Global Framework Research Articles

Building a resilient future: collaborative sustainability regulation

Abstract The challenge of sustainability lies in achieving a balance between satisfying present needs and protecting resources for future generations with an emphasis on its three pillars—environmental, social and governance. This study explored sustainable development encompassing environmental, social and governance aspects along with sustainability reporting through various sustainability frameworks. A systematic review of literature for the period 2010–23 on major worldwide sustainability frameworks was conducted, by offering insights into enhancing reporting mechanisms for a sustainable future. Secondary data related to sustainability reports were obtained from the Sustainability Accounting Standards Board and International Integrated Reporting Council, which helped in examining sector and year variations across countries. The results reflected that mandatory sustainability disclosures help to meet the United Nations Sustainable Development Goals and global sustainability frameworks help to set standards, disseminate information and promote transparency. Collaboration of investment, company action and sustainability organizations can lead to a sustainable global economy. The adoption of sustainability reporting can help organizations by fostering a proper understanding of sustainability practices, improving transparency and identifying potential business opportunities in sectors with lower sustainability. The paper provided insights into sustainability reporting published across various countries in both advanced as well as emerging and developing economies. The analysis showed which sectors and time periods have had the most sustainability reports and which areas needed to be targeted for action to advance sustainable development.

Live Streaming of Court Proceedings in India: A Step Towards Strengthening the Access to a Transparent and an Accountable Judiciary

Objectives: The objective of this research is to analyze the efficacy of the adoption of Court Proceedings’ Live Streaming in India as a means to strengthen access to a transparent and accountable Judiciary. The research also aims to examine existing global frameworks concerning court proceedings’ live streaming.   Methods: This research utilizes a comprehensive analysis approach, examining the implementation and impact of Court Proceedings’ Live Streaming in India and globally. It involves reviewing existing literature, legal frameworks, and case studies to understand the various dimensions and implications of live streaming in the legal and judicial field.   Results: The analysis reveals that Court Proceedings’ Live Streaming has significant potential to enhance transparency and accountability within the judiciary. It allows real-time access to courtroom proceedings, aligning with the open justice principle. However, it also highlights various concerns such as balancing the right to privacy of parties involved, addressing copyright ownership issues, mitigating cyber security threats, and preventing the dissemination of false information. The research identifies potential safeguards and measures to address these concerns effectively.   Conclusion: In conclusion, Court Proceedings’ Live Streaming represents a significant development in the legal and judicial field, providing unprecedented access to courtroom proceedings. While it has the potential to enrich constitutionalism and empower the masses, it also necessitates careful consideration of various legal and ethical concerns. By implementing appropriate safeguards and measures, live streaming can contribute to a more transparent and accountable judiciary while ensuring the protection of rights and interests of all parties involved.

Adoption d’un nouveau cadre mondial pour la biodiversité : bilan critique de la COP 15

ABSTRACT The preparation of a new global framework for the post-2020 period occupied a central place in the intergovernmental negotiations on biodiversity from 2018 to 2022. The framework had to be adopted at the fifteenth Conference of the Parties (COP 15) to the Convention on Biological Diversity. This article presents a critical analysis of COP 15 based on a recount of past biodiversity governance initiatives at the global scale, a review of the negotiations held from 2018 to 2022, and a comparison of the expectations and results of the conference. The objective is to offer a critical appraisal of COP 15 based on interviews realized during and after the conference with experts and practitioners, as well as a review of the scientific literature and official documentation. The appraisal raises four main critics pertaining to the limits of the targets, governance tools, text clarity, and the approach to the new global framework. The results contribute to the reflection on biodiversity governance, the evaluation of international negotiations, and the discussions on the operationalization and implementation of the new global biodiversity framework.

Spatial conservation planning of forest genetic resources in a Mediterranean multi-refugial area

The Kunming-Montreal Global Biodiversity Framework recognised the urgency of taking action to conserve intraspecific genetic diversity (IGD) as an insurance against habitat degradation and environmental change. Recent work suggests that 90–99 % of IGD should be conserved to safeguard viability of future generations.Here, we addressed such a conservation issue in three forest tree species in Italy: silver fir (Abies alba Mill.), Heldreich's pine (Pinus heldreichii H. Christ), and pedunculate oak (Quercus robur L.). We used microsatellite markers to measure IGD of 36 (A. alba), 15 (P. heldreichii) and 25 (Q. robur) natural sites, including several putative glacial refugia. We developed a spatial conservation planning (SCP) analysis to quantify the genetic irreplaceability of each site and identify the minimum set coverage ensuring IGD protection. Finally, we compared SCP results with the contributions to allelic diversity within and between sites, total allelic diversity and private allelic richness.We found that between 44 % and 73 % of sites were required to conserve 90–99 % of the alleles, and that this conservation effort held even when targeting lower percentages of alleles to protect (50–75 %). Glacial refugia were often included in the minimum set coverage, confirming biogeographical expectations. Finally, sites with high genetic irreplaceability were found to have higher private allelic richness on average. These results are discussed in the light of the biogeographic history of the species studied and the current policies for the conservation of forest genetic resources.

Formulating a Descriptive Framework and Tagging system for Design Futures Practice Cases: Enabling Heuristic Tool Development for Design Education and Creative Inspiration

There has been a growing trend to extend the domain of futures studies into practical realms by integrating materials, methodologies, and perspectives from design and the arts. “Design Futures” is an emerging field that arises from the interaction between design and foresight, holding great potential for expansion and development. However, there is still a lack of heuristic design tools to empower the creation of practice cases in design futures. Due to the intricacies of the sub-genres of Design Futures practice cases, our prior work included the development of a universal case description framework with a quantitative tagging system to place the different genres of cases on a common ground for study. Firstly, the study established a global descriptive framework and tagging system (4 segments, 7 primary labels, and 36 secondary labels) around 5 Design Futures sub-types through a qualitative approach. Secondly, the study invited 109 participants from five different subjects areas to conduct an empirical study to validate the proposed framework and quantify the tagging system. The results show that the rationality of the framework is preliminarily confirmed; the strength of the correlation between genres and labels is weak; in terms of the quantification of labels, the study produces 62 valid secondary labels (positive 29, negative 33), accompanied by quantitative data as the basis for recommendation, forming a creativity-enabling, content-rich labelling system that can reflect the characteristics and differences between the many genres of Design Futures. Finally, the study proposes three modes of heuristic design (confirmatory, constructive and open-ended), which provide rules to guide the use and collocation of the tagging system. The results of this research have deepened the understanding of the concepts and structures of knowledge in the field of Design Futures, which will play a more extensive role in design pedagogy and creative inspiration contexts.

Tinkering While the Arctic Marine Environment Totters: Governance and the Triple Polar Crisis$

After describing how the marine environment is tottering in the face of the triple environmental crisis, this article explores the limited governance progressions at the global and regional levels in addressing the threats of pollution, climate change and biodiversity loss in the especially vulnerable Arctic. For pollution, key limitations include slow and arduous processes to add chemicals for control under the Stockholm and Rotterdam Conventions and reliance at the regional level on a fragmented array of pollution studies and projects but without specific region-wide legally binding pollution standards. For climate change, the world is not on track to meet the Paris Agreement’s temperature targets which is especially problematic for the Arctic cryosphere while the Arctic Council has largely been limited to providing general statements of concern and aspirational calls for enhanced climate mitigation and adaptation actions. For marine biodiversity losses, a pan-Arctic network of marine protected areas has yet to be developed and various implementation challenges surround the Agreement to Prevent Unregulated High Seas Fisheries in the Central Arctic Ocean including the need to ensure adequate financial, human resource and technical support. The paper concludes by highlighting some promising future governance directions. They include: the conclusion of a global treaty on plastic pollution; implementation of a new Global Framework on Chemicals –For a Planet Free of Harm from Chemicals and Waste; expected further clarifications from international tribunals on State responsibilities to address climate change; and regional implementation of the Kunming-Montreal Global Biodiversity Framework and the new agreement under the UN Convention on Law of the Sea on the conservation and sustainable use of marine biological diversity of areas beyond national jurisdiction.

Pathogenetic strategies for addressing periodontal morphological and functional disorders in plaque-induced gingivitis

Relevance. Plaque-induced gingivitis represents the initial phase of periodontal diseases and a significant medical and social challenge within global healthcare frameworks, particularly prevalent among younger people.Demographics. This prevalence arises from its multifactorial etiology, complex developmental mechanisms, and notable pathogenetic features, most evidently microcirculatory disruptions leading to tissue hypoxia. Addressing these pathological conditions requires the development of novel diagnostic methodologies and therapeutic interventions to prevent further complications.Materials and methods. The study encompassed 54 subjects with an average age of 22.5 ± 1.7 years. The control group included 34 participants (GroupI), and the comparison group 20 participants (Group II). Group II received vacuum laser therapy in conjunction with Mexidol-based dressings, noted for their antihypoxant and antioxidant properties.Results. Evaluations conducted post-treatment indicated enhancements in both arterial and venous capillary functions. Amid the antioxidant and antihypoxant treatment regimen, capillary diameters were reduced to match those observed in the control group.Conclusion. Regimen implemented in this study was clinically and functionally effective in a combined treatment protocol involving vacuum laser therapy on periodontal tissues of plaque-induced gingivitis patients. This regimen is recommendable as a corrective measure for microcirculatory disturbances within the scope of managing inflammatory periodontal diseases.

The impact of LHC jet and ZpT\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p_T$$\\end{document} data at up to approximate N3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO order in the MSHT global PDF fit

We present an analysis of two key sets of data constraining the high x gluon at up to approximate N3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO in QCD within the MSHT global PDF fitting framework. We begin with LHC 7 and 8 TeV inclusive jet and dijet production at both NNLO and aN3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO. This makes use of the formalism established in the previous global MSHT20aN3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO PDF fit, but now considers the role of dijet production for the first time at this order. We present a detailed comparison of the fit quality and PDF impact for both cases, and consider the role that electroweak corrections, and the scale choice for inclusive jet production has. Some mild tension between these data sets in the impact on the high x gluon is seen at NNLO, but this is largely eliminated at aN3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO. While a good fit quality to the dijet data is achieved at both orders, the fit quality to the inclusive jet data is relatively poor. We examine the impact of including full colour corrections in a global PDF fit for the first time, finding this to be relatively mild. We also revisit the fit to the ATLAS 8 TeV ZpT\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p_T$$\\end{document} data, considering the role that the pT\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p_T$$\\end{document} cuts, data selection and different aspects of the aN3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO treatment have on the fit quality and PDF impact. We observe that in all cases the aN3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${}^3$$\\end{document}LO fit quality is consistently improved relative to the NNLO, indicating a clear preference for higher order theory for these data.

International Linkages of Inflation‐Output Dynamics: Fresh GVAR Evidence from Pakistan and Its Trading Partners

The key purpose of this study is to explore the relationship between inflation and output dynamics in a global macroeconomic framework by utilising time‐series data from Pakistan and thirty‐two trading partners which account for around 95 per cent of foreign trade of Pakistan, over the period 1979Q2–2016Q4. By featuring the GVAR approach, this paper empirically examined the international linkages to account for cross‐country inflationary spillovers. The findings show that both foreign and global variables jointly and significantly matter for the inflation‐output relationship in developing economies, in general and, in particular, in the economy of Pakistan. The findings from general impulse response functions (GIRF) reveal that shocks to the US real output, oil prices and food prices are transmitted and settled quickly, and put forward a significant impact on real GDP and inflation in Pakistan and its trading partner economies. Inflation in Pakistan is driven more strongly by the global changes in oil and food prices than GDP. For monetary policy formulation, the central bank should take into account developments in inflation‐output dynamics of Pakistan's major trading partners.

Global mercury concentrations in biota: their use as a basis for a global biomonitoring framework.

An important provision of the Minamata Convention on Mercury is to monitor and evaluate the effectiveness of the adopted measures and its implementation. Here, we describe for the first time currently available biotic mercury (Hg) data on a global scale to improve the understanding of global efforts to reduce the impact of Hg pollution on people and the environment. Data from the peer-reviewed literature were compiled in the Global Biotic Mercury Synthesis (GBMS) database (>550,000 data points). These data provide a foundation for establishing a biomonitoring framework needed to track Hg concentrations in biota globally. We describe Hg exposure in the taxa identified by the Minamata Convention: fish, sea turtles, birds, and marine mammals. Based on the GBMS database, Hg concentrations are presented at relevant geographic scales for continents and oceanic basins. We identify some effective regional templates for monitoring methylmercury (MeHg) availability in the environment, but overall illustrate that there is a general lack of regional biomonitoring initiatives around the world, especially in Africa, Australia, Indo-Pacific, Middle East, and South Atlantic and Pacific Oceans. Temporal trend data for Hg in biota are generally limited. Ecologically sensitive sites (where biota have above average MeHg tissue concentrations) have been identified throughout the world. Efforts to model and quantify ecosystem sensitivity locally, regionally, and globally could help establish effective and efficient biomonitoring programs. We present a framework for a global Hg biomonitoring network that includes a three-step continental and oceanic approach to integrate existing biomonitoring efforts and prioritize filling regional data gaps linked with key Hg sources. We describe a standardized approach that builds on an evidence-based evaluation to assess the Minamata Convention's progress to reduce the impact of global Hg pollution on people and the environment.

Review of “1st Liveable Futures Report: Food of Mass Destruction: How Exploiting Animals Drives Us to Extinction"

This report, compiled by Jaime del Val, Reverso/Metabody Institute, in 2023, synthesises over 100 previous reports by United Nations, governmental commissions and high profile scientific commissions that state that animal based food is the major source of climate change, biodiversity loss, human health problems, human inequality and animal suffering. The report coins the acronym “AEFI” (Animal Exploitation Food Industries) for highlighting the central, present and historical role of this industry in the crisis, and pushes for a renewal of global legal frameworks that recognise the rights of all life forms as condition of possibility for a liveable future for humans themselves, while exposing the interconnection of the core role of shifting diets away from animal products with a voluntary reduction of overconsumption and overpopulation.

Using teachers’ prior knowledge as the foundation for collaborative policy development: an Australian case study

ABSTRACT Too often international policies, such as the OECD PISA Global Competence framework, are incorporated into domestic education policies without consultation with school leaders or classrooms teachers. This “top down” approach means the educators are often obliged to implement policies they may not fully understand or have the professional learning to implement successfully. This paper draws from research that explored an alternative approach where a group of Australian school leaders and classroom teachers were provided with the opportunity to collaboratively translate the PISA Framework into a state-based, whole-school approach. The paper reports particularly on the results of a survey, undertaken prior to the commencement of this collaboration, to identify the participants’ existing conceptualizations of global competence. The survey questions and data analysis framed by Keltchermans’ Personal Interpretive Framework explored how the participants’ conceptualizations were shaped by their personal beliefs and contexts. Data gathered showed alignment between the teachers’ conceptualizations, their known pedagogical frameworks, and the Australian Curriculum, particularly the general capabilities and the cross-curriculum priority of Sustainability. This acts as a reminder of the need to ensure that policy is reflective of its context and developed from the ground up, even if it is developed in response to international initiatives.

METHODOLOGICAL FEATURES OF TEACHING RANDOM VARIABLES AT THE COMPREHENSIVE SECONDARY SCHOOL

In the evolving landscape of educational methodologies, the integration of complex mathematical concepts such as random variables into secondary school curriculums poses significant challenges and opportunities. As the global educational framework increasingly emphasizes the importance of a robust mathematical foundation, understanding and teaching stochastic elements within the school system has become crucial. This article delves into the nuanced methodological features essential for imparting knowledge of random variables effectively to secondary school students. We explore the historical context of mathematical education reforms in Armenia, highlighting the recent inclusion of stochastic topics in the school programs since 2004. The reformed educational standards introduced in 2020 and implemented in 2023 have further emphasized the need for a structured approach to teaching random variables, alongside other advanced mathematical topics. Through this lens, we examine the preparedness of educators, the adequacy of existing teaching methods, and the potential cognitive hurdles faced by students. Our analysis is rooted in both qualitative assessments and a theoretical framework that aims to bridge the gap between abstract mathematical theories and practical understanding, ensuring that students not only learn but also appreciate the significance of probability theory in everyday contexts .

A standard lexicon of terms for area-based conservation version 1.0.

Target 3 in the Kunming-Montreal Global Biodiversity Framework (GBF) calls for protecting at least 30% of the world's lands and waters in area-based conservation approaches by 2030. This ambitious 30×30 target has spurred great interest among policy makers, practitioners, and researchers in defining and measuring the effectiveness of these types of approaches. But along with this broad interest, there has also been a proliferation of terms and their accompanying abbreviations used to describe different types of conservation areas and their governance, planning, management, and monitoring. The lack of standard terms is hindering the use and assessment of area-based approaches to conserve the world's biodiversity. It is difficult to track progress toward GBF Target 3 or to share learning with other practitioners if different groups of people are using different words to describe the same concept or similar words to talk about different concepts. To address this problem, the International Union for Conservation of Nature's World Commission on Protected Areas commissioned a task force to review existing terms and recommend a standard English-language lexicon for this field based on key criteria. The results were definitions of 37 terms across 6 categories, including types of protected and additional conservation areas (e.g., protected area, additional conservation area), sets of these areas (protected area network, protected area system), their governance and management (governance, rightsholders), assessment (effectiveness, equitability), spatial planning (key biodiversity area), and action planning (value, outcome, objective). Our standard lexicon can provide a common language for people who want to use it and a shared reference point that can be used to translate various terms used by different groups. The common understanding provided by the lexicon can serve as a foundation for collaborative efforts to improve the policies, implementation, assessments, research, and learning about this important set of conservation approaches.

Deriving lessons learned from monitoring adaptation activities in projects under the EU mission on adaptation

Actions to strengthen climate resilience are gaining more traction. In order to ensure effective adaptation, it is important to monitor the outcomes and impacts of these actions. However, there are numerous challenges and a multitude of approaches when it comes to monitoring adaptation to climate change. This paper addresses challenges in setting up mechanisms for monitoring climate resilience and adaptation projects. Drawing from three EU Horizon 2020 projects under the EU Mission on Adaptation to Climate Change, it synthesizes challenges and insights to support future initiatives in their monitoring endeavors for other projects to learn from. Findings, acquired through workshops with experts who shared learnings and challenges, highlight four key themes: the challenge of tailoring global frameworks to local needs, data availability and evaluation of data, interdisciplinary collaboration in monitoring, and stakeholder engagement for monitoring endeavors.

Ten principles for responsible quantum innovation

This paper proposes a set of guiding principles for responsible quantum innovation. The principles are organized into three functional categories: safeguarding, engaging, and advancing (SEA), and are linked to central values in responsible research and innovation (RRI). Utilizing a global equity normative framework and literature-based methodology, we connect the quantum-SEA categories to promise and perils specific to quantum technology (QT). The paper operationalizes the responsible QT framework by proposing ten actionable principles to help address the risks, challenges, and opportunities associated with the entire suite of second-generation QTs, which includes the quantum computing, sensing, simulation, and networking domains. Each quantum domain has different technology readiness levels, risks, and affordances, with sensing and simulation arguably being closest to market entrance. Our proposal aims to catalyze a much-needed interdisciplinary effort within the quantum community to establish a foundation of quantum-specific and quantum-tailored principles for responsible quantum innovation. The overarching objective of this interdisciplinary effort is to steer the development and use of QT in a direction not only consistent with a values-based society but also a direction that contributes to addressing some of society’s most pressing needs and goals.

Challenges and Institutional Barriers to Forest and Landscape Restoration in the Chittagong Hill Tracts of Bangladesh

Preventing, halting, and reversing ecosystem degradation is now a global priority, partly due to the declaration of the United Nations (UN) Decade on Ecosystem Restoration by the UN General Assembly 2021–2030 on 1 March 2019. Apart from the most recent global target to protect 30% of the natural planet by 2030 as part of the Kunming-Montreal Global Biodiversity Framework agreed during COP15, there are several other global goals and targets. The Government of Bangladesh (GoB) has also pledged to restore 0.75 million hectares of forests as part of the Bonn Challenge. The Chittagong Hill Tracts (CHT) of Bangladesh contain almost one-third of the country’s state-owned forests and are home to 12 ethnic communities, whose livelihoods are dependent on forests. Although once rich in biodiversity, the majority of the forests in the region are highly degraded due to faulty management, complex institutional arrangements, and land disputes with locals. The CHT, therefore, represent the most promising region for ecosystem restoration through forest and landscape restoration (FLR). Here, using the secondary literature, we examine the current institutional arrangements and drivers of deforestation and forest degradation in the CHT region and potential benefits and modalities to make FLR successful in the region. Based on our study, we suggest that institutional reform is essential for successful FLR in the CHT. We also discuss key interventions that are necessary to halt ecosystem degradation and to secure community participation in natural resources management in the region.

Global proficiency framework: Analysis of national and Colleges of Education curricula in Ghana

Global proficiency framework: Analysis of national and Colleges of Education curricula in Ghana

Harmony in Biodiversity: Spearheading the Global Biodiversity Agenda through National Policy on Biological Diversity (NPBD) 2022-2030

In the heart of Malaysia's commitment to biodiversity conservation, lies a comprehensive strategy encapsulated in the National Policy on Biological Diversity (NPBD) 2022-2030. With five ambitious goals, the policy is a guiding light for the nation, steering stakeholders towards a future where the rich tapestry of ecosystems, species and genetic diversity flourishes. The correlation between this national policy and the global biodiversity framework under the Convention on Biological Diversity (CBD) is evident, providing a robust framework for sustainable development.

Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes: A multinational cohort study.

Few studies examining the patient outcomes of concurrent neurological manifestations during acute COVID-19 leveraged multinational cohorts of adults and children or distinguished between central and peripheral nervous system (CNS vs. PNS) involvement. Using a federated multinational network in which local clinicians and informatics experts curated the electronic health records data, we evaluated the risk of prolonged hospitalization and mortality in hospitalized COVID-19 patients from 21 healthcare systems across 7 countries. For adults, we used a federated learning approach whereby we ran Cox proportional hazard models locally at each healthcare system and performed a meta-analysis on the aggregated results to estimate the overall risk of adverse outcomes across our geographically diverse populations. For children, we reported descriptive statistics separately due to their low frequency of neurological involvement and poor outcomes. Among the 106,229 hospitalized COVID-19 patients (104,031 patients ≥18 years; 2,198 patients <18 years, January 2020-October 2021), 15,101 (14%) had at least one CNS diagnosis, while 2,788 (3%) had at least one PNS diagnosis. After controlling for demographics and pre-existing conditions, adults with CNS involvement had longer hospital stay (11 versus 6 days) and greater risk of (Hazard Ratio = 1.78) and faster time to death (12 versus 24 days) than patients with no neurological condition (NNC) during acute COVID-19 hospitalization. Adults with PNS involvement also had longer hospital stay but lower risk of mortality than the NNC group. Although children had a low frequency of neurological involvement during COVID-19 hospitalization, a substantially higher proportion of children with CNS involvement died compared to those with NNC (6% vs 1%). Overall, patients with concurrent CNS manifestation during acute COVID-19 hospitalization faced greater risks for adverse clinical outcomes than patients without any neurological diagnosis. Our global informatics framework using a federated approach (versus a centralized data collection approach) has utility for clinical discovery beyond COVID-19.