Facemask Removal Research Articles

Non-Pharmacological Interventions During SARS-CoV-2 Pandemic: Effects on Pediatric Viral Respiratory Infections

IntroductionViral lower respiratory tract infections frequently cause morbidity and mortality in children. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic led to isolation and hygiene measures, resulting in decreased respiratory virus transmission and pediatric admissions. This study aimed to assess the impact of these measures and their uplifting on respiratory virus circulation in children before and during the SARS-CoV-2 pandemic (January 2017-December 2022). MethodsWe conducted a weekly time series analysis of multiple virus molecular assays in children. This included those admitted to a university reference hospital's Pediatric Intensive Care Unit (PICU) and those with risk pathologies exhibiting fever and/or respiratory symptoms. We included patients aged 0-18 years residing in Catalonia and adjusted the positive results to account for diagnostic effort. ResultsWe performed a total of 2991 respiratory virus tests during the period. Confinement significantly decreased the detection of all viruses, especially Rhinovirus (RV). After the deconfinement of children, the viral detection trend remained stable for all viruses, with no short-term impact on virus transmission. The mandatory implementation of facemasks in those aged ≥6 years led to decreased viral circulation, but we observed an influenza virus rebound after facemask removal. At that time, we also noticed an interrupted drop in the detection rates of RV and respiratory syncytial virus (RSV). The reopening of schools led to a progressive increase in viral detections, especially of Rhinovirus. ConclusionNon-pharmacological interventions significantly impact the circulation of respiratory viruses among children. We observed these effects even when some measures did not specifically target preschool-aged children.

GANMasker: A Two-Stage Generative Adversarial Network for High-Quality Face Mask Removal.

Deep-learning-based image inpainting methods have made remarkable advancements, particularly in object removal tasks. The removal of face masks has gained significant attention, especially in the wake of the COVID-19 pandemic, and while numerous methods have successfully addressed the removal of small objects, removing large and complex masks from faces remains demanding. This paper presents a novel two-stage network for unmasking faces considering the intricate facial features typically concealed by masks, such as noses, mouths, and chins. Additionally, the scarcity of paired datasets comprising masked and unmasked face images poses an additional challenge. In the first stage of our proposed model, we employ an autoencoder-based network for binary segmentation of the face mask. Subsequently, in the second stage, we introduce a generative adversarial network (GAN)-based network enhanced with attention and Masked-Unmasked Region Fusion (MURF) mechanisms to focus on the masked region. Our network generates realistic and accurate unmasked faces that resemble the original faces. We train our model on paired unmasked and masked face images sourced from CelebA, a large public dataset, and evaluate its performance on multi-scale masked faces. The experimental results illustrate that the proposed method surpasses the current state-of-the-art techniques in both qualitative and quantitative metrics. It achieves a Peak Signal-to-Noise Ratio (PSNR) improvement of 4.18 dB over the second-best method, with the PSNR reaching 30.96. Additionally, it exhibits a 1% increase in the Structural Similarity Index Measure (SSIM), achieving a value of 0.95.

A Teaching Simulation is Effective in Improving Athletic Training Students' Football Helmet Facemask Removal Clinical Skills and Confidence

Context: Patient encounters related to acute care skills rarely occur in clinical education, leaving a potential gap in students' skills and confidence. Objective: Investigate the effects of an acute care simulation requiring football helmet facemask removal on clinical skill application and confidence in athletic training students. Design: Cross-sectional. Patients or Other Participants: Forty-four students (16 male, 28 female; age = 20.9 ± 1.12 years) enrolled in 2 accredited professional athletic training programs. Intervention(s): Participants completed a confidence assessment survey and were pretested on football helmet facemask removal skills. Pairs of participants engaged in a simulation where they evaluated and managed a football player who required facemask removal, followed by a debriefing session. Participants repeated the confidence assessment survey and were posttested to evaluate skills. Main Outcome Measure(s): Dependent variables were clinical skills scores and confidence, as measured by a confidence assessment survey. Simulation served as the independent variable. Paired samples t test determined changes in clinical skills scores. Wilcoxson Signed-Rank Test determined changes in confidence. Results: Paired samples t test revealed a significant increase in performance on the posttest, including: primary survey (t43 = 4.13, P < .001), facemask removal (t43 = 4.00, P < .001), vital signs assessment (t43 = 5.57, P < .001), and secondary survey (t43 = 8.85, P < .001). Wilcoxon Signed-Rank Test revealed increased confidence in participants' recognition of (Z = 4.96, n = 44, P < .001), knowledge of (Z = 5.03, n = 44, P < .001), and skills (Z = 4.78, n = 43, P < .001) needed for football helmet facemask removal. Conclusions: With the inability to ensure students have authentic, real-time evaluation of acute care skills during clinical experiences, a simulation can assist in acquisition of skills, while also improving confidence in managing acute care conditions.

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy

Objective: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. Methods: Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. Results: The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. Conclusions: Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

Is the new Quick Release Attachment System more efficient at removing face masks than the Combined Tool Approach?

This is a systematic review to determine which method, combined tool approach or quick release attachment system, removes a football helmet facemask quicker. Evidence indicates both methods for facemask removal can be quick and efficient. However, the quick release attachment system was quicker and produced less movement of the head compared to the combined tool approach during the facemask removal process. In emergent football cervical spine injuries, the quick release attachment system is better to use in removing the helmet facemask than the combined tool approach.

Head Acceleration, Time, and Difficulty During Helmet Removal With and Without Facemask Removal

Head Acceleration, Time, and Difficulty During Helmet Removal With and Without Facemask Removal

Time and Head and Neck Movement Associated With Lacrosse Helmet Facemask Removal

Time and Head and Neck Movement Associated With Lacrosse Helmet Facemask Removal

The Role of Practice on Lacrosse Helmet Facemask Removal Time

Facemask removal (FMR) is crucial for immediate treatment of helmeted athletes. The purpose of this study was to determine the effect of practice on the time required for lacrosse helmet FMR. Participants removed the facemasks of two helmet models (Cascade CPXR and Warrior Trojan) four times over four weeks with either a cordless screwdriver or pruner. We found a significant interaction for removal tool and time (p &lt; .001). Participants became faster at FMR across the 4 weeks of data collection. We recommend three consecutive weeks of practice to improve FMR speed, though depending on FMR tool, an individual could benefit from additional sessions.

Comparison of face mask removal times in lacrosse helmets

In the event of a head or neck injury in helmeted sports, it has been recommended to remove just the facemask (FM) rather than the entire helmet. Research surrounding FM removal time and difficulty, however, has focused primarily on football helmets. To date, there has been limited controlled research regarding men’s lacrosse helmet FM removal. The purpose of this study was to examine the effect of helmet type on FM removal time and difficulty. Design Repeated measure design conducted in a laboratory setting. Eight certified athletic trainers (male = 4, female = 4; age = 24.13 ± 2.17 yr, experience = 1.75 ± .71 yr). Intervention and main outcome measures included the independent variable of helmet type (Warrior Venom, Cascade CPX-R, Cascade Pro7, and Riddell Revolution) and the dependent variables of FM removal time (seconds), rate of perceived exertion (Borg Scale 0-10), and failure rate (trials failed divided by total trials). Results The Cascade Pro7 FM took 61%, 93%, and 108%. longer to remove than the Warrior Venom, Cascade CPX-R, and Riddell Revolution FMs, respectively. The Warrior Venom FM took 29% longer to remove compared to the Riddell Revolution FM. The participants found the Cascade Pro7 FM to be 59%, 100%, and 199% more difficult to remove than the Warrior Venom, Riddell Revolution, and Cascade CPX-R, respectively. There were no other statistically significant differences identified. The Cascade Pro7 FM was the most difficult to remove due to additional removal sites and the Velcro that helped to adhere the chin guard to the helmet shell.

Lacrosse Helmet Facemask Removal Timeliness and Preference Rating Using a Cordless Screw Driver, FMX, and Two-tool Approach

Lacrosse Helmet Facemask Removal Timeliness and Preference Rating Using a Cordless Screw Driver, FMX, and Two-tool Approach

Effects of Long-Duration Wearing of N95 Respirator and Surgical Facemask: A Pilot Study

The protection efficacy of facemasks and respirators has been well documented. The change of human nasal functions after wearing N95 respirator and surgical facemask is not known. In a parallel group study, we recruited 87 healthy healthcare workers. Each of the volunteers attended two sessions, and wore N95 respirator in session 1 (S1) and surgical facemask in session 2 (S2) for 3 hours. Mean minimum cross sectional area (mMCA) of the two nasal airways via acoustic rhinometry and nasal resistance via rhinomanometry were measured before and immediately after the mask wearing. Rhinomanometry was repeated every 30 minutes for 1.5 hours after the removal of masks. A questionnaire was distributed to each of the volunteers, during the 3 hours mask wearing period, to report subjective feelings on discomfort level of breathing activity. Among 77 volunteers who completed both the two sessions, the mean nasal resistance immediately increased upon the removal of surgical facemask and N95 respirator. The mean nasal resistance was significantly higher in S1 than S2 at 0.5 hour and 1.5 hours after removal of the masks (p<0.01). There is no statistical difference on mMCA before and after mask wearing in both sessions (p=0.85). The discomfort level was increasing with time while wearing masks, with significantly higher magnitude in S1 (p<0.001). There is an increase of nasal resistance upon removal of N95 respirator and surgical facemask potentially due to nasal physiological changes. N95 respirator caused higher post-wearing nasal resistance than surgical facemask with different recovering routines.

Face mask removal is safer than helmet removal for emergent airway access in American football

Background contextIn cases of possible cervical spine injury, medical professionals must be prepared to achieve rapid airway access while concurrently restricting cervical spine motion. Face mask removal (FMR), rather than helmet removal (HR), is recommended to achieve this. However, no studies have been reported that compare FMR directly with HR. PurposeThe purpose of this study was to compare motion, time, and perceived difficulty in two commonly used American football helmets between FMR and HR techniques, and when helmet air bladders were deflated before HR compared with inflated scenarios. Study design/settingThe study incorporated a repeated measures design and was performed in a controlled laboratory setting. ParticipantsParticipants included 22 certified athletic trainers (15 men and seven women; mean age, 33.9±10.5 years; mean experience, 11.4±10.0 years; mean height, 172±9.4 cm; mean mass, 76.7±14.9 kg). All participants were free from upper extremity or central nervous system pathology for 6 months and provided informed consent. Outcome measuresDependent variables included head excursion in degrees (computed by subtracting the minimum position from the maximum position) in each of the three planes (sagittal, frontal, transverse), time to complete the required task, and ratings of perceived exertion. To address our study purposes, we used two-by-two repeated-measures analysis of variance (removal technique×helmet type, helmet type×deflation status) for each dependent variable. MethodsIndependent variables consisted of removal technique (FMR and HR), helmet type (Riddell Revolution IQ [RIQ] and VSR4), and helmet deflation status (deflated [D], inflated, [I]). After familiarization, participants conducted two successful trials for each of six conditions in random order (RIQ-FMR, VSR4-FMR, RIQ-HR-D, VSR4-HR-D, RIQ-HR-I, and VSR4-HR-I). Face masks, helmets, and shoulder pads were removed from a live model wearing a properly fitted helmet and shoulder pads. The participant and an investigator stabilized the model's head. A six-camera three-dimensional motion system and a three-point one-segment marker set were used to record motion of the head. ResultsFace mask removal resulted in less motion in all three planes, required less completion time, and was easier to perform than HR. The RIQ helmet resulted in less frontal plane motion and less time to task completion, and was easier to remove than VSR4 helmets. Inflated helmets—regardless of helmet type—required less removal time but did not result in greater cervical spine motion or difficulty. ConclusionsIt is safer to remove the face mask in the prehospital setting for the potential spine-injured American football player than to remove the helmet, based on results from both a traditional and newer football helmet designs. Deflating the air bladder inside the helmet does not provide an advantage.

Lacrosse Helmet Facemask Removal

Facemask removal (FMR) is required to access the airway of a catastrophically injured football or ice hockey athlete. However, the best method of caring for the helmeted lacrosse athlete with suspected catastrophic injury remains unclear. To evaluate the effects of sex and grip strength on the speed and ease of use of various FMR methods across different lacrosse helmet types. Cross-sectional study. Setting : Athletic training laboratory. Fourteen athletic trainers (7 men, 7 women). Removal method (cordless screwdriver [CSD], Face Mask Extractor 2 [FMX], pruner, Trainer's Angel [TA]), helmet type (Cascade CPX, Cascade Pro7, Riddell Revolution, Brine Triumph, Warrior Venom), and sex. Facemask removal time and participant-reported ease of use of the removal method (6-point Likert scale). We found a 2-way interaction for removal method and sex only for the ease-of-use scores (F3,246 = 4.67, P = .01). A main effect for removal method for time (F3,200 = 19.41, P < .001) and ease of use (F3,200 = 53.78, P < .001) was seen. The fastest times (32.32 ± 11.70 seconds) and highest ease-of-use scores (4.94 ± 0.30) were recorded for the CSD. We noted a main effect for helmet type only for time (F4,200 = 5.34, P < .001), with the fastest removal times (72.75 ± 74.67 seconds) recorded for the CPX. We discovered a main effect for sex only for time (F1,200 = 17.57, P < .001), with slower times recorded for women (115.51 ± 110.80 seconds) than men (75.71 ± 83.87 seconds). We found correlations between FMR time and grip strength only when using the FMX (r = -0.40, P = .001), pruner (r = -0.26, P = .04), and TA (r = -0.26, P = .047). Based on our results, FMR of lacrosse helmets should be attempted with a CSD. We recommend carrying a pruner as a backup cutting tool in case the CSD fails, practicing FMR regularly, and inspecting helmets for faulty hardware to reduce the chance of CSD failure.

Removal Time and Efficacy of Riddell Quick Release Face Guard Attachment System Side Clips During 1 Football Season

In the National Athletic Trainers' Association position statement, "Acute Management of the Cervical Spine-Injured Athlete," the technique recommended for face-mask (FM) removal is one that "creates the least head and neck motion, is performed most quickly, is the least difficult, and carries the least chance of failure." Industrial and technological advances in football helmet design and FM attachment systems might influence the efficacy of emergency FM removal. To examine the removal times and success rates of the Quick Release (QR) Face Guard Attachment System (Riddell Sports, Inc, Elyria, OH) throughout and at the conclusion of 1 season of play by a National Collegiate Athletic Association Division III football team competing in the Midwest. Controlled laboratory study. College laboratory. A total of 69 randomly selected Revolution IQ (Riddell Sports, Inc) football helmets fitted with the QR system were used. Each helmet was secured to a spine board, and investigators attempted to remove both of the QR side clips from the helmet with the Riddell insertion tool. Dependent variables included total time for removal of both QR side clips from the FM and success rate for removal of both side clips. The overall success rate for removal of both clips was 94.8% (164/173), whereas the mean times for removal of both clips ranged from 9.92 ± 12.06 seconds to 16.65 ± 20.97 seconds over 4 trial sessions. We found no differences among mean times for trial sessions throughout the season of play among the same helmets or among different helmets (P > .05). Removal time and success rate of the Riddell QR were satisfactory during and after 1 season of play despite use in various temperatures and precipitation.

The Effect of Lacrosse Helmet Design on Face Mask Removal with Different Removal Tools

The Effect of Lacrosse Helmet Design on Face Mask Removal with Different Removal Tools

Emergency Face-Mask Removal Effectiveness: A Comparison of Traditional and Nontraditional Football Helmet Face-Mask Attachment Systems

Football helmet face-mask attachment design changes might affect the effectiveness of face-mask removal. To compare the efficiency of face-mask removal between newly designed and traditional football helmets. Controlled laboratory study. Applied biomechanics laboratory. Twenty-five certified athletic trainers. The independent variable was face-mask attachment system on 5 levels: (1) Revolution IQ with Quick Release (QR), (2) Revolution IQ with Quick Release hardware altered (QRAlt), (3) traditional (Trad), (4) traditional with hardware altered (TradAlt), and (5) ION 4D (ION). Participants removed face masks using a cordless screwdriver with a back-up cutting tool or only the cutting tool for the ION. Investigators altered face-mask hardware to unexpectedly challenge participants during removal for traditional and Revolution IQ helmets. Participants completed each condition twice in random order and were blinded to hardware alteration. Removal success, removal time, helmet motion, and rating of perceived exertion (RPE). Time and 3-dimensional helmet motion were recorded. If the face mask remained attached at 3 minutes, the trial was categorized as unsuccessful. Participants rated each trial for level of difficulty (RPE). We used repeated-measures analyses of variance (α = .05) with follow-up comparisons to test for differences. Removal success was 100% (48 of 48) for QR, Trad, and ION; 97.9% (47 of 48) for TradAlt; and 72.9% (35 of 48) for QRAlt. Differences in time for face-mask removal were detected (F(4,20) = 48.87, P = .001), with times ranging from 33.96 ± 14.14 seconds for QR to 99.22 ± 20.53 seconds for QRAlt. Differences were found in range of motion during face-mask removal (F(4,20) = 16.25, P = .001), with range of motion from 10.10° ± 3.07° for QR to 16.91° ± 5.36° for TradAlt. Differences also were detected in RPE during face-mask removal (F(4,20) = 43.20, P = .001), with participants reporting average perceived difficulty ranging from 1.44 ± 1.19 for QR to 3.68 ± 1.70 for TradAlt. The QR and Trad trials resulted in superior results. When trials required cutting loop straps, results deteriorated.

The Combined Tool Approach for Face Mask Removal During On-Field Conditions

The Combined Tool Approach for Face Mask Removal During On-Field Conditions

The Combined Tool Approach for Face Mask Removal During On-field Conditions

An effective approach to emergency removal of the face mask (FM) from a football helmet should include successful removal of the FM and limitation of both the time required and the movement created during the process. Current recommendations and practice are to use a cutting tool to remove the FM. Researchers recently have suggested an alternate approach that combines the use of a cordless screwdriver and a cutting tool. This combined tool approach has not been studied, and FM removal has not been studied in a practical setting. To investigate the effectiveness and speed of using a combined tool approach to remove the FMs from football helmets during on-field conditions throughout the course of a football season. Randomized multigroup design. Practice field of 1 National Collegiate Athletic Association Division II football college. Eighty-four members of 1 football team. We used a battery-operated screwdriver for FM removal and resorted to using a cutting tool as needed. We tracked FM removal success and failure and trial time and compared results based on helmet characteristics, weather variables, and the seasonal timing of the removal trial. Of the 84 players, 76 were available for data-collection trials. Overall, 98.6% (75/76) of FM removal trials were successful and resulted in a mean removal time of 40.09 +/- 15.1 seconds. We found no differences in FM removal time throughout the course of the season. No differences in effectiveness or trial time were found among helmet characteristics, weather variables, or the timing of the trial. Combining the cordless screwdriver and cutting tool provided a fast and reliable means of on-field FM removal in this Division II setting. Despite the excellent overall result, 1 FM was not removed in a timely manner. Therefore, we recommend that athletic trainers practice helmet removal to be prepared should FM removal fail.

Loop-Strap Type Does Not Affect Facemask Removal Using an Anvil Pruner

Purpose: To compare time and movement characteristics of four different brands of football facemask loop straps during a cutting task. Methods: Ten certified athletic trainers, age 24.8 ± 3.4, years of experience 2.4 ± 2.5, cut four different brands of football helmet loop straps (ShockblockerTM, ASI (Athletic Specialty), SchuttTM AG (Armourguard) Elite, and RiddellTM) with an anvil pruner. Task completion time was measured with a time code generator. Helmet movement was measured in the lateral flexion plane using 2-dimensional motion analysis. Results:Measureable but non-significant differences were observed between loop strap types (P &lt; 0.05) for dependent variables (time, range movement, and mean movement). Conclusions: Emergency personnel can effectively cut through various brands of football helmet loop straps using an anvil pruner and do not need brand-specific tools for facemask removal. Similar movement characteristics were observed while cutting all four brands of loop straps. Movement occurring during facemask removal may increase cervical displacement and increase injury severity. Measureable differences in cutting time warrant further investigation.

Combined Tool Approach is 100% Successful for Emergency Football Face Mask Removal

To compare effectiveness of two techniques for removing football face masks: cutting loop straps [cutting tool: FMXtractor (FMX)] or removing screws with a cordless screwdriver and using the FMXtractor as needed for failed removals [combined tool (CT)]. Null hypotheses: no differences in face mask removal success, removal time or difficulty between techniques or helmet characteristics. Retrospective, cross-sectional. NOCSAE-certified helmet reconditioning plants. 600 used high school helmets. Face mask removal attempted with two techniques. Success, removal time, rating of perceived exertion (RPE). Both techniques were effective [CT 100% (300/300); FMX 99.4% (298/300)]. Use of the backup FMXtractor in CT trials was required in 19% of trials. There was significantly (P<0.001) less call for the backup tool in helmets with silver screws (6%) than in helmets with other screws (31%). Mean removal time was 44.51+/-18.79s (CT: 37.84+/-15.37s, FMX: 51.21+/-19.54s; P<0.001). RPE was different between techniques (CT: 1.83+/-1.20, FMX: 3.11+/-1.27; P<0.001). Removal from helmets with silver screws was faster (Silver=33.38+/-11.03, Others=42.18+/-17.64; P<0.001) and easier (Silver=1.42+/-0.89, Other=2.23+/-1.33; P<0.001). CT was faster and easier than FMX. Most CT trials were completed with the screwdriver alone; helmets with silver screws had 94% screwdriver success. Clinically, these findings are important because this and other research shows that compared to removal with cutting tools, screwdriver removal decreases time, difficulty and helmet movement (reducing potential for iatrogenic injury). The combined-tool approach captures benefits of the screwdriver while offering a contingency for screw removal failure. Teams should use degradation-resistant screws. Sports medicine professionals must be prepared with appropriate tools and techniques to efficiently remove the face mask from an injured football player's helmet.