BACKGROUND

Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution.

METHODS

A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise.

RESULTS

Fifty subjects age 10.4 ± 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ± 29 for sites with erythema versus 75 ± 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers.

CONCLUSIONS

This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity.

As the COVID-19 pandemic progressed across the world, governments, international agencies, policymakers, and public health officials began recommending widespread use of nonmedical cloth masks to reduce the transmission of SARS-CoV-2. The authors of this article suggest that there is convincing evidence to support this recommendation.

Keywords: Bacteria; COVID-19; Disinfection; Health care providers; Hygiene; Pathogens; Prevention, policy, and public health; Rabbits; SARS coronavirus; Tea.

Capacitive deionization (CDI) removes charged ions from aqueous solutions through entrapment in the electric double layer (EDL) when the porous electrodes are polarized. In this study, three types of activated carbon cloth (ACC) with different pore-size distributions were used to study the effect of pore characteristics on electrosorption during CDI. Removal of seven different monovalent ions was examined for each ACC in batch reactors under 5 different combinations of applied potential and ionic strength. Results show underlying sorption mechanisms in the meso- and micro-pores were different. Electrosorption in the mesopores is influenced by partially-distorted EDL caused by EDL overlapping. Sorption capacity increased with increasing applied potential or ionic strength as overlapping effects were reduced. In contrast, EDL in the microporous regions could be highly distorted resulting in enhanced sorption capacity, which cannot be adequately described using the classic EDL theories. Electrosorption density (i.e., sorption capacity normalized by pore volume) decreased as the mesoporosity-to-microporosity ratio increased. These results are in agreement with those obtained using mathematical modeling by other recent CDI studies. Charge efficiency values were between 20% and 40% and appear to be substantially influenced by Faradaic reactions and ion desorption from the electrode surfaces. These findings suggest that pore-size distribution of electrode materials, especially the meso/microporosity ratio, should be optimized for the removal of targeted ions by CDI and well characterized to conduct more precise CDI modeling.

Epidermal UV transmittance (TUV ) and UV-absorbing compounds were measured in sun and shade leaves of Populus tremuloides and Vicia faba exposed to contrasting light environments under field conditions to evaluate UV acclimation potentials and regulatory roles of photosynthetically active radiation (PAR) and UV in UV-shielding. Within a natural canopy of P. tremuloides, TUV ranged from 4 to 98% and showed a strong nonlinear relationship with mid-day horizontal fluxes of PAR [photon flux density (PFD) = 6-1830 µmol m⁻² s⁻¹]; similar patterns were found for V. faba leaves that developed under a comparable PFD range. A series of field transfer experiments using neutral-density shade cloth and UV blocking/transmitting films indicated that PAR influenced TUV during leaf development to a greater degree than UV, and shade leaves of both species increased their UV-shielding when exposed to full sun; however, this required the presence of UV, with both UV-A and UV-B required for full acclimation. TUV of sun leaves of both species was largely unresponsive to shade either with or without UV. In most, but not all cases, changes in TUV were associated with alterations in the concentration of whole-leaf UV-absorbing compounds. These results suggest that, (1) moderate-to-high levels of PAR alone during leaf development can induce substantial UV-protection in field-grown plants, (2) mature shade leaves have the potential to adjust their UV-shielding which may reduce the detrimental effects of UV that could occur following sudden exposures to high light and (3) under field conditions, PAR and UV play different roles in regulating UV-shielding during and after leaf development.

Forty-seven dairy herds (approximately 3,129 lactating cows) from northeast of Spain that were offering exactly the same lactating ration were surveyed to determine the effect of nondietary factors on herd performance. The survey collected information on the profile of the owners (their future intentions, the number of workers, and time devoted to the enterprise), information regarding the animals (reproductive performance, incidence of pathology, culling rate, etc.), information on the facilities (number of feeders, waters, stalls, cleanliness, etc.) and information on management practices (numbers of daily milkings, feed deliveries, feed push-ups, cleaning frequency, etc.). In addition, the chemical quality of drinking water from each dairy enterprise was determined. Also, amount of feed delivered to each herd, daily total milk production, and milk quality were obtained for each herd for a period of 8 mo before the fulfillment of the survey. Mortality rate of calves tended to be lesser in herds that weaned progressively than in those that weaned abruptly. Age at first calving was negatively correlated with level of milk production (mainly due to the type of heifer rearing system used). Culling rate tended to be lower in herds that used a close-up ration than in those that did not. Using gloves and paper towels (instead of cloth towels) tended to reduce the somatic cell count in milk. Concentration of calcium in the drinking water tended to be negatively correlated with the number of days open and with the proportion of cows culled due to infertility problems. Despite that the 47 herds fed the same ration and shared a similar genetic base, average milk production per cow ranged from 20.6 to 33.8 kg/d. A positive relationship (r = 0.57) between the number of stalls per cow and milk production was found. The most important nondietary factors that affected milk production in these dairy herds were age at first calving, presence or absence of feed refusals, number of free stalls per lactating cow, and whether feed was pushed up in the feed bunk. These factors accounted for more than 50% of the observed variation, not attributable to the diet, in milk yield.

To obtain long-duration protection from mosquitoes using insect repellent N, N-diethyl-m-toluamide (DEET), this compound was incapsulated in situ during the graft copolymerization of butyl acrylate onto chitosan in an aqueous solution. Morphology of microcapsules was characterized by scanning electron microscopy, scanning probe microscopy, and transmission electron microscopy. This morphology supported successful encapsulation of DEET into polymer capsules. The encapsulation ratio of DEET was greater than 33%, as estimated from thermo-gravimetric results. The aqueous emulsions were applied to cotton textiles by spraying. Treated cloth showed high bactericidal activity against Staphylococcus aureus. Mosquito repellency of the bio-cloth was evaluated with Aedes albopictus. The 90% effective dose of emulsions on textiles was compared with that of DEET in ethanol. A time profile showed that the repellency of an optimized emulsion was 100% after eight hours, and partially preserved even after exposure to air for 48 hours.

Face masks wearing during the coronavirus disease 2019 (COVID-19) pandemic became ubiquitous. The aim of our study was to assess the use of face masks among young adults during the current viral pandemic. The survey was based on specially created Google Forms and posted on numerous Facebook groups for young people in Poland. Seven days were considered as a recall period. A total of 2315 answers were obtained, 2307 were finally analysis, as eight questionnaires were removed because of data incompleteness. 60.4% of responders declared using the face masks. Those who reported an atopic predisposition wore face masks significantly (P = .007) more commonly (65.5% and 57.7%, respectively). Cloth masks (46.2%) appeared to be most popular ones, followed by surgical masks (39.2%), respirators (N95 and FFP) (13.3%), half-face elastomeric respirators (0.8%) and full-face respirators (0.4%). Females significantly more frequently (P = .0001) used cloth masks; respirators, half-face elastomeric respirators and full-face respirators were used more commonly by males (P < .0001, P = .001 and P = .001, respectively). 23.9% of responders who used single-use mask wore it again. Moreover, 73.6% participants declared mask decontamination; however, the procedures were not always appropriate. We suggest that our results may be of help in construction of general public education campaigns on the proper use of face masks.

Keywords: COVID-19; face masks.

Self-driven and continuous directional transport of water droplets in an oil environment has great potential applications in microfluidics, oil-water separation, etc. Nevertheless, most current studies exploit water behaviors occurring in air, and the directional regulation of water in a viscous oil medium remains a challenge. In this work, a superhydrophilic geometry-gradient stainless steel platform with nanoparticle-covered nanoripple structures is proposed using femtosecond laser direct writing technology. The as-prepared platform spontaneously and directionally transported water droplets in the oil environment from the minor side to the large side of the trapezoidal platform surface, but not in the opposite direction. The transport velocity of water droplets as a function of trapezoid angle and tilt angle of the as-prepared platform was investigated in detail. In addition, a pumpless under-oil water transport platform was successfully prepared on other substrates including Ti and Ni sheets, polyimide film, and C cloth, and exhibited transport capabilities when the platform was flexed and combined into various shapes. This work offers insight into the simple fabrication of a flexible and substrate-independent pumpless under-oil directional transport device for water.

Bacterial infections constitute a severe problem in various areas of everyday life, causing pain and death, and adding enormous costs to healthcare worldwide. Besides, they cause important concerns in other industries, such as cloth, food packaging, and biomedicine, among others. Despite the intensive efforts of academics and researchers, there is lack of a general solutions to restrict bacterial growth. Among the various approaches, the use of antibacterial nanomaterials is a very promising way to fight the microorganisms due to their high specific surface area and intrinsic or chemically incorporated antibacterial action. Graphene, a 2D carbon-based ultra-thin biocompatible nanomaterial with excellent mechanical, thermal, and electrical properties, and its derivatives, graphene oxide (GO) and reduced graphene oxide (rGO), are highly suitable candidates for restricting microbial infections. However, the mechanisms of antimicrobial action, their cytotoxicity, and other issues remain unclear. This mini-review provides select examples on the leading advances in the development of antimicrobial nanocomposites incorporating inorganic nanoparticles and graphene or its derivatives, with the aim of providing a better understanding of the antibacterial properties of graphene-based nanomaterials.

Keywords: antibacterial activity; antibiotic resistance; bacterial infection; graphene; graphene oxide; nanocomposites; reduced graphene oxide.

Background: There is a worldwide shortage of medical grade face masks. Donning masks can play an important role in curbing the spread of SARS-CoV-2.

Aim: To conclude if there is an effective mask for the population to wear in public that could easily be made during a medical face mask shortage using readily available materials.

Methods: We determined the effectiveness of readily available materials and models for making a face mask. The outcomes were compared with N95/FFP2/KN95 masks that entered the Netherlands in April-May 2020. Masks were tested to see if they filter a minimum of 35% of 0.3ɥm particles, are hydrophobic, seal on the face, are breathable, and can be washed.

Findings: Fourteen of the 25 (combinations of) materials filtered at least 35% of 0.3ɥm particles. Four of the materials proved hydrophobic, all commercially manufactured filters. Two models sealed the face. Twenty-two of the 25 materials were breathable at <0.7 mbar. None of the hydrophobic materials stayed intact after washing.

Conclusions: It would be possible to reduce the reproduction rate of SARS CoV-2 from 2.4 to below one if 39% of the population would wear a mask made from ePM₁ 85% commercially manufactured filter fabric and in a duckbill form. This mask performs better than 80% of the imported N95/FFP2/KN95 masks and provides a better fit than a surgical mask. Two layers of quilt fabric with a household paper towel as filter is also a viable choice for protecting the user and the environment.

Keywords: MERV; cloth; ePM1; filter; surgical mask.

During the COVID-19 pandemic the use of cloth masks has increased dramatically due to the shortage of medical masks. However, the efficiency of this material is controversial. We aimed to investigate the efficiency of cloth masks in reducing transmission and contamination by droplets and aerosols for the general population and healthcare workers. Electronic databases were searched without year or language restrictions. Clinical and laboratorial studies were included. The risk of bias (RoB) was assessed using an adapted quality checklist for laboratory-based studies. ROBINS-I tool and Cochrane RoB 2.0 were used to evaluate non-randomized (n-RCT) and randomized clinical trials (RCT), respectively. The quality of the evidence was assessed through GRADE tool. From the eleven studies selected, eight were laboratory-based studies, one non-randomized and one RCT supported by laboratory data. Between the evaluated fabrics only three presented a filtration efficiency > 90%. Hybrid of cotton/chiffon (95%CI 95.2 to 98.8), hybrid of cotton/silk (95%CI 92.2 to 95.8) and cotton quilt (95%CI 94.2 to 97.8). However, cloth masks are not recommended for healthcare workers. A meta-analysis was not feasible due to a high methodological heterogeneity. The overall quality of evidence ranged from very low to moderate. Despite the lower efficiency compared to medical masks, laboratorial results may underestimate the efficiency of cloth masks in real life. Cloth mask efficiency is higher when made of hybrid fabrics (cotton/chiffon, cotton/silk) and cotton quilt, mainly with multiple layers.

Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited.

In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions - whole room cleaning and wipe cleaning of touched surfaces - were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention.

Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings.

Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant.

The World Health Organization and the United States Centers for Disease Control have recommended universal face masking by the general public to slow the spread of COVID-19. A number of recent studies have evaluated the filtration efficiency and pressure differential (an indicator of breathability) of various, widely available materials that the general public can use to make face masks at home. In this review, we summarize those studies to provide guidance for both the public to select the best materials for face masks and for future researchers to rigorously evaluate and report on mask material testing. Of the tested fabric materials and material combinations with adequate breathability, most single and multilayer combinations had a filtration efficiency of <30%. Most studies evaluating commonly available mask materials did not follow standard methods that would facilitate comparison across studies, and materials were often described with too few details to allow consumers to purchase equivalent materials to make their own masks. To improve the usability of future study results, researchers should use standard methods and report material characteristics in detail.

Keywords: COVID-19; SARS-CoV-2; breathability; cloth mask; face mask; filtration efficiency; homemade mask; pressure differential.

In north-western Europe, the common tick, Ixodes ricinus, is widely established, its distribution appears to be increasing and the spread of tick-borne diseases is of increasing concern. The project 'Flått i Nord' (Ticks in northern Norway) commenced in spring 2009 with the intention of studying the tick's distribution and that of its pathogens in northern Norway. Several methods were used: cloth-dragging, collecting from trapped small mammals, and collecting from pets. Since 2010, the occurrence of ticks in the region of northern Norway was determined directly by cloth-dragging 167 times in 109 separate locations between the latitudes of 64 °N and 70 °N (included seven locations in the northern part of Trøndelag County). The northernmost location of a permanent I. ricinus population was found to be Nordøyvågen (66.2204 °N, 12.59 °E) on the Island of Dønna. In a sample of 518 nymphal and adult ticks, the Borrelia prevalence collected close to this distribution limit varied but was low (1-15 %) compared with the locations in Trøndelag, south of the study area (15-27 %). Five specimens (1 %) were positive for Rickettsia helvetica. The length of the vegetation growing season (GSL) can be used as an approximate index for the presence of established populations of I. ricinus. The present study suggests that the threshold GSL for tick establishment is about 170 days, because the median GSL from 1991 to 2015 was 174-184 days at sites with permanent tick populations, showing a clear increase compared with the period 1961-1990. This apparent manifestation of climate change could explain the northward extension of the range of I. ricinus.

Monitoring of wound pH is critical for interpreting wound status, because early identification of wound infection or nonhealing wounds is conducive to administion of therapies at the right time. Here, novel orange-emissive carbon quantum dots (O-CDs) are synthesized via microwave-assisted heating of 1,2,4-triaminobenzene and urea aqueous solution. The as-prepared O-CDs exhibit distinctive colorimetric response to pH changing, and also display pH-sensitive fluorescence. Benefiting from the response of O-CDs over a wound-relevant pH range (5-9), medical cotton cloth is selected to immobilize O-CDs through hydrogen bond interactions, the resultant O-CDs-coated cloth with emission at 560 nm shows a high response to pH variation in the range of 5-9 via both fluorescence and visible colorimetric changes. Moreover, the sensitivity of fluorescence to pH is capable of establishing an analytical mode for determining pH value. Further, the O-CDs-based pH indicator possesses not only superior biocompatibility and drug compatibility but also excellent resistance leachability and high reversibility. Importantly, the usage of O-CDs-coated cloth to detect pH is free from the interference of blood contamination and long-term storage, thus providing a valuable strategy for wound pH monitoring through visual response and quantitative determination.

Efficient and low-cost electrocatalysts for water splitting are essential for solar fuel production. Herein, we report that nanoarrays of CoP supported on carbon cloth are an efficient bifunctional catalyst for overall water splitting. The catalyst exhibits remarkable activity for both the oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) in alkaline media, delivering a current density of 10 mA cm(-2) at an overpotential of 281 mV for OER and 95 mV for HER. During electrocatalysis, the surface of the CoP catalyst was covered with a layer of CoOx , which was the active species. However, the CoP core and the nanoarray morphology contributed significantly to the activity.

Replacement of precious Pt with earth-abundant electrocatalysts for the hydrogen evolution reaction (HER) holds great promise for clean energy devices, but the development of low-cost and durable HER catalysts with Pt-like activity is still a huge challenge. In this communication, we report on the development of self-standing ternary FexCo1-xP nanowire array on carbon cloth (FexCo1-xP/CC) as a Pt-free HER catalyst with activities being strongly related to Fe substitution ratio. Electrochemical tests show that Fe0.5Co0.5P/CC not only possesses Pt-like activity with the need of overpotential of only 37 mV to drive 10 mA cm-2, outperforming all non-noble-metal HER catalysts reported to date, but demonstrates superior long-term durability in 0.5 M H2SO4. Density functional theory calculations further reveal that Fe substitution of Co in CoP leads to more optimal free energy of hydrogen adsorption to the catalyst surface. This study offers us a promising flexible monolithic catalyst for practical applications.

Here we report a new microfluidic microbial fuel cell (MFC) platform built by soft-lithography techniques. The MFC design includes a unique sub-5 μL polydimethylsiloxane soft chamber featuring carbon cloth electrodes and microfluidic delivery of electrolytes. Bioelectricity was generated using Shewanella oneidensis MR-1 cultivated on either complex organic substrates or lactate-based minimal medium. These micro-MFCs exhibited fast start-ups, reproducible current generation, and enhanced power densities up to 62.5 W m(-3) that represents the best result for sub-100 μL MFCs. Systematic comparisons of custom-made MFC reactors having different chamber sizes indicate volumetric power density is inversely correlated with chamber size in our systems: i.e., the smaller the chamber, the higher the power density is achieved.

OBJECTIVE

The aims of this study were (1) to subjectively quantify the degree of scratching and smudging that had taken place in the junior clinic in the 9 months following the implementation of digital radiology; (2) to compare the findings with a previously published report; and (3) to identify areas in the protocol and training that can be refined to minimize future scratching and smudging.

METHODS

Seven sets of blank clinical photostimulable storage phosphor (PSP) plates were scanned after exposing them at 65 kV and 7 mA for 0.80 s. Scanned plates were lightly wiped with a soft cloth and alcohol, repackaged in plastic sleeves, re-exposed and rescanned. The two sets of resulting images were subjectively rated independently by two investigators for artefacts and placed in five categories.

RESULTS

Of all the images, approximately 75% were rated in the top 3 categories (most readable), leaving 17% and 8% in the poor and unsatisfactory categories, respectively. Mean rated values of the two image sets (before and after wiping) were not statistically different, but ratings slightly improved after cleaning the plates.

CONCLUSIONS

Wiping all plates to remove surface contamination may not always be necessary or desirable. Systems that are designed to minimize handling of the plates may help minimize scratching of them.

Focused Antenatal Care (FANC) is advocated by the World Health Organization (WHO) as a key service approach to improving the health of pregnant women. Four targeted visits to antenatal clinics are recommended starting in the first trimester. First trimester attendance for FANC in Mangochi District, Malawi was low at 8%. FANC has mainly been promoted through health facility based communication activities with less emphasis on activities at community level. We developed and tested a community focused health communication approach "Community Driven Total FANC Attendance (CDTFA)" with the aim of increasing FANC clinic attendance. We included a research component in order to understand the context and responses of community members to this intervention.

CDTFA meetings were designed in parallel with data gathering with approval of the local research ethics committee and community stakeholders. Participants in both the CDTFA meetings and data gathering activities, undertaken from December, 2015 to June, 2016 were of reproductive age (15-49 years). Data were collected through flexible interactive processes from participants through recording on pre-designed forms. Quantitative data were processed and analyzed in Microsoft Excel, while qualitative data were manually analyzed to identify themes.

In total, 403 CDTFA meetings were held. In the course of interactions with community members, some barriers that affected early utilization of FANC services were identified. Women who did not bring their partners and those who could not bring along with them cloth wraps for the newborn to clinics were not allowed to access FANC services. Payment for authorization letters from village heads for women who have no partners and user fees in non-governmental health facilities were also identified as barriers.

Despite the benefits of FANC services, health authorities in the District should ensure that use and promotion of the approach does not inadvertently bar some pregnant women from accessing services. There is a need to explore strategies and redesign an approach to health promotion that will promote uptake of the integrated services in FANC clinics without infringing on women's rights to access health care.

Antimicrobial-resistant bacteria represent an important concern impacting both veterinary medicine and public health. The rising prevalence of extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase, carbapenemase (CRE) and fluoroquinolone-resistant Enterobacteriaceae continually decreases the efficiency of clinically important antibiotics. Moreover, the potential for zoonotic transmission of antibiotic-resistant enteric bacteria increases the risk to public health. Our objective was to estimate the prevalence of specific antibiotic-resistant bacteria on human contact surfaces in various animal environments. Environmental surface samples were collected from companion animal shelters, private equine facilities, dairy farms, livestock auction markets and livestock areas of county fairs using electrostatic cloths. Samples were screened for Enterobacteriaceae expressing AmpC, ESBL, CRE or fluoroquinolone resistance using selective media. Livestock auction markets and county fairs had higher levels of bacteria expressing both cephalosporin and fluoroquinolone resistance than did equine, dairy, and companion animal environments. Equine facilities harboured more bacteria expressing cephalosporin resistance than companion animal shelters, but less fluoroquinolone resistance. The regular use of extended-spectrum cephalosporins in livestock populations could account for the increased levels of cephalosporin resistance in livestock environments compared to companion animal and equine facilities. Human surfaces, as well as shared human and animal surfaces, were contaminated with resistant bacteria regardless of species environment. Detecting these bacteria on common human contact surfaces suggests that the environment can serve as a reservoir for the zoonotic transmission of antibiotic-resistant bacteria and resistance genes. Identifying interventions to lower the prevalence of antibiotic-resistant bacteria in animal environments will protect both animal and public health.