Associations between Acute Exposures to PM2.5 and Carbon Dioxide Indoors and Cognitive Function in Office Workers: A Multicountry Longitudinal Prospective Observational Study.

Despite evidence of the air pollution effects on cognitive function, little is known about the acute impact of indoor air pollution on cognitive function among the working-age population. We aimed to understand whether cognitive function was associated with real-time indoor concentrations of particulate matter (PM2.5) and carbon dioxide (CO2). We conducted a prospective observational longitudinal study among 302 office workers in urban commercial buildings located in six countries (China, India, Mexico, Thailand, the United States of America, and the United Kingdom). For 12 months, assessed cognitive function using the Stroop color-word test and Addition-Subtraction test (ADD) via a mobile research app. We found that higher PM2.5 and lower ventilation rates, as assessed by CO2 concentration, were associated with slower response times and reduced accuracy (fewer correct responses per minute) on the Stroop and ADD for 8 out 10 test metrics. Each interquartile (IQR) increase in PM2.5 (IQR=8.8 µg/m3) was associated with a 0.82% (95%CI: 0.42, 1.21) increase in Stroop response time, a 6.18% (95% CI: 2.08, 10.3) increase in Stroop interference time, a 0.7% (95% CI: -1.38, -0.01) decrease in Stroop throughput, and a 1.51% (95% CI: -2.65, -0.37) decrease in ADD throughput. For CO2, an IQR increase (IQR=315ppm) was associated with a 0.85% (95% CI: 0.32, 1.39) increase in Stroop response time, a 7.88% (95% CI: 2.08, 13.86) increase in Stroop interference time, a 1.32% (95% CI: -2.3, -0.38) decrease in Stroop throughput, and a 1.13% (95% CI: 0.18, 2.11) increase in ADD response time. A sensitivity analysis showed significant association between PM2.5 in four out of five cognitive test performance metrics only at levels above 12 µg/m3. Enhanced filtration and higher ventilation rates that exceed current minimum targets are essential public health strategies that may improve employee productivity.

Heart Rate Variability and Performance of Commercial Airline Pilots during Flight Simulations.

Pilots undergo a variety of stressors that may affect their performance during all phases of flight. Heart rate variability (HRV) has been considered as a reliable indicator of the parasympathetic and sympathetic activities of human autonomic nervous system, which can be used to characterize the sympathetic stress response of pilots during flight. In this study, thirty active commercial airline pilots were recruited to fly three flight segments in a Federal Aviation Administration (FAA)-certified A320 flight simulator with each segment at a different carbon dioxide (CO2) concentration on the flight deck. The pilots performed a series of maneuvers of varying difficulty, and their performance was evaluated by FAA designated pilot examiners. The HRV metrics (SDNN, RMSSD and LF/HF ratio) of each pilot both before and during flight simulations were measured with a Movisens EcgMove3 sensor. The average SDNN, RMSSD and LF/HF ratio of the pilots during flight simulations were 34.1 ± 12.7 ms, 23.8 ± 10.2 ms and 5.7 ± 2.8 respectively. Decreased HRV was associated with aging, obesity and performing difficult maneuvers. Both CO2 exposure and HRV had an independent effect on the pilot performance, while their interaction was not significant. The generalized additive mixed effect model results showed that a pilot performed better on a maneuver when his stress response was lower, as indicated by higher SDNN and RMSSD and lower LF/HF ratio. An interquartile range (IQR) increase in SDNN (21.97 ms) and RMSSD (16.00 ms) and an IQR decrease in LF/HF ratio (4.69) was associated with an increase in the odds of passing a maneuver by 37%, 22% and 20%, respectively.

Airplane pilot flight performance on 21 maneuvers in a flight simulator under varying carbon dioxide concentrations.

BACKGROUND: Recent studies suggest that carbon dioxide has an impact on cognitive function performance of office workers at concentrations previously thought to be benign (1000-2500 ppm). The only available data for CO2 on the flight deck indicate that the average CO2 concentrations are typically <1000 ppm, but the 95th percentile concentration can be as high as 1400 ppm, depending on airplane type. METHODS: We recruited 30 active commercial airline pilots to fly three 3-h flight segments in an FAA-approved flight simulator with each segment at a different CO2 concentration on the flight deck (700, 1500, 2500 ppm). CO2 concentrations were modified by introducing ultra-pure CO2 into the simulator; ventilation rates remained the same for each segment. The pilots performed a range of predefined maneuvers of varying difficulty without the aid of autopilot, and were assessed by a FAA Designated Pilot Examiner according to FAA Practical Test Standards. Pilots and the Examiner were blinded to test conditions and the order of exposures was randomized. RESULTS: Compared to segments at a CO2 concentration of 2500 ppm, the odds of passing a maneuver as rated by the Examiner in the simulator were 1.52 (95% CI: 1.02-2.25) times higher when pilots were exposed to 1500 ppm and 1.69 (95% CI: 1.11-2.55) times higher when exposed to 700 ppm, controlling for maneuver difficulty, Examiner and order of maneuvers. DISCUSSION: Examiner rating captured a wider range of performance indicators than output from the flight simulator, which can characterize only a few quantitative aspects of the flight performance. More broadly, these findings suggest that there is a direct effect of carbon dioxide on performance, independent of ventilation, with implications for many other indoor environments that routinely experience CO2 concentrations above 1000 ppm.

The Impact of Working in a Green Certified Building on Cognitive Function and Health.

Thirty years of public health research have demonstrated that improved indoor environmental quality is associated with better health outcomes. Recent research has demonstrated an impact of the indoor environment on cognitive function. We recruited 109 participants from 10 high-performing buildings (i.e. buildings surpassing the ASHRAE Standard 62.1-2010 ventilation requirement and with low total volatile organic compound concentrations) in five U.S. cities. In each city, buildings were matched by week of assessment, tenant, type of worker and work functions. A key distinction between the matched buildings was whether they had achieved green certification. Workers were administered a cognitive function test of higher order decision-making performance twice during the same week while indoor environmental quality parameters were monitored. Workers in green certified buildings scored 26.4% (95% CI: [12.8%, 39.7%]) higher on cognitive function tests, controlling for annual earnings, job category and level of schooling, and had 30% fewer sick building symptoms than those in non-certified buildings. These outcomes may be partially explained by IEQ factors, including thermal conditions and lighting, but the findings suggest that the benefits of green certification standards go beyond measureable IEQ factors. We describe a holistic "buildingomics" approach for examining the complexity of factors in a building that influence human health.

Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes.

BACKGROUND: There are > 7,000 e-cigarette flavors currently marketed. Flavoring chemicals gained notoriety in the early 2000s when inhalation exposure of the flavoring chemical diacetyl was found to be associated with a disease that became known as "popcorn lung." There has been limited research on flavoring chemicals in e-cigarettes. OBJECTIVE: We aimed to determine if the flavoring chemical diacetyl and two other high-priority flavoring chemicals, 2,3-pentanedione and acetoin, are present in a convenience sample of flavored e-cigarettes. METHODS: We selected 51 types of flavored e-cigarettes sold by leading e-cigarette brands and flavors we deemed were appealing to youth. E-cigarette contents were fully discharged and the air stream was captured and analyzed for total mass of diacetyl, 2,3-pentanedione, and acetoin, according to OSHA method 1012. RESULTS: At least one flavoring chemical was detected in 47 of 51 unique flavors tested. Diacetyl was detected above the laboratory limit of detection in 39 of the 51 flavors tested, ranging from below the limit of quantification to 239 µg/e-cigarette. 2,3-Pentanedione and acetoin were detected in 23 and 46 of the 51 flavors tested at concentrations up to 64 and 529 µg/e-cigarette, respectively. CONCLUSION: Because of the associations between diacetyl and bronchiolitis obliterans and other severe respiratory diseases observed in workers, urgent action is recommended to further evaluate this potentially widespread exposure via flavored e-cigarettes. CITATION: Allen JG, Flanigan SS, LeBlanc M, Vallarino J, MacNaughton P, Stewart JH, Christiani DC. 2016. Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environ Health Perspect 124:733-739; http://dx.doi.org/10.1289/ehp.1510185.

Green Buildings and Health.

Green building design is becoming broadly adopted, with one green building standard reporting over 3.5 billion square feet certified to date. By definition, green buildings focus on minimizing impacts to the environment through reductions in energy usage, water usage, and minimizing environmental disturbances from the building site. Also by definition, but perhaps less widely recognized, green buildings aim to improve human health through design of healthy indoor environments. The benefits related to reduced energy and water consumption are well-documented, but the potential human health benefits of green buildings are only recently being investigated. The objective of our review was to examine the state of evidence on green building design as it specifically relates to indoor environmental quality and human health. Overall, the initial scientific evidence indicates better indoor environmental quality in green buildings versus non-green buildings, with direct benefits to human health for occupants of those buildings. A limitation of much of the research to date is the reliance on indirect, lagging and subjective measures of health. To address this, we propose a framework for identifying direct, objective and leading "Health Performance Indicators" for use in future studies of buildings and health.