A Low-Fidelity Stochastic Model of Viral Spread in Aircraft to Assess Risk Mitigation Strategies

2021 ◽  
Author(s):  
Leigh McCue
Keyword(s):  
Large Scale ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Traffic Network ◽  
Computationally Efficient ◽  
Passenger Compartment ◽  
Stochastic Effects ◽  
Viral Spread ◽  
Risk Mitigation Strategies ◽  
Baseline Health

Abstract The purpose of this work is to develop a computationally efficient model of viral spread that can be utilized to better understand influences of stochastic factors on a large-scale system - such as the air traffic network. A particle-based model of passengers and seats aboard a single-cabin 737-800 is developed for use as a demonstration of concept on tracking the propagation of a virus through the aircraft's passenger compartment over multiple flights. The model is sufficiently computationally efficient so as to be viable for Monte Carlo simulation to capture various stochastic effects, such as number of passengers, number of initially sick passengers, seating locations of passengers, and baseline health of each passenger. The computational tool is then exercised in demonstration for assessing risk mitigation of intervention strategies, such as passenger-driven cleaning of seating environments and elimination of middle seating.

Does the fungus causing white-nose syndrome pose a significant risk to Australian bats?

2019 ◽  
Vol 46 (8) ◽  
pp. 657 ◽  
Author(s):  
Peter Holz ◽  
Jasmin Hufschmid ◽  
Wayne S. J. Boardman ◽  
Phillip Cassey ◽  
Simon Firestone ◽  
...  
Keyword(s):  
North America ◽  
Large Scale ◽  
Risk Mitigation ◽  
Significant Risk ◽  
Mitigation Strategies ◽  
Pseudogymnoascus Destructans ◽  
Term Survival ◽  
White Nose Syndrome ◽  
Scale Population ◽  
Risk Mitigation Strategies

Abstract ContextPseudogymnoascus destructans is the fungus responsible for white-nose syndrome (WNS), which has killed millions of hibernating bats in North America, but also occurs in bats in Europe and China without causing large-scale population effects. This is likely to be due to differences in species susceptibility and behaviour, and environmental factors, such as temperature and humidity. Pseudogymnoascus destructans is currently believed to be absent from Australia. AimsTo ascertain the level of risk that white-nose syndrome poses for Australian bats. Methods This risk analysis examines the likelihood that P. destructans enters Australia, the likelihood of the fungus coming in contact with native bats on successful entry, and the potential consequences should this occur. Key results This risk assessment concluded that it is very likely to almost certain that P. destructans will enter Australia, and it is likely that bats will be exposed to the fungus over the next 10 years. Eight cave-dwelling bat species from southern Australia are the ones most likely to be affected. ConclusionsThe risk was assessed as medium for the critically endangered southern bent-winged bat (Miniopterus orianae bassanii), because any increase in mortality could affect its long-term survival. The risk to other species was deemed to range from low to very low, owing to their wider distribution, which extends beyond the P. destructans risk zone. Implications Although Australia’s milder climate may preclude the large mortality events seen in North America, the fungus could still significantly affect Australian bat populations, particularly bent-winged bats. Active surveillance is required to confirm Australia’s continuing WNS-free status, and to detect the presence of P. destructans should it enter the country. Although White-nose Syndrome Response Guidelines have been developed by Wildlife Health Australia to assist response agencies in the event of an incursion of WNS into bats in Australia, these guidelines would be strengthened by further research to characterise Australian cave temperatures and hibernating bat biology, such as length of torpor bouts and movement over winter. Risk-mitigation strategies should focus on education programs that target cavers, show-cave managers and tourists, particularly those who have visited regions where WNS is known to occur.

scholarly journals P–725 COVID–19: Fertility patients’ attitudes to pregnancy and implemented changes within fertility services during a pandemic

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Schaler ◽  
L Glover ◽  
M Wingfield
Keyword(s):  
Large Scale ◽  
Risk Mitigation ◽  
Virus Transmission ◽  
Mitigation Strategies ◽  
Fertility Treatment ◽  
Patient Portal ◽  
Fertility Treatments ◽  
Global Pandemic ◽  
Significant Difference ◽  
Risk Mitigation Strategies

Abstract Study question To investigate the attitudes of male and female fertility patients to risk mitigation strategies and pregnancy advice during the first wave of the COVID–19 pandemic. Summary answer The desire to conceive outweighed fears regarding infection. Patients felt fertility treatments should be classified as essential and were agreeable to most risk mitigation strategies. What is known already The effects of the COVID–19 global pandemic on fertility services became evident in early 2020. Because of possible impacts of the virus on gametes, embryos and patients and concerns over virus transmission and the ability of medical services to cope, fertility treatments were temporarily suspended, as advised by ESHRE, ASRM and others. Across Europe, services were paused for approximately 7 weeks. Patients have reported that they found this extremely stressful and in some cases, unfair. After the initial closures, many clinics re-opened but with new risk mitigation strategies regarding PPE, hygiene and reducing staff and patient footfall. Study design, size, duration Men and women with a scheduled appointment at a fertility clinic over a 7-week period during the first wave of the COVID–19 pandemic were asked to complete a questionnaire outlining their experience and how it affected them. Participants were recruited via email using a secure online patient portal. A standardised anonymous 25-item questionnaire was sent to 828 patients and a reminder was circulated seven days later. The questionnaire remained open for 28 days. Participants/materials, setting, methods Participants were invited to complete a questionnaire and assured that all data would remain anonymous. Three areas were assessed. Firstly, how the pandemic itself affected their attempts to conceive. Secondly, participant perceptions regarding the overall disruption to fertility services. Thirdly, how participants feel fertility services should be treated in the event of a future large scale global pandemic. Main results and the role of chance 135 responses were received, giving a response rate of 16.3%. 80% of respondents were female and 20% male with no significant difference in responses between the sexes. Most participants (96%) had completed third level education and 90% were fully employed. Interestingly, 69% of participants continued trying to conceive during this time. This was despite 28% having concerns about contracting COVID–19 should they attend a clinic, 21% having concerns regarding the effect of the virus on pregnancy and 21% having concerns regarding an impact on the fetus. The majority surveyed (93%) stated that fertility treatment should be considered essential. 90% had their treatment disrupted or altered and, of these, 44% felt that this was justified, 23% disagreed and 33% were unsure. Regarding changes implemented within the clinic, 68% were satisfied with online video consultations and a further 16% would be content in certain circumstances. 92% felt privacy was maintained and 95% were happy to sign consent forms via video link. Many disagreed with the no partner policy at early pregnancy scans(57%) and embryo transfer(44%); however, they agreed with it for phlebotomy and treatment scans. In the event of a future pandemic, 79% felt fertility services should or probably should be continued. Limitations, reasons for caution This study focuses on the first wave of COVID–19. The long term, ongoing nature of the pandemic may influence participants’ perspectives on the areas investigated over time. Wider implications of the findings: It is estimated that the world will face a global pandemic approximately once every generation. Fertility stakeholders must learn from these events and studies such as ours are important to ascertain the views of service users. Some policies, such as video consultations, may be of benefit even in non-pandemic times. Trial registration number Not applicable

scholarly journals Use of failure modes and effects analysis to mitigate potential risks prior to implementation of an intravenous compounding technology

2021 ◽  
Author(s):  
Agnes Ann Feemster ◽  
Melissa Augustino ◽  
Rosemary Duncan ◽  
Anand Khandoobhai ◽  
Meghan Rowcliffe
Keyword(s):  
Medication Safety ◽  
Failure Modes ◽  
Risk Mitigation ◽  
New Technology ◽  
Hazard Index ◽  
Mitigation Strategies ◽  
Investigational Drug ◽  
Workflow Optimization ◽  
Proactive Approach ◽  
Risk Mitigation Strategies

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach. Methods An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores. Results The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk. Conclusion The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.

scholarly journals Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. E335-E342
Author(s):  
Jason Friedrich
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Joint Pain ◽  
Risk Mitigation ◽  
Narrative Review ◽  
Mitigation Strategies ◽  
Web Based ◽  
Electrical Devices ◽  
Risk Mitigation Strategies

Background: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. Objectives: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. Study Design: Web-based provider survey and narrative review. Setting: Multispecialty pain clinic, academic medical center. Methods: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. Results: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. Limitations: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. Conclusions: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. Key words: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain

scholarly journals Restarting elective endoscopy safely amidst an evolving pandemic and the impact of patient perception

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Nguyen ◽  
Kevin T. Kline ◽  
Shehzad Merwat ◽  
Sheharyar Merwat ◽  
Gurinder Luthra ◽  
...  
Keyword(s):  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Transmission Risk ◽  
Dynamic Monitoring ◽  
Successful Model ◽  
Outpatient Procedures ◽  
Risk Patients ◽  
Risk Mitigation Strategies ◽  
Spread Of Infection ◽  
The Impact

Abstract Background The COVID-19 pandemic has led to disruptions in elective and outpatient procedures. Guidance from the Centers for Medicare and Medicaid Services provided a framework for gradual reopening of outpatient clinical operations. As the infrastructure to restart endoscopy has been more clearly described, patient concerns regarding viral transmission during the procedure have been identified. Moreover, the efficacy of the measures in preventing transmission have not been clearly delineated. Methods We identified patients with pandemic-related procedure cancellations from 3/16/2020 to 4/20/2020. Patients were stratified into tier groups (1–4) by urgency. Procedures were performed using our hospital risk mitigation strategies to minimize transmission risk. Patients who subsequently developed symptoms or tested for COVID-19 were recorded. Results Among patients requiring emergent procedures, 57.14% could be scheduled at their originally intended interval. COVID-19 concerns represented the most common rescheduling barrier. No patients who underwent post-procedure testing were positive for COVID-19. No cases of endoscopy staff transmission were identified. Conclusions Non-COVID-19 related patient care during the pandemic is a challenging process that evolved with the spread of infection, requiring dynamic monitoring and protocol optimization. We describe our successful model for reopening endoscopy suites using a tier-based system for safe reintroduction of elective procedures while minimizing transmission to patients and staff. Important barriers included financial and transmission concerns that need to be addressed to enable the return to pre-pandemic utilization of elective endoscopic procedures.

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