ASYNCHRONOUS TELECONSULTATION BY WHATSAPP CHATBOT IN CONTROLLED AXIAL SPONDYLOARTHRITIS PATIENTS UNDER BIOLOGICAL THERAPY: PATIENTS' PERSPECTIVE

BackgroundBefore COVID pandemic, rheumatologists were not confident with telehealth for the need to adquire new technology, need of specific training and poorer reimbursement [1]. Two groups of rheumatoid arthritis (RA) patients have been identified in a study of PROMS-based telehealth use (2): the keen and the reluctant. We proposed teleconsultation followup with a whatsapp platform chatbot to our axial spondyloarthritis (AxSPA) patients with controlled disease and we asked them for preferences at the end of the study.ObjectivesTo explore the degree of acceptance of asynchronous telehealth followup with whatsapp platform chatbot among our controlled AxSPA patients under biological therapy, and to search for a patient profile more prone to telehealth consultation.MethodsA prospective study with retrospective control was performed, chosing AxSPA patients under biological therapy with stable disease, visited in our centre from 01/01 to 30/11/2021. We recruited 62 patients, but finally include 60 (2 quit for home moving or personal reasons). We offered them two teleconsultation visits (using their personal mobile), every four months, and a presential final visit one year after inclusion. The chatbot sends PROMS (BASDAI, VAS for patient global disease assessment, ASDAS, and 3 questions for extraarticular disease), and feedback and schedule for the following visits. In the case of lab test or PROMs deviation or when the patient asks for contact, he/she is phoned by nurse/doctor who solves the question and/or arranges an additional presential visit. We collect patient and disease characteristics (age, gender, educational level, employment, disease activity, duration and treatments), and patient´s satisfation and preferences in the final visit.ResultsWe included 60 patients (83,3% men), mean aged 48,22 years (SD 12,128), 36% under 45 years at inclusion. 27% had received primary, 33.9% secondary and 39% tertiary education. 83.3% were active working and only 10 patients were jobless or retired. They were Ankylosing Spondylitis (AS) (90%), HLA B27 positive (85%) with longstanding disease (mean 23 years, SD 12,8), and were receiving the first (71%), or the second (23%) biological therapy (51,7% tapered anti-TNF). 50% were never smokers and 70% presented no remarkable comorbidity;25% presented peripheral impairment, and over 40% extraarticular manifestations.At inclusion 93,3% were at remission/LDA by ASDAS/BASDAI-RCP and 4 patients were considered clinically controlled in spite of higher scores. At followup 3 patients with reduced dose needed to increase to standard dose of biological drug, with no other need of treatment change. There was no worsening from basal to final visits according BASDAI, BASFI, ASDAS-RCP or AsQOL.Patients final VAS score (1-10) assessment of telehealth consultation was very high: mean 9,14 (DS 1,498);91.7% ≥ 8 and 76.7% ≥ 9.83,3% preferred telehealth followup. There was a trend towards telehealth preferences in higher educational levels, and active working (86% vs 70%) but not statistically significant. We found no correlation with gender, age and disease characteristics tested.ConclusionAsynchronous teleconsultation seems promising, not inferior to presential consultation and preferred for follow-up by our AxSpa patients with stable disease with biological drugs. We met some "reluctant patients”, that were more inactive working and with lower educational levels, but the differences were not significant. Further reserarch is needed with this telehealth model in other age and disease populations (RA), in order to characterize the reluctant and keen patients.References[1]Muehlensiepen F, et al. Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study. J Med Internet Res. 2021 Mar 29;23(3):e23742.[2]Knudsen LR, et al. Experiences With Telehealth Followup in Patients With Rheumatoid Arthritis: A Qualitative Interview Study. Arthritis Care Res (Hoboken). 2018 Sep;70(9):1366-1372.AcknowledgementsGrupo INNOBIDE.Disclosure of I terestsNone Declared.

ASYNCHRONOUS TELECONSULTATION BY WHATSAPP CHATBOT IN CONTROLLED AXIAL SPONDYLOARTHRITIS (SPA) PATIENTS UNDER BIOLOGICAL THERAPY: CLINICAL RESULTS OF A SINGLE CENTER

BackgroundThe use of telehealth in the control of rheumatic diseases had been scarce, but COVID pandemic forced to try alternatives to classic face-to-face consultation, and an overflow of telehealth consultations appeared, mainly synchronous (phone, video calls), and finally asynchronous. We try to demonstrate that asynchronous WhatsApp teleconsultation is a good alternative, at least for followup of patients that find it difficult to attend face-to-face visits. We chose axial spondyloarthritis (AxSPA) patients under biological therapy with controlled disease and we proposed teleconsultation with a WhatsApp platform chatbot created for this purpose. The chatbot sends PROMS (BASDAI, VAS for patient global disease assessment, ASDAs, and 3 questions for extraarticular disease), and receive feedback and schedule for the following visits.ObjectivesTo prove that teleconsultation through WhatsApp platform is not inferior to face-to-face consultation in terms of maintaining axial SPA patients disease controlled.MethodsProspective study with retrospective control of patients diagnosed of Axial SPA, fulfilling ASAS criteria and with stable disease under biological therapy for the previous year, recruited from 01 jan to 30 nov 2021. We recruited 62 patients, but two of them gave up (personal reasons, one moved to other region), so we finally include 60 patients. We offer them two teleconsultation visits with their personal mobile device, every four months, and a face-to-face final visit one year after inclusion. In the case of lab test or PROMs deviation or when the patient asks for contact (possible via WhatsApp) he/she is called up by the person in charge (nurse/doctor) that solves the question and arranges an additional presential visit if needed. We consider disease controlled if BASDAI <4, ASDAS < 2,1 or if in rheumatologist´s opinion there is no need to change treatment. We collect patient and disease information (age, gender, employment, characteristics of the disease, previous and actual treatment), activity (BASDAI, PCR, ASDAS), physical function (BASFI), and Quality of life (AsQol).Results60 patients (50 men, 83,3%) were included, mean aged 48,22 years (SD 12,128), 36% were under 45 years at the time of inclusion. They were mostly Ankylosing Spondylitis (AS) (90%;only 6 non radiographic SPA), positive HLA B27 (85%) and with longstanding disease (mean 23 years, SD 12,8), and only 6 patients less than five years. 25% had peripheral impairment (arthritis/dactylitis/enthesitis), and more than 40% presented extraarticular manifestations, mainly psoriasis (26,7%) and uveitis (21%)71,7% were under their first biological (TNF inhibitor, mostly adalimumab), 23,3% were refractory to the first, and 3 patients to at least two biologicals. 51,7% of patients were treated with tapered dose of TNF inhibitors. At inclusion 93,3 % presented remission/LDA by ASDAS/BASDAI-RCP. Only 4 patients included presented higher activity scores but were considered clinically controlled.Table 1.We did not find meaningful clinical differences between basal to final visits in BASDAI, BASFI, ASDAS-RCP or AsQOL.3 patients with reduced dose of biological drug needed to increase to standard dose with no other need to treatment adjustment.ConclusionWe consider asynchronous teleconsultation is promising, and not inferior to face to face consultation in terms of keeping disease control and quality of life, especially for follow-up in patients with stable rheumatic disease, The clinical results presented here are consistent with this considerations.AcknowledgementsGrupo INNOBIDE.Disclosure of InterestsNone Declared.

Impacto clínico de cumplimentar un protocolo de tratamiento nutricional en pacientes críticos afectados por SARS-COV2 The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-COV2 infection

INTRODUCCIÓN: El paciente critico afecto por SARS-COV2 tiene riesgo de desnutrición. La necesidad de evitar la sobrecarga de volumen y las maniobras que retrasan alcanzar los requerimientos nutricionales como la pronación hacen que el abordaje nutricional de estos pacientes sea complejo. Para asegurar un tratamiento adecuado, se desarrolló un protocolo de soporte nutricional como guía de práctica clínica adaptado al paciente COVID19. OBJETIVO: Describir el protocolo de soporte nutricional creado en nuestro centro, el cumplimiento del mismo y analizar los resultados de su aplicación en los pacientes afectos de SARS-CoV2, ingresados en la unidad de cuidados intensivos (UCI) del Consorcio Hospital General Universitario de Valencia (CHGUV) de Marzo a Mayo del 2020. MATERIAL Y METODOS: Diseño observacional, descriptivo, retrospectivo y longitudinal para evaluar el cumplimiento de un protocolo de soporte nutricional. RESULTADOS Se incluyeron 31 pacientes. No se puede establecer un seguimiento nutricional en ocho pacientes. De los 23 pacientes restantes, ocho alcanzan el 80% de los requerimientos calóricos antes del décimo día tras el inicio del tratamiento (grupo buen cumplimiento) y quince a partir del undécimo día (grupo mal cumplimiento). El grupo con buen cumplimiento obtuvo 75% (n=6) curación y 25% éxitus (n=2), en comparación al grupo con ¨mal cumplimiento¨ donde un 53% (n=8) se fueron de alta a planta respecto un 47% (n=7) que fallecieron (Chi square test, p-value 0.019). Aquellos pacientes que alcanzaron el 80% de las necesidades calóricas en algún momento del ingreso en UCI tuvieron menor duración de ingreso frente a los que no lo alcanzaron (mediana días ingreso 14, IQR 10-16 y mediana días ingreso 22, IQR 13-39, p-valor=0.025). CONCLUSIONES La creación de un protocolo nutricional durante las primeras semanas de la pandemia por SARS-COV2 podría estar asociada con una mejoría de los resultados clínicos al favorecer la curación y disminuir las complicaciones asociadas.

[Acute disseminated encephalomyelitis associated with SARS-CoV-2 infection without respiratory compromise]. / Encefalomielitis aguda diseminada asociada a infección por el SARS-CoV-2 sin afectación respiratoria.

INTRODUCTION: COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to grow all over the world since december of 2019. Although the main clinical manifestation is pulmonary disease, neurological manifestations are a prominent and increasingly recognized feature of the disease. The Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune disorder, most commonly triggered by a viral infection. There are a few case reports of ADEM associated with COVID-19, almost all of them associated pulmonary disease. We report the case of a young patient with diagnosis of ADEM with SARS-CoV-2 infection without clinical respiratory symptoms. CASE REPORT: A 20-year-old woman with no relevant medical history was brought to the emergency department with a progressive confusional state lasted for 7 days. Family reported the development of smell and taste deficit since two weeks before the onset of neurological symptoms. There were no complaints of pulmonary symptoms. At admission, she was drowsy and disoriented. Left homonymous hemianopsia and an ipsilateral Babinski sign was identified. A brain magnetic resonance image was done showing multiple hyperintense bilateral, asymmetric patchy and poorly marginated lesions with gadolinium enhancement. She was SARS-CoV-2 PCR positive on nasopharyngeal swab. Intravenous high-dose glucocorticoids were administered with marked clinical improvement. CONCLUSION: ADEM is an extremely uncommon complication of SARS-CoV-2infection. Acute disseminated encephalomyelitis should be considered a potentially treatable cause of encephalopathy or multifocal neurological deficits in COVID-19 patients, even in the absence of respiratory symptoms.

TITLE: Encefalomielitis aguda diseminada asociada a infección por el SARS-CoV-2 sin afectación respiratoria.Introducción. COVID-19 (coronavirus disease-2019) es la enfermedad secundaria a la infección por el coronavirus de tipo 2 o SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2), que se ha constituido como pandemia desde diciembre de 2019. Si bien la afectación más frecuente y grave es la pulmonar, las complicaciones neurológicas secundarias a la COVID-19 son cada vez más reconocidas. La encefalomielitis aguda diseminada (EMAD) es una enfermedad autoinmune poco frecuente, clásicamente secundaria a una infección viral previa o concomitante. Existen informes de EMAD asociada a la COVID-19, casi todos con afectación respiratoria asociada. Presentamos el caso de una mujer joven diagnosticada con EMAD secundaria a la infección por el SARS-CoV-2 sin afectación respiratoria. Caso clínico. Mujer de 20 años que consultó por cuadro de desorientación y alteración conductual de una semana de evolución. Destaca en la historia la presencia de anosmia y sensación febril dos semanas antes del inicio de los síntomas neurológicos. En el examen físico destacó somnolencia, desorientación, hemianopsia homónima izquierda y síndrome piramidal ipsilateral. Se realizó una resonancia magnética encefálica que mostró múltiples lesiones inflamatorias desmielinizantes bihemisféricas de la sustancia blanca sugerentes de EMAD. La reacción en cadena de la polimerasa del SARS-CoV-2 en aspirado nasofaríngeo resultó positiva. Se descartaron otras causas de lesiones inflamatorias. Recibió esteroides con excelente respuesta. Conclusión. La EMAD es una complicación extremadamente rara en pacientes con COVID-19 que debe considerarse como una causa tratable de encefalopatía y/o déficits neurológicos multifocales en pacientes con infección activa o reciente por SARS-CoV-2 con o sin manifestaciones respiratorias.

[The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection]. / Impacto clínico de cumplimentar un protocolo de tratamiento nutricional en pacientes críticos afectados por SARS-CoV-2.

Introduction: The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. Objective: To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. Material and methods: Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. Results: Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance¼ 75% (n = 6) were discharged and 25% died (n = 2), compared to the group with «bad compliance¼ where 53% (n = 8) were discharged and 47% (n = 7) died (Chi square test, p-value = 0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission = 14, IQR = 10-16 and median days of admission = 22, IQR = 13-39, p-value = 0.025). Conclusions: Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.

PLASMA LIPIDS AND AMINO ACIDS LINKED TO LOW SARS-CoV-2 SUSCEPTIBILITY

Background: The mechanisms driving SARS-CoV-2 susceptibility remain poorly understood, especially the factors determining why a subset of unvaccinated individuals remain uninfected despite high-risk exposures. Method(s): We studied an exceptional group of unvaccinated healthcare workers heavily exposed to SARS-CoV-2 ('nonsusceptible') from April to June 2020, who were compared against 'susceptible' individuals to SARS-CoV-2, including uninfected subjects who became infected during the follow-up, and hospitalized patients with different disease severity providing samples at early disease stages. We analyzed plasma samples using different mass spectrometry technique and obtained metabolites and lipids profiles. Result(s): We found that the metabolite profiles were predictive of the selected study groups and identified lipids profiles and metabolites linked to SARS-CoV-2 susceptibility and COVID-19 severity. More importantly, we showed that non-susceptible individuals exhibited unique metabolomics and lipidomic patterns characterized by upregulation of most lipids -especially ceramides and sphingomyelin-and amino acids related to tricarboxylic acid cycle and mitochondrial metabolism, which could be interpreted as markers of low susceptibility to SARS-CoV-2 infection. Lipids and metabolites pathways analysis revealed that metabolites related to energy production, mitochondrial and tissue dysfunction, and lipids involved in membrane structure and virus infectivity were key markers of SARS-CoV-2 susceptibility. Conclusion(s): Lipid and metabolic profiles differ in 'nonsusceptible' compared to individuals susceptible to SARS-CoV-2. Our study suggests that lipid profiles are relevant actors during SARS-CoV-2 pathogenesis and highlight certain lipids relevant to understand SARS-CoV-2 pathogenesis. (Figure Presented).

The impact of COVID-19 pandemic on the psychological well-being among health care workers: a 6-month cohort longitudinal survey study.

INTRODUCTION: Health care workers (HCW) have been identified as a risk group to suffer psychological burden derived from Coronavirus Disease 19 (COVID-19) pandemic. In addition, possible gender differences in the emotional reactions derived from COVID-19 pandemic have been suggested in this population. The aims of the study were to explore the impact of COVID-19 as well as possible gender differences on mental health status and suicidality in a cohort of HCW. MATERIALS AND METHODS: One thousand four hundred and thirty-two HCW responded to an online survey including sociodemographic, clinical, and psychometric tests in May 2020 while 251 HCW answered in November 2020. Mental health status was measured by General Health Questionnaire 28 (GHQ-28) in both time periods. RESULTS: HCW informed of a worsening in somatic symptomatology over the follow up period. Gender differences were found in all GHQ-28 dimensions as well in the total score of the questionnaire. Post-hoc analyses displayed significant interaction between the time and gender in somatic and anxiety dimensions as well as in GHQ-28 total score. Stress produced by COVID-19 spreading and the feeling of being overwhelmed at work resulted the main predictors of psychological distress although each domain is characterized by a specific set of predictors. CONCLUSIONS: Somatic reactions represent the most sensitive dimension over the follow-up period. Moreover, women are characterized by a greater psychological distress at the beginning, although these differences tend to disappear over time. Finally, a complex network of factors predicted different dimensions of psychological distress, showing the complexity of prevention in high-risk populations facing major disasters.

Reflections on alternative dispute resolution mechanisms in times of pandemic and their application through digital media in Colombia

This article studies the meaning of the relationship between virtuality and alternative dis- pute resolution mechanisms in times of pandemic, as well as the legal development of the phenom- enon in Colombian law. Likewise, it exposes how ADRs have become an alternative to the world's inevitable status quo due to the COVID-19 pandemic, which affirms that virtual media have moved in the direction of developing social relations and everyday social life. Most known processes are mov- ing to virtual platforms, which are not alien to alternative dispute resolution mechanisms and the Colombian judicial system.

Exploring Moodle Effectiveness to Foster Online ESP During the COVID-19 Pandemic: An Analysis of Task Performance and Students' Perceptions in Online Language Learning Contexts

Education during the COVID-19 pandemic has experienced a massive shift towards online modes of instruction in higher education. This paper presents an example of such adaptation during the spring 2020 lockdown in the context of an ESP course taught to psychology students at a Spanish university. Specifically, we adopted the Cybertask model (Girón-García C.Learning styles and reading modes in the development of language learning autonomy through ‘Cybertasks'. Barcelona. ed. Universitat Jaume I. Retrieved November 7, 2020, from http://hdl.handle.net/10803/125440, 2013;Girón-García & C, Boghiu-Balaur S. Revista de Lingüística y Lenguas Aplicadas 16:95–122. https://doi.org/10.4995/rlyla.2021.13950, 2021) to design an online task about psychotherapy that could be integrated into the Moodle platform in the form of a Lesson to explore the effectiveness of this asynchronous ‘Cybertask-based Lesson' as compared to an equivalent synchronous online task guided by the teacher during a live online session. The study examines the outcomes of each type of task by assessing the students' achievement in learning new specialized content as well as their impressions regarding perceived interest and usefulness. 144 students were assigned to one of three different groups. The Experimental group 1 (N = 40) performed the Lesson/asynchronous task, the Experimental group 2 (N = 38) did the teacher-guided/synchronous task while the Control group (N = 36) did a regular online class addressing a different topic. The results indicate that, regarding achievement, both pedagogical alternatives are effective to a similar extent. However, task perception scores were significantly higher in the Experimental group 1. Further research is needed to explore the potential benefits of similar asynchronous tasks in the current higher education panorama, where there is a progressively greater demand for online learning. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The Impact Of Years Since Transplant On The Clinical Course After SARS-CoV-2 Infection In Heart Transplant Recipients

Introduction: The risk of Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2) infection and mortality is higher in heart transplant (HT) recipients compared to immunocompetent individuals. The impact of years since transplant on clinical course risk is unknown. We evaluated the differences in clinical phenotypes and outcomes according to years since transplant in HT recipients with active SARS-CoV-2 infection. Method(s): Consecutive HT recipients from our National Transplant Centre with confirmed SARS-CoV-2 between April 2020 and March 2022 were enrolled in this retrospective observational study. Patients were stratified into 2 groups: <5 years after HT (Group A) and >/= 5 years after HT (Group B). Result(s): A total of 63 HT recipients were enrolled [median age 56 (41,66) years, 32% female] with 33% of patients (n=21) assigned to Group A, and 67% (n=42) to Group B. In Group B patients, the prevalence of diabetes mellitus and cardiac allograft vasculopathy was significantly higher compared to those in Group A. Meanwhile, Group A patients were more likely to have a history of neutropenia prior to SARS-CoV-2 infection and were more frequently taking maintenance steroids and antimetabolite immunosuppressants (Table 1). Those recipients less than 5 years since HT were also significantly more likely than those >5 years out to develop the infection despite a 3rd dose of COVID vaccine (60% vs 31%, p 0.03).During the active infection, Group A recipients more frequently developed neutropenia (73% vs 27%, p 0.01), and trended towards higher rates of hospitalizations (57% vs 32%, p 0.06). Notably, none of the patients in Group A required mechanical ventilation compared to just under 10 % (n=4) of those in Group B. Further, no Group A patients died during the active infection hospitalization compared to 14% (n=6) of those in Group B. Conclusion(s): In HT recipients, years since transplant is a simple, clinically useful parameter stratifying outcomes after SARS-CoV-2 infection. While patients with less than 5 years since transplant are more likely to develop infection despite booster vaccination and require hospitalization, greater number of years since transplant was associated with more severe consequences during hospitalization.Copyright © 2022

Unemployment and Innovation in Small and Medium-Sized Enterprises (SMEs) during the First Year of COVID-19 Pandemic in Metropolitan Lima, Peru

Due to the increase in unemployment caused by the COVID-19 pandemic in Metropolitan Lima (Peru), unemployment in 2020 rose to 16.5% (1.3 million unemployed) compared to the previous year. Through innovation, SMEs sought new strategies to continue growing in the highly competitive market, generating labour demand. Therefore, the research question proposed was: How has business innovation favoured the reduction of unemployment in SMEs during the pandemic caused by COVID-19 in Metropolitan Lima? In order to solve this problem, this research developed a qualitative approach using grounded theory. Data was collected by interviewing 17 key subjects, in addition to the observation of 12 businesses between the months of August and October 2021. The results show that the observed businesses that were able to successfully cope with the pandemic had to modify their structure or processes with new sales methods (home delivery), as well as novel promotion and advertising techniques. © 2023 Maldonado-Cueva et al.

Assessing Wellbeing and Soft Skills of Software Developers and Students in the Context of Working from Home during the COVID-19 era

Derived from COVID-19 pandemic remote work is now a trend, involving new skills and variations on developers' wellbeing. Current students are going to live this new era in the labor market;it is needed to know if they are getting ready for this scenario. This paper presents an exploratory study based on a survey to assess how developers in industry and students in the academy experienced their wellbeing expressed in emotions during the pandemic, as well as how they practiced the soft skills involved in software development. The results of developers are considered as basis to assess how students are prepared for this context. The descriptive study has shown that developers experienced more positive emotions, while students had a mix of positive and negative emotions. In terms of soft skills, developers and students showed closer levels of practice, however students should reinforce some skills. © 2022 IEEE.

Best Practices for Training in Sustainable Greenhouse Horticulture

Consumer demands and current legislation require intensive greenhouse horticulture to be sustainable. This poses the challenge of how to teach the concept of sustainable horticulture to all professionals involved in farming. The province of Almeria, in the south-east of Spain, is one of the major horticulture greenhouse areas in Europe, and an expert panel of relevant stakeholders was invited to look into the best pedagogical practices and methods to transfer technology and knowledge, with the goal of improving the sustainability of greenhouse horticulture. A combination of an online questionnaire, a Delphi method, and desk research was, therefore, used as the strategy to collect the data and implement the research design during 2021. On-farm/business demonstrations, virtual education, and classroom education were common pedagogical methods used. On-farm/business demonstrations, participatory education, and co-learning were identified as the best pedagogical methods to use in sustainable agriculture/horticulture training. The expert panel also concluded that participatory education and co-learning should be further explored whereas virtual and classroom education should play a less dominant role in the training activities. This knowledge can help training organizations and designers to avoid common mistakes, tailor their training activities, and be mindful of common barriers and (mis)conceptions. © 2023 by the authors.

Sotrovimab in Heart Transplant Recipients with Covid-19 in the Omicron Era: A National Transplant Center Experience

Early use of anti-SARS-CoV-2 monoclonal antibodies has shown to be a safe option to reduce hospitalization and death in solid organ transplant recipients with COVID-19. Real world data regarding sotrovimab in heart transplant (HT) recipients is scarce. We aim to describe our experience in terms of safety and outcomes in this group. Consecutive HT recipients from our center with confirmed SARS-CoV-2 Omicron variant who received intravenous sotrovimab infusion between January and April 2022 were enrolled in this observational study. Clinical data was recorded including the first 24 hours post infusion, as well as 1-month and 3-month follow-ups. A total of 29 HT recipients with SARS-CoV-2 infection who received sotrovimab were enrolled [median age 53 (IQR 36, 62), 52% female]. Baseline characteristics are shown in Table 1. The median time since symptom onset was 2 (1,3) days, and 86% of patients had previously received ≥3 doses of COVID-19 vaccine. No acute infusion-related reactions were reported. A total of five patients were admitted (17%), 3 of them with COVID-19 pneumonitis, receiving high-dose steroids. Bacterial superinfection was reported in 4 patients. Neither invasive mechanical ventilation nor ICU care were required, and no in-hospital deaths were recorded. Hospitalized patients had more comorbidities [diabetes (40 vs 13%, p 0.13), hyperlipidemia (80 vs 29%, p 0.03), advanced chronic kidney disease (100 vs 38%, p 0.01), leucopenia (40 vs 4%, p 0.02), and anemia (100 vs 46%, 0.03)], compared to non-hospitalized patients. Over a median follow-up of 111 (86, 131) days, there were 2 cases of COVID-19 reinfection and 6 non-COVID-19-related readmissions. No episodes of acute rejection, new onset graft dysfunction or death were registered. In our series, the early use of sotrovimab in HT recipients with COVID-19 was safe. No COVID-19-related deaths were recorded, hospitalization rate was low and more frequent in patients with prior chronic comorbidities. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Challenges of the wine industry of Baja California, Mexico

The Baja California wine industry has developed significantly in recent decades, based on the increase in wine consumption in Mexico and the state government's interest for the development of regional vocations. However, its growth has not been accompanied by an integration of the sector among the producers and with the communities where it is based. This work presents an analysis of the current situation of viticulture in the state from its value chain, to identify the challenges before and after the COVID-19 pandemic, considering the actions carried out from the production of the grape, transformation of the wine, distribution, marketing and commercialization, highlighting the social problems that affect the development of the sector and cultural identity. In this research was used the systematization methodology, which articulates the experiences of key actors related to the industry in the territory. To obtain the information, focus groups organized by activities related to the wine sector in Valle de Guadalupe were held.

THE EFFECT OF SURGICAL MASKS ON OXYGEN SATURATION AND PERCEIVED EXERTION DURING RESISTANCE TRAINING

Objective: This investigation aimed to evaluate SpO2, and the rate of perceived exertion (RPE) derived from a strength training session in two distinct scenarios: normal condition versus the usage of surgical masks for COVID-19 prevention. Methods: Fifteen trained men (81.66 ± 8.37 kg;177.66 ± 6.31 cm;26.88 ± 5.55 years of age;12.17 ± 5.98 % fat;1.15 ± 0.19 kg/kg bench press relative strength/body weight) were selected, and they performed two test sessions to determine 10-RM loads for all exercises adjusted for 80%. The SpO2 measurement was verified immediately after each set for every exercise, and, concomitantly, the participants were asked to identify their RPE to provide a subjective measure of fatigue. In the first session, subjects performed the training routine using the SARS-CoV-2 protection surgical mask with a passive rest interval of 2 minutes, but the second was performed without wearing a surgical mask. Results: The SpO2 showed a difference (p = 0.03) under the condition curve with the mask (481.33 ± 3.04) versus without the mask (484.46 ± 5.96), with increments in SpO2 for the condition without the mask at different verification times (p = 0.039). Regarding the initial sets and exercises, there were no significant differences between the RPE values between the different conditions, that is, regardless of the mask use (p = 0.052). However, for the final exercises, significant differences were observed in the second set (PD, p = 0.01;LC, p = 0.02) and in the three sets of the TE exercise (p = 0.006). Conclusion: Overall, we found that the use of surgical masks reduces SpO2 and increases RPE in a strength training session. © 2022, Drustvo Pedagoga Tjelesne i Zdravstvene Kulture. All rights reserved.

Development of a Non-Invasive Respiratory Support Pathway in COVID19 patients with severe respiratory failure in an Intermediate Respiratory Care Unit

The respiratory failure caused by COVID19 and the need to provide non-invasive respiratory support (NIRS) and invasive mechanical ventilation (IMV) has saturated the Intensive Care Units (ICU). In our hospital, an Intermediate Respiratory Care Unit (IMCU) and a protocol (Figure 1) were created to coordinate escalation to NIRS and referral to ICU. The aim of this study was to evaluate the result of implementing this protocol in the IMCU. Retrospective observational cohort study between May 2021 to January 2022, included 174 patients with need NIRS in IMCU (143 receiving HFNC, 23 combining CPAP/HFNC and 8 BIPAP/HFNC). 141 met requirements for cardiopulmonary resuscitation (CPR). The average age was 60 +/-16 years, 67% (117) were male. The median stay in IMCU was 10.5 [8,15] days, requiring NIRS a median of 5 [3,8] days. 39 patients were transferred to the ICU and 28% (11) required IMV in a mean of 3 +/- 2 days after transfer. The mortality rate among patients CPR was 4% (6/141). Prior to the creation of the IMCU 3,172 COVID+ patients were admitted, with a mortality of 20.3%. 10% were admitted to the ICU due to HFNC or NIV requirements, with a mortality rate of 32.5%. This study supports the clinical benefit of creating an IMCU in collaboration with ICU, achieving low mortality rates by monitoring and providing NIRS in COVID19 patients with severe respiratory failure. (Figure Presented).

What is going on within google earth engine? A systematic review and meta-analysis

Google Earth Engine (GEE) is a geospatial processing platform based on geo-information applications in the ‘cloud'. This platform provides free access to huge volumes of satellite data for computing, and offers support tools to monitor and analyse environmental features on a large scale. Such facilities have been widely used in numerous studies about land management and planning. Considering the current lack of relevant overviews, it may be useful to evaluate the utilization paths of GEE and its impact on the scientific community. For this purpose, a systematic review has been conducted using the PRISMA methodology based on 343 articles published from 2020 to 2022 in high-impact scientific journals, selected from the Scopus and Google Scholar databases. After an overview of the publishing context, an analysis of the frequency of satellite features, processing methods, applications are carried out, and a special attention is given to the COVID-19 studies. Finally, the geographical distribution of the reviewed articles is evaluated, and the citation impact metrics is analysed. On a bibliometric approach, 90 journals published articles on GEE in the reference period (January 2020 to April 2022), and this large number of journals reveals the multidisciplinary application of GEE platform as well as the interest of publishers towards this topic of relevance for the international scientific community. The results of the meta-analysis following the systematic review showed that: (i) the Landsat 8 was the most widely-used satellite (25%);(i) the non-parametric classification methods, mainly Random Forest, were the most recurrent algorithms (31%);and (iii) the water resources assessment and prediction were the most common methodological applications (22%). A low number of articles about COVID-19, in spite of the planetary importance of the pandemic effects. The reviewed articles were geographically distributed among 86 countries, China, United States, and India accounting for the large number. ‘Remote Sensing' and ‘Remote Sensing of Environment' were the leading journals in the citation impact metrics, while the Random Forest method and the agriculture-related applications being the mostly cited. It is expected that these results might change over the mid to long term, due to fast progress in environmental and spatial information technologies, although currently our findings may be worthwhile and useful for assessing the current global deployment of GEE platform. © 2022 The Authors

Collaborative online international learning (COIL) programme: Your career opportunities worldwide - learning from the experience and personal view of professionals in the sector

Introduction Degrees in Pharmacy, Biotechnology and Nutrition & Dietetics courses offer a wide range of career opportunities, but many students are unaware of these and feel disorientated when deciding on their professional future. In a global context, employers demand qualities such as intercultural communication skills, team-working skills, networking abilities and international collaborative experience. The COVID-19 pandemic has limited access to global mobility. Collaborative Online International Learning (COIL) programmes enable students to gain an international experience without travelling abroad. In this COIL project, students from Torino, Coventry and CEU-San Pablo Universities worked collaboratively to research the worldwide professional opportunities related to their degrees Method: This COIL included: Introductory session with icebreaker and intercultural activities;Teams' online meetings, where professors from three Universities guided and supervised the students'' work;Interviews of the students' teams with two to three professionals of Pharmacy, Biotechnology or Nutrition & Dietetics;Conferences by relevant professionals;and International Congress where information gathered by the students through oral communication was prepared and presented. It also included plenary conferences and a workshop on LinkedIn Results: This COIL programme involved three Universities, 38 professors, 111 students and 76 professionals (from 11 countries working in 60 institutions). More than 400 people from 40 different countries and 60 Universities were registered at the Congress. 41 interviews with professionals, 12 conferences by 32 speakers and one International Congress were organised. More than 80% of the students agreed that the COIL allowed them to improve their soft and intercultural skills, made them more employable and increased their motivation to work abroad. 90% of the students considered this COIL to be useful for their professional future Conclusion(s): These excellent results highlight the benefit of COIL programmes for students and their careers. This led the authors in 2022 to organise a second edition of the COIL programme with a possible international visit included.