Sterilization Facilities Research Articles

Outcome differences of emergency cesarean delivery in the delivery room versus the operating room: A study based on propensity score matching.

This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room. The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters. The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates. The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.

12231 PAPP-A As A Potential Target In Thyroid Eye Disease

Abstract Disclosure: C.A. Conover: None. L.K. Bale: None. D. Hamadi: None. M. Stan: ; Tourmaline, Genentech, Third Rock Ventures, ArgenX, Septerna, OrthoDi. ; Horizon, Immunovant, Lassen, Sling. Background: Proptosis in Thyroid Eye Disease (TED) can result in facial disfigurement and visual dysfunction. Studies revealed an interaction between thyroid-stimulating hormone receptor (TSHR) and insulin-like growth factor-I receptor (IGF-IR) that is essential in promoting TED pathogenesis. Treatment with Insulin-like growth factor I receptor (IGF-IR) inhibitors has been shown to be effective in reducing proptosis but with side effects. PAPP-A is metalloprotease that can increase pericellular IGF bioavailability through specific cleavage of inhibitory IGF binding proteins, in particular IGFBP-4. We propose that inhibition of IGF-IR indirectly and more selectively with PAPP-A inhibitory antibodies attenuates IGF-IR signaling in TED with fewer side effects. Methods: Informed consent was obtained from TED patients undergoing surgery in Mayo Clinic operating suites in Rochester, MN. Retro-orbital tissue was collected from 19 TED patients and 2 control subjects for fibroblast isolation and culture and was performed in a sterile tissue culture facility. TED and control fibroblasts were treated with pro-inflammatory cytokines, and flow separation of CD34- and CD34+ orbital fibroblasts was done, the latter representing infiltrating fibrocytes into the orbit in TED. Main outcome measured were PAPP-A expression and proteolytic activity, IGF-I stimulation of phosphatidylinositol 3 kinase/Akt pathway and inhibition by immuno-neutralizing antibodies against PAPP-A, CD34+ status and associated PAPP-A and IGF-IR expression. Results: Primary cultured cells showed that PAPP-A is expressed in orbital fibroblasts from TED patients but not in control subject fibroblasts and were markedly increased by pro-inflammatory cytokines stimulation. IGF-IR expression was not affected by cytokine treatment. Inhibition of PAPP-A’s proteolytic activity suppressed IGF-IR activation in orbital fibroblasts from TED patients. CD34+ orbital fibroblasts represent 80% of cells in culture from TED patients, and approximately 70% of these cells were accountable for PAPP-A and IGF-IR expression. Conclusion: These results support a role for PAPP-A in TED pathogenesis and indicate the potential for novel therapeutic targeting of the IGF axis. Presentation: 6/2/2024

PAPP-A as a Potential Target in Thyroid Eye Disease.

Proptosis in Thyroid Eye Disease (TED) can result in facial disfigurement and visual dysfunction. Treatment with Insulin-like growth factor I receptor (IGF-IR) inhibitors has been shown to be effective in reducing proptosis but with side effects. To test the hypothesis that inhibition of IGF-IR indirectly and more selectively with PAPP-A inhibitors attenuates IGF-IR signaling in TED. Informed consent was obtained from TED patients undergoing surgery, and retro-orbital tissue collected for fibroblast isolation and culture. Surgeries were performed in Mayo Clinic operating suites. Cell culture was performed in a sterile tissue culture facility. Retro-orbital tissue was collected from 19 TED patients. Treatment of TED fibroblasts with pro-inflammatory cytokines. Flow separation of CD34- and CD34+ orbital fibroblasts, the latter representing infiltrating fibrocytes into the orbit in TED. PAPP-A expression and proteolytic activity, IGF-I stimulation of phosphatidylinositol 3 kinase/Akt pathway and inhibition by immuno-neutralizing antibodies against PAPP-A, CD34+ status and associated PAPP-A and IGF-IR expression. Pro-inflammatory cytokines markedly increased PAPP-A expression in TED fibroblasts. IGF-IR expression was not affected by cytokine treatment. Inhibition of PAPP-A's proteolytic activity suppressed IGF-IR activation in orbital fibroblasts from TED patients. TED fibroblasts that were CD34+ represented ∼80% of the cells in culture and accounted for ∼70% of PAPP-A and IGF-IR expressing cells. These results support a role for PAPP-A in TED pathogenesis and indicate the potential for novel therapeutic targeting of the IGF axis.

A comprehensive technology strategy for microbial identification and contamination investigation in the sterile drug manufacturing facility-a case study.

A comprehensive strategy for microbial identification and contamination investigation during sterile drug manufacturing was innovatively established in this study, mainly based on MALDI-TOF MS for the identification and complemented by sequencing technology on strain typing. It was implemented to monitor the bacterial contamination of a sterile drug manufacturing facility, including its bacterial distribution features and patterns. In three months, two hundred ninety-two samples were collected covering multiple critical components of raw materials, personnel, environment, and production water. Based on our strategy, the bacterial profile across the production process was determined: 241/292 bacterial identities were obtained, and Staphylococcus spp. (40.25%), Micrococcus spp.(11.20%), Bacillus spp. (8.30%), Actinobacteria (5.81%), and Paenibacillus spp. (4.56%) are shown to be the most dominant microbial contaminants. With 75.8% species-level and 95.4% genus-level identification capability, MALDI-TOF MS was promising to be a first-line tool for environmental monitoring routine. Furthermore, to determine the source of the most frequently occurring Staphylococcus cohnii, which evidenced a widespread presence in the entire process, a more discriminating S. cohnii whole-genome SNP typing method was developed to track the transmission routes. Phylogenetic analysis based on SNP results indicated critical environment contamination is highly relevant to personnel flow in this case. The strain typing results provide robust and accurate information for the following risk assessment step and support effective preventive and corrective measures. In general, the strategy presented in this research will facilitate the development of improved production and environmental control processes for the pharmaceutical industry, and give insights about how to provide more sound and reliable evidence for the optimization of its control program.

Patterns in staff reported surgical instrument errors point to failures in visualization as a critically weak point in sterile processing of surgical instruments

BackgroundSurgical Instrument Errors (missing, broken, bioburden/contamination etc.) account for significant delays in the operating room. During sterile processing, instruments must be inspected for correctness, functionality, and cleanliness (bioburden) prior to packaging for sterilization. The environment where these tasks are performed is typically high stress and high throughput. There is a growing body of research in human performance that indicates that under stress, the skill of human visualization (inspection and identification) deteriorates. Furthermore, error modeling of sterile processing of surgical instruments suggests that the tasks at highest risk for errors involve human visualization. Reporting of Surgical Instrument Errors at our institution falls to OR staff and, during the period of this study, was done through a mechanism termed the Patient safety notice or PSN. PSNs are filed via computer through the healthcare system website. There is no integration or linkage of the PSN to the electronic medical record and information in all fields must be typed in as it does not automatically populate. We hypothesized that the most common PSNs reporting Surgical Instrument Errors would involve tasks of visualization (inspection, identification). Accordingly, the most common reported Surgical Instrument Errors would be missing instruments, bioburden/contamination, and broken instruments. We also hypothesized that due to the complexity and lack of both data automation and integration with the electronic medical record in filing PSNs, the majority of PSNs reporting Surgical Instrument Errors would be incomplete. To test these two hypotheses, we analyzed one year's worth staff reported Surgical Instrument Error rates at two hospitals with the operating rooms at both locations serviced by a single sterile processing facility. MethodsThis study was conducted at a major healthcare center that houses 38 ORs located at 3 sites (Children's (8), Adult inpatient (24) and Adult outpatient (6)) all of which share a sterile processing facility. Staff reported Patient Safety Notices (PSNs), a reporting mechanism for safety events, were collected from July 2019 through June of 2020. PSNs reporting the following Surgical Instrument Errors: missing instrument (listed on the count sheet but absent from the tray), broken instrument, assembly or packaging error, wrong instrument, failed sterilization/bioburden/contamination, fleet management (trays missing), extra instrument and transport errors were identified. Raw annual rates of reported Surgical Instrument Errors were determined for each hospital. Rates per surgical service line (percent affected cases) per hospital were then determined by dividing the annual number of reported errors per service by the annual number of cases per service line. Whether the instrument error affected the sterile field was determined as well. An analysis of bioburden/contamination error rates and Surgical Instrument Error types by hospital was also determined. Results368 PSNs reporting 419 Surgical Instrument Errors were identified over a 12-month period (0.0432 errors/OR/elective OR day). The majority of reported errors (83 %) had to do with failures in inspection (bioburden/contamination) or in tracking and identification (missing). At both hospitals, cardiovascular surgery had the highest reported error rates per case (4.47 % of cases affected at the Adult hospital and 3.68 % of cases affected at the Children's hospital). In only 64 instances was the sterile field reported to be affected by the error. Bioburden/contamination was the most commonly reported instrument error (68.97 %) with the most common types of bioburden/contamination being debris, blood and tissue, failed instrument cleaning due to incomplete disassembly and the presence of hair. Overall, only 20.4 % of PSN had all fields filled to completion and 15 % were submitted days after the event (average of 12.70 ± 27.97 days, median of 2 days). Conclusionsthe data from this study indicates that failure in human visualization vis-à-vis inspection and identification are the root cause of the majority (83 %) of staff reported Surgical Instrument Errors. This manifests primarily through problems with bioburden/contamination and missing instruments. Implementation of technologies to improve inspection and identification and ultimately tracking of surgical instruments should substantially reduce Surgical Instrument Error rates. Furthermore, staff dependent reporting of these errors is rarely done to completion and a significant portion of events are reported days after an event. These latter findings suggest that the process is cumbersome and likely impedes accurate and timely reporting and may results in underreporting of Surgical Instrument Errors.

A Comparison of Ambient Air Ethylene Oxide Modeling Estimates from Facility Stack and Fugitive Emissions to Canister-Based Ambient Air Measurements in Salt Lake City

Ethylene oxide (EtO) is a colorless, flammable gas at room temperature produced by the catalytic oxidation of ethylene. EtO is widely used by medical sterilization facilities to clean medical supplies and equipment. Recent epidemiological studies showed that EtO is a more potent carcinogen than previously documented, leading the Environmental Protection Agency (EPA) to update, in December 2016, the inhalation unit risk estimate for EtO. This resulted in the identification of EtO as a potential health concern in several areas across the US, including the state of Utah. The geography surrounding Salt Lake Valley creates a bowl, which is ideal for collecting air pollution emissions. The region often experiences inversion episodes which inhibit vertical mixing and cause an accumulation of air pollutants, leading to unhealthy pollution levels. Using the EPA’s dispersion modeling software, AERMOD, this study estimated EtO concentrations through facility stack and fugitive emissions modeling results. These values were compared with those of canister-based concentrations from ambient air samples taken near a medical device sterilization facility in Salt Lake Valley. Stainless steel whole-air passivated canisters were used to collect 24 h ambient concentration samples of EtO. Eight locations surrounding a Salt Lake Valley medical device sterilization facility and four background sites were chosen to measure the ambient concentrations. Accounting for potential atmospheric impacts on EtO, measurements were sampled in winter 2022 (January–March) and summer 2022 (July–September). The modeled EtO concentrations were adjusted to account for background values associated with the winter or summer data. Then, the two methodologies were compared using a Wilcoxon signed-ranked paired test. The statistical analysis resulted in six of the eight sample locations surrounding the sterilization facility being significantly different when comparing the canister-based measurements of ambient EtO to modeled estimates. Canister-based measurements taken at sites one, three, and four were statistically greater than the modeled estimates, while sites two, five, and seven were statistically less than the modeled estimates. Also, the summer background value calculated was almost 2.5 times greater than the winter one. The results do not suggest whether one method is more or less conservative than the other. In conclusion, the five of the closest sites and site seven were statistically different when comparing measured and modeled ambient concentrations of EtO. The comparison results do not clearly indicate if a correction factor could be derived for future human exposure to cancer risk assessment modeling. However, it is reasonable that the closer to the sterilization facility, the more total EtO exposure will be realized.

From hotspots to background: High-resolution mapping of ethylene oxide in urban air

Ethylene oxide (EtO) is a human carcinogen whose release from sterilization facilities to ambient air has gained recent attention. Measurements have typically relied on canister samples collected over minutes to hours and analyzed using gas chromatography/mass spectrometry (GC/MS). A novel application of tunable infrared laser direct absorption spectrometry (TILDAS) was recently deployed aboard a mobile air quality laboratory in Toronto, Canada, to measure EtO in near real-time. Detection limits comparable to canister-GC/MS methods were achieved while stationary at averaging times of only 100 s, and high frequency (1-s) sampling detected EtO at several locations. EtO was observed consistently near the only local facility reporting on-site releases to Canada's National Pollutant Release Inventory. The maximum 1-s mixing ratio observed nearby was 18 ppb (33 μg m−3), and a mean 1-s mixing ratio of 0.43 ppb (0.78 μg m−3) was observed in the vicinity of the detectable plumes that covered industrial, commercial and residential land uses up to 900 m downwind. EtO in those plumes was not related to common air pollutants such as nitric oxide (NO), carbon monoxide (CO), or methane (CH4), whereas it was paired with elevated NO or CO and CH4 at some other locations. EtO was less abundant elsewhere in the city, and no detectable EtO was found near potential sources including hospitals, spice distributors and vehicle exhaust. The EtO background measured in wintertime Toronto air was indistinguishable from zero and substantially lower than that reported in studies using canister-GC/MS methods. The multi-pollutant mobile method described herein marks a significant step forward in the capability to characterize atmospherically relevant concentrations of EtO at high spatiotemporal resolution. Future applications of high-resolution techniques will allow for comprehensive investigations of source impacts and characterization of ambient levels for which deployment of conventional canister/GC-MS methods would be unsuitable or prohibitive.

Performance of the Harwell tape-tab alanine EPR dosimeter under typical production conditions. Effect of irradiation and storage temperature on the stability of the response

The performance of the alanine tape-tab alanine dosimeter (Harwell) under typical irradiation conditions found on an industrial Co-60 gamma sterilization facility has been investigated over a period of 11 and 56 days. The factors investigated were the pre-irradiation temperature storage, the temperature during irradiation, and the time after irradiation. The response measurements were statistically analyzed using 2-Sample T-Test and ANOVA. The results show that for the purpose of the use of this system in a processing facility the response of the dosimeter can be considered stable over the period of time considered in this study.

Setup of a Contamination Control Strategy Using the Hazard Analysis Critical Control Point (HACCP) Methodology.

A Contamination Control Strategy (CCS) is a document that focuses on how to prevent contaminations with microorganisms, particles, and pyrogens within sterile and/or aseptic and preferably also in nonsterile manufacturing facilities. This document determines to what extent measures and controls in place are efficient in preventing contamination. In order to efficiently evaluate and control all potential hazards associated with sources of contamination within a CCS, the Hazard Analysis Critical Control Point (HACCP) methodology could be a useful tool to monitor all Critical Control Points (CCPs) related to various sources of contamination. This article describes a way to set up the CCS within a pharmaceutical sterile and aseptic manufacturing facility (GE HealthCare Pharmaceutical Diagnostics) by applying the HACCP methodology. In 2021, a global CCS procedure and a general HACCP template became effective for the GE HealthCare Pharmaceutical Diagnostics sites having sterile and/or aseptic manufacturing processes. This procedure guides the sites through the setup of the CCS by applying the HACCP methodology and helps each site to evaluate whether the CCS is still effective taking all (proactive and retrospective) data following the CCS into account. A summary of setting up a CCS using the HACCP methodology, specifically for the pharmaceutical company GE HealthCare Pharmaceutical Diagnostics Eindhoven site, is provided in this article. Use of the HACCP methodology enables a company to include proactive data within the CCS, making use of all identified sources of contamination, associated hazards, and/or control measures and CCPs. The constructed CCS allows the manufacturer to identify whether all included sources of contamination are under control and, if not, which mitigatory actions need to be performed. All current states are reflected by a traffic light color to reflect the level of residual risk, thereby providing a simple and clear visual representation of the current contamination control and microbial state of the manufacturing site.

Patient Safety Incident Reporting in Sterile Processing: A Systems Perspective

After use, surgical instruments are sent to a Sterile Processing Department (SPD) or facility to be cleaned, reorganized, maintained, sterilized and stored for eventual re-use. Though essential for safe, efficient and cost-effective surgical delivery, the functions, trade-offs and outcomes within SPDs have rarely been studied. Patient safety incident (PSI) reports are the most ubiquitous form of safety data collected within acute care environments and are often used to report issues in the SPD. Using the work systems analysis perspective we developed in previous work, we created a framework for areas where system failures might occur and manually evaluated PSI reports to investigate a period of possible system strain. We identify the assembly stage as a potentially significant contributor to system strain in the SPD and suggest that several issues related to sterile processing may be interconnected with an aim to assist decisionmakers and healthcare team members in SPD system management.

Multi-purpose reverse logistics network design for medical waste management in a megacity: Istanbul, Turkey.

In the study, a multi-purpose reverse logistics network has been designed to create effectual management of medical waste (MW) generated in 39 districts of Istanbul, a heavily populated city, during the COVID-19 pandemic as well as that to be generated in the next decade. With the model, the medical waste management system in Istanbul is analyzed during the pandemic and for the next 10 years. The model attempts to integrate economic, environmental, and social objectives within the sustainable development goals. It aims to maximize the number of personnel and government earnings for the estimated MW of a megacity while minimizing the total fixed cost and the cost of carbon emissions and transportation. The results indicated that the existing facilities are sufficient for the treatment and disposal of MW generated even under pandemic conditions. However, the capacity of the sterilization facility could be insufficient to treat the estimated amount of MW in the next decade. Opening a sterilization facility near the sanitary landfill in Komurcuoda with a total management cost of 62,450,332 €/year would be an optimum solution for Istanbul MW. In comparison to the single-purpose model results, the multi-purpose model resulted in approximately 42,000 € more in total cost. Sensitivity analyses show that the amount of MW has the most significant effect on the total cost. This simple model created an effective MW management proposal for Istanbul, which can be a model for megacities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10669-022-09873-z.

Recycling of Mediterranean Fruit Fly Rearing Waste by Black Soldier Fly, Hermetia illucens

PurposeObjective of this study is the valorisation of mass rearing waste of fruit flies from sterile insect technique facilities by black soldier flies into high quality and quantity products as a sustainable utilisation concept.MethodsDifferent ratios of medfly rearing waste in hen feed were used for rearing black solder fly (BSF) larvae. The growth rate and insect survival were determined. Moreover, the mass gains were determined and bioconversion rates were assessed. Furthermore, the nutritional compositions of BSF pupae were analysed to evaluate the product quality.ResultsThe omnivorous BSF larvae were highly efficient at converting digested waste into body mass as compared to the control treatment (hen feed). High weight of pre-pupae was recorded for all experimental diets. The efficacy of larvae to reach pupae ranged from 92.5 to 98.5%, while the efficacy of pupae to reach adults ranged from 81.7 to 89.0%. All experimental diets exhibited high rates of prepupal weight, metabolism and efficiency of conversion of digested food. A nutritional analysis revealed that the protein and fat contents were high, while the bioaccumulation of heavy metals was low,ConclusionMedfly rearing waste is a potential feed ingredient for the production of BSF pre-pupae and could be applied to valorise this rearing waste into high-value feed.Graphical

Male involvement in family planning in a rural area of India.

ABSTRACTIntroduction:Family planning is one of the essential health care services to promote and ensure reproductive health. Nearly 40.2 percent of men think it as a woman’s responsibility as per the National Family Health Survey 4. Not much attention has been given to the male partners in the usage of contraceptives. So, this study was conducted to assess the male participation in family planning among married males in a rural area of Chhattisgarh.Methodology:A sample of 365 married males were interviewed through a semi-structured questionnaire at a primary health care center.Results:Only 48 (13.1%) participants were using condoms or male sterilization as a method of contraception at the time of the study. Good involvement of males in family planning was found to be (10.9%) in our study. Those who were above the poverty line and educated (graduation and above) had good involvement in family planning. The chief reason cited for not opting for male sterilization by participants was fear of physical weakness followed by family opposition.Conclusion:The socio-cultural barrier in itself demotivates men from getting involved in the family planning program. This study recommends increasing health literacy regarding family planning among men by including it in the school curriculum and through awareness activities and counseling that influences them positively and motivates them to accept contraceptive services and shared decision making. Sterilization facilities should be made accessible to them to further encourage them.

Quality Control Methods for Aedes albopictus Sterile Male Transportation.

Simple SummaryThe Sterile Insect Release Technique (SIT) is currently considered an environmentally friendly method to control populations of Aedes albopictus, an invasive mosquito species in Europe and elsewhere. Assessing the quality of mass reared, sterilized males that are transported to release sites is of the utmost importance for the success of the SIT programs. The current paper presents a series of quality control (QC) tests that have been conducted at the mass rearing facility in Italy and at delivery points in Greece and Montenegro to assess the impact of mass rearing, sterilization, and shipping on survival during transportation, longevity, flight ability and mating performance. Overall, our results reveal the detrimental effects of a long transportation period on the sterile male Ae. albopictus and provide a series of reliable QC tests to be considered in future SIT operations.Genetic based mosquito control methods have been gaining ground in recent years for their potential to achieve effective suppression or replacement of vector populations without hampering environments or causing any public health risk. These methods require the mass rearing of the target species in large facilities sized to produce millions of sterile males, as already well established for a number of insects of agricultural importance. Assessing the performance of released males in Sterile Insect Technique (SIT) control programs is of the utmost importance for the success of the operation. Besides the negative effects of mass rearing and sterilization, the handling of sterilized insects and shipment to distant areas may also negatively impact the quality of sterilized males. The aim of the current study was to design and executive quality control (QC) tests for sterilized Aedes albopictus (Asian tiger mosquito) males delivered by air shipment from the mass production facility located in Italy to Greece and Montenegro field release sites. Mass reared mosquito strains were based on biological materials received from Italy, Greece and Montenegro. Tests conducted at the mass rearing facility before transportation revealed a rather high residual female contamination following mechanical sex separation (approximately 1.5% females, regardless of the mosquito strain). Irradiated males of all three mosquito strains induced high levels of sterility to females. Shipment lasting approximately 24 h resulted in approximately 15% mortality, while when shipment lasted nearly two days this increased to almost 40%. The flight ability of sterilized males following one day transportation time was satisfactory (over 60%). The response of sterile males to food and water starvation was comparable and slightly lower than that of wild non-transported males. Longevity of sterile males was shorter than that of wild counterparts and it seems it was not affected by mating to wild females. Both mating propensity and mating competitiveness for wild virgin females was higher for the wild, control males compared to the sterile, transported ones. Overall, the performance of sterile male Ae. albopictus delivered from the mass rearing facility of Italy to Greece in approximately 24 h was satisfactory. Transportation lasting two days or longer incurred detrimental effects on males, which called into question the outcome of the SIT release programs. In conclusion, our results demonstrate the need of quality control procedures, especially when sterile male production facilities are not near to the releasing point. Transportation could be a serious drawback for the implementation of Sterile Insect Releases and, consequently, it is important to establish an efficient and fast transportation of sterilized males in advance.

Health Care Facilities for Senior Citizens in Selected Tertiary Hospitals During Covid-19 Pandemic

Background: To assess the health care facilities provided for senior citizens in selected tertiary hospitals. Methods: This descriptive type of cross-sectional study was carried out among service providers (doctors and nurses) and hospital administrators within the period of January to December 2020. A total of 305 respondents was selected purposively. Semi structured questionnaire and observational checklist was used to collect data. Data was collected by face to face interview and observation. Data was analyzed by using SPSS (Statistical Package for Social Science) software version 25. Results: Among participants, Administrator 2.6%, Doctor 25.2% and Nurse 72.1%. Mean age of the respondents was 32.72±7.67 years. Most of the respondents 90.8% working experience less than 10 years and their average monthly income was Tk. 35398.90±16509.12. In DMCH separate geriatric ward present but in BSMMU geriatric ward absent. Rehabilitation center &amp; long-term care facilities for elderly patients, telemedicine service, separation facility for non COVID geriatric patients from COVID positive patients, free care facility for poor elderly patients, social welfare support facilities present in both hospitals. Separate bed facility in general wards, geriatric ICU and COVID ward absent, training facility on geriatric health absent in both hospitals. Majority of the respondents 97.0% take consent before any procedure, 89.6% service provider involve geriatric patients in decision making about their care and treatment, 56.6% respondents follow polypharmacy guideline. Opinion regarding utility service was average. Opinion regarding diagnostic facilities, essential drugs, sterilization facilities, of this hospital for senior citizens was moderately sufficient 50.5%, 60.6% and 59.3% respectively and ambulance service insufficient 53.4%. Among respondents 89.8% face barriers in providing geriatric health care. Opinion regarding the existing health care facilities for senior citizens of this hospitals insufficient 52.8%. Regarding improvement of health care services 26.0% mentioned that training of doctor/ nurses followed by separate geriatric ward facilities for geriatric patients 20.8%, increase the number of supporting staff 16.2%, free health care facilities for poor elderly patients 11.8%, training of supporting staffs 10.6%, training for informal/family caregiver 7.4%, separate bed for geriatric patient in general wards 6.4% and the rest others mentioned 0.7%. Analysis found statistically significant association between national guideline follow for the treatment and care of older patients and their educational qualification (0.001), designation (p=0.001), polypharmacy guideline follows for the treatment and care of older patients and their designation, referral guideline follows for geriatric patients and their designation (p=0.001). Conclusion: To provide quality healthcare service to the senior citizens of Bangladesh, geriatric health care should be given highest priority. JOPSOM 2021; 40(1): 51-58

Electron Accelerator for Replacement of Radioactive Sources in Insect Sterilization Facilities

Electron Accelerator for Replacement of Radioactive Sources in Insect Sterilization Facilities

The indications and safety of prolonged temporary pacing using active-fixation leads and externalized pulse generator.

Temporary cardiac pacing, conventionally achieved using a passive transvenous pacing wire, can be life-saving for unstable arrhythmias. However, they run the risk of complications, the longer they remain in-situ. Externalized prolonged temporary pacing (EPTP), using active-fixation lead and an externalized pulse generator; may be an alternative for transient pacing indications, concurrent illness or sepsis that precludes permanent pacing. Sixty-seven patients (mean age 69 ± 14 years; 82% male) underwent EPTP between November 2011 and April 2019. EPTP was performed in a sterile facility, under fluoroscopy, using active-fixation leads anchored to the right ventricle septum. Externalized lead was connected to a re-sterilized pulse generator and secured to anterior chest wall with transparent dressings. EPTP indications and patient outcomes were evaluated. Pacing indications were high-grade atrio-ventricular (AV) block (73.2%), sinus arrest (14.9%), overdrive suppression of VT (5.9%) and pause-dependent VT (4.5%). Reasons for ETPT rather than permanent pacing included: sepsis (38.8%), CIED-related infection (8.9%), transient pacing indication (25%), to allow further investigations prior to decision on CIED type (22%), and over-drive arrhythmia suppression (6%). Sixty three percent patients were severely ill in an ICU. Mean duration of pacing was 16 ± 12 days. Sixty seven percent patients subsequently received a CIED and had no evidence of device-related infection at 1-year post-implant. There were three non-fatal complications during EPTP while no deaths were attributed to EPTP. EPTP is a safe and useful method of prolonged temporary pacing for patients who require chronotropic support, but in whom immediate permanent pacemaker implantation is contraindicated.

US backs domestic drug production

As a new administration gets to work in Washington, DC, projects launched by the previous administration to secure domestic pharmaceutical production are moving ahead. On Jan. 15, the US awarded a $69.3 million contract to Continuus Pharmaceuticals to build a facility in Woburn, Massachusetts, that will produce three medicines that are currently imported. A week later, Civica Rx said it will use government funding to build a $124.5 million sterile injectable-drug facility in Petersburg, Virginia. The grant to Continuus is from the US Department of Defense in conjunction with the Department of Health and Human Services. It will fund construction of what the firm says will be the first facility to employ continuous manufacturing technology in the end-to-end production of small-molecule active pharmaceutical ingredients (APIs) and finished drugs. Continuus, which grew out of a partnership between the Massachusetts Institute of Technology and Novartis, is among the companies pioneering continuous technologies

Ethylene Oxide Exposure in U.S. Populations Residing Near Sterilization and Other Industrial Facilities: Context Based on Endogenous and Total Equivalent Concentration Exposures

Given ubiquitous human exposure to ethylene oxide (EO), regardless of occupation or geography, the current risk-specific concentrations (RSCs: 0.0001–0.01 ppb) from the U.S. Environmental Protection Agency (EPA) cancer risk assessment for EO are not useful metrics for managing EO exposures to the general U.S. population. The magnitude of the RSCs for EO are so low, relative to typical endogenous equivalent metabolic concentrations (1.1–5.5 ppb) that contribute ~93% of total exposure, that the RSCs provide little utility in identifying excess environmental exposures that might increase cancer risk. EO monitoring data collected in the vicinity of eight EO-emitting facilities and corresponding background locations were used to characterize potential excess exogenous concentrations. Both 50th and 90th percentile exogenous exposure concentrations were combined with the 50th percentile endogenous exposure concentration for the nonsmoking population, and then compared to percentiles of total equivalent concentration for this population. No potential total exposure concentration for these local populations exceeded the normal total equivalent concentration 95th percentile, indicating that excess facility-related exposures are unlikely to require additional management to protect public health.

STUDIES AND RESEARCH REGARDING THE UNITARY ENERGY CONSUMPTION OF A RECIRCULATING AQUACOL SYSTEM

This paper aims to highlight the consumption of electricity and caloric energy consumed by a recirculating aquaculture system for the growth of aquatic life. The energy needed to operate a recirculating aquaculture system for fish farming is divided into two categories, namely the electricity needed to operate various technological equipment, the main equipment in a recirculating aquaculture system that uses electricity being recirculation pumps, mechanical filters (some types), UV sterilization facilities and aeration systems. The second category of energy consumed is the caloric energy required for heating / cooling the water in the system and the hall.