Bubble concept for sporting tournaments during the COVID-19 pandemic: Football Club World Cup

ObjectivesTo report the person-to-staff transmission of COVID-19 with the implementation of a bubble concept that included testing, hygiene, distancing and monitoring strategies to mitigate risks.MethodsA prospective case series included all staff on-site involved in the Football Club World Cup. The tournament was conducted within ‘bubbles’. All personnel travelling to the tournament were required to be in possession of a negative RT-PCR test within 72 hours of arrival and subjected to a testing schedule during the tournament. Each location was assigned a COVID-19 protocol enforcement officer to ensure adherence to regular testing, hygiene measures, physical distancing and daily symptom reporting (via ScribePro app).ResultsThe study involved 70 recruited staff with a combined 1321 test days on the symptom checker app. The mean number of days completed on the symptom checker app was 18.87 days (range: 7–28). Of the five questions asked as part of the daily symptom checker, only one was answered positively (0.015%). This individual was isolated, assessed within 20 min and tested. The initial diagnosis was likely a non-COVID-19-related viral illness. Further testing returned three negative tests during the remainder of the tournament.ConclusionsThere was no person-to-staff transmission of COVID-19 during the tournament within our sample. The organisation of a sporting tournament during the COVID-19 pandemic is possible with risk mitigation strategies. These strategies include setting up a bubble with regular testing, hygiene measures, physical distancing and daily symptom reporting.

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Contemporary design, operation, and monitoring of potable reuse systems

Journal of Water Reuse and Desalination ◽

10.2166/wrd.2014.148 ◽

2014 ◽

Vol 5 (1) ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

J. E. Drewes ◽

S. J. Khan

Keyword(s):

Drinking Water ◽

Risk Mitigation ◽

Climate Change Impacts ◽

Mitigation Strategies ◽

Treated Wastewater ◽

Source Control ◽

Potable Reuse ◽

Monitoring Strategies ◽

De Facto Reuse ◽

Fail Safe

Water scarcity driven by population growth, lack of conventional supplies, and climate change impacts have resulted in increasing interest worldwide in drinking water augmentation using treated wastewater effluents. Potable reuse can occur indirect or direct, but is also practiced in many places as ‘de facto reuse’, where upstream wastewater discharge occurs to drinking water supplies. With this increasing recognition of potable reuse, there is very limited guidance and standardization for proper design and operation of potable reuse schemes that is protective of public health. This study provided guidance on contemporary approaches for the design, operation, and monitoring of potable reuse schemes, including source water characterization and source control approaches; linking water quality treatment performance goals to health risks; risk mitigation strategies including the design principles of multiple barriers for microbial and chemical contaminants; assessing system reliability and fail-safe design approaches; and, finally, monitoring strategies for process performance and compliance.

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Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital

Therapeutic Advances in Psychopharmacology ◽

10.1177/20451253211015070 ◽

2021 ◽

Vol 11 ◽

pp. 204512532110150

Author(s):

Edward Silva ◽

Melanie Higgins ◽

Barbara Hammer ◽

Paul Stephenson

Keyword(s):

Risk Mitigation ◽

Case Series ◽

Patient Characteristics ◽

Mitigation Strategies ◽

Treatment Resistant ◽

Serious Adverse Events ◽

Forensic Hospital ◽

Risk Mitigation Strategies ◽

Male Patients

Objective: Clozapine remains the most effective intervention for treatment resistant schizophrenia; however, its use is prohibited following neutropenias. We review neutrophil biology as applied to clozapine and describe the strategies to initiate clozapine following neutropenia used in a case series of 14 consecutive patients rechallenged in a United Kingdom (UK) high-secure psychiatric hospital. We examine outcomes including the use of seclusion and transfer. Methods: A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using this routinely collected clinical data, we describe the patient characteristics, causes of neutropenia, the strategies used for rechallenging with clozapine and clinical outcomes. Results: Previous neutropenias were the result of benign ethnic neutropenia, clozapine, other medications and autoimmune-related. Our risk mitigation strategies included: granulocyte-colony stimulating factor (G-CSF), lithium and watch-and-wait. There were no serious adverse events; at follow up half of the patient’s had improved sufficiently to transfer them to conditions of lesser security. There were dramatic reductions in the use of seclusion. Conclusion: Even in this extreme group, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients. This requires careful planning based on an understanding of neutrophil biology and the aetiology of the specific episode of neutropenia.

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Clozapine Re-Challenge and Initiation Despite Neutropenia and Outcomes from 14 Patients

10.21203/rs.2.16940/v1 ◽

2019 ◽

Author(s):

Edward Silva ◽

Melanie Higgins ◽

Barbara Hammer ◽

Paul Stephenson

Keyword(s):

Risk Mitigation ◽

Case Series ◽

Patient Characteristics ◽

Mitigation Strategies ◽

Treatment Resistant ◽

Serious Adverse Events ◽

The Face ◽

Risk Mitigation Strategies ◽

Male Patients

Abstract Objective: Clozapine remains the most effective intervention for treatment resistant schizophrenia. But its use is limited because of the risk of neutropenia and agranulocytosis. In the absence of effective alternatives its use after blood dyscrasias is possible. Methods: A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using routinely collected clinical data we describe the patient characteristics, causes of neutropenia, the strategies used and outcomes. Results: Previous neutropaenia was due to varying aetiologies: benign ethnic neutropaenia; clozapine induced; other medication; autoimmune. A range of risk mitigation strategies were used to prevent neutropaenia on clozapine rechallenge: G-CSF; lithium; watch and wait. There were no serious adverse events associated with clozapine or risk mitigation treatments. At follow up during 2019, half of the original 14 patients had improved sufficiently to transfer to conditions of lesser security. Conclusion: With careful planning and monitoring, taking into account what is known about neutrophil biology, clozapine can be successfully reinitiated following CIN or in the face of preexisting neutropenia resulting in significant benefits for patients.

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