The efficacy, effectiveness and safety of SARS-CoV-2 disinfection methods (including ozone machines) in educational settings for children and young people

Several non-touch disinfectant methods including ozone, light-based technologies, and hydrogen peroxide are being considered to reduce the risk of SARS-CoV-2 virus transmission to children and young people in educational settings. Concerns have been raised about the evidence of efficacy, effectiveness and safety of these technologies in these settings. We aimed to address the following research questions: What is the evidence for the surface survival of SARS-CoV-2? What is the evidence for the efficacy (in vitro) and real-life effectiveness (in situ) of ozone machines, light-based technologies and hydrogen peroxide vapour as air or surface disinfectants against SARS-CoV-2? What are the potential health effects of ozone, in particular for children and young people and the benefits and harms of using ozone machines

Environmental & Occupational Medicine

The book includes all of the most important issues of environmental and occupational medicine. As ecological parts of the environment, the air, water, settlements, as well as food toxicology, safety and quality assurance have been discussed. Some chapters are devoted to work environment and assessment of the effect of environmental risk factors on human body. The textbook has been written for international medical students. Environmental and occupational medicine is closely related to other branches of environmental science and public health, therefore it may be used by many-branched environmental and public health specialists, environmental and work inspectors, ergonomists, ecologists and other interested groups

The efficacy, effectiveness and safety of SARS-CoV-2 disinfection methods (including ozone machines) in educational settings for children and young people

While evidence for the importance of transmission of SARS-CoV-2 from contaminated surfaces is limited, ozone disinfection methods have been considered for surface cleaning as a response to stopping the spread of the virus in educational settings. This rapid evidence summary aimed to search the available literature and summarise findings on the surface survival of SARS-CoV-2, efficacy and effectiveness of ozone machines against SARS-CoV-2, and benefits and harms caused by using these cleaning technologies, including their impact on health. Alternative cleaning technologies, such as light-based technologies and hydrogen peroxide vapour, were also investigated. Findings indicate that gaseous ozone can inactivate different bacteria and viruses, although there is a lack of direct evidence investigating the effect of these cleaning methods on SARS-CoV-2 in real-world settings, specifically in schools. However, regarding harm, ozone is a highly reactive oxidising agent, and high concentrations can contribute to decay of building materials, and health issues (mainly respiratory) by direct exposure or by-product formation. Therefore, leading environmental health organisations do not recommend the use of ozone cleaning technologies in real-world settings, such as schools. Research and policy focus may need to shift towards other interventions that could help reduce transmission, and consequently minimise disruption to education

Terapia fotodinâmica na inativação de bacteriófagos com porfirina e potenciadoresem águas residuais

Pathogenic viruses are frequently introduced into marine and estuarine waters through the discharge of treated and untreated sewage, since current treatments are unable to provide virus-free wastewater (WW) effluents, affecting the receiving waters quality and, consequently, human health. The removal of harmful constituents by the conventional treatments comprises a combination of chemical, physical and biological methods. Usually, WW from urban areas is secondarily, rarely tertiary, treated. Although the secondary effluent contains high concentrations of microorganisms, the effect of water dilution makes it acceptable in terms of quality indicators. In tertiary treatment, chlorination is the most common method used to ensure microbiological safety in tertiarily treated effluents. However, its massive utilization, both in free and combined chlorine forms, may lead to the formation of chemical disinfection by-products though the reaction with organic matter present in the effluents, being those chemicals toxic to aquatic organisms, representing potential health hazards. Unfortunately, these conventional methods are limited and may not be adequate to reach the quality levels specified by the guidelines. Photodynamic therapy (PDT) with porphyrins may be a promising approach for the inactivation of pathogens as they are effective in inactivating microorganisms without the formation of potentially toxic products. Some studies have reported an enhancer effect on antimicrobial photodynamic therapy (aPDT) by the combined used of some photosensitizer (PS) with potassium iodide (KI) and hydrogen peroxide (H2O2). The main objective of this study was to evaluate the aPDT efficacy of a PS based on a low-cost formulation constituted by five cationic porphyrins (Form) and its potentiation effect by KI and H2O2 in the inactivation of a T4-like bacteriophage in WW. The experiments were done in phosphate buffered saline and in filtered and non-filtered contaminated wastewater. The aPDT assays in filtered WW (0.45 μm pore-size) were performed with different concentrations of Form (1.0 to 10 μM). In a second phase was evaluated the effect of KI (100 mM) in the photodynamic action of Form (1.0 to 10 μM). The results of these experiments demonstrated that Form is efficient in filtered WW treatment and that the efficacy of bacteriophage photoinactivation is correlated with the concentration of the used PS. When combined with KI, the Form is clearly less effective to inactivate the bacteriophage. To evaluate if the organic matter present in water influences the efficiency of PS, the WW was filtered using three different pore-sized membranes (0.45, 0.30 and 0.22 μm). The results demonstrated that the increase of organic matter promote a significant decrease in the efficiency of Form. In order to evaluate if the efficiency of aPDT to inactivate bacteriophages is maintained when the treatments are performed in non-filtrated WW, the effect of Form alone (10 μM) and combined with H2O2 (2, 5 and 9%) in non-filtered WW was evaluated. The Form alone proved to be an efficient PS to photoinactivate the bacteriophage in non-filtered WW, but the presence of H2O2 enhanced the photodynamic effect. The FORM can be an effective alternative to control viruses in WW, particularly if combined with H2O2.Os vírus patogénicos são frequentemente introduzidos nas águas marinhas e estuarinas através da descarga de esgoto tratado e não tratado, uma vez que os tratamentos atuais não inativam os vírus presentes nas águas residuais (WW), afetando a qualidade das águas recetoras e, consequentemente, a saúde humana. Nos tratamentos convencionais, a remoção de constituintes nocivos consiste no uso de métodos químicos, físicos e biológicos. Geralmente, a WW de áreas urbanas é tratada secundariamente e não terciariamente. Embora o efluente secundário contenha altas concentrações de microrganismos, o efeito da diluição na água torna-o aceitável em termos de indicadores de qualidade. A cloração é o método mais comum usado para garantir a segurança microbiológica em efluentes tratados terciariamente. No entanto, a sua utilização maciça, tanto na forma de cloro livre como combinada, pode levar à formação de subprodutos químicos como resultado da reação com a matéria orgânica presente nos efluentes, sendo esses produtos químicos tóxicos para os organismos aquáticos, apresentando riscos para a saúde. Os métodos convencionais são limitados e podem não ser adequados para manter os níveis de qualidade especificados nas diretrizes. As porfirinas quando usadas como fotossensibilizadores (PS) na terapia fotodinâmica (PDT) podem ser desinfetantes promissores para a inativação de microrganismos patógenicos, pois são eficazes na inativação de microrganismos sem formação de produtos tóxicos. Alguns estudos mostraram efeito potenciador de alguns PS usados em terapia fotodinâmica antimicrobiana (aPDT) quando estes são usados em combinação com iodeto de potássio (KI) e peróxido de hidrogénio (H2O2). O principal objetivo deste estudo foi avaliar a eficácia da aPDT de um PS baseado numa formulação de baixo custo constituída por cinco porfirinas catiónicas (Form) e o seu efeito potenciador por KI e H2O2 na inativação de um bacteriófago tipo T4. As experiências foram realizadas em solução salina tamponada com fosfato e em água residual contaminada filtrada e não filtrada. Os ensaios de aPDT em WW filtrada (tamanho do poro de 0,45 μm) foram realizados com diferentes concentrações de Form (1,0 a 10 μM). Numa segunda fase foi avaliado o efeito do KI (100 mM) na ação fotodinâmica da FORM (1,0 a 10 μM). Os resultados dessas experiências demonstraram que a Form é eficiente no tratamento de WW filtrada e que a eficácia da fotoinativação de bacteriófagos está correlacionada com a concentração do PS usado. Quando combinada com o KI, a Form é claramente menos eficaz na inativação do bacteriófago. Para avaliar se a matéria orgânica presente na água influencia a eficiência do PS, a WW foi filtrada usando três membranas com tamanho de poros diferentes (0,45, 0,30 e 0,22 μm). Os resultados mostraram que o aumento da matéria orgânica promove uma diminuição significativa na eficiência da Form. Para avaliar se a eficiência da aPDT para inativar bacteriófagos é mantida quando os tratamentos são realizados em WW não filtrada, o efeito da Form sozinha (10 μM) e combinado com H2O2 (2, 5 e 9%) em WW não filtrada foi avaliado. A Form por si só provou ser um PS eficiente para fotoinativar o bacteriófago em WW não filtrada, mas a presença de H2O2 aumentou significativamente o efeito fotodinâmico. A Form pode ser uma alternativa eficaz para controlar vírus na WW, principalmente se combinada com H2O2.This work was supported by funding FEDER through COMPETE – Programa Operacional Factores de Competitividade, and by National funding through Fundação para a Ciência e Tecnologia (FCT) and Marine Studies (CESAM).Mestrado em Biologia Molecular e Celula

Investigations into heat- and light-induced terpene modifications in essential oils

Essential oils belong to secondary plant metabolites, with terpenoids and phenylpropanoids being among the main constituents in terms of quantity. Due to their lipophilic character and high volatility, they are mainly obtained by steam distillation. Citrus essential oils (agrumen oils) are an exceptionsince they are usually extracted from the peels by means of pressing, whereby less volatile components such as coumarins and furocoumarins are also introduced. Due to their odor and taste-giving properties, essential oils are used in the food, beverage, and cosmetics industries. In addition, due to a wide range of pharmacological properties, they are used in phytotherapy as well as in aromatherapy. However, most essential oils are highly susceptible to oxidation, polymerization, dehydrogenation, and isomerization reactions in the presence of atmospheric oxygen, light, and at high temperatures. The resulting organoleptic changes usually lead to a significant quality reduction. The formation of terpene hydroperoxides is another problem, as these are suspected of causing intolerances such as redness and itching in 1-3% of the European population upon contact with the skin. The detection of these chemical changes forms an integral part of quality control and can be prevented as far as possible by suitable production, transport, and storage strategies. Due to their volatility, essential oils are mainly analyzed by gas chromatography. However, due to their instability, the detection of hydroperoxides places considerable demands on common analytical methods. For this reason, a novel spectrophotometric method for the detection of peroxides and hydroperoxides in terpenes and essential oils was developed (paper 1). The oxidation of N-N-dimethyl-p-phenylenediamine by peroxides yielding an intensely red-colored cation (Wursters red) allowed colorimetric detection and quantitation of even smallest amounts (LOD: 0.5 ppm). The minimal sample amount of only a few milligrams, as well as simple and fast performance predestine this method for daily laboratory routine (paper 1). Among plant terpenoids, the monoterpene R-(+)-limonene is very widespread. Thus, it is not only found in citrus oils but also of in caraway oil, where its proportion amounts to almost 50%. To investigate the storage stability, R-(+)-limonene, S-(+)-carvone, different caraway oils, and the corresponding caraway seeds were stored in desiccators at 25 °C and 40 °C for eighteen months (paper 2). The samples were analyzed monthly by GC/MS and GC/FID, as well as HPLC/DAD-MS/MS. This showed that the comparison of seed, isolated essential oil, and pure substance, whichhad not been considered in storage studies so far, was of extraordinary importance. Here, both the plant matrix and the essential oil had a protective effect on individual terpenes and delayed their degradation (paper 2). Further, a clear difference between photo-oxidation and autoxidation was observed. Light-induced oxidation of terpenes primarily resulted in the formation of hydroperoxides, whereas autoxidation led to a variety of compounds such as alcohols, ketones, and epoxides. Thus, the secondary products can serve as specific markers for conclusions about the preload and quality of essential oils. In the study presented in paper 3, further photo-oxidation experiments were conducted with beta-pinene, R-(+)-limonene, and gamma-terpinene, with added furocoumarins. Furocoumarins can absorb UV-A light in the range of 320 380 nm and enter an energetically excited state. This energy difference between the ground state and excited state can be dissipated again by the emission of fluorescent and phosphorescent light. In this process, short-wave energy-rich UV light is converted into lower-energy visible light (bathochromic shift). For this reason, the UV light-induced degradation of the terpenes beta-pinene, R-(+)-limonene, and gamma-terpinene could be significantly reduced by adding 5% each of xanthotoxin, bergapten, bergaptol, and bergamottin. The effect of adding bergaptol was most pronounced in the photooxidation of gamma-terpinene (paper 3). Consequently, in citrus essential oils from which the natural furocoumarins had been previously removed, irradiation with UV light resulted in a strong degradation of the terpenes. This process could be markedly reduced by the re-addition of 5% of the previously removed plant-specific furocoumarins (paper 4). In summary, it can be concluded that not only the plant matrix and the essential oil as a multicomponent mixture but also potential interactions with other substances forming part of the essential oil such as furocoumarins may significantly slow down the oxidation of terpenoids.Ätherische Öle gehören zu den sekundären Pflanzenstoffen, wobei Terpenoide und Phenylpropanoide mengenmäßig zu den Hauptbestandteilen zählen. Aufgrund ihres lipophilen Charakters und ihrer hohen Flüchtigkeit werden diese überwiegend mittels Wasserdampfdestillation gewonnen. Eine Ausnahme bilden ätherische Zitrusöle (Agrumenöle), die in der Regel mittels Pressverfahren aus den Schalen gewonnen werden, wobei auch weniger flüchtige Komponenten wie z.B. Cumarine und Furocumarine in die Ölphase übergehen. Aufgrund ihrer geruchs- und geschmacksgebenden Eigenschaften finden ätherische Öle Anwendung in der Lebensmittel-, Getränke- und Kosmetikindustrie. Darüber hinaus werden sie aufgrund zahlreicher pharmakologischer Eigenschaften in der Phytotherapie sowie in der Aromatherapie eingesetzt. Allerdings sind die meisten ätherischen Öle in Gegenwart von Luftsauerstoff, Licht und bei erhöhten Temperaturen sehr anfällig für Oxidations-, Polymerisations-, Dehydrierungs- und Isomerisierungsreaktionen. Die damit einhergehenden organoleptischen Veränderungen führen meist zu einer deutlichen Qualitätsminderung. Ein weiteres Problem stellt die Bildung von Terpenhydroperoxiden dar, da diese im Verdacht stehen, bei 1-3% der europäischen Bevölkerung bei Hautkontakt Unverträglichkeiten wie Rötungen und Juckreiz auszulösen. Die Erfassung derartiger chemischer Veränderungen ist fester Bestandteil der Qualitätskontrolle, und diese sind durch geeignete Herstellungs-, Transport- und Lagerbedingungen zu minimieren. Die Analytik der ätherischen Öle findet aufgrund ihrer Flüchtigkeit vorwiegend mittels Gaschromatographie statt. Die Detektion von Hydroperoxiden stellt aufgrund ihrer Instabilität jedoch erhebliche Anforderungen an die herkömmlichen Analysemethoden. Deshalb wurde in der in Paper 1 vorgestellten Studie eine neue spektrophotometrische Methode zur Detektion und Quantifizierung von Peroxiden und Hydroperoxiden in Terpenen und ätherischen Ölen entwickelt. Die Oxidation von N-N-Dimethyl-p-phenylendiamin durch Peroxide zu einem intensiv rot gefärbten Kation (Wursters Rot) ermöglichte die kolorimetrische Detektion und Quantifizierung selbst kleinster Mengen (LOD 0,5 ppm). Die geringe Probenmenge von nur wenigen Milligramm sowie die einfache und schnelle Durchführung prädestinieren diese Methode für die tägliche Laborroutine (Paper 1). Unter den pflanzlichen Terpenoiden ist das Monoterpen R-(+)-Limonen sehr weit verbreitet. So findet es sich nicht nur in Zitrusölen, sondern auch mit einem Anteil von knapp 50% in Kümmelöl. Zur Untersuchung der Lagerstabilität wurden R-(+)-Limonen, S-(+)-Carvon, verschiedene Kümmelöle und die entsprechende Kümmelsaat achtzehn Monate lang bei 25 °C und 40 °C in Exsikkatoren gelagert (Paper 2). Mittels GC/MS und GC/FID sowie HPLC/DAD-MS/MS wurden die Proben monatlich analysiert. Hierbei zeigte sich, dass der bisher in Lagerstudien nicht berücksichtige Vergleich von Saat, ätherischem Öl und Reinstoff von außerordentlicher Bedeutung ist. Dabei wirkten sich sowohl die Pflanzenmatrix als auch das ätherische Öl schützend auf die einzelnen Terpene aus und verzögerten deren Abbau (Paper 2). Dabei zeigte sich zudem ein deutlicher Unterschied zwischen der Photooxidation und der hier ablaufenden Autoxidation. Bei der lichtinduzierten Oxidation von Terpenen werden primär Hydroperoxide gebildet, während die Autoxidation zu einer Vielzahl von Verbindungen wie Alkoholen, Ketonen und Epoxiden führt. So können die Folgeprodukte als spezifische Marker zur Bewertung der Vorbelastung und Qualität eines ätherischen Öles herangezogen werden. In der in Paper 3 dargestellten Studie wurden weitere Photooxidationsversuche mit beta-Pinen, R-(+)-Limonen und gamma-Terpinen durchgeführt, denen zuvor Furocumarine zudotiert wurden. Furocumarine können UVA Licht im Bereich 320 380 nm absorbieren und gehen dabei in einen energetisch angeregten Zustand über. Die Energiedifferenz zwischen Grundzustand und angeregtem Zustand kann durch Emission von Fluoreszenz- und Phosphoreszenzlicht dissipiert werden. Hierbei wird energiereiches kurzwelliges UV-Licht in energieärmeres, sichtbares Licht umgewandelt (bathochromer Shift). Aus diesem Grund konnte der UV-Licht induzierte Abbau der Terpene beta-Pinen, R-(+)-Limonen und gamma-Terpinen durch die Zugabe von je 5% Xanthotoxin, Bergapten, Bergaptol und Bergamottin erheblich reduziert werden. Der deutlichste Effekt wurde bei Zugabe von Bergaptol zu gamma-Terpinen beobachtet (Paper 3). Folgerichtig kam es bei ätherischen Zitrusölen, aus denen die natürlichen Furocumarine zuvor entfernt wurden, durch Bestrahlung mit UV-Licht zu einem starken Abbau der Terpene. Dieser Prozess konnte durch erneute Zugabe von 5% der zuvor entfernten pflanzenspezifischen Furocumarine deutlich verringert werden (Paper 4). Zusammenfassend lässt sich feststellen, dass nicht nur die pflanzliche Matrix und das ätherische Öl als Mehrkomponentengemisch, sondern auch die Wechselwirkung mit anderen, im ätherischen Öle enthaltenen Substanzen wie Furocumarinen die Oxidation von Terpenoiden signifikant verlangsamen kann

European position paper on rhinosinusitis and nasal polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included

A Classification for Medical and Veterinary Libraries

The third edition of Classification for Medical and Veterinary Libraries is a long overdue revision of Cyril C. Barnard’s scheme, last updated in 1955. Barnard devised his scheme to meet the specialist focus of the London School of Hygiene & Tropical Medicine, focusing on tropical medicine and public health. Unlike many schemes, Barnard’s is based on specific entry, with an almost entirely alphabetical notation system. Classes include the sciences, general medicine, history of medicine, epidemiology, diseases and causative agents, pathology, diagnosis, specialties of medicine, surgery, dentistry, veterinary science, agriculture, and the social sciences. Auxiliary schedules enable further subdivision under any topic. This new edition provides a classification scheme which meets health-focused library and information services’ collections requirements and reflects current research and teaching priorities in public and global health. Subjects and structures have been revised to support increased findability and accessibility of resources. Equity, diversity and inclusion are promoted, with conscious and unconscious biases challenged. Language and content have been decolonised, resisting colonial taxonomies, integrating different voices and acknowledging the global creation of knowledge. The scheme supports library collection management activities and is suitable for integration across research systems which use taxonomies, leading to benefits for both libraries and their wider organisations

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

A Classification for Medical and Veterinary Libraries

The third edition of Classification for Medical and Veterinary Libraries is a long overdue revision of Cyril C. Barnard’s scheme, last updated in 1955. Barnard devised his scheme to meet the specialist focus of the London School of Hygiene & Tropical Medicine, focusing on tropical medicine and public health. Unlike many schemes, Barnard’s is based on specific entry, with an almost entirely alphabetical notation system. Classes include the sciences, general medicine, history of medicine, epidemiology, diseases and causative agents, pathology, diagnosis, specialties of medicine, surgery, dentistry, veterinary science, agriculture, and the social sciences. Auxiliary schedules enable further subdivision under any topic. This new edition provides a classification scheme which meets health-focused library and information services’ collections requirements and reflects current research and teaching priorities in public and global health. Subjects and structures have been revised to support increased findability and accessibility of resources. Equity, diversity and inclusion are promoted, with conscious and unconscious biases challenged. Language and content have been decolonised, resisting colonial taxonomies, integrating different voices and acknowledging the global creation of knowledge. The scheme supports library collection management activities and is suitable for integration across research systems which use taxonomies, leading to benefits for both libraries and their wider organisations. 424 Abstract Views 43 Downloads 3