Reduction in the risk of progression of solid organ transplant recipients infected by SARS-CoV-2 treated with monoclonal antibodies.

Recipients of solid organ transplants (SOT) are at higher risk of infection by SARS-CoV-2 virus especially due to chronic immunosuppression therapy and frequent multiple comorbid conditions. COVID-19 is a potentially life-threatening disease in SOT recipients, with an increased likelihood of progressing to severe disease, with the need of hospitalization, admission to the intensive care unit (ICU) and mechanical ventilatory support. This article presents an updated review of different aspects related to the outcome of COVID-19 in SOT recipients. In nvaccinated SOT recipients, COVID-19 is associated with a high mortality rate, in-patient care and ICU admission, and impaired graft function or rejection in severe disease. In vaccinated SOT recipients even after full vaccination, there is a reduction of the risk of mortality, but the course of COVID-19 may continue to be severe, influenced by the time from transplant, the net state of immunosuppression and having suffered graft rejection or dysfunction. SOT recipients develop lower immunity from mRNA vaccines with suboptimal response. Treatment with mAbs provides favorable outcomes in non-hospitalized SOT recipients at high risk for severe disease, with lower rates of hospitalization, emergency department visits, ICU care, progression to severe disease, and death. However, broad vaccination and therapeutic options are required, particularly in light of the tendency of the SARS-CoV-2 virus to adapt and evade both natural and vaccine-induced immunity.

SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households

Background: SARS-CoV-2 clinical presentation is associated with the patients' age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases' age group, are accumulating. Methods: We performed a follow-up cohort study including all COVID-19 real-time polymerase chain reaction (RT-PCR)-confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests, and infection transmission in households. Results: The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases (n = 178) were followed (students aged 12–19 years, median age 14 years, n = 153, school staff aged 24–67 years, median age 39 years, n = 25) and the cases' household close contacts (n = 639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests, and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students' contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (odds ratio: 2.06, 95% CI 1.26–3.4) and higher in adults compared to adolescents (odds ratio: 2.69, 95% CI 1.43–4.89). Conclusions: Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing nonpharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered. © 2023 The Author(s)

Reduction of the Nutritional Diagnosis of Eutrophy Among Brazilian Adolescents, Evaluation from 2010 to 2021

Introduction: Identifying the nutritional diagnosis of adolescents is crucial for developing public health strategies that promote the adequate development of this population. Objective(s): To analyze the temporal trends of the BMI of Brazilian adolescents (10 to 19 years old) between 2010 and 2021. Method(s): Descriptive ecological study. Data obtained from e-SUS Primary Care. The prevalence rate of the categories was obtained: severe thinness (ST), thinness (T), eutrophic (E), overweight (OW), obesity (OB), and severe obesity (SOB), and the trend was calculated by segmented linear regression, the variations annual percentages (APCs). In addition, time-series analysis was performed in the Joinpoint Regression Program. Result(s): In the analysis of the country as a whole, the BMI showed a decreasing character in the categories 'ST' (APC:-2.7;p=0.029) and 'E' (APC:-3.8;p=0.008). BP' (APC: 3.0;p<0.031), 'OB' (APC: 9;1;p<0.001) and 'SOB' (APC: 29.6;p=0.012). The highest annual percentage reduction (APC-) of 'E' occurred between 2019 and 2020 (67.78% -> 64.17%). The highest APC+ of 'OW', 'OB' and 'SOB' occurred between 2019 and 2020 ('SB': 18.25% ->19.97%;'OB':7.91% ->10.46%;'SOB':1.8% -> 2.41%). 'ST' was stationary in the Northeast and decreasing in the others 'T' showed an increasing character in the Northeast, Southeast, and South. In all regions, 'E' had a decreasing trend, while we observed an increasing character in the prevalence of 'OW', 'OB' and 'SOB'. Conclusion(s): The growing trend of the 'OW', 'OB' and 'SOB' categories in the last 12 years evidence exposure to risk factors harmful to the development of this population, such as the intake of hypercaloric foods and a sedentary lifestyle. In addition, the increase in 'MA' in some regions highlights the country's socioeconomic inequalities and differences in nutritional profile. The most considerable reduction in 'E' and the most significant increase in 'OW' and 'OB' in the 2019-2020 period can be attributed to the Covid-19 pandemic's impact on the habits of this population.

The role of human factors in the human-centred design of service processes: a focus on the healthcare sector

The term “human factors” refers to all the elements – such as cognitive, physical, and organisational aspects – influencing human behaviour in the workplace. The field of human factors in industrial engineering is concerned with understanding interactions among humans and other elements of a system. It focuses on the design of tools, machines, systems, tasks, jobs and environments for safe, comfortable, and effective human involvement and interaction. Human factors are highly valued in complex systems such as aviation, nuclear power plants management, and manufacturing, and their relevance is also increasing within the service sector as well. This interest stems from the fact that human resources have become predominant in many companies' operations and objectives achievement. Consequently, considering human factors in process design and management has countless advantages. Taking into account human factors during the process design stage avoids the occurrence of problems afterwards. Human-centred process design has been proven to reduce errors and costs and improve quality and productivity. This work aims to make an appraisal of the perception, within the scientific literature, of the role of human factors in human-centred design in the service sector. In particular, the specific case analysed concerns the design of healthcare services, assessing the more relevant factors and possible evolutions of these factors. The choice of the human factors analysis in healthcare service is salient, especially considering that it is one of the services most affected by the Sars-Cov-2 pandemic. © 2022, AIDI - Italian Association of Industrial Operations Professors. All rights reserved.

Agent-based simulation for vaccination networks design and analysis: preliminary gaps

During an epidemic or a pandemic emergency, various approaches are undertaken to contain the infectious disease spread. Some of the most common interventions are lockdowns, social distancing, contact tracing and the use of personal protective equipment. However, whenever available, the most helpful intervention is the administration of vaccinations. Countermeasures need to be taken as quickly as possible in emergencies, but predicting their full consequences and effects is often difficult, mainly because there is no room for trial-and-error approaches. Simulation - in its different implementations - represents a useful approach for modelling and analysing reality and predicting the evolution of a real-world system. Agent-based models could be particularly beneficial as they allow for modelling each individual as a distinct entity, thereby enabling the evaluation of the effects of public policies in the field of interest. This paper reviews the existing literature on agent-based simulation for vaccine distribution and administration. This work highlights areas where agent-based simulation has been most utilised and areas that could be explored further. Specifically, the most significant gaps are the lack of application of agent-based simulations to vaccine distribution networks and the lack of consideration given to resources requirements and costs associated with alternative vaccine administration methods to citizenship. Copyright (C) 2022 The Authors.

Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis. © 2022 Published by Scientific Scholar on behalf of Journal of Musculoskeletal Surgery and Research.

COVID-19 pandemic impact on diagnosis and management of breast cancer in Northern Portugal

Background: COVID-19 pandemic brought pressure to Portuguese National Health Service (NHS). We aim to assess pandemic impact on diagnosis and management of breast cancer (BC) in a high-volume Portuguese comprehensive cancer centre, which was classified as a COVID-free institution by public health authorities.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements Type of funding sources: None. Background Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

EDUCATION IN PANDEMIC TIMES: POSSIBILITY OF FORMATION OR SILENCE AS BARBARISM

This article seeks to reflect on the conception of education and training in contemporary society from the theoretical framework of authors of the Frankfurt School, especially Theodor Adorno (1903-1969) and Max Horkheimer (1895-1973). It intends to understand the idea of the subject's autonomy, in a Kantian perspective of "intellectual maturity", opposed to the economic and social aspects arising from the ideological mechanisms of capitalism's domination. The constitution of this subject, in the logic of instrumental reason, represented by the cultural industry, uses ideological instruments capable of dismissing or weakening the individual, as well as preventing him from carrying out formative experiences and autonomously deciding on choices in this society. And, furthermore, it disregards the objective and subjective conditions that guide human action in the socio historical movement. In this context, by mystifying actions and allowing the admission and expansion of instrumental rationality, there is an obfuscation of what formation for autonomy is, thus leading to (de)formation. And, in times of the Covid-19 pandemic, training is increasingly damaged.

Impact of the COVID-19 Pandemic on Adherence to Exercise Prescription: The case of Cardiac Rehabilitation Programs

Cardiac Rehabilitation Programs (CRPs) are an important tool of secondary prevention and their implementation within health services, despite the uneven geographical distribution, has been receiving attention from decision-makers in recent years. Adherence to the CRPs is one of the great challenges faced by the multidisciplinary team, and there are several strategies to maintain adherence, particularly in CRP-Phase III, which occurs outside the hospital environment. One of the strategies followed is the use of remote performance monitoring and recording of possible alert symptoms. With the pandemic due to COVID-19, these challenges have become even more evident as Phase II programs have been suspended, thus increasing the importance of the home-based CRPs. In this work, the results of a study aiming to understand the impact of the pandemic on adherence to the prescription of exercise and the perception of patients regarding the effects of physical activity on health conditions are shown. The results indicate that the pandemic did not have a major effect on the adherence to home-based exercises, in particular, in patients undergoing programs using a telemonitoring system. Moreover, the perception of the importance of physical activity for health and well-being was reinforced in the context of the pandemic. © 2022 Croatian Society MIPRO.

Shorter cardiac rehabilitation programs: taking time is taking effectiveness?

Introduction: Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective: To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods: Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results: A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112). Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion: Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.

Cardiorespiratory fitness assessment on active patientswhokept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Introduction: Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis. Purpose: To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era. Methods: The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA's Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively. Results: A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043). Conclusion: Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

Detection of Facial Spoofing Attacks in Uncontrolled Environments Using ELBP and Color Models

Distance education has become an alternative in teaching derived from the Covid-19 pandemic. However, distance education has led to bad practices for some students. For example, it was detected that some students spoofed the teacher in a class or exam. Therefore, facial biometrics can be used to solve, in real-time, the spoofing problem. However, the solution is not exempt from presentation attacks that undermine the reliability of the systems. Other challenges that must be considered are lighting, resolution, and variable size of the faces, among others. In this paper, we present a methodology to address the problem of facial spoofing attacks. We combine the Extended Local Binary Patterns (ELBP) descriptor and YCbCr, HSV color models to highlight the saturation and illumination of an image. For the experiments, we present a comparison of our proposal against other state-of-the-art methods. We obtain an error of 2.45% with the Half Total Error Rate (HTER) metric in the MSU image bank. The results revealed that for environments where the camera resolutions are not controlled, our proposal provides a feasible solution reducing the costs of acquiring specific hardware © 2003-2012 IEEE.

Emergent virtual networks amid emergency: insights from a case study

In the aftermath of catastrophic events, problems always arise in the supply of goods in places affected by the emergency. During the early stages of the COVID-19 pandemic, the shortage of Personal Protective Equipment (PPE) created problems, especially in the healthcare sector, contributing to the uncontrolled spread of the virus. This paper presents a case in which the emergence of a voluntary local production and distribution network based on 3D printing technology played an important role in compensating for the lack of PPE. From the case analysed, we compare the core characteristics of the emergent virtual networks against the features of well-established supply chains models to systematize relevant differences and common traits. This research contributes to defining, developing, and scoping the concept of emergent supply chains and illustrates how such networks can constitute an essential first response to the lack of materials and goods in emergency contexts.

A quantitative study of particle dispersion due to respiratory support modalities in pre-hospital and in-hospital critical care environments

RATIONALE: Patients with COVID-19 may require supplemental oxygen and non-invasive respiratory support devices during pre-hospital aeromedical transport as well as in-hospital intensive care units. It is unclear whether these therapies increase the dispersion of potentially infectious bioaerosols and placing health workers at increased risk. METHODS: The studies were conducted in two environments: (1) fixed-wing air ambulance cruising at 25,000 ft;(2) a simulated critical care unit in hospital. A breathing patient simulator consisting of a medical mannequin exhaling nebulized particles from the lower respiratory tract was connected to a ventilator to simulate a patient with mild-moderate respiratory distress. Aerosolized saline and DNA bacteriophage φX174 were used to model aerosol dispersion in the aeromedical and simulated intensive care unit, respectively. Dispersion of 1.0 μm particles were measured in key locations, due to the three respiratory support modalities including;non-invasive bilevel positive pressure ventilation (BiPAP);high-flow nasal oxygen (HFNO);and nasal prongs. In the simulated intensive care unit study, viability of aerosolized bacteriophage φX174 was quantified using plaque assays (Fig. 1) RESULTS: In both environments, particle concentrations were highest close to the simulator's mouth and declined with distance from the mouth. In the aeromedical environment, nasal prongs (with a surgical mask) were associated with the highest particle concentrations and BiPAP the lowest. In that environment, at a location near the mouth, particle concentrations associated with HFNO with a surgical mask (5.5 × 104 particles/L of sampled air) and BiPAP (7.5 × 103 particles/L) were significantly lower when compared to nasal prongs with a surgical mask (1.2 × 105 particles/L) (each P < 0.05). In the simulated intensive care unit, HFNO was associated with the highest particle concentrations and BiPAP the lowest. In this environment, at a location near the mouth, particle concentrations as well as bacteriophage viability associated with nasal prongs (7.4 × 104 particles/L and 1.6 × 104 PFU/L) and BiPAP (1.1 × 104 particles/L and 1.9 × 102 PFU/L) were significantly lower when compared to HFNO (5.3 × 105 particles/L and 2.6 × 104 PFU/L) (each P < 0.05). CONCLUSIONS: These findings highlight the comparable risk of dispersing particles among respiratory support devices and the importance of appropriate infection prevention and control practices and personal protective equipment for healthcare workers when caring for patients with transmissible respiratory viral infections such as COVID-19. These findings also suggest a comparable risk associated with use of nasal prongs and HFNO in both environments.