HAT-field: a very cheap, robust and quantitative point-of-care serological test for Covid-19.

We have recently described a very simple and cheap serological test called HAT to detect antibodies directed against the RBD of the SARS-Cov-2 virus. HAT is based on hemagglutination, triggered by a single reagent (IH4-RBD) comprised of the viral RBD domain fused to a nanobody specific for glycophorin, which is expressed at very high levels at the surface of human red blood cells (RBCs). One of the main initial goals of this study was to devise a test protocol that would be sensitive and reliable, yet require no specialized laboratory equipment such as adjustable pipets, so that it could be performed in the most remote corners of the world by people with minimal levels of training. Because antibody levels against the viral RBD have been found to correlate closely with sero-neutralisation titers, and thus with protection against reinfection, it has become obvious during the course of this study that making this test reliably quantitative would be a further significant advantage. We have found that, in PBN, a buffer which contains BSA and sodium azide, IH4-RBD is stable for over 6 months at room temperature, and that PBN also improves HAT performance compared to using straight PBS. We also show that performing HAT at either 4°C, room temperature or 37°C has minimal influence on the results, and that quantitative evaluation of the levels of antibodies directed against the SARS-CoV-2 RBD can be achieved in a single step using titration of the IH4-RBD reagent. The HAT-field protocol described here requires only very simple disposable equipment and a few microliters of whole blood, such as can be obtained by finger prick. Because it is based on a single soluble reagent, the test can be adapted very simply and rapidly to detect antibodies against variants of the SARS-CoV-2, or conceivably against different pathogens. HAT-field appears well suited to provide quantitative assessments of the serological protection of populations as well as individuals, and given its very low cost, the stability of the IH4-RBD reagent in the adapted buffer, and the simplicity of the procedure, could be deployed pretty much anywhere, including in the poorest countries and the most remote corners of the globe.

Adenoviral Vector COVID-19 Vaccines: Process and Cost Analysis

The COVID-19 pandemic has motivated the rapid development of numerous vaccines that have proven effective against SARS-CoV-2. Several of these successful vaccines are based on the adenoviral vector platform. The mass manufacturing of these vaccines poses great challenges, especially in the context of a pandemic where extremely large quantities must be produced quickly at an affordable cost. In this work, two baseline processes for the production of a COVID-19 adenoviral vector vaccine, B1 and P1, were designed, simulated and economically evaluated with the aid of the software SuperPro Designer. B1 used a batch cell culture viral production step, with a viral titer of 5 × 1010 viral particles (VP)/mL in both stainless-steel and disposable equipment. P1 used a perfusion cell culture viral production step, with a viral titer of 1 × 1012 VP/mL in exclusively disposable equipment. Both processes were sized to produce 400 M/yr vaccine doses. P1 led to a smaller cost per dose than B1 ($0.15 vs. $0.23) and required a much smaller capital investment ($126 M vs. $299 M). The media and facility-dependent expenses were found to be the main contributors to the operating cost. The results indicate that adenoviral vector vaccines can be practically manufactured at large scale and low cost.

Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

In the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

Cold Technique in Adult Tonsillectomy Reduces Waste and Cost

Objectives: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques. Methods: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified. Results: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation. Discussion: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Implications for Practice: Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.

Instilling a culture of cleaning: Effectiveness of decontamination practices on non-disposable sphygmomanometer cuffs

Background: Sphygmomanometers and their cuffs are non-critical items that can act as a fomite for transmission of pathogens which may cause healthcare-associated infection (HAI), leading to an argument that disposable equipment improves patient safety. Aim: The aim of this study was to demonstrate that decontamination decreased in microbial contamination of non-disposable sphygmomanometer cuffs, providing evidence to negate the need to purchase, and dispose of, single-patient-use cuffs, reducing cost and environmental impact. Methods: A pre–post intervention study of available sphygmomanometer cuffs and associated bedside patient monitors was conducted using a series of microbiological samples in a rural emergency department. A Wilcoxon signed-rank test analysed the effect of the decontamination intervention. To further examine the effect of the decontamination intervention, Mann–Whitney U-tests were conducted for each aspect. Findings: Contamination was significantly higher before decontamination than afterwards (Z = −5.14, U = 55.0, P < 0.001, η2 = 0.61 inner; Z = −5.05, U = 53.5, P < 0.001, η2 = 0.59 outer). Discussion: Decontamination of non-disposable sphygmomanometer cuffs decreases microbial load and risk of HAI, providing evidence to negate arguments for disposable cuffs while being environmentally sensitive and supportive of a culture of patient safety and infection control.

Research on the Process Layer and Substation Layer Relay Protection in Smart Substation Relay Protection

The intelligent substation relay protection facility is a fundamental element in construction of modern power system, based on the principles of flexibility, security and accuracy, and it can be divided into process layer and substation layer according to specific equipment. The former is suitable for individual sampling of disposable equipment, can be separated from the base station synchronization sampling, with the help of synchronous digital system and ping-pong algorithm to achieve synchronization of the overall sampling, that is to take the distribution protection components, through the separate transmission medium to realize the information transmission; the latter is for variable power plant components centralized backup protection, taking online real-time tuning technique.

The principles of endourology

The chapter discusses the principles of endourology outlining the principles behind the sub-specialty. Topics disused include endoscopes, cystoscopes, rigid and semi-rigid ureteroscopes, flexible ureterorenoscopes, rigid and flexible nephroscopes, disposable equipment, integrated operating theatres, narrow band imaging (NBI), theatre ergonomics, and antibiotics. Urologic endoscopes are generally of two optical designs: the rigid, rod lens system described by Hopkins, while fibre-optic imaging bundles are used in both rigid and flexible endoscopes. The rod lens system consists of a series of glass rods with polished ends with the key feature of air gaps that act as a lens. Light is carried efficiently along the rod, resulting in a clear and bright image.