vaccine between December 2020 and April 2021. All patients had total antibodies against SARS-CoV-2 measured before vaccination and 1 week after the second vaccination (VITROS Immunodiagnostic Products)., Results: Of 134 patients (median age, 70 years), 77% were able to mount a detectable serological response to the vaccine. Among patients treated with rituximab, only 24% had detectable anti-SARS-CoV-2 antibodies in their serum after vaccination. The time since the last rituximab treatment did not seem to influence the vaccine response. No significant difference was observed between patients with RA or SLE when adjusting for treatment, and no correlation between antibody levels and age was detected (r = -0.12; P = 0.18)., Conclusion: Antibody measurements against SARS-CoV-2 in patients with RA and SLE after two doses of the BNT162b2 vaccine demonstrated that 23% of patients could not mount a detectable serological response to the vaccine. B cell-depleting therapy (BCDT) is of specific concern, and our findings call for particular attention to the patients receiving BCDT., (© 2021 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: People suffering from Borderline Personality Disorder (BPD) seem to have incoherent autobiographical narratives. Tentative evidence suggests that reduced narrative coherence of autobiographical memories is associated with insecure attachment. However, it remains unknown whether incoherent autobiographical narratives in people with BPD are coupled to experiences of childhood trauma, which is highly prevalent in BPD., Method: We examined if written autobiographical memories in 26 female participants with BPD had reduced narrative coherence relative to 28 healthy female controls and whether more incoherent narratives were associated with childhood trauma., Results: As hypothesized, results showed that compared to controls, the autobiographical memories in participants with BPD had reduced narrative coherence, specifically inadequate orientation about the narrative and lack of narrative structure. More self-reported childhood adversity was coupled to lower orientation across groups whereas increased childhood adversity showed a specific relationship to lowered narrative structure in BPD participants., Conclusion: Women with BPD had incoherent autobiographical narratives, and reduced narrative coherence was associated with more self-reported childhood adversity, which appeared to explain the group differences.

Competing Interests: We declare no competing interests. The Danish Rheumatism Association funded the questionnaire study. The funder had no role in data collection, data analysis, data interpretation, or writing of the report. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. All authors contributed equally to study design, data collection, data interpretation, and writing of the report. CA and AT accessed and verified the underlying data.

Serological assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are needed to support clinical diagnosis and epidemiological investigations. Recently, assays for large-scale detection of total antibodies (Ab), immunoglobulin G (IgG), and IgM against SARS-CoV-2 antigens have been developed, but there are limited data on the diagnostic accuracy of these assays. This study was a Danish national collaboration and evaluated 15 commercial and one in-house anti-SARS-CoV-2 assays in 16 laboratories. Sensitivity was evaluated using 150 samples from individuals with asymptomatic, mild, or moderate COVID-19, nonhospitalized or hospitalized, confirmed by nucleic acid amplification tests (NAAT); samples were collected 13 to 73 days either from symptom onset or from positive NAAT (patients without symptoms). Specificity and cross-reactivity were evaluated in samples collected prior to the SARS-CoV-2 epidemic from >586 blood donors and patients with autoimmune diseases, cytomegalovirus or Epstein-Barr virus infections, and acute viral infections. A specificity of ≥99% was achieved by all total-Ab and IgG assays except one, DiaSorin Liaison XL IgG (97.2%). Sensitivities in descending order were Wantai ELISA total Ab (96.7%), CUH-NOVO in-house ELISA total Ab (96.0%), Ortho Vitros total Ab (95.3%), YHLO iFlash IgG (94.0%), Ortho Vitros IgG (93.3%), Siemens Atellica total Ab (93.2%), Roche Elecsys total Ab (92.7%), Abbott Architect IgG (90.0%), Abbott Alinity IgG (median 88.0%), DiaSorin Liaison XL IgG (median 84.6%), Siemens Vista total Ab (81.0%), Euroimmun/ELISA IgG (78.0%), and Snibe Maglumi IgG (median 78.0%). However, confidence intervals overlapped for several assays. The IgM results were variable, with the Wantai IgM ELISA showing the highest sensitivity (82.7%) and specificity (99%). The rate of seropositivity increased with time from symptom onset and symptom severity., (Copyright © 2021 American Society for Microbiology.)

Objective: To examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes., Methods: This nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use., Results: The study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users., Conclusions: ACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic., Trial Registration Number: EUPAS34887., Competing Interests: Competing interests: CFC, UH-J, RWT and HTS have not received any personal fees, grants, travel grants or teaching grants from companies, but the Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to (and administered by) Aarhus University. MR, LCL, AP and JH have participated in industry-funded projects with money paid to their employer, the University of Southern Denmark. MM has received speaker or advisory board fees from AstraZeneca, Bayer, Boston Scientific, Boehringer-Ingelheim, Bristol-Myers Squibb, and Novo Nordisk., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To facilitate research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a prospective cohort of all Danish residents tested for SARS-CoV-2 in Denmark is established., Data Structure: All Danish residents tested by reverse transcriptase polymerase chain reactions (RT-PCR) for SARS-CoV-2 in Denmark are included. The cohort is identified using the Danish Microbiology Database. Individual-level record linkage between administrative and health-care registries is facilitated by the Danish Civil Registration System. Information on outcomes related to SARS-CoV-2 infection includes hospital admission, intensive care unit admission, mechanical ventilation, and death and is retrieved from the five administrative Danish regions, the Danish National Patient Registry, and the Danish Register of Causes of Death. The Patient Registry further provides a complete hospital contact history of somatic and psychiatric conditions and procedures. Data on all prescriptions filled at community pharmacies are available from the Danish National Prescription Registry. Health-care authorization status is obtained from the Danish Register of Healthcare Professionals. Finally, selected laboratory values are obtained from the Register of Laboratory Results for Research. The cohort is governed by a steering committee with representatives from the Danish Medicines Agency, Statens Serum Institut, the Danish Health Authority, the Danish Health Data Authority, Danish Patients, the Faculties of Health Sciences at the Danish universities, and Danish regions. The steering committee welcomes suggestions for research studies and collaborations. Research proposals will be prioritized based on timeliness and potential clinical and public health implications. All research protocols assessing specific hypotheses for medicines will be made publicly available using the European Union electronic Register of Post-Authorisation Studies., Conclusion: The Danish COVID-19 cohort includes all Danish residents with an RT-PCR test for SARS-CoV-2. Through individual-level linkage with existing Danish health and administrative registries, this is a valuable data source for epidemiological research on SARS-CoV-2., Competing Interests: KBK, NBJ, MAV, SC, NB, AH, JK, MTE, and MKT declare no conflicts of interest. RWT, CFC, and HTS declare no personal conflicts of interest. The Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to and administered by Aarhus University. None of these studies are related to the current study. HS reports personal fees from Bristol-Myers Squibb, Novartis, and Roche, outside the submitted work. AP and JH report participation in research funded by Alcon, Almirall, Astellas, AstraZeneca, Boehringer-Ingelheim, Novo Nordisk, Servier, and LEO Pharma, all with funds paid to the institution where they were employed (no personal fees) and with no relation to the work reported in this paper. LCL reports participation in research projects funded by Menarini Pharmaceutical and LEO Pharma, with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this paper. MR reports participation in research projects funded by LEO Pharma, with funds paid to the institution where she was employed (no personal fees) and with no relation to the work reported in this paper., (© 2020 Pottegård et al.)

Since the outbreak of enterovirus D68 (EV-D68) in the USA in 2014, the association between infection with EV-D68 and acute flaccid myelitis (AFM) has been well described. EV-D68 has been detected before in Denmark, but this is the first case report of EV-D68 in the respiratory tract of a one-year-old child with AFM. Simultaneously, another child with EV-D68 detected in a respiratory tract sample was admitted, who had a severe respiratory tract infection without AFM, needing two weeks of intensive care treatment.

Enterovirus D68 (EV-D68) was detected in 93 patients from five European countries between 1 January 2019 and 15 January 2020, a season with expected low circulation. Patients were primarily children (n = 67, median age: 4 years), 59 patients required hospitalisation and five had severe neurologic manifestations. Phylogenetic analysis revealed two clusters in the B3 subclade and subclade A2/D. This circulation of EV-D68 associated with neurological manifestations stresses the importance of surveillance and diagnostics beyond expected peak years.

Congenital cytomegalovirus (cCMV) is the most common infectious cause of congenital malformations in Denmark. The disease is not notifiable, and there are no national data. A regional Danish prospective study from the 1970s found a cCMV incidence of 0.4%. We propose three algorithms for microbiological diagnosing: 1) Testing of pregnant women should only be -applied, when symptoms compatible with CMV infection are present, and no other diagnoses are found. 2) In children less than three weeks of age urine is the -preferred sample. 3) Retrospectively, cCMV may be diagnosed on dried blood spots, if the mother is CMV IgG-positive.

The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.

Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior to beginning mentalization-based therapy and again after 6 months of treatment. Twenty-eight nonpsychiatric controls were tested over the same period of time but received no intervention. Before starting treatment, patients performed lower than controls on tests assessing sustained attention and visuospatial working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD.

In Denmark, both influenza A(H1N1)pdm09 and influenza B co-circulated in the 2015/16 season. We estimated the vaccine effectiveness (VE) of the trivalent influenza vaccine in patients 65 years and older using the test-negative case-control design. The adjusted VE against influenza A(H1N1)pdm09 was 35.0% (95% confidence interval (CI): 11.1-52.4) and against influenza B 4.1% (95% CI: -22.0 to 24.7). The majority of influenza A(H1N1)pdm09 circulating in 2015/16 belonged to the new genetic subgroup subclade 6B.1.

Antibiotic dosing in septic shock patients poses a challenge for clinicians due to the pharmacokinetic (PK) variability seen in this patient population. Piperacillin-tazobactam is often used for empirical treatment, and initial appropriate dosing is crucial for reducing mortality. Accordingly, we determined the pharmacokinetic profile of piperacillin (4 g) every 8 h, during the third consecutive dosing interval, in 15 patients treated empirically for septic shock. We developed a population pharmacokinetic model to assess empirical dosing and to simulate alternative dosing regimens and modes of administration. Time above the MIC (T>MIC) predicted for each patient was evaluated against clinical breakpoint MIC for Pseudomonas aeruginosa (16 mg/liter). Pharmacokinetic-pharmacodynamic (PK/PD) targets evaluated were 50% fT>4×MIC and 100% fT>MIC. A population PK model was developed using NONMEM, and data were best described by a two-compartment model. Central and intercompartmental clearances were 3.6 liters/h (relative standard error [RSE], 15.7%) and 6.58 liters/h (RSE, 16.4%), respectively, and central and peripheral volumes were 7.3 liters (RSE, 11.8%) and 3.9 liters (RSE, 9.7%), respectively. Piperacillin plasma concentrations varied considerably between patients and were associated with levels of plasma creatinine. Patients with impaired renal function were more likely to achieve predefined PK/PD targets than were patients with preserved or augmented renal function. Simulations of alternative dosing regimens showed that frequent intermittent bolus dosing as well as dosing by extended and continuous infusion increases the probability of attaining therapeutic plasma concentrations. For septic shock patients with preserved or augmented renal function, dose increment or prolonged infusion of the drug needs to be considered. (This study has been registered at ClinicalTrials.gov under registration no. NCT02306928.)., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)