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The use of personal protective equipment (PPE) has become essential to reduce the transmission of coronavirus disease 2019 (COVID-19) as it prevents the direct contact of body fluid aerosols expelled from carriers. However, many countries have reported critical supply shortages due to the spike in demand during the outbreak in 2020. One potential solution to ease pressure on conventional supply chains is the local fabrication of PPE, particularly face shields, due to their simplistic design. The purpose of this paper is to provide a research protocol and cost implications for the rapid development and manufacturing of face shields by individuals or companies with minimal equipment and materials. This article describes a best practice case study in which the establishment of a local manufacturing hub resulted in the swift production of 12,000 face shields over a seven-week period to meet PPE shortages in the North-West region of Ireland. Protocols and processes for the design, materials sourcing, prototyping, manufacturing, and distribution of face shields are described. Three types of face shields were designed and manufactured, including Flat, Laser-cut, and 3D-printed models. Of the models tested, the Flat model proved the most cost-effective (€0.51/unit), while the Laser-cut model was the most productive (245 units/day). The insights obtained from this study demonstrate the capacity for local voluntary workforces to be quickly mobilised in response to a healthcare emergency, such as the COVID-19 pandemic.

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Objetivo. Conocer los factores intrínsecos y extrínsecos asociados a anemia en pacientes post-operadas atendidas en las áreas de obstetricia COVID-19 y no COVID-19, del Hospital Nacional Alberto Sabogal Sologuren, EsSalud. Métodos. El estudio fue observacional, retrospectivo y transversal, enfoque cuantitativo, nivel explicativo, de modelo caso control, aplicado a 358 puérperas; de las cuales 179 fueron los casos, es decir aquellas puérperas con anemia en el post parto y 179 los controles, tomados de ambas áreas. Los datos fueron procesados con el estadístico SPSS 25. Resultados. Los factores intrínsecos: alimentación sin variación, sobrepeso u obesidad mórbida, paridad de 4 a más, número de cesáreas de 3 a más, y el periodo intergenésico menor de 2 años, fueron condiciones que representaron riesgo doble de producir anemia en el puerperio entre las mujeres del estudio, en relación a las que no tuvieron estas características. Además, el factor intrínseco o condición de haber tenido anemia durante el embarazo, resultó en una probabilidad 5 veces mayor a producir anemia en el puerperio entre las mujeres del estudio (Odds Ratio 5,156), en comparación a las mujeres que no tuvieron anemia. La ingesta de ácido fólico tuvo una probabilidad 3,4 veces menor (Odds Ratio de 3,408) de desarrollar la anemia respecto de aquellas que no lo hicieron y las complicaciones en el puerperio inmediato (Odds Ratio de 3,397) estuvieron asociados a la anemia en puérperas. Conclusiones. Los factores intrínsecos como el diagnóstico de anemia durante el embarazo y los factores extrínsecos como la no ingesta de ácido fólico y complicaciones en el puerperio inmediato, estuvieron asociados a la anemia en puérperas en el área de obstetricia COVID-19 y no COVID-19 del Hospital Alberto Sabogal.

Objective. To know the intrinsic and extrinsic factors associated with anemia in post-cesarean women treated in the COVID-19 and non-COVID-19 obstetric area of the Alberto Sabogal Hospital. Methods. The study was observational, retrospective and cross-sectional, quantitative approach, explanatory level, case- control model, applied to 358 puerperal women; of which 179 were the cases, that is, those puerperal women with postpartum anemia and 179 were controls, taken from both areas. The data were processed with the SPSS 25 statistic. Results. The intrinsic factors: diet without variation, overweight or morbid obesity, parity of 4 or more, number of cesarean sections of 3 or more, and the intergenetic period of less than 2 years, were conditions that represented a double risk of producing anemia in the puerperium among women in the study, in relation to those who did not have these characteristics. Also, the intrinsic factor or condition of having had anemia during pregnancy, resulted in a 5 times greater probability of producing anemia in the puerperium among the women in the study (Odds Ratio 5.156), compared to the women who did not have anemia. Folic acid intake was 3.4 times less likely (Odds Ratio of 3.408) to develop anemia compared to those who did not, and complications in the immediate puerperium (Odds Ratio of 3.397) were associated with anemia in puerperal women. Conclusions. Intrinsic factors such as the diagnosis of anemia during pregnancy and extrinsic factors such as folic acid not ingest and complications in the immediate puerperium were associated with anemia in puerperal women in the COVID-19 and non-COVID-19 obstetric area of Hospital Alberto Sabogal.

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The outbreak of COVID-19 has spread rapidly across the globe, greatly affecting how humans as a whole interact, work and go about their daily life. One of the key pieces of personal protective equipment (PPE) that is being utilised to return to the norm is the face mask or respirator. In this review we aim to examine face masks and respirators, looking at the current materials in use and possible future innovations that will enhance their protection against SARS-CoV-2. Previous studies concluded that cotton, natural silk and chiffon could provide above 50% efficiency. In addition, it was found that cotton quilt with a highly tangled fibrous nature provides efficient filtration in the small particle size range. Novel designs by employing various filter materials such as nanofibres, silver nanoparticles, and nano-webs on the filter surfaces to induce antimicrobial properties are also discussed in detail. Modification of N95/N99 masks to provide additional filtration of air and to deactivate the pathogens using various technologies such as low- temperature plasma is reviewed. Legislative guidelines for selecting and wearing facial protection are also discussed. The feasibility of reusing these masks will be examined as well as a discussion on the modelling of mask use and the impact wearing them can have. The use of Artificial Intelligence (AI) models and its applications to minimise or prevent the spread of the virus using face masks and respirators is also addressed. It is concluded that a significant amount of research is required for the development of highly efficient, reusable, anti-viral and thermally regulated face masks and respirators.

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PURPOSE OF THE STUDY: To measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis. STUDY DESIGN: A retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed. RESULTS: There were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age <64.5 years, female gender and NPSS <2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree. CONCLUSIONS: Increased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.

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Teleradiology allows contemporaneous interpretation of imaging exams performed at some distance from the interpreting radiologist. The transmitted images are usually static. However, there is benefit to real-time review of full-motion ultrasound (US) exams as they are performed. Telesonography is transmission of full-motion sonographic data to a remote site. We hypothesize that US exams, read after having been compressed utilizing Motion Picture Experts Group version 4 (MPEG-4) compression scheme, transmitted over the Internet as streaming multimedia, decompressed, and displayed, are equivalent in diagnostic accuracy to reading the examinations locally. MPEG-4 uses variable compression on each image frame to achieve a constant output bit rate. With less compression, the bit rate rises, and the only way the encoder can contain bit rate within the set bandwidth is by lowering frame rate or reducing image quality. We review the relevant technologies and industry standard components that will enable low-cost telesonography.

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RATIONALE AND OBJECTIVES: The authors' institution had decided to convert its radiology teaching files from film to digital media. This study was performed to determine the simplest method for converting the analog film images to digital images without a subsequent loss in diagnostic accuracy. MATERIALS AND METHODS: Twenty chest radiographs that demonstrated interstitial lung disease were randomly selected from the departmental teaching files and matched with 20 control radiographs from healthy adults. Analog film images were converted with both a diagnostic-quality film image digitizer (digitized) and a flatbed scanner equipped with a transparency adapter (scanned). Three radiology faculty members reviewed a mixed set of corresponding analog film, digitized, and scanned images. Reviewers judged whether each image depicted interstitial lung disease, indicated their level of confidence in the diagnosis, and rated each image for quality. Image quality was assessed by each reviewer subjectively at the time of viewing the individual image, without regard to other images. A one-way analysis of variance was performed to determine whether there was a statistically significant difference in diagnostic accuracy between the three image formats. Agreement in diagnosis between corresponding images in the three different formats was evaluated for each reviewer with the McNemar test. RESULTS: There was no statistically significant difference in diagnostic accuracy between analog film and scanned images, but there was such a difference between these two groups and digitized images. Accuracy was 97% for analog film, 94% for scanned, and 89% for digitized images. Results of the McNemar test showed no statistically significant difference in agreement between the analog film images and the scanned images for any of the reviewers (P > .05). CONCLUSION: A high-end flatbed scanner with transparency adapter provided accurate, simple, and inexpensive conversion of analog film teaching files to digital format, with no loss of the ability to detect or diagnose subtle abnormalities such as interstitial lung disease.

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