The evolving landscape of COVID‐19 and post‐COVID condition in patients with chronic lymphocytic leukemia: A study by ERIC, the European research initiative on CLL

In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations

COVID-19 severity and mortality in patients with CLL: an update of the international ERIC and Campus CLL study

Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to Coronavirus disease 2019 (COVID-19) due to age, disease, and treatment-related immunosuppression. We aimed to assess risk factors of outcome and elucidate the impact of CLL-directed treatments on the course of COVID-19. We conducted a retrospective, international study, collectively including 941 patients with CLL and confirmed COVID-19. Data from the beginning of the pandemic until March 16, 2021, were collected from 91 centers. The risk factors of case fatality rate (CFR), disease severity, and overall survival (OS) were investigated. OS analysis was restricted to patients with severe COVID-19 (definition: hospitalization with need of oxygen or admission into an intensive care unit). CFR in patients with severe COVID-19 was 38.4%. OS was inferior for patients in all treatment categories compared to untreated (p < 0.001). Untreated patients had a lower risk of death (HR = 0.54, 95% CI:0.41–0.72). The risk of death was higher for older patients and those suffering from cardiac failure (HR = 1.03, 95% CI:1.02–1.04; HR = 1.79, 95% CI:1.04–3.07, respectively). Age, CLL-directed treatment, and cardiac failure were significant risk factors of OS. Untreated patients had a better chance of survival than those on treatment or recently treated

The Diverse Legal and Regulatory Framework for Marine Sustainability Policy in the North Atlantic – Horrendograms as Tools to Assist Circumnavigating Through a Sea of Different Maritime Policies

Although considerable progress has been made in the management and planning of the marine environment, important gaps still exist in streamlining policies across governance levels, maritime sectors, and between different countries. This can hinder effective Maritime Spatial Planning (MSP) and prevent harmonious cross-sectoral cooperation, and importantly, cross-border or trans-boundary collaboration. These may in turn have serious implications for overall ocean governance and ultimately, marine sustainability. The North Atlantic presents an ideal case-study region for reviewing these issues: North Atlantic countries have different governance structures, and as such, different approaches to marine policy. Therefore, for an effective marine management, cross-sectoral and cross-border MSP in the region, there is a need to review marine and maritime policies in order to identify differences and commonalities among countries. This chapter reviews major policies for the marine environment in the North Atlantic and assesses where differences between countries exist and at which governance level they are being created. Key research questions include: (i) Are there significant differences in marine policy between North Atlantic countries? Moreover, are there any substantial geographical/political differences? (ii) Are there differences in implementation of key policies? Such an analysis requires a sound framework for comparison among countries. To that end, the use of “horrendograms”, a tool increasingly being used by the marine research and planning community to assess such issues, is adopted. Results indicate that key differences between countries are created primarily at a national level of marine governance. Although differences between countries exist, overall strategic targets are similar. For instance, whilst the political systems of certain North Atlantic countries may differ substantially, key objectives for major sectors, such as fisheries and conservation, are similar – even when such objectives are implemented at different levels. Findings from the study can enable targeted policy intervention and, as such, assist the development of future outlooks of ocean governance in the region. Results can also aid the development of future visions and scenarios for MSP in the Atlantic region

Not all those who wander are lost - Responses of fishers' communities to shifts in the distribution and abundance of fish

As species respond to warming water temperatures, fishers dependent upon such species are being compelled to make choices concerning harvest strategies. Should they “follow fish” to new fishing grounds? Should they change their mix of target species? Should they relocate their operations to new ports? We examined how fishing communities in the Northeast United States —a hotspot of recent warming—have already responded to documented shifts in the distribution and abundance of fluke, red and silver hake. We focused on groundfish trawl communities that historically targeted these species and examined their “at-sea” responses by combining qualitative interviews with quantitative analysis of fishing records and ecological surveys. Three distinct responses emerged: shifting fishing grounds, shifting target species, and shifting port of landing. Our research finds that following the fish is rare and only occurred in one of the assessed communities, the large trawler community of Beaufort, North Carolina. The more common response was a shift in target species and a change in catch composition. However, regulations and markets often constrained the ability to take advantage of a changing mix of species within fishing grounds. Indeed, the overall species diversity in catch has declined among all of our focal communities suggesting that communities have lost the ability to be flexible when it may be most needed as a response to climate change. Additionally, the high value of fluke and the need to land in southern states with higher quota allocations is likely a driver of the changing nature of “community” with increasing vessels landing outside their home port, especially when landing fluke. Our findings suggest that fidelity to historical fishing grounds combined with perceiving environmental change as non-permanent, predispose many fishers to trust in “cyclicality” and return of species over time. However, this strategy may make those communities unable or unwilling to “follow fish” more vulnerable to changes in distribution and abundance due to climate change. Our findings have the potential to directly inform resource management policies as well as more deliberate adaptations by communities themselves as they strive to address the imminent risks of climate change

A contemporary therapeutic approach to bone disease in beta-thalassemia - a review.

Homozygous beta-thalassemia represents a serious hemoglobinopathy, in which an amazing prolongation in the survival rate of patients has been achieved over recent decades. A result of this otherwise positive evolution is the fact that bone problems have become a major issue in this group of patients. Through an in-depth review of the related literature, the purpose of this study is to present and comment on the totality of the data that have been published to date pertaining to the prevention and treatment of thalassemia bone-disease, focusing on: the contribution of diet and lifestyle, the treatment of hematologic disease and its complications, the management of hypercalciuria, the role of vitamins and minerals and the implementation of anti-osteoporosis medical regimen. In order to comprehensively gather the above information, we mainly reviewed the international literature through the PubMed database, searching for the preventive and therapeutic data that have been published pertaining to thalassemia bone-disease over the last twenty-nine years. There is no doubt that thalassemia bone-disease is a complication of a multi-factorial etiopathology, which does not follow the rules of classical postmenopausal osteoporosis. Bisphosphonates have been the first line of treatment for many years now, with varied and usually satisfactory results. In addition, over the last few years, more data have arisen for the use of denosumab, teriparatide, and other molecules that are in the clinical trial phase, in beta-thalassemia

Drivers of conflict and resilience in shifting transboundary fisheries

Climate change is causing fish stocks to shift, upending the social-ecological systems that rely on the historic distributions of these stocks and creating or exacerbating fisheries conflicts. The movements of internationally shared stocks between Exclusive Economic Zones (EEZs) or between EEZs and the high seas are especially concerning because they bring into play a variety of geopolitical factors and equity issues surrounding missing or conflicting regulations of jurisdictional boundary zones. Though many studies have explored the responses to and repercussions of shifting stocks on fisheries management, there is a dearth of interdisciplinary case studies that provide insight into the complexity of conflict formation in shifting transboundary fisheries, and that highlight the initial response stages where inclusion of proactive and cooperative measures can greatly improve a system's resilience to conflict. Our study helps to fill this gap by drawing on the knowledge of a diverse group of experts to analyze four case studies where transboundary stock shifts, geopolitical or governance tensions, and uncertainty regarding the future of the marine environment collide. Through synthesis of case study findings, we create a causal model of fishery conflict, within which we highlight factors that may heighten or mitigate the risk of conflict over shifting resources such as complex histories of power imbalance, unequal access to resources, or a lack of consistent and transparent data collection. Cooperation and equitable decision-making processes are recognized as vital components of internationally shared stock management which can promote lasting, effective, and conflict-resilient fisheries

Drivers of conflict and resilience in shifting transboundary fisheries

Climate change is causing fish stocks to shift, upending the social-ecological systems that rely on the historic distributions of these stocks and creating or exacerbating fisheries conflicts. The movements of internationally shared stocks between Exclusive Economic Zones (EEZs) or between EEZs and the high seas are especially concerning because they bring into play a variety of geopolitical factors and equity issues surrounding missing or conflicting regulations of jurisdictional boundary zones. Though many studies have explored the responses to and repercussions of shifting stocks on fisheries management, there is a dearth of interdisciplinary case studies that provide insight into the complexity of conflict formation in shifting transboundary fisheries, and that highlight the initial response stages where inclusion of proactive and cooperative measures can greatly improve a system's resilience to conflict. Our study helps to fill this gap by drawing on the knowledge of a diverse group of experts to analyze four case studies where transboundary stock shifts, geopolitical or governance tensions, and uncertainty regarding the future of the marine environment collide. Through synthesis of case study findings, we create a causal model of fishery conflict, within which we highlight factors that may heighten or mitigate the risk of conflict over shifting resources such as complex histories of power imbalance, unequal access to resources, or a lack of consistent and transparent data collection. Cooperation and equitable decision-making processes are recognized as vital components of internationally shared stock management which can promote lasting, effective, and conflict-resilient fisheries