Inhibitory effects of 190 compounds against SARS-CoV-2 Mpr o protein: Molecular docking interactions.

COVID-19 has caused many deaths since the first outbreak in 2019. The burden on healthcare systems around the world has been reduced by the success of vaccines. However, population adherence and the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are still challenging tasks to be affronted. In addition, the newly approved drug presents some limitations in terms of side effects and drug interference, highlighting the importance of searching for new antiviral agents against SARS-CoV-2. The SARS-CoV-2 main protease (Mpr o ) represents a versatile target to search for new drug candidates due to its essential role in proteolytic activities responsible for the virus replication. In this work, a series of 190 compounds, composed of 27 natural ones and 163 synthetic compounds, were screened in vitro for their inhibitory effects against SARS-CoV-2 Mpro . Twenty-five compounds inhibited Mpro with inhibitory constant values (Ki ) between 23.2 and 241 µM. Among them, a thiosemicarbazone derivative was the most active compound. Molecular docking studies using Protein Data Bank ID 5RG1, 5RG2, and 5RG3 crystal structures of Mpro revealed important interactions identified as hydrophobic, hydrogen bonding and steric interactions with amino acid residues in the active site cavity. Overall, our findings indicate the described thiosemicarbazones as good candidates to be further explored to develop antiviral leads against SARS-CoV-2. Moreover, the studies showed the importance of careful evaluation of test results to detect and exclude false-positive findings.

Use of Schirmer strips and conjunctival swabs for virus detection on the ocular surface of adults: a scoping review.

Schirmer strips and conjunctival swabs are used in ophthalmology for the collection of tears and fluids. One of the biggest challenges during the COVID-19 pandemic has been accurate diagnosis and, in some cases, ocular manifestations are among the first symptoms. In this context, this study aimed to collect evidence to support the use of Schirmer strips and conjunctival swabs as a method of sample collection for viral analysis. A literature search was conducted following the Scoping Review protocol defined by The Joanna Briggs Institute. Studies were analyzed regarding virus research, collection methods, and sample analysis. The findings support that viruses can be detected on the ocular surface through analysis of Schirmer strips and conjunctival swabs. However, additional studies with larger samples and time data are necessary to confirm these conclusions.

The impacts airising from the COVID-19 pandemic on supply chains

The global COVID-19 pandemic brought about unimaginable consequences for businesses, with lockdown, quarantine and social isolation causing the closure of borders, factories and stores in several countries, which ultimately locked down the most diverse supply chains, demonstrating an important characteristic of society today: supply chains are highly dependent. Business analysts are citing that the effects of the COVID-19 pandemic on supply chains are unprecedented in recent business history, something that can be visualized with supply chains becoming partially paralyzed as a result of official measures to prevent the pandemic from spreading at a speed that health systems cannot meet. However, some academic works have already warned of the danger of business concentration in specific regions of the planet, where the main focus is the low cost of production, without addressing strategic objectives or focusing on strategic products. This work proposes a reflection on the location of suppliers in certain geographical areas, as this implies the use of long supply chains, proposing an alternative for the creation and planning of shorter supply chains for products that are classified as strategic.Alternate :A pandemia global da COVID-19 trouxe consequências inimagináveis para as empresas, com fechamento, quarentena e isolamento social causando o fechamento de fronteiras, fábricas e lojas em vários países, que acabaram por fechar as mais diversas cadeias de abastecimento, demonstrando uma característica importante da sociedade atual: as cadeias de abastecimento são altamente dependentes. Os analistas empresariais estão citando que os efeitos da pandemia COVID-19 sobre as cadeias de abastecimento são sem precedentes na história recente dos negócios, algo que pode ser visualizado com as cadeias de abastecimento ficando parcialmente paralisadas como resultado de medidas oficiais para evitar que a pandemia se propague a uma velocidade que os sistemas de saúde não podem atender. Entretanto, alguns trabalhos acadêmicos já alertaram para o perigo da concentração de negócios em regiões específicas do planeta, onde o foco principal é o baixo custo de produção, sem abordar objetivos estratégicos ou focar em produtos estratégicos. Este trabalho propõe uma reflexão sobre a localização de fornecedores em determinadas áreas geográficas, pois isto implica no uso de longas cadeias de abastecimento, propondo uma alternativa para a criação e planejamento de cadeias de abastecimento mais curtas para produtos que são classificados como estratégicos.

Previous BCG vaccination is associated with less severe clinical progression of COVID-19.

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre study

Background: Minimally invasive lumbar interbody fusion (MI-LIF) procedures are an effective treatment for patients with degenerative lumbar disease (DLD). However, consensus does not exist among surgeons for selecting 1 approach over another. The objectives were to collect patientreported, surgical and fusion outcome data at 1 year after surgery for patients receiving either anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF), oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or midline lumbar interbody fusion (MIDLF) for DLD. Methods: A total of 340 patients with DLD were consecutively enrolled in a prospective, global, multicentre cohort study (MASTERS-D2;NCT02617563). Patients were treated according to the surgeon's choice with 1 of 6 MI-LIF procedures. Outcome data for disability (Oswestry Disability Index), back and leg pain (Visual Analogue Scale), quality of life (EQ-5D) were collected at baseline, 4 weeks, 3 months and 12 months. Demographic, surgical and safety data were also recorded. Fusion status was assessed by using computed tomography or x-rays at 1 year (plus or minus 6 mo) after surgery. Paired sample t tests were used to test for improvement from baseline. Results: One year after surgery, patients attained clinically significant improvements on all patient-reported outcome measures regardless of approach used. Patients who were selected to receive an ALIF comprised the highest proportion of smokers, were the youngest and had the longest operating time, but low fluoroscopy exposure. Anterolateral (ALIF, DLIF, OLIF) compared with posterior (MIDLF, PLIF, TLIF) approaches had the least amount of blood loss, despite similar or longer surgical times. Within 1 year of follow-up, 7 device-related and 7 surgery-related serious adverse events (SAEs) had been recorded. Assessment of fusion was hindered by the effects of COVID-19. In total, 196 out of 340 (57.6%) patients were assessed. The aggregate fusion rate for anterolateral approaches was 88.1% and for posterior approaches 85.1% at 12 months of follow-up. Conclusion: All 6 approaches for MI-LIF surgery demonstrate favourable patient-reported and surgical outcomes for patients with DLD. Continuing data collection up to 5 years after surgery will yield information on long-term effectiveness, safety, health economics and revision surgery and on the long-term impact of surgeons' choice of approach.

Creative Tourism in Islands and Regional Sustainable Development: What Can We Learn from the Pilot Projects Implemented in the Azores Territory?

The current need for territories and societies to grow is based on the Sustainable Development Models as well as the United Nations (UN) Agenda for 2030 Sustainable Development Goals (SDGs). In that case, such new forms of tourism development imply creating and upgrading critical infrastructures, facilities, equipment, or differentiated activities to bring clients who align with the desired Sustainable Development Models and SDGs. In this regard, the thematic literature provides evidence that some tourism typologies (nature-based, rural, culturally-based creative tourism) play a critical role in attaining sustainable regional development. Therefore, this paper aims to unfold what can be learned from the pilot projects implemented in the Azores region aimed toward the so-desired regional sustainability. Contextually, the obtained results ask for the regional leaders to consider encouraging entrepreneurship associated with small and medium-sized firms;fostering the diversity of touristic offerings;designing guidelines that follow sustainable development models and the SDGs;or creating meaningful investments in the conservation and protection of cultural heritage, as well as the Azorean endogenous resources.

Older Adults Who Maintained a Regular Physical Exercise Routine before the Pandemic Show Better Immune Response to Vaccination for COVID-19.

BACKGROUND: In this study, we aimed to investigate the specific-antibody response to the COVID-19 vaccination and the immunophenotyping of T cells in older adults who were engaged or not in an exercise training program before the pandemic. METHODS: Ninety-three aged individuals (aged between 60 and 85 years) were separated into 3 groups: practitioners of physical exercise vaccinated with CoronaVac (PE-Co, n = 46), or vaccinated with ChadOx-1 (PE-Ch, n = 23), and non-practitioners vaccinated with ChadOx-1 (NPE-Ch, n = 24). Blood samples were collected before (pre) and 30 days after vaccination with the second vaccine dose. RESULTS: Higher IgG levels and immunogenicity were found in the PE-Ch and NPE-Ch groups, whereas increased IgA levels were found only in the PE-Ch group post-vaccination. The PE-Co group showed a positive correlation between the IgA and IgG values, and lower IgG levels post-vaccination were associated with age. Significant alterations in the percentage of naive (CD28+CD57-), double-positive (CD28+CD57+), and senescent (CD28-CD57+) CD4+ T and CD8+ T cells were found post-vaccination, particularly in the PE-Ch group. CONCLUSIONS: The volunteers vaccinated with the ChadOx-1 presented not only a better antibody response but also a significant modulation in the percentage of T cell profiles, mainly in the previously exercised group.

Hospital-Acquired COVID-19 among Patients of Two Acute-Care Hospitals: Implications for Surveillance.

OBJECTIVES: We quantified hospital-acquired COVID-19 during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition. DESIGN: Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected SARS-CoV-2 from 30 days before admission through discharge. All episodes detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired, or possible or probable hospital-acquired. SETTING: Two acute-care hospitals in Chicago, IL. PATIENTS: All hospitalized patients including an inpatient rehabilitation unit. INTERVENTIONS: Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient- and staff-cohorting, universal masking, and restricted visitation policies. RESULTS: Among 2,667 patients with SARS-CoV-2, detection before hospital day six was most common (n=2,612; 98%); days 6-14 uncommon (n=43; 1.6%); and, after day 14, rare (n=16; 0.6%). By chart review, most episodes after day 5 were categorized as community-acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14; 53% of cases after day 14). Incidence for possible and probable hospital-acquired cases, per 10,000 patient-days, was similar for ICU- and non-ICU patients at Hospitals A (1.2 vs 1.3, difference = 0.1; 95% CI, -2.8 to 3.0) and B (2.8 vs 1.2, difference = 1.6; 95% CI, -0.1 to 4.0). CONCLUSIONS: Most patients were protected by early and sustained application of infection-control precautions, modified to reduce COVID-19 transmission. Using solely temporal criteria to discriminate hospital- vs community-acquisition would have misclassified many "late-onset" SARS-CoV-2 positive episodes.

Conjunctival Swabs Reveal Higher Detection Rate Compared to Schirmer Strips for SARS-CoV-2 RNA Detection in Tears of Hospitalized COVID-19 Patients.

Purpose: To determine the prevalence of SARS-CoV-2 in tear samples and to investigate whether it correlates with ocular findings and patients' prognosis in Brazil. Methods: Tears were collected using Schirmer strips (SS) and conjunctival swabs (CS) from patients hospitalized with laboratory-confirmed SARS-CoV-2 infection. Samples were analyzed using qRT-PCR. Demographic and clinical data, ocular symptoms, and Schirmer tests (ST) were collected from patients. Charlson Comorbidity Index (CCI) was used to rate comorbidities, and patients were monitored until hospital discharge or death. Results: There were 61 hospitalized patients, 33 of which were diagnosed with COVID-19. Within the confirmed COVID-19 patients, SARS-CoV-2 was detected in 18.2% (n = 6) of CS and 12.1% (n = 4) of SS samples. Subjective and objective parameters for dry eye syndrome (e.g., ST COVID-19: 8.3 ± 6.4mm, non-COVID-19: 8.9 ± 6.6mm, p > 0.05) were comparable between COVID-19 (n = 33) and non-COVID-19 patients (n = 28). Among the 16 COVID-19 patients exhibiting ocular symptoms, only tearing was reported significantly more frequently when tear samples were positive for SARS-CoV-2 (p < 0.05). Strikingly, patients whose tears tested positive for SARS-CoV-2 had significantly inferior CCI (pos.: 34.0 ± 31.8%, neg.: 67.6 ± 36.4%, p < 0.05) and higher mortality rates (pos.: 50.0%, neg.: 7.4%, p < 0.01). Conclusions: SARS-CoV-2 was detected with a prevalence of 18.2% on the ocular surface. Decreased CCI and increased mortality rate in the positive tear group suggests that viral detection may relate to prognosis and highlight the need of personal protective measures for healthcare professionals. Most of the patients, regardless of COVID-19 diagnosis, had low tear production and eye discomfort, possibly pointing to the need for artificial tear use during hospitalization.

Fast, low-cost and highly specific colorimetric RT-LAMP assays for inference of SARS-CoV-2 Omicron BA.1 and BA.2 lineages.

Two lineages (BA.1 and BA.2) of the Omicron variant are the main ones responsible for the recent COVID-19 pandemic waves worldwide. Monitoring the prevalence and spread of these variants is important as the presence of mutations might lower the efficacy of vaccines and hinder the benefits of monoclonal antibody therapies. Although the need to screen these new lineages is emerging, genetic sequencing is scarce due to its high cost. Alternatively, we propose using reverse transcription loop-mediated isothermal amplification (RT-LAMP) to infer the prevalence of these lineages and aid in genomic surveillance in countries with limited genetic sequencing capacity. For this, we designed specific primers and tested them on a panel of 267 sequenced RNA genomes from different lineages. The test for BA.1 and its descendants showed 96.63% sensitivity, 100% specificity, and 98.85% accuracy, and the test for BA.2 and descendants showed 90.00% sensitivity, 98.85% specificity, and 98.52% accuracy. These results demonstrate the potential of RT-LAMP to be an alternative to help monitor variants, especially in countries with scarce resources.

Computing antimicrobial use/antimicrobial resistance ratios: A novel way to assess inpatient antimicrobial utilization using current National Healthcare Safety Network metrics.

BACKGROUND: Current methods for benchmarking inpatient antimicrobial use (AU) could benefit from combining AU with antimicrobial resistance (AR) information to provide metrics benchmarked to microbiological data; this may yield more instructive and better risk-adjusted measurements than AU and AR in isolation. METHODS: In this retrospective single-center study, we computed facility-wide AU/AR ratios from 2019 to 2020 for specific antimicrobial agents and corresponding AR events, and compared median monthly AU/AR ratios between March 2019 through December 2019 (pre-COVID period) and March 2020 through December 2020 (COVID period). Aggregate AU was expressed as a ratio to aggregate AR events for antimicrobials that typically have activity against the AR organism and are frequently used to treat the AR organism in clinical practice. We also computed AU/AR ratios in our surgical intensive care unit in the pre-COVID period. RESULTS: High-median facility-wide monthly AU/AR ratios were observed for intravenous vancomycin/methicillin-resistant Staphylococcus aureus, with 130.0 in the pre-COVID period and 121.3 in the COVID period (p =.520). Decreases in facility-wide median monthly AU/AR ratios were observed between periods for meropenem/ESBL Enterobacterales (20.9 vs. 7.9, p < .001), linezolid/vancomycin-resistant Enterococcus (48.5 vs. 15.8, p =.004), and daptomycin/vancomycin-resistant Enterococcus (32.2 vs. 4.8, p = .002). Increases in facility-wide median monthly AU/AR ratios were observed between periods for ceftazidime-avibactam/carbapenem-resistant Enterobacterales (0.0 vs. 3.2, p = .020) and ceftazidime-avibactam/multidrug-resistant Pseudomonas aeruginosa (0.0 vs. 4.0, p = .017). The AU/AR ratio for intravenous vancomycin/methicillin-resistant S. aureus in the surgical intensive care unit was 191.5 in the pre-COVID period. CONCLUSIONS: AU/AR ratios may be used to supplement current AU and AR metrics. Future directions should include the development of more AU metrics benchmarked to microbiological information. AU metrics more specific to transplant infectious diseases should be developed.

Older Women Who Practiced Physical Exercises before the COVID-19 Pandemic Present Metabolic Alterations and Worsened Functional Physical Capacity after One Year of Social Isolation.

BACKGROUND: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. METHODS: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. RESULTS: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. CONCLUSION: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.

Detecting lineage-defining mutations in SARS-CoV-2 using colorimetric RT-LAMP without probes or additional primers.

Despite the advance of vaccination worldwide, epidemic waves caused by more transmissible and immune evasive genetic variants of SARS-CoV-2 have sustained the ongoing pandemic of COVID-19. Monitoring such variants is expensive, as it usually relies on whole-genome sequencing methods. Therefore, it is necessary to develop alternatives that could help identify samples from specific variants. Reverse transcription loop-mediated isothermal amplification is a method that has been increasingly used for nucleic acid amplification, as it is cheaper and easier to perform when compared to other molecular techniques. As a proof of concept that can help distinguish variants, we present an RT-LAMP assay capable of detecting samples carrying a group of mutations that can be related to specific SARS-CoV-2 lineages, here demonstrated for the Variant of Concern Gamma. We tested 60 SARS-CoV-2 RNA samples extracted from swab samples and the reaction showed a sensitivity of 93.33%, a specificity of 88.89% and a kappa value of 0.822 for samples with a Ct ≤ 22.93. The RT-LAMP assay demonstrated to be useful to distinguish VOC Gamma and may be of particular interest as a screening approach for variants in countries with poor sequencing coverage.

Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study.

BACKGROUND: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. OBJECTIVE: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. METHODS: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users' engagement from May 2020 to February 2021. RESULTS: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). CONCLUSIONS: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app's listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families.

Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women.

Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers' physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.

An international, interlaboratory ring trial confirms the feasibility of an extraction-less "direct" RT-qPCR method for reliable detection of SARS-CoV-2 RNA in clinical samples.

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is used worldwide to test and trace the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). "Extraction-less" or "direct" real time-reverse transcription polymerase chain reaction (RT-PCR) is a transparent and accessible qualitative method for SARS-CoV-2 detection from nasopharyngeal or oral pharyngeal samples with the potential to generate actionable data more quickly, at a lower cost, and with fewer experimental resources than full RT-qPCR. This study engaged 10 global testing sites, including laboratories currently experiencing testing limitations due to reagent or equipment shortages, in an international interlaboratory ring trial. Participating laboratories were provided a common protocol, common reagents, aliquots of identical pooled clinical samples, and purified nucleic acids and used their existing in-house equipment. We observed 100% concordance across laboratories in the correct identification of all positive and negative samples, with highly similar cycle threshold values. The test also performed well when applied to locally collected patient nasopharyngeal samples, provided the viral transport media did not contain charcoal or guanidine, both of which appeared to potently inhibit the RT-PCR reaction. Our results suggest that direct RT-PCR assay methods can be clearly translated across sites utilizing readily available equipment and expertise and are thus a feasible option for more efficient COVID-19 coronavirus disease testing as demanded by the continuing pandemic.

Islandscapes and Sustainable Creative Tourism: A Conceptual Framework and Guidelines for Best Practices

As strategies for the development of creative tourism multiply in contexts ranging from global cities to small communities, the need for a clearer conceptual framework, capable of better differentiating existing approaches, has become more evident. Building upon existing knowledge on cultural and creative tourism, and on a prior review of the literature on creative tourism on islands, this paper proposes a typology of creative tourism initiatives, and after examining this new categorization, develops the concept of sustainable creative tourism. Through highlighting the need for creative tourism developers, policymakers, and practitioners to deepen their engagement with more holistic and integrated approaches oriented towards sustainable development in all its dimensions (economic, environmental, social, and cultural), the authors systematize a set of international principles and policy recommendations meant to promote sustainable creative tourism development strategies, duly adjusted to different places and realities, with an emphasis on vulnerable islandscapes.