Pandemic preparedness from the perspective of Occupational Health professionals.

BACKGROUND: Prior to any infectious disease emergence as a public health concern, early occupational preparedness is crucial for protecting employees from novel pathogens- coronavirus disease 2019 (COVID-19) is no different. AIMS: This study ascertains how occupational safety and health (OSH)/Human Resource (HR) professionals in the Republic of Ireland had managed to prepare their workplaces prior to the advent of COVID-19. METHODS: As part of a larger COVID-19 workplace study, online focus groups were conducted with OSH/HR professionals. Collected data were transcribed verbatim and entered into NVivo for thematic analysis incorporating intercoder reliability testing. RESULTS: Fifteen focus groups were conducted with OSH/HR professionals (n = 60) from various occupational settings. Three levels of organizational preparedness were identified: 'early awareness and preparation'; 'unaware and not ready' and 'aware, but not ready'. Most organizations were aware of the COVID-19 severity, but not fully prepared for the pandemic, especially stand-alone enterprises that may not have sufficient resources to cope with an unanticipated crisis. The experiences shared by OSH professionals illustrate their agility in applying risk management and control skills to unanticipated public/occupational health crises that arise. CONCLUSIONS: General pandemic preparedness such as the availability of work-from-home policies, emergency scenario planning and prior experience in workplace outbreaks of infectious diseases were helpful for workplace-associated COVID-19 prevention. This is the first study conducted with OSH/HR professionals in Ireland regarding COVID-19 preparedness in workplaces, which provides valuable insights into research literature, as well as empirical experience for the preparation of future public health emergencies.

Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study.

BACKGROUND: Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM: The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS: Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS: Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION: The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.

Effects of grazing platform stocking rate on productivity and profitability of pasture-based dairying in a fragmented farm scenario.

The area adjacent to the milking parlor, accessible for grazing by lactating dairy cows (i.e., the grazing platform [GP]), can be limited on fragmented pasture-based dairy farms. Such farms, with a moderate overall farm stocking rate, typically have a much higher stocking rate of dairy cows on the GP. This study quantified the effects of farm fragmentation on milk and herbage production and profitability in a whole-farm systems-scale study over 3 yr (2017-2019). Four systems, each with an overall farm stocking rate of 2.5 cows/ha but with different grazing platform stocking rates (GPSR), were examined. The proportions of the overall farm area within the GP were 100%, 83%, 71%, and 63% in each of the 4 systems, respectively. Hence, the 4 systems had a GPSR of 2.5, 3.0, 3.5, and 4.0 cows/ha. The GP was used for grazing and silage (ensiled herbage) production, and the non-GP portion of each GPSR system was used solely for silage production. Concentrate supplementation per cow was the same across all GPSR systems; approximately 10% of the annual feed budget. All systems were compact spring-calving with 24 cows per system. We discovered a lower proportion of grazed herbage in the diet with higher GPSR. All silage produced on the non-GP areas was required to support higher GPSR on each of the systems. Annual herbage production and milk production per cow were not different between GPSR systems, resulting in similar milk production per hectare of the overall system area. The economic implications of different GPSR on fragmented farms were modeled in 2 scenarios: (1) quantifying the cost associated with different levels of farm area fragmentation; (2) investigating the optimum GPSR on fragmented pasture-based dairy farms, depending on variable criteria. A greater level of farm fragmentation lowered the profitability of pasture-based dairy production. Costs of production increased with higher GPSR and longer distances between GP and non-GP areas. At a fixed GP area, it was most profitable to increase GPSR up to 4 cows/ha on the GP when milk price was high, land rental price was low, and shorter distance existed between GP and non-GP areas.

Effect of ageing on the physicochemical properties of human faeces in the context of onsite sanitation.

Sanitation systems involving onsite storage of faecal matter cause excreta to undergo transformation and primary treatment in-situ. However, little is known about the transformation pathway followed by fresh faeces while contained in situ. The current paper investigated this transformation under ambient conditions during a 16-week in-situ-storage period. Moisture content, drying kinetics, rheological, physicochemical, and thermal properties were analysed to determine the effects of ageing. The faeces experienced dehydration, mainly affecting moisture-dependent characteristics. Moisture content decreased from 79%wt to 26%wt, and water activity of 0.67, which corresponds mainly to the removal of interstitial bound water, reducing mass by 72%. The decreasing moisture content expectantly reduced drying ability, flowability and thermal properties (heat capacity and thermal conductivity). During this period, negligible biodegradation was recorded (volatile solids reduced by 3%), resulting in consistent chemical oxygen demand, particle size, carbon content and calorific values. Ammonium and nitrates decreased, but total nitrogen remained unchanged. Therefore, ageing affects nitrogen chemical forms and not nutrient composition. The findings demonstrate the benefits of source separation and in particular ventilated storage as a passive way to pre-treat and recover resources from faecal material.

Increases in 'deaths of despair' during the COVID-19 pandemic in the United States and the United Kingdom.

OBJECTIVES: The COVID-19 pandemic significantly impacted mental health, health-related behaviours such as drinking and illicit drug use and the accessibility of health and social care services. How these pandemic shocks affected 'despair'-related mortality in different countries is less clear. This study uses public data to compare deaths from alcohol, drugs and suicide in the United States and the United Kingdom to identify similarities or differences in the impact of the pandemic on important non-COVID causes of death across countries and to consider the public health implications of these trends. STUDY DESIGN AND METHODS: Data were taken from publicly available mortality figures for England and Wales, Northern Ireland, Scotland and the United States of America, 2001-2021, and analysed descriptively through age-standardised and age-specific mortality rates from suicide, alcohol and drug use. RESULTS: Alcohol-specific deaths increased in all countries between 2019 and 2021, most notably in the United States and, to a lesser extent, England and Wales. Suicide rates did not increase markedly during the pandemic in any of the included nations. Drug-related mortality rates rose dramatically over the same period in the United States but not in other nations. CONCLUSIONS: Mortality from 'deaths of despair' during the pandemic has displayed divergent trends between causes and countries. Concerns about increases in deaths by suicide appear to have been unfounded, whereas deaths due to alcohol have risen across the United Kingdom and in the United States and across almost all age groups. Scotland and the United States had similarly high levels of drug-related deaths pre-pandemic, but the differing trends during the pandemic highlight the different underlying causes of these drug death epidemics and the importance of tailoring policy responses to these specific contexts.

Determinants of diarrhoeal infections among users of shared sanitation in informal settlements in Durban, South Africa.

Diarrhoeal disease continues to be a major health problem in many parts of the world, especially in developing countries, mainly due to the lack of access to sanitation, water, and hygienic living conditions. Identifying the determinants of diarrhoeal infections continues to be a challenge in developing countries. In this study, we ascertained the factors behind diarrhoea among inhabitants of informal settlements in the city of Durban, South Africa. Prevalence of diarrhoea in the study area varied between 7-year historical clinical records and data collected during the current study (primary data), with the primary data giving the highest monthly prevalence odds ratio (POR) up to 18.1 (±1.6)%. The main factors associated with diarrhoeal infections were open defaecation (POR = 1.8; 95% confidence interval (CI): 0.9-3.12), use of shared sanitation (POR = 1.7; 95%; CI: 1.05-2.26), and exposure to faecal matter around the homes (POR = 1.69; 95% CI: 1.25-3.10). Several other factors were also determined to be associated with diarrhoeal infections, such as hygiene practices in the communities, the non-treatment of water before use, and the presence of solid waste and faecal materials around the households. This study shows that diarrhoeal disease infections in informal settlements could be multifactorial; therefore, a multifactorial approach is needed to reduce these infections. These could include improving education on hygiene practices within the home setting as well as in public places, such as the community ablution blocks.

Convective drying kinetics of faecal sludge from VIP latrines.

In striving to achieve sustainable sanitation, one challenge is to ensure hygienic treatment of faecal sludge from on-site sanitation. Thermal drying is an important treatment step for moisture removal and disinfection. Improved understanding of the drying process is crucial for the proper design of treatment technologies for faecal sludge. In this study, faecal sludge from ventilated improved pit (VIP) latrines from Durban, South Africa, were dried in a convective drying thermobalance by varying the temperature from 40 to 80 °C, the relative humidity from 0 to 25% and the air velocity from 0.3 to 1.2 mm/s. The faecal sludge samples were in the form of a thin layer and pellets with different diameters from 8 to 14 mm. Kinetic parameters were determined from the experimental data, were compared to classical drying models in literature and were then used to develop a correlative drying model. Drying rates ranged between 1 and 40 g/min/m2, leading to drying times comprised between 100 and 300 min. The drying kinetics increased as temperature was higher, and pellet diameter and relative humidity were lower. Temperature had the greatest influence on the drying kinetics (in both the constant and falling rate periods), followed by the effect of pellet diameter. The drying kinetics were affected in a moderate way by the relative humidity in the constant rate period and part of the falling rate period. The air velocity had a slight effect of drying kinetics during the constant rate period, but this becomes insignificant during the falling rate period. The effective diffusivities increased from 7.81 × 10-8 to 1.97 × 10-7 m2/s by increasing the temperature from 40° to 80 °C, leading to an activation energy of 23 kJ/mol. These values are typical from those found for wastewater sludge. The sludge exhibited a critical moisture content varying between 2.4 and 3.2 g/g db during drying without a clear trend as a function of the operating conditions and suggested that sludge was composed of considerably more bound moisture than unbound. The experimental data fitted the most closely to the Page model and, based on this, a new model was proposed for the prediction of drying times across the range of explored temperatures and pellet diameters in this study. The results of the proposed model fitted the experimental data with acceptable accuracy, so that the developed model could be employed as an analytical tool for the design, operation and optimisation of drying equipment.

Long COVID syndrome and the lung: how long will it last?

The prevalence and duration of the long-term respiratory complications of COVID-19 infection remains to be elucidated. This short commentary reports on recently published studies in patients post-acute COVID-19 infection in terms of symptom prevalence, physiological and radiological sequela and where only symptoms are present despite investigation. Pulmonary function testing, 6-min walk tests, computed tomography chest and more advanced imaging modalities have been incorporated to reveal the underlying pathophysiology that cause such disabling symptoms in patient with post-acute COVID-9 syndrome (PACS). PACS has a serious impact on people's ability to return to work, affecting the physical, mental, social sphere and with significant healthcare and general economic consequences for them, their families and society.

TRAFIC: statistical design and analysis plan for a pragmatic early phase 1/2 Bayesian adaptive dose escalation trial in rheumatoid arthritis.

BACKGROUND: Adaptive model-based dose-finding designs have demonstrated advantages over traditional rule-based designs but have increased statistical complexity but uptake has been slow especially outside of cancer trials. TRAFIC is a multi-centre, early phase trial in rheumatoid arthritis incorporating a model-based design. METHODS: A Bayesian adaptive dose-finding phase I trial rolling into a single-arm, single-stage phase II trial. Model parameters for phase I were chosen via Monte Carlo simulation evaluating objective performance measures under clinically relevant scenarios and incorporated stopping rules for early termination. Potential designs were further calibrated utilising dose transition pathways. DISCUSSION: TRAFIC is an MRC-funded trial of a re-purposed treatment demonstrating that it is possible to design, fund and implement a model-based phase I trial in a non-cancer population within conventional research funding tracks and regulatory constraints. The phase I design allows borrowing of information from previous trials, all accumulated data to be utilised in decision-making, verification of operating characteristics through simulation, improved understanding for management and oversight teams through dose transition pathways. The rolling phase II design brings efficiencies in trial conduct including site and monitoring activities and cost. TRAFIC is the first funded model-based dose-finding trial in inflammatory disease demonstrating that small phase I/II trials can have an underlying statistical basis for decision-making and interpretation. TRIAL REGISTRATION: Trials Registration: ISRCTN, ISRCTN36667085 . Registered on September 26, 2014.

Moistube irrigation fouling due to anaerobic filtered effluent (AF) and horizontal flow constructed wetland (HFCW) effluent.

The study assessed the suitability of two effluent types, namely anaerobic filtered (AF) and horizontal flow constructed wetland (HFCW) effluent for Moistube irrigation (MTI). Secondary to this, the study determined the plugging coefficients (α) on MTI for the respective effluents. The feed water was supplied from a raised tank (3.5 m), and mass-flow rates were recorded at 15 min intervals using an electronic balance. The effluent feed water concentrations and experimental room temperature (25 °C ± 1 °C) were continuously monitored and kept constant. Hermia's models based on the [Formula: see text] coefficient was used to select the best fitting fouling mechanism model and, consequently, the plugging coefficients. In addition, microbial colony analysis and scanning electron microscopy (SEM) analysis was carried out to assess the composition of the deposited sediment (DS) and adhered bacterial film (ABF) onto the MTI lateral. The study revealed that MTI pore blocking was a complex phenomenon described by complete pore-blocking model ([Formula: see text] ≥ 0.50). Discharge followed an exponential decay with early fouling observed on AF effluent because of a high concentration of total suspended solids (TSS) and dissolved organic matter (DOM). Discharge declined by 50% after 20 and 10 h of intermittent operation for AF and HFCW effluent, respectively. The α for each effluent (foulant) were [Formula: see text] = 0.07 and [Formula: see text] = 0.05, respectively, for AF and HFCW. The microbial analysis revealed bacterial aggregation structures that contributed to pore blocking. SEM imaging revealed complete surface coverage by deposited sediment. It is concluded that water quality determines the operation life span of MTI, and the two effluents promote accelerated MTI pore fouling or blocking. Continuous use without flushing the MTI will promote membrane degradation and reduced discharge efficiency. Additional filtration can potentially mitigate the membrane degradation process.

Dementia palliative care: A multi-site survey of long term care STAFF'S education needs and readiness to change.

Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.

Priming as a strategy to overcome detrimental pH effects on cells for intervertebral disc regeneration.

Disc disease is characterised by degeneration of the nucleus pulposus (NP), the central gelatinous tissue of the intervertebral disc (IVD). As degeneration progresses, the microenvironment of the IVD becomes more hostile (i.e. decrease in oxygen, glucose and pH), providing a significant challenge for regeneration using cell-based therapies. Tissue engineering strategies such as priming cells or micro tissues with growth factors prior to implantation may overcome some of these issues by providing a pre-formed protective niche composed of extracellular matrix. The present study investigated the effect of priming on bone-marrow-derived stem cells (BMSCs) and articular chondrocytes (ACs) using transforming growth factor ß3 (TGF-ß3), cultured at different pH levels (pH 7.1, 6.8 and 6.5) representative of the in vivo disc microenvironment. Low pH was found to have a detrimental effect on both cell viability and matrix accumulation, which could be mitigated by priming cells using TGF-ß3. Investigating the activation of the transmembrane acid-sensing ion channels (ASIC-1 and -3) showed an increased expression of ASIC-1 in BMSCs and ASIC-3 in ACs at lower pH levels post-priming. Metabolic activity in terms of lactic acid production was also found to be affected significantly by priming, whereas oxygen and glucose consumptions did not change considerably. Overall, the study demonstrated that cells could be equipped to sustain the harsh environment of the IVD and promote accumulation of NP-like matrix through priming. Such an approach may open new avenues to engineer tissues capable of sustaining challenging microenvironments such as those found in the IVD.

Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020.

OBJECTIVES: The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN: The study design is monitoring and evaluation of a national public health protection programme. METHODS: All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS: Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS: The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.

Optimization of Cathode Functional Layers of Solid Oxide Electrolysis Cells.

Sluggish CO2 reduction on the cathodes of solid oxide electrolysis cells greatly affects electrolysis performance. However, there is no study systematically investigating the cathode functional layer (CFL), where the reduction occurs. Cathode supports equipped with fast gas diffusion channels were employed as a platform to investigate the CFL, including porosity, NiO/(Y2O3)0.08Zr0.92O2 (YSZ) ratio, and thickness. The porosity was adjusted by pore former content, and a higher porosity generated a higher electrolysis current density, while the porosity improvement is limited by the fabrication process. The three-dimensional microstructure of the CFL with different NiO/YSZ ratios was reconstructed by distance correlation functions to estimate three-phase boundary density, which can explain the optimal NiO/YSZ weight ratio of 60:40 for CO2 electrolysis. Increasing CFL thickness can provide more active sites until the optimal thickness of 35 µm. Further increasing the thickness results in gas diffusion limitation. Based on the channeled cathode supports, the CFL was optimized according to CO2 electrolysis performance.

Establishing nationally representative benchmarks of farm-gate nitrogen and phosphorus balances and use efficiencies on Irish farms to encourage improvements.

Agriculture faces considerable challenges of achieving more sustainable production that minimises nitrogen (N) and phosphorus (P) losses and meets international obligations for water quality and greenhouse gas emissions. This must involve reducing nutrient balance (NB) surpluses and increasing nutrient use efficiencies (NUEs), which could also improve farm profitability (a win-win). To set targets and motivate improvements in Ireland, nationally representative benchmarks were established for different farm categories (sector, soil group and production intensity). Annual farm-gate NBs (kg ha-1) and NUEs (%) for N and P were calculated for 1446 nationally representative farms from 2008 to 2015 using import and export data collected by the Teagasc National Farm Survey (part of the EU Farm Accountancy Data Network). Benchmarks for each category were established using quantile regression analysis and percentile rankings to identify farms with the lowest NB surplus per production intensity and highest gross margins (€ ha-1). Within all categories, large ranges in NBs and NUEs between benchmark farms and poorer performers show considerable room for nutrient management improvements. Results show that as agriculture intensifies, nutrient surpluses, use efficiencies and gross margins increase, but benchmark farms minimise surpluses to relatively low levels (i.e. are more sustainable). This is due to, per ha, lower fertiliser and feed imports, greater exports of agricultural products, and for dairy, sheep and suckler cattle, relatively high stocking rates. For the ambitious scenario of all non-benchmark farms reaching the optimal benchmark zone, moderate reductions in farm nutrient surpluses were found with great improvements in profitability, leading to a 31% and 9% decrease in N and P surplus nationally, predominantly from dairy and non-suckler cattle. The study also identifies excessive surpluses for each level of production intensity, which could be used by policy in setting upper limits to improve sustainability.

Effect of drying on the physical and chemical properties of faecal sludge for its reuse.

This work explores the effect of drying on the chemical and physical properties of faecal sludge, and evaluates the reuse potential of the dried material. For the purpose of this study, the nutrient content, calorific value and thermal properties were determined for faecal sludge samples dried at different moisture contents and under different drying and operating conditions. The results show that drying does not affect the nutrient content and calorific value, but it induces modifications of the chemical form of nitrogen and the thermal properties. The dried product was demonstrated to be suitable for reuse as an agricultural product and biofuel. In agriculture, dried faecal sludge could be used as an organic fertilizer with a particularly high phosphorous content and a slow release of nitrogen and phosphorous. As a biofuel, dried faecal sludge would have similar characteristics as wood.

Natural conception resulting in a ruptured heterotopic pregnancy in a multiparous woman.

A 31-year-old multigravida woman 16 weeks pregnant by natural conception presented with right lower abdominal pain and bloody emesis. She was hypotensive and anemic with hemoperitoneum resulting from rupture of an ectopic pregnancy. At operation, she was found to have a right tubal heterotopic pregnancy with attachments to the appendix and omentum.