Impacts of residential indoor air quality and environmental risk factors on adult asthma-related health outcomes in Chicago, IL.

BACKGROUND: Residential environments are known to contribute to asthma. OBJECTIVE: To examine the joint impacts of exposures to residential indoor and outdoor air pollutants and housing risk factors on adult asthma-related health outcomes. METHODS: We analyzed >1-year of data from 53 participants from 41 homes in the pre-intervention period of the Breathe Easy Project prior to ventilation and filtration retrofits. Health outcomes included surveys of asthma control, health-related quality of life, stress, and healthcare utilizations. Environmental assessments included quarterly measurements of indoor and outdoor pollutants (e.g., HCHO, CO, CO2, NO2, O3, and PM), home walk-throughs, and surveys of environmental risk factors. Indoor pollutant concentrations were also matched with surveys of time spent at home to estimate indoor pollutant exposures. RESULTS: Cross-sectional analyses using mixed-effects models indicated that lower annual average asthma control test (ACT) scores were associated (p < 0.05) with higher indoor NO2 (concentration/exposure: ß = -2.42/-1.57), indoor temperature (ß = -1.03 to -0.94), and mold/dampness (ß = -3.09 to -2.41). In longitudinal analysis, lower ACT scores were also associated (p < 0.05) with higher indoor NO2 concentrations (ß = -0.29), PM1 (concentration/exposure: ß = -0.12/-0.24), PM2.5 (concentration/exposure: ß = -0.12/-0.26), and PM10 (concentration/exposure: ß = 10.14/-0.28). Emergency department visits were associated with poorer asthma control [incidence rate ratio (IRR) = 0.84; p < 0.001], physical health (IRR = 0.95; p < 0.05), mental health (IRR = 0.95; p < 0.05), higher I/O NO2 ratios (IRR = 1.30; p < 0.05), and higher indoor temperatures (IRR = 1.41; p < 0.05). SIGNIFICANCE: Findings suggest that residential risk factors, including indoor air pollution (especially NO2 and particulate matter), higher indoor temperature, and mold/dampness, may contribute to poorer asthma control. IMPACT: This study highlights the importance of residential indoor air quality and environmental risk factors for asthma control, health-related quality of life, and emergency department visits for asthma. Two timescales of mixed models suggest that exposure to indoor NO2 and particulate matter, higher indoor temperature, and mold/dampness was associated with poorer asthma control. Additionally, emergency department visits were associated with poorer asthma control and health-related quality of life, as well as higher I/O NO2 ratios and indoor temperatures. These findings deepen our understanding of the interrelationships between housing, air quality, and health, and have important implications for programs and policy.

Indoor air quality impacts of residential mechanical ventilation system retrofits in existing homes in Chicago, IL.

Mechanical ventilation systems are used in residences to introduce ventilation air and dilute indoor-generated pollutants. A variety of ventilation system types can be used in home retrofits, influencing indoor air quality (IAQ) in different ways. Here we describe the Breathe Easy Project, a >2-year longitudinal, pseudo-randomized, crossover study designed to assess IAQ and adult asthma outcomes before and after installing residential mechanical ventilation systems in 40 existing homes in Chicago, IL. Each home received one of three types of ventilation systems: continuous exhaust-only, intermittent powered central-fan-integrated-supply (CFIS), or continuous balanced system with an energy recovery ventilator (ERV). Homes with central heating and/or cooling systems also received MERV 10 filter replacements. Approximately weeklong field measurements were conducted at each home on a quarterly basis throughout the study to monitor environmental conditions, ventilation operation, and indoor and outdoor pollutants, including size-resolved particles (0.3-10 µm), ozone (O3), nitrogen dioxide (NO2), carbon dioxide (CO2), carbon monoxide (CO), and indoor formaldehyde (HCHO). Mean reductions in indoor/outdoor (I/O) ratios across all systems after the intervention were approximately 12% (p = 0.001), 10% (p = 0.008), 42% (p < 0.001), 39% (p = 0.002), and 33% (p = 0.007), for CO2, NO2, and estimated PM1, PM2.5, and PM10, respectively. There was a reduction in I/O ratios for all measured constituents with each type of system, on average, but with varying magnitude and levels of statistical significance. The magnitudes of mean differences in I/O pollutant concentrations ratios were generally largest for most pollutants in the homes that received continuous balanced with ERV and smallest in the homes that received intermittent CFIS systems, with apparent benefits to providing ventilation continuously rather than intermittently. All ventilation system types maintained similar indoor temperatures during pre- and post-intervention periods.

Mechanistic transmission modeling of COVID-19 on the Diamond Princess cruise ship demonstrates the importance of aerosol transmission.

Several lines of existing evidence support the possibility of airborne transmission of coronavirus disease 2019 (COVID-19). However, quantitative information on the relative importance of transmission pathways of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains limited. To evaluate the relative importance of multiple transmission routes for SARS-CoV-2, we developed a modeling framework and leveraged detailed information available from the Diamond Princess cruise ship outbreak that occurred in early 2020. We modeled 21,600 scenarios to generate a matrix of solutions across a full range of assumptions for eight unknown or uncertain epidemic and mechanistic transmission factors. A total of 132 model iterations met acceptability criteria (R2 > 0.95 for modeled vs. reported cumulative daily cases and R2 > 0 for daily cases). Analyzing only these successful model iterations quantifies the likely contributions of each defined mode of transmission. Mean estimates of the contributions of short-range, long-range, and fomite transmission modes to infected cases across the entire simulation period were 35%, 35%, and 30%, respectively. Mean estimates of the contributions of larger respiratory droplets and smaller respiratory aerosols were 41% and 59%, respectively. Our results demonstrate that aerosol inhalation was likely the dominant contributor to COVID-19 transmission among the passengers, even considering a conservative assumption of high ventilation rates and no air recirculation conditions for the cruise ship. Moreover, close-range and long-range transmission likely contributed similarly to disease progression aboard the ship, with fomite transmission playing a smaller role. The passenger quarantine also affected the importance of each mode, demonstrating the impacts of the interventions.

An artificial neural network based mathematical model for a stochastic health care facility location problem.

This research is conducted to investigate the problem of locating the trauma centers and helicopters' station in order to optimize the trauma care system. The stochastic characteristics of the system, such as stochastic transferring time of the patients, stochastic demand and stochastic servicing time of the patients in trauma centers are taken into account. The problem is first modeled as a stochastic mixed-integer linear mathematical model. In the proposed model, minimizing the total cost, minimizing the transferring time, and minimizing the waiting time inside the trauma center are considered as the three separate objectives. The third objective cannot be expressed by an analytical expression because of the complexity inside a trauma center. Therefore, an artificial neural network (ANN) is first trained by a simulation model and then is utilized to estimate the third objective function. A hybrid multi-objective algorithm is developed based on a non-dominated sorting water flow algorithm in order to search the solution space. Different numerical examples are applied to study the performance of the proposed method. The computational results show that the combination of simulation, ANN, and optimization technique provides an effective means for the highly complex optimization problems.

An Unrecognized Hazard in E-Cigarette Vapor: Preliminary Quantification of Methylglyoxal Formation from Propylene Glycol in E-Cigarettes.

Up to 95% of the liquid volume in an e-cigarette consists of propylene glycol. Previous research has shown that propylene glycol can generate diacetyl and formaldehyde when heated. New research shows that propylene glycol can also generate methylglyoxal, an alpha di-carbonyl compound recently shown to cause epithelial necrosis at even lower concentrations than diacetyl, the flavoring chemical associated with bronchiolitis obliterans ("Popcorn Lung"). We analyzed chemical emissions from 13 JUUL pod flavors. Diacetyl and methylglyoxal was detected in 100% of samples with median concentration (range) of 20 µg/m3 (less than limit of quantification: 54 µg/m3) and 4219 µg/m3 (677-15,342 µg/m3), respectively. We also detected acetaldehyde (median concentration: 341 µg/m3) and propionaldehyde (median concentration: 87 µg/m3) in all samples. The recent evidence that methylglyoxal is more cytotoxic to airway epithelial cells than diacetyl makes this an urgent public health concern. Current smokers considering e-cigarettes as a smoking cessation tool, and never users, who may be under the impression that e-cigarettes are harmless, need information on emissions and potential risks to make informed decisions.

Estimating the nationwide transmission risk of measles in US schools and impacts of vaccination and supplemental infection control strategies.

BACKGROUND: The spread of airborne infectious diseases such as measles is a critical public health concern. The U.S. was certified measles-free in 2000, but the number of measles cases has increased in recent years breaking the record of the nationwide annual number of cases since 1992. Although the characteristics of schools have made them one of the most vulnerable environments during infection outbreaks, the transmission risk of measles among students is not completely understood. We aimed to evaluate how three factors influence measles transmission in schools: personal (vaccination), social (compartmentalizing), and building systems (ventilation, purification, and filtration). METHODS: We used a combination of a newly developed multi-zone transient Wells-Riley approach, a nationwide representative School Building Archetype (SBA) model, and a Monte-Carlo simulation to estimate measles risk among U.S. students. We compared our risk results with the range of reported transmission rates of measles in school outbreaks to validate the risk model. We also investigated the effectiveness of vaccination and ten supplemental infection control scenarios for reducing the risk of measles transmission among students. RESULTS: Our best nationwide estimate of measles transmission risk in U.S. schools were 3.5 and 32% among all (both unvaccinated and immunized) and unvaccinated students, respectively. The results showed the transmission risk of measles among unvaccinated students is > 70 times higher than properly immunized ones. We also demonstrated that the transmission risk of measles in primary schools (assuming teacher self-contained classrooms) is less than secondary schools (assuming departmentalized systems). For building-level interventions, schools with ductless-with-air-filter and ductless-without-air-filter systems have the lowest and highest transmission risks of measles, respectively. Finally, our simulation showed that infection control strategies could cut the average number of infected cases among all students in half when a combination of advanced air filtration, ventilation, and purification was adopted in the modeled schools. CONCLUSIONS: Our results highlight the primary importance of vaccination for reducing the risk of measles transmission among students. Yet, additional and significant risk reduction can be achieved through compartmentalizing students and enhancing building ventilation and filtration systems.

Correction to: Estimating the nationwide transmission risk of measles in US schools and impacts of vaccination and supplemental infection control strategies.

An amendment to this paper has been published and can be accessed via the original article.

A framework for estimating the US mortality burden of fine particulate matter exposure attributable to indoor and outdoor microenvironments.

Exposure to fine particulate matter (PM2.5) is associated with increased mortality. Although epidemiology studies typically use outdoor PM2.5 concentrations as surrogates for exposure, the majority of PM2.5 exposure in the US occurs in microenvironments other than outdoors. We develop a framework for estimating the total US mortality burden attributable to exposure to PM2.5 of both indoor and outdoor origin in the primary non-smoking microenvironments in which people spend most of their time. The framework utilizes an exposure-response function combined with adjusted mortality effect estimates that account for underlying exposures to PM2.5 of outdoor origin that likely occurred in the original epidemiology populations from which effect estimates are derived. We demonstrate the framework using several different scenarios to estimate the potential magnitude and bounds of the US mortality burden attributable to total PM2.5 exposure across all non-smoking environments under a variety of assumptions. Our best estimates of the US mortality burden associated with total PM2.5 exposure in the year 2012 range from ~230,000 to ~300,000 deaths. Indoor exposure to PM2.5 of outdoor origin is typically the largest total exposure, accounting for ~40-60% of total mortality, followed by residential exposure to indoor PM2.5 sources, which also drives the majority of variability in each scenario.

Microbial Exchange via Fomites and Implications for Human Health.

PURPOSE OF REVIEW: Fomites are inanimate objects that become colonized with microbes and serve as potential intermediaries for transmission to/from humans. This review summarizes recent literature on fomite contamination and microbial survival in the built environment, transmission between fomites and humans, and implications for human health. RECENT FINDINGS: Applications of molecular sequencing techniques to analyze microbial samples have increased our understanding of the microbial diversity that exists in the built environment. This growing body of research has established that microbial communities on surfaces include substantial diversity, with considerable dynamics. While many microbial taxa likely die or lay dormant, some organisms survive, including those that are potentially beneficial, benign, or pathogenic. Surface characteristics also influence microbial survival and rates of transfer to and from humans. Recent research has combined experimental data, mechanistic modeling, and epidemiological approaches to shed light on the likely contributors to microbial exchange between fomites and humans and their contributions to adverse (and even potentially beneficial) human health outcomes. SUMMARY: In addition to concerns for fomite transmission of potential pathogens, new analytical tools have uncovered other microbial matters that can be transmitted indirectly via fomites, including entire microbial communities and antibiotic-resistant bacteria. Mathematical models and epidemiological approaches can provide insight on human health implications. However, both are subject to limitations associated with study design, and there is a need to better understand appropriate input model parameters. Fomites remain an important mechanism of transmission of many microbes, along with direct contact and short- and long-range aerosols.

Emissions of Ultrafine Particles and Volatile Organic Compounds from Commercially Available Desktop Three-Dimensional Printers with Multiple Filaments.

Previous research has shown that desktop 3D printers can emit large numbers of ultrafine particles (UFPs, particles less than 100 nm) and some hazardous volatile organic compounds (VOCs) during printing, although very few filament and 3D printer combinations have been tested to date. Here we quantify emissions of UFPs and speciated VOCs from five commercially available filament extrusion desktop 3D printers utilizing up to nine different filaments by controlled experiments in a test chamber. Median estimates of time-varying UFP emission rates ranged from ∼10(8) to ∼10(11) min(-1) across all tested combinations, varying primarily by filament material and, to a lesser extent, bed temperature. The individual VOCs emitted in the largest quantities included caprolactam from nylon-based and imitation wood and brick filaments (ranging from ∼2 to ∼180 µg/min), styrene from acrylonitrile butadiene styrene (ABS) and high-impact polystyrene (HIPS) filaments (ranging from ∼10 to ∼110 µg/min), and lactide from polylactic acid (PLA) filaments (ranging from ∼4 to ∼5 µg/min). Results from a screening analysis of potential exposure to these products in a typical small office environment suggest caution should be used when operating many of the printer and filament combinations in poorly ventilated spaces or without the aid of combined gas and particle filtration systems.

Evaluating the Long-Term Health and Economic Impacts of Central Residential Air Filtration for Reducing Premature Mortality Associated with Indoor Fine Particulate Matter (PM2.5) of Outdoor Origin.

Much of human exposure to fine particulate matter (PM2.5) of outdoor origin occurs in residences. High-efficiency particle air filtration in central heating, ventilating, and air-conditioning (HVAC) systems is increasingly being used to reduce concentrations of particulate matter inside homes. However, questions remain about the effectiveness of filtration for reducing exposures to PM2.5 of outdoor origin and adverse health outcomes. Here we integrate epidemiology functions and mass balance modeling to estimate the long-term health and economic impacts of HVAC filtration for reducing premature mortality associated with indoor PM2.5 of outdoor origin in residences. We evaluate 11 classifications of filters (MERV 5 through HEPA) using six case studies of single-family home vintages and ventilation system combinations located in 22 U.S. cities. We estimate that widespread use of higher efficiency filters would reduce premature mortality by 0.002-2.5% and increase life expectancy by 0.02-1.6 months, yielding annual monetary benefits ranging from $1 to $1348 per person in the homes and locations modeled herein. Large differences in the magnitude of health and economic impacts are driven largely by differences in rated filter efficiency and building and ventilation system characteristics that govern particle infiltration and persistence, with smaller influences attributable to geographic location.

HVAC filtration for controlling infectious airborne disease transmission in indoor environments: Predicting risk reductions and operational costs.

This work describes and applies a methodology for estimating the impact of recirculating heating, ventilating, and air-conditioning (HVAC) particle filters on the control of size-resolved infectious aerosols in indoor environments using a modified version of the Wells-Riley model for predicting risks of infectious disease transmission. Estimates of risk reductions and associated operational costs of both HVAC filtration and equivalent outdoor air ventilation are modeled and compared using a case study of airborne transmission of influenza in a hypothetical office space. Overall, recirculating HVAC filtration was predicted to achieve risk reductions at lower costs of operation than equivalent levels of outdoor air ventilation, particularly for MERV 13-16 filters. Medium efficiency filtration products (MERV 7-11) are also inexpensive to operate but appear less effective in reducing infectious disease risks.