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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.

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.

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.

The current situation of healthcare units is characterised by the increasing cost of providing the respective care, the consequent deterioration of the financial situation, and the complicated and time-consuming processes. Together with rising demand, they may become factors contributing to a decrease in service demand. Due to this situation, more efficient and effective logistics and supply chain management are widely recognised as one of the main areas for improvement. To provide insight on which areas to improve, several objectives were looked at in this work, including the analysis of the methods and criteria for the selection of medicines in hospital pharmacies, the definition of obstacles to the rational management of stocks, and the analysis of historical data to forecast future demand for a Portuguese public hospital. The study revealed that some of the 1346 products present on the pharmacy’s ERP do not have sufficient historical data to create an accurate forecast. In this context, and with a service level of 95%, 41% of products have a stock higher than what should be the maximum stock, amounting to approximately € 147.908.87 in fixed assets, and 11% of products were at risk of being out of stock at the time. The importance of the evolution of the core information system of hospitals was at stake, ensuring the technological sustainability of the ongoing digital transformation, alignment with ICT rationalisation measures, improvement of customer service, and improvement of the quality of information available to the user.

The evolution of tourism must be framed into policies that aim a development model perspective for the destinations, based on the analysis of economic, political, and social indicators. Therefore, emerging destinations, located in territories with low population density, should be a target of a careful strategy policy, considering the characteristics of the region. In particular, the disaster caused by the pandemic context (i.e., COVID-19) implied profound changes in tourism thinking, planning, and development of regions in Portugal and throughout the world. The present chapter proposes the creation of a tourism monitoring system for Arouca (Portugal), a territory classified as Low-Density Territory, with specific characteristics. The monitoring will involve the planning and management of database, at the disposal of all stakeholders, ensuring that the tourism flows in analysis do not get overwhelmed, allowing the discussion of opportunities and threats for the territory, based on the partnership between the population, public and private sector, adjusted to the social, cultural, economic, and environment perception. Will also be considered the perspective of the local community from Arouca's region, the main actors from the territory such as Geopark Association of Arouca and the City Council, according to the surveys used as data basis of this study, along with statistics analysis.

We use many kinds of digital technologies in our daily life and they lead to radical changes. These technologies are recently being adopted by agriculture and food industry and their use in various applications is tested. The results of the studies conducted with the use of these technologies, especially IoT (internet of things)-based systems, are quite promising for the solution of the chronic problems of agriculture and food industry such as food-borne diseases, mycotoxin contaminations, pesticide residues, increasing waste, etc. Under extraordinary conditions, just like the ones we have recently experienced due to COVID-19 pandemic, IoT-based systems are crucial to ensure the sustainability of agriculture and food supply chain. In this review, the fundamentals of IoT-based systems and recent developments in their use in agriculture and food supply chain are explained. Based on the literature, examples of successful applications of IoT-based systems for irrigation efficiency, pesticide treatments, supply chain management etc. are given. Nowadays, there is a great demand for the integration of IoT-based systems into the present agricultural practices and supply chains and it seems to increase exponen-tially. Experts in electronics and computer sciences have achieved noteworthy success in the simulations. On the other hand, only a few studies have been conducted in real agricultural and food systems. However, IoT-based systems should be tested on-site and their success in practical applications should be proved. It is obvious that new era will be one in which IoT-based technologies and their tools will be more commonly used in agriculture and food supply.