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      Reusable elastomeric air-purifying respirators: Physiologic impact on health care workers

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          Abstract

          Background

          Elastomeric air-purifying respirators offer the benefit of reusability, but their physiological impact on health care workers is unknown.

          Methods

          Ten health care workers exercised at 2 health care-associated work rates wearing an elastomeric air-purifying respirator. Mixed inhalation/exhalation respirator dead space gases (oxygen, carbon dioxide) were sampled, and physiological parameters were monitored (heart rate, breathing rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide). Numerical rating scales were used to evaluate comfort and exertion.

          Results

          Compared with controls (no respirator), significant decreases in the breathing rate at both work rates ( P < .05) and increases in tidal volume at the lower work rate ( P < .01) were noted with respirator use. Approximately half the subjects had transcutaneous carbon dioxide levels above the upper limit of normal after 1 hour of use. Although well tolerated, comfort was negatively impacted by elastomeric air-purifying respirators wear.

          Conclusion

          Reusable elastomeric air-purifying respirators impose little additional physiological burden over the course of 1 hour at usual health care work rates. However, the potential for carbon dioxide retention in a significant proportion of users exists and requires further investigation.

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          Most cited references21

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          Compendium of physical activities: an update of activity codes and MET intensities.

          We provide an updated version of the Compendium of Physical Activities, a coding scheme that classifies specific physical activity (PA) by rate of energy expenditure. It was developed to enhance the comparability of results across studies using self-reports of PA. The Compendium coding scheme links a five-digit code that describes physical activities by major headings (e.g., occupation, transportation, etc.) and specific activities within each major heading with its intensity, defined as the ratio of work metabolic rate to a standard resting metabolic rate (MET). Energy expenditure in MET-minutes, MET-hours, kcal, or kcal per kilogram body weight can be estimated for specific activities by type or MET intensity. Additions to the Compendium were obtained from studies describing daily PA patterns of adults and studies measuring the energy cost of specific physical activities in field settings. The updated version includes two new major headings of volunteer and religious activities, extends the number of specific activities from 477 to 605, and provides updated MET intensity levels for selected activities.
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            Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations

            Aim: The study was aimed at investigating the effects of wearing N95 and surgical facemasks with and without nano-functional treatments on thermophysiological responses and the subjective perception of discomfort. Method: Five healthy male and five healthy female participants performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25°C and a relative humidity of 70%. Four types of facemasks, including N95 (3M 8210) and surgical facemasks, which were treated with nano-functional materials, were used in the study. Results: (1) The subjects had significantly lower average heart rates when wearing nano-treated and untreated surgical facemasks than when wearing nano-treated and untreated N95 facemasks. (2) The outer surface temperature of both surgical facemasks was significantly higher than that of both N95 facemasks. On the other hand, the microclimate and skin temperatures inside the facemask were significantly lower than those in both N95 facemasks. (3) Both surgical facemasks had significantly higher absolute humidity outside the surface than both N95 facemasks. The absolute humidity inside the surgical facemask was significantly lower than that inside both N95 facemasks. (4) Both surgical facemasks were rated significantly lower for perception of humidity, heat, breath resistance and overall discomfort than both N95 facemasks. The ratings for other sensations, including feeling unfit, tight, itchy, fatigued, odorous and salty, that were obtained while the subjects were wearing the surgical facemasks were significantly lower than when the subjects were wearing the N95 facemasks. (5) Subjective preference for the nano-treated surgical facemasks was the highest. There was significant differences in preference between the nano-treated and untreated surgical facemasks and between the surgical and N95 facemasks. Discussion: We discuss how N95 and surgical facemasks induce significantly different temperature and humidity in the microclimates of the facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.
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              Monitoring of ventilation during exercise by a portable respiratory inductive plethysmograph.

              To evaluate the accuracy of a portable respiratory inductive plethysmograph that allows the monitoring of ventilation without airway instrumentation during exercise in unrestrained subjects. Validation of a novel technique by comparison to a reference standard. Thirty-one subjects, including 20 healthy volunteers, 6 patients with COPD, and 5 patients with congestive heart failure. Participants performed progressive treadmill exercise to exhaustion. Ventilation was monitored by a novel battery-powered, miniaturized, and calibrated respiratory inductive plethysmograph. Inductance sensors encircling the rib cage and abdomen were built into an elastic body garment. A pneumotachograph attached to a mouthpiece served as the reference method. Breath-by-breath comparisons between the inductance plethysmograph and pneumotachograph over the course of progressive exercise to exhaustion revealed no significant bias of respiratory cycle time, tidal volume (Vt), and minute ventilation. The corresponding limits of agreement (bias +/- 2 SDs) were +/- 6%, +/-17%, and +/- 17%, respectively, for 2,480 breaths. Comparisons of mean values averaged over 20 breaths revealed improved limits of agreement of +/- 1% for cycle time, and +/- 7% for tidal volume and minute ventilation, respectively, for 124 comparisons. Agreement between methods was similar for patients and healthy subjects. Among the patients, maximal minute ventilation was lower, and breathing was more rapid and shallow than in healthy subjects. Obstructive lung disease was associated with a shorter duty cycle than heart failure. The portable respiratory inductive plethysmograph accurately estimates ventilation during treadmill exercise, and identifies differences in breathing patterns among patients with pulmonary or cardiac diseases and healthy subjects. This unobtrusive monitoring technique is promising for application in ambulatory patients.
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                Author and article information

                Contributors
                Journal
                Am J Infect Control
                Am J Infect Control
                American Journal of Infection Control
                Mosby
                0196-6553
                1527-3296
                1 March 2010
                June 2010
                1 March 2010
                : 38
                : 5
                : 381-386
                Affiliations
                [a ]National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA
                [b ]EG & G Technical Services, Pittsburgh, PA
                Author notes
                []Address correspondence to Raymond Roberge, MD, National Personal Protective Technology Laboratory, B-29, 626 Cochrans Mill Rd, Pittsburgh, PA 16236. dtn0@ 123456cdc.gov
                Article
                S0196-6553(10)00036-2
                10.1016/j.ajic.2009.11.006
                7115335
                20189685
                7d979794-6965-4f9f-bc62-db46601b581e

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                elastomeric respirators,reusable,physiological impact

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