Colonization With Antibiotic-Resistant Bacteria in a Hospital and Associated Communities in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

BACKGROUND: We estimated the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) from a hospital and associated communities in western Guatemala. METHODS: Randomly selected infants, children, and adults (<1, 1-17, and ≥18 years, respectively) were enrolled from the hospital (n = 641) during the coronavirus disease 2019 (COVID-19) pandemic, March to September 2021. Community participants were enrolled using a 3-stage cluster design between November 2019 and March 2020 (phase 1, n = 381) and between July 2020 and May 2021 (phase 2, with COVID-19 pandemic restrictions, n = 538). Stool samples were streaked onto selective chromogenic agar, and a Vitek 2 instrument was used to verify ESCrE or CRE classification. Prevalence estimates were weighted to account for sampling design. RESULTS: The prevalence of colonization with ESCrE and CRE was higher among hospital patients compared to community participants (ESCrE: 67% vs 46%, P < .01; CRE: 37% vs 1%, P < .01). Hospital ESCrE colonization was higher for adults (72%) compared with children (65%) and infants (60%) (P < .05). Colonization was higher for adults (50%) than children (40%) in the community (P < .05). There was no difference in ESCrE colonization between phase 1 and 2 (45% and 47%, respectively, P > .05), although reported use of antibiotics among households declined (23% and 7%, respectively, P < .001). CONCLUSIONS: While hospitals remain foci for ESCrE and CRE colonization, consistent with the need for infection control programs, community prevalence of ESCrE in this study was high, potentially adding to colonization pressure and transmission in healthcare settings. Better understanding of transmission dynamics and age-related factors is needed.

High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico.

BACKGROUND: Human papillomavirus infection is an important factor associated with cervical cancer (CC) development. The prevalence and genotype distribution vary greatly worldwide. Examining local epidemiological data constitutes an important step towards the development of vaccines to prevent CC. In this work, we studied the prevalence of HPV genotypes in women from Western Mexico with the COBAS 4800 and/or Linear Array Genotyping Test (LA). METHODS: The samples analysed in this study represent a population from Western Mexico, which includes six different states. Our approach was first to test for HPV in cervical samples from women who attended their health clinic for routine gynaecological studies (open-population, n = 3000) by utilizing COBAS 4800. Afterwards, 300 of the HPV-positive samples were randomly selected to be genotyped with LA; finally, we genotyped samples from women with cervical intraepithelial neoplasia grade 1 (CIN 1, n = 71) and CC (n = 96) with LA. Sociodemographic data of the diverse groups were also compared. RESULTS: The overall HPV prevalence among the open-population of women as determined by COBAS 4800 was 12.1% (n = 364/3000). Among the HPV-positive samples, single infections (SI) with HPV16 were detected in 12.4% (n = 45/364), SI with HPV18 were detected in 1.4%, and infection with at least one of the genotypes included in the high-risk HPV pool was detected in 74.5% of the cases. LA analysis of the samples showed that in addition to HPV genotypes 16 and 18, there was a high prevalence of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. With respect to the sociodemographic data, we found statistically significant differences in the number of pregnancies, the use of hormonal contraceptives and tobacco intake. CONCLUSIONS: Our data indicate that there is a high prevalence of HPV genotypes which are not covered by the vaccines currently available in Mexico; therefore, it is necessary to include HPVs 59, 66, 51, 39 and 56 in the design of future vaccines to reduce the risk of CC development. It is also essential to emphasize that the use of hormonal contraceptives and tobacco smoking are risk factors for CC development in addition to the presence of HPV.

Consideration of stakeholder interests in the planning of sustainable waste management programmes.

Those responsible for developing sustainable solid waste management programmes must consider the impacts of programme elements on everyone involved. This paper focuses on identifying the effects of waste management activities and assessing their overall impact on stakeholders. Collaborating with four focus groups and 36 experts, 19 effects were identified and nine questionnaires were designed to evaluate them, one for each stakeholder group. All told, 1805 people took part in the survey. The results show that the effects most important to the survey participants are: (a) recycling solid urban waste, (b) pollution and (c) corporate social responsibility.

Accident data study of concrete construction companies' similarities and differences between qualified and non-qualified workers in Spain.

The aim of this paper is to discuss findings from an analysis of accidents in concrete construction companies in Spain and to compare the accident rates of qualified and non-qualified workers. A total of 125,021 accidents between 2003 and 2008 involving both blue-collar and white-collar workers were analysed, comparing the variables of occupation, age, company staff, length of service, location of the accident, together with the severity of the accidents. Results showed that lack of experience in the first month is more significant in non-qualified workers and experienced supervisors and that head injuries are more likely to lead to fatalities. The most remarkable similarity was that fatal accidents to and from the worksite are a problem common to both groups of workers.

Synthesis, anti-inflammatory activity and modeling studies of cycloartane-type terpenes derivatives isolated from Parthenium argentatum.

The 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced edema model in mice determined the anti-inflammatory activities in vivo of argentatins A, B and D, the main cycloartenol-type triterpenes present in Parthenium argentatum. Our results showed that argentatin B (ED50=1.5×10(-4)mmol/ear) and argentatin A (ED50=2.8×10(-4)mmol/ear) were more potent anti-inflammatory agents than indomethacin (ED50=4.5×10(-4)mmol/ear), the reference drug. Based on these findings, we decided to evaluate 13 derivatives of argentatins A and B. All the derivatives showed anti-inflammatory activity in the TPA-induced edema model in mice. The most active compound was 25-nor-cycloart-3, 16-dione-17-en-24-oic acid, obtained from argentatin A (ED50=1.4×10(-4)mmol/ear). Argentatin B was assayed as inhibitor of COX-2 activity one of the key enzymes involved in the TPA assay. The results showed that argentatin B at 15µM doses inhibited 77% COX-2 activity. Docking studies suggest that argentatin B interacts with Arg 120, a key residue for COX-2 activity.

Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study.

Objectives: The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala. Methods: Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21). Results: A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients. Conclusion: The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.

Key Factors in Crane-Related Occupational Accidents in the Spanish Construction Industry (2012-2021).

The construction industry is one of the riskiest sectors worldwide, with crane operations being one of the most dangerous activities. The aim of this study was to gain insight into the key factors involved in crane-related occupational accidents in the construction industry in Spain. To this end, 1314 accidents involving cranes were analyzed from a total of 241,937 accidents that occurred in the construction of buildings. The data were collected from the Spanish government's occupational accident statistics corresponding to the years 2012-2021. The results evidenced a statistically significant relationship between cranes as the material agent and the size of the company, with 95% of cases corresponding to small- or medium-sized companies (less than 250 employees). Additionally, it shows how the crane operator is identified as a material contributor to crane accidents in the construction industry, and may be considered a key component to these accidents. In conclusion, improving the knowledge gained about the key factors in crane-related accidents at work in the construction industry provides essential information that helps to design and implement appropriate preventive measures to avoid the recurrence of unwanted events with these machines.

Performance of barrier systems and functions in the construction industry.

Objectives. Improving knowledge about the mechanism of accident occurrence in the construction industry provides important information to help design and implement appropriate barriers to stop the spread of unexpected events. This study characterizes the sequence of accidents in the construction industry by linking the most commonly identified circumstances, the barriers and barrier functions infringed and the specific way in which each of these functioned. Methods. In order to achieve the proposed objective, an analysis was made of 241 investigations of work accidents that occurred in the construction sector in Spain between 2009 and 2014. The statistical difference between the groups of variables was determined using contingency tables in which the value of the χ2 statistic was calculated. Results. The results obtained show that behavioural factors are fundamentally identified, such as the worker's non-observance of ensuring their own safety or the deficient interpretation of rules. Conclusions. This study illustrates that to understand the performance of barrier systems and functions, efforts must be focused not only on the things that go wrong, i.e., accidents, but also on the things that go right within the variability of daily performance in systems as complex as the construction industry.

Short communication: Torsional tests on long-bone cylindrical medullary-canal exo-endoprostheses.

Torsion tests are performed for cylindrical type of a novel exo-endoprosthesis internal part. It is verified that it has values greater than those obtained for elliptical type. The best bonding method between PEEK and threaded rod is the resin adhesive, matching the obtained results for elliptical implant. Results of cylindrical type are discussed versus elliptical type.

Brain metastasis treatment guidelines: consensus by the Spanish Society of Neurosurgery Tumor Section.

Brain metastases are tumors that arise from a tumor cell originated in another organ reaching the brain through the blood. In the brain this tumor cell is capable of growing and invading neighboring tissues, such as the meninges and bone. In most patients a known tumor is present when the brain lesion is diagnosed, although it is possible that the first diagnose is the brain tumor before there is evidence of cancer elsewhere in the body. For this reason, the neurosurgeon must know the management that has shown the greatest benefit for brain metastasis patients, so treatments can be streamlined and optimized. Specifically, in this document, the following topics will be developed: selection of the cancer patient candidate for surgical resection and the role of the neurosurgeon in the multidisciplinary team, the importance of immunohistological and molecular diagnosis, surgical techniques, radiotherapy techniques, treatment updates of chemotherapy and immunotherapy and management algorithms in brain metastases. With this consensus manuscript, the tumor group of the Spanish Society of Neurosurgery (GT-SENEC) exposes the most relevant neurosurgical issues and the fundamental aspects to harmonize multidisciplinary treatment, especially with the medical specialties that are treating or will treat these patients.

Low grade gliomas guide-lines elaborated by the tumor section of Spanish Society of Neurosurgery.

Adult low-grade gliomas (Low Grade Gliomas, LGG) are tumors that originate from the glial cells of the brain and whose management involves great controversy, starting from the diagnosis, to the treatment and subsequent follow-up. For this reason, the Tumor Group of the Spanish Society of Neurosurgery (GT-SENEC) has held a consensus meeting, in which the most relevant neurosurgical issues have been discussed, reaching recommendations based on the best scientific evidence. In order to obtain the maximum benefit from these treatments, an individualised assessment of each patient should be made by a multidisciplinary team. Experts in each LGG treatment field have briefly described it based in their experience and the reviewed of the literature. Each area has been summarized and focused on the best published evidence. LGG have been surrounded by treatment controversy, although during the last years more accurate data has been published in order to reach treatment consensus. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.

Expert perspective on health and safety determinants in wineries.

BACKGROUND: The scientific literature contextualizes health and safety (H&S) in two major models, the first is based on a holistic perspective with H&S processes in all company departments, and the second approaches health and safety management from a more operational perspective. In this study, we examine the issue of health and safety in wineries. In 2017, a census showed that wineries account for 14% of the food and beverage industry in Spain. They provide direct employment for 24,051 people and involve complex winemaking processes that can cause accidents or occupational diseases. Wineries are part of the industrial sector, which, with 5,264 lost-time accidents per 100,000 workers in 2017, ranks second in the number of occupational accidents in Spain. This shows the need to determine the changes needed to improve health and safety in wineries. METHODS: In this study, we identify H&S determinants in wineries using Delphi methodology with a panel of 11 experts. CONCLUSION: The experts gave high scores to the "activities" dimension, and others such as "control of personal and collective protective equipment" and "training", together with "accident investigation", "coordinated health and safety measures" and "signage" are associated with operational health and safety determinants, namely, capitalizing on knowledge gained in situ and promoting organizational learning.

Biomechanical Tests on Long-Bone Elliptical Medullary-Canal Endoprostheses for Limb Salvage in Dogs.

Exo-endoprosthesis is a limb salvage procedure poorly described for animals, as only expensive metal devices have been used so far. Currently, additive manufacturing (AM) can make this type of implant affordable by exploring a wide new range of materials. However, safety factors should be considered and could be related to kinetic and kinematic studies of canine natural gaits. The suitability of a novel inner part of an exo-endoprosthesis manufactured by fuse deposition modeling (FDM) was assessed for long canine bones with an elliptical medullary canal. Polyether ether ketone (PEEK) was the material used as an alternative to metal for veterinary traumatology. Poisson's ratio of 3D-printed PEEK material and ex vivo mechanical tests of the customized endoprosthesis were performed for the evaluation. The customized endoprostheses had promising outcomes for the radii of 20 kg dogs. Quasistatic mechanical tests of bone-inserted endoprostheses-pure compression tests-reached a maximum force of 1045.0 ± 78.0 N. In fatigue tests, the samples reached 500,000 cycles without failure or detriment to their quasistatic results. These outcomes surpass the natural weight-bearing of dogs, even during a galloping pace. Furthermore, torque tests with different adhesives were performed to obtain reference data for future assessments comparing with natural dog movements.

An analysis of occupational accidents involving national and international construction workers in Spain using the association rule technique.

Worker safety awareness on construction sites is a major concern due to the hazardous work conditions. Additionally, globalization is increasing the cultural diversity of the workforce and this influences workers' attitudes, beliefs and behaviour. The growing number of migrant workers in this sector has become a distinctive feature of the industry's labour market. The objective of this article is to analyse occupational accidents that occurred on Spanish construction sites while taking into consideration the nationality of the workers. Due to the large number of accidents and attributes associated with them, the use of association rules is proposed. Overall, results evince similar behaviour, although interesting differences can be observed regarding the occupation of workers. In addition, the results are in accordance with previous studies carried out in other countries. The analysis of these accidents will serve to establish initiatives that provide safer work environments.

Biomechanical Test of a New Endoprosthesis for Cylindrical Medullary Canals in Dogs.

Exo-endoprosthesis is a limb salvage procedure for animals, although only expensive metal devices have been described. Now-a-days, new materials for this type of implant could be considered due to novel and affordable manufacturing techniques. However, a factor of safety (FoS) should be considered. There are kinetic and kinematic studies of canine natural gaits, which can be used to establish an FoS for mechanical tests for new non-metallic devices. Polyetheretherketone (PEEK) is used in different specialties in human medicine. Its mechanical properties (and its close mechanical stiffness to that of bone) make this polymer an alternative to metals in veterinary traumatology. PEEK could also be used in 3D printing. The suitability of a novel inner part of an exo-endoprosthesis manufactured by fuse deposition modeling (FDM) was presented in this study for long canine bones. Mechanical characterization of 3D-printed PEEK material and ex vivo mechanical tests of a customized endoprosthesis were performed to address it. Young's modulus of 3D-printed PEEK suffered a reduction of 30% in relation to bulk PEEK. Customized 3D-printed PEEK endoprostheses had promising outcomes for the tibiae of 20 kg dogs. Pure compression tests of the non-inserted endoprostheses showed a maximum force of 936 ± 199 N. In the bending tests of non-inserted endoprostheses, the PEEK part remained intact. Quasistatic mechanical tests of bone-inserted endoprostheses (compression-bending and pure compression tests) reached a maximum force of 785 ± 101 N and 1,642 ± 447 N, respectively. In fatigue tests, the samples reached 500,000 cycles without failure or detriment to their quasistatic results. These outcomes surpass the natural weight-bearing of dogs, even during a galloping pace. In conclusion, the 3D-printed PEEK part of the endoprosthesis for an exo-endoprosthesis can withstand loading, even during a galloping pace.

Isolation and characterization of wood-decomposing basidiomycetes from the Andean Forest in Boyacá, Colombia.

This study explores the biotechnological potential of lignocellulolytic fungi collected in an oak forest. Fungal collections were obtained from natural reserves located in Boyacá-Colombia, ranging from 2700 to 3000 m.a.s.l. Twenty-three strains were isolated on malt agar, molecular characterization was performed, and ligninolytic and cellulolytic enzymatic activities were screened. Several white-rot fungi of biotechnological importance were identified as follows: Trametes sp., Trametes versicolor, Trametes villosa, Pycnoporus sanguineus, Bjerkandera adjusta, Lentinula boryana, Panus conchatus, Antrodia neotropica, Brunneoporus malicola, Laetiporus gilbertsonii, Stereum sp., Ganoderma sp., and Dichomitus sp. The strains T. versicolor 0554 and 0583, T. villosa 0562, and B. adusta 0556 showed the highest response in the qualitative enzymatic assays. These strains were used to determine their ability to decolorate the dyes aniline blue and Congo red, and it was found that T. villosa 0562 reached a level of decolorization close to 90% after 48 h of submerged culture. The fungal strains obtained here could offer alternatives to develop a process to accomplish sustainable development objectives.

[The first Mexican consensus of endometrial cancer. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México]. / Primer consenso Mexicano de cancer de endometrio.

INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.

The Impact of Enforcement Capabilities on the Effectiveness of Public Assessment on Occupational Safety.

(1) Objective: The objective of this study was to evaluate the effect of enforcement capabilities on the efficacy of two public interventions to improve occupational safety in olive mills. (2) Method: The difference in efficacy was evaluated by comparing the risks detected in two groups in an initial assessment (with visits in the 2006-2008 period) to the risks detected in a later assessment, either after an intervention by Authorized Technicians with enforcement capabilities or after an intervention by Technical Advisors without enforcement capabilities (2011-2013). The assessments identified risks in the companies, according to a specific risk map for olive oil mill enterprises. (3) Results: Statistically significant differences were observed in the comparison of the risk reductions of the two groups, with regard to the initial assessment. The greatest reductions in risk were found in the companies that received interventions by Authorized Technicians with enforcement capabilities, in the sections of individual protection equipment and the storage of dangerous products. (4) Conclusion: Interventions by Authorized Technicians with enforcement capabilities are more effective than interventions by Technical Advisors without enforcement capabilities.

New Risk Situations Related to Low Noise from Electric Vehicles: Perception of Workers as Pedestrians and Other Vehicle Drivers.

Sales of electric and hybrid electric vehicles are increasing steadily worldwide, and consequently their presence increases in city areas. At low speeds, the low levels of noise produced by these vehicles could become a new risk factor for road users. However, the magnitude of the risk has not been accurately determined. In addition, its inclusion in the work environment could pose a new risk that should be managed. Thus, in relation to low noise levels of electric and hybrid vehicles, this study aimed to characterise the risk situations and determine the risk perception of workers as pedestrians and internal combustion engine vehicle drivers coming into contact with these vehicles. The data were extracted from 417 questionnaires filled out by the employees of public service companies who come into contact with electric and hybrid vehicles during their working day in the city of Málaga, in the region of Andalusia, Spain. According to the experiences reported, it seems that the risk due to the low noise levels of electric vehicles is moderate and does not reach alarming levels. These risk situations usually occurred in low speed urban areas, particularly when crossing the road, or in semi-pedestrian areas. Almost half the respondents considered that the electric vehicle poses a risk to other road users because it is more difficult to hear, and they believe it likely that other road users could be injured. Despite that risk, pedestrians did not change their way of walking or moving around the parking areas and other areas of the company. Electric and hybrid electric cars are now required to produce sound when travelling at low speeds. Nevertheless, the effectiveness of this measure should be assessed once implemented and future research should explore alternative non-acoustic measures.

Disposable masks: Disinfection and sterilization for reuse, and non-certified manufacturing, in the face of shortages during the COVID-19 pandemic.

The COVID-19 pandemic is posing a huge global health threat. To deal with this problem, in addition to research and work in the medical field, the main health measures being taken in the workplace and at home involve the establishment of safety protocols, which include distance measures, hygiene and the use of personal protective equipment, such as masks, etc. The WHO still does not recommend the use of masks for the general population. However, their successful use in China, South Korea and the Czech Republic has encouraged their widespread use, and the shortage that already existed. This has caused that companies and individuals are looking at the best way to reuse them, and to manufacture, homemade or not, of non-certified masks. This paper is based on two objectives: to consult the scientific literature to identify the main strategies for disinfecting them, and to determine the effectiveness of non-certified disposable masks. A rapid review has been conducted in which the main publications and other information available online have been analyzed. Results showed that the most promising methods are those that use hydrogen peroxide vapor, ultraviolet radiation, moist heat, dry heat and ozone gas. Soapy water, alcohol, bleach immersion, ethylene oxide, ionizing radiation, microwave, high temperature, autoclave or steam are not fully recommended. Regarding the effectiveness of surgical masks compared to PPE, the former have been seen to be slightly less effective than PPE. As for other types of masks the effectiveness of homemade or non-certified masks is very low.