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Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
@ToshiAkima
Jun 11 • 13 tweets • 8 min read Twitter logo Read on Twitter
A review of the @readimask N95. Unless you consistently pass a fit test in it, as many do, I recommend taking care with using the Readimask as your standard everyday respirator, but hands up everyone who goes to the hairdresser.🙋‍♀️🙋‍♂️
The @readimask is metal-free, making it ideal for MRI scans. Other respirators with aluminium nose-wires may be MRI-safe, but the metal degrades the image quality of brain scans and should be avoided. ncbi.nlm.nih.gov/pmc/articles/P…
You can wear them as a nasal respirator at the dentist as well. I don't know how effective it is but it's not like there's any alternative. I suggest the size S ones for this purpose.
Even a 34/100 (pass mark = 100+) on a fit test is at the “perfection is the enemy of the good” level. That correlates well with my own QLFT fit-testing experience. That's much better than what the vast majority of us typically get from earloops (3-6/100). From @FitTestMyPlanet Image
My problem is that I have oily skin and the seal weakens after 10 minutes, leading to leakage, but I have heard from others who don't experience this (@amandalhu). If, for some medical reason, you can't wear headstraps the @readimask is probably your best alternative.
Sizing is also crucial. Use this size chart to guide you with size. I found it worked for the @readimask. Image
Read the instructions carefully. The crucial bit is that you get a proper “tab” forming. @readimask kindly sent me free samples of the medium size to try (I paid for shipping), but I badly failed a fit test as it was too small and could not form a tab. medical.averydennison.com/content/dam/me… Image
I had to get the L-size @readimask sent to me and I fared much better in it, almost passing a fit test in it, except for ultra-low-grade leakage at the chin that became worse when the test was immediately repeated. Pressing the seal back down temporarily fixed it. YMMV. ImageImage
@readimask has NIOSH approval for mandatory occupational use situations in the US/CAN. They don't have EU/UK approval as an FFP2. They used to have AU/NZ approval but let it lapse due to low demand. Interested international buyers should contact @readimask regarding shipping.
@readimask will reply with an electronic invoice to ship promptly via courier. If there is enough consumer demand, @readimask will reconsider activating their TGA approval. Yes, I have put @CO2RadicalAus in touch with them already so they may yet return to the AU market.
The @readimask N95 respirator is made in the USA and they ship free within the US. There are discounts for subscriptions. They also come in acrylic grey version if canary yellow is not your thing. readimask.com/collections/re…
Canadian readers interested in purchasing the @readimask N95 respirator are directed to the @DonateMask website.
Regarding sizing, it goes S L XL. There is no M size. The L is more like a regular/M size. The XL fits more like the L in the size chart. The one I wear in the above photo is the N1901X which is a size XL. I suspect I score about ~30/100 in the L and closer to 100 in the XL. Image

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More from @ToshiAkima

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jun 11
None of this is original. Anti-contagionists opposed us drinking cholera-free clean water and pulled similar crazy stunts back in the 19th century to gaslight us. Once cleanwater systems were in place, they found it had other health benefits beyond cholera.
Pettenkofer ordered Vibrio cholerae culture from Robert Koch’s lab and proceeded to drink it before witnesses to “prove” it was not a contagious germ-spread disease. Vinay is our modern Pettenkofer.
Pettenkofer’s views were favoured among those who favour a fatalistic laissez-faire view that regarded intervention to clean our drinking water as futile and harmful. They argued that intervention was worse than the disease because it induced “panic”.
Read 4 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jun 10
More caveats about the COVID-OUT of Metformin for #longСОVΙD. The benefits of Metformin were diminished by vaccination but it was only taken for 14 days (“500 mg on day one, 500 mg twice daily on days 2–5, then 500 mg in the morning and 1000 mg in the evening up to day 14”).🧵 Image
There are plenty of studies of viral persistence, showing the ongoing presence of replication-competent virus for many months after the acute illness. In chronic hepatitis C, we treat with antivirals not for 2 weeks but for 12 to 24 weeks!
The BMJ editorial also states, “Other arms of the trial looked at…fluvoxamine and found that [it did not decrease] the risk of long СОVΙD.” That should say, “looked at a subclinical dose of Fluvoxamine” and found it didn’t work. A half-dose of Metformin probably wouldn’t either.
Read 8 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jun 8
You could argue that there are no cluster RCTs randomising districts to fire station vs no fire station. Firefighting is, you could proclaim, pointless, as it has never been “proven” by RCT to reduce the adverse impacts of fires. Disband the fire service now! 🧵 Image
And when the firefighters do come rushing to put out the fire, guess what they will be wearing? Firefighting respiratory protective equipment. Not tested by RCT.
But this is how Vinay would react if his house caught fire. Image
Read 4 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jun 7
This article takes a step in the right direction by admitting RCTs are not a universal scientific method suitable for every question, e.g. “Is the earth round?” But clinicians need to go even further beyond their training to study broader questions in the philosophy of science.🧵
We must look at applied physics and engineering to ask ourselves why medicine failed to develop normatively as a science by creating models with high predictive power. We know that models like the rotundity of the earth and the heliocentric solar system work without RCTs.
We know that hydrogen bombs work as a weapon of mass destruction without ever being lethally live-tested on a human population vs placebo.
Why do we think predictions based on physics are valid when none of it has been lethally live-tested in
RCTs on people?
Read 14 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jun 4
I think these Tour de France safety protocols can be improved. They are too 2020. I'd get all riders and support staff fit-tested by QNFT to FFP2/3+ RPE. I'd allow autograph signing with riders wearing fitted RPE outdoors. 🧵 reuters.com/sports/cycling…
“Do not get too close to the spectators—social distancing, no selfies, no autographs.” This is archaic stuff. It’s pointless if the RPE is of sufficiently high grade and it is outdoors. If you think FFP2/3s aren’t enough, move them to fit tested P3/P100 elastomerics. Image
I'd have rules about all training rides having to be done in fit-tested valved FFP2/3s. Considers mandating test-fitted valved FFP2/3s on stages involving pelotons, but there is little research on the impact of valved RPE upon performance. No RPE is needed for time trials. Image
Read 6 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
May 28
The feedback to this thread has been overwhelmingly positive but some just wanted to shoot the messenger. A thought. I have never heard of a hospital in AU that purchases earloop respirators for their staff, even though AU (unlike NIOSH) certifies earloop respirators. Why?
This excerpt of an interview with 3M division vice-president Nikki McCullough gives us a hint. Companies that brought earloop respirators like KN95 and KF94s find they have a low fit test pass rate (~8-13%). They end up with a lot of unusable inventory.
Professional fit testers also do not like testing models with large failure rates (87-92%). Like the @H_S_E, they consider it a waste of their time, so discourage institutions from buying earloops. Can you blame fit testers for refusing to test them?
Read 7 tweets

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