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In the post-pandemic COVID-19 period, human activities have returned to normal and COVID-19 cases are usually mild. However, patients with multiple myeloma (MM) present an increased risk for breakthrough infections and severe COVID-19 outcomes, including hospitalization and death. The European Myeloma Network has provided an expert consensus to guide patient management in this era. Vaccination with variant-specific booster vaccines, such as the bivalent vaccine for the ancestral Wuhan strain and the Omicron BA.4/5 strains, is essential as novel strains emerge and become dominant in the community. Boosters should be administered every 6–12 months after the last vaccine shot or documented COVID-19 infection (hybrid immunity). Booster shots seem to overcome the negative effect of anti-CD38 monoclonal antibodies on humoral responses; however, anti-BCMA treatment remains an adverse predictive factor for humoral immune response. Evaluation of the immune response after vaccination may identify a particularly vulnerable subset of patients who may need additional boosters, prophylactic therapies and prevention measures. Pre-exposure prophylaxis with tixagevimab/cilgavimab is not effective against the new dominant variants and thus is no longer recommended. Oral antivirals (nirmatrelvir/ritonavir and molnupiravir) and remdesivir are effective against Omicron subvariants BA.2.12.1, BA.4, BA.5, BQ.1.1 and/or XBB.1.5 and should be administered in MM patients at the time of a positive COVID-19 test or within 5 days post symptoms onset. Convalescent plasma seems to have low value in the post-pandemic era. Prevention measures during SARS-CoV-2 outbreaks, including mask wearing and avoiding crowded places, seem prudent to continue for MM patients.

Abstract:Nirmatrelvir/ritonavir (Paxlovid) consists of a peptidomimetic inhibitor (nirmatrelvir) of the SARS-CoV-2 main protease and a pharmacokinetic enhancer (ritonavir). It is approved for the treatment of mild-to-moderate COVID-19. This combination of nirmatrelvir and ritonavir can mediate significant and complex drug-drug interactions (DDIs), primarily due to the ritonavir component. Indeed, ritonavir inhibits the metabolism of nirmatrelvir through cytochrome P450 3A (CYP3A) leading to higher plasma concentrations and a longer half-life of nirmatrelvir. Coadministration of nirmatrelvir/ritonavir with immunosuppressive drugs (ISDs) is particularly challenging given the major involvement of CYP3A in the metabolism of most of these drugs and their narrow therapeutic ranges. Exposure of ISDs will be drastically increased through the potent ritonavir-mediated inhibition of CYP3A, resulting in an increased risk of adverse drug reactions. Although a decrease in the dosage of ISDs can prevent toxicity, an inappropriate dosage regimen may also result in insufficient exposure and a risk of rejection. Here, we provide some general recommendations for therapeutic drug monitoring of ISDs and dosing recommendations when coadministered with nirmatrelvir/ritonavir. Particularly, tacrolimus should be discontinued, or patients should be given a microdose on day 1, whereas cyclosporine dosage should be reduced to 20% of the initial dosage during the antiviral treatment. Dosages of mammalian target of rapamycin inhibitors (m-TORis) should also be adjusted while dosages of mycophenolic acid and corticosteroids are expected to be less impacted.

Supplementary Tables of Scientific Paper

Deliverable report 3.2 describes the findings on the analysis of the Science-Policy-Society (SPS) collaboration system on specific casesthrough a Net-Map analysis. Net-Map is an interview-based mapping tool to visualize implicit knowledge and understand the interplay of complex formal and informal networks, power relations, and actors/stakeholders’ goals; uncover sources of conflicts as well as potentials for cooperation; facilitate knowledge exchange and learning processes; and develop visions and strategies to achieve common goals. The development of the Net-Map analysis tool is described. Due to the Covid-19 pandemic, the interviewbased mapping tool was adapted to fit in an online setting. Online meeting applications such as Microsoft Teams® and MIRO® were implemented to map the stakeholders and their relations in the society-policyscience (SPS) collaboration system in risk analysis of emerging food safety issues and to identify constraints in relations, resources, and capabilities. Food safety scenarios based on gobal challenges were selected based on the in-depth expert interviews (Deliverable 3.1). These were food safety concerns regarding emerging mycotoxins and recycled food contact materials (FCM). Several steps in mycotoxin risk analysis are incomplete due to e.g. lack of occurrence or toxicokinetic/toxicity data, lack of analytical techniques and lack of scientific knowledge. Therefore, this case of emerging mycotoxins was used to perform a Net-Map analysis to identify stakeholders involved in this risk analysis and how they interact. For the FCMs, the focus was put on packaging consisting of recycled paper or cardboard, as they have become increasingly important in the light of sustainability and circular economy. However, food safety challenges are related to these materials, making it a good model case to apply the Net-Map tool on. A Net-Map guidance protocol, including a standardized data reporting format, was distributed among the food safety hub (HUB) leaders. Pilot workshops with FS4EU consortium partners were held, enabling further refinement of the protocol. The final protocol has been made publicly available through the FS4EU website and can be applied in many other contexts. Next, four Net-Map workshops were carried out in the respective home countries of the HUB leaders. In Belgium (West HUB) and Finland (North HUB) the case of FCMs was implemented, while participants of Italy (South HUB) and the Czech Republic (East HUB) worked on the emerging mycotoxins case. First, stakeholders and their main goals in mycotoxin/FCM risk analysis were identified. The next step was to characterise how the stakeholders were linked in the system, followed by an assessment on how influential the stakeholders were. Finally a discussion took place on constraints compromising the risk analysis. The workshops resulted in complex Net-Maps, visualizing how the SPS collaboration system regarding risk analysis of the aforementioned food safety issues is set up in each country. The most prominent stakeholders who take up a central role in the risk analysis process were identified. Many linkages between stakeholders were revealed, going from information sharing (legally required or voluntary), data requesting or communicating to the public. Moreover, in every country, constraints related to these linkages could be identified. These constraints, such as lack of resources or communication issues can be used to define needs for improvements in the current SPS collaboration system. While the initial results are already very interesting to discuss, further validation and verification of the obtained conclusions is needed.

OBJECTIVE: Assessment of the results of the ProtekDuo cannula applied for dedicated right ventricular support with oxygenator in ARDS secondary to COVID-19. METHODS: Systematic literature search in NHS library, Medline (Pubmed) and EMBASE using appropriate keywords as well as PICOS and PRISMA approach. RESULTS: Out of 285 publications found, 5 publications met the search criteria and were included in this review. A total of 194 patients with ARDS secondary to COVID-19 underwent ProtekDuo placement to establish a combination of respiratory [veno-venous extracorporeal membrane oxygenation (V-V ECMO)] and right ventricular support. Patients treated using the ProtekDuo cannula had survival rates between 59% and 89% throughout the five studies, and a significant survival benefit when compared to an invasive ventilation group or compared to dual site V-V ECMO or other double lumen ECMO cannulas. One study focused on extubation and discontinuation of ventilator support, which could be achieved in 100% of ProtekDuo patients. An association for reduced incidence of acute kidney injury (AKI) and use of continuous renal replacement therapy (CRRT) could be shown when the ProtekDuo was used. CONCLUSION: Only limited literature is available for the ProtekDuo in V-P ECMO configuration in the setting of COVID-19 ARDS and should be interpreted with caution. Data on the ProtekDuo is suggestive for lower rates of mortality, AKI and CRRT as compared to other respiratory support modalities.

The EU is facing a severe mental health crisis worsened by the COVID-19 pandemic, with insufficient treatment options exacerbating the situation. Access to mental health services is inadequate in many EU countries, contributing to high levels of neuropsychiatric problems. It is therefore crucial to prioritize mental health by investing in comprehensive accessible and cost-effective healthcare. Prioritizing the wellbeing of EU citizens is essential for building resilience and a healthier future, thus respecting the principles of dignity, equality, and the right to health.

Higher education is constantly changing, both in relation to the characteristics of the different agents that constitute it (particularly teachers and students) and in relation to the particular experiences from this formative context. With the Covid-19 pandemic, new pedagogical challenges have emerged due to what were the emergency circumstances that we all experienced. Classrooms and teaching dynamics inevitably had to reinvent themselves, to get closer to the specific references and practices of distance teaching and learning. With this chapter, the authors present a plural set of experiences developed during their teaching experiences. Through reflection on these practices, five areas that were established as variables with special pedagogical value: i) availability of teachers and students; ii) programmatic content as a mean and not an end; iii) the centrality of interaction between peers; iv) the plurality of resources and perspectives and v) evaluation at the service of learning.

Events influence the destinations that host them. It was therefore considered interesting to analyze the influence of the Portuguese Rally sports’ event at Porto. This research aims at evaluating the role of the Rally of Portugal in Porto as a tourism destination. It aims to identify the stakeholders’ opinion regarding the impact of the Rally of Portugal on tourism demand in the city of Porto, to evaluate the impact of the Rally of Portugal in Porto as a destination, to identify the conditioning components of the realization of the Rally of Portugal, and to perceive strategies to be applied in future editions, in less secure contexts. A qualitative methodology was used for data collection, through the convenience sampling method, according to the availability of the participants. Individual semi-structured online interviews using the Zoom platform were applied to event organizers, a former pilot, and a pilot of the event. It was verified that the Porto Street Stage, stage of the Rally of Portugal that takes place in the city of Porto, presents many positive impacts for the destination, which in the perspective of the organization include the international projection of the city of Porto (through the presence of the specialized international press), with passage of the circuit by the main urban tourism resources, increase of income, complementary social programs to the event, and pride of the resident community, regarding the reception of the event. From this perspective, the fact that the event was not held in 2020 due to the SARS-CoV-2 virus was significantly reflected in the absence of revenue at the destination, with a negative impact in organizational terms, given the advanced state of this process when the event was canceled, in particular the stages of route definition, budgeting, and communication/dissemination, with the involvement of specialized teams.

The coronavirus (COVID-19) pandemic spread rapidly around the world, generating economic shocks with pace and intensity above those observed in previous crises. Faced with this pandemic scenario, several economic sectors such as tourism, health, transportation were seriously affected. This paper focuses on the tourism sector which has been affected by various restrictions on passenger transport, the end of the free movement of people between countries, and the insecurity of travelers. This paper uses the Method Unified for Strategic Prospective Planning (Momento) for a company in the tourism sector so that it is possible to deal more effectively with uncertainties about the coming years. The methodology applied here can be a strategic-prospective planning proposal for this sector. The study based on the collected data allowed the creation of three possible future scenarios, which could support the creation of action plans and help the company's decision-makers to avoid themselves in the worst-case scenario and maximize the use of the best-case scenario. From this study, it was possible to bring greater knowledge to the tourism company about which are the variables that can most impact its business in a 5-year horizon, because the approach by the Momento method allowed the structuring and analysis of the variables and uncertainties observed in the construction of the prospective scenarios of tourism and its business in the middle of the socioeconomic instability experienced in the current period of the COVID-19 pandemic.