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In order to effectively assist countries in 'building back better' following the COVID-19 pandemic and returning to a path towards the Sustainable Development Goals (SDGs), the United Nations (UN) and its development entities, organised within the United Nations Development System (UNDS), will need to adjust their approach. They need to respond not just through selected interventions of limited scope, which aim to achieve quick and tangible results, but by providing more and higher quality policy advice to governments for dealing with the deep inequalities laid bare by the pandemic worldwide. The argument for a stronger focus on policy advice directed at high-level decision-makers and delivered through both dialogue and advocacy, is not to deny the importance of service delivery, capacity-building and systems strengthening - other key UN delivery modalities that currently account for the majority of the UN's development activities. Through them, the UN saves lives and helps developing countries reduce their reliance on external support. However, such work often fails to achieve the kind of broader, sustainable impact so urgently needed for ensuring a more equitable and sustainable recovery. The UN has long recognised the importance of policy advice, and UN entities have a unique role to play in helping to implement universal norms and values that have been agreed by UN member states and which should inform any recovery. The recent strengthening of the UN resident coordinator system (2019), which ensures that the on average 18 UN entities per programme country deliver more 'as one', has put the UN in a better position to provide integrated policy advice. Building on these reforms, UN Secretary-General António Guterres recently encouraged a greater role for the UN in the provision of 'integrated policy advice', citing 'persistent challenges in forging integrated policies' (UN, 2020). These 'persistent challenges' to policy advice (or 'upstream work' in UN parlance) also come from structural factors that push UN entities towards implementation or 'downstream' work directed at interventions on the ground. Also, member states have been increasingly reluctant - despite often lofty commitments at the global level - to support policy advice through robust mandates, their own strategic engagement and suitable funding at the level of UN entities. The following actions are recommended to correct disincentives to policy advice: * The UN should define policy advice more clearly as a distinct mode of UN engagement and track good practice from UN country teams to further develop this mode of engagement. * Member states should strengthen their endorsement of UN entities' provision of quality policy advice and request them to undertake concrete steps to expand this mode of engagement. * Resident coordinators need to fully exercise the new roles envisioned by the UNDS reform and lead on policy dialogue in collaboration with the UN entities concerned. * Donors should engage strategically with UN entities through core contributions and non-core partnerships to incentivise, rather than discourage, the provision of increased policy advice.

Objectives: North Carolina COVID-19 task orders were designed to increase statewide testing access. This study explored how CHAMP and OP-9 task orders issued by NC Department of Health and Human Services (DHHS) and the Community Health Center (CHC) Association influenced Piedmont Health Services’ (PHS) COVID-19 testing target populations, location priorities, and patient services. Methods: The researcher conducted a quantitative secondary data analysis using descriptive statistics and a time series evaluation. This assessed how PHS’s target populations, location priorities, and patient services were influenced by task order implementation. This analysis utilized COVID-19 testing administration data to determine how each task order influenced these elements of COVID-19 testing access at PHS during specified task order implementation stages. Findings: This study found that the implementation of CHAMP and OP-9 task orders influenced PHS to improve COVID-19 testing access to Black and Latinx populations and more rural areas of North Carolina. Most findings also suggest a major influence from both task orders on PHS’s fulfillment of required patient services, including collecting race and ethnicity data, providing linguistically appropriate services, and connecting patients to a primary care provider. Implications: This research has concluded that both task orders have influenced COVID-19 testing accessibility at PHS. These findings could be applicable to additional CHCs across North Carolina and other states. Future studies should examine the collective impact of task orders on multiple CHCs in order to analyze their effect on health care accessibility on a larger scale. 

Background New technologies offer great opportunities for health care systems but can also represent significant costs. Increasing the usage and development of medical technologies balancing cost and utility is a priority for many health care managers. Ensuring maximised diffusion and uptake of new technologies can be positively impacted by the degree of involvement of end-users in the purchasing and/or development of new products. While the idea that culture can promote or inhibit innovation is not new, innovation in the health care setting has only relatively recently been explored. Little information specific to university hospitals and procurement of innovation exists. The global COVID-19 pandemic has furthermore greatly influenced healthcare in the last months including medical procurement and innovation. This protocol details a planned qualitative research study to explore cultural factors influencing innovation at European university hospitals as well as the recent impact of the COVID-19 pandemic in depth. Methods Key informant interviews will be conducted at ten European university hospitals. The semi-structured interview guide includes questions on: the perspectives and experiences of staff in relation to the procurement of innovation; examples of past or ongoing projects in this area or in the area of digital health innovation; and changes related to COVID-19. Participant characteristics will be summarised with descriptive statistics. Multi-step thematic analysis using meaning condensation will be used to analyse transcribed data. Identified concepts will be linked with existing theories and/or factors identified by literature search. Results will be presented in narrative and table formats. Historical public procurement data will be downloaded from the European Union’s public procurement records portal TED. Trends from during COVID-19 will be statistically analysed in comparison to prior years. Discussion This manuscript describes the steps of our proposed qualitative study to explore cultural factors that contribute to successful and/or unsuccessful innovation in relation to digital health procurement, and the impact of COVID-19 on this field. Results will be used to provide points for consideration when conducting procurement of innovation, an important tool that organisations can use to drive digital research and development and a policy goal for the EU. Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 826157.

Introduction: While there is a significant amount of information about invasive meningococcal disease (IMD), meningococcal carriage, and meningococcal vaccines in children and adolescents, data in older adults are limited. Studies of meningococcal carriage and transmission modeling can be utilized to predict the spread of IMD and guide prevention and treatment strategies. Our study’s main objective was to assess the prevalece of Neisseria meningitidis (Nm) carriage, serogroup distribution, and associated risk factors among older adults in Türkiye. Methods: Nasopharyngeal samples were collected between December 2022 and January 2023 from a total of 329 older adults (65 years of age and above). The samples were tested via PCR for Nm, and a serogroup (A, B, C, Y, W, X, E, Z, H) analysis of the positive samples was performed. Results: In total, 329 adults over 65 years of age (150 females and 179 males; 69% were 65–75 years old and 31% were 75 years of age and older) were included in the study. Nm carriage was detected in 46 participants (13.9%), and the serogroup distribution was as follows: 2.4% MenY (n = 8), 1.8% MenB (n = 6), 0.2% MenW (n = 2), and 9.4% non-groupable (n = 31). Other serogroups were not detected. Between the meningococcal carriers and the non-carriers, there were no differences between previous vaccination histories (meningococcal, pneumococcal, influenza, and COVID-19), travel history for Hajj and/or Umrah, and the presence of chronic disease. Of the 16 cases positive for the serogroups Y, B, and W, 13 patients were between the ages of 65 and 74 and three patients were over 75 years old, and these three cases represented MenY. Conclusion: In our study, the percentage of meningococcal carriage was found to be 13.9%, the carriage rate for encapsulated strains was 4.8%, and the most common serogroup was MenY. Men Y was also the only serogroup detected in patients over 75 years of age. The MenY serogroup, which is one of the most important causes of IMD (especially in pneumonia cases) in people older than 65 years, was the most frequently carried serogroup in people over 65 years of age in our study. Adequate surveillance and/or a proper carriage study would help to define potential vaccination strategies for older adults.

I. Introduction. - II. The European Commission's efforts to protect the four freedoms and the internal market. - III. The European Union recovery instrument. - III.1. Negotiation of a balanced EU Recovery Agreement. - III.2. The Next Generation EU Recovery Plan. - IV. The European Central Bank's "Pandemic Emergency Purchase Programme" (PEPP). - V. A temporary increase on public deficit goals for Member States. - VI. The "Pan-European Guarantee Fund" and the "Support to mitigate Unemployment Risks in an Emergency" (SURE) programme. - VII. The 2021-2027 Multiannual Financial Framework (MFF). - VII.1. The Commission's proposal. - VII.2. Renegotiation of the MFF at the European Council Summit. - VII.3. Adjustments made by the European Parliament. - VII.4. Relevance of the MFF negotiation in the light of the pandemic. - VIII. The temporary framework for State aid measures to support the economy in the current COVID-19 outbreak. - VIII.1. The European Union's unique legislation on State Aid. - VIII.2. Notifiable State Aid measures under Art. 107 TFEU. - VIII.3. Legal basis and functioning of the temporary framework for State aid measures to support the economy. - VIII.4. Remarks on notifiable State Aid measures. - IX. Conclusions, criticism and lessons learnt from the COVID-19 crisis. - IX.1. Political tensions over NGEU's rule of law requirement and the European Parliament's necessary approval of the 2021-2027 MFF. - IX.2. The PEPP legitimacy should not be questioned by national judges in breach of the EU's exclusive competences. - IX.3. Short-term work schemes, liquidity support and the Temporary framework for State aid measures in the current COVID-19 outbreak are fostering the economic recovery. - IX.4. Solidarity: the core value for the EU's common response to the pandemic. The EU has fast reacted in adopting a so-called Next Generation EU Recovery Plan (NGEU) and a 2021-2027 Multiannual Financial Framework (MFF) with the aim of overcoming the consequences of the disruptive COVID-19 pandemic for citizens' health and businesses across Europe. However, there have been several political discussions during the negotiations until an agreement was reached on 21 July 2020. A political drift made the positions not just of northern and southern but also eastern and western EU Member States differ. NGEU and the 2021-2027 MFF have posed significant challenge to the notion of solidarity in the EU. Furthermore, these mechanisms have been complemented by the European Central Bank's (ECB) Pandemic Emergency Purchase Programme (PEPP) and the temporary increase of public deficit goals for Member States. Finally, a critical analysis and lessons learnt from the EU strategy to overcome the economic slump provoked by the outbreak. European Papers - A Journal on Law and Integration, 2020 5(3), 1399-1423 European Forum Insight of 16 January 2021

Working capital, which businesses need to carry out their daily activities and pay their short-term debts, also significantly affects the profitability of companies. The Covid-19 pandemic in 2020 forced countries to close during the periods when the disease increased, which led to almost cessation of domestic and foreign trade. Many enterprises with weak liquidity had to close their short-term debts. With the pandemic, working capital has become much more important for enterprises. In this study, apparel enterprises operating in Turkey and whose financial statement data can be accessed through the Central Bank were classified according to their size and the liquidity ratios of these companies between 2011-2020 were analysed. In the last 10 years, it has been determined that especially large and medium-sized enterprises have strengthened their liquidity and significantly increased their cash and cash equivalents. However, such an increase was not observed in the cash power of small enterprises. In addition, the factors affecting the profitability of the companies were analysed in the study, and it was determined that the decrease in the Financial Leverage and Debt to Equity ratios in large enterprises increased the profitability. In medium-sized enterprises, it has been determined that the increase in current ratio and receivables collection periods increased profitability. It has been determined that the only significant ratio that affects profitability in small-scale enterprises is the current ratio. © 2022 Inst. Nat. Cercetare-Dezvoltare Text. Pielarie. All rights reserved.

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020–February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.

Въведение: Заболяването от COVID-19 води до мултиорганно засягане, ендотелно възпаление и микро- и макроваскулит, при които може да настъпи тромбоза в малките съдове, в съдове в различни органи, както и в сърдечните кухини. Някои от усложненията може да персистират, което се наблюдава в нашия клиничен случай и това го прави особено интересен. Клиничен случай: Представяме 73-годишен пациент с известно перманентно предсърдно мъждене и прояви на хронична сърдечна недостатъчност, поплитеална флеботромбоза и операция на лява тазобедрена става. 53 дни след доказан положителен тест за COVID-19 поради оплаквания от фебрилитет и кашлица на фона на негативен ваксинационен статус пациентът е хоспитализиран с клиника на лека дихателна недостатъчност и кардиогенен шок. От направените лабораторни изследвания се установиха повишени маркери за възпаление. ЕКГ показа тахиаритмия (170 уд./min) и предсърдно мъждене. ЕхоКГ разкри наличието на ДК-систолна дисфункция, пулмонална хипертония и масивен тромб в дясното предсърдие. С помощта на Доплер се доказа феморопоплитеална тромбоза вдясно, а CT-пулмоангиографията показа данни за масивна двустранна БТЕ. Взе се решение за провеждане на системна фибринолиза, която се понесе без усложнения. По време на хоспитализацията не се установи наличие на неопластично заболяване. Заключение: Този клиничен случай потвърждава високия риск от тромбози вследствие на Ковид инфекция (флеботромбоза, предсърдна тромбоза и масивна двустранна БТЕ) без оптимална антикоагулантна терапия и при прием на антиагрегант около 2 месеца след началото на симптомите. Background: The coronavirus disease (COVID-19 disease) leads to multiple organ disease, inflammation of the endothelium, and micro- or macrovasculitis that may result in thrombosis of the small vessels, and thrombosis of vessels in various organs, as well as intracardiac thrombosis. Some of the complications may be long-lasting, as in our case, which makes it particularly interesting to discuss. Case report: We present a 73-year-old male patient with a history of permanent atrial fibrillation and chronic heart failure (II NYHA class), popliteal phlebothrombosis, and surgery of the left hip joint. 53 days after a positive rapid test for Covid 19 performed because of fever and coughing, the patient, who is not vaccinated for Covid 19, was hospitalised at our Department with clinical signs of mild respiratory failure and cardiogenic shock. The laboratory tests revealed elevated markers of inflammation. The ECG showed tachyarrhythmia (170/min) and atrial fibrillation. The EchoCG displayed evidence of right systolic dysfunction, pulmonary hypertension, and a massive thrombus in the right atrium. The Doppler ultrasonography revealed the presence of right femoropopliteal thrombosis, while the CT-pulmoangiography showed evidence of massive bilateral PE. A decision was made to perform systemic fibrinolysis, which the patient tolerated without complications. During the hospitalisation, the examinations revealed no evidence of an oncological disease. Conclusion: The reported clinical case confirms the high risk of thrombosis due to a COVID-19 infection, such as phlebothrombosis, atrial thrombosis, and massive bilateral PE, in the absence of optimal anticoagulant therapy and against the backdrop of the administration of antiplatelet therapy roughly 2 months after the onset of the COVID-19 symptoms.

Abstract : We compare test results of SARS-CoV-2 positive patients, depending on their vaccine status, the presence of symptoms and whether they are infected by the Delta variant or not, using a large number of PCR tests done in the community in France from 14 June 2021 to 30 July 2021. In asymptomatic individuals, Ct values at the first positive test were higher in fully vaccinated individuals (> 2 weeks after final dose) than non fully vaccinated individuals (1.7 [1, 2.3], p < 1e-6). In symptomatic individuals however, Ct values at the time of symptoms were not significantly different in vaccinated compared to unvaccinated individuals (p = 0.26). This was true both for infections by Delta and non-Delta (essentially Alpha in France at the time) variants. These results imply that some infected vaccinated individuals, especially if symptomatic, may transmit the virus as much as unvaccinated individuals.