A solution scan of societal options to reduce transmission and spread of respiratory viruses: SARS-CoV-2 as a case study

Societal biosecurity – measures built into everyday society to minimize risks from pests and diseases – is an important aspect of managing epidemics and pandemics. We aimed to identify societal options for reducing the transmission and spread of respiratory viruses. We used SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) as a case study to meet the immediate need to manage the COVID-19 pandemic and eventually transition to more normal societal conditions, and to catalog options for managing similar pandemics in the future. We used a ‘solution scanning’ approach. We read the literature; consulted psychology, public health, medical, and solution scanning experts; crowd-sourced options using social media; and collated comments on a preprint. Here, we present a list of 519 possible measures to reduce SARS-CoV-2 transmission and spread. We provide a long list of options for policymakers and businesses to consider when designing biosecurity plans to combat SARS-CoV-2 and similar pathogens in the future. We also developed an online application to help with this process. We encourage testing of actions, documentation of outcomes, revisions to the current list, and the addition of further options.</p

Sputum and serum calprotectin are useful biomarkers during CF exacerbation

AbstractBackgroundAdequate monitoring of cystic fibrosis lung disease is difficult. CF exacerbation offers a unique setting to test the utility of biomarkers in the assessment of changing airways inflammation. We hypothesised that levels of calprotectin in sputum (and serum) would change informatively following treatment of an exacerbation.Methods27 patients with CF were recruited at onset of pulmonary exacerbation. Sputum and serum were collected at the start and end of anti-biotic therapy. Sputum calprotectin, interleukin-8 (IL8), and myeloperoxidase (MPO) were measured, as were serum calprotectin, CRP and vascular endothelial growth factor (VEGF).ResultsSputum calprotectin decreased following treatment of an exacerbation (p<0.05), and was superior to other sputum markers. Serum calprotectin, CRP, and VEGF also decreased significantly (p=0.002, p=0.002, p=0.013 respectively). Serum calprotectin level following treatment had predictive value for time to next exacerbation (p=0.032).ConclusionsThis study demonstrates the superiority of calprotectin (in sputum and serum) as a biomarker of CF exacerbation over better-established markers

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A systematic review and meta-analysis of adjuncts to minimally invasive treatment of urethral stricture in men

Context Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates. Objective To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD. Evidence acquisition A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist. Evidence synthesis A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C-N-acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27–0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11–0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02–0.61; p = 0.01). Urinary tract infection (2.9–14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen. Conclusions Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence. Patient summary We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality

Guard Games on Graphs: Keep the Intruder Out!

A team of mobile agents, called guards, tries to keep an intruder out of an assigned area by blocking all possible attacks. In a graph model for this setting, the guards and the intruder are located on the vertices of a graph, and they move from node to node via connecting edges. The area protected by the guards is an induced subgraph of the given graph. We investigate the algorithmic aspects the guarding problem, which is to find the minimum number of guards sufficient to patrol the area. We show that the guarding problem is PSPACE-hard and provide a set of approximation algorithms. All approximation algorithms are based on the study of a variant of the game where the intruder must reach the guarded area in a single step in order to win. This variant of the game appears to be a 2-approximation for the guarding problem, and for graphs without cycles of length 5 the minimum number of required guards in both games coincides. We give a polynomial time algorithm for solving the one-step guarding problem in graphs of bounded treewidth, and complement this result by showing that the problem is W[1]-hard parameterized by the treewidth of the input graph. We also show that the problem is fixed parameter tractable (FPT) parameterized by the treewidth and maximum degree of the input graph. Finally, we turn our attention to a large class of sparse graphs, including plana

Estimativa do consumo de água na cultura da cenoura (Daucus carota, L.) v. nantes superior, para a região de piracicaba, através do método do balanço hídrico Estimation of carrot water consumption (Daucus carota, L.) t. nantes superior, in piracicaba county through the water balance methodology

O presente trabalho teve como objetivo estimar a demanda hídrica da cultura da cenoura (Daucus carota, L.) cv. Nantes Superior, pelo método do balanço hídrico sob condições de campo, para a região de Piracicaba, Estado de São Paulo (22&deg; 42' 30" S; 47&deg; 30' 00" W, à 560 metros de altitude). Os valores de evapotranspiração máxima obtidos pelo método do balanço hídrico foram correlacionados com os valores de evapotranspiração de referência estimados pelo método de Penman, objetivando a determinação do coeficiente de cultura. O consumo total de água considerando-se um ciclo vegetativo de 101 dias foi de 365 mm, gerando um consumo médio de 3,61 mm/dia. Nesta situação, o coeficiente de cultura médio encontrado foi de 1,1.<br>To estimate the evapotranspiration of a carrot crop (Daucus carota, L.) v. Nantes Superior, under field conditions, in Piracicaba (22&deg; 42' 30" S; 47&deg; 30' 00" W, at 560 m.), maximum evapotranspiration was determinated by the water balance method and correlated to the reference evapotranspiration estimated by Penman's method, in order to obtain the crop coefficient. The total water consumption of the vegetative cycle (101 days) was about 365 mm, with a mean of 3,61 mm/dia. In this situation the mean crop coefficient was 1.1