Drive De-fossilisation and Avoid De-industrialization: Possible, but Difficult

The German economy is in difficult waters. Since the beginning of the coronavirus crisis, there has been no end to the challenges posed by interruptions in production and supply problems. Despite the need for crisis management, politicians have pledged not to lose sight of environmental sustainability. In addition, our community itself must take more responsibility for strengthening the resilience of supply, value and innovation chains. All of this will only succeed with a greater focus on economic performance;this requires a supply-side economic policy. Drawing insight from this crisis will allow for a successful transition management and a comprehensively transformed economy. © 2022, Der/die Autor:in.

Building Resilient Post-pandemic Supply Chains Through Digital Transformation

The COVID-19 pandemic has created a challenging environment for firms on a global scale. Due to policies aiming to contain the spread of the virus, firms across all industries are forced to quickly adapt to highly dynamic changes in supply and demand, while simultaneously managing internal production disruptions. Most companies experience severe financial consequences during the supply chain disruptions. Digital technologies can be used to create more resilient supply chains that are able to better cope with future large-scale disruptions. In this chapter, we present current industry best practices, related to blockchain, digital platforms, analytics, and digital twins, to provide actionable insights for decision makers. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The COVID-19 viral 3a protein forms a potassium channel that can be inhibited by antiarrhythmic drugs

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Deutsche Gesellschaft für Kardiologie /German Cardiac Society Joachim Herz Stiftung /Joachim Herz Foundation Background/Introduction Supraventricular and ventricular arrhythmias can often be observed in patients with COVID-19 infection. Both, the clinically observed increase in cardiac biomarkers as well as histological studies indicate virus replication within cardiomyocytes. The 3a open reading frame of the viral genome encodes for a transmembrane protein that is transported to the cell membrane where it can serve as a potassium channel. Purpose The aim of this study was to investigate whether COVID-19 infected induced pluripotent stem cell (iPSC)-derived cardiomyocytes also express the 3a protein and whether the potassium currents that are conducted through the 3a protein can be inhibited by clinically used antiarrhythmic drugs. Methods and Results iPSC-derived cardiomyocytes were infected with COVID-19 and subsequently subjected to immunoblotting, where expression of the 3a protein could be observed. Plasmid DNA, encoding the COVID-19 3a protein, was generated by gene synthesis and used for in vitro transcription of cRNA. 3–5 days after intracytoplasmic injection of the 3a protein cRNA into Xenopus laevis oocytes, potassium currents could be measured by two-electrode voltage clamp recordings. While class I and class IV antiarrhythmic drugs showed only minor effects on the potassium currents of the 3a protein, a robust inhibition by several beta-blockers and by class III antiarrhythmic drugs could be observed. The strongest effects were found with dofetilide (58.1 % inhibition at 100 µM) and amiodarone (50.1 % inhibition at 100 µM, IC50 level 4.7 µM). An in silico docking analysis, based on the recently revealed crystal structure of the 3a protein, identified the amino acid residues K61 and D142 as part of the binding site of amiodarone. After deactivation of these amino acid residues by site-directed mutagenesis, the inhibition by amiodarone was significantly attenuated. Conclusion The COVID-19 viral 3a protein is expressed in COVID-19-infected iPS-derived cardiomyocytes and forms a potassium channel that can be inhibited by antiarrhythmic drugs.

Impact of a home-based cardiac rehabilitation program in heart failure during the COVID-19 pandemic

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6]. Introduction Cardiac rehabilitation (CR) is an evidence-based recommended treatment of heart failure (HF) patients. During the COVID-19 pandemic, the shutdown of CR centers was necessary to limit the infection risk among high-risk patients. The integration of a home-based CR (HBCR) program in CR units can help to improve the delivery of care and improve cardiovascular outcomes of HF patients. Purpose To assess the effectiveness of an HBCR program in HF patients. Methods This is a sub­study of the EXercise InTervention in Heart Failure trial (EXIT-HF), which include forty-nine HF patients (preserved and reduced ejection fraction). The HBCR program consisted in 12-week combined exercise program (60%-80% of peak oxygen consumption (VO2 peak)), 2 training sessions per week, for a total of 24 sessions. Patients performed 4 supervised training sessions and the remaining sessions at home. All patients performed a cardiopulmonary exercise test (VO2 peak), the 6-minute-walking test (6MWT), collected blood analysis (plasma NT-proBNP), and answered the Minnesota Living with Heart Failure Questionnaire. Results Forty-two patients (86%) complete at least 80% of prescribed training sessions (age: 61.1±12;FEVE: 37.1±10.8). The HBCR program improve VO2 peak from 18.3 to 20.1ml/kg/min (+1.8 ml/kg/min;95%IC:1.4 to 2.4;p<0.001) and the walked distance at the 6MWT from 462 to 512 meters (+49 meters;95%IC: 38 to 60;p<0.001). In addition, overall quality of life was improved (-13 points;95%IC:-7.8 to -18.5;p<0.001), as well physical (-6.3 points;95%IC:-3.5 to -9;p<0.001) and emotional dimension of quality of life (-2.8points ;95%IC: -0.9 to -4.7;p=0.06). No significant change was found in NT-proBNP levels (820±1220 vs 674±903;p=0.285). Conclusions Our results showed that HBCR is feasible and can improve functional capacity and quality of life in HF patients.

THE EFFECT OF CONVERTING AN INTEGRATED BEHAVIORAL HEALTH PRACTICE TO TELEHEALTH DURING THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: When COVID-19 emerged in March 2020, we transitioned to 100% telemedicine visits. We asked: 1. Is our practice providing equitable depression screening and care for patients after transitioning to telemedicine? 2. How might we improve access to care and increase equity for depression in our practice and systemwide? DESCRIPTION OF PROGRAM/INTERVENTION: In March 2019, we integrated mental health services at our academic faculty internal medicine practice consisting of over 5000 patients. We implemented the Collaborative Care model (University Washington, AIMS): 1) to consistently identify patients in primary care with distressing depressive symptoms, and 2) to quickly treat patients with distressing symptoms of depression. We began systematically screening patients for depressive symptom severity and treated using a team-based approach. The team-based approach included psychotherapy, psychiatric consultation, support for psychosocial needs, and online resources. MEASURES OF SUCCESS: We will describe our workflow and program evaluation measures. We explored whether differences in screening and treatment rates occurred based on age, sex and payor status comparing patients screened and treated one year before versus one year after the start of the COVID pandemic as we transitioned to using telemedicine. Patients were defined as “screened” if the Patient Health Questionnaire, 9-item version (PHQ-9) was administered at their physical examination, Annual Wellness Visit, or new patient visit. Patients were defined as“treated” if they enrolled in our mental health program and had more than one visit with the program psychologist. Chi-square tests of independence were conducted to determine associations between time period (Pre COVID vs Pandemic) and equity variables: age (<65 and 65+ years), payor (Medicaid vs. all others), and sex. FINDINGS TO DATE: The number of Annual Wellness, physicals and new patient visits dropped from 2,333 during the pre-COVID period to 1,464 during the pandemic period. The percentage of patients screened for depression using the PHQ-9 at physical examinations initially dropped, then increased dramatically in the Fall of 2020 and has trended back up to pre-COVID rates. Overall, our results may indicate we are offering equitable care. There were no significant differences in screening rates comparing the pre-COVID and pandemic periods stratified by age (p=.24), payor (p=.16) or sex (p=.32);patients who screened positive for depression, stratified by age (p=1.0), payer (p=.15) or sex (p=.22);or for patients who were treated on age (p=.14), payer (p=.51) or sex (p=.39). KEY LESSONS FOR DISSEMINATION: Screening and treatment of depression markedly improved in our primary care ambulatory setting since integrating mental health services. Depression screening after the start of the pandemic nearly ceased but has nearly returned to pre-COVID levels. Screening for depression in the clinic served to improve screening rates, but additional solutions are needed to modernizing telehealth tools for screening for depression.

Quantifying changes in ambient NOx, O3 and PM10 concentrations in Austria during the COVID-19 related lockdown in spring 2020.

During spring 2020, unprecedented changes in local and regional emissions have occurred around the globe due to governmental restrictions associated with COVID-19. Many European countries including Austria issued partial curfews or stay-at-home order policies, which have impacted ambient air quality through reductions in non-essential transportation and energy consumption of industrial sites and work places. Here, we analyse the effect of these measures on ambient concentrations of nitrogen oxides (NOx), ozone (O3) and particulate matter (PM10) during the first nationwide lockdown in Austria (16.03.2020 to 14.04.2020). To ensure a robust analysis, the Austrian domain is divided into four individual subsectors contingent on regional climate. For air quality analysis a novel method is applied for filtering days with comparable weather conditions during the 2020 lockdown and spring 2017 to 2019. In general, our analysis shows decreasing pollutant concentrations, although in magnitude dependent on pollutant and regional subdomain. Largest reductions are found for NOx reaching up to -68% at traffic sites reflecting the substantial decrease in non-essential transport. Changes in the O3 concentrations at background sites show a rather weak response to NOx declines varying between roughly -18 to +8% for both the median and the upper tail of the distribution. Occasional site level increases in O3 concentrations can be attributed to comparably weak titration during night-time. PM10 concentrations show the smallest response among air pollutants, attributable to manifold precursor sources not affected by the lockdown measures. However, our analysis indicates also a shift of PM10 distributions at traffic sites closer to distributions observed at background sites. Supplementary Information: The online version contains supplementary material available at 10.1007/s11869-022-01232-w.

Home-based cardiac rehabilitation can reduce anxiety and depression in heart failure patients

Introduction: The current COVID-19 pandemic has led to significant changes in physical and mental health and has become a major challenge for cardiac rehabilitation (CR) programs. CR is an essential component in the treatment of heart failure (HF), as it improves cardiorespiratory fitness and quality of life, as well as reducing hospitalization rates. COVID-19 pandemic increased social isolation, and the CR centers were closed. Center-based CR requires the patient to travel to the hospital, which increases the risk of SARS-CoV-2 infection in this high-risk population. In this context, home-based CR can be an excellent strategy to reduce the physical and mental consequences of the social isolation imposed by the COVID-19 pandemic. Objective: To test the effectiveness of a home-based CR program on cardiorespiratory fitness and anxiety and depression levels in individuals with HF during covid-19 pandemic. Methods: Forty-two individuals with HF (age: 61.3±12.0;LVEF: 37.5±11.2) were included in this study. The exercise training program consisted in 12 weeks of combined exercise training (2x/week;60min/day, 60-80% VO2peak), with 4 supervised exercise sessions in the hospital context and the remaining at home. Patients were monitored using a heart rate monitor and weekly phone calls. The following parameters were evaluated: cardiorespiratory fitness through the 6-minute walk test (6MWT) and anxiety and depression levels through the Hospital Anxiety and Depression Scale (HADS). Results: After the home-based CR program, there was a significant increase in the 6MWT of 49 meters (95%IC: 38 to 60;p<0.001) and a significant decrease in anxiety levels of -1.12 points (95%CI: - 2.163 to -0.075 p=0.036). No significant changes were found in depression levels (p=0.954). Furthermore, the improvements in cardiorespiratory fitness were significantly associated with the reduction in the levels of anxiety (r= -0.281;p=0.028) and depression (r=: -0.278;p=0.030). Conclusions: The home-based CR program was able to improve cardiorespiratory fitness and this improvement was associated with a decrease in anxiety and depression levels in individuals with HF. The results suggest that home-based CR can be an important strategy to minimize the physical and mental impact induced by social isolation imposed by COVID-19 pandemic in HF patients.

How to implement the European digital single market: identifying the catalyst for digital transformation

COVID-19 is regarded as a major driver for digital transformation of our society and potentially as a boost for further digital single market integration. From the current perspective, pandemics cannot be avoided, but fully enabled digital societies will be better prepared to cope with them in future. This will, however, require reliable digital infrastructures to be put in place and further developed. Member States of the European Union and the European Commission have worked for more than 30 years to realise a European Digital Single Market. One key element in this development has been the so-called 'Large-Scale Piloting' (LSP) approach. This paper will focus on implementation of the 'Once-Only Principle' Pilot (TOOP) as part of LSP and the adjoint Single Digital Gateway Regulation (SDGR). This paper will examine whether, and how these initiatives can foster further integration into a digital single market.

Update on the north american covid-19 myocardial infarction (NACMI) registry

Background: The Coronavirus 2019 (COVID-19) pandemic has impacted ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). The goal of The North American COVID-19 and STEMI (NACMI) registry is to describe demographic characteristics, management strategies and outcomes of COVID-19 patients with STEMI. Methods: A prospective, ongoing observational registry was created under the guidance of 3 societies. STEMI patients with confirmed COVID + or suspected (person under investigation or PUI) COVID-19 infection were included. A group of age and sex matched STEMI patients (matched to COVID + in a 2:1 ratio) treated in the pre-COVID era (2015-2019) serves as the control group for comparison of treatment strategies and outcomes. The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction or repeat unplanned revascularization. Results: Current enrollment numbers is comprised of 1,507 patients NACMI (301 COVID +, 604 PUIs and 602 controls). COVID + patients were more likely to have minority ethnicity and have diabetes and undergo medical therapy as primary perfusion therapy (all p <0.001 relative to PUI). Among COVID + patients who received angiography, 71% received PPCI and 23% had no culprit vessels identified on angiography (both p <0.001 relative to controls). The primary outcome occurred in 36% of COVID +, 13% of PUI and 5% of control patients (p<0.001 relative to controls). For the Late Breaking presentation, we will update the numbers of enrolment, present new insights into the ethnic differences, explore patient characteristics in those with no culprit disease and hope to present preliminary results from the EKG and angiographic core lab. Conclusions: COVID + patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics and high in-hospital cardiac events.

The possibility and importance of immersive technologies during COVID-19 for autistic people

Purpose: The purpose of this paper is to identify three key areas where autistic people may find themselves impacted through COVID-19, namely, education;employment;and anxiety. Design/methodology/approach: This paper provides some views based on the extensive experience of using immersive technologies for the utilisation and application with autistic groups during COVID-19. Findings: This paper offers some examples of immersive technology application that might be helpful for practitioners, services and others to consider in overcoming possible challenges faced by people with autism. Originality/value: This opinion piece offers expert insights to the role immersive technologies and virtual reality might play during COVID-19 in the lives of autistic groups. © 2020, Emerald Publishing Limited.

Google searches reveal changing consumer food sourcing in the COVID-19 pandemic

Based on observing Google search trends, this paper examines how the interest and preoccupations of US food consumers has changed since the advent of the COVID-19 pandemic. Three fairly distinct periods in terms of food-related searches are observed. First, a concern with food storage emerged starting the week of February 16-22 and continued until mid-April, coupled with some evidence about concerns over food shortages (starting March 1-7). Second, starting the week of March 1-7, a growing interest in more local, direct options for acquiring food emerged. Third, starting the week of March 8-14 and spiking a few weeks later (except for Grubhub), interest in take-out food and home delivery grew, as the stay-at-home orders became more widespread. This was also the week in which searches for food banks and pantries started to take off, just preceding the week of March 22, which saw record increases in initial jobless claims. It is also revealed that demand for breweries and wineries has dramatically dropped.

Americans' food spending patterns explain devastating impact of COVID-19 lockdowns on agriculture

This paper explores the impact of the COVID-19 pandemic on US agriculture by using USDA's Food Expenditures by Outlet data. With the social distancing and stay-at-home orders, where people obtain their food has changed dramatically. This has contributed to logistical problems in the supply chain.

Urologic Surgery and COVID-19: How the Pandemic Is Changing the Way We Operate.

The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.