Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy.

PURPOSE: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment. MATERIALS AND METHODS: A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria. RESULTS: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy. CONCLUSIONS: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.

Instagranimal: Animal Welfare and Animal Ethics Challenges of Animal-Based Tourism.

By animal-based tourism, a host of activities offering passive viewing or active interaction with wild, semi-wild or captive animals is included. The multibillion dollar industry is on the rise globally today, offering modes of engagement with animals that trade on increasingly embodied close encounters with non-human animals. As new modes of animal-based tourism proliferate, such as sloth selfies, visiting cat cafes, swimming with sharks and agri-tourism petting zoos, animal welfare standards risk deteriorating. In the following paper, we collate concerns over animal welfare into a discussion on the challenges facing animal-based tourism. Our synthesis is the first to consider the full spectrum of such animal-based tourism: across agri-, hunting, zoo and safari tourism, to name a few, and crossing consumptive and non-consumptive boundaries. A literature review is first provided. Findings are then presented thematically following workshops at an international interdisciplinary symposium of leading tourism, animal welfare, ethics and leisure sciences scholars together with practitioners of the industry. It discusses macrolevel drivers to animal-based tourism as an industry, the problem of cultural relativism and the role of technology in enhancing or promoting the experience. We indicate ways forward toward implementing a compassionate animal-based tourism.