Linkages between COVID-19, solar UV radiation, and the Montreal Protocol.

There are several connections between coronavirus disease 2019 (COVID-19), solar UV radiation, and the Montreal Protocol. Exposure to ambient solar UV radiation inactivates SARS-CoV-2, the virus responsible for COVID-19. An action spectrum describing the wavelength dependence of the inactivation of SARS-CoV-2 by UV and visible radiation has recently been published. In contrast to action spectra that have been assumed in the past for estimating the effect of UV radiation on SARS-CoV-2, the new action spectrum has a large sensitivity in the UV-A (315-400 nm) range. If this "UV-A tail" is correct, solar UV radiation could be much more efficient in inactivating the virus responsible for COVID-19 than previously thought. Furthermore, the sensitivity of inactivation rates to the total column ozone would be reduced because ozone absorbs only a small amount of UV-A radiation. Using solar simulators, the times for inactivating SARS-CoV-2 have been determined by several groups; however, many measurements are affected by poorly defined experimental setups. The most reliable data suggest that 90% of viral particles embedded in saliva are inactivated within ~ 7 min by solar radiation for a solar zenith angle (SZA) of 16.5° and within ~ 13 min for a SZA of 63.4°. Slightly longer inactivation times were found for aerosolised virus particles. These times can become considerably longer during cloudy conditions or if virus particles are shielded from solar radiation. Many publications have provided evidence of an inverse relationship between ambient solar UV radiation and the incidence or severity of COVID-19, but the reasons for these negative correlations have not been unambiguously identified and could also be explained by confounders, such as ambient temperature, humidity, visible radiation, daylength, temporal changes in risk and disease management, and the proximity of people to other people. Meta-analyses of observational studies indicate inverse associations between serum 25-hydroxy vitamin D (25(OH)D) concentration and the risk of SARS-CoV-2 positivity or severity of COVID-19, although the quality of these studies is largely low. Mendelian randomisation studies have not found statistically significant evidence of a causal effect of 25(OH)D concentration on COVID-19 susceptibility or severity, but a potential link between vitamin D status and disease severity cannot be excluded as some randomised trials suggest that vitamin D supplementation is beneficial for people admitted to a hospital. Several studies indicate significant positive associations between air pollution and COVID-19 incidence and fatality rates. Conversely, well-established cohort studies indicate no association between long-term exposure to air pollution and infection with SARS-CoV-2. By limiting increases in UV radiation, the Montreal Protocol has also suppressed the inactivation rates of pathogens exposed to UV radiation. However, there is insufficient evidence to conclude that the expected larger inactivation rates without the Montreal Protocol would have had tangible consequences on the progress of the COVID-19 pandemic.

ROUTLEDGE HANDBOOK OF PEACEBUILDING AND ETHNIC CONFLICT

This handbook offers a comprehensive analysis of peacebuilding in ethnic conflicts, with attention to theory, peacebuilder roles, making sense of the past and shaping the future, as well as case studies and approaches. Comprising 28 chapters that present key insights on peacebuilding in ethnic conflicts, the volume has implications for teaching and training, as well as for practice and policy. The handbook is divided into four thematic parts. Part 1 focuses on critical dimensions of ethnic conflicts, including root causes, gender, external involvements, emancipatory peacebuilding, hatred as a public health issue, environmental issues, American nationalism, and the impact of the COVID-19 pandemic. Part 2 focuses on peacebuilders' roles, including Indigenous peacemaking, nonviolent accompaniment, peace leadership in the military, interreligious peacebuilders, local women, and young people. Part 3 addresses the past and shaping of the future, including a discussion of public memory, heritage rights and monuments, refugees, trauma and memory, aggregated trauma in the African-American community, exhumations after genocide, and a healing-centered approach to conflict. Part 4 presents case studies on Sri Lanka's postwar reconciliation process, peacebuilding in Mindanao, the transformative peace negotiation in Aceh and Bougainville, external economic aid for peacebuilding in Northern Ireland, Indigenous and local peacemaking, and a continuum of peacebuilding focal points. The handbook offers perspectives on the breadth and significance of peacebuilding work in ethnic conflicts throughout the world. This volume will be of much interest to students of peacebuilding, ethnic conflict, security studies, and international relations. © 2023 selection and editorial matter, Jessica Senehi, Imani Michelle Scott, Sean Byrne and Thomas G. Matyók;individual chapters, the contributors.

IAPT CBT treatment for PTSD following COVID-19-related intensive care admission - a case study

The current case study was conducted as part of the National Health Services and Health Education England implemented IAPT top-up training in trauma-focused cognitive therapy for post-traumatic stress disorder (PTSD). There has been an increase in the number of clients presenting to IAPT with COVID-19 intensive care unit PTSD since the pandemic. However, there are no current unitary guidelines for psychological therapy for this population. Treatment of PTSD using individual trauma-focused cognitive therapy has been shown to be effective for ICU-PTSD. The National Institute for Health and Care Excellence treatment guidelines recommend adapting existing protocols. This study describes how these recommendations were used in the treatment of COVID-19 ICU-PTSD in a 46-year-old male. It illustrates the use of trauma-focused cognitive therapy for PTSD and how ICU trauma memories including hallucinations were conceptualised. It also illustrates how the challenges of co-morbid panic attacks, long COVID and remote working were managed. The client attended 16 individual, 60- to 90-minute video sessions of trauma-focused cognitive therapy, conducted weekly via Microsoft Teams over a period of five months. The treatment plan was conducted in collaboration with the client's general practitioner, physiotherapists, cardiopulmonary specialists, and his family. Treatment included a timeline, written narrative and imaginal reliving. It also applied stimulus discrimination, behavioural experiments and site visit. At the end of treatment, the client no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up.

Antimicrobial use and antimicrobial resistance in Enterobacterales and Enterococcus faecium: a time series analysis.

BACKGROUND: Irish and European antimicrobial resistance (AMR) surveillance data have highlighted increasing AMR in Enterobacterales and vancomycin resistance in Enterococcus faecium (VRE). Antimicrobial consumption (AC) in Irish hospital settings is also increasing. METHODS: A retrospective time series analysis (TSA) was conducted to evaluate the trends and possible relationship between AC of selected antimicrobials and AMR in Enterobacterales and vancomycin resistance in E. faecium, from January 2017 to December 2020. RESULTS: Increased AC was seen with ceftriaxone (P = 0.0006), piperacillin/tazobactam (P = 0.03) and meropenem (P = 0.054), while ciprofloxacin and gentamicin use trended downwards. AMR rates in Escherichia coli, Klebsiella pneumoniae and other Enterobacterales were largely stable or decreasing, an increase in ertapenem resistance in the latter from 0.58% in 2017 to 5.19% in 2020 (P = 0.003) being the main concern. The proportion of E. faecium that was VRE did not changed significantly (64% in 2017; 53% in 2020, P = 0.1). TSA identified a correlation between piperacillin/tazobactam use and the decreasing rate of ceftriaxone resistance in E. coli. CONCLUSION: Our data suggest that the hospital antimicrobial stewardship programme is largely containing, but not reducing AMR in key nosocomial pathogens. An increase in AC following the COVID-19 pandemic appears as yet to have had no impact on AMR rates.

Keeping the endoscopy ship afloat against the first wave of covid-19-the utilisation of a private institution to bolster mmuh gi services during covid-19

Aims During COVID-19, guidelines for performance of endoscopy meant procedure numbers were significantly curtailed.From April-June 2020, the Health Authorities in Ireland procured private hospitals for public use. The aims of this study were 1. to determine if additional private hospital capacity was utilised effectively for endoscopy, as this model is oftenemployed to deal with long waiting lists in Ireland. 2. to compare pathology and follow up rates between the two institutions. Methods We analysed all documentation relating to 242 endoscopy procedures outsourced to the private institution (MPH). For the period of June 2020 we compared indications, follow up rates and pathology for outpatient endoscopy proceduresperformed in our public institution, MMUH (n = 111) and MPH (n = 104). Results 197/242 (81.4 %) procedures in 167 patients were completed. Non-completion was due to refusal or failure toattend (32) and illness (6). 102 patients (61 %) were subsequently discharged to the GP and 39 % of patients requiredhospital follow up. There was no significant difference between indications in both institutions (p = 0.843). As shown in Table 1, rates ofsignificant pathology in MPH vs MMUH were not statistically significant, 4 % vs 7 %;p = 0.315. There was no difference infollow up rates in MPH vs MMUH, 62 % vs 51 %, p = 0.849. Conclusions The use of private capacity in MPH during the first wave of COVID19 significantly reduced the burden on thepublic system for GI procedures. However arranging the necessary follow up for the 39 % of patients from the MPHgenerated a substantial clinical and administrative workload on the public system. Although the endoscopy procedures performed in both institutions were deemed 'urgent', significant pathology was rare, between 4-7 %, suggesting more stringent criteria for endoscopy should be considered in the future.

Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2020.

This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.