Notes

Damaging electron exchange procedures influences phototrophic yoga exercise mat composition and action.
All respiratory care represents some risk of becoming an Aerosol Generating Procedure (AGP) during COVID-19 patient management. Personal Protective Equipment (PPE) and Environmental Control/Engineering is advised. High Velocity Nasal Insufflation (HVNI) and High Flow Nasal Cannula (HFNC) deliver High Flow Oxygen (HFO) therapy, established as a competent means of supporting oxygenation for acute respiratory distress patients, including that precipitated by COVID-19. Although unlikely to present a disproportionate particle dispersal risk, AGP from HFO continues to be a concern. Previously, we published a preliminary model. Here, we present a subsequent high-resolution simulation (higher complexity/reliability) to provide a more accurate and precise particle characterization on the effect of surgical masks on patients during HVNI, Low-Flow Oxygen therapy (LFO2), and tidal breathing.

This
modeling study of HVNI, LFO2, and tidal breathing presents ANSYS Fluent Computational Fluid Dynamics simulations that evaluate the effect of Type I surgical mask use over patient face on particle/droplet behavior.

This
modeling simulation study of HVNI (40L∙min
) with a simulated surgical mask suggests 88.8% capture of exhaled particulate mass in the mask, compared to 77.4% in LFO2 (6L∙min
) capture, with particle distribution escaping to the room (>1m from face) lower for HVNI+Mask versus LFO2+Mask (8.23% versus 17.2%). The overwhelming proportion of particulate escape was associated with mask-fit designed model gaps. Particle dispersion was associated with lower velocity.

These simulations suggest employing a surgical mask over the HVNI interface may be useful in reduction of particulate mass distribution associated with AGPs.This article is protected by copyright. All rights reserved.
These simulations suggest employing a surgical mask over the HVNI interface may be useful in reduction of particulate mass distribution associated with AGPs.This article is protected by copyright. All rights reserved.Well-being and burnout are concepts that have become well described throughout emergency medicine. In the past, both well-being and burnout have been defined and addressed as a singular phenomenon, similar for all physicians, regardless of career stage. However, unique stressors may exist for physicians, as a function of their work environment and stage. In this concepts article we present clinician well-being as a dynamic and continuous process, subject to unique factors along the professional lifespan. Specific individual and system-level factors are discussed, ranging from demographic variables, to evolving administrative and professional responsibilities depending on the career stage of a clinician. This detailed description of stressors spanning an emergency physician's professional career may help create more targeted physician well-being and burnout interventions.Background The SARS-CoV-2 (COVID-19) virus has wide community spread. The aim of this study was to describe patient characteristics and to identify factors associated with COVID-19 among emergency department patients under investigation for COVID-19 who were admitted to the hospital. check details Methods This was a retrospective observational study from eight emergency departments within a nine-hospital health system. Patients with COVID-19 testing around the time of hospital admission were included. The primary outcome measure was COVID-19 test result. Patient characteristics were described and a multivariable logistic regression model was used to identify factors associated with a positive COVID-19 test. Results During the study period from March 1, 2020 to April 8, 2020, 2,182 admitted patients had a test resulted for COVID-19. Of these patients, 786 (36%) had a positive test result. For COVID positive patients, 63 (8.1%) died during hospitalization. COVID-19 positive patients had lower pulse oximetry (0.91 [95%CI], [0.88-0.94]), higher temperatures (1.36 [1.26-1.47]), and lower leukocyte counts than negative patients (0.78 [0.75-0.82]). Chronic lung disease (OR 0.68, [0.52-0.90]) and histories of alcohol (0.64 [0.42-0.99]) or substance abuse (0.39 [0.25-0.62]) were less likely to be associated with a positive COVID-19 result. Conclusion We observed a high percentage of positive results among an admitted emergency department cohort under investigation for COVID-19. Patient factors may be useful in early differentiation of patients with COVID-19 from similarly presenting respiratory illnesses although no single factor will serve this purpose. This article is protected by copyright. All rights reserved.
This study evaluates aerosol production with high flow nasal cannula (
) and noninvasive positive pressure ventilation (
) compared to six liters per minute by low-flow nasal cannula.

Two healthy volunteers were randomized to control (six liters per minute by low-flow nasal cannula), NIPPV, or HFNC using block randomization. NIPPV conditions were studied using continuous positive airway pressures of 5, 10, and 15 cm H
O with an FiO
of 1.0 delivered via full-face mask. HFNC conditions included flow rates of 30 and 40 liters per minute with an FiO
of 1.0 with and without coughing. HFNC and low-flow nasal cannula conditions were repeated with and without participants wearing a surgical mask. Six aerosol sizes (0.3, 1.0, 2.5, 5, and 10 μm) and total aerosol mass were measured at two feet and six feet from the participant's nasopharynx.

There was no significant difference in aerosol production between either HFNC or NIPPV and control. There was also no significant difference with the use of procedural mask over the HFNC. There was significant variation between the two participants, but in neither case was there a difference compared to control. There was an aerosol-time trend, but there does not appear to be a difference between either flow rate, pressure, or control. Furthermore, there was no accumulation of total aerosol particles over the total duration of the experiment in both HFNC and NIPPV conditions.

HFNC and NIPPV did not increase aerosol production compared to six liters per minute by low-flow nasal cannula in this experiment involving healthy volunteers.This article is protected by copyright. All rights reserved.
HFNC and NIPPV did not increase aerosol production compared to six liters per minute by low-flow nasal cannula in this experiment involving healthy volunteers.This article is protected by copyright. All rights reserved.
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