Airborne particle radioactivity during desert dust days in Cyprus.

Mediterranean countries are often affected by desert dust storms, which have significant effects on the environment and public health. We compared airborne particle radioactivity levels during desert dust and non-dust days in Cyprus. Gross α- and ß-radioactivity from Total Suspended Particle (TSP) samples, collected at two urban routine monitoring stations in Limassol and Nicosia, were available for the period 2017-2020 and 2008-2020, respectively. Radionuclides 137Cs and 40K, from TSP samples, were also available from a semi-industrial monitoring station in Nicosia during 2008-2020. Information on desert dust presence, dust origin, particulate matter (PM) levels, and solar activity (KP index and solar sunspot numbers - SSN) were also obtained. We used linear regression models adjusting for seasonality and long-term trends, and solar activity to assess the effect of dust storms on TSP gross α- and ß-, and 137Cs and 40K radioactivity levels. Gross α- and ß-radioactivity, and 137Cs and 40K radioactivity levels were significantly higher on days with desert dust compared to days characterized with no influence of desert dust. Levels of gross α- and ß-radioactivity during dust days were higher when dust originated from the Middle East deserts than from the Sahara Desert. The same trend was observed for the ratios 137Cs to 40K and 137Cs to PM10. Conversely, ratios of TSP gross α- and ß-radioactivity to PM10 were significantly lower during desert dust days in comparison to days without dust influence. This study suggests that desert dust increase both TSP gross α- and ß-radioactivity, as well as 137Cs and 40K radioactivity levels. Further studies should clarify the contribution of anthropogenic and other natural sources to the emission or transportation of particles radioactivity, to better mitigate future exposures.

Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial.

INTRODUCTION: Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma. OBJECTIVE: The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece. DESIGN, PARTICIPANTS, INTERVENTIONS AND SETTING: Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO). RESULTS: In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (ß=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (ß=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (ß=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls. CONCLUSION: Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma. TRIAL REGISTRATION NUMBER: NCT03503812.

MEDEA randomised intervention study protocol in Cyprus, Greece and Israel for mitigation of desert dust health effects in adults with atrial fibrillation.

INTRODUCTION: Mediterranean countries experience frequent desert dust storm (DDS) events originating from neighbouring Sahara and Arabian deserts, which are associated with significant increase in mortality and hospital admissions, mostly from cardiovascular and respiratory diseases. Short-term exposure to ambient air pollution is considered as a trigger for symptomatic exacerbations of pre-existing paroxysmal atrial fibrillation (AF) and other types of heart arrhythmia. The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches clinical randomised intervention study in adults with AF is funded by EU LIFE+programme to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related heart arrhythmia effects. METHODS AND ANALYSIS: The study is performed in three heavily exposed to desert dust regions of the Eastern Mediterranean: Cyprus, Israel and Crete-Greece. Adults with paroxysmal AF and implanted pacemaker are recruited and randomised to three parallel groups: (a) no intervention, (b) interventions to reduce outdoor exposure to desert dust, (c) interventions to reduce both outdoor and indoor exposure to particulate matter during desert dust episodes. Eligible participants are enrolled on a web-based platform which communicates, alerts and makes exposure reduction recommendations during DDS events. Exposure changes are assessed by novel tools (smartwatches with Global Positioning System and physical activity sensors, air pollution samplers assessing air quality inside and outside participant's homes, etc). Clinical outcomes include the AF burden expressed as the percentage of time with paroxysmal AF over the total study period, the incidence of ventricular arrhythmia episodes as recorded by the participants' pacemakers or cardioverters/defibrillators and the disease-specific Atrial Fibrillation Effect on QualiTy-of-Life questionnaire. ETHICS AND DISSEMINATION: Local bioethics' authorities approved the study at all sites, according to national legislations (Cyprus: National Bioethics Committee, Data Protection Commissioner and Ministry of Health; Greece, Scientific Committee and Governing Board of the University General Hospital of Heraklion; Israel: Institutional Review Board ('Helsinki committee') of the Soroka University Medical Center). The findings will be publicised in peer-reviewed scientific journals, in international conferences and in professional websites and newsletters. A summary of the results and participants' interviews will be included in a documentary in English, Greek and Hebrew. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier; NCT03503812.

Improved indoor air quality during desert dust storms: The impact of the MEDEA exposure-reduction strategies.

Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider "MEDEA" project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM10 and PM2.5, was conducted in participants' homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM10 and PM2.5 samples, mass and content in main and trace elements was determined. Indoor PM2.5 and PM10 mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM2.5-intervention/PM2.5-control = 0.57, 95% CI: 0.47, 0.70; PM10-intervention/PM10-control = 0.59, 95% CI: 0.49, 0.71). In addition, the PM2.5 and PM10 particles of outdoor origin were significantly lower in the intervention vs. the control group (PM2.5 infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM10 infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.

Responses of schoolchildren with asthma to recommendations to reduce desert dust exposure: Results from the LIFE-MEDEA intervention project using wearable technology.

Current public health recommendations for desert dust storms (DDS) events focus on vulnerable population groups, such as children with asthma, and include advice to stay indoors and limit outdoor physical activity. To date, no scientific evidence exists on the efficacy of these recommendations in reducing DDS exposure. We aimed to objectively assess the behavioral responses of children with asthma to recommendations for reduction of DDS exposure. In two heavily affected by DDS Mediterranean regions (Cyprus & Crete, Greece), schoolchildren with asthma (6-11 years) were recruited from primary schools and were randomized to control (business as usual scenario) and intervention groups. All children were equipped with pedometer and GPS sensors embedded in smartwatches for objective real-time data collection from inside and outside their classroom and household settings. Interventions included the timely communication of personal DDS alerts accompanied by exposure reduction recommendations to both the parents and school-teachers of children in the intervention group. A mixed effect model was used to assess changes in daily levels of time spent, and steps performed outside classrooms and households, between non-DDS and DDS days across the study groups. The change in the time spent outside classrooms and homes, between non-DDS and DDS days, was 37.2 min (pvalue = 0.098) in the control group and -62.4 min (pvalue < 0.001) in the intervention group. The difference in the effects between the two groups was statistically significant (interaction pvalue < 0.001). The change in daily steps performed outside classrooms and homes, was -495.1 steps (pvalue = 0.350) in the control group and -1039.5 (pvalue = 0.003) in the intervention group (interaction pvalue = 0.575). The effects on both the time and steps performed outside were more profound during after-school hours. To summarize, among children with asthma, we demonstrated that timely personal DDS alerts and detailed recommendations lead to significant behavioral changes in contrast to the usual public health recommendations.

Spatiotemporal variations of ozone exposure and its risks to vegetation and human health in Cyprus: an analysis across a gradient of altitudes.

Ground-level ozone (O3) affects vegetation and threatens environmental health when levels exceed critical values, above which adverse effects are expected. Cyprus is expected to be a hotspot for O3 concentrations due to its unique position in the eastern Mediterranean, receiving air masses from Europe, African, and Asian continents, and experiencing a warm Mediterranean climate. In Cyprus, the spatiotemporal features of O3 are poorly understood and the potential risks for forest health have not been explored. We evaluated O3 and nitrogen oxides (NO and NO2) at four regional background stations at different altitudes over 2014-2016. O3 risks to vegetation and human health were estimated by calculating accumulated O3 exposure over a threshold of 40 nmol mol-1 (AOT40) and cumulative exposure to mixing ratios above 35 nmol mol-1 (SOMO35) indices. The data reveal that mean O3 concentrations follow a seasonal pattern, with higher levels in spring (51.8 nmol mol-1) and summer (53.2 nmol mol-1) and lower levels in autumn (46.9 nmol mol-1) and winter (43.3 nmol mol-1). The highest mean O3 exposure (59.5 nmol mol-1) in summer occurred at the high elevation station Mt. Troodos (1819 m a.s.l.). Increasing (decreasing) altitudinal gradients were found for O3 (NOx), driven by summer-winter differences. The diurnal patterns of O3 showed little variation. Only at the lowest altitude O3 displayed a typical O3 diurnal pattern, with hourly differences smaller than 15 nmol mol-1. Accumulated O3 exposures at all stations and in all years exceeded the European Union's limits for the protection of vegetation, with average values of 3-month (limit: 3000 nmol mol-1 h) and 6-month (limit: 5000 nmol mol-1 h) AOT40 for crops and forests of 16,564 and 31,836 nmol mol-1 h, respectively. O3 exposures were considerably high for human health, with an average SOMO35 value of 7270 nmol mol-1 days across stations and years. The results indicate that O3 is a major environmental and public health issue in Cyprus, and policies must be adopted to mitigate O3 precursor emissions at local and regional scales.

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned.

BACKGROUND: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. METHODS: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. DISCUSSION: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03503812 , April 20, 2018.

Secondary organic aerosol tracers and related polar organic compounds between urban and rural areas in the Eastern Mediterranean region: source apportionment and the influence of atmospheric oxidants.

Fine particle samples were collected during summer at an urban (LIM) and a rural/background (AGM) site of Cyprus. They were analyzed for pinene and isoprene secondary organic aerosol (PSOA-ISOA) tracers, linear dicarboxylic acids (DCAs), hydroxyacids (HAs), aromatic acids (AAs), monocarboxylic acids (MCAs) and levoglucosan by GC/MS with prior 3-step derivatization. DCAs, AAs, MCAs and levoglucosan exhibited significantly higher concentrations (p < 0.05) in LIM, PSOAs and ISOAs in AGM (p < 0.05), whereas mixed trends were found for HAs. Among DCAs, succinic was the most abundant in both sites, accounting for 42.5% and 36.5% of the total DCAs in LIM and AGM respectively, followed by adipic in LIM (20.1%) and azelaic in AGM (22.4%). Malic, phthalic and palmitic acids were the dominant HA, AA and MCA, respectively. Regarding PSOAs, significant differences were observed between the two sites, with the first-generation products accounting for 59.8% of the total measured PSOAs in AGM, but were remarkably lowered (10.3%) in LIM indicating that they were highly oxidized. 2-Methylerythritol was the dominant ISOA tracer in both sites; nevertheless the elevated relative abundance of 2-methylglyceric acid in LIM implies the influences of higher NOx levels. The increased O3 levels observed in AGM appear to have a significant impact on SOA formation. Source apportionment tools employed revealed factors related to secondary formation processes including oxidation of unsaturated fatty acids, pinene, isoprene and anthropogenic VOCs and factors associated with primary sources such as biomass burning, plant emissions and/or cooking and motor exhaust, with noteworthy differences observed between the two areas.

Spatio-temporal variability of desert dust storms in Eastern Mediterranean (Crete, Cyprus, Israel) between 2006 and 2017 using a uniform methodology.

The characteristics of desert dust storms (DDS) have been shown to change in response to climate change and land use. There is limited information on the frequency and intensity of DDS over the last decade at a regional scale in the Eastern Mediterranean. An algorithm based on daily ground measurements (PM10, particulate matter ≤10 µm), satellite products (dust aerosol optical depth) and meteorological parameters, was used to identify dust intrusions for three Eastern Mediterranean locations (Crete-Greece, Cyprus, and Israel) between 2006 and 2017. Days with 24-hr average PM10 concentration above ~30 µg/m3 were found to be a significant indicator of DDS for the background sites of Cyprus and Crete. Higher thresholds were found for Israel depending on the season (fall and spring: PM10 > 70 µg/m3, winter and summer: PM10 > 90 µg/m3). We observed a high variability in the frequency and intensity of DDS during the last decade, characterized by a steady trend with sporadic peaks. The years with the highest DDS frequency were not necessarily the years with the most intense episodes. Specifically, the highest dust frequency was observed in 2010 at all three locations, but the highest annual median dust-PM10 level was observed in 2012 in Crete (55.8 µg/m3) and Israel (137.4 µg/m3), and in 2010 in Cyprus (45.3 µg/m3). Crete and Cyprus experienced the same most intense event in 2006, with 24 h-PM10 average of 705.7 µg/m3 and 1254.6 µg/m3, respectively, which originated from Sahara desert. The highest 24 h-PM10 average concentration for Israel was observed in 2010 (3210.9 µg/m3) during a three-day Saharan dust episode. However, a sub-analysis for Cyprus (years 2000-2017) suggests a change in DDS seasonality pattern, intensity, and desert of origin. For more robust conclusions on DDS trends in relation to climate change, future work needs to study data over several decades from different locations.

Evaluation of EU air quality standards through modeling and the FAIRMODE benchmarking methodology.

We evaluate air quality modeling over the East Mediterranean using the benchmarking methodology developed in the framework of the Forum for Air Quality Modelling in Europe (FAIRMODE). FAIRMODE aims to provide a harmonized approach of model evaluation for regulatory purposes. We test the methodology by assessing the performance of the Weather Research and Forecasting model coupled with chemistry (WRF-Chem) against ground-based air quality observations over Cyprus, a member state of the European Union. Two nested domains are used (at 50- and 10-km horizontal grid spacing) with the comparison performed over the innermost domain. We consider performance indicators reflecting regulations for air quality standards (maximum daily 8-hourly mean ozone, hourly nitrogen dioxide, and daily fine particulate matter concentrations). The WRF-Chem model is found to satisfy the proposed performance objectives regarding ozone and NO2, though it underestimates the latter in urban areas possibly due to uncertainties in emission inventories. Fine particulate matter is well represented by the model, except on days with strong influence from natural sources, highlighting the necessity for fine-tuning dust mobilization and transport in the region. The objectives are fulfilled even though discrepancies exist between model and observations. Our results indicate the need for more stringent performance criteria at relatively low concentrations. Overall, we find that the methodology provides in-depth information and relevant statistical metrics to guide air quality and model assessments for monitoring compliance with the EU Air Quality Directives and other guidelines to limit the impact of air pollution on human health and ecosystems.

An alternative method for the treatment of waste produced at a dye and a metal-plating industry using natural and/or waste materials.

The aim of this study was to develop cost-effective, appropriate solidification technologies for treating hazardous industrial wastes that are currently disposed of in ways that may threaten the quality of local groundwater. One major objective was to use materials other than cement, and preferably materials that are themselves wastes, as the solidification additives, namely using wastes to treat wastes or locally available natural material. This research examines the cement-based and lime-based stabilization/solidification (S/S) techniques applied for waste generated at a metal-plating industry and a dye industry. For the lime-based S/S process the following binder mixtures were used: cement kiln dust/ lime, bentonite/lime and gypsum/lime. For the cement-based S/S process three binder mixtures were used: cement kiln dust/cement, bentonite/cement and gypsum/cement. The leachability of the wastes was evaluated using the toxicity characteristic leaching procedure. The applicability and optimum weight ratio of the binder mixtures were estimated using the unconfined compressive strength test. The optimum ratio mixtures were mixed with waste samples in different ratios and cured for 28 days in order to find the S/S products with the highest strength and lowest leachability at the same time. The results of this work showed that the cement-and lime-based S/S process, using cement kiln dust and bentonite as additives can be effectively used in order to treat industrial waste.