Comparing the performance of 3 bioaerosol samplers for influenza virus.

Respiratory viral diseases can be spread when a virus-containing particle (droplet) from one individual is aerosolized and subsequently comes into either direct or indirect contact with another individual. Increasing numbers of studies are examining the occupational risk to healthcare workers due to proximity to patients. Selecting the appropriate air sampling method is a critical factor in assuring the analytical performance characteristics of a clinical study. The objective of this study was to compare the physical collection efficiency and virus collection efficiency of a 5 mL compact SKC BioSampler®, a gelatin filter, and a glass fiber filter, in a laboratory setting. The gelatin filter and the glass fiber filter were housed in a home-made filter holder. Submersion (with vortexing and subsequent centrifugation) was used for the gelatin and glass fiber filters. Swabbing method was also tested to retrieve the viruses from the glass fiber filter. Experiments were conducted using the H1N1 influenza A virus A/Puerto Rico/8/1934 (IAV-PR8), and viral recovery was determined using culture and commercial real-time-PCR (BioFire and Xpert). An atomizer was used to aerosolize a solution of influenza virus in PBS for measurement, and two Scanning Mobility Particle Sizers were used to determine particle size distributions. The SKC BioSampler demonstrated a U-shaped physical collection efficiency, lowest for particles around 30-50 nm, and highest at 10 nm and 300-350 nm within the size range examined. The physical collection efficiency of the gelatin filter was strongly influenced by air flow and time: a stable collection across all particle sizes was only observed at 2 L/min for the 9 min sampling time, otherwise, degradation of the filter was observed. The glass fiber filter demonstrated the highest physical collection efficiency (100% for all sizes) of all tested samplers, however, its overall virus recovery efficiency fared the worst (too low to quantify). The highest viral collection efficiencies for the SKC BioSampler and gelatin filter were 5% and 1.5%, respectively. Overall, the SKC BioSampler outperformed the filters. It is important to consider the total concentration of viruses entering the sampler when interpreting the results.

Associations between household air pollution and reduced lung function in women and children in rural southern India.

Half of the world's population still relies on solid fuels to fulfill its energy needs for cooking and space heating, leading to high levels of household air pollution (HAP), adversely affecting human health and the environment. A cross-sectional cohort study was conducted to investigate any associations between: (1) HAP metrics (mass concentration of particulate matter of aerodynamic size less than 2.5 µm (PM2.5 ), lung-deposited surface area (LDSA) and carbon monoxide (CO)); (2) a range of household and socio-demographic characteristics; and (3) lung function for women and children exposed daily to biomass cookstove emissions, in rural southern India. HAP measurements were collected inside the kitchen of 96 households, and pulmonary function tests were performed for the women and child in each enrolled household. Detailed questionnaires captured household characteristics, health histories and various socio-demographic parameters. Simple linear and logistic regression analysis was performed to examine possible associations between the HAP metrics, lung function and all household/socio-demographic variables. Obstructive lung defects (forced vital capacity (FVC) ≥ lower limit of normal (LLN) and forced expiratory volume in 1 second (FEV1 )/FVC < LLN) were found in 8% of mothers and 9% of children, and restrictive defects (FVC < LLN and FEV1 /FVC ≥ LLN) were found in 17% of mothers and 15% of children. A positive association between LDSA, included for the first time in this type of epidemiological study, and lung function was observed, indicating LDSA is a superior metric compared to PM2.5 to assess effects of PM on lung function. HAP demonstrated a moderate association with subnormal lung function in children. The results emphasize the need to look beyond mass-based PM metrics to assess fully the association between HAP and lung function.

Characterization of Aerosols Generated During Patient Care Activities.

Background: Questions remain about the degree to which aerosols are generated during routine patient care activities and whether such aerosols could transmit viable pathogens to healthcare personnel (HCP). The objective of this study was to measure aerosol production during multiple patient care activities and to examine the samples for bacterial pathogens. Methods: Five aerosol characterization instruments were used to measure aerosols during 7 patient care activities: patient bathing, changing bed linens, pouring and flushing liquid waste, bronchoscopy, noninvasive ventilation, and nebulized medication administration (NMA). Each procedure was sampled 5 times. An SKC BioSampler was used for pathogen recovery. Bacterial cultures were performed on the sampling solution. Patients on contact precautions for drug-resistant organisms were selected for most activity sampling. Any patient undergoing bronchoscopy was eligible. Results: Of 35 sampling episodes, only 2 procedures showed a significant increase in particle concentrations over baseline: NMA and bronchoscopy with NMA. Bronchoscopy without NMA and noninvasive ventilation did not generate significant aerosols. Of 78 cultures from the impinger samples, 6 of 28 baseline samples (21.4%) and 14 of 50 procedure samples (28.0%) were positive. Conclusions: In this study, significant aerosol generation was only observed during NMA, both alone and during bronchoscopy. Minimal viable bacteria were recovered, mostly common environmental organisms. Although more research is needed, these data suggest that some of the procedures considered to be aerosol-generating may pose little infection risk to HCP.

Organic and inorganic speciation of particulate matter formed during different combustion phases in an improved cookstove.

Residential solid fuel combustion in cookstoves has established health impacts including bladder and lung cancers, cataracts, low birth weight, and pneumonia. The chemical composition of particulate matter (PM) from 4 commonly-used solid fuels (coal, dung, ambient/dry applewood, and oakwood pellets), emitted from a gasifier cookstove, as well as propane, were examined. Temporal changes between the different cookstove burn-phases were also explored. Normalized concentrations of non-refractory PM1, total organics, chloride, ammonium, nitrate, sulfate, and 41 particle-phase polycyclic aromatic hydrocarbons (PAHs) were measured using a High-Resolution Time-of-Flight Aerosol Mass Spectrometer (HR-ToF-AMS) and a Thermal desorption Aerosol Gas chromatograph (TAG), respectively. Coal demonstrated the highest fraction of organic matter in its particulate emission composition (98%), followed by dung (94%). Coal and dung also demonstrated the highest numbers and concentrations of PAHs. While dry applewood emitted ten times lower organic matter compared to ambient applewood, a higher fraction of these organics was composed of PAHs, especially the more toxic ones such as benzo(a)pyrene (9.63ng/L versus 0.04ng/L), and benzo(b)fluoranthene (31.32ng/L versus 0.19ng/L). Data from the AMS demonstrated no clear trends for any of the combustion fuels over the different combustion phases unlike the previously reported trends observed for the physical characteristics. Of the solid fuels, pellets demonstrated the lowest emissions. Emissions from propane were below the quantification limit of the instruments. This work highlights the benefits of incorporating additional metrics into the cookstove evaluation process, thus enriching the existing PM data inventory.

Comparing on-road real-time simultaneous in-cabin and outdoor particulate and gaseous concentrations for a range of ventilation scenarios.

Advanced automobile technology, developed infrastructure, and changing economic markets have resulted in increasing commute times. Traffic is a major source of harmful pollutants and consequently daily peak exposures tend to occur near roadways or while traveling on them. The objective of this study was to measure simultaneous real-time particulate matter (particle numbers, lung-deposited surface area, PM2.5, particle number size distributions) and CO concentrations outside and in-cabin of an on-road car during regular commutes to and from work. Data was collected for different ventilation parameters (windows open or closed, fan on, AC on), whilst traveling along different road-types with varying traffic densities. Multiple predictor variables were examined using linear mixed-effects models. Ambient pollutants (NOx, PM2.5, CO) and meteorological variables (wind speed, temperature, relative humidity, dew point) explained 5-44% of outdoor pollutant variability, while the time spent travelling behind a bus was statistically significant for PM2.5, lung-deposited SA, and CO (adj-R2 values = 0.12, 0.10, 0.13). The geometric mean diameter (GMD) for outdoor aerosol was 34 nm. Larger cabin GMDs were observed when windows were closed compared to open (b = 4.3, p-value = <0.01). When windows were open, cabin total aerosol concentrations tracked those outdoors. With windows closed, the pollutants took longer to enter the vehicle cabin, but also longer to exit it. Concentrations of pollutants in cabin were influenced by outdoor concentrations, ambient temperature, and the window/ventilation parameters. As expected, particle number concentrations were impacted the most by changes to window position / ventilation, and PM2.5 the least. Car drivers can expect their highest exposures when driving with windows open or the fan on, and their lowest exposures during windows closed or the AC on. Final linear mixed-effects models could explain between 88-97% of cabin pollutant concentration variability. An individual may control their commuting exposure by applying dynamic behavior modification to adapt to changing pollutant scenarios.

Real-time particulate and CO concentrations from cookstoves in rural households in Udaipur, India.

Almost 3 billion people around the globe use traditional three-stone cookstoves and open fires to warm and feed themselves. The World Health Organization estimates annual mortality rates from domestic solid fuel combustion to be around 4 million. One of the most affected countries is India. Quantifying pollutant concentrations from these cookstoves during different phases of operation and understanding the factors influencing their variability may help to identify where improvements should be targeted, enhancing indoor air quality for millions of the world's most vulnerable people. Gas and particulate measurements were collected between June and August, 2012, for 51 households using traditional cookstoves, in the villages of Udaipur district, Rajasthan, India. Mean pollutant concentrations during steady-state mode were 4989 µm(2) cm(-3), 9835 µg m(-3), and 18.5 ppm for lung-deposited surface area, PM2.5, and CO, respectively. Simple and multivariate regression analysis was conducted. Fuel amount, fuel diameter, duration of the cookstove run, roof-type, and the room dimension explained between 7% and 21% of the variability for the pollutant metrics. CO demonstrated weaker correlations with explanatory variables. Some of these variables may be indicative of socio-economic status and could be used as proxies of exposure in lieu of pollutant measurements, hence these variables may help identify which households to prioritize for intervention. Such associations should be further explored.

Gestational age at birth and risk of autism spectrum disorders in Alberta, Canada.

OBJECTIVE: To examine the association between autism spectrum disorders (ASD) and each completed week of gestation using a graphical method of presenting results at all possible categorizations of gestational age (GA). STUDY DESIGN: The risk of ASD in a total of 218110 singleton live births with complete data from Alberta, Canada between 1998 and 2004 was examined through linkage to health insurance records. The relative risk of developing ASD according to the 21 dichotomizations of shorter gestation (GA ≤ 23 weeks vs >23 weeks to ≤ 43 weeks vs >43 weeks, in 1-week increments) was calculated using log-binomial regression and adjusted for fetal sex, socioeconomic status, and birth year. RESULTS: We observed a gradual increased risk of ASD with shorter gestation. Cutoffs only between 29 and 40 weeks clearly denoted an elevated risk of developing ASD compared with longer gestation, and the risk increased with earlier GA cutoff. The results were not affected by sex or measures of fetal growth. CONCLUSION: Our data confirm the role of shortened gestation in ASD risk. We warn against the use of prespecified or a data-driven GA cutoff, however; instead, we recommend systematically examining all plausible cutoffs for GA to avoid overstating the homogeneity of risk in children on either side of a given cutoff, as well as to increase the comparability of studies.

Hypothyroidism among former workers of a nuclear weapons facility.

BACKGROUND: Ionizing radiation alters thyroid function, and workers at a nuclear weapons facility may be exposed to above environmental levels of radiation. METHODS: Hypothyroid status was determined for 622 former workers of a nuclear weapons facility located in Texas, using a combination of measured thyroid stimulating hormone (TSH) levels and thyroid medication history, as part of an on-going health surveillance program. We classified 916 unique job titles into 35 job categories. RESULTS: According to the most stringent TSH definition used in this study (0.3-3.0 IU/ml), 174 (28.0%) former workers were considered to be hypothyroid; of these 66 (41.8%) were females and 108 (23.3%) were males. In logistic regression analysis adjusted for age, gender, and smoking status, only having worked as a material handler (n = 18) exhibited an elevated risk of developing hypothyroidism compared to other jobs (OR 3.88, 95% CI 1.43-11.07). This is one of the jobs with suspected exposure to radiation. No excess risk of hypothyroidism was observed for any of the other job categories. CONCLUSIONS: There is suggestive evidence that only material handlers at this nuclear weapons facility may have elevated risk of hypothyroidism; further evaluation of thyroid health in this population is warranted.

Comparative Study on the Size Distributions, Respiratory Deposition, and Transport of Particles Generated from Commonly Used Medical Nebulizers.

BACKGROUND: Medical nebulizers are widely and conveniently used to deliver medication to the lungs as an inhalable mist; however, the deposition of nebulized particles in the human respiratory system and the transport of the nebulized particles in the environment have not been studied in detail. METHODS: Five medical nebulizers of three different types (constant output, breath enhanced, and dosimetric) were evaluated. The size distribution functions (SDFs) and respiratory deposition of the particles generated from the nebulizers were characterized. The SDFs were obtained with an aerodynamic particle sizer (APS; TSI, Inc., St. Paul) after data correction, and the respiratory deposition was calculated according to the model developed by the International Commission on Radiological Protection. The evaporation, Brownian diffusion, and convective movement are further calculated based on aerosol properties. RESULTS AND CONCLUSIONS: The SDFs measured by the APS indicated that most of the generated particles were in the size range of 1-8 µm. The operating pressure and flow rate affected the number-based SDF of the nebulized particles. Although different values of mean aerodynamic diameter (MAD) were obtained for the nebulizers, the mass median aerodynamic diameter did not differ significantly from each other (between 4 and 5 µm). According to calculation, the deposition of particles in the head airways region accounted for the most of the particle mass collected by the respiratory system. Convective movement was the dominant mechanism for the transport of particles in the size ranges investigated. Relative humidity-dependent evaporation can significantly decrease the size of the emitted particles, resulting in a different respiratory deposition pattern such that the amount of particles deposited in the alveolar region is greatly enhanced. Appropriate protection from these particles should be considered for those persons for whom the medication is not intended (e.g., healthcare workers, family members).