Benchtop assessment of sealing efficacy and breathability of additively manufactured (AM) face masks

The onset of the 2019 novel coronavirus disease (COVID-19) led to a shortage of personal protective equipment (PPE), medical devices, and other medical supplies causing many stakeholders and the general public alike to turn to additive manufacturing (AM) as a stopgap when normally accessible devices were not available. However, without a method to test these AM constructs, there continued to be a disconnect between AM suppliers and the community's needs. The objective of this study was to characterize the pressure drop and leakage of four different publicly available AM face mask models with two filter material combinations, as well as to investigate the impact of frame modification techniques including the use of foam strips and hot-water face forming to improve fit when the masks are donned on manikin head forms. AM face mask frame designs were downloaded from public repositories during the early stages of the COVID-19 pandemic. AM face masks were fabricated and tested on manikin head forms within a custom chamber containing dry aerosolized NaCl. Pressure drops, particle penetration, and leakage were evaluated for various flow rates and NaCl concentrations. Results indicated that filter material combination and frame modification played a major role in the overall performance of the AM face masks studied. Filter material combinations showed improved performance when high filtration fabric was used, and the cross-sectional area of the fabric was increased. AM frame modifications appeared to improve AM face mask leakage performance by as much as 69.6%.

Evaluation of Ventilation with Nasal Versus Face Mask After General Anesthesia Induction in Pediatric Patients

Background

Because of some difficulties during face mask ventilation in unconscious patients, such as upper airway obstruction patients, we conducted this study to compare nasal and face mask ventilation during general anesthesia induction.

Methods

In this clinical trial study, 70 patients between 3 and 12 years old undergoing elective lower abdominal surgery with general anesthesia were randomly divided into two groups. After administration of induction agents, one group was ventilated with the face mask and 100% oxygenation in three minutes and the other with the nasal mask. The mean expiratory volume, airway pressure, end-tidal CO₂ (EtCO₂), blood oxygen saturation (SpO₂), and hemodynamic factors were recorded and compared in the baseline, two minutes after mask ventilation, and five minutes after intubation.

Results

The mean EtCO₂ in the second minute after ventilation was significantly higher in the nasal mask group than in the face mask group (P = 0.04). However, in the fifth minute after intubation, there was no significant difference between the two groups (P = 0.31). Other factors related to ventilation did not significantly differ between the two groups.

Conclusions

It can be concluded that nasal mask ventilation is as effective as facial mask ventilation. The nasal mask can replace the face mask if there is difficult face mask ventilation or airway obstruction.

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

OBJECTIVES

To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak.

DESIGN

Systematic review and narrative synthesis of observational studies.

DATA SOURCES

We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies.

STUDY SELECTION

We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ('social distancing') during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included.

DATA EXTRACTION AND SYNTHESIS

We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively.

RESULTS

Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains.

CONCLUSIONS

Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

Feasibility of face mask spirometry during decannulation in head and neck surgery: prospective cohort study

OBJECTIVES

To analyze the relationship between spirometric parameters measured with a face mask versus a mouthpiece, as well as the feasibility of face mask spirometric evaluation in a head and neck surgery (HNS) decannulation context. Furthermore, we examine peak inspiratory flow (PIF) cut-off values before and after decannulation.

DESIGN

Prospective cohort study.

SETTING

Otolaryngology HNS Department of a University teaching hospital.

PARTICIPANTS

Twenty-four patients were selected. A maximal flow-volume loop was conducted before (with mouthpiece) and after (with mouthpiece and face mask) decannulation.

MAIN OUTCOME MEASURES

Recorded outcomes were forced vital capacity (FVC), forced expiratory volume in the first second, peak expiratory flow, PIF, forced expiratory flow at 50% of FVC and forced inspiratory flow at 50% of FVC. Spearman correlation coefficients between spirometric parameters measured with a face mask versus a mouthpiece were calculated. Wilcoxon test was used to check differences between mouthpiece and face mask values.

RESULTS

Correlation between mouthpiece and face mask spirometric values was moderate to high (r = 0.46 to 0.95). All parameters measured by spirometry were significantly lower with a face mask than those obtained with a mouthpiece (p < 0.05). Before decannulation, the lowest PIF value (tested with mouthpiece) that allowed successful decannulation was 1 L/s. After decannulation, the lowest PIF value tested with mouthpiece and face mask for successful completion of the decannulation process were 0.77 and 0.56 L/s, respectively.

CONCLUSION

Face mask is a feasible option to perform a spirometry when face diseases hinder spirometric evaluation through a mouthpiece in an HNC surgery context.

Face masks on Instagram: an analysis of public health authorities' guidance toward prevention

Instagram (IG) has been used as a health promotion tool by national and international sanitary authorities to tackle COVID-19. The profile of the World Health Organization (WHO) on IG contributed to spread and update information on the new coronavirus prevention This study focus attention on a non-pharmaceutical control measure (face mask in the community) and discusses the adaptation of health authorities from Portugal and Brazil to WHO guidelines on this topic, and how they passed them to citizens. A content analysis of posts from WHO, Portuguese National Health Service (NHS), and the Brazilian Ministry of Health (MH) profiles on IG was carried out, in the first 100 days of the pandemic. The sample is composed of 65 posts - WHO (12), NHS (36) and, MH (17). NHS highlights masks in 8,8% of posts and MH in 3,3%. WHO guidelines followed scientific evidence and prioritized the surgical masks, while NHS and MH adapted the guidelines to regional scenarios (community transmission and difficulty to social distancing) and produced information on non-surgical masks. NHS recommends the use of certified non-surgical masks. MH diverged from WHO guidelines and advised cloth masks. NHS has adopted the preventive approach and the use of celebrities to stress the importance of following its guidelines. MH adopted an institutional approach to encourage adherence to the instructions. Both profiles offered incomplete content on the production, use, disposal, and maintenance of masks.

Photopolymerizable, Universal Antimicrobial Coating to Produce High-Performing, Multifunctional Face Masks

COVID-19 poses a major threat to global health and socioeconomic structures, and the need for a highly effective, antimicrobial face mask has been considered a major challenge for protection against respiratory diseases. Here, we report the development of a universal, antiviral, and antibacterial material that can be dip-/spray-coated over conventional mask fabrics to exhibit antimicrobial activities. Our data shows that antimicrobial fabrics rapidly inactivated multiple types of viruses, i.e., human (alpha/beta) coronaviruses, the influenza virus, and bacteria, irrespective of their modes of transmission (aerosol or droplet). This research provides an immediate method to contain infectious diseases, such as COVID-19.

Rapid Implementation of a Statewide Observational Surveillance System to Monitor Wearing of Face Masks in Public Spaces

This report describes the rapid implementation of a statewide observational surveillance program to monitor the public's wearing of face masks in public spaces during community spread of Coronavirus disease 2019 (COVID-19). It describes how the Hawai'i State Department of Health partnered with University of Hawai'i faculty to develop and implement the surveillance program. The surveillance program involved organizing volunteers to conduct weekly direct observations in designated locations. A smartphone application (app) was created to record real-time observational surveillance data. From September 5, 2020, to March 13, 2021, a total of 84 577 observations were conducted across the state. Eighty-three percent of those observed were correctly wearing a face mask, 7% were wearing a face mask incorrectly, and 10% were not wearing a mask. Following the 2-week pilot phase of the project, volunteers were surveyed regarding facilitators and barriers for conducting observations and motivations for volunteering. Feedback was used to refine project procedures. With few states having implemented such a surveillance program, the information reported in this article may inform communities interested in tracking mask-wearing behaviors in the context of the COVID-19 pandemic.

Social Distancing and Transmission-reducing Practices during the 2019 Coronavirus Disease and 2015 Middle East Respiratory Syndrome Coronavirus Outbreaks in Korea

BACKGROUND

The absence of effective antiviral medications and vaccines increased the focus on non-pharmaceutical preventive behaviors for mitigating against the coronavirus disease 2019 (COVID-19) pandemic. To examine the current status of non-pharmaceutical preventive behaviors practiced during the COVID-19 outbreak and factors affecting behavioral activities, we compared to the 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in Korea.

METHODS

This was a serial cross-sectional population-based study in Korea with four surveys conducted on June 2 and 25, 2015 (MERS-CoV surveys), and February 4, and April 2, 2020 (COVID-19 surveys). Of 25,711 participants selected using random digit dialing numbers, 4,011 participants (aged ≥ 18 years) were successfully interviewed, for the 2020 COVID-19 (n = 2,002) and 2015 MERS-CoV (n = 2,009) epidemics were included. Participants were selected post-stratification by sex, age, and province. The total number of weighted cases in this survey equaled the total number of unweighted cases at the national level. We measured the levels of preventive behaviors (social distancing [avoiding physical contact with others]), and practicing transmission-reducing behaviors such as wearing face mask and handwashing.

RESULTS

Between the surveys, respondents who reported practicing social distancing increased from 41.9%-58.2% (MERS-CoV) to 83.4%-92.3% (COVID-19). The response rate for the four surveys ranged between 13.7% and 17.7%. Practicing transmission-reducing behaviors (wearing face masks and handwashing) at least once during COVID-19 (78.8%, 80.2%) also increased compared to that during MERS-CoV (15.5%, 60.3%). The higher affective risk perception groups were more likely to practice transmission-reducing measures (adjusted odds ratio, 3.24-4.81; 95 confidence interval, 1.76-6.96) during both COVID-19 and MERS-CoV.

CONCLUSION

The study findings suggest markedly increased proportions of non-pharmaceutical behavioral practices evenly across all subgroups during the two different novel virus outbreaks in Korea. Strategic interventions are needed to attempt based on preventive behavior works.

Particulate-Matter Related Respiratory Diseases

Particulate matter (PM) is suspended dust that has a diameter of <10 µm and can be inhaled by humans and deposited in the lungs, particularly the alveoli. Recent studies have shown that PM has an adverse effect on respiratory diseases. The aim of this article is to review respiratory diseases associated with PM. According to existing studies, PM is associated with chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases and increases the mortality rates of these diseases. Moreover, increased exposure in the high concentration of atmospheric PM is associated with the development of lung cancer. The most simple and common way to protect an individual from airborne PM is to wear a face mask that filters out PM. In areas of high concentration PM, it is recommended to wear a face mask to minimize the exposure to PM. However, the use of N95 or KF94 masks can interfere with respiration in patients with chronic respiratory diseases who exhibit low pulmonary function, leading to an increased risk of respiratory failure. Conclusionally, reduction of the total amount of PM is considered to be important factor and strengthening the national warning notification system to vulnerable patients and proper early management of exacerbated patients will be needed in the future.