Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial).

BACKGROUND: Conventional cardiopulmonary resuscitation (CPR) training for the general public involves the use of a manikin and a training video, which has limitations related to a lack of realism and immersion. To overcome these limitations, virtual reality and extended reality technologies are being used in the field of medical education. The aim of this study is to explore the efficacy and safety of extended reality (XR)-based basic life support (BLS) training. METHODS: This study is a prospective, multinational, multicentre, randomised controlled study. Four institutions in 4 countries will participate in the study. A total of 154 participants will be randomly assigned to either the XR group or the conventional group stratified by institution and sex (1:1 ratio). Each participant who is allocated to either group will be sent to a separate room to receive training with an XR BLS module or conventional CPR training video. All participants will perform a test on a CPR manikin after the training. The primary outcome will be mean compression depth. The secondary outcome will be overall BLS performance, including compression rate, correct hand position, compression, and full release and hands-off time. DISCUSSION: Using virtual reality (VR) to establish a virtual educational environment can give trainees a sense of realism. In the XR environment, which combines the virtual world with the real world, trainees can more effectively learn various skills. This trial will provide evidence of the usefulness of XR in CPR education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04736888. Registered on 29 January 2021.

The efficacy of low molecular weight heparin is reduced in Covid-19.

BACKGROUND: A significant degree of mortality and morbidity in Covid-19 is through thromboembolic complications, only partially mitigated by anticoagulant therapy. Reliable markers of infection severity are not fully established. OBJECTIVES: This study investigated whether visco-elastic biomarkers predict disease severity on presentation to the Emergency Department (ED) and how they measure response to anticoagulationMETHODS:Patients testing positive for Covid-19 at a large University Teaching Hospital ED were recruited at presentation. Multiple blood samples were taken throughout hospital admission to monitor disease progression with end outcome recorded. Visco-elastic markers, fractal dimension (df) and Time to Gel Point (TGP) which measure the properties of the incipient clot were compared in patients with and without anticoagulation by Low Molecular Weight Heparin (LMWH). RESULTS: TGP and df did not predict severity of infection with Covid-19. Although LMWH prolonged TGP, there was no change in df indicating LMWH did not change clot microstructure. CONCLUSIONS: Therapeutic efficacy of LMWH appears blunted in Covid-19 infection. This may be due to the inflammatory state creating a resistance to LMWH activity, which may explain why LMWH appears less effective in Covid-19 compared to other disease states. Covid-19 was not predicted by visco-elastic testing at the time of ED presentation.

Impaired fibrinolysis in severe Covid-19 infection is detectable in early stages of the disease.

BACKGROUND: A significant degree of mortality and morbidity in Covid-19 is due to thromboembolic disease. Coagulopathy has been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time. OBJECTIVE: We sought to investigate whether coagulation markers can predict severity and how they change over the disease course. METHODS: Patients presenting to a single University Teaching Hospital were recruited and followed up if PCR was positive. Alongside routine blood testing, Rotational Thromboelastometry (ROTEM) was performed. Outcome data was recorded for all patients, and ROTEM values were compared across outcome groups. RESULTS: Extem and Intem Maximum Lysis were significantly reduced in those who died or required an ICU admission, indicating a reduced ability to break down clot mass in the most critically unwell patients. CONCLUSION: Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of Covid-19 compared with those who survive a hospital stay to discharge was the extent to which fibrinolysis could occur. Mortality and morbidity in Covid-19 infection appears in part driven by an inability to break down clot mass.

High levels of soluble RAGE are associated with a greater risk of mortality in COVID-19 patients treated with dexamethasone.

Blood levels of the soluble receptor for advanced glycation end-products (sRAGE) are acutely elevated during the host inflammatory response to infection and predict mortality in COVID-19. However, the prognostic performance of this biomarker in the context of treatments to reduce inflammation is unclear. In this study we investigated the association between sRAGE and mortality in dexamethasone-treated COVID-19 patients. We studied 89 SARS-CoV-2 positive subjects and 22 controls attending the emergency department of a University Teaching Hospital during the second wave of COVID-19 and measured sRAGE at admission. In positive individuals sRAGE increased with disease severity and correlated with the National Early Warning Score 2 (Pearson's r = 0.56, p < 0.001). Fourteen out of 72 patients treated with dexamethasone died during 28 days of follow-up. Survival rates were significantly lower in patients with high sRAGE (> 3532 pg/mL) than in those with low sRAGE (p = 0.01). Higher sRAGE levels were associated with an increased risk of death after adjustment for relevant covariates. In contrast, IL-6 did not predict mortality in these patients. These results demonstrate that sRAGE remains an independent predictor of mortality among COVID-19 patients treated with dexamethasone. Determination of sRAGE could be useful for the clinical management of this patient population.

Electron beam technology for Re-processing of personal protective equipment.

Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0-200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator; however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.

Electron beam technology for Re-processing of personal protective equipment

Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0–200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator;however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.

COVID-19: Rapid prototyping and production of face shields via flat, laser-cut, and 3D-printed models.

The use of personal protective equipment (PPE) has become essential to reduce the transmission of coronavirus disease 2019 (COVID-19) as it prevents the direct contact of body fluid aerosols expelled from carriers. However, many countries have reported critical supply shortages due to the spike in demand during the outbreak in 2020. One potential solution to ease pressure on conventional supply chains is the local fabrication of PPE, particularly face shields, due to their simplistic design. The purpose of this paper is to provide a research protocol and cost implications for the rapid development and manufacturing of face shields by individuals or companies with minimal equipment and materials. This article describes a best practice case study in which the establishment of a local manufacturing hub resulted in the swift production of 12,000 face shields over a seven-week period to meet PPE shortages in the North-West region of Ireland. Protocols and processes for the design, materials sourcing, prototyping, manufacturing, and distribution of face shields are described. Three types of face shields were designed and manufactured, including Flat, Laser-cut, and 3D-printed models. Of the models tested, the Flat model proved the most cost-effective (€0.51/unit), while the Laser-cut model was the most productive (245 units/day). The insights obtained from this study demonstrate the capacity for local voluntary workforces to be quickly mobilised in response to a healthcare emergency, such as the COVID-19 pandemic.

Plasma generated ozone and reactive oxygen species for point of use PPE decontamination system.

This paper reports a plasma reactive oxygen species (ROS) method for decontamination of PPE (N95 respirators and gowns) using a surface DBD source to meet the increased need of PPE due to the COVID-19 pandemic. A system is presented consisting of a mobile trailer (35 m3) along with several Dielectric barrier discharge sources installed for generating a plasma ROS level to achieve viral decontamination. The plasma ROS treated respirators were evaluated at the CDC NPPTL, and additional PPE specimens and material functionality testing were performed at Texas A&M. The effects of decontamination on the performance of respirators were tested using a modified version of the NIOSH Standard Test Procedure TEB-APR-STP-0059 to determine particulate filtration efficiency. The treated Prestige Ameritech and BYD brand N95 respirators show filtration efficiencies greater than 95% and maintain their integrity. The overall mechanical and functionality tests for plasma ROS treated PPE show no significant variations.

Antimicrobial TiO2 nanocomposite coatings for surfaces, dental and orthopaedic implants.

Engineering of self-disinfecting surfaces to constrain the spread of SARS-CoV-2 is a challenging task for the scientific community because the human coronavirus spreads through respiratory droplets. Titania (TiO2) nanocomposite antimicrobial coatings is one of the ideal remedies to disinfect pathogens (virus, bacteria, fungi) from common surfaces under light illumination. The photocatalytic disinfection efficiency of recent TiO2 nanocomposite antimicrobial coatings for surfaces, dental and orthopaedic implants are emphasized in this review. Mostly, inorganic metals (e.g. copper (Cu), silver (Ag), manganese (Mn), etc), non-metals (e.g. fluorine (F), calcium (Ca), phosphorus (P)) and two-dimensional materials (e.g. MXenes, MOF, graphdiyne) were incorporated with TiO2 to regulate the charge transfer mechanism, surface porosity, crystallinity, and the microbial disinfection efficiency. The antimicrobial activity of TiO2 coatings was evaluated against the most crucial pathogenic microbes such as Escherichia coli, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Legionella pneumophila, Staphylococcus aureus, Streptococcus mutans, T2 bacteriophage, H1N1, HCoV-NL63, vesicular stomatitis virus, bovine coronavirus. Silane functionalizing agents and polymers were used to coat the titanium (Ti) metal implants to introduce superhydrophobic features to avoid microbial adhesion. TiO2 nanocomposite coatings in dental and orthopaedic metal implants disclosed exceptional bio-corrosion resistance, durability, biocompatibility, bone-formation capability, and long-term antimicrobial efficiency. Moreover, the commercial trend, techno-economics, challenges, and prospects of antimicrobial nanocomposite coatings are also discussed briefly.

Heterogeneous Fenton catalysts: A review of recent advances.

Heterogeneous Fenton catalysts are emerging as excellent materials for applications related to water purification. In this review, recent trends in the synthesis and application of heterogeneous Fenton catalysts for the abatement of organic pollutants and disinfection of microorganisms are discussed. It is noted that as the complexity of cell wall increases, the resistance level towards various disinfectants increases and it requires either harsh conditions or longer exposure time for the complete disinfection. In case of viruses, enveloped viruses (e.g. SARS-CoV-2) are found to be more susceptible to disinfectants than the non-enveloped viruses. The introduction of plasmonic materials with the Fenton catalysts broadens the visible light absorption efficiency of the hybrid material, and incorporation of semiconductor material improves the rate of regeneration of Fe(II) from Fe(III). A special emphasis is given to the use of Fenton catalysts for antibacterial applications. Composite materials of magnetite and ferrites remain a champion in this area because of their easy separation and reuse, owing to their magnetic properties. Iron minerals supported on clay materials, perovskites, carbon materials, zeolites and metal-organic frameworks (MOFs) dramatically increase the catalytic degradation rate of contaminants by providing high surface area, good mechanical stability, and improved electron transfer. Moreover, insights to the zero-valent iron and its capacity to remove a wide range of organic pollutants, heavy metals and bacterial contamination are also discussed. Real world applications and the role of natural organic matter are summarised. Parameter optimisation (e.g. light source, dosage of catalyst, concentration of H2O2 etc.), sustainable models for the reusability or recyclability of the catalyst and the theoretical understanding and mechanistic aspects of the photo-Fenton process are also explained. Additionally, this review summarises the opportunities and future directions of research in the heterogeneous Fenton catalysis.

Face masks and respirators in the fight against the COVID-19 pandemic: An overview of the standards and testing methods.

The COVID-19 outbreak has resulted in a shortage of personal protective equipment (PPE) throughout the world. This shortage has resulted in an increase in production of PPE to meet the demand, and as a result, several substandard equipment has entered the market. With face masks and respirators now beginning to see widespread use throughout the world, the standards and test with which they are required to undertake have become points of interest. The filtration efficiency of the masks is a key testing element that examines its ability to filter particles, bacteria and viruses; this examines the penetration efficiency percentage of each with lower results being preferable. Masks are also subjected to NaCl testing method, which allows a range of particle sizes to be examined and their penetration to be observed. The masks must also show considerable resistance to fluids and flames, to prevent the penetration of liquids and to be non-flammable. Various PPE testing protocols such as biological, chemical, fluid and flame resistances, protective ensemble, facepiece fit testing, NIOSH NaCl method and impact protection have been discussed. In addition, various tests involving bacterial and viral filtration efficiencies are also discussed. Differential pressure is examined to ascertain the comfort, airflow and breathability of the masks, whilst fit testing is examined to ensure a correct fit of the mask.

Face Masks and Respirators in the Fight against the COVID-19 Pandemic: A Review of Current Materials, Advances and Future Perspectives.

The outbreak of COVID-19 has spread rapidly across the globe, greatly affecting how humans as a whole interact, work and go about their daily life. One of the key pieces of personal protective equipment (PPE) that is being utilised to return to the norm is the face mask or respirator. In this review we aim to examine face masks and respirators, looking at the current materials in use and possible future innovations that will enhance their protection against SARS-CoV-2. Previous studies concluded that cotton, natural silk and chiffon could provide above 50% efficiency. In addition, it was found that cotton quilt with a highly tangled fibrous nature provides efficient filtration in the small particle size range. Novel designs by employing various filter materials such as nanofibres, silver nanoparticles, and nano-webs on the filter surfaces to induce antimicrobial properties are also discussed in detail. Modification of N95/N99 masks to provide additional filtration of air and to deactivate the pathogens using various technologies such as low- temperature plasma is reviewed. Legislative guidelines for selecting and wearing facial protection are also discussed. The feasibility of reusing these masks will be examined as well as a discussion on the modelling of mask use and the impact wearing them can have. The use of Artificial Intelligence (AI) models and its applications to minimise or prevent the spread of the virus using face masks and respirators is also addressed. It is concluded that a significant amount of research is required for the development of highly efficient, reusable, anti-viral and thermally regulated face masks and respirators.