Nature-based solutions potential for flood risk reduction under extreme rainfall events.

Climate change will substantially increase extreme rainfall events, especially in the Tropics, enhancing flood risks. Such imminent risks require climate adaptation strategies to endure extreme rainfall and increase drainage systems. Here, we evaluate the potential of nature-based solutions by using an ecosystem service modeling approach, evaluating the impact of extreme rainfall events on flood risks in a large urban area and with a real-world land recovery plan. We evaluate the cost-effectiveness of four different land recovery scenarios and associated co-benefits, based on a gradient increase in area recovered and cost of implementation. Although the scenarios reveal increasing flood risk reduction and co-benefits along with greater proportion of land recovery, the most cost-effective scenario was the one with an intermediate land recovery where 30% of the study area would be reforested. We emphasize the striking benefits of nature-based solutions for flood risk reduction in cities, considering landscape scale and stakeholders' needs.

Effect of Porosity/Binder Index on Strength, Stiffness and Microstructure of Cemented Clay: The Impact of Sustainable Development Geomaterials.

Searching for alternative material options to reduce the extraction of natural resources is essential for promoting a more sustainable world. This is especially relevant in construction and infrastructure projects, where significant volumes of materials are used. This paper aims to introduce three alternative materials, crushed ground glass (GG), recycled gypsum (GY) and crushed lime waste (CLW), byproducts of construction industry geomaterials, to enhance the mechanical properties of clay soil in Cartagena de Indias, Colombia. These materials show promise as cementitious and frictional agents, combined with soil and cement. Rigorous testing, including tests on unconfined compressive strength (qu) and initial stiffness (Go) and with a scanning electron microscope (SEM), reveals a correlation between strength, stiffness and the novel porosity/binder index (η/Civ) and provides mixed design equations for the novel geomaterials. Micro-level analyses show the formation of hydrated calcium silicates and complex interactions among the waste materials, cement and clay. These new geomaterials offer an eco-friendly alternative to traditional cementation, contributing to geotechnical solutions in vulnerable tropical regions.

Deterrence against Terrorist Attacks in Sports-Mega Events: A Method to Identify the Optimal Portfolio of Defensive Countermeasures.

Sports mega-events, such as the Olympic Games or the Super Bowl, are attractive targets for terrorist organizations, due to their visibility, size, and number of people involved. Two characteristics of sports mega-events, however, make them distinctive in comparison with other well-studied target protection problems in counterterrorism analysis (such as transportation hubs or infrastructure facilities). First, defensive measures are often publicly known. Second, their finite horizon means that deterrence against any attack must be prioritized. In this article we thus propose a method that identifies the best portfolio of defensive measures the defense may adopt, given a fixed budget, to minimize the chances of suffering a terrorist attack during a sports mega-event. The method makes some relevant contributions to adversarial risk analysis: (i) it represents attackers that can choose among multiple attack scenarios and the no-attack scenario; (ii) it measures the deterrence effect caused by synergic portfolios of defensive measures; and (iii) it proposes an algorithm that identifies dominated portfolios and may, thus, overcome the scalability problems inherent to this portfolio optimization. We apply this method to a real-world defense problem, revisiting the defensive countermeasure planning for the 2016 Brazilian Olympic Games in Rio de Janeiro, Brazil. In the case study, we find a nonlinear relationship between budget expenditure and deterrence, as well as a decreasing marginal effectiveness use of resources after a given budget threshold, which would support a more efficient allocation of investments in the Games defense.

Women's Lives Matter-The Critical Need for Women to Prioritize Optimal Physical Activity to Reduce COVID-19 Illness Risk and Severity.

Physical activity (PA) is beneficial for the health and wellness of individuals and societies. During an infectious disease pandemic, such as the one caused by COVID-19, social distancing, quarantines, and lockdowns are used to reduce community spread of the disease. Unfortunately, such nonpharmacological interventions or physical risk mitigation measures also make it challenging to engage in PA. Reduced PA could then trigger physiological changes that affect both mental and physical health. In this regard, women are more likely to experience physical and psychological distress. PA is a safe and effective nonpharmacological modality that can help prevent and manage several mental and physical health problems when performed correctly. PA might even confer benefits that are directly related to decreasing COVID-19 morbidity and mortality in women. In this review, we summarize why optimal PA must be a priority for women during the COVID-19 pandemic. We then discuss chronic COVID-19 illness and its impact on women, which further underscores the need for worldwide preventive health strategies that include PA. Finally, we discuss the importance of vaccination against COVID-19 for women, as part of prioritizing preventive healthcare and an active lifestyle.

The Economics of Antibiotic Cement in Total Knee Arthroplasty: Added Cost with No Reduction in Infection Rates.

BACKGROUND: To reduce the substantial clinical and financial burden of periprosthetic joint infection (PJI), some surgeons advocate for the use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA), although its effectiveness continues to be debated in the literature. The purpose of this study was to determine whether the routine use of ALBC is cost-effective in reducing PJI after primary TKA. METHODS: We retrospectively reviewed a consecutive series of patients undergoing cemented primary TKA at two hospitals within our institution from 2015 to 2017. We compared demographics, comorbidities, costs, and PJI rates between patients receiving ALBC and plain cement. We performed a multivariate regression analysis to determine the independent effect of ALBC on PJI rate. We calculated readmission costs for PJI and reduction in PJI needed to justify the added cost of ALBC. RESULTS: Of 2511 patients, 1077 underwent TKA with ALBC (43%), with no difference in PJI rates (0.56% vs 0.14%, P = .0662) or complications (1.2% vs 1.6%, P = .3968) but higher cement costs ($416 vs $117, P < .0001) and overall procedure costs ($6445 vs $5.968, P < .0001). ALBC had no effect on infection rate (P = .0894). Patients readmitted with PJI had higher overall 90-day episode-of-care claims costs ($49,341 vs $19,032, P < .001). To justify additional costs, ALBC would need to prevent infection in one of every 101 patients. CONCLUSION: Routine use of ALBC in primary TKA is not cost-effective, adding $299 to the cost of episode of care without a reduction in PJI rate. Further study is needed to determine whether select use of ALBC would be justified in high-risk patients.

TRENDS IN CLINICAL ENGINEERING PRACTICES

Appropriate deployment of technological tools contributes to improvement in the quality of healthcare delivered, the containment of cost, and better access to healthcare systems. Hospitals have been allocating significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new biomedical technology while asked to manage existing inventory for which they are not well prepared. To effectively manage their investments, hospitals are developing medical technology management programs that need expertise and planning methodology for safe and efficient deployment of healthcare technological tools. Clinical engineers are practitioners that can lead such programs and deliver technological solutions based on carefully determined needs and specified set of organization objectives and abilities. The successful practice of clinical engineering is dependent on the ability of these practitioners to transfer knowledge from the engineering and life sciences to the support of clinical applications. As rapid changes in the complexity and variety of technological tools and in the measurement of patient care outcomes taking place, it is best to facilitate transfer of such knowledge having well defined body of knowledge. This can be accomplished only when the goals of the profession are clearly described and uniformly accepted accommodating profession vision and commitment. Such a commitment must include the promotion of safe and effective application of science and technology in patient care and on the acceptance of professional accountability demonstratable by the achievement of competency recognition by national professional certification program. To be ready, clinical engineers must participate in continuing education activities and maintain wide level of expertise, demonstrate ability for leading and effectively executing complex projects and functions, and be accountable for maintaining safe technological tools/systems used in the patient environment. As systems complexity and integration continues to increase, now is the time to demonstrate that the required competencies do contribute to desired outcomes.

La adecuada implementación y aplicación de herramientas tecnológicas contribuye al mejoramiento de la calidad en la prestación de los servicios de salud, la minimización de los costos de dichos servicios, y el aumento de la accesibilidad al sistema hospitalario. En las últimas décadas los hospitales han venido asignando una considerable porción de sus recursos al cuidado y administración de sus bienes de capital; enfrentan continuamente la necesidad de adquirir nuevas tecnologías biomédicas al tiempo que deben administrar la existente, situación para la que no están bien preparados. Con el fin de orientar eficientemente sus inversiones, los hospitales han venido desarrollando programas de administración de tecnología médica que requieren expertos en el tema y la aplicación de metodologías específicas para un aprovechamiento seguro y eficiente de estas herramientas en el sector salud. Los ingenieros clínicos son quienes pueden liderar estos programas al proveer soluciones tecnológicas basadas en las necesidades prioritarias, cuidadosamente establecidas, y en los objetivos organizacionales específicos. El éxito en la práctica de la ingeniería clínica radica en la habilidad de estos profesionales de transferir los conocimientos del campo de la ingeniería y de las ciencias de la salud al entorno hospitalario para servir de soporte en las aplicaciones médicas. A medida que se dan grandes y rápidos cambios en la complejidad y variedad de las herramientas tecnológicas disponibles y en las formas de evaluar el cuidado que se le brinda a los pacientes, la mejor forma de transferir dichos desarrollos es mediante un completo conocimiento del tema. Esto se puede lograr sólo cuando los objetivos de la profesión han sido claramente definidos y son coherentes con el compromiso y la visión profesional. Tal compromiso debe incluir la promoción del uso seguro y eficaz de la ciencia y la tecnología al servicio del cuidado de los pacientes y la aceptación de la necesidad de demostrar sus capacidades como ingeniero clínico al adquirir el reconocimiento de sus competencias profesionales mediante el programa de certificación profesional nacional. Para estar preparados para estos desafíos los ingenieros clínicos deben participar en actividades de educación continua, mantener su pericia y habilidades profesionales, demostrar capacidad para liderar y ejecutar eficientemente proyectos y funciones complejas, y velar por el seguro mantenimiento de las herramientas y sistemas tecnológicos utilizados en el sector salud. A medida que aumenta la integración y la complejidad de los sistemas, es el momento de demostrar que las competencias de los ingenieros clínicos realmente contribuyen al cumplimiento de las metas establecidas.