Assessment of dispersion of airborne particles of oral/nasal fluid by high flow nasal cannula therapy

Background

Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients.

Methods

Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared.

Results

Conclusion

During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of μL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used.

Clinical trial registration

ACTRN12614000924651

Evaluation of a Desktop 3D Printed Rigid Refractive-Indexed-Matched Flow Phantom for PIV Measurements on Cerebral Aneurysms

PURPOSE

Fabrication of a suitable flow model or phantom is critical to the study of biomedical fluid dynamics using optical flow visualization and measurement methods. The main difficulties arise from the optical properties of the model material, accuracy of the geometry and ease of fabrication.

METHODS

Conventionally an investment casting method has been used, but recently advancements in additive manufacturing techniques such as 3D printing have allowed the flow model to be printed directly with minimal post-processing steps. This study presents results of an investigation into the feasibility of fabrication of such models suitable for particle image velocimetry (PIV) using a common 3D printing Stereolithography process and photopolymer resin.

RESULTS

An idealised geometry of a cerebral aneurysm was printed to demonstrate its applicability for PIV experimentation. The material was shown to have a refractive index of 1.51, which can be refractive matched with a mixture of de-ionised water with ammonium thiocyanate (NH₄SCN). The images were of a quality that after applying common PIV pre-processing techniques and a PIV cross-correlation algorithm, the results produced were consistent within the aneurysm when compared to previous studies.

CONCLUSIONS

This study presents an alternative low-cost option for 3D printing of a flow phantom suitable for flow visualization simulations. The use of 3D printed flow phantoms reduces the complexity, time and effort required compared to conventional investment casting methods by removing the necessity of a multi-part process required with investment casting techniques.

Measuring the torque required to cause vertebral dislocation in cattle tails

Aim: To estimate, ex vivo, the torque required to cause vertebral dislocation of cattle tails.Methods: Five tails from dairy cows, severed at the junction between the sacrum and the first caudal vertebra, were sourced from a slaughterhouse. Within 2 hours of slaughter, the severed end of each tail was clamped in a vice and a steel collar was placed halfway along the tail. A torque wrench was attached to the steel collar, which was then rotated to produce an audible and palpable vertebral dislocation, and the torque at the time of the break was recorded.Results: The maximum torque required to break a tail was 20 Nm, the minimum was 9.8 Nm, and the uncertainty was 4.9 Nm.Conclusion: The torque required to break a cow's tail is unlikely to be applied accidentally if cattle are handled following recommended best practice. Thus if cattle on a farm can be shown to have broken tails due to manipulation by farm staff, cattle handling is not meeting the recommended best practice of the New Zealand Dairy Cattle Code of Welfare.

Experimental measurement of breath exit velocity and expirated bloodstain patterns produced under different exhalation mechanisms

In an attempt to obtain a deeper understanding of the factors which determine the characteristics of expirated bloodstain patterns, the mechanism of formation of airborne droplets was studied. Hot wire anemometry measured air velocity, 25 mm from the lips, for 31 individuals spitting, coughing and blowing. Expirated stains were produced by the same mechanisms performed by one individual with different volumes of a synthetic blood substitute in their mouth. The atomization of the liquid at the lips was captured with high-speed video, and the resulting stain patterns were captured on paper targets. Peak air velocities varied for blowing (6 to 64 m/s), spitting (1 to 64 m/s) and coughing (1 to 47 m/s), with mean values of 12 m/s (blowing), 7 m/s (spitting) and 4 m/s (coughing). There was a large (55-65%) variation between individuals in air velocity produced, as well as variation between trials for a single individual (25-35%). Spitting and blowing involved similar lip shapes. Blowing had a longer duration of airflow, though it is not the duration but the peak velocity at the beginning of the air motion which appears to control the atomization of blood in the mouth and thus stain formation. Spitting could project quantities of drops at least 1600 mm. Coughing had a shorter range of near 500 mm, with a few droplets travelling further. All mechanisms could spread drops over an angle >45°. Spitting was the most effective for projecting drops of blood from the mouth, due to its combination of chest motion and mouth shape producing strong air velocities. No unique method was found of inferring the physical action (spitting, coughing or blowing) from characteristics of the pattern, except possibly distance travelled. Diameter range in expirated bloodstains varied from very small (<1 mm) in a dense formation to several millimetres. No unique method was found of discriminating expirated patterns from gunshot or impact patterns on stain shape alone. Only 20% of the expirated patterns produced in this study contained identifiable bubble rings or beaded stains.

Examination of the mixed-alkali effect in (Li,Na) disilicate glasses by nuclear magnetic resonance and conductivity measurements

Results from 29Si, 23Na and 7Li magic-angle spinning nuclear magnetic resonance (NMR) spectroscopy, 7Li NMR relaxation and electrical conductivity in a series of [Li(1-x).Nax]2O.2SiO2 (disilicate) glasses are used to investigate the mixed-alkali effect. From the 29Si NMR spectra there is relatively little change of the network with alkali composition. 23Na and 7Li NMR linewidths and shifts change continuously as a function of composition, indicating that the alkali ions are intimately and uniformly mixed rather than separated into lithium and sodium-rich domains. The activation energy from electrical conductivity shows a distinct maximum at the central composition (x = 0.5), whereas the local activation energy for lithium motion determined from NMR shows only a smaller but monotonic increase as the lithium-content decreases.