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Objective.—Explore the impact of proactive outreach to a health plan population during COVID-19 pandemic in New Mexico. Background.—By March 2020, the 2019 novel coronavirus (COVID-19) was a global pandemic, circulating in more than 114 countries. As more information about virus transmission, symptoms, and comorbidities were reported over time, recommendations for reducing the spread of the virus within communities was provided by leading health organizations like the Centers for Disease Control and Prevention (CDC). Methods.—Criteria were developed to identify health plan members most at risk for virus complications. Once members were identified, a health plan representative contacted each member to inquire about member needs, questions, and provide them with resources. Members were then tracked for COVID-19 testing results and vaccination status. Results.—Overall, 50,000+ members received an outreach call (during 8-month timeframe), and 26,000 calls were tracked for member outcomes. Over 50% of the outreach calls were answered by the health plan member. Of the members who were called, 1186 (4.4%) tested positive for COVID-19. Health plan members that could not be reached represented 55% of the positive cases. A chi-square test of the two populations (reached vs unable to reach) showed a significant difference in COVID-19 positive test results (N = 26,663, X2(1) = 16.33, P Conclusions.—Community outreach was related to lower rates of COVID-19. Community connection is important, especially in tumultuous times, and proactive outreach to the community provides an opportunity for information sharing and community bonding.

Akute oder chronische Rötungen der Unterschenkel sind ein häufiger Vorstellungsgrund in Kliniken und Praxen und stellen oftmals eine differenzialdiagnostische Herausforderung dar. Ziel dieser Leitlinie ist es, Kriterien und Vorgehensweisen für die Differenzialdiagnose akuter oder chronischer, uni- oder bilateraler Rötungen der Unterschenkel festzulegen. Eine korrekte Diagnosestellung ist essenziell, um die adäquate Therapie auszuwählen und den nicht indizierten Einsatz von Antibiotika zu reduzieren. Von der Leitliniengruppe wurden die relevantesten Differenzialdiagnosen identifiziert: (1.) Erysipel, (2.) Stauungsdermatitis, (3.) hypererge Ictusreaktion, (4.) oberflächliche und tiefe Beinvenenthrombose, (5.) Gicht, (6.) chronisch allergisches Kontaktekzem und (7.) akutes toxisches beziehungsweise allergisches Kontaktekzem. Für diese sieben Diagnosen wurden Algorithmen beziehungsweise Diagnosepfade zum diagnostischen Vorgehen, die jeweils in Anamnese, klinische Untersuchung und apparative Diagnostik aufgegliedert sind, entwickelt. Darüber hinaus hat die Leitliniengruppe mindestens 40 weitere Differenzialdiagnosen gesammelt und spezifische Charakteristika zur differenzialdiagnostischen Abgrenzung tabellarisch gegenübergestellt.

In Europe, North America, and Australia, 5% to 10% of the population are now classified as penicillin (β-lactam) allergic. Only ~ 10% of these questionable diagnoses, mostly made in childhood, can be confirmed by allergy diagnostics.The aim of this review is to show causes and consequences as well as recommendations for dealing with the often questionable diagnosis of penicillin (β-lactam) allergy (BLA).An incorrect BLA diagnosis may negatively impact antibiotic treatment needed in the future, by using a less effective antibiotic or using a broad-spectrum antibiotic, for example, further exacerbating the problem of increasing antibiotic resistance. Accordingly, there is growing pressure from antibiotic stewardship programs to critically challenge the BLA diagnosis. Conservatively, a suspected BLA is reviewed by an allergist using medical history, skin testing, laboratory testing, and provocation. This clarification is costly and is not remunerated in the German health care system; that is the reason why this testing is only offered in a few specialized clinics and practically not at all in general practice. In view of thousands of affected patients, additional strategies are needed to treat patients with a low risk of hypersensitivity reaction despite suspected allergy with a β-lactam antibiotic. In recent years, various methods have been proposed to eliminate suspected allergy as promptly as possible and directly before necessary treatment with a β-lactam antibiotic, including standardized history (also in the form of an algorithm), skin test with immediate reading after 15 minutes, or administration of a small test dose. Investigations of small case series and also multi-center studies to date have yielded promising results in terms of feasibility and safety.Of the large number of patients with (questionable) BLA, most have never been tested and - if antibiotic treatment becomes necessary - simply receive an alternative antibiotic. The diagnosis of BLA therefore requires new approaches besides classical allergy testing to critically question BLA.

Microplastic (MP) pollution is an important challenge for human life which has consequently affected the natural system of other organisms. Mismanagement and also careless handling of plastics in daily life has led to an accelerating contamination of air, water and soil compartments with MP. Under estuarine conditions, interactions with suspended particulate matter (SPM) like fine sediment in the water column play an important role on the fate of MP. Further studies to better understand the corresponding transport and accumulation mechanisms are required. This paper aims at providing a new modeling approach improving the MP settling velocity formulation based on higher suspended fine sediment concentrations, as i.e. existent in estuarine turbidity zones (ETZ). The capability of the suggested approach is examined through the modeling of released MP transport in water and their interactions with fine sediment (cohesive sediment/fluid mud). The model results suggest higher concentrations of MP in ETZ, both in the water column as well as the bed sediment, which is also supported by measurements. The key process in the modeling approach is the integration of small MP particles into estuarine fine sediment aggregates. This is realized by means of a threshold sediment concentration, above which the effective MP settling velocity increasingly approaches that of the sediment aggregates. The model results are in good agreement with measured MP mass concentrations. Moreover, the model results also show that lighter small MP particles can easier escape the ETZ towards the open sea.

An extensive field campaign, the Ems-Dollard Measurements (EDoM), was executed in the Ems Estuary, bordering the Netherlands and Germany, aimed at better understanding the mechanisms that drive the exchange of water and sediments between a relatively exposed outer estuary and a hyper-turbid tidal river. More specifically, the reasons for the large up-estuary sediment accumulation rates and the role of the tidal river on the turbidity in the outer estuary were insufficiently understood. The campaign was designed to unravel the hydrodynamic and sedimentary exchange mechanisms, comprising two hydrographic surveys during contrasting environmental conditions using eight concurrently operating ships and 10 moorings measuring for at least one spring–neap tidal cycle. All survey locations were equipped with sensors measuring flow velocity, salinity, and turbidity (and with stationary ship surveys taking water samples), while some of the survey ships also measured turbulence and sediment settling properties. These observations have provided important new insights into horizontal sediment fluxes and density-driven exchange flows, both laterally and longitudinally. An integral analysis of these observations suggests that large-scale residual transport is surprisingly similar during periods of high and low discharge, with higher river discharge resulting in both higher seaward-directed fluxes near the surface and landward-directed fluxes near the bed. Sediment exchange seems to be strongly influenced by a previously undocumented lateral circulation cell driving residual transport. Vertical density-driven flows in the outer estuary are influenced by variations in river discharge, with a near-bed landward flow being most pronounced in the days following a period with elevated river discharge. The study site is more turbid during winter conditions, when the estuarine turbidity maximum (ETM) is pushed seaward by river flow, resulting in a more pronounced impact of suspended sediments on hydrodynamics. All data collected during the EDoM campaign, but also standard monitoring data (waves, water levels, discharge, turbidity, and salinity) collected by Dutch and German authorities are made publicly available at 4TU Centre for Research Data (https://doi.org/10.4121/c.6056564.v3; van Maren et al., 2022).

Die Relevanz der unterschiedlichen landseitigen Mikroplastikeinträge für die Verschmutzung der Meere ist bisher noch weitgehend unklar. Trotzdem hat die Kontamination der terrestrischen Umwelt erhebliches öffentliches Interesse erlangt. Besonders die deutliche Medienpräsenz dieses Umweltthemas verursachte in jüngster Zeit Forderungen nach politischer Regulation der Mikroplastikeinträge in die Umwelt. In der öffentlichen Wahrnehmung spielt die Landwirtschaft als Verursacherin eine übergeordnete Rolle. Um jedoch eine Sachbasis zu schaffen, ist es notwendig, in einer systemübergreifenden Betrachtung sämtliche Quellen und Eintragspfade sowie deren mengenmäßige Relevanz für die Verschmutzung mit Mikroplastik zu erfassen. Mit dem Ziel einer ökosystemübergreifenden Quantifizierung der Mikroplastikeinträge und -migrationspfade vom Land bis ins Randmeer wurde im Rahmen des Projektes PLAWES (Mikroplastikkontamination im Modellsystem Weser - Nationalpark Wattenmeer) der Modellverbund MOMENTUM entwickelt. Durch die Verknüpfung dreier unabhängiger, für Mikroplastik angepasster Modelle - RAUMIS-MP, mGROWA+TeMBa und FSK-MPTP - wurde ein Modellsystem-Prototyp entwickelt, der erstmalig relevante Quellen und Migrationspfade in einem Flusseinzugsgebiet und dem Mündungsbereich modellhaft abbildet. Berücksichtigt wurden dabei Emissionen auf landwirtschaftliche Flächen und der diffuse Austrag von diesen in Oberflächengewässer, atmosphärische Deposition auf die terrestrische Umwelt, Einträge aus Punktquellen in das Flusssystem und Ästuar sowie dreidimensionale Partikelbewegungen und deren Wechselwirkung mit Mikroorganismen und Feinsediment im Küstenbereich. Die Ergebnisse der Modellierung sind in weiten Teilen als exemplarisch anzusehen, da sie, bedingt durch noch sehr lückenhafte Eingangsdatensätze, mit großen Unsicherheiten behaftet sind. Dennoch belegt die Anwendung des MOMENTUM-Modellsystems im Flusssystem Weser die Funktionstüchtigkeit des Modellsystems zur Abschätzung des gesamten Mikroplastikmassenflusses im Einzugsgebiet und Ästuar. Die Modellkette wurde zudem so konzipiert, dass sie leicht auf andere Regionen übertragbar ist und neue Datengrundlagen integriert werden können. Durch erste Abschätzungen der Mikroplastikeinträge und Stoffflüsse unterstützen die Modelle die zielgerichtete Datenerhebung, was besonders in Anbetracht der aufwendigen Analytik wichtig ist. Die Möglichkeit der flächendeckenden Einbeziehung sämtlicher Eintragsquellen, -pfade und Prozesse trägt - komplementär zur Probenanalytik - zur Verbesserung des Gesamtsystemverständnisses bei und bildet die Grundlage für Politikberatung und Maßnahmenentwicklung. The relevance of different land-based microplastic inputs to marine pollution is still largely unclear. Nevertheless, the contamination of the terrestrial environment has gained considerable public interest. In particular, the high media presence of this environmental issue reinforces calls for policy regulation of microplastic inputs to the environment. In the public perception, agriculture plays a predominant role as a polluter. However, in order to create a factual basis, it is necessary to record all sources and input pathways as well as their quantitative relevance for microplastic pollution in a system-overarching view. With the aim of an ecosystem-wide quantification of microplastic inputs and migration pathways from the land to the marginal sea, the model network MOMENTUM was developed within the PLAWES project. By linking three independent models adapted for microplastics, RAUMIS-MP, mGROWA+TeMBa, and FSK-MPTP, a model system prototype was developed, which for the first time models relevant sources and migration pathways in a river basin and the estuary. Emissions to agricultural land and diffuse discharge to surface waters, atmospheric deposition to land surfaces, point source inputs to the river system and estuary, and three-dimensional particle movement and their interaction with microorganisms and fine sediment in the coastal zone were considered. The results of the modeling are to be considered exemplary in large parts, since they are subject to large uncertainties due to still very incomplete input data sets. Nevertheless, the application of the MOMENTUM model system in the Weser river system proves the functional capability of the model to estimate the total microplastic mass flux in the catchment and estuary. The model chain was designed to be easily transferable to other regions and to integrate new data sets. By providing initial estimates of microplastic inputs and mass fluxes, the models support targeted data collection, which is highly relevant, especially given the complexity of microplastics analytics. The possibility to include all input sources, pathways and processes over a wide spatial extent contributes - complementary to sample analysis - to the improvement of the overall system understanding and forms the basis for policy advice and development of mitigation measures.