Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India

Background Poor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latrines often do not safely dispose of their child’s feces. Working with caregivers in rural Odisha, India, we co-developed an intervention aimed at improving safe disposal of child feces and encouraging child latrine use at an earlier age. We describe the rationale for the intervention and summarize the protocol for a cluster randomized trial (CRT) to evaluate its effectiveness at changing CFM practices. Methods The intervention consists of six behavior change strategies together with hardware provision: wash basin and bucket with lid to aid safe management of soiled nappies and a novel latrine training mat to aid safe disposal and latrine training. The intervention will be offered at the village level to interested caregivers of children < 5 years of age by a community-based organization. Following a baseline survey, 74 villages were randomly allocated to either intervention or control arm. The primary outcome is caregiver reported safe disposal of child feces after last defecation, either by the caregiver disposing of the child’s feces into the latrine or the child using the latrine, measured approximately four to six months following intervention delivery. Secondary outcomes include fecal contamination of household drinking water and the childs’ hands. A process evaluation will also be conducted to assess intervention fidelity and reach, and explore implementer and participant feedback. Discussion This study addresses a crucial knowledge gap in sanitation by developing a scalable intervention to improve safe management of child feces. The behavior change strategies were designed following the Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) approach, which has shown to be effective for other environmental behavior change interventions in low-income settings. The latrine training mat hardware is a novel design developed cooperatively and manufactured locally. The evaluation follows a rigorous CRT study design assessing the impact of the intervention on CFM behavior change, as well as fecal contamination of two sources of potential exposure. Trial registration This trial is registered at ISRCTN: ISRCTN15831099.

A prospective study of costs associated with the evaluation of allergic reactions to radiological contrast media

Background: The prevalence of hypersensitivity reactions to radiological contrast media (RCM) is increasing due to the greater performance of diagnostic and therapeutic tests that require RCMs. Objective: We carried out a year-long real-life observational study to prospectively evaluate the patients referred to the Allergy Service from Primary Care, Emergency Room, and other Services with suspected moderate to severe RCM hypersensitivity. Methods: To study the costs of RCM hypersensitivity evaluation, we systematically recorded direct and indirect costs. Results: Sixty-nine patients with previous reactions to RCM were evaluated in the Allergy Service from June 1st, 2017, to May 31st, 2018. Total direct health care costs were € 10715.84, with a mean cost per patient of € 155.30 ± 77.08. Specifically, direct non-health costs reached € 1605.42 (mean € 23.27 ± 41.14), and indirect costs were € 6490.85 (mean € 94.07 ± 110.61). In summary, the total cost was € 18812.11, which means a mean cost of € 272.64 ± 164.77. Conclusions: Our study reflects that the costs of an elective evaluation of hypersensitivity to RCM are low. This fact reaffirms that correct and safe management of these patients could be cost-effective, so our efforts should be directed to implement the necessary logistics.

Measurement of indoor environmental parameters and analysis of the condensation phenomenon in urban utility tunnels

Condensation is a major issue in the safe operation of utility tunnels. To address the condensation problem, the indoor air temperature, relative humidity (RH) and surface temperature in an urban utility tunnel in Jining were continuously measured, and the condensation conditions were surveyed and analysed. The results indicated that under natural ventilation conditions, the air temperature in the comprehensive cabin varied from 23.4°C to 24.5°C, the RH fluctuated between 86.4% and 95.3%, and the corresponding air dew point temperature (DPT) remained in the range of 22.2°C–22.9°C. The surface temperature of the water supply pipeline ranged from 17.8°C to 18.5°C, which was far lower than the DPT in the tunnel, resulting in serious condensation. A water supply pipeline with an anti-condensation design was developed based on environmental test data. A 25-mm-thick rubber plastic sponge insulation layer was used to thermally insulate the water supply pipeline, preventing further dew condensation. Furthermore, mechanical ventilation had little effect on reducing the RH in the tunnel and may actually cause dew condensation; therefore, a ventilation control mode was proposed in this study. These results are expected to provide basic data for further research and reference for the safe management of utility tunnels.

To fight or to flee? -- a systematic review of ectopic pregnancy management during Covid-19.

Background: Concerns about virus spread during surgery contributed to changes in the clinical management of ectopic pregnancies (EP) during the COVID19 pandemic. Objective: To compare published data on EP management prior versus during the COVID-19 pandemic and evaluate any difference in the management, rupture rate and complications where Early Pregnancy Unit (EPU) structures exist. Search strategy: We performed a systematic review of the literature using a keyword strategy based on our PICO criteria. Selection criteria: We included studies which recruited women diagnosed with ectopic pregnancy and compared the management during and prior the COVID-19 pandemic peak. Data collection and Analysis: Three independent reviewers screened the literature and extracted the data. Meta-analysis of the data was performed on Revman. Main Results: Our search yielded 34 studies; 12 were included in our meta-analysis (3122 women). We found no difference in the type of management of EP between the pre-Covid and Covid cohorts [2714 women, OR 0.99(0.63-1.55), p=0.96, I2=77%]. We observed a non-statistically significant reduction of surgical management within the EPU branch ([OR 0.47(0.19-1.13), p=0.09, I2=81%]). There was no difference in the ectopic rupture rate in units with EPU [OR= 0.66 (0.33-1.31), p=0.24, I2=37%]. In contrast, in non-EPU (NPEU) the risk of ruptured EP [OR=2.86(1.84-4.46), p<0.01 I2=13%] and complications [OR=1.69(1.23-2.31), p=0.001, I2=45%] were increased. Conclusions: The worldwide trend was not reflected in the UK suggesting that EPU may have contributed to prompt diagnosis and safe management of EP. Funding: No funding was received. Keywords: ectopic pregnancy, COVID 19, meta-analysis, early pregnancy unit

SARS-CoV-2 Positivity in a Combat Sports Bubble

ObjectiveThe objective of this report is to describe a SARS-CoV-2 protocol and subsequent positivity rate for athletes and staff participating in combat sports events.BackgroundCombat sports are among the most challenging to protect against the transmission of communicable diseases. Sports neurologists are often called on to take a leadership role in the safe management of these events. Our team was asked to provide a plan for pre-fight SARS-CoV-2 testing during the recent pandemic. As a result, we were able to successfully host 28 major combat sports events at a single venue with minimal exposure for staff and participants.Design/MethodsAthletes and staff were tested for the SARS-CoV-2 virus with a PCR method. Samples were obtained via nasal swab upon arrival at the host hotel. All participants were then quarantined until the results were available. Those with negative tests were allowed to resume training in isolated pods. All participants were retested within 72 hours of the event. Those who were positive were quarantined off site for up to 2 weeks. Consultation was provided with an infectious disease specialist via telemedicine.ResultsA total of 8,135 tests were performed from July 1, 2020 until April 30, 2021 for the purpose of maintaining a safe venue. A total of 1,649 subjects were tested. There were 42 positive tests that resulted in an overall SARS-CoV-2 positivity rate of 0.516% for these events.ConclusionsOur sports neurology team was able to design and implement an effective plan to protect combat sports athletes and staff during the SARS-CoV-2 pandemic. This allowed the safe continuation of 28 events. This protocol design can be implemented when dealing with future outbreaks of communicable diseases.

Conservation Treatment on the Bamboo Sunblind from the No. 1 Catchment Site in Baesanseongji, Busan

In the present study, safe management and value improvement of bamboo sunblind, which is an item of cultural heritage, were performed by adopting stable conservation treatment methods. The bamboo sunblind used in the present study was excavated from No. 1 catchment site in Baesanseongji, Busan. It was determined that the main material used to make the sunblind was bamboo, and herbal plants were used to weave the bamboo using lacquer as an adhesive agent. All contaminants and soil adhered to the sunblind was removed. Thereafter, the sunblind, which was recovered in the form of blocks, was washed separately after fixing it to a temporary plaster frame and to avoid the blocks from breaking during washing. Then, polyethylene glycol (PEG) impregnation was utilized for the reinforcement treatment. Based on the preliminary test results, the shape of the sunblind was fixed using a stainless-steel frame to prevent physical damage that may occur during the drying process. Thereafter, the bamboo sunblind was vacuum freeze-dried. PEG 20% (in ethyl alcohol) was applied as a surface treatment agent for stabilization the sunblind. After the surface treatment, the bamboo sunblind were joined together to fit the maximum width, and the rectangular shape of the sunblind was restored—as best as possible—while filling in the missing parts by maximizing the use of unknown members such as in the disturbed layers below bamboo sunblind surface. The conservation treatment was completed by fixing the bamboo sunblind into the fabricated frame.

Dental education continuity during the COVID-19 pandemic – Experience at National Dental Centre Singapore

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the COVID-19 pandemic which started in 2020. This resulted in a disruption to educational activities across the globe. Dental education, in particular, was affected because of its vocational nature where learners come into close contact with patients when performing dental procedures. Methods: This is a narrative review with no research data analysis involved. Results: Social distancing measures introduced to curb the spread of the infection revolutionised the advancement of online education as the virtual environment is a safer place to conduct teaching compared to face-to-face teaching. In this article, we share our experience at the National Dental Centre Singapore (NDCS) in ensuring the safety of our faculty and learners when conducting didactic and clinical education during the pandemic. Didactic lectures were conducted in the virtual environment via synchronous and non-synchronous teaching. Essential clinical education was conducted in small groups with safe management measures in place. In addition, we provide guidelines to highlight the importance of meticulous planning, thorough preparation, and seamless delivery in conducting effective synchronous teaching. Conclusion: Safe management measures put in place to ensure the well-being of our faculty and learners can ensure dental education continuity during the pandemic.

EP.FRI.583 Re-Audit of the Quality of Operation Notes

Aims High quality operation notes are crucial for the safe management of surgical patients. The Royal College of Surgeons Good Surgical Practice (2014) describes eighteen separate pieces of information that should be included in operation notes. Our aim was to determine whether the quality of operation notes have improved since the introduction in our hospital in 2015 of an electronic proforma to record these notes. Methods We conducted a retrospective audit of operation notes between 28th October and 19th November 2020 based on the RCS guidelines. These results were compared to those of our 2015 audit. Results Of the seventy eight operation notes analysed in this re-audit, twenty eight percent were produced using the electronic proforma compared to forty five percent in 2015. In our re-audit a significantly higher proportion of notes had records of whether operations were elective or emergency (p &lt; 0.01), intraoperative diagnosis (p &lt; 0.01) and estimated blood loss (p &lt; 0.05).Compared to the 2015 audit data there was a significant improvement in recording whether or not the surgery was elective or emergency (p &lt; 0.0001). Conclusion In this audit we noted a disappointing decrease in proportion of operation notes that were produced using the electronic proforma. We also noted that operation notes produced using the electronic proforma were of higher quality compared to those that were not. We need to increase awareness amongst surgeons in our hospital of the benefits of using the electronic proforma to improve the quality of operation notes.

Hand-foot syndrome and nail disorders secondary to treatment with paclitaxel: Is there a relationship with the presence of fungi?

Introduction This study aimed to evaluate the frequency of nail disorders and the presence of fungi on the nails of the hands and feet of patients with hand-foot syndrome secondary to treatment with paclitaxel. Methods Prospective study, carried out from October 2018 to December 2019, which included 81 patients undergoing treatment for breast cancer using paclitaxel and had signs and or symptoms of hand-foot syndrome with or without nail disorders. The data were collected through interviews guided by a structured questionnaire, information from medical records and reports of mycological exams. Results The average age of women was 54.7 ± 7.4 years. Nail disorders occurred in 69 patients (85.2%), and of these, 43 (62.3%) were positive for fungi. The fungi were yeasts ( n = 38; 69%), dermatophytes ( n = 15; 27.2%) and non-dermatophyte filamentous fungi ( n = 8; 14.5%). Conclusions Nail disorders were the most frequent manifestations in patients with hand-foot syndrome treated with paclitaxel and occurred in 85.2% of them. It was evidenced that fungi are present on the nails of these patients and can occur in up to 65.28%. The most prevalent fungi were Candida and Trichophyton. The nail lesion was associated with the type of treatment protocol used by the patient. The results of the study point to the need to select safe management alternatives for patients, so they can prevent nail lesions and prevent the proliferation of fungi, consequently reducing negative life impact during treatment.