A perspective on early detection systems models for COVID-19 spreading

The ongoing COVID-19 epidemic highlights the need for effective tools capable of predicting the onset of infection outbreaks at their early stages. The tracing of confirmed cases and the prediction of the local dynamics of contagion through early indicators are crucial measures to a successful fight against emerging infectious diseases (EID).

The proposed framework is model-free and applies Early Warning Detection Systems (EWDS) techniques to detect changes in the territorial spread of infections in the very early stages of onset. This study uses publicly available raw data on the spread of SARS-CoV-2 mainly sourced from the database of the Italian Civil Protection Department.

Two distinct EWDS approaches, the Hub-Jones (H&J) and Strozzi-Zaldivar (S&Z), are adapted and applied to the current SARS-CoV-2 outbreak. They promptly generate warning signals and detect the onset of an epidemic at early surveillance stages even if working on the limited daily available, open-source data.

Additionally, EWDS S&Z criterion is theoretically validated on the basis of the epidemiological SIR.

Discussed EWDS successfully analyze self-accelerating systems, like the SARS-CoV-2 scenario, to precociously identify an epidemic spread through the calculation of onset parameters. This approach can also facilitate early clustering detection, further supporting common fight strategies against the spread of EIDs. Overall, we are presenting an effective tool based on solid scientific and methodological foundations to be used to complement medical actions to contrast the spread of infections such as COVID-19.

Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital

PURPOSE

Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study explores if intelligence from such datasets could be used to improve quality, efficiency, and safety.

DESIGN/METHODOLOGY/APPROACH

Incident reporting data recorded in one NHS acute Trust was mined for insight (n = 133,893 April 2005-July 2016 across 201 fields, 26,912,493 items). An a priori dataset was overlaid consisting of staffing, vital signs, and national safety indicators such as falls. Analysis was primarily nonlinear statistical approaches using Mathematica V11.

FINDINGS

The organization developed a deeper understanding of the use of incident reporting systems both in terms of usability and possible reflection of culture. Signals emerged which focused areas of improvement or risk. An example of this is a deeper understanding of the timing and staffing levels associated with falls. Insight into the nature and grading of reporting was also gained.

PRACTICAL IMPLICATIONS

Healthcare incident reporting data is underused and with a small amount of analysis can provide real insight and application to patient safety.

ORIGINALITY/VALUE

This study shows that insight can be gained by mining incident reporting datasets, particularly when integrated with other routinely collected data.

Resilience support to enhance positive health outcomes for police officers in five Anglosphere nations: a scoping review protocol

INTRODUCTION

Law enforcement involves exposure to threatening situations and traumatic events that place police officers at risk for negative physical and mental health outcomes. Resilience support, among other elements of training, may help mitigate these risks, yet little is known about which aspects of resilience support help officers achieve better health and quality of life outcomes.

METHODS AND ANALYSIS

This review will consider all literature that examines the links between resilience support, physical/mental health and quality of life outcomes for police officers in five Anglosphere nations: Canada, the USA, Australia, New Zealand and the UK. This review will include all literature (including those that show null or negative links) involving any public policing agency that has a formal rank structure and includes a localized, uniformed emergency response function. Resilience support may include, but is not limited to: tools, policies, models, frameworks, programmes and organizational features that seek to promote positive, physical/mental health and quality of life outcomes at three levels of resilience: (1) readiness and preparedness, (2) response and adaptation, (3) recovery and adjustment. Peer reviewed and grey literature examining resilience support since 2000 that focuses on police officers are eligible for inclusion. Databases/sources to be searched will include: PsycINFO, Academic Search Premier, CINAHL, Public Affair Index, Campbell Collaboration, ProQuest Dissertations and Theses Global, Business Source Complete, Scopus and Google. Retrieval of full-text, English-language studies (and other literature), data extraction, data synthesis and data mapping will be performed independently by two reviewers, following Joanna Briggs Institute methodology.

ETHICS AND DISSEMINATION

Ethics approval is not required for this scoping review, and the literature search will start in November 2020 or upon acceptance of this protocol. The findings of the scoping review will be available [April 2021] and will be published in a peer reviewed journal.

Urgent hyperbaric oxygen therapy for suicidal carbon monoxide poisoning: from a preliminary survey to a proposal for an integrated somatic-psychiatric protocol

A considerable number of patients who made a carbon monoxide (CO) suicidal attempt are treated with urgent hyperbaric oxygen therapy (HBOT). For these patients at potential persistent risk of suicide, the hyperbaric chamber is a dangerous environment and their management a complex challenge for the Emergency Department (ED) and Hyperbaric Medicine Unit (UMH) teams. We aimed to (1) identify cases of intentional CO poisoning treated with urgent HBOT in the UMH of the University Hospitals of Geneva (HUG) during 2011-2018 and (2) test a proposed operational and integrated somatic-psychiatric protocol based on acquired experience. A total of 311 patients with CO poisoning were treated using urgent HBOT, for which poisoning was assumed suicidal in 40 patients (12.9%). This percentage appears greater than in other European countries. Both the excess of cases of intentional CO poisonings and difficulties encountered in their management resulted in the implementation of an operational and integrated somatic-psychiatric protocol addressing the entire patient's clinical trajectory, from the admission at ED-HUG to the treatment at the UMH-HUG. The established institutional protocol includes (1) clinical evaluation, (2) suicide risk assessment, and (3) safety measures. This is the first report-at our best knowledge-of a protocol detailing a practical procedure algorithm and focusing on multidisciplinary and mutual collaboration between the medical-nursing teams at the ED, psychiatric ED, and UMH. Improvements in patient's safety and care team's sense of security were observed. In conclusion, the opportunity to refer to a standardized protocol was beneficial in that it offers both reduced risks for suicidal patients and reduced stress for care teams operating in very acute and complex situations. Further studies are needed.

Modeling risks from natural hazards with generalized additive models for location, scale and shape

We investigate a new framework for estimating the frequency and severity of losses associated with catastrophic risks such as bushfires, storms and floods. We explore generalized additive models for location, scale and shape (GAMLSS) for the quantification of regional risk factors - geographical, weather and climate variables - with the aim of better quantifying the frequency and severity of catastrophic losses from natural perils. Due to the flexibility of the GAMLSS approach, we find a superior fit to empirical loss data for the applied models in comparison to generalized linear regression models typically applied in the literature. In particular the generalized beta distribution of the second kind (GB2) provides a good fit to the severity of losses. Including covariates in the calibration of the scale parameter, we obtain vastly differently shaped distributions for the predicted individual losses at different levels of the covariates. Testing the GAMLSS approach in an out-of-sample validation exercise, we also find support for a correct specification of the estimated models. More accurate models for the losses from natural hazards will help state and local government policy development, in particular for risk management and scenario planning for emergency services with respect to these perils.

A real time data driven algal bloom risk forecast system for mariculture management

In eutrophic coastal waters, harmful algal blooms (HAB) often occur and present challenges to environmental and fisheries management. Despite decades of research on HAB early warning systems, the field validation of algal bloom forecast models have received scant attention. We propose a daily algal bloom risk forecast system based on: (i) a vertical stability theory verified against 191 past algal bloom events; and (ii) a data-driven artificial neural network (ANN) model that assimilates high frequency data to predict sea surface temperature (SST), vertical temperature and salinity differential with an accuracy of 0.35^oC, 0.51^oC, and 0.58 psu respectively. The model does not rely on past chlorophyll measurements and has been validated against extensive field data. Operational forecasts are illustrated for representative algal bloom events at a marine fish farm in Tolo Harbour, Hong Kong. The robust model can assist with traditional onsite monitoring as well as artificial-intelligence (AI) based methods.

Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness

Two diametrically opposed positions predominate discourse for the care and treatment of persons with severe mental illness: anti-deinstitutionalization and anti-institutionalization. Both share the same goal of ensuring best quality of life for those with severe psychiatric disorders, but pathways to achieving this goal are very different and have resulted in much contention. Supporters of each position espouse a different belief system regarding people with psychiatric disorders and their presumed capabilities, placing varying emphasis on maximizing protection of the community versus protection of individual rights, and result in contrasting mental health policies and practice orientations. The authors delineate the history from which these positions evolved, consequent views, and policies and practices that emerged from these differing attitudes. The article culminates in a proposed practice approach that offers a more balanced approach to serving adults with mental illness -navigating risk management by preserving freedom and opportunities of risk while affording mutually satisfactory "risk control."

Preoperative assessment of patient comorbidities before left colectomy: Comparison between ASA performance status scale and a new computed tomography physical status score

PURPOSE

To compare a newly developed preoperative computed tomography physical status (CT-PS) score with the American Society of Anesthesiology performance status (ASA-PS) scale in the assessment of patient preoperative health status and stratification of perioperative risk before left colectomy.

MATERIALS AND METHODS

Preoperative chest-abdomen-pelvis CT examinations of patients who were scheduled to undergo elective laparoscopic left colonic resection for cancer in two centers were reviewed by two radiologists blinded to clinical data for the presence of several key imaging features in order to assess general, cardiac, pulmonary, abdominal, renal, vascular and musculoskeletal status. CT examinations of patients from center 1 were used to build a CT-PS score to predict ASA-PS≥III. CT-PS score was further validated using an external cohort of patients from center 2.

RESULTS

During a 2-year period, 117 consecutive patients (63 men, 54 women; mean age, 65±13 [SD] years; age range: 53-90 years) who underwent laparoscopic left colectomy for cancer in center 1 (66 patients, building cohort) and center 2 (51 patients, validation cohort) were retrospectively included. Ninety-one percent of patients were ASA-PS 1-2. Overall postoperative morbidity was 23% and severe morbidity 12%. The area under the receiver operating characteristic curve of CT-PS score was 0.968 (95% CI: 0.901-1.000) in the building cohort and 0.828 (95% CI: 0.693-0.963) in the validation cohort. The optimal thresholds yielded 87% (95% CI: 83-91%) sensitivity and 100% (95% CI: 91-100%) specificity in the building cohort and 75% (95% CI: 69-81%) sensitivity and 83% (95% CI: 77-88%) specificity in the validation cohort for the prediction of ASA-PS.

CONCLUSION

Preoperative chest-abdomen-pelvis CT thoroughly and wisely read is highly accurate to differentiate patients with ASA-PS I/II from those with ASA-PS III/IV before left colectomy.

Pervasive Risk Avoidance: Nursing Staff Perceptions of Risk in Person-Centered Care Delivery

BACKGROUND AND OBJECTIVES

Nursing home (NH) staff perceptions of risks to residents' health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' preferences for everyday living and care activities.

RESEARCH DESIGN AND METHODS

Qualitative, descriptive design using sequential focus group (FG) methodology.

RESULTS

Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6-12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences.

DISCUSSION AND IMPLICATIONS

Development of a multidimensional framework with specific risk engagement measures that account for the unique risk perspectives of nursing staff will contribute significantly to the clinical management of older adult preferences and research on the effectiveness of preference-based PCC delivery in the NH setting.

Incident reports involving hospital administrative staff: analysis of data from the Japan Council for Quality Health care nationwide database

Background

Task shifting and task sharing in health care are rapidly becoming more common as the shortage of physicians increases. However, research has not yet examined the changing roles of hospital administrative staff. This study clarified: (1) the adverse incidents caused by hospital administrative staff, and the direct and indirect impact of these incidents on patient care; and (2) the incidents that directly involved hospital administrative staff.

Methods

This study used case report data from the Japan Council for Quality Health care collected from April 1, 2010 to March 31, 2019, including a total of 30,823 reports. In April 2020, only the 88 self-reported incidents by hospital administrative staff were downloaded, excluding incidents reported by those in medical and co-medical occupations. Data from three reports implicating pharmacists were rejected and the quantitative and textual data from the remaining 85 case reports were analyzed in terms of whether they impacted patient care directly or indirectly.

Results

Thirty-nine reports (45.9%) involved direct impact on patient care, while 46 (54.1%) involved indirect impact on patient care. Most incidents that directly impacted patient care involved administrative staff writing prescriptions on behalf of a doctor (n = 24, 61.5%); followed by errors related to system administration, information, and documentation (n = 7, 17.9%). Most reported errors that indirectly affected patient care were related to system administration, information, and documentation used by administrative staff (n = 22, 47.8%), or to reception (n = 9, 19.6%). Almost all errors occurred during weekdays. Most frequent incidents involved outpatients (n = 23, 27.1%), or occurred next to examination/operation rooms (n = 12, 14.1%). Further, a total of 14 cases (16.5%) involved patient misidentification.

Conclusions

Incidents involving hospital administrative staff, the most common of which are medication errors from incorrect prescriptions, can lead to severe consequences for patients. Given that administrative staff now form a part of medical treatment teams, improvements in patient care may require further submission and review of incident reports involving administrative staff.

Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization

Previously, we published selected Eliciting Dose (ED) values (i.e. ED01 and ED05 values) for 14 allergenic foods, predicted to elicit objective allergic symptoms in 1% and 5%, respectively, of the allergic population (Remington et al., 2020). These ED01 and ED05 values were specifically presented and discussed in the context of establishing Reference Doses for allergen management and the calculation of Action Levels for Precautionary Allergen Labeling (PAL). In the current paper, we publish the full range of ED values for these allergenic foods and provide recommendations for their use, specifically in the context of characterizing risks of concentrations of (unintended) allergenic proteins in food products. The data provided in this publication give risk assessors access to full population ED distribution information for 14 priority allergenic foods, based on the largest threshold database worldwide. The ED distributions were established using broad international consensus regarding suitable datapoints and methods for establishing individual patient's NOAELs and LOAELs and state of the art statistical modelling. Access to these ED data enables risk assessors to use this information for state-of-the-art food allergen risk assessment. This paper contributes to a harmonization of food allergen risk assessment and risk management and PAL practices.

Comparison of two algorithms to support medication surveillance for drug-drug interactions between QTc-prolonging drugs

BACKGROUND

QTc-prolongation is an independent risk factor for developing life-threatening arrhythmias. Risk management of drug-induced QTc-prolongation is complex and digital support tools could be of assistance. Bindraban et al. and Berger et al. developed two algorithms to identify patients at risk for QTc-prolongation.

OBJECTIVE

The main aim of this study was to compare the performances of these algorithms for managing QTc-prolonging drug-drug interactions (QT-DDIs).

MATERIALS AND METHODS

A retrospective data analysis was performed. A dataset was created from QT-DDI alerts generated for in- and outpatients at a general teaching hospital between November 2016 and March 2018. ECGs recorded within 7 days of the QT-DDI alert were collected. Main outcomes were the performance characteristics of both algorithms. QTc-intervals of > 500 ms on the first ECG after the alert were taken as outcome parameter, to which the performances were compared. Secondary outcome was the distribution of risk scores in the study cohort.

RESULTS

In total, 10,870 QT-DDI alerts of 4987 patients were included. ECGs were recorded in 26.2 % of the QT-DDI alerts. Application of the algorithms resulted in area under the ROC-curves of 0.81 (95 % CI 0.79-0.84) for Bindraban et al. and 0.73 (0.70-0.75) for Berger et al. Cut-off values of ≥ 3 and ≥ 6 led to sensitivities of 85.7 % and 89.1 %, and specificities of 60.8 % and 44.3 % respectively.

CONCLUSIONS

Both algorithms showed good discriminative abilities to identify patients at risk for QTc-prolongation when using ≥ 2 QTc-prolonging drugs. Implementation of digital algorithms in clinical decision support systems could support the risk management of QT-DDIs.

Can we define a level of protection for allergic consumers that everyone can accept?

Substantial progress has been made in characterising the risk associated with exposure to allergens in food. However, absence of agreement on what risk is tolerable has made it difficult to set quantitative limits to manage that risk and protect allergic consumers effectively. This paper reviews scientific progress in the area and the diverse status of allergen management approaches and lack of common standards across different jurisdictions, including within the EU. This lack of regulation largely explains why allergic consumers find Precautionary Allergen Labelling confusing and cannot rely on it. We reviewed approaches to setting quantitative limits for a broad range of food safety hazards to identify the reasoning leading to their adoption. This revealed a diversity of approaches from pragmatic to risk-based, but we could not find clear evidence of the process leading to the decision on risk acceptability. We propose a framework built around the criteria suggested by Murphy and Gardoni (2008) for approaches to defining tolerable risks. Applying these criteria to food allergy, we concluded that sufficient knowledge exists to implement the framework, including sufficient expertise across the whole range of stakeholders to allow opinions to be heard and respected, and a consensus to be achieved.

Are CIN3 risk or CIN3+ risk measures reliable surrogates for invasive cervical cancer risk?

•Discuss ASCCP guideline. •CIN3 reliable surrogates for cervical cancer? •The Pittsburgh Cervical Cancer Screening Model.

Optimising testing strategies for classification of human health and environmental hazards - A proof-of-concept study

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Testing of chemicals does not always inform their subsequent risk management.

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Optimised testing strategies can improve efficiency of classification and labelling.

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Hazard pictograms were used to reflect the protection level for a given chemical.

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Two strategies led to the same protection level and required fewer tests.

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Another strategy led to the same protection level and reduced animal testing.

This paper outlines a new concept to optimise testing strategies for improving the efficiency of chemical testing for hazard-based risk management. While chemical classification based on standard checklists of information triggers risk management measures, the link is not one-to-one. Toxicity testing may be performed with no impact on the safe use of chemicals . Each hazard class and category is not assigned a unique pictogram and for the purpose of this proof-of-concept study, the level of concern for a chemical for the population and the environment is simplistically considered to be reflected by the hazard pictograms. Using active substances in biocides and plant protection products as a dataset, three testing strategies were built with the boundary condition that an optimal approach must indicate a given level of concern while requiring less testing (strategy B), prioritising new approach methodologies (strategy C) or combining the two considerations (strategy D). The implementation of the strategies B and D reduced the number of tests performed by 6.0% and 8.8%, respectively, while strategy C relied the least on in vivo methods. The intentionally simplistic approach to optimised testing strategies presented here could be used beyond the assessment of biocides and plant protection products to gain efficiencies in the safety assessment of other chemical groups, saving animals and making regulatory testing more time- and cost-efficient.

Impact of Deep-seated Gravitational Slope Deformation on urban areas and large infrastructures in the Italian Western Alps

Deep-seated Gravitational Slope Deformations (DsGSDs) are huge ground-deformation slow evolving phenomena, highly widespread in alpine territory. Their long-lasting evolution, with continuous deformation rate, may represents a natural hazard, able to endanger various anthropic structures and infrastructures. Until today, the development of technical and regulatory tools, aimed to effectively manage the interactions between DsGSDs and anthropic elements, has been generally lightly considered in risk management and land use planning. The definition of the type and severity of impacts on the anthropic elements, becomes increasingly important in terms of urban planning and risk management, and deserve an update in the current adopted procedures. Focusing on the Western Italian Alps, we implemented an interdisciplinary analysis, based on multi-source data, by means of geoinformatics, remote sensing and archive consultation approaches. Intersecting DsGSDs available information with the urbanized territory in a Geographic Information System environment, we obtained, despite the high data heterogeneity, an overall framework of the existing interactions. Specifically, we defined the interactions between these large phenomena and buildings, roads and rail networks, and linear infrastructures, as penstocks, waterworks or dams, also highlighing the state of activity of the inventoried phenomena. Moreover, we analysed the degree of the DsGSD impacts on the anthropic elements, detecting and classifying all the documented damages within the Italian Western Alps territory. The obtained results highlight the need for an innovative approach in DsGSDs risk assessment, both in terms of the definition of their behavior over time and of their impacts on the anthropic elements, for a more effective land use planning and a proper handling of these phenomena in the legislation framework.

Emergency management at the health and security interface

The world has recently witnessed the global impact of natural disease outbreaks, such as those caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Ebola virus and Middle East respiratory syndrome coronavirus, and the lasting impact of the accidental spread of foot and mouth disease in the United Kingdom. Natural outbreaks, of both emerging and re-emerging diseases, can have significant impacts on local, national and regional communities. An effective response to these outbreaks relies heavily on the coordination of both public health and Veterinary Services to identify the signs, symptoms and patterns of disease quickly and respond accordingly. The future global risks related to infectious disease are influenced by several factors, including human migration, urban development, agricultural development and climate change. As technology advances, we are more aware of the potential risks associated with dual-use equipment and research (defined as equipment or research that can be used for legitimate as well as nefarious purposes), synthetic biology, the engineering of biological systems, and the evolving modus operandi of criminals and terrorist groups. The ability to detect natural, accidental or deliberate outbreaks and incidents will rely heavily on cross-agency communication, establishment of informationsharing platforms, development of joint investigative strategies, and recognition that effective response requires a strong health and security agency interface. Therefore, the management of a suspicious biological incident requires intersectoral and interregional cooperation employing a comprehensive approach which considers prevention, preparedness, response and recovery and identifies and considers the unique characteristics and requirements of the incident.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents

OBJECTIVES

During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program.

METHODS

To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program.

RESULTS

The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors.

CONCLUSIONS

The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

A coupled ODE-diffusion modeling framework for removing organic contaminants in crops using a simple household method

Organic contaminants are frequently detected in fresh crops and can cause severe damage to human health. To help control this risk, we introduce a diffusion-based model framework for estimating the removal efficiency for organic contaminants in fresh crops using a simple water soaking method. The framework was developed based on the diffusion coefficient of the organic contaminants, and its application indicates that the removal factor (RF) for organic contaminants has an inverse-exponential relationship with log K_ow (K_ow is the octanol-water partition coefficient), which thermodynamically restricts the removal efficiency for chemicals with large steady state log K_ow. Additionally, the diffusion coefficient of the chemical in water affects the kinetic removal efficiency. For example, the RF simulated for glyphosate, which has a relatively high diffusion coefficient, is 0.592 (61.9% of the steady state RF) after soaking for 1 h, while the RF of lindane is 0.224, which is only 25.0% of the steady state RF. However, if a refreshing method is applied, the RF of lindane can be significantly improved even if more potatoes are used in the water bowl, and this has been demonstrated theoretically with the refreshing function. Model validation indicates that the macro properties of crops, e.g., the active area through which crop tissues interact with water, have a larger impact on the results than do the micro-properties of crops and the physiochemical properties of the organic contaminants. Comparison of our results with those of other studies shows that the simulated ranges for some pesticides compare well with experimental data collected using other household washing methods. However, for other pesticides such as HCB and DDT, the simulated results and current studies are inconsistent due to physical interactions between the water and crop tissues not considered in our model.

Transmittance and Survival of SARS-CoV-2 in Global Trade: The Role of Supply Chain and Packaging

We are living in uncertain times and facing a paradigm shift in human health and sustainability. The number of SARS-CoV-2 victims is rising daily and all nations are going through dramatic effects and exploring various solutions to this imminent calamity facing the humanity. The world is confronting a public health issue that has forced it to come to a halt and evaluate the future of our modern society and our way of living. It can be stated that the sustainability of our societies inextricably depends on the performance of our global trade and supply chains. This review article is the first published assessment on the global trade and especially packaging’s role in the transmittance of SARS-CoV-2 virus. Surprisingly, based on our findings, the lack of knowledge on transmittance and survival of SARS-CoV-2 in supply chain and packaging is substantial. Although there are several existing and available technologies that can be used for the risk mitigation, our assessment shows a major and timely need for broad conceptual advancements and necessary understanding of the supply chain risks associated with the viral surface transmittances. The specificity to the current and possibly future pandemics demands an increasing amount of multidisciplinary research and involvement of public and private sectors. This proposed erudition is imminent and may be highly critical in safeguarding and the sustainability of the critical supply chains in our society now and in the future.

Covid-19: implications for insurer risk management and the insurability of pandemic risk

This paper analyzes the insurability of pandemic risk and outlines how underwriting policies and scenario analysis are used to build resilience upfront and plan contingency actions for crisis scenarios. It then summarizes the unique "lessons learned" from the Covid-19 crisis by baselining actual developments against a reasonable, pre-Covid-19 pandemic scenario based on the 2002 SARS epidemic and 1918 Spanish influenza pandemic. Actual developments support the pre-Covid-19 hypothesis that financial market developments dominate claims losses due to the demographics of pandemics and other factors. However, Covid-19 "surprised" relative to the pre-Covid-19 scenario in terms of its impact on the real economy as well as on the property and casualty segment as business interruption property triggers and exclusions are challenged, something that may adversely impact the insurability of pandemics as well as the perception of the industry for some time to come. The unique lessons of Covid-19 reinforce the need for resilience upfront in solvency and liquidity, the need to improve business interruption wordings and re-underwrite the book, and the recognition that business interruption caused by pandemics may not be an insurable risk due to its large accumulation potential and the threat of external moral hazard. These insurability limitations lead to a discussion about the structure and financing of protection against the impact of future pandemics.

Lay people and experts' risk perception of pharmaceuticals in the environment in Southwestern Europe

This study aims to contribute to the risk management of pharmaceuticals in the environment, illustrating risk perceptions of lay people and experts from Southwestern Europe (Portugal, Spain, and France). The psychometric paradigm was applied to assess risk regarding four hazards: pharmaceuticals in the environment (i.e., broadly framed), pharmaceuticals in treated wastewater, pharmaceuticals in drinking water, and pharmaceuticals in crops. Two factors explained most of the variance of risk assessments: dread and unknown. The dread factor combined immediacy and severity of effects, and the old nature of hazards. Pharmaceuticals in crops and drinking water scored higher in this factor, as did experts and French respondents. The unknown factor differentiated between the assessments of lay people and experts. Lay people assessed the hazards as being more known by those who were exposed but less known by science; and exposure was perceived as more voluntary and the risk as more controllable. Even though pharmaceutical residues are present in much higher concentrations in treated wastewater, risk assessments were overall higher for drinking water and crops. Moreover, data also revealed risk management preferences: whereas lay people preferred technological and awareness-type measures, experts preferred measures to improve the disposal of pharmaceutical waste and health-type measures.

Digital transformation risk management in forensic science laboratories

Technological advances are changing how forensic laboratories operate in all forensic disciplines, not only digital. Computers support workflow management, enable evidence analysis (physical and digital), and new technology enables previously unavailable forensic capabilities. Used properly, the integration of digital systems supports greater efficiency and reproducibility, and drives digital transformation of forensic laboratories. However, without the necessary preparations, these digital transformations can undermine the core principles and processes of forensic laboratories. Pertinent examples of problems involving technology that have occurred in laboratories are provided, along with opportunities and risk mitigation strategies, based on the authors' experiences. Forensic preparedness concentrating on digital data reduces the cost and operational disruption of responding to various kinds of problems, including misplaced exhibits, allegations of employee misconduct, disclosure requirements, and information security breaches. This work presents recommendations to help forensic laboratories prepare for and manage these risks, to use technology effectively, and ultimately strengthen forensic science. The importance of involving digital forensic expertise in risk management of digital transformations in laboratories is emphasized. Forensic laboratories that do not adopt forensic digital preparedness will produce results based on digital data and processes that cannot be verified independently, leaving them vulnerable to challenge. The recommendations in this work could enhance international standards such as ISO/IEC 17025 used to assess and accredit laboratories.

[COVID-19 emergency management activities promoted by an university hospital in Northern Italy]

Background. In December 2019, a Coronavirus 2019 epidemic (COVID-19) was reported, caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which occurred in the city of Wuhan, Hubei province, China. Perceived risk of contracting diseases has led many Governments and Healthcare Organizations to implement a variety of control and protection measures for the population, in particular for health professionals who have made contact with positive Covid-19 patients. In this publication, we have carried out a review of the information available, in order to share the prevention and protection measures for health and safety at work, which a University Hospital of Pavia, in Northern Italy, has remodulated, according to the changed scenario in which professionals finds themselves carrying out their profession in the post lockdown, in account to the specificity of processes and methods of work organizing, which overall, they serve to characterize risks, in order to be able to prevent them in the best possible way for patients, visitors and healthcare professionals.