COVID-19 IN PATIENTS WITH RHEUMATIC IMMUNE-MEDIATED INFLAMMATORY DISEASES IN AMERICA: DIFFERENCES AND SIMILARITIES BETWEEN MEXICO AND ARGENTINA

BackgroundPatients with immune-mediated rheumatic diseases (IRD) have poorer outcomes of SARS-CoV-2 infection compared to the general population.ObjectivesTo assess and compare clinical course, severity and complications of SARS-CoV-2 infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Mexico and Argentina.MethodsData from both national registries, CMR-COVID (Mexico) and SAR-COVID (Argentina), were combined. Briefly, adult IRD patients with SARS-CoV-2 infection were recruited between 08.2020 and 09.2022 in SAR-COVID and between 04.2020 and 06.2022 in CMR-COVID. Sociodemographic data, comorbidities, and DMARDs were recorded, as well as clinical characteristics, complications, and treatment for SARS-CoV-2 infection. Descriptive analysis. Chi square, Fisher, Student T, Mann Whitney U tests and multiple logistic regression analyses were performed.ResultsA total of 3709 patients were included, 1167 (31.5%) from the CMR-COVID registry and 2542 (68.5%) from the SAR-COVID registry. The majority (82.3%) were women, with a mean age of 50.4 years (SD 14.4). The most frequent IRD were rheumatoid arthritis (47.5%) and systemic lupus erythematosus (18.9%). Mexican patients were significantly older, had a higher female predominance and had higher prevalence of rheumatoid arthritis, antiphospholipid syndrome, and axial spondyloarthritis, while the Argentine patients had more frequently psoriatic arthritis and ANCA-associated vasculitis. In both cohorts, approximately 80% were in remission or low disease activity at the time of infection. Mexicans took glucocorticoids (43% vs 37%, p<0.001) and rituximab (6% vs 3%, p<0.001) more frequently. They also reported more comorbidities (48% vs 43%, p=0.012).More than 90% of patients presented symptoms related to SARS-CoV-2 infection. The frequency of hospitalization was comparable between the groups (23.4%), however, the Mexicans had more severe disease (Figure 1) and a higher mortality rate (9.4% vs 4.0%, p<0.0001). After adjusting for risk factors, Mexicans were more likely to die due to COVID-19 (OR 2.2, 95%CI 1.5-3.1).ConclusionIn this cohort of patients with IRD from Mexico and Argentina with SARS-CoV-2 infection, the majority presented symptoms, a quarter were hospitalized and 6% died due to COVID-19. Mexicans presented more severe disease, and after considering risk factors they were two times more likely to die.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsCarolina Ayelen Isnardi Grant/research support from: SAR-COVID is a multi- sponsor registry, where Pfizer, Abbvie, and Elea Phoenix provided unrestricted grants. None of them participated or infuenced the development of the project, data collection, analysis, interpretation, or writing the report. They do not have access to the information collected in the database, Deshire Alpizar-Rodriguez: None declared, Marco Ulises Martínez-Martínez: None declared, Rosana Quintana: None declared, Ingrid Eleonora Petkovic: None declared, Sofia Ornella: None declared, Vanessa Viviana Castro Coello: None declared, Edson Velozo: None declared, David Zelaya: None declared, María Severina: None declared, Adriana Karina Cogo: None declared, Romina Nieto: None declared, Dora Aida Pereira: None declared, Iris Jazmin Colunga-Pedraza: None declared, Fedra Irazoque-Palazuelos: None declared, GRETA CRISTINA REYES CORDERO: None declared, Tatiana Sofía Rodriguez-Reyne: None declared, JOSE ANTONIO VELOZ ARANDA: None declared, Cassandra Michele Skinner Taylor: None declared, INGRID MARIBEL JUAREZ MORA: None declared, Beatriz Elena Zazueta Montiel: None declared, Atzintli Martínez: None declared, Cesar Francisco Pacheco Tena: None declared, Guillermo Pons-Estel: None declared.

Direct to CT screening pilot for patients with COPD in a deprived area: longitudinal analysis of the pulmonary nodule cohort outcomes

Introduction: Lung cancer is third most common cancer and highest cause of cancer death in the UK. COPD and smoking are known cancer risk factors so early intervention is essential. Incidence is higher in areas of deprivation where early presentation is less likely and outcomes poorer. Middlesbrough has some of the highest areas of deprivation. Aim(s): To evaluate diagnostic value of CT screening pilot in detecting lung cancer and follow-up outcomes for patients with incidental finding of pulmonary nodules. Method(s): Between March 2019 - December 2022 17 GP practices in Middlesbrough were invited to offer non-contrast CT thorax to asymptomatic COPD patients eligible for review, aged 50-75 with 20 pack year history and QCancer risk >5%. Pulmonary nodules followed up as per BTS guidelines. This pilot was conducted in partnership and with support from the Northern Cancer Alliance. Result(s): 407 patients referred for CT, 312 met the criteria and enrolled. 5 (1.6% conversion rate) lung cancers, also 1 renal cancer diagnosed. 51 (17%) had features of pulmonary nodules or groundglass opacities and selected for follow up. 2 died from COVID infection before follow-up CT. 32 (62.8%) discharged after followup CT revealed stable appearances or resolution, follow-up CT still outstanding for 2. 4 (7.8%) selected for further follow-up of sub-solid, new or increasing nodules. 2 (3.9%) received radiological diagnosis of lung cancer and referred for radiotherapy, 1 underwent surgical resection revealing lung tumourlets and 1 referred for surgical resection of enlarging nodule. Conclusion(s): Pulmonary nodules consisted significant part of the CT screening pilot findings in COPD patients with significant further conversion rate to lung cancer diagnosis after follow-up. Therefore, CT screening of high-risk population in deprived areas has a role in detecting lung cancer and identifying pulmonary nodules, with a proportion of those later diagnosed as early lung cancer. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Impacts of the COVID-19 Pandemic on Live Musical Performance in the United States and the United Kingdom: Outsider and Insider Perspectives

In March 2020, live music venues were shuttered because of the COVID-19 pandemic. To gauge the mood and opinions of persons involved in aspects of live performance, a questionnaire was developed. Responses from 19 individuals representing many aspects of the live music portion of the industry were analyzed. These versatile professionals have been resilient during the pandemic. Time not spent traveling on the tour circuit gave some the chance to pursue non-musical interests, foster aspects of music that could be done from home, provided time for reflection and songwriting, and allowed some to complete albums. All of the musicians expressed sympathy for the tribulations experienced by ancillary personnel vital to the operation of live venues and touring. They also expressed sympathy for new musical acts that depended on live performance for audience exposure. The pandemic spawned new musical innovations to pique the interest of the music-consuming public such as subscriptions to view live streaming of performances, and musicians reaching out directly to fans using online services. Such innovations have partially offset some of the revenue lost from being unable to tour and may continue when the pandemic is finally over. Three innovative musical performances during the COVID-19 period are highlighted. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Otolaryngology residency selection: are we doing it right?

PURPOSE OF REVIEW: This article will provide an overview of recent disruptions to the otolaryngology residency match process and conclude with questions and resources that can guide future selection system design. RECENT FINDINGS: During the implementation of the single accreditation system, the loss of osteopathic programs, reduction of osteopathic leadership positions, and lack of interest in Osteopathic Recognition represent serious threats to the profession; this has implications for the distribution of the otolaryngology workforce, plausibly decreasing healthcare access in less-populated communities. Next, the impacts of COVID-19 reverberated throughout the application process, including the reduction/elimination of away rotations, modification of application requirements, conversion to virtual interviews, and initiation of preference signaling. Soon, the transition to pass/fail scoring for the United States Medical Licensing Exam Step 1 could stimulate a paradigm shift, with a heightened emphasis on holistic review. SUMMARY: The last two match cycles have been the most dynamic and unpredictable in decades. Out of the commotion, the otolaryngology community has an opportunity for a fresh start, combining insights from past literature with recent articles compiled for this review. Moving forward, it will be advantageous to approach residency selection as a well-executed quality improvement project, requiring continuous assessment and adjustment.

Using a Combined Model of the Theory of Planned Behavior and the Technology Acceptance Model to Assess Radiologic Technology Educators' Intentions Toward Virtual Technology Use as a Result of the COVID-19 Pandemic

A quantitative cross-sectional survey design was utilized to evaluate a combined model utilizing the theory of planned behavior and the technology acceptance model to investigate continuance intentions for virtual technology use (CITU) by United States radiologic science educators as a result of the COVID-19 pandemic. A total of 255 participants completed an online survey through Qualtrics. Results found that the overall regression model was statistically significant (F5, 230 = 59.167, p < .001) and explained about 56% of the variance in CITU (R² = .563, Adj. R² = .553). Attitude was the strongest predictor and mediated the effects of other predictors on CITU. Radiologic sciences educators with more positive attitudes toward using virtual technology, higher actual utilization, and more perceived usefulness were more likely to report higher intentions to continue technology use. The combined model was found to be an effective tool for measuring educators' CITU.

Lactoferrin for Mental Health: Neuro-Redox Regulation and Neuroprotective Effects across the Blood-Brain Barrier with Special Reference to Neuro-COVID-19.

Overall mental health depends in part on the blood-brain barrier, which regulates nutrient transfer in-and-out of the brain and its central nervous system. Lactoferrin, an innate metal-transport protein, synthesized in the substantia nigra, particularly in dopaminergic neurons and activated microglia is vital for brain physiology. Lactoferrin rapidly crosses the blood-brain barrier via receptor-mediated transcytosis and accumulates in the brain capillary endothelial cells. Lactoferrin receptors are additionally present on glioma cells, brain micro-vessels, and neurons. As a regulator of neuro-redox, microglial lactoferrin is critical for protection/repair of neurons and healthy brain function. Iron imbalance and oxidative stress are common among patients with neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease, dementia, depression, and multiple sclerosis. As an endogenous iron-chelator, lactoferrin prevents iron accumulation and dopamine depletion in Parkinson's disease patients. Oral lactoferrin supplementation could modulate the p-Akt/PTEN pathway, reduce Aß deposition, and ameliorate cognitive decline in Alzheimer's disease. Novel lactoferrin-based nano-therapeutics have emerged as effective drug-delivery systems for clinical management of neurodegenerative disorders. Recent emergence of the Coronavirus disease-2019 (COVID-19) pandemic, initially considered a respiratory illness, demonstrated a broader virulence spectrum with the ability to cross the blood-brain barrier and inflict a plethora of neuropathological manifestations in the brain - the Neuro-COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are widely reported in Parkinson's disease, Alzheimer's disease, dementia, and multiple sclerosis patients with aggravated clinical outcomes. Lactoferrin, credited with several neuroprotective benefits in the brain could serve as a potential adjuvant in the clinical management of Neuro-COVID-19.

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey.

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.

The COVID-19 threat and luxury advertising

The purpose of this research is to examine how the COVID-19 pandemic has impacted the luxury goods industry. The authors hypothesize that pandemic threats drive consumers toward luxury consumption to increase their perceptions of control. The article reports results of three experimental studies conducted in the United States. In Study 1, after participants read an article about COVID-19, they respond favorably to an advertisement for a luxury brand. The comparative control participants read an article about a tofu dish and respond less favorably to the luxury advertisement. Study 2 provides further evidence that perceived control acts as a mediator, while ruling out alternative explanations. Study 3 indicates that threat evokes luxury preferences only when advertisements for both luxury and nonluxury products use messages, as opposed to concrete messages. The findings provide practical insights showing that the most effective advertising strategy for luxury brand managers is to use rather than concrete messages for targeting consumers who feel highly threatened by COVID-19. © 2023 John Wiley & Sons Ltd.

Management of Extremely Complex Constipation Patients in a Nurse-Led Clinic with Health Play Specialist Involvement

Introduction Children with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurseled constipation clinic is to address behaviours around toileting. Aims To demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies. Case Studies We demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school. 9-year-old boy with history of sexual abuse, with soiling and wetting accidents. 5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved. 5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling. 8 sessions with HPS - Intense toilet training for 2-4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries - body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved 5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers. Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents. 8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years. Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time. Satisfaction questionnaires were given to parents and feedback was extremely positive. Conclusion The health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child's needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.

RSV-associated Hospitalizations in Adults Aged >=18 Years and the Impact of the COVID-19 Pandemic in the United States, October 2018 - February 2022

Background. Respiratory syncytial virus (RSV) is a significant cause of hospitalizations in older adults and typically circulates during the fall and winter in the United States. The COVID-19 pandemic and implementation of nonpharmaceutical interventions (NPIs) including masking, improved handwashing, and social distancing likely impacted RSV circulation. To explore the pandemic's impact on RSV seasonality and hospitalizations in adults aged >=18 years, we analyzed laboratory-confirmed RSV-associated hospitalizations through the RSV Hospitalization Surveillance Network (RSV-NET) across four seasons. Methods. RSV-NET is a population-based surveillance system that collects data on RSV-associated hospitalizations across 75 counties in 12 states. An RSV-NET case is a resident of a defined catchment area who tests positive for RSV through a clinician-ordered test within 14 days prior to or during hospitalization. Surveillance was conducted October-April for the 2018-19 and 2019-20 pre-pandemic seasons and October 2020-September 2021 (2020-21 season). Available data October 2021-February 2022 (ongoing 2021-22 season) are presented. Results. 2,536, 3,195, 618, and 1,758 laboratory-confirmed hospitalizations were identified in adults >=18 years in 2018-19, 2019-20, 2020-21, and 2021-22, respectively;case counts were 4.1 and 5.2 times higher in 2018-19 and 2019-20, respectively, than in 2020-2021. Hospitalizations peaked in January for pre-pandemic and 2021-22 seasons and in September for 2020-21 (Figure). For all years combined, 16.2%, 23.4%, 33.3%, and 27.1% of all RSV-associated hospitalizations were among those aged 18-49, 50-64, 65-79 and >=80 years, respectively. Laboratory-confirmed RSV-associated hospitalizations in adults >=18 years, October 2018 - February 2022 Conclusion. Laboratory-confirmed RSV-associated hospitalizations in adults were lower during the 2020-21 and 2021-22 seasons compared with pre-pandemic seasons, with a marked change in seasonal patterns in 2020-21, likely because of NPIs implemented during the pandemic. Continued monitoring of RSV-associated hospitalizations will be critical to understand ongoing changes in RSV circulation that resulted from the COVID-19 pandemic and associated NPIs. (Figure Presented).

COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages >=65 Years - COVID-NET, 14 U.S. States, March 2020-January 2022

Background. Adults aged >=65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes. Methods. Hospitalizations among LTCF residents aged >= 65 years from March 2020-January 2022 were described using data on a representative sample of hospitalizations from the CDC's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization. Results. Of 11,901 hospitalizations among adults aged >= 65 years reported during the study period, 2,965 (24.9%) were LTCF residents;most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or >= 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01-1.05) among LTCF residents compared to non-residents. Conclusion. Compared to non-residents, LTCF residents were older, had more underly ingconditions, and had a higher risk of in-hospital death. After adjusting formultiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.

Viral and bacterial infections among adults hospitalized with COVID-19, Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, 14 states, March 2020-February 2022

Background. Coinfections, both bacterial and viral, occur with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but prevalence, risk factors, and associated clinical outcomes are not fully understood. Methods. We used the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance platform to investigate the occurrence of viral and bacterial coinfections among hospitalized adults with laboratory-confirmed SARS-CoV-2 infection during March 2020 and February 2022. Patients receiving additional standard of care (SOC) molecular testing for viral pathogens (14 days prior to admission or 7 days after), including respiratory syncytial virus, rhinovirus/enterovirus (RV/EV), influenza, adenovirus, human metapneumovirus, parainfluenza viruses, and endemic coronaviruses, were included. SOC testing for clinically relevant bacterial pathogens (7 days before admission or 7 days after) from sputum, deep respiratory, and sterile sites were included. The demographic and clinical features of those with and without bacterial infections were compared. Results. Among 2,654 adults hospitalized with COVID-19 and tested for all 7 virus groups, another virus was identified in 3.1% of patients. RV/EV (1.2%) and influenza (0.4%) were the most commonly detected viruses. Half (17,842/35,528, 50.2%) of hospitalized adults with COVID-19 had bacterial cultures taken within 7 days of admission, and 1,092 (6.1%) of these had a clinically relevant bacterial pathogen. A higher percentage of those with a positive culture died compared to those with negative cultures (32.3% vs 13.3%, p< 0.001). Staphylococcus aureus was the most common isolate overall;Pseudomonas aeruginosa was the second most common respiratory isolate This figure includes 1,408 bacterial cultures from 1,066 individuals. Deep respiratory sites include endotracheal aspirate, bronchoalveolar lavage fluid, bronchial washings, pleural fluid, and lung tissue. Commensal organisms were excluded. Conclusion. Consistent with previous studies, a relatively low proportion of adults hospitalized with COVID-19 had concomitantly identified viral or bacterial infections. Identification of a bacterial infection within 7 days of admission is associated with increasedmortality among adults hospitalized with COVID-19. Conclusions about the clinical relevance of bacterial infections is limited by the retrospective nature of this study.

Differential transcriptomic changes in the central nervous system and urinary bladders of mice infected with a coronavirus.

Multiple sclerosis (MS) often leads to the development of neurogenic lower urinary tract symptoms (LUTS). We previously characterized neurogenic bladder dysfunction in a mouse model of MS induced by a coronavirus, mouse hepatitis virus (MHV). The aim of the study was to identify genes and pathways linking neuroinflammation in the central nervous system with urinary bladder (UB) dysfunction to enhance our understanding of the mechanisms underlying LUTS in demyelinating diseases. Adult C57BL/6 male mice (N = 12) received either an intracranial injection of MHV (coronavirus-induced encephalomyelitis, CIE group), or sterile saline (control group). Spinal cord (SC) and urinary bladders (UB) were collected from CIE mice at 1 wk and 4 wks, followed by RNA isolation and NanoString nCounter Neuroinflammation assay. Transcriptome analysis of SC identified a significantly changed expression of >150 genes in CIE mice known to regulate astrocyte, microglia and oligodendrocyte functions, neuroinflammation and immune responses. Two genes were significantly upregulated (Ttr and Ms4a4a), and two were downregulated (Asb2 and Myct1) only in the UB of CIE mice. Siglec1 and Zbp1 were the only genes significantly upregulated in both tissues, suggesting a common transcriptomic link between neuroinflammation in the CNS and neurogenic changes in the UB of CIE mice.

Sustainable development and finance post-pandemic - future directions and challenges

Sustainable development, finance and related global policies and mechanisms have evolved over the decades. Today, regional initiatives for classifying sustainable activities exist, and several decades' research and development of ecosystem services and natural capital have identified and tested alternative economic models. The World Bank has the potential to finance them and sustainability at the landscape scale is achievable. But economic and environmental values can come into conflict. In developing countries, sustainable alternatives exist in business activities such as coastal and marine tourism. Financing small businesses through sound digital infrastructure is critical, as is the use of public fiscal instruments for the sustainable use of natural resources. Despite its developed status, renewable energy policies in the EU are leading to forest destruction. Financial vehicles such as green bonds have a similar potential. To avoid greenwashing, more focus needs to be on meeting the needs of those at the base of the economic pyramid, resourcing them with smart technologies and valuing civic engagement. Climate finance must be ethical and its allocation have integrity;this will foster community resilience. To avoid repeating the mistakes of terrestrial development, the world's oceans need to be protected and new business models adopted in this expanding frontier. Now is the time for all sectors to create a sustainable future for the planet and its inhabitants in the post-COVID, postcarbon era to come. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Certification and sustainable development

Non-state market-driven certification has become a critical component of global trade in natural resource commodities. This consists of companies and producers being assessed against standards that are developed by certification schemes founded and managed by non-state actors. These certification schemes are organised around a privatised form governance largely operating within norms and rationalities of neoliberalism and liberal environmentalism. They make use of identities, visibilities and concepts such as sustainable development. In this chapter, the practices of forest certification are discussed as an example of non-state market-driven certification in reference to governmentality and the mentality and rationalities of governing are considered. These schemes form a rationality of self-government that is largely independent of the state. In this sense, forests are governed at a distance through indirect impositions of power, which are exercised in the form of performance being demonstrated to an audience, consisting of consumers and interested actors, that the values of public concern are being conserved, protected or compensated. The selfgovernment rationality of these schemes avoids the problems associated direct impositions of power as afforded by the state. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

The Diagnostic and Clinical Utility of Extended ECG Monitoring for Risk Stratification in Virtual Cardiac Rehabilitation

Background: The COVID-19 pandemic resulted in a necessary transition from centre-based cardiac rehabilitation to virtual cardiac rehabilitation (VCR) to continue delivery of effective and high-quality care. To enhance risk stratification, an extended duration electrocardiographic (ECG) patch monitor was added to the intake protocol for patient's enrolled in a virtual only cardiac rehabilitation program. Method(s): The objectives of this study were to assess the diagnostic yield of extended ECG patch monitoring (DR400 3-channel monitor, NorthEast Monitoring, Inc., Maynard MA;5-day duration) and the effect on clinical management in a tertiary cardiac rehabilitation population. A retrospective analysis of consecutive patients enrolled in VCR at a single site was performed. All patients who were enrolled in VCR and underwent extended ECG patch monitoring as part of their intake assessment were included. Risk was defined by the AACVPR 2020 risk categorization. Extended patch monitor diagnoses were reviewed for accuracy and classified as a new or known diagnosis. Impact on clinical management was defined as any medication adjustment, procedure requirement/recommendation, or exercise prescription modification. Patient characteristics, cardiac testing results, and risk categorization were described using basic descriptive methods including frequency distributions, and means and SDs. Result(s): Two-hundred and sixty-nine patients [mean age 61.7 years (SD 12.0) 63% male] out of 286 patients enrolled in VCR between August 13, 2020 and October 26, 2021 met inclusion criteria (Table 1). Two percent of patients were classified as high risk, 41% as moderate risk, and 57% as low risk. Thirty (11%) new arrythmia diagnoses were obtained from extended ECG patch monitoring. Diagnoses included one patient with atrial flutter and high-grade AV block, one patient with paroxysmal atrial fibrillation, and 28 patients with non-sustained ventricular tachycardia (NSVT) (4-48 beats;11% symptomatic). Fifty-seven percent (n=17) of diagnoses were evident on the first 24-hours of monitoring and 43% (n=13) required extended duration monitoring for diagnosis. Thirteen patients with known atrial fibrillation or flutter were noted to have this arrhythmia present. Of those with a new diagnosis, 6 (20%) resulted in a change in clinical management (Figure 1). Conclusion(s): Extended duration ECG patch monitoring appears diagnostically and clinically useful when utilized as a component of intake evaluation for VCR. Furthermore, added benefit of extended (i.e., 5 day) versus the initial 24-hour period of monitoring was observed. Further evaluation is required to determine the optimal duration and clinical utility of asynchronous ECG monitoring as a component of risk stratification for VCR programs.

Label compliance for ingredient verification: regulations, approaches, and trends for testing botanical products marketed for "immune health" in the United States.

During the COVID-19 pandemic, the botanical product market saw a consumer interest increase in immune health supplements. While data are currently insufficient to support public health guidance for using foods and dietary supplements to prevent or treat COVID-19 and other immune disorders, consumer surveys indicate that immune support is the second-most cited reason for supplement use in the United States. Meanwhile, consumers showed increased attention to dietary supplement ingredient labels, especially concerning authenticity and ingredient claims. Top-selling botanical ingredients such as elderberry, turmeric, and functional mushrooms have been increasingly marketed toward consumers to promote immune health, but these popular products succumb to adulteration with inaccurate labeling due to the intentional or unintentional addition of lower grade ingredients, non-target plants, and synthetic compounds, partially due to pandemic-related supply chain issues. This review highlights the regulatory requirements and recommendations for analytical approaches, including chromatography, spectroscopy, and DNA approaches for ingredient claim verification. Demonstrating elderberry, turmeric, and functional mushrooms as examples, this review aims to provide industrial professionals and scientists an overview of current United States regulations, testing approaches, and trends for label compliance verification to ensure the safety of botanical products marketed for "immune health."

IMPACT in PRENATAL EVALUATION of PREGNANT WOMEN with RHEUMATIC DISEASES by the SARS-COV2 PANDEMIC

Background: Due to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2) Objectives: This study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic. Methods: This study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital 'Dr. José Eleuterio González' during the period from February 2018 to August 2021. Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gesta-tional diabetes screening, was addressed. Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group. The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program. Results: 50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically signifcant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically signifcant, a higher rate of adherence to laboratory and cabinet studies was found, being signifcant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1. Conclusion: A higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically signifcant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.