N95 masks: skin changes in health professionals in northern Brazil / Máscaras N95: alterações de pele em profissionais de saúde do norte brasileiro / Mascarillas N95: alteraciones en la piel de profesionales de salud en el norte de Brasil

Resumo Objetivo Identificar os fatores associados ao uso de máscara N95 relacionados a alterações de pele entre profissionais de saúde do Norte do Brasil durante a pandemia de COVID-19. Métodos Estudo multicêntrico realizado na região Norte do Brasil no período de outubro a dezembro de 2020, com 1.684 profissionais de saúde que atuaram na assistência à saúde durante a pandemia da COVID-19. Os participantes foram convidados via mídias sociais e as informações coletadas eletronicamente foram armazenadas na plataforma Survey Monkey. Foi usada estatística descritiva para caracterização da amostra, testes de associação (Qui-quadrado), com nível de significância estatística em p < 0,05. Os fatores associados ao uso de máscara N95 relacionados a alterações de pele foram determinados por Regressão Logística Binária, nível de significância de 5% (α = 0,05). Resultados Profissionais de saúde do sexo masculino apresentaram 1,708 mais chances de ter alterações de pele. Outros fatores como, o período de troca de máscara N95, ter atuado em hospital de campanha para COVID-19, terapia intensiva, urgência e emergência e ter recebido alguma capacitação ou curso sobre o COVID-19 foram considerados protetores ao desenvolvimento de alterações de pele, enquanto os principais motivos de troca de máscara N95 foram a umidade, perda de vedação, contaminação, danificação (rasgo). Conclusão Concluiu-se que profissionais de saúde do sexo masculino apresentaram mais chances de ter alterações de pele relacionadas ao uso de máscaras N95. Destacaram-se os fatores protetores e torna-se relevante a realização de estudos de intervenção a fim explorar medidas para prevenção destes tipos de lesões.

Resumen Objetivo Identificar los factores asociados al uso de la mascarilla N95 relacionados con las alteraciones en la piel entre profesionales de salud del norte de Brasil durante la pandemia de COVID-19. Métodos Estudio multicéntrico realizado en la región Norte de Brasil, en el período de octubre a diciembre de 2020, con 1.684 profesionales de salud que actuaron en la asistencia a la salud durante la pandemia de COVID-19. Se convocó a los participantes a través de las redes sociales y la información recopilada electrónicamente fue guardada en la plataforma Survey Monkey. Se utilizó la estadística descriptiva para la caracterización de la muestra, pruebas de asociación (Ji-cuadrado), con un nivel de significación estadística de p < 0,05. Los factores asociados al uso de la mascarilla N95 relacionados con alteraciones en la piel fueron determinados por regresión logística binaria, nivel de significación del 5 % (α = 0,05). Resultados Profesionales de salud de sexo masculino tuvieron 1,708 más posibilidades de presentar alteraciones en la piel. Otros factores como el intervalo de tiempo entre los cambios de mascarillas N95, haber trabajado en hospitales de campaña para COVID-19, cuidados intensivos, urgencias y emergencias y haber realizado alguna capacitación o curso sobre COVID-19 fueron considerados protectores del surgimiento de alteraciones en la piel, mientras que los principales motivos para el cambio de la mascarilla N95 fueron la humedad, la pérdida del sellado, la contaminación y daños (rotura). Conclusión Se concluye que los profesionales de la salud de sexo masculino presentaron más probabilidades de tener alteraciones en la piel relacionadas con el uso de mascarillas N95. Se destacaron los factores protectores y resulta importante la realización de estudios experimentales con la finalidad de explorar medidas para la prevención de este tipo de lesiones.

Abstract Objective To identify the factors associated with N95 mask use related to skin changes among health professionals in northern Brazil during the COVID-19 pandemic. Methods This is a multicenter study carried out in northern Brazil, from October to December 2020, with 1,684 health professionals who worked in health care during the COVID-19 pandemic. Participants were invited via social media and the information collected electronically was stored on the Survey Monkey platform. Descriptive statistics were used to characterize the sample, association tests (chi-square), with statistical significance level at p < 0.05. Factors associated with N95 mask ruse elated to skin changes were determined by Binary Logistic Regression, significance level of 5% (α = 0.05). Results Male health professionals were 1.708 more likely to have skin changes. Other factors such as the N95 mask change period, having worked in a COVID-19 field hospital, intensive care, urgency and emergency and having received some training or course on COVID-19 were considered protective against the development of skin changes, while the main reasons for changing the N95 mask were humidity, loss of seal, contamination, damage (tear). Conclusion We concluded that male health professionals were more likely to have skin changes related to N95 mask use. The protective factors were highlighted and it is relevant to carry out intervention studies in order to explore measures to prevent these types of injuries.

Required Personal Protective Equipment for Prehospital Healthcare Provider in COVID-19 Pandemic: A Systematic Review

Aims. Coronavirus Disease 2019 (COVID-19) is a highly contagious disease, and a variety of personal protective equipment (PPE) has been recommended as preventive measures for prehospital emergency personnel, which has led to considerable challenges and a great confusion for the personnel. This review aims to identify different types of PPE required in the care of COVID-19 patients in prehospital emergency system.Material and methods. This study was carried out by searching through databases including: Pubmed, Proqust, Google Scholar, and Cinahl. All articles that recommended different types of PPE against COVID-19 and infectious diseases for prehospital emergency personnel were collected in a table.Results. After carrying out the initial search in the databases, 1,009 studies were obtained and then 16 articles were selected. The findings seem to suggest using equipment including: gloves, face shields (shield/goggles), protective clothes (medical jumpsuit/scrubs), surgical masks, N-95 masks, powered air purifying respirators (PAPR), hair covers, shoe covers and washing up the hands by the emergency medical service (EMS) personnel.Discussion. The scrutiny of the relevant studies showed that each of them advised the EMS personnel to use a number of PPE. The present study highlighted the fact that there are other components of the PPE which can be useful to them.Conclusion. This study identified the most appropriate PPE needed for prehospital emergency personnel against COVID-19, and it is believed that planning for adequate access to this equipment and training on how to use them can significantly help to reduce the infection among the personnel.

Awareness and Pragmatic Use of Respirators among Dental Healthcare Professionals during COVID-19 Pandemic: A Cross-sectional Study

Aim: This cross-sectional study intends to assess dental healthcare professionals' (DHCPs) knowledge and awareness of the proper use and reuse of respirators. Materials and methods: A hospital-based cross-sectional survey was conducted using a self-administered questionnaire adapted from the Centers for Disease Control and Prevention (CDC) guidelines regarding the use of respirators with the primary objective of cognizance regarding fit testing, use, reuse, and reprocessing. A total of 478 dental professionals, including 192 postgraduate (PG) students, 176 interns, and 110 teaching faculty, participated in the survey. Data were analyzed using descriptive statistics. Results: A cumulative assessment revealed that 56.9% of dental professionals signed in to use level III masks and 29.3% for N95/KN95 respirators. Amongst those individuals using respirators, only 2.9% have got fit testing done. 92.1% (n = 440) were clueless about the various fit testing methods. 75.7% of DHCPs chose rotation base reuse of respirators rather than extended use of respirators. Conclusion: Clear evidence of incognizance among dental professionals regarding respirator use may put the health care professional at risk of infection. The incorporation of respirator training in infection prevention and control programs should be a prerequisite for preventing cross-infection. Clinical significance: There is a definite need for regular training and educational programs among DHCPs on various infection control protocols with the incorporation of respirator training and the terms of use of the respirator. © The Author(s).

Physio-metabolic and clinical consequences of wearing face masks-Systematic review with meta-analysis and comprehensive evaluation.

Background: As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation. Methods: A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes. Results: We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, p < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31-0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01). Discussion: Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health. Conclusion: Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.

Nosocomial SARS-CoV-2 transmission in multi-bedded hospital cubicles over successive pandemic waves: Lower mortality but wider spread with Omicron despite enhanced infection-prevention measures.

BACKGROUND: Increased transmissibility of severe-acute-respiratory-syndrome-coronavirus-2(SARS-CoV-2) variants, such as the Omicron-variant, presents an infection-control challenge. We contrasted nosocomial transmission amongst hospitalized inpatients across successive pandemic waves attributed to the Delta- and Omicron variants, over a 9-month period in which enhanced-infection-prevention-measures were constantly maintained. METHODS: Enhanced-infection-prevention-measures in-place at a large tertiary hospital included universal N95-usage, routine-rostered-testing (RRT) for all inpatient/healthcare-workers (HCWs), rapid-antigen-testing (RAT) for visitors, and outbreak-investigation coupled with enhanced-surveillance (daily-testing) of exposed patients. The study-period lasted from 21st June 2021-21st March 2022. Chi-square test and multivariate-logistic-regression was utilized to identify factors associated with onward transmission and 28d-mortality amongst inpatient cases of hospital-onset COVID-19. RESULTS: During the Delta-wave, hospital-onset cases formed 2.7% (47/1727) of all COVID-19 cases requiring hospitalisation; in contrast, hospital onset-cases formed a greater proportion (17.7%, 265/1483; odds-ratio, OR = 7.78, 95%CI = 5.65-10.70) during the Omicron-wave, despite universal N95-usage and other enhanced infection-prevention measures that remained unchanged. The odds of 28d-mortality were higher during the Delta-wave compared to the Omicron-wave (27.7%, 13/47, vs. 10.6%, 28/265, adjusted-odds-ratio, aOR = 2.78, 95%CI = 1.02-7.69). Onward-transmission occurred in 21.2% (66/312) of hospital-onset cases; being on enhanced-surveillance (daily-testing) was independently associated with lower odds of onward-transmission (aOR = 0.18, 95%CI = 0.09-0.38). Costs amounted to $USD7141 per-hospital-onset COVID-19 case. CONCLUSION: A surge of hospital-onset COVID-19 cases was encountered during the Omicron-wave, despite continuation of enhanced infection-prevention measures; mortality amongst hospital-onset cases was reduced. The Omicron variant poses an infection-control challenge in contrast to Delta; surveillance is important especially in settings where infrastructural limitations make room-sharing unavoidable, despite the high risk of transmission.

Qualitative fit test outcomes for N95 filtering facepiece respirators in health care workers.

BACKGROUND: We analyzed the qualitative fit test results of the filtering facepiece respirators (FFRs) used at our institution to determine their performance and utility. METHODS: We retrospectively analyzed 12,582 qualitative fit testing results for several FFR models among 8,809 health care workers (HCWs). RESULTS: The overall failure rate for HCWs was 15.2%. Nearly one-third (2933/8809, 33.3%) had multiple FFRs fit tested. HCW sex was a statistically significant indicator of fit testing failure (χ2 = 29.9, df = 1, P < .001), with women having a 44% higher likelihood (OR, 1.4; 95% CI: 1.27-1.65) than men. There were statistically significant differences in the failure rate across FFRs (Fig 4, F[5, 12475] = 8.4, P < .001). Fluidshield 46867S had a significantly higher failure rate (49%) than the 3M 1860 (P = .012), 3M 1860S (P < .001), 3M 8210 (P < .001), and Safelife (P < .001) FFRs. CONCLUSIONS: There was a large degree of variation in fit testing results for the FFRs tested. Although we were unable to find an FFR that fit more than 95% of the HCWs successfully, we identified poorly functioning FFRs that can help our institution with decision-making and budgeting for acquisition and stocking appropriate FFRs.

The effect of N95 respirators on vital parameters, PETCO2, among healthcare providers at the pandemic clinics.

BACKGROUND: Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. AIMS: The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. METHODS: The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. RESULTS: Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). CONCLUSION: Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.

Pandemic reveals new concerns about facial protection products: Design may be the answer to altering behaviors, habits ushered into standard practice

The article examines what medical suppliers and providers learned about facial protection products after the Covid-19 pandemic of 2020-2022. Topics discussed include remarks from Jason Burnham, Senior Director of Facial Protection at Owens & Minor, evidence of pandemic-relaxed behaviors morphing into workflow acceptance, and statement from Gary Harris, Vice President of Sales and Marketing at Prestige Ameritech, about emergency use guidelines for personal protective equipment (PPE).

The Flow Physics of Face Masks

Although face masks have been used for over a century to provide protection against airborne pathogens and pollutants, close scrutiny of their effectiveness has peaked in the past two years in response to the COVID-19 pandemic. The simplicity of face masks belies the complexity of the physical phenomena that determine their effectiveness as a defense against airborne infections. This complexity is rooted in the fact that the effectiveness of face masks depends on the combined effects of respiratory aerodynamics, filtration flow physics, droplet dynamics and their interactions with porous materials, structural dynamics, physiology, and even human behavior. At its core, however, the face mask is a flow-handling device, and in the current review, we take a flow physics-centric view of face masks and the key phenomena that underlie their function. We summarize the state of the art in experimental measurements, as well as the growing body of computational studies that have contributed to our understanding of the factors that determine the effectiveness of face masks. The review also lays out some of the important open questions and technical challenges associated with the effectiveness of face masks.

Safe and effective re-use policy for high-efficiency filtering facepiece respirators (FFRS): Experience of one hospital during the Covid-19 pandemic in 2020.

The high transmissibility rate of the Severe Acute Respiratory Syndrome Coronavirus 2 facilitated an exponential growth in the number of infections, posing a tremendous threat to healthcare systems across the world. The use of Non-oil 95% efficiency (N95) respirators demonstrated to reduce the risk of virus transmission. The escalated demand in N95 respirators during 2020 generated a massive shortage worldwide which resulted in serious implications, one being an increase in healthcare providers' costs. In response, various optimization strategies were implemented. This study aimed to assess the implementation of a safe and effective re-use policy for high-efficiency filtering facepiece respirators (FFRs) in a high-complexity university hospital in 2020. Associated costs were estimated through a descriptive accounting analysis of resources saved. Acceptability, appropriateness, and feasibility rates were 80.5%, 78.8%, and 83.6%, respectively. With an implementation cost of approximately 10,000 USD, there was a 56.1% reduction in FFRs consumption, compared with a non-policy scenario, with savings exceeding 500,000 USD in 2020. In a pandemic scenario where it is vital to spare resources, a FFRs rational use policy demonstrated to be a highly cost-efficient alternative in order to save resources without increasing contagion risk among healthcare workers.

A Systematic Review of Whether the Use of N95 Respirator Masks Decreases the Incidence of Cardiovascular Disease in the General Population.

The usage of masks such as the N95 has increased exponentially worldwide. With the ever-increasing global rates of cardiovascular disease, it is vital that preventative measures are adopted to help tackle this crisis. N95 masks have been promoted as health prevention odysseys in the battle against viruses such as COVID-19. A systematic review was conducted on whether the N95 masks could help improve our cardiovascular health. Our data sources included PubMed, Medline and Scopus. Eleven studies met the eligibility criteria to be included in the review. N95 mask usage led to increased reports of dyspnoea, however, no significant effect was seen on blood pressure. N95 masks also showed improvement in aortic parameters. While encouraging results were yielded, further focussed studies on the use of N95 masks and the effect on various cardiovascular parameters would help strengthen the association.

New Masks, New Meanings: Covid Perspectives on African Art History: Part 1: Behind The Mask: African Art History in a Pandemic Era

An introduction is presented in which author discusses articles on topics including focuses on N95 masks which have none of panache of a fine masquerade performance, but they have gained the cultural force of a powerful masquerade society, drawing authority from spiritual and political sanction.

The adequacy of user seal checking for N95 respirators compared to formal fit testing: A multicentred observational study.

OBJECTIVE: The objective of this study was to evaluate the adequacy of the user seal check (USC) in predicting N95 respirator fit. DESIGN: This was a prospective, observational study conducted from May to September 2020. SETTING: The study setting included three private intensive care units (ICUs) in Victoria, Australia. PARTICIPANTS: ICU staff members in three private ICUs in Melbourne and regional Victoria participated in this study. MAIN OUTCOME MEASURES: The main outcome measure is the proportion of participants who passed a USC and subsequently failed fit testing of an N95 respirator. INTERVENTION: Three different respirators were available: two N95 respirator brands and CleanSpace HALO® powered air-purifying respirator. Participants were sequentially tested on N95 respirators followed by powered air-purifying respirators until either successful fit testing or failure of all three respirators. The first N95 tested was based on the availability on the day of testing. The primary outcome was failure rate of fit testing on the first N95 respirator type passing a USC. RESULTS: Of 189 participants, 22 failed USC on both respirators, leaving 167 available for the primary outcome. Fifty-one of 167 (30.5%, 95% confidence interval = 23.7-38.1) failed fit testing on the first respirator type used that had passed a USC. CONCLUSION: USC alone was inadequate in assessing N95 respirator fit and failed to detect inadequate fit in 30% of participants. Mandatory fit testing is essential to ensure adequate respiratory protection against COVID-19 and other airborne pathogens. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12620001193965.

Wearing a KN95/FFP2 facemask induces subtle yet significant brain functional connectivity modifications restricted to the salience network.

BACKGROUND: The use of facemasks is one of the consequences of the coronavirus disease 2019 (COVID-19) pandemic. We used resting-state functional magnetic resonance imaging (fMRI) to search for subtle changes in brain functional connectivity, expected notably related to the high-level salience network (SN) and default mode network (DMN). METHODS: Prospective crossover design resting 3-T fMRI study with/without wearing a tight FFP2/KN95 facemask, including 23 community-dwelling male healthy controls aged 29.9 ± 6.9 years (mean ± standard deviation). Physiological parameters, respiration frequency, and heart rate were monitored. The data analysis was performed using the CONN toolbox. RESULTS: Wearing an FFP2/KN95 facemask did not impact respiration or heart rate but resulted in a significant reduction in functional connectivity between the SN as the seed region and the left middle frontal and precentral gyrus. No difference was found when the DMN, sensorimotor, visual, dorsal attention, or language networks were used as seed regions. In the absence of significant changes of physiological parameter respiration and heart rate, and in the absence of changes in lower-level functional networks, we assume that those subtle modifications are cognitive consequence of wearing facemasks. CONCLUSIONS: The effect of wearing a tight FFP2/KN95 facemask in men is limited to high-level functional networks. Using the SN as seed network, we observed subtle yet significant decreases between the SN and the left middle frontal and precentral gyrus. Our observations suggest that wearing a facemask may change the patterns of functional connectivity with the SN known to be involved in communication, social behavior, and self-awareness.

Special Report: Humbled CDC Seeks Reinvention, Culture Change

The article reports that the U.S. Centers for Medicare and Medicaid Services (CDC) has taken responsibility for its haphazard response to the COVID-19 pandemic and is making changes, taking into consideration the recommendations by an independent consultant who conducted an internal review. Topics covered include the declining trust in the CDC during the pandemic, some of the mistakes that the CDC has made in its pandemic response, and the challenges that the agency is facing.

The impact of facemasks on blood donation process: The professionals' perspective.

Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.

Effects of Wearing N95 Respirators and Surgical Masks during Progressive Running Exercise and High-Intensity Interval Training on Time- and Frequency-Domain Indicators of Heart Rate Variability.

Background and purpose: Wearing face masks has become popular during the COVID-19 pandemic as a measure to prevent the spread of the virus. Some studies have pointed out the intervening role of these masks in the effect of exercise on the cardiovascular system. This study aimed at examining and comparing the effects of masking (N95 respirators and surgical masks) and not wearing a mask during exercise on heart rate variability (HRV) parameters. Materials and methods: In this semi-experimental design, 15 healthy women were randomly placed into three groups: surgical mask, N95 respirators and no mask. The participants took part in a progressive running session and then two weeks of HIIT program (2-4 sets, 20-60 seconds with 15-60 seconds of rest between repetitions and 3-5 minutes between the sets) with 80-90% of HRmax. The time and frequency-domain parameters of HRV were recorded during rest and recovery after exercises using electrocardiogram and then analyzed in Kubios HRV software. Results: Progressive running session before two weeks of HIIT training caused a significant decrease in parasympathetic time-domain parameter (RMSSD) and average RR in all groups in the fifth minute of recovery compared with rest values (P≤0.05). In addition, after HIIT training, sympathetic time domain (SDNN) parameter and average RR significantly increased (P=0.01 and P=0.02, respectively) while a significant decrease was seen in the sympathetic frequency-domain (LF) parameter in rest and recovery compared with baseline values (P=0.01). No significant differences were observed between the two masked groups in parameters studied (P=0.43). Conclusion: Increase in parasympathetic parameters and decrease in sympathetic parameters improved HRV. Wearing surgical masks or N95 respirators during exercise did not have an intervening effect on the positive results of exercise, including improving the autonomic function of the heart and maintaining sympathovagal balance in healthy women. [ FROM AUTHOR] Copyright of Journal of Mazandaran University of Medical Sciences (JMUMS) is the property of Mazandaran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Reuse during the COVID-19 Pandemic.

In response to the demand for N95 respirators by health care workers during the COVID-19 pandemic, we evaluated decontamination of N95 respirators using an aerosolized hydrogen peroxide (aHP) system. This system is designed to dispense a consistent atomized spray of aerosolized, 7% hydrogen peroxide (H₂O₂) solution over a treatment cycle. Multiple N95 respirator models were subjected to 10 or more cycles of respirator decontamination, with a select number periodically assessed for qualitative and quantitative fit testing. In parallel, we assessed the ability of aHP treatment to inactivate multiple viruses absorbed onto respirators, including phi6 bacteriophage, herpes simplex virus 1 (HSV-1), coxsackievirus B3 (CVB3), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For pathogens transmitted via respiratory droplets and aerosols, it is critical to address respirator safety for reuse. This study provided experimental validation of an aHP treatment process that decontaminates the respirators while maintaining N95 function. External National Institute for Occupational Safety & Health (NIOSH) certification verified respirator structural integrity and filtration efficiency after 10 rounds of aHP treatment. Virus inactivation by aHP was comparable to the decontamination of commercial spore-based biological indicators. These data demonstrate that the aHP process is effective, with successful fit-testing of respirators after multiple aHP cycles, effective decontamination of multiple virus species, including SARS-CoV-2, successful decontamination of bacterial spores, and filtration efficiency maintained at or greater than 95%. While this study did not include extended or clinical use of N95 respirators between aHP cycles, these data provide proof of concept for aHP decontamination of N95 respirators before reuse in a crisis-capacity scenario. IMPORTANCE The COVID-19 pandemic led to unprecedented pressure on health care and research facilities to provide personal protective equipment. The respiratory nature of the SARS-CoV2 pathogen makes respirator facepieces a critical protective measure to limit inhalation of this virus. While respirator facepieces were designed for single use and disposal, the pandemic increased overall demand for N95 respirators, and corresponding manufacturing and supply chain limitations necessitated the safe reuse of respirators when necessary. In this study, we repurposed an aerosolized hydrogen peroxide (aHP) system that is regularly utilized to decontaminate materials in a biosafety level 3 (BSL3) facility, to develop a method for decontamination of N95 respirators. Results from viral inactivation, biological indicators, respirator fit testing, and filtration efficiency testing all indicated that the process was effective at rendering N95 respirators safe for reuse. This proof-of-concept study establishes baseline data for future testing of aHP in crisis-capacity respirator-reuse scenarios.

Pandemic management requires exposure science.

COVID-19 was first detected in Wuhan, China, on 8.12.2019, and WHO announced it a pandemic on 11.3.2020. No vaccines or medical cures against COVID-19 were available in the first corona year. Instead, different combinations of generic non-pharmaceutical interventions - to slow down the spread of infections via exposure restrictions to 'flatten the curve' so that it would not overburden the health care systems, or to suppress the virus to extinction - were applied with varying levels of strictness, duration and success in the Pacific and North Atlantic regions. Due to an old misconception, almost all public health authorities dismissed the possibility that the virus would be transmitted via air. Opportunities to reduce the inhalation exposure - such as wearing effective FFP2/N95 respirators, improving ventilation and indoor air cleaning - were missed, and instead, hands were washed and surfaces disinfected. The fact that aerosols were acknowledged as the main route of COVID-19 transmission in 2021 opened avenues for more efficient and socially less disruptive exposure and risk reduction policies that are discussed and evaluated here, demonstrating that indoor air and exposure sciences are crucial for successful management of pandemics. To effectively apply environmental and personal exposure mitigation measures, exposure science needs to target the human-to-human exposure pathways of the virus.