OBJECTIVE: Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.
METHODS: A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.
RESULTS: Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07-2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.
CONCLUSIONS: Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.

UNASSIGNED: Despite the high efficacy of using Continuous positive airway pressure (CPAP) in reversing upper airway obstruction in obstructive sleep apnea (OSA), the efficiency of this treatment is limited due to the low adherence. Mask pressure is suggested to play a significant role in adherence. In this study, we intend to investigate the effect of Lidocaine-prilocaine cream CPAP mask on pressure sensation.
UNASSIGNED: In this study, 75 patients referred to CPAP titration were divided into three groups. In groups one and two, Lidocaine-prilocaine cream and Petroleum jelly were used respectively. The third group had no intervention.
UNASSIGNED: VAS discomfort immediately (VAS0), after 15 min (VAS15), and the next day (VAS all) in three groups were compared. VAS0, VAS15, and VAS all were not significantly different among the three groups (P > 0.05). Among participants with VAS0 above 5, VAS15 was significantly lower in intervention groups than the control group (P < 0.05).
UNASSIGNED: This study shows that both Petroleum jelly and Lidocaine-prilocaine cream can be used for decreasing pressure sensation during CPAP titration among patients who suffer excessive facial discomfort immediately after putting on a CPAP mask.

Facial features are important sources of information about perceived trustworthiness. Masks and protective clothing diminish the visibility of facial cues by either partially concealing the mouth and nose or covering the entire face. During the pandemic, the use of personal protective equipment affected and redefined who trusts whom in society. This study used the classical investment game of interpersonal trust with Chinese participants to explore the impact of occlusion on interpersonal trust. Faces with moderate initial trustworthiness were occluded by a mask or protective clothing in Experiment 1 and were digitally occluded by a square in Experiment 2, and faces with three levels of initial trustworthiness were occluded by a mask in Experiment 3. Results showed that both undergraduates (Experiment 1a) and non-student adults (Experiment 1b) perceived the faces with protective clothing as more trustworthy than faces wearing standard masks and faces not wearing masks. Faces with the top halves showing were perceived as trustworthy as full faces, while faces with the bottom halves showing were perceived as less trustworthy. The effect of masks is weak and complex. Masks reduced participants\' trust in faces with high initial trustworthiness, had no effect on faces with low and moderate initial trustworthiness, and only slightly increased the trust of undergraduates in faces with moderate initial trustworthiness. Our findings indicate that the lack of information caused by occlusion and the social significance associated with occlusion collectively affect people\'s trust behavior in Chinese society. We believe the findings of this study will be useful in elucidating the effects of personal protective equipment usage on perceptions of trustworthiness.

Cruise ships carrying COVID-19-vaccinated populations applied near-identical nonpharmaceutical measures during July-November 2021; passenger masking was not applied on 2 ships. Infection risk for masked passengers was 14.58 times lower than for unmasked passengers and 19.61 times lower than in the community. Unmasked passengers\' risk was slightly lower than community risk.

To assess the impact of wearing masks (KN95, surgical, cloth mask) due to COVID-19 pandemic on interpersonal communication among health care workers and with patients. The present observational study was conducted in tertiary care centre and also included participants from various other health care facilities from all over India over a period of one year from March 2022 to March 2023. 203 health care workers consented to participate in the study. The study was done as an online survey using the questionnaire which was adapted into a Google form consisting of a 15 closed set questions. Participants rated the question using a binary forced choice as either YES or NO. The mean age of participants consenting to the study was 30.9 ± 6.3 SD years,with male predominance (%). Among the choice of use of face mask, 76.35% used surgical mask, 14.77% used KN95 and 8.86% used cloth masks. 15 questions were divided in 5 categories; analysis showed that majority of questions had an affirmative \"yes\" response. This results of this study indicated that the sudden change in the existing communication situation due to use of face masks in the clinical setup affected interpersonal communication among healthcare workers and with patients, which may also have a bearing on both patient and clinician well being and could have a significant economic impact on health care systems globally. These results provide information about the clinical strain introduced from use of face masks in healthcare settings. Overall, results showed that in healthcare settings, there is increased cognitive load and listening effort for patients and health care providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss.

UNASSIGNED: Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively deployed and assessed the performance of a patient-specific 3D-printed mask (3Dp-mask), generated solely from MR imaging, to replicate a reproducible positioning and tolerable immobilization for patients undergoing cnsRT.
UNASSIGNED: Patients undergoing LINAC-based cnsRT (primary tumors or resected metastases) were enrolled into two arms: control (T-mask) and investigational (3Dp-mask). For the latter, an in-house designed 3Dp-mask was generated from MR images to recreate the head positioning during MR acquisition and allow coupling with the LINAC tabletop. Differences in inter-fraction motion were compared between both arms. Tolerability was assessed using patient-reported questionnaires at various time points.
UNASSIGNED: Between January 2020 - July 2022, forty patients were enrolled (20 per arm). All participants completed the prescribed cnsRT and study evaluations. Average 3Dp-mask design and printing completion time was 36 h:50 min (range 12 h:56 min - 42 h:01 min). Inter-fraction motion analyses showed three-axis displacements comparable to the acceptable tolerance for the current standard-of-care. No differences in patient-reported tolerability were seen at baseline. During the last week of cnsRT, 3Dp-mask resulted in significantly lower facial and cervical discomfort and patients subjectively reported less pressure and confinement sensation when compared to the T-mask. No adverse events were observed.
UNASSIGNED: The proposed total inverse planning paradigm using a 3D-printed immobilization device is feasible and renders comparable inter-fraction performance while offering a better patient experience, potentially improving cnsRT workflows and its cost-effectiveness.

BACKGROUND: During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends.
OBJECTIVE: The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period.
METHODS: Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic.
RESULTS: A total of 2345 face mask-related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of -11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney.
CONCLUSIONS: This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response.

BACKGROUND: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors.
OBJECTIVE: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high-foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching.
METHODS: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching.
RESULTS: Of the 490 observed subjects, 241 (49.2%) were wearing a mask properly and 249 (50.8%) were not. In the unmasked group, 33.7% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4% (56/490) of the masked group and 17.6% (88/490) in the unmasked group. Of those who touched their face, 61.1% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group.
CONCLUSIONS: Contrary to expectations, non-mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles.

BACKGROUND: In contrast to the beginning of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), pandemic, more and more hospital issues are now regulated by policy.
OBJECTIVE: To identify differences between expert recommendations and legal requirements regarding infection prevention and control (IPC) strategies.
METHODS: A cross-sectional study was conducted between 29th September 2022 and 3rd November 2022 addressing 1319 members of the German Society for Hygiene and Microbiology. The response rate was 12%. This paper reports the expert recommendations on different IPC strategies.
RESULTS: The majority (66%) of experts recommended universal mask usage, with 34% recommending it seasonally, even after the SARS-CoV-2 pandemic. Medical microbiology (MM) experts were more likely to recommend continuing to wear the masks indefinitely compared with IPC experts. Concerning the mask type, medical masks were recommended more frequently by IPC experts (47.3%), while FFP2 masks were preferred by MM experts (31.8%). The majority (54.7%) of experts recommended universal screening of employees, mainly in settings with extremely vulnerable patients and if regional incidence rates were high, at a frequency of twice per week. The dominant advice (recommended by at least 50% of experts) for employees exposed to SARS-CoV-2 was daily testing and wearing a mask, regardless of the length of exposure.
CONCLUSIONS: Expert recommendations deviate from the legal requirements and appear to be more differentiated and proportional. The influence of specific experience and expertise on mask recommendations should be investigated in more detail. For relevant policy decisions, a quick, focused and broad-based consultation of expertise could be of added value.

UNASSIGNED: The physician--patient relationship plays a critical role in the quality of primary care management. The generalised wearing of surgical masks in enclosed spaces - common during the COVID-19 pandemic -- could change the communication between patients and healthcare professionals.
UNASSIGNED: To assess how general practitioners (GPs) and patients feel about wearing masks during a consultation and its influences on physician--patient relationship. To evaluate methods healthcare professionals could use to compensate for mask wearing during a consultation.
UNASSIGNED: A qualitative study using semi-structured interviews based on a literature-based interview guide with GPs and patients in Brittany, France. Recruitment took place from January to October 2021 until data saturation. Two independent investigators performed an open and thematic coding and then discussed their results with a consensus procedure.
UNASSIGNED: Thirteen GPs and 11 patients were included. It appears that wearing masks complicates consultations by creating distance, impairing communication, mainly non-verbal and altering relationship quality. However, GPs and patients believed relationships were preserved, especially those with a solid foundation prior to the pandemic. GPs described having to adapt to maintain relationship. Patients worried about misunderstandings or diagnostic errors but saw the mask as a protective factor. GPs and patients described similar populations requiring vigilance, including geriatric and paediatric populations, and people with hearing impairments or learning difficulties. According to GPs, possible adaptations include speaking clearly, exaggerating non-verbal communication, temporarily removing mask while maintaining safe distance and identifying patients who need increased vigilance.
UNASSIGNED: Wearing masks makes the doctor--patient relationship more complex. GPs adjusted their practice to compensate.