“New” cyanobacterial blooms are not new: two centuries of lake production are related to ice cover and land use

Recent cyanobacterial blooms in otherwise unproductive lakes may be warning signs of impending eutrophication in lakes important for recreation and drinking water, but little is known of their historical precedence or mechanisms of regulation. Here, we examined long-term sedimentary records of both general and taxon-specific trophic proxies from seven lakes of varying productivity in the northeastern United States to investigate their relationship to historical in-lake, watershed, and climatic drivers of trophic status. Analysis of fossil pigments (carotenoids and chlorophylls) revealed variable patterns of past primary production across lakes over two centuries despite broadly similar changes in regional climate and land use. Sediment abundance of the cyanobacterium Gloeotrichia, a large, toxic, nitrogen-fixing taxon common in recent blooms in this region, revealed that this was not a new taxon in the phytoplankton communities but rather had been present for centuries. Histories of Gloeotrichia abundance differed strikingly across lakes and were not consistently associated with most other sediment proxies of trophic status. Changes in ice cover most often coincided with changes in fossil pigments, and changes in watershed land use were often related to changes in Gloeotrichia abundance, although no single climatic or land-use factor was associated with proxy changes across all seven lakes. The degree to which changes in lake sediment records co-occurred with changes in the timing of ice-out or agricultural land use was negatively correlated with the ratio of watershed area to lake area. Thus, both climate and land management appeared to play key roles in regulation of primary production in these lakes, although the manner in which these factors influenced lakes was mediated by catchment morphometry. Improved understanding of the past interactions between climate change, land use, landscape setting, and water quality underscores the complexity of mechanisms regulating lake and cyanobacterial production and highlights the necessity of considering these interactions—rather than searching for a singular mechanism—when evaluating the causes of ongoing changes in low-nutrient lakes

Researching COVID to Enhance Recovery (RECOVER) Pregnancy Study: Rationale, Objectives and Design

IMPORTANCE: Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. METHODS: RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. DISCUSSION: RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. CLINICAL TRIALS.GOV IDENTIFIER: Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011

Researching COVID to Enhance Recovery (RECOVER) Adult Study Protocol: Rationale, Objectives, and Design

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

IMPORTANCE: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC

Monitoring for toxic contaminants in Mytilus edulis from New Hampshire and the Gulf of Maine

Gulfwatch is an international monitoring program that uses Mytilus edulis as the sentinel species for habitat exposure to toxic contaminants in the Gulf of Maine. Since 1991, the Gulfwatch program has measured the concentrations of 10 trace metals, 17 chlorinated pesticides, 24 polynuclear aromatic hydrocarbons (PAHs), and 24 polychlorinated biphenyl (PCB) congeners in mussel tissue from over 60 sites throughout the Gulf of Maine. In 1998, the Gulfwatch program included a more intensive survey of sites in New Hampshire. Of the 21 sites sampled in the Gulf in 1998, six sites were sampled in New Hampshire and the other 15 sites were in Nova Scotia, New Brunswick, Maine, and Massachusetts. Results for the Gulfwide program showed a southward trend of increasing concentrations for organic contaminants and Ag, Cr, and Pb, reflecting major local and regional pollution sources. The distribution of the remaining trace metals was more uniform, without obvious impacts from the more heavily urbanized areas of the southern gulf. At some sites there appears to be localized hot spots for a variety of contaminants. Gulfwide geometric mean (GM) concentrations were lower than GM +85% confidence level (CL) concentration for the NOAA National Status and Trends (NS&T) Mussel Watch program, except for Hg. Two sites had Pb concentrations that exceeded U.S. FDA guideline levels. While Hg concentrations did not exceed the U.S. FDA action concentration at any site, the NS&T GM +85% CL was exceeded at all 1998 Gulfwatch sites. The spatially intensive New Hampshire program has been useful in identifying local sources of contaminants and determining the significance of mussel exposure to oil from chronic discharges and larger spills. Similar to comparisons between Gulfwatch and NS&T data, interpretation of New Hampshire results benefit from comparisons to the greater Gulfwatch program

Gulfwatch: Monitoring Spatial and Temporal Patterns of Trace Metal and Organic Contaminants in the Gulf of Maine (1991–1997) with the Blue Mussel, Mytilus edulis L

Gulfwatch, established in 1991, is an international contaminant monitoring program in which the blue mussel, Mytilus edulis, is used as an indicator of the level and extent of contamination in the Gulf of Maine. Since 1991, trace metals, PAHs, PCBs, and OC pesticides have been measured in mussel tissues at 56 sites. The distribution of most metals was relatively uniform throughout the Gulf with the exception of Ag, Pb and Cr. However, the concentration of organic contaminants increased in a north-to-south direction. High concentrations of contaminants were correlated with large human population density and proximity to large rivers. Temporal analysis of five sites revealed that the majority of contaminant concentrations were either unchanged or decreasing. The concentrations of most contaminants were lower than the median of the National Status and Trends (NS & T) Mussel Watch with the exceptions of Cr, Hg, Pb and ∑PCB24. Hg concentrations at \u3e80% of the Gulfwatch sites exceeded the NS & T median + 1 SD. Gulfwatch continues as a primary contaminant monitoring program in the Gulf of Maine