Integrating longitudinal clinical and microbiome data to predict growth faltering in preterm infants.

Preterm birth affects more than 10% of all births worldwide. Such infants are much more prone to Growth Faltering (GF), an issue that has been unsolved despite the implementation of numerous interventions aimed at optimizing preterm infant nutrition. To improve the ability for early prediction of GF risk for preterm infants we collected a comprehensive, large, and unique clinical and microbiome dataset from 3 different sites in the US and the UK. We use and extend machine learning methods for GF prediction from clinical data. We next extend graphical models to integrate time series clinical and microbiome data. A model that integrates clinical and microbiome data improves on the ability to predict GF when compared to models using clinical data only. Information on a small subset of the taxa is enough to help improve model accuracy and to predict interventions that can improve outcome. We show that a hierarchical classifier that only uses a subset of the taxa for a subset of the infants is both the most accurate and cost-effective method for GF prediction. Further analysis of the best classifiers enables the prediction of interventions that can improve outcome.

Exposure at the indoor water-air interface: Fill water constituents and the consequent air emissions from ultrasonic humidifiers: A systematic review.

This systematic review investigates the emissions from ultrasonic humidifiers (e.g., cool mist humidifiers) within indoor air environments, namely soluble and insoluble metals and minerals as well as microorganisms and one organic chemical biocide. Relationships between ultrasonic humidifier fill water quality and the emissions in indoor air are studied, and associated potential adverse health outcomes are discussed. Literature from January 1, 1980, to February 1, 2022, was searched from online databases of PubMed, Web of Science, and Scopus to produce 27 articles. The results revealed clear positive proportional relationships of the concentration of microorganisms and soluble metals/minerals between fill water qualities and emitted airborne particles, for both microbial (n = 9) and inorganic (n = 15) constituents. When evaluating emissions and the consequent health outcomes, ventilation rates of specific exposure scenarios affect the concentrations of emitted particles. Thus, well-ventilated rooms may alleviate inhalation risks when the fill water in ultrasonic humidifiers contains microorganisms and soluble metals/minerals. Case reports (n = 3) possibly due to the inhalation of particles from ultrasonic humidifier include hypersensitivity pneumonitis in adults and a 6-month infant; the young infant exhibited nonreversible mild obstructive ventilator defect. In summary, related literature indicated correlation between fill water quality of ultrasonic humidifier and emitted particles in air quality, and inhalation of the emitted particles may cause undesirable health outcomes of impaired respiratory functions in adults and children.

Data Analytics Determines Co-occurrence of Odorants in Raw Water and Evaluates Drinking Water Treatment Removal Strategies.

A complex dataset with 140 sampling events was generated using triple quadrupole gas chromatography-mass spectrometer to track the occurrence of 95 odorants in raw and finished water from 98 drinking water treatment plants in 31 cities across China. Data analysis identified more than 70 odorants with concentrations ranging from not detected to thousands of ng/L. In raw water, Pearson correlation analysis determined that thioethers, non-oxygen benzene-containing compounds, and pyrazines were classes of chemicals that co-occurred, and geosmin and p(m)-cresol, as well as cyclohexanone and benzaldehyde, also co-occurred, indicating similar natural or industrial sources. Based on classification and regression tree analysis, total dissolved organic carbon and geographical location were identified as major factors affecting the occurrence of thioethers. Indoles, phenols, and thioethers were well-removed through conventional and advanced treatment processes, while some aldehydes could be generated. For other odorants, higher removal was achieved by ozonation-biological activated carbon (39.3%) compared to the conventional treatment process (14.5%). To our knowledge, this is the first study to systematically identify the major odorants in raw water and determine suitable treatment strategies to control their occurrence by applying data analytics and statistical methods to the complex dataset. These provide informative reference for odor control and water quality management in drinking water industry.

Survival of the Enveloped Virus Phi6 in Droplets as a Function of Relative Humidity, Absolute Humidity, and Temperature.

Infectious diseases caused by enveloped viruses, such as influenza, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS), cause thousands of deaths and billions of dollars of economic losses per year. Studies have found a relationship among temperature, humidity, and influenza virus incidence, transmission, or survival; however, there are contradictory claims about whether absolute humidity (AH) or relative humidity (RH) is most important in mediating virus infectivity. Using the enveloped bacteriophage Phi6, which has been suggested as a surrogate for influenza viruses and coronaviruses, we designed a study to discern whether AH, RH, or temperature is a better predictor of virus survival in droplets. Our results show that Phi6 survived best at high (>85%) and low (<60%) RHs, with a significant decrease in infectivity at mid-range RHs (∼60 to 85%). At an AH of less than 22 g · m-3, the loss in infectivity was less than 2 orders of magnitude; however, when the AH was greater than 22 g · m-3, the loss in infectivity was typically greater than 6 orders of magnitude. At a fixed RH of 75%, infectivity was very sensitive to temperature, decreasing two orders of magnitude between 19°C and 25°C. We used random forest modeling to identify the best environmental predictors for modulating virus infectivity. The model explained 83% of variation in Phi6 infectivity and suggested that RH is the most important factor in controlling virus infectivity in droplets. This research provides novel information about the complex interplay between temperature, humidity, and the survival of viruses in droplets.IMPORTANCE Enveloped viruses are responsible for a number of infectious diseases resulting in thousands of deaths and billions of dollars of economic losses per year in the United States. There has been a lively debate in the literature over whether absolute humidity (AH) or relative humidity (RH) modulates virus infectivity. We designed a controlled study and used advanced statistical modeling techniques specifically to address this question. By providing an improved understanding of the relationship between environmental conditions and virus infectivity, our work will ultimately lead to improved strategies for predicting and controlling disease transmission.

Food Safety Practices Linked with Proper Refrigerator Temperatures in Retail Delis.

Listeria monocytogenes (L. monocytogenes) causes the third highest number of foodborne illness deaths annually. L. monocytogenes contamination of sliced deli meats at the retail level is a significant contributing factor to L. monocytogenes illness. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study to learn more about retail delis' practices concerning L. monocytogenes growth and cross-contamination prevention. This article presents data from this study on the frequency with which retail deli refrigerator temperatures exceed 41°F, the Food and Drug Administration (FDA)-recommended maximum temperature for ready-to-eat food requiring time and temperature control for safety (TCS) (such as retail deli meat). This provision was designed to control bacterial growth in TCS foods. This article also presents data on deli and staff characteristics related to the frequency with which retail delis refrigerator temperatures exceed 41°F. Data from observations of 445 refrigerators in 245 delis showed that in 17.1% of delis, at least one refrigerator was >41°F. We also found that refrigeration temperatures reported in this study were lower than those reported in a related 2007 study. Delis with more than one refrigerator, that lacked refrigerator temperature recording, and had a manager who had never been food safety certified had greater odds of having a refrigerator temperature >41°F. The data from this study suggest that retail temperature control is improving over time. They also identify a food safety gap: some delis have refrigerator temperatures that exceed 41°F. We also found that two food safety interventions were related to better refrigerated storage practices: kitchen manager certification and recording refrigerated storage temperatures. Regulatory food safety programs and the retail industry may wish to consider encouraging or requiring kitchen manager certification and recording refrigerated storage temperatures.

Enabling Science Support for Better Decision-Making when Responding to Chemical Spills.

Chemical spills and accidents contaminate the environment and disrupt societies and economies around the globe. In the United States there were approximately 172,000 chemical spills that affected US waterbodies from 2004 to 2014. More than 8000 of these spills involved non-petroleum-related chemicals. Traditional emergency responses or incident command structures (ICSs) that respond to chemical spills require coordinated efforts by predominantly government personnel from multiple disciplines, including disaster management, public health, and environmental protection. However, the requirements of emergency response teams for science support might not be met within the traditional ICS. We describe the US ICS as an example of emergency-response approaches to chemical spills and provide examples in which external scientific support from research personnel benefitted the ICS emergency response, focusing primarily on nonpetroleum chemical spills. We then propose immediate, near-term, and long-term activities to support the response to chemical spills, focusing on nonpetroleum chemical spills. Further, we call for science support for spill prevention and near-term spill-incident response and identify longer-term research needs. The development of a formal mechanism for external science support of ICS from governmental and nongovernmental scientists would benefit rapid responders, advance incident- and crisis-response science, and aid society in coping with and recovering from chemical spills.

Tale of two isomers: complexities of human odor perception for cis- and trans-4-methylcyclohexane methanol from the chemical spill in West Virginia.

Application of gas chromatography with mass spectrometric and human olfactory "sniffer" detectors reveals the nature of odorous chemicals from an industrial chemical spill. Crude 4-methylcyclohexane methanol (4-MCHM) spilled in a river and then contaminated drinking water and air for over 300000 consumers living in West Virginia. Olfactory gas chromatography allows investigators to independently measure the odor of chemical components in a mixture. Crude 4-MCHM is comprised of several major cyclohexane components, four of which have distinct isomer pairs. The cis- and trans-4-MCHM isomers are the only components to have distinct odors at the concentrations used in this study. The trans-4-MCHM is the dominant odorant with descriptors of "licorice" and "sweet". Trans-4-MCHM has an air odor threshold concentration of 0.060 ppb-v (95% CI: 0.040-0.091). The odor threshold concentrations are not influenced by gender or age but are lower by a factor of 5 for individuals with prior exposure compared to naïve subjects. Individual trans-4-MCHM odor threshold concentrations vary by more than a factor of 100. The cis-4-MCHM isomer has approximately a 2000-fold higher odor threshold concentration, different descriptors, and an even wider individual response range.

Profiling Private Water Systems to Identify Patterns of Waterborne Lead Exposure.

Although extensive literature documents corrosion in municipal water systems, only minimal data is available describing corrosion in private water systems (e.g., wells), which serve as a primary source of drinking water for approximately 47 million Americans. This study developed a profiling technique specifically tailored to evaluate lead release in these systems. When applied in an intensive field study of 15 private systems, three patterns of lead release were documented: no elevated lead or lead elevated in the first draw only (Type I), erratic spikes of particulate lead (Type II), and sustained detectable lead concentrations (Type III). While flushing protocols as short as 15-30 s may be sufficient to reduce lead concentrations below 15 µg/L for Types I and III exposure, flushing may not be an appropriate remediation strategy for Type II exposure. In addition, the sustained detectable lead concentrations observed with Type III exposure likely result from corrosion of components within the well and therefore cannot be reduced with increased flushing. As profiling techniques are labor- and sample-intensive, we discuss recommendations for simpler sampling schemes for initial private system surveys aimed at quantifying lead and protecting public health.

Incidence of waterborne lead in private drinking water systems in Virginia.

Although recent studies suggest contamination by bacteria and nitrate in private drinking water systems is of increasing concern, data describing contaminants associated with the corrosion of onsite plumbing are scarce. This study reports on the analysis of 2,146 samples submitted by private system homeowners. Almost 20% of first draw samples submitted contained lead concentrations above the United States Environmental Protection Agency action level of 15 µg/L, suggesting that corrosion may be a significant public health problem. Correlations between lead, copper, and zinc suggested brass components as a likely lead source, and dug/bored wells had significantly higher lead concentrations as compared to drilled wells. A random subset of samples selected to quantify particulate lead indicated that, on average, 47% of lead in the first draws was in the particulate form, although the occurrence was highly variable. While flushing the tap reduced lead below 15 µg/L for most systems, some systems experienced an increase, perhaps attributable to particulate lead or lead-bearing components upstream of the faucet (e.g., valves, pumps). Results suggest that without including a focus on private as well as municipal systems it will be very difficult to meet the existing national public health goal to eliminate elevated blood lead levels in children.

Assessing risk with increasingly stringent public health goals: the case of water lead and blood lead in children.

Previous predictions of children's blood lead levels (BLLs) through biokinetic models conclude that lead in tap water is not a primary health risk for a typical child under scenarios representative of chronic exposure, when applying a 10 µg/dL BLL of concern. Use of the US Environmental Protection Agency Integrated Exposure Uptake Biokinetic (IEUBK) model and of the International Commission on Radiological Protection (ICRP) biokinetic model to simulate children's exposure to water lead at home and at school was re-examined by expanding the scope of previous modeling efforts to consider new public health goals and improved methodology. Specifically, explicit consideration of the more sensitive population groups (e.g., young children and, particularly, formula-fed infants), the variability in BLLs amongst exposed individuals within those groups (e.g., more sensitive children at the upper tail of the BLL distribution), more conservative BLL reference values (e.g., 5 and 2 µg/dL versus 10 µg/dL) and concerns of acute exposure revealed situations where relatively low water lead levels were predicted to pose a human health concern.

An update on galanin and spexin and their potential for the treatment of type 2 diabetes and related metabolic disorders.

Spexin (SPX) and galanin (GAL) are two neuropeptides widely expressed in the central nervous system as well as within peripheral tissues in humans and other species. SPX and GAL mediate their biological actions through binding and activation of galanin receptors (GALR), namely GALR1, GALR2 and GLAR3. GAL appears to trigger all three galanin receptors, whereas SPX interacts more specifically with GALR2 and GLAR3. Whilst the biological effects of GAL have been well-described over the years, in-depth knowledge of physiological action profile of SPX is still in its preliminary stages. However, it is recognised that both peptides play a significant role in modulating overall energy homeostasis, suggesting possible therapeutically exploitable benefits in diseases such as obesity and type 2 diabetes mellitus. Accordingly, although both peptides activate GALR's, it appears GAL may be more useful for the treatment of eating disorders such as anorexia and bulimia, whereas SPX may find therapeutic application for obesity and obesity-driven forms of diabetes. This short narrative review aims to provide an up-to-date account of SPX and GAL biology together with putative approaches on exploiting these peptides for the treatment of metabolic disorders.

Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach.

STUDY DESIGN: Narrative review. OBJECTIVE: To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS: An extensive literature review was conducted. RESULTS: The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS: Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.

A passive wireless multi-sensor SAW technology device and system perspectives.

This paper will discuss a SAW passive, wireless multi-sensor system under development by our group for the past several years. The device focus is on orthogonal frequency coded (OFC) SAW sensors, which use both frequency diversity and pulse position reflectors to encode the device ID and will be briefly contrasted to other embodiments. A synchronous correlator transceiver is used for the hardware and post processing and correlation techniques of the received signal to extract the sensor information will be presented. Critical device and system parameters addressed include encoding, operational range, SAW device parameters, post-processing, and antenna-SAW device integration. A fully developed 915 MHz OFC SAW multi-sensor system is used to show experimental results. The system is based on a software radio approach that provides great flexibility for future enhancements and diverse sensor applications. Several different sensor types using the OFC SAW platform are shown.

Transscaphoid Transcapitate Perilunate Fracture-dislocation with Inferior Arc Injury and Acute Ulnar Nerve Compression: A Case Report.

Introduction: Perilunate dislocations and perilunate fracture-dislocations (PLFD) are relatively uncommon injuries, comprising <10% of wrist injuries. Perilunate injuries are often complicated by median neuropathy reported in 23-45% of cases, whereas there are very few reported cases of associated ulnar neuropathy. Combined greater arc and inferior arc injuries are also rare. We report an unusual PLFD pattern with associated inferior arc injury and acute ulnar nerve compression. Case Report: A 34-year-old male sustained a wrist injury after a motorcycle collision. Computed tomography scan revealed a trans-scaphoid, transcapitate, perilunate fracture-dislocation, and a distal radius lunate facet volar rim fracture with radiocarpal subluxation. Examination revealed acute ulnar neuropathy without median neuropathy. He underwent urgent nerve decompression and closed reduction, followed by open reduction internal fixation the next day. He recovered without complication. Conclusion: This case emphasizes the importance of a thorough neurovascular examination to rule out less commonly seen neuropathies. With up to 25% of perilunate injuries misdiagnosed, surgeons should have a low threshold for advanced imaging in high-energy injuries.

Environmental risks from consumer products: Acceptable drinking water quality can produce unacceptable indoor air quality with ultrasonic humidifier use.

The commonly used consumer product of an ultrasonic humidifier (e.g., cool mist humidifier) emits fine particles containing metals from tap water used to fill the humidifier. The objectives are: 1) predict emitted indoor air inhalable metal concentrations produced by an ultrasonic humidifier filled with tap-water containing As, Cd, Cr, Cu, Mn, and Pb in 33 m3 or 72 m3 rooms with varying air exchange rates; 2) calculate daily ingestion and 8-h inhalation average daily dose (ADD) and hazard quotient (HQ) for adults and children (aged 0.25-6 yr); and 3) quantify deposition in respiratory tract via multi-path particle dosimetry (MPPD) model. Mass concentrations of indoor air metals increase proportionally with aqueous metal concentrations in fill water, and are inversely related to ventilation. Inhalation-ADDs are 2 magnitudes lower than ingestion-ADDs, using identical water quality for ingestion and fill-water. However, in the 33 m3, low 0.2/h ventilated room, inhalation-HQs are >1 for children and adults, except for Pb. HQ inhalation risks exceed ingestion risks at drinking water regulated levels for As, Cd, Cr, and Mn. MPPD shows greater dose deposits in lungs of children than adults, and 3 times greater deposited doses in a 33 m3 vs 72 m3 room. Rethinking health effects of drinking water and consumer products to broaden consideration of multiple exposure routes is needed.

Plasma Environment, Radiation, Structure, and Evolution of the Uranian System (PERSEUS): A Dedicated Orbiter Mission Concept to Study Space Physics at Uranus.

The Plasma Environment, Radiation, Structure, and Evolution of the Uranian System (PERSEUS) mission concept defines the feasibility and potential scope of a dedicated, standalone Heliophysics orbiter mission to study multiple space physics science objectives at Uranus. Uranus's complex and dynamic magnetosphere presents a unique laboratory to study magnetospheric physics as well as its coupling to the solar wind and the planet's atmosphere, satellites, and rings. From the planet's tilted and offset, rapidly-rotating non-dipolar magnetic field to its seasonally-extreme interactions with the solar wind to its unexpectedly intense electron radiation belts, Uranus hosts a range of outstanding and compelling mysteries relevant to the space physics community. While the exploration of planets other than Earth has largely fallen within the purview of NASA's Planetary Science Division, many targets, like Uranus, also hold immense scientific value and interest to NASA's Heliophysics Division. Exploring and understanding Uranus's magnetosphere is critical to make fundamental gains in magnetospheric physics and the understanding of potential exoplanetary systems and to test the validity of our knowledge of magnetospheric dynamics, moon-magnetosphere interactions, magnetosphere-ionosphere coupling, and solar wind-planetary coupling. The PERSEUS mission concept study, currently at Concept Maturity Level (CML) 4, comprises a feasible payload that provides closure to a range of space physics science objectives in a reliable and mature spacecraft and mission design architecture. The mission is able to close using only a single Mod-1 Next-Generation Radioisotope Thermoelectric Generator (NG-RTG) by leveraging a concept of operations that relies of a significant hibernation mode for a large portion of its 22-day orbit.

Multicomponent NAPL source dissolution: evaluation of mass-transfer coefficients.

Mass transfer rate coefficients were quantified by employing an inverse modeling technique to high-resolution aqueous phase concentration data observed following an experimental release of a multicomponent nonaqueous phase liquid (NAPL) at a field site. A solute transport model (SEAM3D) was employed to simulate advective-dispersive transport over time coupled to NAPL dissolution. Model calibration was demonstrated by accurately reproducing the observed breakthrough times and peak concentrations at multiple observation points, observed mass discharge at pumping wells, and the reported mass depletions for three soluble NAPL constituents. Vertically variable NAPL mass transfer coefficients were derived for each constituent using an optimized numerical solute transport model, ranging from 0.082 to 2.0 day(-1) across all constituents. Constituent-specific coefficients showed a positive correlation with liquid-phase diffusion coefficients. Application of a time-varying mass transfer coefficient as NAPL mass depleted showed limited sensitivity during which over 80% of the most soluble NAPL constituent dissolved from the source. Long-term simulation results, calibrated to the experimental data and rendered in terms of mass discharge versus source mass depletion, exhibited multistage behavior.

Interfacing With the Electronic Health Record (EHR): A Comparative Review of Modes of Documentation.

Electronic health records (EHRs) have provided physicians with a systematic framework for collecting patient data, organizing notes from the healthcare team, and managing the daily workflow in the modern era of healthcare. Despite these advantages, EHRs have proven to be problematic for clinicians. The burdensome regulations requiring increased documentation with the EHR paradigm have led to inefficiencies from data-entry requirements forcing physicians to spend an inordinate amount of time on it, affecting the time available for direct patient care as well as leading to professional burnout. As a result, new modalities such as speech recognition, medical scribes, pre-made EHR templates, and digital scribes [a form of artificial intelligence (AI) based on ambient speech recognition] are increasingly being used to reduce charting time and increase the time available for patient care. The purpose of our review is to provide an up-to-date review of the literature on these modalities including their benefits and shortcomings, to help physicians and other medical professionals choose the best methods to document their patient-care encounters efficiently and effectively.

Determining human exposure and sensory detection of odorous compounds released during showering.

Modeling of human exposure to aqueous algal odorants geosmin (earthy), 2-methylisoborneol (musty), and (trans,cis)-2,6-nonadienal (cucumber, fishy), and the solvent trichloroethylene (sweet chemical), was investigated to improve the understanding of water-air transfer by including humans as sensors to detect contaminants. A mass-transfer model was employed to determine indoor air concentrations when water was used for showering under varying conditions (shower stall volume, water and air flow rate, temperature, aqueous odorant concentration, shower duration). Statistical application of multiple linear regression and tree regression were employed to determine critical model parameters. The model predicted that concentrations detectable to the human senses were controlled by temperature, odor threshold, and aqueous concentration for the steady-state model, whereas shower volume, air flow, and water flow are also important for the dynamic model and initial detection of the odorant immediately after the showering is started. There was excellent agreement of model predictions with literature data for human perception of algal odorants in their homes and complaints to water utilities. TCE performed differently than the algal odorants due to its higher Henry's law constant, in spite of similar gas and liquid diffusivities. The use of nontoxic odorants offers an efficient tool to calibrate indoor air/water shower models.

Risks to children from inhalation of aerosolized aqueous manganese emitted from ultrasonic humidifiers can be greater than for corresponding ingestion.

The essential trace element manganese (Mn) can cause neurotoxicity with inhalation acknowledged as a more severe health and cognition threat than ingestion. METHODS: Over a range of aqueous Mn concentrations present in tap water, this research characterizes exposures and risks for adults and 0.25, 1, 2.5, and 6 yr old children who ingest the water and inhale respirable particles produced by a room-sized ultrasonic humidifier filled with the same water. Aqueous Mn concentrations evaluated included 50 µg/L USEPA esthetic guideline, 80 µg/L WHO infant guideline, and 120 µg/L Canadian regulatory level. Airborne-particle-bound Mn concentrations were generated for water filling an ultrasonic humidifier under four realistic room conditions (33 m3 small or 72 m3 large) with varying ventilation rates from 0.2/h -1.5/h. Average daily doses (ADD) and reference intake doses were calculated for ingestion and 8-h inhalation of humidified air. Hazard quotients (HQ) compared the intake doses and reference doses. Multi-path particle dosimetry (MPPD) model quantified the particle deposition and deposited dose in children's and adults' respiratory tracts. RESULTS: At only 11 µg/L Mn, the resulting humidified air Mn exceeds USEPA's reference concentration of 0.05 µg/m3 Mn in small room with low, energy-efficient ventilation. Inhalation ADD are 2 magnitudes lower than ingestion ADD for identical water Mn concentrations and daily exposure frequency. Even so, ingestion HQs are approximately 0.2 but inhalation risk is significant (HQ>1) for children and adults when breathing Mn-humidified air under most small room conditions at 50, 80 or 120 µg/L Mn. MPPD model indicates inhaled Mn deposits in head and pulmonary regions, with greater Mn dose deposits in children than adults. CONCLUSION: Inhalation of Mn-particles produced from ultrasonic humidifiers can pose greater risks than ingestion at the same water concentration, especially for children. Aqueous Mn concentration and room size influence risks. Limiting manganese exposures and setting regulations requires consideration of both ingestion and inhalation of water.