Masks and respirators for prevention of respiratory infections: a state of the science review.

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

Quantification, characterization and risk assessment of microplastics from five major estuaries along the northern Bay of Bengal coast.

Microplastics (MPs) as hazardous contaminants has drawn the rapid attention of the general public due to their omnipresence and adverse impacts on ecosystems and human health. Despite this, understanding of MPs contamination levels in the estuarine ecosystems along the Bay of Bengal coast remains very limited. This research focused on the presence, spatial distribution, morpho-chemical characteristics and ecological implications of MPs in water and sediment from five key estuaries (Meghna, Karnaphuli, Matamuhuri, Bakkhali, and Naf rivers) within the Bengal delta. Out of the five estuaries, the Meghna exhibited the least amount of MPs in both surface water (150.00 ± 65.62 items/m3) and sediment (30.56 ± 9.34 items/kg). In contrast, the highest occurrence of MPs was recorded in Karnaphuli river water (350.00 ± 69.22 items/m3) and Matamuhuri river sediment (118.33 ± 26.81 items/kg). ANOVA indicated a statistically significant distinction (p < 0.01) among the examined estuaries. Most identified MPs were fibers and < 0.5 mm in size in both water and sediment samples. Transparent MPs were dominant in both water (42.28%) and sediment (45.22%). Besides violet, red, blue, pink and green colored MPs were also observed. Various polymer types, including PE, PP, PET, PS, Nylon, EVA, and ABS, were detected, with PE being the dominant one. Based on the polymer risk index (PHI), the estuaries were classified as hazard level V, signifying a severe level of MP contamination. However, the potential ecological hazardous index (PHI), potential ecological risk index (RI), and pollution load index (PLI) indicated moderate pollution levels. This study offers initial insights into the pollution caused by MPs in major estuaries of Bengal delta, which policymakers can utilize to implement suitable management strategies.

The burden of non-disabled frailty and its associated factors among older adults in Bangladesh.

OBJECTIVE: The present study aims to measure the prevalence of non-disabled frailty and its associated factors among Bangladeshi older adults. METHODS: This cross-sectional study was conducted during September and October 2021 among 1,045 Bangladeshi older adults (≥60 years). Telephone interviews, using a semi-structured questionnaire, were undertaken to collect data on participants' characteristics and level of frailty. The non-disabled frailty was measured using the 'Frail Non-Disabled (FiND)' questionnaire. A multinomial logistic regression model assessed the factors associated with frailty among the participants. RESULTS: Around a quarter of the participants (24.8%) were frail. The multinomial regression analysis showed that older participants aged ≥80 years (RRR = 3.23, 95% CI: 1.41-7.37) were more likely to be frail compared to participants aged 60-69 years. Likewise, the participants living in a large family with ≥4 members (RRR = 1.39, 95% CI: 1.01-1.92) were more likely to be frail compared to those living in smaller families. Also, participants having memory or concentration problems (RRR = 1.56, 95% CI: 1.12-2.17) were more likely to be frail compared to those who were not suffering from these problems. Moreover, participants whose family members were non-responsive to their day-to-day assistance (RRR = 1.47, 95% CI: 1.06-2.03) were more likely to be frail compared to those whose family members were responsive. Furthermore, participants who were feeling lonely (RRR = 1.45, 95% CI: 1.07-1.98) were more likely to be frail than their counterparts who were not feeling lonely. CONCLUSIONS: The findings of the present study suggest developing tailored interventions to address the burden of frailty among the older populations in Bangladesh. In particular, providing long-term care and health promotion activities can be of value in preventing frailty and reducing adverse health outcomes among this vulnerable population group.

Flow dynamics of droplets expelled during sneezing.

Respiratory infections transmit through droplets and aerosols generated by the infected individual during respiratory emissions. It is essential to study the flow dynamics of these emissions to develop strategies for mitigating the risk of infection. In particular, the dynamics of droplets expelled during violent exhalations such as sneezing is crucial, but has received little attention to date. Here, for the first time, we present the results of droplet dynamics of 35 sneezes, obtained from four volunteers, using particle tracking velocimetry experiments. Our results reveal a mean droplet velocity of 2-5.4 m/s across the different subjects. These values are significantly lower than what is usually assumed in the studies simulating or replicating sneezes. Furthermore, the large variation in droplet speeds, flow direction, spread angle, and head movement is also quantified. These findings will enable the refinement of models and simulations of sneezes toward improving infection control guidelines.

Experimental Evidence for the Optimal Design of a High-Performing Cloth Mask.

Cloth masks can be an alternative to medical masks during pandemics. Recent studies have examined the performance of fabrics under various conditions; however, the performance against violent respiratory events such as human sneezes is yet to be explored. Accordingly, we present a comprehensive experimental study using sneezes by a healthy adult and a tailored image-based flow measurement diagnostic system evaluating all dimensions of protection of commonly available fabrics and their layered combinations: the respiratory droplet blocking efficiency, water resistance, and breathing resistance. Our results reveal that a well-designed cloth mask can outperform a three-layered surgical mask for such violent respiratory events. Specifically, increasing the number of layers significantly increases the droplet blocking efficiency, on average by ∼20 times per additional fabric layer. A minimum of three layers is necessary to resemble the droplet blocking performance of surgical masks, and a combination of cotton/linen (hydrophilic inner layer)-blends (middle layer)-polyester/nylon (hydrophobic outer layer) exhibited the best performance among overall indicators tested. In an optimum three-layered design, the average thread count should be greater than 200, and the porosity should be less than 2%. Furthermore, machine washing at 60 °C did not significantly impact the performance of cloth masks. These findings inform the design of high-performing homemade cloth masks.

Droplets and Aerosols Generated by Singing and the Risk of Coronavirus Disease 2019 for Choirs.

Choral singing has become a major risk during the coronavirus disease 2019 (COVID-19) pandemic due to high infection rates. Our visualization and velocimetry results reveal that the majority of droplets expelled during singing follow the ambient airflow pattern. These results point toward the possibility of COVID-19 spread by small airborne droplets during singing.

Graphene- and Nanoparticle-Embedded Antimicrobial and Biocompatible Cotton/Silk Fabrics for Protective Clothing.

Protection against pathogens using personal protective equipment is essential yet challenging in healthcare settings. Concerns over emerging biothreats and outbreaks of infectious diseases underscore the need for antimicrobial and biocompatible protective clothing to protect patients and staff. Herein, we report the antimicrobial efficacy and cytotoxicity of cotton/silk fabrics containing embedded reduced graphene oxide (RGO) and Ag/Cu nanoparticles (NPs), prepared using a 3-glycidyloxypropyl trimethoxy silane coupling agent followed by chemical reduction and vacuum heat treatment. Embedding NPs on top of the RGO layer substantially increased the antimicrobial activity. All RGO-Ag NPs or RGO-Cu NPs embedded in cotton or silk fabrics reduced the viability of approximately 99% of the Gram-negative bacteria Escherichia coli and Pseudomonas aeruginosa. RGO-Ag NPs embedded into cotton or silk fabrics reduced the viability of the Gram-positive bacterium Staphylococcus aureus by 78-99%, which was higher than the growth inhibition by RGO-Cu NPs samples against S. aureus. Both silk and cotton containing RGO-Cu NPs produced a greater reduction in the viability of the yeast Candida albicans compared to RGO-Ag NPs fabrics. All RGO-Ag NPs or RGO-Cu NPs embedded in cotton or silk fabrics showed good washing durability by sustaining good bactericidal activity, even on washing up to 10 times. Moreover, none of the RGO-Ag or RGO-Cu fabrics reduced mammalian cells' (HEK293) viability by >30%, suggesting low cytotoxicity and good biocompatibility. These findings show that RGO-NPs embedded in cotton or silk fabrics have great potential for use in protective clothing and medical textiles.

Last-resort strategies during mask shortages: optimal design features of cloth masks and decontamination of disposable masks during the COVID-19 pandemic.

Face masks and respirators are the most widely used intervention measures for respiratory protection. In the wake of COVID-19, in response to shortages and lack of availability of surgical masks and respirators, the use of cloth masks has become a research focus. Various fabrics have been promoted with little evidence-based foundation and without guidelines on design principles for optimal performance. In these circumstances, it is essential to understand the properties, key performance factors, filter mechanisms and evidence on cloth masks materials. The general community might also need to decontaminate and reuse disposable, single-use devices as a last resort. We present an overview of the filter materials, filter mechanisms and effectiveness, key performance factors, and hydrophobicity of the common disposable masks, as well as cloth masks. We also reviewed decontamination methods for disposable respiratory devices. As an alternative to surgical masks and respirators, we recommend a cloth mask made of at least three layers (300-350 threads per inch) and adding a nylon stocking layer over the mask for a better fit. Water-resistant fabrics (polyesters/nylon), blends of fabrics and water-absorbing fabrics (cotton) should be in the outside layer, middle layer/layers and inside layer, respectively. The information outlined here will help people to navigate their choices if facing shortages of appropriate respiratory protection during the COVID-19 pandemic.

Graphene Modified Multifunctional Personal Protective Clothing.

Personal protective clothing is intended to protect the wearer from various hazards (mechanical, biological, chemical, thermal, radiological, etc.) and inhospitable environmental conditions that may cause harm or even death. There are various types of personal protective clothing, manufactured with different materials based on hazards and end user requirements. Conventional protective clothing has impediments such as high weight, bulky nature, lack of mobility, heat stress, low heat dissipation, high physical stress, diminishing dexterity, diminishing scope of vision, lack of breathability, and reduced protection against pathogens and hazards. By virtue of the superlative properties of graphene, fabrics modified with this material can be an effective means to overcome these limitations and to improve properties such as mechanical strength, antibacterial activity, flame resistance, conductivity, and UV resistance. The limitations of conventional personal protective equipment are discussed, followed by necessary measures which might be taken to improve personal protective equipment (PPE), the unique properties of graphene, methods of graphene incorporation in fabrics, and the current research status and potential of graphene-modified performance textiles relevant to PPE.

Reinforcement of Gelatin-Based Nanofilled Polymer Biocomposite by Crystalline Cellulose from Cotton for Advanced Wound Dressing Applications.

This study is designed to extract crystalline cellulose from cotton and reinforcing gelatin film for biomedical applications, especially as a wound dressing material for its exceptional biocompatibility and bio-activity. Moreover, gelatin helps in wound healing and crystalline cellulose as additive can improve its properties. Crystalline cellulose was prepared through hydrolysis and the effects of crystalline cellulose loading on the morphology, mechanical properties, and water sensitivity of the nanocomposite were investigated by means of scanning electron microscopy, tensile strength testing, and water absorption testing. Developed biocomposite film showed homogeneous dispersion of crystalline cellulose within the gelatin matrix and strong interfacial adherence between the matrix and reinforcement. Samples were tested for biocompatibility and in vitro cytotoxicity and found to have excellent biocompatibility without having any cytotoxicity. In vivo wound healing study in an animal model showed 40% increased healing than the model dressed by conventional dressing.