Green Synthesis of Ceria Nanoparticles from Cassava Tubers for Electrochemical Aptasensor Detection of SARS-CoV-2 on a Screen-Printed Carbon Electrode.

Green synthesis approaches for making nanosized ceria using starch from cassava as template molecules to control the particle size are reported. The results of the green synthesis of ceria with an optimum calcination temperature of 800 °C shows a size distribution of each particle of less than 30 nm with an average size of 9.68 nm, while the ratio of Ce3+ to Ce4+ was 25.6%. The green-synthesized nanoceria are applied to increase the sensitivity and attach biomolecules to the electrode surface of the electrochemical aptasensor system for coronavirus disease (COVID-19). The response of the aptasensor to the receptor binding domain of the virus was determined with the potassium ferricyanide redox system. The screen-printed carbon electrode that has been modified with green-synthesized nanoceria shows 1.43 times higher conductivity than the bare electrode, while those modified with commercial ceria increase only 1.18 times. Using an optimized parameter for preparing the aptasensors, the detection and quantification limits were 1.94 and 5.87 ng·mL-1, and the accuracy and precision values were 98.5 and 89.1%. These results show that green-synthesized ceria could be a promising approach for fabricating an electrochemical aptasensor.

Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD).

BACKGROUND: This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation. METHODS: We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. RESULTS: 97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project. CONCLUSIONS: There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.

Numerical performance of CO2 accumulation and droplet dispersion from a cough inside a hospital lift under different ventilation strategies.

The impact of mechanical ventilation on airborne diseases is not completely known. The recent pandemic of COVID-19 clearly showed that additional investigations are necessary. The use of computational tools is an advantage that needs to be included in the study of designing safe places. The current study focused on a hospital lift where two subjects were included: a healthy passenger and an infected one. The elevator was modelled with a fan placed on the middle of the ceiling and racks for supplying air at the bottom of the lateral wall. Three ventilation strategies were evaluated: a without ventilation case, an upwards-blowing exhausting fan case and a downwards-blowing fan case. Five seconds after the elevator journey began, the infected person coughed. For the risk assessment, the CO2 concentration, droplet removal performance and dispersion were examined and compared among the three cases. The results revealed some discrepancies in the selection of an optimal ventilation strategy. Depending on the evaluated parameter, downward-ventilation fan or no ventilation strategy could be the most appropriate approach.

Preliminary report on therapeutic potential of coal-derived carbon quantum dots against SARS-CoV-2 virus.

Due to the pandemic of COVID-19 and subsequent emerging of new mutant strains, there has been a worldwide hunt for therapeutic and protective agents for its inhibition. In this short communication, for the first time, we report the coal-derived carbon quantum dot (CQD) for the possible therapeutic application against SARS-CoV-2. The synthesized C1-CQD is observed to be safe towards the normal cell line at highest dose, while effectively inhibiting growth of SARS-CoV2 (>95%) with IC50 value of 5.469 µg/mL. Moreover, C1-CQD showed activity against SARS-CoV-2 infection which is comparable to known inhibitory antiviral drug i.e., Remdesivir. These novel findings indicate that coal-based CQDs have highly potent anti-viral activity and could be investigated further for developing cheap and safer alternative therapeutic strategies for inhibition of SARS-CoV-2.

COVID-19 electrochemical immunosensor with Ag-MOF: Rapid and high-selectivity nasal swab testing for effective detection.

Early detection of the coronavirus is acknowledged as a crucial measure to mitigate the spread of the pandemic, facilitating timely isolation of infected individuals, and disrupting the transmission chain. In this study, we leveraged the properties of synthesized Ag-MOF, including high porosity and increased flow intensity. Electrochemical techniques such as cyclic voltammetry (CV) and differential pulse voltammetry (DPV) were employed to develop an economical and portable sensor with exceptional selectivity for COVID-19 detection. The methodology involves the deposition of Ag-MOF onto the surface of a Glassy Carbon Electrode (GCE), which resulted in a progressive augmentation of electric current. Subsequently, the targeted antibodies were applied, and relevant tests were conducted. The sensor demonstrated the capacity to detect the virus within a linear range of 100 fM to 10 nM, boasting a noteworthy Limit of Detection (LOD) of 60 fM. The entire detection process could be completed in a brief duration of 20 min, exhibiting high levels of accuracy and precision, outperforming comparable techniques in terms of speed and efficacy.

Computational aptamer design for spike glycoprotein (S) (SARS CoV-2) detection with an electrochemical aptasensor.

A new bioinformatic platform (APTERION) was used to design in a short time and with high specificity an aptamer for the detection of the spike protein, a structural protein of SARS-CoV-2 virus, responsible for the COVID-19 pandemic. The aptamer concentration on the carbon electrode surface was optimized using static contact angle and fluorescence method, while specificity was tested using differential pulse voltammetry (DPV) associated to carbon screen-printed electrodes. The data obtained demonstrated the good features of the aptamer which could be used to create a rapid method for the detection of SARS-CoV-2 virus. In fact, it is specific for spike also when tested against bovine serum albumin and lysozyme, competitor proteins if saliva is used as sample to test for the virus presence. Spectrofluorometric characterization allowed to measure the amount of aptamer present on the carbon electrode surface, while DPV measurements proved the affinity of the aptamer towards the spike protein and gave quantitative results. The acquired data allowed to conclude that the APTERION bioinformatic platform is a good method for aptamer design for rapidity and specificity. KEY POINTS: • Spike protein detection using an electrochemical biosensor • Aptamer characterization by contact angle and fluorescent measurements on electrode surface • Computational design of specific aptamers to speed up the aptameric sequence time.

Hydroxyapatite-Gold Modified Screen-Printed Carbon Electrode for Selective SARS-CoV-2 Antibody Immunosensor.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or coronavirus disease 2019 (COVID-19), is still spreading worldwide; therefore, the need for rapid and accurate detection methods remains relevant to maintain the spread of this infectious disease. Electrochemical immunosensors are an alternative method for the rapid detection of the SARS-CoV-2 virus. Herein, we report the development of a screen-printed carbon electrode immunosensor using a hydroxyapatite-gold nanocomposite (SPCE/HA-Au) directly spray-coated with the immobilization receptor binding domain (RBD) Spike to increase the conductivity and surface electrode area. The HA-Au composite synthesis was optimized using the Box-Behnken method, and the resulting composite was characterized by UV-vis spectrophotometry, TEM-EDX, and XRD analysis. The specific interaction of RBD Spike with immunoglobulin G (IgG) antibodies was evaluated by differential pulse voltammetry and electrochemical impedance spectroscopy methods in a [Fe(CN)6]4-/3- solution redox system. The IgG was detected with a detection limit of 0.0561 pg mL-1, and the immunosensor had selectivity and stability of 103-122% and was stable until week 7 with the influence of storage conditions. Also, the immunosensor was tested using real samples from human serum, where the results were confirmed using the chemiluminescent microparticle immunoassay (CMIA) method and showed satisfactory results. Therefore, the developed electrochemical immunosensor can rapidly and accurately detect SARS-CoV-2 antibodies.

The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study.

BACKGROUND: Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use. OBJECTIVE: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India. METHODS: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources. RESULTS: This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories. CONCLUSIONS: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.

Electrochemical biosensor for the evaluation of monoclonal antibodies targeting the N protein of SARS-CoV-2 virus.

The emergence of COVID-19 caused by the coronavirus SARS-CoV-2 has prompted a global pandemic that requires continuous research and monitoring. This study presents a design of an electrochemical biosensing platform suitable for the evaluation of monoclonal antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein. Screen-printed carbon electrodes (SPCE) modified with gold nanostructures (AuNS) were applied to design a versatile and sensitive sensing platform. Electrochemical techniques, including electrochemical impedance spectroscopy (EIS) and square wave voltammetry (SWV), were used to investigate the interactions between immobilised recombinant N (rN) protein and several monoclonal antibodies (mAbs). The electrochemical characterisation of SPCE/AuNS/rN demonstrated a successful immobilisation of rN, enhancing the electron transfer kinetics. Affinity interactions between immobilised rN and four mAbs (mAb-4B3, mAb-4G6, mAb-12B2, and mAb-1G5) were explored. Although mAb-4B3 showed some non-linearity, the other monoclonal antibodies exhibited specific and well-defined interactions followed by the formation of an immune complex. The biosensing platform demonstrated high sensitivity in the linear range (LR) from 0.2 nM to 1 nM with limits of detection (LOD) ranging from 0.012 nM to 0.016 nM for mAb-4G6, mAb-12B2, and mAb-1G5 and limits of quantification (LOQ) values ranging from 0.035 nM to 0.139 nM, as determined by both EIS and SWV methods. These results highlight the system's potential for precise and selective detection of monoclonal antibodies specific to the rN. This electrochemical biosensing platform provides a promising route for the sensitive and accurate detection of monoclonal antibodies specific to the rN protein.

Trans-boundary spatio-temporal analysis of Sentinel 5P tropospheric nitrogen dioxide and total carbon monoxide columns over Punjab and Haryana Regions with COVID-19 lockdown impact.

This study conducts a spatio-temporal analysis of tropospheric nitrogen dioxide (NO2) and total carbon monoxide (CO) concentrations in the Punjab and Haryana regions of India and Pakistan, using datasets from the Sentinel 5-Precursor (S5P) satellite. These regions, marked by diverse economic growth factors including population expansion, power generation, transportation, and agricultural practices, face similar challenges in atmospheric pollution, particularly evident in major urban centers like Delhi and Lahore, identified as pollution hotspots. The study also spotlights pollution associated with power plants. In urban areas, tropospheric NO2 levels are predominantly elevated due to vehicular emissions, whereas residential activities mainly contribute to CO pollution. However, precisely attributing urban CO sources is complex due to its longer atmospheric residence time and intricate circulation patterns. Notably, the burning of rice crop residue in November significantly exacerbates winter pollution episodes and smog, showing a more pronounced correlation with total CO than with tropospheric NO2 levels. The temporal analysis indicates that the months from October to December witness peak pollution, contrasted with the relatively cleaner period during the monsoon months of July to September. The severe pollution in the OND quarter is attributed to factors such as variations in boundary layer height and depletion of OH radicals. Furthermore, the study highlights the positive impact of the COVID-19 lockdown on air quality, with a significant decrease in NO2 concentrations during April, 2020 (Delhi: 59%, Lahore: 58%). However, the reduction in total CO columns was less significant. The study also correlates lockdown stringency with tropospheric NO2 columns (R2: 0.37 for Delhi, 0.25 for Lahore, 0.22 for Rawalpindi/Islamabad), acknowledging the influence of various meteorological and atmospheric variables. The research highlights the significant impact of crop residue burning on winter pollution levels, particularly on total CO concentrations. The study also shows the notable effect of the COVID-19 lockdown on air quality, significantly reducing NO2 levels. Additionally, it explores the correlation between lockdown stringency and tropospheric NO2 columns, considering various meteorological factors.

Impact of prone position on dead-space fraction in COVID-19 related acute respiratory distress syndrome.

INTRODUCTION: COVID-19 Related Acute Respiratory Syndrome (C-ARDS) is characterized by a mismatch between respiratory mechanics and hypoxemia, suggesting increased dead-space fraction (DSF). Prone position is a cornerstone treatment of ARDS under invasive mechanical ventilation reducing mortality. We sought to investigate the impact of prone position on DSF in C-ARDS in a cohort of patients receiving invasive mechanical ventilation. METHODS: we retrospectively analysed data from 85 invasively mechanically ventilated patients with C-ARDS in supine and in prone positions, hospitalized in Intensive Care Unit (Reims University Hospital), between November, 1st 2020 and November, 1st 2022. DSF was estimated via 3 formulas usable at patients' bedside, based on partial pressure of carbon dioxide (PaCO2) and end-tidal carbon dioxide (EtCO2). RESULTS: there was no difference of DSF between supine and prone position, using the 3 formulas. According to Enghoff, Frankenfield and Gattinoni equations, DSF in supine vs. prone position was in median respectively [IQR]: 0.29 [0.13-0.45] vs. 0.31 [0.19-0.51] (p = 0.37), 0.5 [0.48-0.52] vs. 0.51 [0.49-0.53] (p = 0.43), and 0.71 [0.55-0.87] vs. 0.69 [0.57-0.81], (p = 0.32). CONCLUSION: prone position did not change DSF in C-ARDS.

Modification of Respiratory Drive and Lung Stress by Level of Support Pressure and ECMO Sweep Gas Flow in Patients With Severe COVID-19-Associated Acute Respiratory Distress Syndrome: an Exploratory Retrospective Analysis.

OBJECTIVES: Patients with severe acute respiratory distress syndrome (ARDS) often exhibit an unusually strong respiratory drive, which predisposes them to effort-induced lung injury. Careful titration of support pressure via the ventilator and carbon dioxide removal via extracorporeal membrane oxygenation (ECMO) may attenuate respiratory drive and lung stress. DESIGN: A retrospective cohort study. SETTING: At a single center, a university hospital. PARTICIPANTS: Ten patients with severe COVID-19-associated ARDS (CARDS) on venovenous ECMO therapy. INTERVENTIONS: Assessment of the effect of titrated support pressure and titrated ECMO sweep gas flow on respiratory drive and lung stress in spontaneously breathing patients during ECMO therapy. MEASUREMENTS AND MAIN RESULTS: Airway occlusion pressure (P0.1) and the total swing of the transpulmonary pressure were determined as surrogate parameters of respiratory drive and lung stress. Ventilator-mediated elevation of support pressure decreased P0.1 but increased transpulmonary driving pressure, airway pressure, tidal volume, and end-inspiratory transpulmonary occlusion pressure. The increase in ECMO sweep gas flow lowered P0.1, transpulmonary pressures, tidal volume, and respiratory frequency linearly. CONCLUSIONS: In patients with CARDS on pressure support ventilation, even moderate support pressure may lead to overassistance during assisted ventilation, which is only reflected by advanced monitoring of respiratory mechanics. Modifying carbon dioxide removal via the extracorporeal system profoundly affects respiratory effort and mechanics. Spontaneously breathing patients with CARDS may benefit from consequent carbon dioxide removal.

The level of partial pressure of carbon dioxide affects respiratory effort in COVID-19 patients undergoing pressure support ventilation with extracorporeal membrane oxygenation.

BACKGROUND: Patients with COVID-19 undergoing pressure support ventilation (PSV) with extracorporeal membrane oxygenation (ECMO) commonly had high respiratory drive, which could cause self-inflicted lung injury. The aim of this study was to evaluate the influence of different levels of partial pressure of carbon dioxide(PaCO2) on respiratory effort in COVID-19 patients undergoing PSV with ECMO. METHODS: ECMO gas flow was downregulated from baseline (respiratory rate < 25 bpm, peak airway pressure < 25 cm H2O, tidal volume < 6 mL/kg, PaCO2 < 40 mmHg) until PaCO2 increased by 5 - 10 mmHg. The pressure muscle index (PMI) and airway pressure swing during occlusion (ΔPOCC) were used to monitor respiratory effort, and they were measured before and after enforcement of the regulations. RESULTS: Ten patients with COVID-19 who had undergone ECMO were enrolled in this prospective study. When the PaCO2 increased from 36 (36 - 37) to 42 (41-43) mmHg (p = 0.0020), there was a significant increase in ΔPOCC [from 5.6 (4.7-8.0) to 11.1 (8.5-13.1) cm H2O, p = 0.0020] and PMI [from 3.0 ± 1.4 to 6.5 ± 2.1 cm H2O, p < 0.0001]. Meanwhile, increased inspiratory effort determined by elevated PaCO2 levels led to enhancement of tidal volume from 4.1 ± 1.2 mL/kg to 5.3 ± 1.5 mL/kg (p = 0.0003) and respiratory rate from 13 ± 2 to 15 ± 2 bpm (p = 0.0266). In addition, the increase in PaCO2 was linearly correlated with changes in ΔPOCC and PMI (R2 = 0.7293, p = 0.0003 and R2 = 0.4105, p = 0.0460, respectively). CONCLUSIONS: In patients with COVID-19 undergoing PSV with ECMO, an increase of PaCO2 could increase the inspiratory effort.

Research on industrial structure adjustment and spillover effect in resource-based regions in the post-pandemic era.

Resource-based regions support national economic development and are essential sources of basic energy and raw materials. In the post-pandemic era, however, there are practical situations to deal with, such as a fractured industrial chain, a weaker industrial structure, and a sharp reduction in economic benefits. Based on data collected from 68 cities in China, from 2010 to 2021, with 816 observations, this paper explores the industrial development process of resource-based regions in China and the change in the toughness of the industrial structure under the impact of COVID-19. The paper studies and analyzes industrial development trends, industrial structure toughness, and spatial spillover effects. The methods used are the Markov chain model and the Industrial Structure Advancement Index. By building the spatial Dubin model, the paper analyzes the spatial spillover effect of regional industrial development. It decomposes the spillover effect using the partial differential model based on regression. The results show that, during the study period, the comprehensive development level of industries in resource-based regions in China was slowly improving and tended to stabilize after entering the post-pandemic era. The evolution of an advanced industrial structure is significantly heterogeneous among regions, and each region has different toughness. The impact of COVID-19 has reduced the toughness of China's resource-based regions' industrial structure. The spatial spillover effect of regional industrial development is significant. Labor force, technology input, and industrial-structure optimization have different impacts on the industrial development of neighboring regions. In the post-pandemic era, China has used new management methods for more innovation. In order to achieve low-carbon, environmental protection, and sustainable development of resources, realize the rapid recovery of the toughness of industrial structure in China's resource-based cities, and reduce the impact of the COVID-19 pandemic, China proposes to expand the supply of resources, improve the allocation of resources, optimize the direction, promote the rational flow and efficient aggregation of various factors, and enhance the impetus for innovation and development.

Revealing the characteristics of biofilms on different polypropylene plastic products: Comparison between disposable masks and takeaway boxes.

The increasingly severe plastic pollution issue was intensified by the enormous plastic emissions into ecosystems during the Covid-19 pandemic. Plastic wastes entering the environment were swiftly exposed to microorganisms and colonized by biofilms, and the plastic-biofilm combined effects further influenced the ecosystem. However, the non-woven structure of disposable masks discarded carelessly during the COVID-19 pandemic was different from those of plastics with flat surface. To reveal the potential effects of plastic structure on colonized biofilms, white disposable surgical masks (DM) and transparent takeaway boxes (TB), both made of polyethylene, were selected for the incubation of organic conditioning films and biofilms. The results indicated that the non-woven structure of disposable mask was destroyed by the influence of water infiltration and biofilm colonization. The influence of surface structure on conditioning films led to a relatively higher proportion of tryptophan-like substances on DM than those on TB samples. Therefore, biofilms with significantly higher microbial biomass and carbon metabolic capacity were formed on DM than those on TB samples owing to the combined effects of their differences in surface structure and conditioning films. Moreover, abundant functional microorganisms associated with stress tolerance, carbon metabolism and biofilm formation were observed in biofilms on disposable mask. Combining with the results of partial least squares regression analysis, the selective colonization of functional microorganisms on disposable masks with uneven surface longitudinal fluctuation was revealed. Although the predicted functions of biofilms on disposable masks and takeaway boxes showed more similarity to each other than to those of free-living aquatic microorganisms owing to the existence of the plastisphere, biofilms on disposable masks may potentially trigger environmental risks different from those of takeaway boxes by unique carbon metabolism and abundant biomass.

Weakened black carbon trans-boundary transport to the Tibetan Plateau during the COVID-19 pandemic.

The lockdowns implemented during the coronavirus disease 2019 (COVID-19) pandemic provide a unique opportunity to investigate the impact of emission sources and meteorological conditions on the trans-boundary transportation of black carbon (BC) aerosols to the Tibetan Plateau (TP). In this study, we conducted an integrative analysis, including in-situ observational data, reanalysis datasets, and numerical simulations, and found a significant reduction in the trans-boundary transport of BC to the TP during the 2020 pre-monsoon season as a result of the lockdowns and restrictive measures. Specifically, we observed a decrease of 0.0211 µgm-3 in surface BC concentration over the TP compared to the 2016 pre-monsoon period. Of this reduction, approximately 6.04 % can be attributed to the decrease in emissions during the COVID-19 pandemic, surpassing the 4.47 % decrease caused by changes in meteorological conditions. Additionally, the emission reductions have weakened the trans-boundary transport of South Asia BC to the TP by 0.0179 µgm-2s-1; indicating that the recurring spring atmospheric pollution from South Asia to the TP will be alleviated through the reduction of anthropogenic emissions. Moreover, it is important to note that BC deposition on glaciers contributes significantly to glacier melting due to its enrichment, posing a threat to the water sustainability of the TP. Therefore, urgent measures are needed to reduce emissions from adjacent regions to preserve the TP as the "Asian Water Tower."

Extracorporeal Carbon Dioxide Removal to De-escalate Venovenous Extracorporeal Membrane Oxygenation in Severe COVID-19 Acute Respiratory Distress Syndrome.

OBJECTIVES: In a subset of patients with COVID-19 acute respiratory distress syndrome (ARDS), there is a need for extracorporeal membrane oxygenation (ECMO) for pulmonary support. The primary extracorporeal support tool for severe COVID-19 ARDS is venovenous (VV) ECMO; however, after hypoxemic respiratory failure resolves, many patients experience refractory residual hypercarbic respiratory failure. Extracorporeal carbon dioxide removal (ECCO2R) for isolated hypercarbic type II respiratory failure can be used in select cases to deescalate patients from VV ECMO while the lung recovers the ability to exchange CO2. The objective of this study was to describe the authors' experience in using ECCO2R as a bridge from VV ECMO. DESIGN: Hemolung Respiratory Assist System (RAS) is a commercially available (ECCO2R) device, and the United States Food and Drug Administration accelerated its use under its Emergency Use Authorization for the treatment of refractory hypercarbic respiratory failure in COVID-19-induced ARDS. This created an environment in which selected and targeted mechanical circulatory support therapy for refractory hypercarbic respiratory failure could be addressed. This retrospective study describes the application of Hemolung RAS as a VV ECMO deescalation platform to treat refractory hypercarbic respiratory failure after the resolution of hypoxemic COVID-19 ARDS. SETTING: A quaternary-care academic medical center, single institution. PARTICIPANTS: Patients with refractory hypercarbic respiratory failure after COVID-19 ARDS who were previously supported with VV ECMO. MEASUREMENTS AND MAIN RESULTS: Twenty-one patients were placed on ECCO2R after VV ECMO for COVID-19 ARDS. Seventeen patients successfully were transitioned to ECCO2R and then decannulated; 3 patients required reescalation to VV ECMO secondary to hypercapnic respiratory failure, and 1 patient died while on ECCO2R. Five (23.8%) of the 21 patients were transitioned off of VV ECMO to ECCO2R, with a compliance of <20 (mL/cmH2O). Of these patients, 3 with low compliance were reescalated to VV ECMO. CONCLUSIONS: Extracorporeal carbon dioxide removal can be used to continue supportive methods for patients with refractory type 2 hypercarbic respiratory failure after COVID-19 ARDS for patients previously on VV ECMO. Patients with low compliance have a higher rate of reescalation to VV ECMO.

Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study.

The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures  are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.

Inhibition of SARS-CoV-2 infection and replication by Petasites hybridus CO2-extract (Ze 339).

BACKGROUND: The intensified search for low-threshold herbal anti-viral drugs would be of great advantage in prevention of early stages of infection. Since the SARS-CoV-2 Omicron variant has prevailed in western countries, the course has only been mild, but there are still no widely available drugs that can alleviate or shorten disease progression and counteract the development of Long-COVID. This study aimed to investigate the antiviral effects of a CO2-extract from Petasites hybridus (Ze 339). METHODS: We analyzed the infection and replication rate of SARS-CoV-2 in primary normal human bronchial epithelial cells (NHBEs) using a GFP-expressing version of the wild-type SARS-CoV-2 virus and live cell imaging. Upon infection with a clinical isolate of the Omicron variant, viral RNA content was quantified, and plaque assays were performed. In addition, the human transcriptome was analyzed after 4- and 24-hours post infection using whole genome microarrays. RESULTS: Ze 339 had a protective effect on primary airway epithelial cells during SARS-CoV-2 infection and impeded SARS-CoV-2 infection and replication in NHBE. Notably, Ze 339 inhibited the expression of infection-induced IFNA10 by 8.6-fold (p < 0.05) and additionally reduced a wide range of other interferons (IFNA6, IFNA7, IFNA8, IFNA21, IFNE, IFNW1). CONCLUSION: Thereby, Ze 339 attenuated epithelial infection by SARS-CoV-2 and modeled the IFN response. In conclusion, this study highlights Ze 339 as a potential treatment option for COVID-19 that limits infection-associated cell intrinsic immune responses.

'Small-scale' tourism versus traditional tourism: Which will be the new key to achieve the desired sustainable tourism?

The tourism sector after COVID-19 has raised different concerns that have lead to a development towards a more sustainable model of tourism. After the health crisis, the increase in environmental awareness of tourists has become evident. In this context, the great paradigm of 'small-scale' tourism has been developed as opposed to traditional tourism. The present work seeks to contribute to sustainable development in the Spanish tourism sector, comparing a hostel in Cantabria (considered as 'small scale' /religious tourism) and a hotel in Lloret de Mar (considered as a traditional tourism) one using the Life Cycle Assessment (LCA) methodology to verify advantages and disadvantages of both types of tourism. The functional unit (FU) used was 'per guest night with breakfast included'. The results have revealed similar results for both establishments in all impact categories, as can be seen in its contribution to Climate Change (4.41 kg CO2 eq./FU caused by the hotel and 4.78 kg CO2 eq./FU by the hostel). The electricity consumption and the impact of the breakfast in the hostel were identified as main contributors to environmental burdens (with 76.72 % of the hotel's impact to climate change and 77.36 % for the hostel); hence, improvement opportunities envisaged were focused on these critical points. On the one hand, a biomass boiler, a solar water-heating system and a hybrid solar/biomass heating are considered a more sustainable alternatives related to electricity. Natural gas and diesel Consumption, respectively. On the other hand, oatmeal, Greek yoghurt and berries are good options for a breakfast with a reduced environmental impact. It is also important to implement responsible and green practices in order to achieve more environmentally sustainable alternative and traditional accommodations. Therefore, it can be concluded by stating that LCA is a tool capable of identifying and studying the processes with the highest environmental impact in order to find out the most sustainable form of tourism.