Investigation of Ultraviolet-C light-emitting diode for airborne disinfection in air duct

Given the current coronavirus (COVID-19) situation around the world, we may have to face a long-term battle with coronavirus. It is necessary to prepare and stay resilient with some other techniques to improve air quality in buildings, especially in clinics and hospitals. In this paper, we have developed Ultraviolet-C (UVC) light-emitting diode (LED) modules which can be implemented in air ducts in heating, ventilation, and air conditioning system for airborne disinfection. An LED module is designed with LED panels as the basic unit so that it is easy to scale up to accommodate for air ducts with different sizes. Both experiments and simulations are carried out to study its disinfection performance. The results show that more than 76% and 85% of the pathogen can be inactivated within 60 and 90 min, respectively, in a meeting room with a volume of 107 m3 by using one LED module. Simulations for two LED modules show that the disinfection efficacy is more than two times compared to that of one LED module. In addition to the pathogen used in the experiments, the disinfection performance of the LED module for inactivation of SARS-CoV-2 virus based on the literature is investigated numerically. It shows that more than 99.70% of pathogens receive UV dose larger than 4.47 J/m2, leading to an almost 89.10% disinfection rate for SARS-CoV-2 virus within one hour using the two LED modules in the same meeting room. © 2023 Author(s).

Clip placement after ultrasound guided biopsy in the setting of neoadjuvant chemotherapy

Introduction: Most breast cancers are diagnosed after an image-guided biopsy. When performed under stereotactic guidance, biopsy markers (clips) are almost always placed. In comparison, clip placement after ultrasound (US) guided biopsy is variable. Neoadjuvant chemotherapy (NAT) may be administered before surgery to shrink large tumors so breast conservation therapy (BCT) instead of mastectomy can be done. After NAT, tumors may no longer be clinically palpable or visible on imaging. The clip localizes tumors so that the site can be identified and less extensive and more precise surgery can be performed. If no clip is placed at the time of biopsy, NAT is delayed and mastectomy may be required in a patient who would have otherwise qualified for BCT. Most often, a second US procedure for clip placement will be required and sometimes a second biopsy prior to NAT. International and national guidelines state that clips should be placed when the radiologist suspects the patient is a candidate for NAT. The aim of this project was to decrease the number of patients presenting to the NAT clinic at BC Cancer Vancouver Center without a clip in situ to less than 5% by the end of 2020. Methods: Ethical risk assessed using the ARECCI screening tool were minimal. Initial data included all patients who presented for NAT at BC Cancer VCC from January 2018 to January 2019 and final data was from January 2021 to March 2021 (delayed due to Covid-19 pandemic). All lower mainland health authority sites (LMMI) were surveyed in regards to Swhether they perform US guided breast biopsies. An online survey about specific radiologist practices was sent out to radiologists at all LMMI sites, as well as in community imaging clinics (CICs) and other health authorities in the province. Patient interviews have been conducted through BC Cancer Patient Engagement. A fee code specific to CICs in the lower mainland, which performover 60% of the US guided breast biopsies, to encourage and support appropriate clip use was proposed to the British Columbia ministry of health and was implemented in July 2019. Education was targeted at other community sites where surgeons were engaged to explain the impact on clinical outcomes when clips are not used. An online webinar about clip placement was developed in conjunction with a local surgeon and was hosted by the Canadian Society of Breast Imaging. Results: 19 LMMI sites perform US breast biopsies. 25% of radiologists surveyed stated anticipation of NAT as a reason for clip placement and 21% were aware of the national guidelines for clip placement. Initial data included 121 patients who presented for NAT clinic in our time frame and 77 were included in our analysis (received NAT and clip status was known). Final data included 33 patients who presented to the NAT clinic and 30 were include in our analysis. Before intervention, 49% of patients considered for NAT had a clip placed at the initial biopsy. Of 50 patients who did not have a clip at initial biopsy, 21 (42%) required a clip prior to NAT. There was a 5.5 day difference in time to NAT after biopsy for patients who had clips placed initially at the time of biopsy (34.7 days) and patients who did not (40.2 days). There was no difference in mastectomy rates. After intervention, 80% of patients considered for NAT had a clip placed at the initial biopsy. Though it is difficult to quantify the clinical impact a 5.5 day delay to start of therapy may have, patient interviews indicate significant anxiety associated with the time between diagnosis and treatment. Conclusion: Targeted education on clip use with engagement of surgeons to explain the clinical implications, and development of a fee code to encourage and support appropriate use of clip placement, reduced the number of patients presenting for NAT without a clip in place. Future projects include exploring the financial costs or savings of increasing clip use.

Increased proportion of alcohol-related trauma in a South London major trauma centre during lockdown, a cohort study

Background: Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of 'lockdown' on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Method: All adult patients admitted as 'trauma calls' to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown;N=316), and 1st April - 31st May 2020 (lockdown;N=191) had electronic patient records analysed. Patients' blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses. Results: Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%);(Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p<0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%);OR -0.40, 95% CI -0.79 to -0.02, p=0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p>0.05). Conclusions: UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global 'waves' of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

Effect of the COVID-19 pandemic on hip fracture patients in a Teaching London Hospital

Introduction: Hip fractures are the commonest serious injury in older people, the commonest reason for older people needing surgery and the commonest cause of death following an accident. The NHFD is a national database whereby markers of care are recorded prospectively for patients over 60 years sustaining a hip fracture and requiring inpatient care, with a Best Practice Tariff linked to key performance indicators. The aim of this study was to review how care varied for patients sustaining a hip fracture during the COVID-19 pandemic compared to the equivalent time last year. Methods: Using the NHFD we compared data from March-May 2019 to the same period in 2020 during the pandemic at St George's Hospital. The study provides a snapshot of care during the pandemic. Results: Therewere more admissions andmore discharges during the pandemic. There was an increase in time to theatre and subsequent reduction in BPT. There was also an increase in non-operative treatment for these patients. 6 patients were confirmed COVID-19 positive, one of whom died. Therewas a reduction in time to ortho-geriatrician review and also a reduction in deliriumreview post-operatively. Length of staywas also reduced. Conclusion: The COVID-19 pandemic had an effect on care provided to hip fracture patients. There was an increase in time and a deterioration in orthogeriatric review within 72 hours. The length of stay however improved due to improved focus on pathways and discharge processes. There was also a lower threshold to offer non-operative care wherever possible.

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic.

BACKGROUND: Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles. AIM: To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site. FINDINGS: Ninety-six hospitals responded to the request between May 26th, 2020 to October 29th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S-3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals. CONCLUSION: Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.