BACKGROUND:The implementation of an innovative form of personal protective equipment (PPE) as an infection and prevention control measure for respiratory transmissible diseases is complex, with several elements to be addressed. AIM:To make considerations for integrated face and respiratory protection implementation in clinical settings. METHODS:This was a multi-site qualitative study with 87 health workers that compared traditional PPE or powered air-purifying (PAPR) respirators with lightweight PAPR (L-PAPR). Semi-structured interviews were performed based on the Consolidated Framework for Implementation Research (CFIR). FINDINGS:Insights into L-PAPR implementation were found. The advantages include enhanced sense of protection, pleasant ventilation, good visibility for both health worker and patient, no fogging of the visor interior, no movement restriction, and easy disinfection process. To enhance usability some barriers should be tackled: reduction of facial pressure; better accommodation for glasses and corrective lenses; reduction of number of steps for assembling the device; infrastructure provision for storage, charging and disinfection of the device; training of health workers for assembling, donning and doffing; and the cost benefit of implementation. CONCLUSION:L-PAPR was overall perceived with advantages by many participants, and can be considered a potential option of PPE to be implemented to protect health workers during outbreaks of respiratory transmissible diseases.

Introduction The design of Personal Protective Equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by health workers (HW) and reduce occupational-acquired diseases. As integrated PPE, a lightweight battery-powered air-purifying respirator (L-PAPR) could be used during health procedures where HWs are exposed to airborne pathogens. The human factors affecting implementation of alternative PPE such as L-PAPR have not been thoroughly studied. Research Question Under which conditions and testing by human factors are NIOSH Standards compliant PAPRs and Light PAPRs superior to a NIOSH certified N95 Respirator and Face shield in clinical care. The population is healthcare professionals, the intervention is task type, the comparators are N95 and Face Shield, Traditional PAPR and Light PAPR. The outcomes are user-error, communications, safety and end-user preferences Type of study and main methods This is an interventional randomized crossover quality improvement feasibility study consisting of a 3 site simulation study (Phase 1; 10 participants each site) and 2 site field testing (Phase 2; 30 participants each site). The following aspects are evaluated comparing L-PAPR (integrated PPE), the traditional PAPR and N95 and Face shield: perceived workload, usability, usage errors, and heart rate. Interviews to identify barriers and enablers to implementation, and effective training will be conducted.

BACKGROUND:The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. OBJECTIVE:This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. METHODS:This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. RESULTS:We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. CONCLUSIONS:The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/36549.

Abstract Objective: The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE), underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate masks and respirators exposed to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus. Design: The 2 arms of the study included (1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment and (2) PPE treatment with MBL for 5 cycles of decontamination to determine maintenance of PPE performance. Methods: MBL treatment was used to inactivate coronaviruses on 3 N95 filtering facepiece respirator (FFR) and 2 medical mask models. We inoculated FFR and medical mask materials with 3 coronaviruses, including SARS-CoV-2, and we treated them with 10 µM MB and exposed them to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5 cycles of decontamination using multiple US and international test methods, and the process was compared with the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method. Results: Overall, MBL robustly and consistently inactivated all 3 coronaviruses with 99.8% to >99.9% virus inactivation across all FFRs and medical masks tested. FFR and medical mask integrity was maintained after 5 cycles of MBL treatment, whereas 1 FFR model failed after 5 cycles of VHP+O3. Conclusions: MBL treatment decontaminated respirators and masks by inactivating 3 tested coronaviruses without compromising integrity through 5 cycles of decontamination. MBL decontamination is effective, is low cost, and does not require specialized equipment, making it applicable in low- to high-resource settings.

The COVID-19 pandemic is currently causing a severe disruption and shortage in the global supply chain of necessary personal protective equipment (e.g., N95 respirators). The U.S. CDC has recommended use of household cloth by the general public to make cloth face coverings as a method of source control. We evaluated the filtration properties of natural and synthetic materials using a modified procedure for N95 respirator approval. Common fabrics of cotton, polyester, nylon, and silk had filtration efficiency of 5-25%, polypropylene spunbond had filtration efficiency 6-10%, and paper-based products had filtration efficiency of 10-20%. An advantage of polypropylene spunbond is that it can be simply triboelectrically charged to enhance the filtration efficiency (from 6 to >10%) without any increase in pressure (stable overnight and in humid environments). Using the filtration quality factor, fabric microstructure, and charging ability, we are able to provide an assessment of suggested fabric materials for homemade facial coverings.

ABSTRACT Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe shortages of personal protective equipment (PPE) necessary to protect front-line healthcare personnel. These shortages underscore the urgent need for simple, efficient, and inexpensive methods to decontaminate SARS-CoV-2-exposed PPE enabling safe reuse of masks and respirators. Efficient decontamination must be available not only in low-resourced settings, but also in well-resourced settings affected by PPE shortages. Methylene blue (MB) photochemical treatment, hitherto with many clinical applications including those used to inactivate virus in plasma, presents a novel approach for widely applicable PPE decontamination. Dry heat (DH) treatment is another potential low-cost decontamination method. Methods MB and light (MBL) and DH treatments were used to inactivate coronavirus on respirator and mask material. We tested three N95 filtering facepiece respirators (FFRs), two medical masks (MMs), and one cloth community mask (CM). FFR/MM/CM materials were inoculated with SARS-CoV-2 (a Betacoronavirus ), murine hepatitis virus (MHV) (a Betacoronavirus ), or porcine respiratory coronavirus (PRCV) (an Alphacoronavirus ), and treated with 10 µM MB followed by 50,000 lux of broad-spectrum light or 12,500 lux of red light for 30 minutes, or with 75°C DH for 60 minutes. In parallel, we tested respirator and mask integrity using several standard methods and compared to the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O 3 ) decontamination method. Intact FFRs/MMs/CM were subjected to five cycles of decontamination (5CD) to assess integrity using International Standardization Organization (ISO), American Society for Testing and Materials (ASTM) International, National Institute for Occupational Safety and Health (NIOSH), and Occupational Safety and Health Administration (OSHA) test methods. Findings Overall, MBL robustly and consistently inactivated all three coronaviruses with at least a 4-log reduction. DH yielded similar results, with the exception of MHV, which was only reduced by 2-log after treatment. FFR/MM integrity was maintained for 5 cycles of MBL or DH treatment, whereas one FFR failed after 5 cycles of VHP+O 3 . Baseline performance for the CM was variable, but reduction of integrity was minimal. Interpretation Methylene blue with light and DH treatment decontaminated masks and respirators by inactivating three tested coronaviruses without compromising integrity through 5CD. MBL decontamination of masks is effective, low-cost and does not require specialized equipment, making it applicable in all-resource settings. These attractive features support the utilization and continued development of this novel PPE decontamination method.

PURPOSE:Although intensive care clinicians are expected to make data-driven critical decisions using the technologies available to them, the effect of those technologies on decision-making are not well understood. Using the macrocognitive framework, we studied critical decision-making and technology use to understand how different specialists within teams make decisions and guide the development of decision-making support technologies.MATERIALS AND METHODS:The Critical Decision Method was used to understand the macrocognitive processes used during critical decision-making of twelve critical care clinicians. Deductive (based on the macrocognition framework) and inductive coding were used to analyze the macrocognitive processes, their interrelationships, and their relation to technologies.RESULTS:Over 60% of critical decision-making macrocognition was devoted to Sensemaking, Anticipation, and Communication. The most technology-mediated process was Sensemaking. Of particular note, physicians and respiratory therapists extracted information for their own use, while nurses extracted information to communicate to others. Physicians switched between ten macrocognitive processes, whereas nurses and respiratory therapists switched between five processes.CONCLUSIONS:This exploratory study provides much needed details about the different ways in which specialists use technologies to support decision-making tasks, particularly those involving sensemaking, which are essential to the design and development of decision-support technologies.

Key Points Question Do data integration and visualization technologies alleviate clinicians’ cognitive workload and alter decision-making performance? Findings In this systematic review and meta-analysis of 20 studies, data integration and visualization technologies were associated with improvements in self-reported performance, mental and temporal demand, and effort compared with paper-based recording systems, but no specific type is superior to others. Only 10% of studies of data integration and visualization technology evaluated them in clinical settings. Meaning Data integration and visualization technologies offer promising features to improve decision making by clinicians in the intensive care setting, but standardized test protocols are needed to generate clinician-centered evaluations and accelerate screening of technologies that support data-driven decision making.

IMPORTANCE Sources of data in the intensive care setting are increasing exponentially, but the benefits of displaying multiparametric, high-frequency data are unknown. Decision making may not benefit from this technology if clinicians remain cognitively overburdened by poorly designed data integration and visualization technologies (DIVTs). OBJECTIVE To systematically review and summarize the published evidence on the association of user-centered DIVTs with intensive care clinician performance. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science were searched in May 2014 and January 2018. STUDY SELECTION Studies had 3 requirements: (1) the study tested a viable DIVT, (2) participants involved were intensive care clinicians, and (3) the study reported quantitative results associated with decision making in an intensive care setting. DATA EXTRACTION AND SYNTHESIS Of 252 records screened, 20 studies, published from 2004 to 2016, were included. The human factors framework to assess health technologies was applied to measure study completeness, and the Quality Assessment Instrument was used to assess the quality of the studies. PRISMA guidelines were adapted to conduct the systematic review and meta-analysis. MAIN OUTCOMES AND MEASURES Study completeness and quality; clinician performance; physical, mental, and temporal demand; effort; frustration; time to decision; and decision accuracy. RESULTS Of the 20 included studies, 16 were experimental studies with 410 intensive care clinician participants and 4 were survey-based studies with 1511 respondents. Scores for study completeness ranged from 27 to 43, with a maximum score of 47, and scores for study quality ranged from 46 to 79, with a maximum score of 90. Of 20 studies, DIVTs were evaluated in clinical settings in 2 studies (10%); time to decision was measured in 14 studies (70%); and decision accuracy was measured in 11 studies (55%). Measures of cognitive workload pooled in the meta-analysis suggested that any DIVT was an improvement over paper-based data in terms of self-reported performance, mental and temporal demand, and effort. With a maximum score of 22, median (IQR) mental demand scores for electronic display were 10 (7-13), tabular display scores were 8 (6.0-11.5), and novel visualization scores were 8 (6-12), compared with 17 (14-19) for paper. The median (IQR) temporal demand scores were also lower for all electronic visualizations compared with paper, with scores of 8 (6-11) for electronic display, 7 (6-11) for tabular and bar displays, 7 (5-11) for novel visualizations, and 16 (14.3-19.0) for paper. The median (IQR) performance scores improved for all electronic visualizations compared with paper (lower score indicates better self-reported performance), with scores of 6 (3-11) for electronic displays, 6 (4-11) for tabular and bar displays, 6 (4-11) for novel visualizations, and 14 (11-16) for paper. Frustration and physical demand domains of cognitive workload did not change, and differences between electronic displays were not significant. CONCLUSIONS AND RELEVANCE This review suggests that DIVTs are associated with increased integration and consistency of data. Much work remains to identify which visualizations effectively reduce cognitive workload to enhance decision making based on intensive care data. Standardizing human factors testing by developing a repository of open access benchmarked test protocols, using a set of outcome measures, scenarios, and data sets, may accelerate the design and selection of the most appropriate DIVT.

BACKGROUND:Intensive care clinicians use several sources of data in order to inform decision-making. We set out to evaluate a new interactive data integration platform called T3™ made available for pediatric intensive care. Three primary functions are supported: tracking of physiologic signals, displaying trajectory, and triggering decisions, by highlighting data or estimating risk of patient instability. We designed a human factors study to identify interface usability issues, to measure ease of use, and to describe interface features that may enable or hinder clinical tasks.METHODS:Twenty-two participants, consisting of bedside intensive care physicians, nurses, and respiratory therapists, tested the T3™ interface in a simulation laboratory setting. Twenty tasks were performed with a true-to-setting, fully functional, prototype, populated with physiological and therapeutic intervention patient data. Primary data visualization was time series and secondary visualizations were: 1) shading out-of-target values, 2) mini-trends with exaggerated maxima and minima (sparklines), and 3) bar graph of a 16-parameter indicator. Task completion was video recorded and assessed using a use error rating scale. Usability issues were classified in the context of task and type of clinician. A severity rating scale was used to rate potential clinical impact of usability issues.RESULTS:Time series supported tracking a single parameter but partially supported determining patient trajectory using multiple parameters. Visual pattern overload was observed with multiple parameter data streams. Automated data processing using shading and sparklines was often ignored but the 16-parameter data reduction algorithm, displayed as a persistent bar graph, was visually intuitive. However, by selecting or automatically processing data, triggering aids distorted the raw data that clinicians use regularly. Consequently, clinicians could not rely on new data representations because they did not know how they were established or derived.CONCLUSIONS:Usability issues, observed through contextual use, provided directions for tangible design improvements of data integration software that may lessen use errors and promote safe use. Data-driven decision making can benefit from iterative interface redesign involving clinician-users in simulated environments. This study is a first step in understanding how software can support clinicians' decision making with integrated continuous monitoring data. Importantly, testing of similar platforms by all the different disciplines who may become clinician users is a fundamental step necessary to understand the impact on clinical outcomes of decision aids.

The Intensive Care Unit (ICU) is a complex and technologically advanced healthcare setting. Technologies enable continuous monitoring through patient signals that are sensed, recorded and displayed at the bedside. Although such technologies have significantly decreased mortality rates in the ICU, the large amounts of data have contributed to clinician information overload. Critical care nurses spend more than half of their time scanning and assimilating information from disparate monitors, at the bedside to assess the patient status. Software that integrates and allows visualization of large data sets on a single screen are now available. In the present study, we evaluated software entitled T3™ (Tracking, Trajectory and Triggering). Such computationally powerful software has great potential to support nurses’ monitoring and decision-making tasks but the usability, efficiency, and effectiveness of the software are key to end-user adoption. As such, we conducted a Heuristic Evaluation, where the study’s evaluators interacted with the software interfaces and were asked to comment on it by describing the usability issues and if they were in compliance with established usability principles, or heuristics, specifically for medical device interfaces. A total of 50 usability issues associated with 194 heuristic violations were found. Identified issues included difficulty with choosing the time period of the patient data signals, distinguishing between several patient signals and appearance of patient values which were imperceptible to evaluators; both issues could lead nurses to misinterpret the timing and/or the physiological status of the patient (e.g., time of shock and exact value of vitals). Heuristic evaluation, an efficient and inexpensive method, was successfully applied to the T3™ software to identify usability problems that if left unresolved could lead to patient safety issues. These findings may have broad implications for the design of the T3™ and other continuous monitoring systems.

Two-phase superconductor tapes were produced by blending high purity magnesium diboride powder with a liquid ethylcellulose-based polymeric binder. This procedure produced a material which is easily formable with a high superconducting transition temperature (38 K). We show that the bulk superconducting properties are not affected by the presence of the binder, nor is there any evidence of a chemical reaction between the superconducting particles and the binder. However, the transport properties of the material are strongly affected by the presence of the binder, which leads to a seven order of magnitude increase of the normal state resistance along with a seven order of magnitude decrease of the transport critical current density. This new material is shown to be equivalent to a system of coupled Josephson junctions.

A CW 4 kW Nd:YAG laser system was used to weld 2-3 mm butt joints of sand-cast ZE41A-T5 magnesium alloy at a power of 2.5 or 3.5 kW, welding speed of 6.0 m/min and defocusing distance from 0 to +3 mm for the material on the as-cast surface conditions. Sound joints with good surface quality, minor pores and micro cracks can be obtained using strictly controlled laser welding parameters.

The 2-mm butt joints of ZE41 A-T5 sand castings were laser welded at different defocusing distances on two surface conditions (as-east or machined) using a continuous wave 4 kW Nd:YAG laser system at a power of 2.5 kW and a welding speed of 6.0 m/min. Two welding modes (conduction or keyhole) have been observed. The adjustment of defocusing distance can greatly influence the establishment of conduction or keyhole modes. On the machined surface conditions conduction welding is obtained at a power density of 4.0 x 10(5) W/cm(2). In contrast, keyhole welding is reached at a 106 W/cm(2) threshold irradiance of 1.5 x 10(6). Neither conduction nor stable keyhole modes have been established at a range of power density from 7.7 x 10(5) to 1.2 x 10(6) W/cm(2) on the machined surface conditions. On the as-cast surface conditions keyhole is obtained at a power density as low as 4.0 x 10(5) W/cm(2) but good surface quality is obtained at a defocusing of +2 mm. The as-cast surfaces require lower power irradiance for the formation of keyholes indicating that they have higher energy absorptivity for Nd:YAG laser beams probably due to coarse surface morphology.