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Eutectic high-entropy alloys (EHEAs) with a fine-lamellar structure and homogenous property profile are of particular interest for wear and corrosion protection coatings. High cooling rates in the laser metal deposition (LMD) process can induce microstructure refinement and allow the formation of a supersaturated solid solution in EHEAs. A subsequent solution annealing can create the equilibrium state. In the present study, LMD coatings with an ultrafine-grained Widmanstätten structure were produced from the EHEA Al0.3CoCrFeNiMo0.75 gas atomized powder. High cooling rates during deposition led to a supersaturated solid solution with face-centered cubic (FCC) structure. The LMD coating exhibits the highest average hardness of 734 HV0.5, which drops to approx. 200 HV0.5 due to an increased microstructural domain size after heat treatment. Under oscillating wear, the formation of oxidized wear debris promotes material removal in the heat-treated condition. Corrosion tests reveal a deterioration of the passivation behavior. LMD processes exhibit great potential to create supersaturated solid solutions with refined structure in EHEAs to enhance the property profile. [ABSTRACT FROM AUTHOR]

The addition of refractory metals represents a promising approach for development of future high-entropy alloys (HEAs). Niobium and molybdenum are particularly suitable additives for increasing hardness as well as wear and corrosion resistance. In the context of surface protection applications, eutectic high-entropy alloys (EHEAs) with their homogeneous property profile are of specific interest. In the present work, two EHEAs were developed starting from the alloy Al0.3CoCrFeNi using electric arc melting. Following mechanical and microstructural characterization, the two alloys were found to have the compositions Al0.3CoCrFeNiMo0.75 and Al0.3CoCrFeNiNb0.5. For thermal spray processing, powders of the above alloys were prepared by inert gas atomization. The coatings produced by high-velocity oxy-fuel spraying (HVOF) were characterized and evaluated compared with castings, allowing process–structure–property relationships to be derived. Based on the results, statements on possible application potential can be made. [ABSTRACT FROM AUTHOR]

In different bioassays, functional antibodies reacting with the human muscarinic acetylcholine receptor M3(m Ach R3) have been detected in sera from patients with Sjögren's syndrome (SS), and there is strong evidence that those antibodies may have pathogenetic relevance. However, depending on the method of detection, their prevalence varied. Furthermore, those bioassays are difficult to standardize. We report on the development and optimization of a novel test system based on a luminometric method to determine downstream signalling of m Ach R3 which produces specific and reproducible results. Chinese hamster ovarian ( CHO) cells were transfected with plasmids encoding m Ach R3 and a green fluorescence protein ( GFP)/aequorin fusion protein. Incubation of cells with carbachol resulted in an increase in intracellular [Ca2+], which was detected by measuring light emission with a luminometer, and the effect of incubation with patients' immunoglobulins ( Ig) was evaluated. Optimal cell density, Ig preparation and time of incubation with patients' sera were determined. Sera from patients with primary Sjögren's syndrome (p SS; n = 40), systemic sclerosis ( SSc; n = 47), myasthenia gravis ( MG; n = 133) and 50 blood donors were analysed. Optimal assay conditions were obtained with a cell density of 100 000 cells/ml, isolation of Ig by ammonium sulphate precipitation and short-term incubation. Based on this highly reliable assay, 50% of the pSS patients had antibodies which inhibited carbachol-induced activation of m Ach R3; none of the SSc patients, 6% of the patients with MG and 12% of the blood donors had antibodies which reacted with the m Ach R3. This method facilitates the determination of functional anti-m Ach R3 antibodies in patients' sera, confirmed their high prevalence in p SS patients and may, therefore, help to analyse their pathogenetic and clinical relevance in more detail. [ABSTRACT FROM AUTHOR]

Abstract Background In a recent study we showed that in patients with primary biliary cirrhosis (PBC) being positive or negative for anti-M2 antibodies reacting with the 2-oxoacid-dehydrogenase complex (ODC) also antibodies to the beta- and gamma-subunits of F1F0-ATPase (anti-β, anti-γ) occur. This is a mitochondrial enzyme but parts are also expressed on plasma membranes of endothelial cells. Here we wanted to analyse in more detail their clinical relevance. Methods Fifty-nine untreated and histologically defined PBC patients who had been followed for at least five years were included into the study (51 anti-M2 positive, 8 anti-M2 negative). Twenty-three of them were treated in the follow up with ursodeoxycholic acid (UDCA), eight received during a trial methotrexate (MTX). In 13 patients orthotopic liver transplantation (OLT) had to be performed. Serum samples before and during therapy were available. Patients were analysed with respect to laboratory parameters, disease activity and histological stages. Patients’ sera were tested by ELISA for IgG- and IgM-antibodies against the beta- and gamma-subunits which had been recombinant expressed in E.coli and highly purified by electro-elution from SDS-gels after electrophoresis. Results Fifty-nine percent of the anti-M2 positive and 50% of the anti-M2 negative PBC patients had anti-β- and/or anti-γ-antibodies. There were no differences between anti-β- and/or anti-γ-antibody positive or negative patients with respect to biochemical parameters, immunoglobulins, histological stages or disease activity. Antibody reactivity significantly decreased during UDCA and MTX-treatment and also after OLT. Conclusions Antibodies to the β- and γ-subunits of F1F0-ATPase occur in anti-M2 positive and –negative PBC but do not have any relevance with respect to clinical activity or prognosis. However, in contrast to the anti-M2 antibodies they decrease during UDCA and immunosuppressive therapy.

There was evidence that perinuclear antineutrophil cytoplasmic antibodies (pANCA) in autoimmune liver diseases react with human beta-tubulin-5 (TBB5). Here, we reevaluate the specificity and clinical relevance of anti-TBB5 antibodies. Patients with untreated autoimmune hepatitis (AIH; n = 53), AIH under immunosuppressive therapy (AIH-IS; n = 125), primary sclerosing cholangitis (PSC; n = 40), primary biliary cholangitis (PBC; n = 250), nonautoimmune liver diseases (n = 158), inflammatory bowel diseases (IBD; n = 30), and healthy individuals (n = 62) were tested by enzyme-linked immunosorbent assay for IgG- and IgA-antibodies against recombinant human TBB5. pANCA were detected by immunofluorescence test. Sera were absorbed with TBB5 coupled to cyanogen bromide-activated sepharose. Prevalence and reactivity of IgG anti-TBB5 were significantly higher in patients with untreated AIH (68%; arbitrary units [AU] median: 369) than in PSC (28%; AU median: 84, P < 0.001), other liver diseases (14%; AU median: 185, P < 0.0001), IBD (3%; AU median: 111, P < 0.0001), and healthy controls (3%; AU median: 135; P < 0.0001). Anti-TBB5 did not correlate with pANCA, and immunoprecipitation with TBB5 did not abolish pANCA reactivity. In untreated AIH, anti-TBB5-reactivity was significantly higher than in AIH-IS. Transaminases decreased under IS preferentially in anti-TBB5-negative patients. There was no correlation between anti-TBB5-reactivity and histological stages. IgA-anti-TBB5 was mainly found in alcohol-associated liver disease (ALD; 39%). Our data do not support TBB5 as an autoantigenic target of pANCA. However, IgG-anti-TBB5 showed high specificity for (untreated) AIH. While they did not correlate with histological and laboratory parameters, their presence may indicate a poor response to IS., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Immunology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To evaluate the effect of autologous stem cell transplantation (aSCT) on functional antibodies (abs) to the angiotensin II type-1-receptor (AT1R) and topoisomerase-I (topo-I) in SSc-patients and to analyse their prognostic relevance., Material and Methods: Forty-three SSc-patients in whom aSCT was performed were analysed. Thirty-one patients had a favourable outcome after aSCT (group 1), 12 patients showed no response or relapse (group 2). Patients' sera were tested for anti-AT1R and anti-topo-I antibodies by ELISA and in a luminometric assay (LA) using AT1R-expressing Huh7-cells for inhibitory or stimulatory anti-AT1R antibodies before and after aSCT (4-217 months, median 28 months). Anti-topo-I antibodies were also analysed for their capacity to inhibit enzyme function., Results: A total of 70% of the SSc patients had anti-topo-I- and 51% anti-AT1R antibodies in the ELISA before aSCT. In all instances, anti-topo-I antibodies inhibited topo-I-enzyme function. In the LA, 40% had stimulatory and 12% inhibitory anti-AT1R antibodies. Anti-topo-I- and anti-AT1R-reactivity (ELISA) significantly decreased after aSCT. Before aSCT, anti-topo-I-reactivity was significantly higher in group 2 patients than in group 1 patients (P < 0.001), while there was no difference between both groups for anti-AT1R antibodies detected by ELISA. Stimulatory anti-AT1R antibodies detected by LA were confined to group 1-patients., Conclusions: Reactivity of functionally active anti-AT1R antibodies was not influenced by aSCT, while anti-topo-I antibodies decreased after aSCT. The fact that anti-topo-I antibodies inhibited enzyme function in all instances supports the hypothesis of a pathogenetic role of the topo-I antigen/antibody-system in SSc. High anti-topo-I reactivity before aSCT was associated with an unfavourable, presence of stimulatory anti-AT1R antibodies with a favourable course after aSCT., (© 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.)

G protein-coupled receptors (GPCR) are involved in various physiological and pathophysiological processes. Functional autoantibodies targeting GPCRs have been associated with multiple disease manifestations in this context. Here we summarize and discuss the relevant findings and concepts presented in the biennial International Meeting on autoantibodies targeting GPCRs (the 4th Symposium), held in Lübeck, Germany, 15-16 September 2022. The symposium focused on the current knowledge of these autoantibodies' role in various diseases, such as cardiovascular, renal, infectious (COVID-19), and autoimmune diseases (e.g., systemic sclerosis and systemic lupus erythematosus). Beyond their association with disease phenotypes, intense research related to the mechanistic action of these autoantibodies on immune regulation and pathogenesis has been developed, underscoring the role of autoantibodies targeting GPCRs on disease outcomes and etiopathogenesis. The observation repeatedly highlighted that autoantibodies targeting GPCRs could also be present in healthy individuals, suggesting that anti-GPCR autoantibodies play a physiologic role in modeling the course of diseases. Since numerous therapies targeting GPCRs have been developed, including small molecules and monoclonal antibodies designed for treating cancer, infections, metabolic disorders, or inflammatory conditions, anti-GPCR autoantibodies themselves can serve as therapeutic targets to reduce patients' morbidity and mortality, representing a new area for the development of novel therapeutic interventions., (Copyright © 2023. Published by Elsevier B.V.)

Introduction: During the COVID-19 pandemic, people in need of long-term care were among the most vulnerable population groups. Home-care services were under exceptional strain, especially at the beginning of the pandemic. The aim of this study is to examine the situation and problems of care services and the people in need of care during the first two waves of the pandemic in Germany., Methods: Two cross-sectional studies were conducted during the first two COVID-19 waves (first survey 28 April to 12 May 2020, second survey 12 January to 7 February 2021). In total, data from N = 1029 outpatient care services were included in the analysis. Descriptive measures were used for the analysis., Results: The clients of home-care services were severely burdened in the first two waves of the pandemic. This can be seen on the one hand in an increased risk of illness and increased mortality, and on the other in the loss of various care and support services. The latter also has negative effects on the psychosocial condition of those in need of care, for example. Care services were affected by high staff absenteeism and additional work due to protective measures., Discussion: The COVID-19 pandemic led to immense burdens for people in need of care and home-care services and to a reduction in care services. The deterioration of care provision met with an already tense situation. It has become clear that the provision of care for those in need of care by outpatient care services is not crisis-proof, and that additional challenges such as a pandemic can have dramatic consequences. For the future, reliable structures and readily available emergency plans should be established with concrete instructions for action., (© 2023. The Author(s).)

Background: The consequences of the COVID-19 pandemic have posed major challenges to different groups. One of these are informal caregivers. This study investigates the changes the pandemic has caused for informal caregivers and the extent to which quality of life and burden of care have changed for specific subgroups., Methods: Data for this cross-sectional study was gathered in the summer of 2020 in a convenient sample of informal caregivers (< 67 years of age, N = 1143). In addition to sociodemographic data, information on the care situation, compatibility of care and work, as well as stress and quality of life was collected in an online survey. The analysis of care situations and compatibility of care and work is done descriptively. Logistic regression models are used for a subgroup analysis of quality of life and care burden., Results: The care situation has changed for 54.7% of participants and has become more time consuming. For 70.8% of respondents, the COVID-19 pandemic has made it even more difficult to balance care-giving and work. However, most respondents were satisfied with their employers' pandemic management (65.9%). A sharp decline in the quality of life and an increase in the burden of care for informal caregivers was ascertained. Both developments are stronger for young and female caregivers and for those caring for people with a greater need of support., Discussion: The results indicate that living situations worsened for a substantial proportion of informal caregivers during the COVID-19 pandemic. Policymakers should recognize additional challenges that informal caregivers have faced since the outbreak of the COVID-19 pandemic and how they vary by subgroups. It is important to include home-based informal care as well as other care settings in future pandemic concepts., (© 2023. The Author(s).)

The COVID-19 pandemic constitutes an exceptional risk to people living and working in nursing homes (NHs). There were numerous cases and deaths among NH residents, especially at the beginning of the pandemic when no vaccines had yet been developed. Besides regional differences, individual NHs showed vast differences in the number of cases and deaths: while in some, nobody was affected, in others, many people were infected or died. We examine the relationship between facility structures and their effect on infections and deaths of NH residents and infections of staff, while considering the influence of COVID-19 prevalence among the general population on the incidence of infection in NHs. Two nationwide German surveys were conducted during the first and second pandemic waves, comprising responses from n = 1067 NHs. Different hurdle models, with an assumed Bernoulli distribution for zero density and a negative binomial distribution for the count density, were fitted. It can be shown that the probability of an outbreak, and the number of cases/deaths among residents and staff, increased with an increasing number of staff and the general spread of the virus. Therefore, reverse isolation of NH residents was an inadequate form of protection, especially at the beginning of the pandemic.

The COVID-19 pandemic placed the United States of America (U.S.) under enormous strain, leaving it with higher deaths during the first wave of the outbreak compared to all other advanced economies. Blacks and Hispanics were among those hardest hit by the virus-a fact attributed to enduring problems related to the social determinants of health adversely affecting Communities of Color (CoC). In this study, we ask which distinct factors relating to policy stringency and community vulnerability influenced COVID-19 mortality among Whites, Blacks, and Hispanics during the first year of the pandemic. To address this question, we utilized a mix of correlational and regression analyses. Findings point to the highly divergent impact of public policy and vulnerability on COVID-19 mortality. Specifically, we observed that state-led measures aimed at controlling the spread of the virus only improved mortality for Whites. However, pre-existing social determinants of health (i.e., population density, epidemiological and healthcare system factors) played a significant role in determining COVID-19 outcomes for CoC, even in the face of stringent containment measures by states. This suggests that state-led policy to address present and/or future public health crises need to account for the particular nature of vulnerability affecting Blacks and Hispanics in the U.S.

The COVID-19 pandemic severely impacted the social health of nursing home residents with dementia due to social isolation. Consequently, the frequency of Behavioral and Psychological Symptoms in Dementia (BPSD) might increase. Technological solutions might help safeguard the social health of nursing home residents with dementia. This study investigates the impacts of the COVID-19 pandemic on clinical outcomes and the availability of social activities and technology to promote social participation in nursing home residents with dementia. The study analyzed cross-sectional data from a follow-up questionnaire nested in a larger national survey of care facilities in Germany. A mixed-methods approach integrated statistical analyses of closed-ended responses and thematic analysis of free-text responses. A total of 417 valid individual responses were received, showing an overall increase in observed BPSD-with anxiety and depression most frequently occurring. Many nursing homes canceled all social activities for residents with dementia, though a few had established procedures to facilitate social participation using technology. Requirements to promote social participation in this population using technology were identified at the micro-, meso-, and macro levels. Technology requirements permeated all three levels. During and beyond the COVID-19 pandemic, technology-driven solutions to promote social health among nursing home residents with dementia should be integrated into caregiving procedures.

Background: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) constitute rare chronic inflammatory biliary diseases which likely comprise genetic, environmental and autoimmune factors. Specific inhibitory (auto-) antibodies against the muscarinic acetylcholine receptor type 3 (mAChR3 auto-ab) may contribute to the pathogenesis of chronic biliary inflammation by modulating mAChR3- mediated signaling., Aims: The aim of this study was to analyze the prevalence and relevance of inhibitory mAChR3 auto-ab (mAChR3inh+ auto-ab) in a large cohort of PBC patients from two independent tertiary centers in Berlin and Leipzig in comparison to a large PSC cohort. Baseline parameters and response rates to standard treatment with ursodeoxycholic acid (UDCA) were characterized with respect to the individual mAChR3 auto-ab status., Methods: In total, the study population comprised 437 PBC patients, 187 PSC patients and 80 healthy controls. Clinical and laboratory baseline characteristics were retrieved from medical records. The response to ursodeoxycholic acid (UDCA) therapy after 12 months of treatment was available in 176 PBC and 45 PSC patients., Results: The prevalence of mAChR3inh+ auto-ab was significantly higher among PBC patients (11.2%, 49/437; p = 0.008 vs. healthy controls) and PSC patients (33.6%, 63/187; p < 0.0001 vs. healthy controls) compared to healthy controls (2.5%, 2/80), respectively. PBC patients with mAChR3inh+ auto-ab exhibited significantly higher levels of alkaline phosphatase (ALP) and bilirubin, which constitute established parameters for PBC risk stratification. Moreover, mAChR3inh+ PBC patients tended to show decreased response rates to UDCA therapy compared to PBC patients without mAChR3inh+ auto-ab (mAChR3- PBC). In contrast, PSC patients with mAChR3inh+ auto-ab showed no significant differences in laboratory findings compared to mAChR3 auto-ab negative (mAChR3-) PSC patients., Conclusion: MAChR3inh+ auto-ab might be involved in the pathogenesis and treatment response of chronic biliary inflammation in patients with PBC but not in patients with PSC.

Objectives: 1) To detect functionally active antibodies(abs) to the angiotensin II type-1-receptor (AT 1 R) by a novel luminometric assay. 2) To assess their prevalence in systemic sclerosis (SSc), other collagen disorders, as well as in further chronic inflammatory disorders including autoimmune, toxic and chronic viral diseases. 3) To compare these abs with anti-AT1R antibodies by ELISA as well as with antibodies to endothelin-type-A receptors (ET A 1) and to topoisomerase I (topo-I) with respect to their specificity and clinical relevance., Methods: Sera from 98 SSc-patients, 110 patients with other chronic inflammatory rheumatic disorders, 97 patients with autoimmune liver diseases, 57 patients with toxic or chronic viral liver diseases and 36 healthy controls were analyzed. A luminometric bioassay was established with Huh-7-cells constitutively expressing the AT 1 R. Patients' sera were also tested by commercially available ELISA for anti-AT 1 R, -ET A 1- and by an in-house ELISA for anti-topo-I-abs., Results: Fifty-two percent of the SSc-patients had functionally active anti-AT 1 R-abs with stimulatory (34%) or inhibitory capacity (18%). They were present also in up to 59% of patients with other rheumatic diseases but only 22% of healthy individuals (sensitivity 52%, specificity 53%). The functionally active antibodies detected by the luminometric assay did not correlate with anti-AT 1 R-, -ET A 1- or -topo-I-abs measured by ELISA, but there was a strong correlation between anti-topo-I-, AT 1 R-, and -ET A 1-ab reactivity measured by ELISA. Sensitivities of 55%, 28% and 47% and specificities of 66%, 87%, and 99% were calculated for these anti-AT 1 R-, -ET A 1-, and anti-topo-I-abs, respectively. Functionally active abs did not correlate with disease severity or any organ manifestation. In contrast, abs to topo-I, AT 1 R, and ET A 1 were associated with digital ulcers, pulmonary- and esophageal manifestation., Conclusions: Functionally active anti-AT 1 R-abs can be detected in SSc-patients but do not correlate with disease activity. They are not specific for this disease and occur also in other autoimmune disorders and even viral or toxic diseases. Also, the vascular antibodies detected by ELISA are not SSc-specific but correlated with disease manifestations. In contrast, anti-topo-I-abs were confirmed to be a highly specific biomarker for both, diagnosis and organ manifestations of SSc., 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 © 2021 Bankamp, Preuß, Pecher, Beucke, Henes and Klein.)

Recently, local governments experienced unprecedented challenges to their recycling programs and are looking to alternative forms to meet their sustainability goals. Traditionally, waste management policies focus on using a mass-based recycling rate to promote and measure sustainability, however that metric inadvertently promotes recycling over source reduction. Here, we present a metric which measures a community's greenhouse gas (GHG) and energy use footprints for their consumed and end-of-life material streams. Using materials and waste statistics for Florida as an example, we estimated the consumed and discarded masses of 24 materials in 2018. We developed methods and used existing (i.e., WARM, literature) lifecycle assessment data to measure upstream and end-of-life environmental footprints of these materials. The total upstream footprints were approximately 12 and 10 times larger than the end-of-life GHG emissions and energy use footprints, respectively, indicating the need for sustainable materials management application. Mixed paper, cardboard, mixed construction and demolition (C&D) materials had the largest lifecycle footprints. We then use these data to illustrate a method for local governments to apply the alternative metric referred to as the lifecycle footprint reduction target. We demonstrate this target's application in Florida using a hypothetical 20% footprint reduction and provide approaches which focus on increasing the source reduction and recycling potentials of key materials to meet the target. The approaches included a junk mail ban, food donation mandate, cardboard takeback mandate, and building deconstruction mandate and were evaluated for their feasibility in meeting the target; the building deconstruction and the food donation mandate resulted in the greatest and least progress, respectively, toward meeting the target. These approaches provide local government a baseline for continued progress toward SMM application. Implications : Consumer consumption of manufactured products - the packaging for our food and beverages, the products in our homes and offices, the vehicles we drive, and the buildings we live and work in - ultimately must be discarded at the end of their useful life. It is through the management of residential and commercial solid waste that local governments face the consequences of society's materials consumption. Thus, not surprisingly, materials conservation efforts at the government level focus primarily on efforts to recycle waste and divert these materials from landfill disposal. Here we examine a concept whereby local governments - normally charged with collecting and managing residential and commercial waste, and thus setting waste recycling targets - expand their thinking to include all life cycle phases for the materials consumed and discarded in their jurisdiction. In doing so, local governments can now shift from a waste management to a lifecycle-oriented perspective and expand beyond just managing waste to managing materials.

We describe the results of two vaccinations of a self-experimenting healthy volunteer with SARS-CoV-2-derived peptides performed in March and April 2020, respectively. The first set of peptides contained eight peptides predicted to bind to the individual's HLA molecules. The second set consisted of ten peptides predicted to bind promiscuously to several HLA-DR allotypes. The vaccine formulation contained the new TLR 1/2 agonist XS15 and was administered as an emulsion in Montanide as a single subcutaneous injection. Peripheral blood mononuclear cells isolated from blood drawn before and after vaccinations were assessed using Interferon-γ ELISpot assays and intracellular cytokine staining. We detected vaccine-induced CD4 T cell responses against six out of 11 peptides predicted to bind to HLA-DR after 19 days, following vaccination, for one peptide already at day 12. We used these results to support the design of a T-cell-inducing vaccine for application in high-risk patients, with weakened lymphocyte performance. Meanwhile, an according vaccine, incorporating T cell epitopes predominant in convalescents, is undergoing clinical trial testing.

T cell immunity is central for the control of viral infections. To characterize T cell immunity, but also for the development of vaccines, identification of exact viral T cell epitopes is fundamental. Here we identify and characterize multiple dominant and subdominant SARS-CoV-2 HLA class I and HLA-DR peptides as potential T cell epitopes in COVID-19 convalescent and unexposed individuals. SARS-CoV-2-specific peptides enabled detection of post-infectious T cell immunity, even in seronegative convalescent individuals. Cross-reactive SARS-CoV-2 peptides revealed pre-existing T cell responses in 81% of unexposed individuals and validated similarity with common cold coronaviruses, providing a functional basis for heterologous immunity in SARS-CoV-2 infection. Diversity of SARS-CoV-2 T cell responses was associated with mild symptoms of COVID-19, providing evidence that immunity requires recognition of multiple epitopes. Together, the proposed SARS-CoV-2 T cell epitopes enable identification of heterologous and post-infectious T cell immunity and facilitate development of diagnostic, preventive and therapeutic measures for COVID-19.

The SARS-CoV‑2 virus and the associated disease COVID-19 pose major challenges to healthcare systems worldwide. Especially the vulnerable group of people in need of long-term care is at risk of suffering a severe course of the disease or of dying from the infection.In a nationwide cross-sectional study the situation and needs of inpatient and outpatient long-term care facilities during the SARS-CoV‑2 pandemic were assessed and analyzed using an online survey.Participants from 531 institutions postulated the need for uniform recommendations for action on SARS-CoV‑2, adequate and affordable protective and hygiene materials, serial tests in the institutions, well-founded advice on the implementation of interventions, a specific pandemic plan and supporting public relations work by the media. This calls for higher nursing remuneration, better staffing levels and greater appreciation of the nursing profession.In order to protect the vulnerable group of people in need of nursing care from a SARS-CoV‑2 infection, long-term care must be given a stronger focus in health policy measures during the pandemic.

Background and Aims: In primary biliary cholangitis (PBC), antibodies to a peptide of the muscarinic acetylcholine receptor 3 (mAChR3) have been described. Since the mAChR3 is expressed on cholangiocytes and mAChR3-signaling is involved in the pathogenesis of chronic inflammatory biliary diseases, we wanted to investigate whether anti-mAChR3-antibodies influence the function of the receptor and the proliferative response of cholangiocytes. Methods: Immunoglobulins were isolated by ammonium sulfate precipitation using sera from patients with PBC ( n = 63) and with other chronic liver disorders ( n = 150). All immunoglobulins were analyzed by a luminometric assay using Chinese hamster ovary (CHO) cells overexpressing the mAChR3 and cholangiocytes (TFK-1-cells) expressing the receptor constitutively. Cell proliferation was measured by 3 H-thymidine assay. PBC patients were also analyzed in the follow-up. Results: Antibodies inhibiting the mAChR3 were found in 49 and 79% of PBC patients using CHO-cells or TFK-1-cells, respectively, but only in up to 26% of controls ( p < 0.01). Stimulatory antibodies were hardly detected. Antibody reactivity only marginally changed during the course of the disease, independently of the choice of treatment (ursodeoxycholic acid, immunosuppressive therapy, or no medication). There was no correlation with laboratory, clinical or histological parameters, but the antibodies were more frequently found in PBC patients with a benign course (96%) than in patients with active disease progressing to late stages within 10 years (57%; p < 0.01). Proliferation of cells was not influenced by immunoglobulins from PBC-patients. Conclusion: Sera from patients with PBC contain inhibitory antibodies to the mAChR3 on cholangiocytes (TFK-1 cells) without influencing TFK-1-cell proliferation. These antibodies were predominantly observed in patients with non-progressing PBC., (Copyright © 2020 Mayer, Preuss, Grottenthaler, Berg and Klein.)

Care in times of Corona: Results of a cross-sectional study in German home care services Abstract. Background: People in need of care are particularly affected by the COVID-19 pandemic due to their age and previous illnesses. At the same time, a large number of daily contacts between nursing staff and those in need of care increase the risk of transmission of the disease., Aim: The study aims to illustrate (I) to what extent home care services and semi-residential care facilities are affected by COVID-19, (II) human and material resources, (III) the care situation of those in need of care and (IV) the organizational handling of the situation and outline support requests to politicians., Methods: More than 12,000 home-care nursing services and semi-residential care facilities were invited to participate in an online survey with quantitative and qualitative elements, 701 nursing services (response rate 7,3 %) and 96 semi-residential facilities (response rate 3,5 %) took part., Results: Almost a third (30,1 %, 189 / 627) of the nursing services surveyed are affected by confirmed or suspected cases of COVID-19 among clients. About half of the services report a reduced use of SGB V (47,6 %, 288 / 605) or SGB XI services (59,7 %, 375 / 628). Two thirds of the semi-residential facilities (65,6 %, 63 / 96) say they are currently closed due to the pandemic. Likewise, half of the nursing services (45,8 %, 253 / 552) reported that care with reduced use of services was at risk / unstable or even not ensured., Conclusions: The results show that the situation of care-dependent people served by home-care services in the present pandemic - and also with a view to a possible second wave - should receive increased attention particularly with regard to unstable / risky care arrangements.

Long-term care during the Corona pandemic - Main results from a nationwide online survey in nursing homes in Germany Abstract. Background: As a highly vulnerable group, people in need of long-term care are particularly affected by the COVID-19 pandemic. Due to their care-dependency, measures of social distancing can only be carried out to a very limited extent. In addition, the social and health consequences of reduced contacts are particularly high for nursing home residents., Aim: The study aims to describe the extent to which nursing homes are affected, the human and material resources of nursing homes, the organizational handling of the situation, and their requests for public support., Methods: More than 7,000 nursing homes were invited to participate in an online survey with quantitative and qualitative elements. Data analysis applies descriptive statistics., Results: 824 nursing homes participated in the survey. One in five nursing homes has at least one confirmed case of SARS-CoV-2 among its residents and / or employees. The initial lack of protective equipment has now decreased, but the facilities still have to cope with additional corona-related care needs with reduced staff. Nursing homes have banned contacts between residents and relative to an extent that now has to be reduced again. Nursing homes demand the provision and external financing of protective equipment as well as the systematic and regular testing of nursing staff and the provision of uniform guidelines for action throughout Germany., Conclusions: As about half of all deceased people with COVID-19 have been living in nursing homes, the support of nursing homes in their attempt to restrict the pandemic requires highest attention.

In coastal areas, demographic increase is likely to result in greater numbers of recreational users, with potential consequences on marine biodiversity. These effects may also occur within Marine Protected Areas (MPAs), which are popular with recreational users. Our analysis builds on data collected over a ten-year period during three year-round surveys to appraise changes in recreational boating activities in coral ecosystems. Results show that the number of boaters has greatly increased, particularly so within MPAs during weekends and the warm season, when peaks in boat numbers have become more frequent. We also observed that the number of anchored boats has increased over the period. These changes may be resulting in biophysical impacts that could be detrimental to conservation objectives in MPAs. This steady increase over time may cause changes in the spatial and temporal distribution of users and in their practices, thus highlighting the importance of monitoring recreational activities., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Aims: Recently, a non-M2-related mitochondrial 60 kDa protein found to be recognized by antimitochondrial antibody (AMA) negative sera from patients with primary biliary cirrhosis (PBC) has been shown to contain parts of the five F(1)-ATPase subunits α, β, γ, δ and ε. In this study, we examined whether this enzyme is, indeed, a target antigen in PBC., Methods: Analysed were 60 AMA-positive/anti-M2-negative and 103 anti-M2-positive PBC patients, 46 patients with autoimmune hepatitis (AIH), 35 patients with primary sclerosing cholangitis (PSC), 110 patients with viral hepatitis, 40 patients with inflammatory bowel diseases (IBD), 33 patients with connective tissue diseases (systemic lupus erythematosus, mixed connective tissue disease, Sjögren disease, systemic sclerosis) and 25 blood donors. The F(1)-ATPase-subunits α-δ were recombinantly expressed in Escherichia coli, purified and applied to ELISA and Western blotting., Results: In all, 40 of the 60 AMA-positive/anti-M2-negative (67%) and 44 (43%) of the 103 anti-M2-positive PBC-sera reacted with at least one of the F(1)-subunits α-δ. The β- and γ-subunits were preferentially recognized. However, also up to 57% of patients with AIH and 34% of patients with PSC had anti-β- or γ-antibodies, while patients with viral hepatitis had these antibodies in up to 13%. Patients with IBD had anti-β and anti-γ-antibodies in up to 20 and 5% respectively. None of the patients with connective tissue diseases had antibodies to the β- and only 6% to the γ-subunit. Sera from healthy blood donors were negative., Conclusions: Antibodies to the β- and γ-subunits of F(1)-ATPase are further AMAs in PBC but occur also in other autoimmune liver disorders; they may be, therefore, indicators for a general autoimmune process of the liver., (© 2011 John Wiley & Sons A/S.)