Response and Adaptation of the Cardiac Autonomic System to Functional High-intensity Interval Training with Respiratory Facemasks: Impacts of the Training Period and Facemask Modality During a COVID-19 Pandemic

Background: Following the SARS-CoV-2 pandemic in 2019, medical face masks were widely recommended for large numbers of people and for long periods of time. The effect of wearing surgical and N95 face masks during long-term high-intensity interval training on the cardiac autonomic system has not been reported. Methods: Eighteen healthy men were randomly divided into three groups (surgical mask, N95 mask, and no mask) and performed high-intensity interval training with (80-90%-heart rate max) intensity three times a week, three repetitions in a session for four weeks. Heart rate variability parameters were evaluated with an electrocardiogram device and Kubius software. The R-R interval was recorded for 5 minutes in a sitting position in the pre-and post-modified Bruce test before and after four weeks of interval training to extract parasympathetic (RMSSD, HF, SD1), sympathetic indices (LF, LF/HF) and RR mean. We used the two-way ANOVA test and the Bonferroni post hoc test. Results: In all groups, four-week functional HIIT exercises increased the resting parasympathetic indices (RMSSD, SD1) compared to baseline levels. This increase was more evident in the N95 mask group than in the surgical mask group. In addition, the five-minute recovery of the cardiac autonomic system after a modified Bruce test following functional HIIT exercise increased parasympathetic tone (RMSSD, HFn.u) in all groups compared to baseline levels. Therefore, a four-week adaptation to HIIT exercises leads to faster recovery of sympathetic indices (LFn.u, LF/HF) in the Nomask group, as compared to the surgical and N95 groups. Despite the above, there was no significant difference in the recovery and resting values of cardiac autonomic system indices between the two types of surgical masks and N95 compared to the control group (No mask). Conclusions: Four weeks of high-intensity interval training using surgical and N95 face masks improved the cardiac autonomic nervous system. This data is important for recommending the use of face masks during physical activity. © 2023, Author(s).

Surface Contamination of Reusable Respirators and Face Shields During Care of Critically Ill COVID-19 Patients.

BACKGROUND: With the emergence of SARS-CoV-2, healthcare workers (HCW) have relied on reusable personal protective equipment (PPE), including respirators and face shields (FSs). The effectiveness of decontamination procedures outside experimental settings is unclear. We examined the prevalence of surface contamination on reusable PPE used by HCWs at a hospital incorporating daily centralized decontamination and post-use wiping by sampling for common pathogens. METHOD: Samples were collected from HCWs' CleanSpace Halo respirator face masks (FMs) and FSs at the start of shift, immediately after use, and after cleaning with disinfecting wipes. Samples were analyzed for pathogens using the Applied Biosystems™ TaqPath™ COVID-19 Combo Kit and ThermoFisher TaqMan Array Card. Patient charts were reviewed for clinical correlation. FINDINGS: Of the 89 samples, 51 from FMs and 38 from FSs, none tested positive for SARS-CoV-2, despite 58 being obtained from PPE used in the care of patients with COVID-19, many with recent aerosol-generating procedures. Four samples tested positive (4.5%) for Staphylococcus aureus, two each from FMs and FSs. FMs that tested positive were not worn concurrently with FSs that tested positive. The FM and FS samples testing positive were worn in the care of patients without diagnosed S. aureus infection. No FMs tested positive following wipe-based disinfection, but both positive FS samples were found after disinfection wiping. CONCLUSION/APPLICATION TO PRACTICE: Contamination of reusable PPE appears uncommon, especially with SARS-CoV-2, when regular decontamination programs are in place. The rare presence of S. aureus highlights the importance of doffing procedures and hand hygiene by HCW to prevent surface contamination.

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).

Willingness to Work amongst Australian Frontline Healthcare Workers during Australia's First Wave of Covid-19 Community Transmission: Results of an Online Survey.

OBJECTIVES: The majority of research investigating healthcare workers' (HCWs) willingness to work during public health emergencies, asks participants to forecast their perceptions based on hypothetical emergencies, rather than in response to the actual public health emergencies they have experienced. This research explored frontline HCWs willingness to work during Australia's first wave of the COVID-19 pandemic among frontline HCWs. METHODS: Participants (n = 580) completed an online questionnaire regarding their willingness to work during the pandemic. RESULTS: A total of 42% of participants reported being less willing to work during the pandemic compared to before. Availability of personal protective equipment (PPE), concern expressed by family members, and viral exposure were significant barriers. A third of participants disagreed that some level of occupational risk for exposure to infectious disease was acceptable while a quarter of participants had received communications from their workplace concerning obligations to work during COVID-19. CONCLUSIONS: The COVID-19 pandemic has impacted Australian frontline HCWs' willingness to work. Scarcity of PPE and exposure to the virus were the most cited reasons impacting on willingness to work. Appropriate policies and practices should be implemented and communicated efficiently to frontline HCW's. This research provides insight into the lived experiences of Australian healthcare professionals' willingness to work during a pandemic.

Experience of using an adapted snorkel mask as personal protective equipment in the COVID-19 pandemic

Introduction: During the COVID-19 pandemic and the cases of shortages of personal protective equipment (PPE), the utilization of modified snorkel masks has been documented, seeking to provide respiratory and facial pro-tection against SARS-CoV-2 aerosols. However, there is no report of changes in vital signs that can occur with its use, along with the perception of its wear by health personnel. Method(s): A case series was performed. Equipment: Snorkel mask, 3D adapter, and antimicrobial filter. CO2 level, respiratory rate, oximetry, pulse, and blood pressure were monitored for one hour. During the time of use, activities related to patient care were simulated. At the end, the usage characteristics were evaluated through a survey. Result(s): 14 volunteers were included in the study. After one hour of conti-nuous use, the clinical parameters were predominantly normal. 85% of the participants preferred this modified snorkel mask instead of personal protective equipment established for COVID-19 (goggles, N95 mask and visor). Conclusion(s): The adapted snorkel mask could be an alternative to PPE equipment in situations of scarce resources. This is only considered within the framework of its acceptability by a group of health professionals, in addition to the few effects on the vital signs evaluated in this case series. Further objective evaluations of usability and effectiveness are required. Copyright © 2023 Universidad de Antioquia.

Functional analysis of a negative pressure airborne infection isolation canopy unit for the prevention of transmission of droplets and aerosols- An experimental study.

Background and Aims: This study describes the functional analysis of a negative pressure canopy unit developed to reduce infective aerosol and droplet spread in ad-hoc wards created to handle patients suffering from infective respiratory illnesses such as those recently encountered in the COVID-19 pandemic. Methods: An experimental study was conducted to verify the functional analysis of a canopy unit for the following variables: a) Quantitative and qualitative analysis of aerosol generation, b) Efficacy of canopy as containment device and c) Aerosol clearance from canopy over a period. We describe the process in the form of a problem statement, a discussion of design considerations (including Computer Aided Design modelling and a functional analysis of the system using a variety of simulated conditions which included various experiments for the purpose of testing the safety and efficiency of the system. We also incorporated Computational Fluid Dynamics analyses to assist us in design modifications of the unit using Euler-Lagrange approach for aerosol tracking. Results: As demonstrated by the series of experiments, it was seen that the aerosol load under the testing conditions reduced significantly. The canopy unit restricted the aerosol particles which either got adhered to the canopy walls or went into recirculation inside the canopy. In experimental conditions, the fan-filter unit was able to operate at >95% efficiency. Conclusion: This device exhibited 95-99% efficiency in eliminating aerosols which would reduce the exposure of health care workers to infective aerosols, which is not only specific to severe acute respiratory syndrome coronavirus (SARS-CoV)-2, but also to other airborne transmitted diseases.

How Are You Feeling? Interpretation of Emotions through Facial Expressions of People Wearing Different Personal Protective Equipment: An Observational Study.

(1) Background: The perception of others' emotions based on non-verbal cues, such as facial expressions, is fundamental for interpersonal communication and mutual support. Using personal protection equipment (PPE) in a work environment during the SAR-CoV-2 pandemic challenged health professionals' ability to recognise emotions and expressions while wearing PPE. The working hypothesis of this study was that the increased limitation of facial visibility, due to the use of a personal protective device, would interfere with the perception of basic emotions in the participants. (2) Methods: Through a cross-sectional descriptive study, the present research aimed to analyse the identification of four basic emotions (happiness; sadness; fear/surprise; and disgust/anger) through three types of PPE (FFP2 respirator, protective overall and powered air-purifying respirator (PAPR)), by using 32 photographs. The study was conducted using volunteer participants who met the inclusion criteria (individuals older than 13 without cognitive limitations). Participants had to recognise the emotions of actors in photographs that were randomly displayed in an online form. (3) Results: In general, the 690 participants better recognised happiness and fear, independently of the PPE utilised. Women could better identify different emotions, along with university graduates and young and middle-aged adults. Emotional identification was at its worst when the participants wore protective overalls (5.42 ± 1.22), followed by the PAPR (5.83 ± 1.38); the best scores were obtained using the FFP2 masks (6.57 ± 1.20). Sadness was the least recognised emotion, regardless of age. (4) Conclusions: The personal protective devices interfere in the recognition of emotions, with the protective overalls having the greatest impact, and the FFP2 mask the least. The emotions that were best recognised were happiness and fear/surprise, while the least recognised emotion was sadness. Women were better at identifying emotions, as well as participants with higher education, and young and middle-aged adults.

Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing.

BACKGROUND: Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission. METHODS: Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence. RESULTS: Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected. CONCLUSIONS: DHCP self-contamination was common with both donning and doffing PPE. PRACTICAL IMPLICATIONS: Proper use of PPE is an important component of occupational health.

Association of headgear mandate and concussion injury rates in girls' high school lacrosse.

OBJECTIVES: Headgear use is a controversial issue in girls' lacrosse. We compared concussion rates among high school lacrosse players in an American state with a headgear mandate (HM) to states without an HM. METHODS: Participants included high schools with girls' lacrosse programmes in the USA. Certified athletic trainers reported athlete exposure (AE) and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019-2021 seasons. The HM cohort was inclusive of high schools from the state of Florida, which mandates the use of ASTM standard F3137 headgear, while the non-HM (NHM) cohort was inclusive of high schools in 31 states without a state-wide HM. Incidence rate ratios (IRRs) and 95% CIs were calculated. RESULTS: 141 concussions (HM: 25; NHM: 116) and 357 225 AEs were reported (HM: 91 074 AEs; NHM: 266 151 AEs) across all games and practices for 289 total school seasons (HM: 96; NHM: 193). Overall, the concussion injury rate per 1000 AEs was higher in the NHM cohort (0.44) than the HM cohort (0.27) (IRR=1.59, 95% CI: 1.03 to 2.45). The IRR was higher for the NHM cohort during games (1.74, 95% CI: 1.00 to 3.02) but not for practices (1.42, 95% CI: 0.71 to 2.83). CONCLUSIONS: These findings suggest a statewide HM for high school girls' lacrosse is associated with a lower concussion rate than playing in a state without an HM. Statewide mandates requiring ASTM standard F3137 headgear should be considered to reduce the risk of concussion.

Management of aerosol generation during upper gastrointestinal endoscopy.

In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.

Effect of surgical and N95 facial masks on exercise tolerance, heart rate, respiratory rate and blood oxygen saturation

Background - Although wearing masks is inevitable these days, the effects of wearing them on physiologic parameters have not been reported. This study aimed to assess the effects of wearing no mask, a three-layer standard surgical mask, and wearing an N95 mask on blood oxygen saturation, aerobic tolerance, and performance during exercise. Methods - Twenty-one participants were enrolled in the study. Each participant was monitored with electrocardiography (ECG) while performing an exercise tolerance test using the Bruce treadmill protocol. Testing was conducted three times on different dates. Participants did not use any mask in the first test but did wear surgical and N95 masks during the second and third tests respectively. Respiratory rate (RR) was assessed for 10 seconds and then multiplied by 6. Heart rate (HR) was monitored by ECG, and oxygen saturation levels were monitored (O2Sat) via digital pulse-oximetry. Assessments were done before warm-up, at the middle and end of each Bruce stage, and as well at 1, 2, and 5 minutes into recovery (masks were worn during recovery). Results - HR, RR, and O2Sat measured data were all significantly different between the three trials at end-stage 3 of Bruce treadmill protocol (p<0.05). Although HR was still higher through the recovery period in the N95 trial in comparison with other trials (p<0.05), RR and O2Sat measured data were not different in the recovery phase. Conclusion - HR, RR, O2Sat and exercise tolerance are significantly affected by wearing surgical and N95 masks.

Prevention of droplet dispersal with 'e-mask': A new daily use endoscopic mask during bronchoscopy.

BACKGROUND AND OBJECTIVE: Bronchoscopy is an airborne particle-generating procedure. However, few methods for safe bronchoscopy have been developed. To reduce airborne particles during bronchoscopy, we created an 'e-mask', which is a simple, disposable mask for patients. Our objective was to evaluate the e-mask's protective ability against airborne particles and to assess respiratory adverse events and complications. METHODS: Patients with stage 2-4 chronic obstructive pulmonary disease were excluded. We performed visualization and quantifying experiments on airborne particles with and without the e-mask. We prospectively evaluated whether wearing the e-mask during bronchoscopy was associated with the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, and patients with >45 mm Hg end-tidal carbon dioxide (EtCO2 ) elevation, in addition to complications, compared to historical controls. RESULTS: In the visualization experiment, more than ten thousand times of airborne particles were generated without the e-mask than with the e-mask. The volume of airborne particles was significantly reduced with the e-mask, compared to that without the e-mask (p = 0.011). Multivariate logistic regression analysis revealed that wearing the e-mask had no significant effect on the incidence of patients requiring >5 L/min oxygen to maintain >90% oxygen saturation, (p = 0.959); however, wearing the e-mask was a significant factor in >45 mm Hg EtCO2 elevation (p = 0.026). No significant differences in complications were observed between the e-mask and control groups (5.8% vs. 2.5%, p = 0.395). CONCLUSION: Wearing the e-mask during bronchoscopy significantly reduced the generation of airborne particles during bronchoscopy without increasing complications.

Fiber-Based Masks and Respirators: Using Decontamination Methods and Antimicrobial Treatment to Improve Its Reusability during Pandemic

Shortage of personal protective equipment (PPE) is often projected in response to public health emergencies such as infection outbreaks and pandemics. Respiratory protective devices (RPDs), namely medical face masks and respirators, are considered the last defense for the front-line healthcare workers. Cleaning, decontamination and reuse of the disposable RPDs have been accepted by local health authorities during the pandemic period. To contribute to the mitigation of RPD shortage and ensure the safe adoption of decontamination protocols, this review discusses the regulated testing standards and the most commonly studied decontamination methods in the literature. The reuse of RPDs must fulfill three criteria: remove the microbial thread, maintain original function and structural integrity (including fitting tests) and leave no harmful residuals. Decontamination methods such as ultraviolet germicidal irradiation, moist heat and vaporized hydrogen peroxide appeared to be the most promising methods in balancing the above-mentioned criteria. However, the effectiveness of decontamination methods varies depending on the RPDs’ models, materials and design. Therefore, the adoption of protocols needs to be evidence-based with full validation in the local institutes. Additionally, new technology such as antimicrobial treated PPE that can reduce the risks of fomite during donning and doffing process with an extended lifespan should be encouraged. Overall, good training and guidance for appropriate reuse of RPDs are fundamental to ensure their efficiency in protecting front-line healthcare workers.

Evaluation of the Microbiological Effectiveness of Three Accessible Mask Decontamination Methods and Their Impact on Filtration, Air Permeability and Physicochemical Properties.

The need to secure public health and mitigate the environmental impact associated with the massified use of respiratory protective devices (RPD) has been raising awareness for the safe reuse of decontaminated masks by individuals and organizations. Among the decontamination treatments proposed, in this work, three methods with the potential to be adopted by households and organizations of different sizes were analysed: contact with nebulized hydrogen peroxide (H2O2); immersion in commercial bleach (NaClO) (sodium hypochlorite, 0.1% p/v); and contact with steam in microwave steam-sanitizing bags (steam bag). Their decontamination effectiveness was assessed using reference microorganisms following international standards (issued by ISO and FDA). Furthermore, the impact on filtration efficiency, air permeability and several physicochemical and structural characteristics of the masks, were evaluated for untreated masks and after 1, 5 and 10 cycles of treatment. Three types of RPD were analysed: surgical, KN95, and cloth masks. Results demonstrated that the H2O2 protocol sterilized KN95 and surgical masks (reduction of >6 log10 CFUs) and disinfected cloth masks (reduction of >3 log10 CFUs). The NaClO protocol sterilized surgical masks, and disinfected KN95 and cloth masks. Steam bags sterilized KN95 and disinfected surgical and cloth masks. No relevant impact was observed on filtration efficiency.

Analysis and Prediction of COVID-19 datasets using Machine Learning Algorithms

The devastating spread caused by Severe Acute Respiratory Disorder - Coronavirus (SARS-CoV-2) which is also known as COVID-2019 has brought global threat to our society. Every country is making immense efforts to stop the spread of the deadly disease through the use of finance, infrastructure and data sources, as well as protective devices, life-risk treatments, as well as other sources. Researchers studying artificial intelligence focus their skills to create mathematical models for studying the scourge of this disease using and shared data. In order to improve the wellbeing of our society. This article proposes using model of deep and machine-learning to understand its daily exponential behavior, as well as the prediction of the future impact of the COVID-2019 across nations using the live data of the Johns Hopkins dashboard © 2022 IEEE.

An Emergency Powered Air-Purifying Respirator From Local Materials and its Efficacy Against Aerosolized Nanoparticles.

We describe an approach used by a rural healthcare provider to convert surgical helmets into emergency powered air-purifying respirators (PAPRs) at the onset of the COVID-19 pandemic. The approach uses common materials and efficacy was demonstrated against aerosols measuring 7 nm to 25 µm in diameter.

The effect of respiratory protective masks on ventilatory efficiency and operating lung volumes in a recreational runner

We evaluated the effect of different respiratory protective masks (RPM) on ventilatory efficiency and operating lung volumes in a recreational runner. A healthy 36-years-old male runner underwent a pulmonary function test and cardiorespiratory exercise test with different RPM types and no mask (NM). Lung volumes and airflow resistance were similar regarding surgical and 3D knit masks compared to NM. Lower functional vital capacity and forced expiratory volume in 1 second were observed for N95 compared to NM. Regarding ventilatory efficiency analysis, lower values for VE/VCO2 slope in the interval at rest-respiratory compensation point and at rest-peak of exercise were observed for the surgical, 3D knit, and N95 masks compared to NM. Tidal flow volume loop analysis showed an increase in end-expiratory lung volume (EELV) in the interval 80% of the ventilatory anaerobic threshold-peak of exercise, while there was a decrease with NM. Lower VO2max was observed for surgical, 3D knit, and N95 masks compared to NM and lower speed at VO2max. The athlete reported greater comfort with 3D knit compared to surgical and N95 masks. The use of different RPM types during a progressive running exercise by a recreational runner showed lower ventilatory response and exercise tolerance, as well as increased EELV, perceived exertion, and respiratory discomfort. © 2021 Edizioni Minerva Medica. All rights reserved.