Short-range airborne transmission of expiratory droplets between two people.

The occurrence of close proximity infection for many respiratory diseases is often cited as evidence of large droplet and/or close contact transmission. We explored interpersonal exposure of exhaled droplets and droplet nuclei of two standing thermal manikins as affected by distance, humidity, ventilation, and breathing mode. Under the specific set of conditions studied, we found a substantial increase in airborne exposure to droplet nuclei exhaled by the source manikin when a susceptible manikin is within about 1.5 m of the source manikin, referred to as the proximity effect. The threshold distance of about 1.5 m distinguishes the two basic transmission processes of droplets and droplet nuclei, that is, short-range modes and the long-range airborne route. The short-range modes include both the conventional large droplet route and the newly defined short-range airborne transmission. We thus reveal that transmission occurring in close proximity to the source patient includes both droplet-borne (large droplet) and short-range airborne routes, in addition to the direct deposition of large droplets on other body surfaces. The mechanisms of the droplet-borne and short-range airborne routes are different; their effective control methods also differ. Neither the current droplet precautions nor dilution ventilation prevents short-range airborne transmission, so new control methods are needed.

Influence of air stability and metabolic rate on exhaled flow.

The characteristics of contaminant transport and dispersion of exhaled flow from a manikin are thoroughly studied in this article with respect to the influence of two important factors: air stability conditions and metabolic rates. Four cases with the combinations of stable and neutral conditions as well as lower (1.2 met) and higher (2 met) metabolic rates for a breathing thermal manikin are employed. The exhaled contaminant is simulated by smoke and N2 O to visualize and measure the contaminant distribution both around and in front of the manikin. The results show that the microenvironment around the manikin body can be affected by different air distribution patterns and metabolic heating. Under stable conditions, the exhaled contaminant from mouth or nose is locked and stratified at certain heights, causing potentially high contaminant exposure to others. In addition, velocity profiles of the pulsating exhaled flow, which are normalized by mean peak velocities, present similar shapes to a steady jet. The outlet velocity close to the mouth shows decrement with both exhalation temperature and body plume. The velocity decay and concentration decay also show significant dependence on air stability and metabolic level.

Measuring the exhaled breath of a manikin and human subjects.

Due to scarcity of accurate information and available data of actual human breathing, this investigation focuses on characterizing the breathing dynamic process based on the measurement of healthy human subjects. The similarities and differences between one breathing thermal manikin and the human subjects, including geometry and breathing functions, were thoroughly studied. As expected, actual human breathing is more complicated than that of the manikin in terms of airflow fluctuations, individual differences, and exhaled flow directions. The simplification of manikin mouth structure could result in overestimated exhaled velocity and contaminant concentration. Furthermore, actual human breathing appears to be relatively stable and reproducible for an individual person in several conditions and is also accompanied by some uncertainties simultaneously. The averaged values are used to analyze the overall characteristics of actual human breathing. There are different characteristics of the exhaled breath between male and female subjects with or without wearing a nose clip. The experimental results obtained from the measurement of human subjects may be helpful for manikin specification or validation and accuracy assessment of CFD simulations.

Protected zone ventilation and reduced personal exposure to airborne cross-infection.

The main objective of this study was to examine the performance of protected zone ventilation (PZV) and hybrid protected zone ventilation (HPZV) to reduce the direct exposure to exhaled air from others' breathing. Experimental measurements are carried out to test the performance of PZV in a full-scale office room with two breathing thermal manikins. The measurements were performed under three configurations, including two standing manikins at different distances: 0.35, 0.5, and 1.1 m. When the supply air velocity is increased to 4 m/s in the downward plane jet, the dimensionless concentration is 40% lower than for fully mixed ventilation, which can be considered as a measure of protection from the zoning condition. The measurement results showed that in both the PZV and the HPZV system it is possible to decrease the transmission of tracer gas from one manikin to the opposite manikin; therefore, it probably would reduce the risk of air borne cross-infection between two people at the same relative positions. The results suggest that PZV and HPZV may be used to reduce the exposure of people in a protected zone from indoor pollutants emitted in a source zone.

Three dimensional analysis of the exhalation flow in the proximity of the mouth.

The human exhalation flow is characterized in this work from the three-dimensional velocimetry results obtained by using the stereo particle image velocimetry (SPIV) measurement technique on the flow emitted from a realistic airway model. For this purpose, the transient exhalation flow through the mouth of a person performing two different breaths corresponding to two metabolic rates, standing relaxed (SR) and walking active (WA), is emulated and studied. To reproduce the flow realistically, a detailed three-dimensional model obtained from computed tomography measurements on real subjects is used. To cope with the variability of the experimental data, a subsequent analysis of the results is performed using the TR-PIV (time resolved particle image velocimetry) technique. Exhalation produces a transient jet that becomes a puff when flow emission ends. Three-dimensional vector fields of the jet velocity are obtained in five equally spaced transverse planes up to a distance of Image 1 from the mouth at equally spaced time instants Image 2 which will be referred to as phases (φ), from the beginning to the end of exhalation. The time evolution during exhalation of the jet area of influence, the velocity field and the jet air entrainment have been characterized for each of the jet cross sections. The importance of the use of realistic airway models for the study of this type of flow and the influence of the metabolic rate on its development are also analyzed. The results obtained contribute to the characterization of the human exhalation as a pathway of the transmission of pathogens such as SARS-CoV-2 virus.

The risk of airborne cross-infection in a room with vertical low-velocity ventilation.

UNLABELLED: Downward flow ventilation systems are one of the most recommended ventilation strategies when contaminants in rooms must be removed and people must be protected from the risk of airborne cross-infection. This study is based on experimental tests carried out in a room with downward flow ventilation. Two breathing thermal manikins are placed in a room face to face. One manikin's breathing is considered to be the contaminated source to simulate a risky situation with airborne cross-infection. The position of the manikins in relation to the diffuser and the location of diffuser in the room as well as the distance between the manikins are being changed to observe the influence of these factors on the personal exposure of the target manikin. The results show that the DWF in different situations often is unable to penetrate the microenvironment generated by the manikins. The downward ventilation system can give an unexpected high level of contaminant exposure of the target manikin, when the distance between the manikins is reduced. PRACTICAL IMPLICATIONS: Several guidelines recommend the downward ventilation system to reduce the risk of cross-infection between people in hospital rooms. This study shows that this recommendation should be taken into careful consideration. It is important to be aware of people position, position to other thermal loads in the room, and especially be aware of the distance between people if the exposure to the exhaled contaminants wants to be reduced.

Distribution of exhaled contaminants and personal exposure in a room using three different air distribution strategies.

UNLABELLED: The level of exposure to human exhaled contaminants in a room depends not only on the air distribution system but also on people's different positions, the distance between them, people's activity level and height, direction of exhalation, and the surrounding temperature and temperature gradient. Human exhalation is studied in detail for different distribution systems: displacement and mixing ventilation as well as a system without mechanical ventilation. Two thermal manikins breathing through the mouth are used to simulate the exposure to human exhaled contaminants. The position and distance between the manikins are changed to study the influence on the level of exposure. The results show that the air exhaled by a manikin flows a longer distance with a higher concentration in case of displacement ventilation than in the other two cases, indicating a significant exposure to the contaminants for one person positioned in front of another. However, in all three cases, the exhalation flow of the source penetrates the thermal plume, causing an increase in the concentration of contaminants in front of the target person. The results are significantly dependent on the distance and position between the two manikins in all three cases. PRACTICAL IMPLICATIONS: Indoor environments are susceptible to contaminant exposure, as contaminants can easily spread in the air. Human breathing is one of the most important biological contaminant sources, as the exhaled air can contain different pathogens such as viruses and bacteria. This paper addresses the human exhalation flow and its behavior in connection with different ventilation strategies, as well as the interaction between two people in a room. This is a key factor for studying the airborne infection risk when the room is occupied by several persons. The paper only takes into account the airborne part of the infection risk.

CFD and ventilation research.

UNLABELLED: There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000-10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part of scientific research and engineering development of complex air distribution and ventilation systems in buildings. This review discusses the major and specific challenges of CFD in terms of turbulence modelling, numerical approximation, and boundary conditions relevant to building ventilation. We emphasize the growing need for CFD verification and validation, suggest ongoing needs for analytical and experimental methods to support the numerical solutions, and discuss the growing capacity of CFD in opening up new research areas. We suggest that CFD has not become a replacement for experiment and theoretical analysis in ventilation research, rather it has become an increasingly important partner. PRACTICAL IMPLICATIONS: We believe that an effective scientific approach for ventilation studies is still to combine experiments, theory, and CFD. We argue that CFD verification and validation are becoming more crucial than ever as more complex ventilation problems are solved. It is anticipated that ventilation problems at the city scale will be tackled by CFD in the next 10 years.

Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

The coronavirus disease 2019 (COVID-19) pandemic has caused untold disruption throughout the world. Understanding the mechanisms for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is key to preventing further spread, but there is confusion over the meaning of 'airborne' whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago which has generated mythological beliefs that obscure current thinking. This article collates and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six 'myths' are presented, explained and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to produce this review to consolidate the evidence for airborne transmission mechanisms, and offer justification for modern strategies for prevention and control of COVID-19 in health care and the community.

An effect of gene dosage on production of human chorionic somatomammotropin.

The gene deletions responsible for isolated partial deficiency of fetal human chorionic somatomammotropin (hCS) production were characterized by restriction endonuclease analysis of genomic DNA prepared from the leukocytes of an affected child. The phenotypically normal child was the product of a 38-week pregnancy characterized by peak maternal hCS levels of 1.1 micrograms/microliter (normal, 3-9.2 micrograms/ml) and normal levels of other pregnancy-associated hormones. Two genes, termed hCS-A and hCS-B, specify the same mature hCS peptide and are responsible for fetal hCS production. Digestion of the child's DNA with the enzymes Hind III, Eco RI, Bam HI, Bgl II, Hinc II and Msp I disclosed absence of the restriction fragments that normally contain the hCS-A gene. However, the hCS-B gene was present in the child's DNA. The child's DNA digests contained an abnormally large Eco RI fragment of 10.0 kb containing the hCS-L gene. This abnormal fragment is a marker for a deletion that is responsible for complete deficiency of hCS when present in the homozygous state. The child's DNA restriction patterns were consistent with heterozygosity for two different deletions involving hCS genes. The paternal hGH gene cluster lacked the hCS-A, human GH variant, and hCS-B genes, while the maternal cluster lacked only the hCS-A gene. Thus, the child's DNA contained only one of the normal complement of four functional hCS genes per diploid genome. Material hCS levels approximately one fourth as great as those present at comparable stages of normal pregnancies indicated that there was no compensatory increase in expression of the remaining hCS gene.

Micellar electrokinetic capillary chromatography of fungal metabolites. Resolution optimized by experimental design.

Fungal metabolites were extracted from two isolates of Penicillium commune and two isolates of Aspergillus versicolor grown on yeast extract agar (YES) and Czapek yeast extract agar (CYA). Optimized conditions for analysing the extracts by high-performance capillary electrophoresis (HPCE) were obtained by experimental designs. The following nine factors were examined by a two-level fractional factorial design: concentration of the buffer ion PO4(3-) and B4O7(2-), ionic strength of buffer, buffer pH, addition of sodium dodecyl sulphate (SDS) and sodium deoxycholate (SCD), addition of acetonitrile and methanol and voltage. Four factors significantly influenced the separation of peaks in all the fungal extracts. For optimization of the HPCE method a subsequent response-surface experiment with the important factors was made with an extract from an isolate of Aspergillus versicolor. Optimum separation conditions were obtained, which gave good resolution of the components in the extract.

Inhibition of fungal growth on bread by volatile components from spices and herbs, and the possible application in active packaging, with special emphasis on mustard essential oil.

The effect of modified atmosphere packaging (MAP) on the most important spoilage fungi of bread was investigated. Penicillium commune, P. roqueforti, Aspergillus flavus and Endomyces fibuliger were able to grow at oxygen levels down to 0.03%, while the chalk mould E. fibuliger was capable of growing even in the presence of an oxygen absorber. High levels of carbon dioxide retarded growth but not completely. As an alternative to MAP active packaging (AP) using volatile essential oils (EO) and oleoresins (OL) from spices and herbs were tested against a range of fungi commonly found on bread. Concentrations of 1, 10 or 100 microl EO or OL were added to a filter paper placed in the lid of a Petri dish inoculated with one of the test fungi. The Petri dish was sealed hermetically to avoid the exchange of gases. Mustard essential oil showed the strongest effect. Cinnamon, garlic and clove also had high activity, while oregano oleoresin only inhibited growth weakly. Vanilla showed no inhibitory effect towards the tested microorganisms at the applied concentrations. A. flavus was more resistant than the other microorganisms while P. roqueforti was the most sensitive. Mustard essential oil was investigated in greater detail. The minimal inhibitory concentration (MIC) for the active component, allyl isothiocyanate (AITC), was determined for the same species and an additional three moulds and one yeast. MIC values ranged from 1.8 to 3.5 microg/ml gas phase. Results showed that whether AITC was fungistatic or fungicidal depended on its concentration, and the concentration of spores. When the gas phase contained at least 3.5 microg/ml, AITC was fungicidal to all tested fungi. Results of sensory evaluation showed, that hot-dog bread was more sensitive to AITC than rye bread. The minimal recognisable concentration of AITC was 2.4 microg/ml gas phase for rye bread and between 1.8 and 3.5 microg/ml gas phase for hot-dog bread. These findings showed that the required shelf-life of rye bread could be achieved by active packaging with AITC. Active packaging of hot-dog bread, may nevertheless require the additional effect of other preserving factors to avoid off-flavour formation

Effect of weak acid preservatives on growth of bakery product spoilage fungi at different water activities and pH values.

Inhibition of spoilage organisms from bakery products by weak acid preservatives in concentrations of 0%, 0.003%, 0.03% and 0.3% (w/v) was investigated experimentally on a substrate media with water activity (a(w)) and pH ranging from sourdough-fermented acidic rye bread to alkaline intermediate moisture sponge cake types (a(w) 0.80-0.95, pH 4.7-7.4). Initially, rye bread conditions (a(w) 0.94-0.97 and pH 4.4-4.8) in combination with calcium propionate were investigated. Results showed that the highest concentration of propionate (0.3%) at all conditions apart from high a(w) (0.97) and high pH (4.8) totally inhibited fungal growth for a 2-week period, with the exception of Penicillium roqueforti, Penicillium commune and Eurotium rubrum. Characteristically for the major spoiler of rye bread, P. roqueforti, all three isolates tested were stimulated by propionate and the stimulation was significantly enhanced at high water activity levels. The effect of propionate on production of secondary metabolites (mycophenolic acid, rugulovasine, echinulin, flavoglaucin) was also studied, and variable or isolate dependent results were found. Subsequently, a screening experiment representing a wider range of bakery products was conducted using calcium propionate, potassium sorbate and sodium benzoate. The obtained data was modelled using survival analysis to determine 'spoilage-free time' for the fungi. At the low a(w) level (0.80) only Eurotium species grew within the test period of 30 days. Higher water activity levels as well as higher pH values decreased spoilage-free times of the fungi. The preservative calcium propionate was less effective than potassium sorbate and sodium benzoate.

Protection by fungal starters against growth and secondary metabolite production of fungal spoilers of cheese.

The influence of fungal starter cultures on growth and secondary metabolite production of fungal contaminants associated with cheese was studied on laboratory media and Camembert cheese. Isolates of the species Penicillium nalgiovense, P. camemberti, P. roqueforti and Geotrichum candidum were used as fungal starters. The species P. commune, P. caseifulvum, P. verrucosum, P. discolor, P. solitum, P. coprophilum and Aspergillus versicolor were selected as contaminants. The fungal starters showed different competitive ability on laboratory media and Camembert cheese. The presence of the Penicillium species, especially P. nalgiovense, showed an inhibitory effect on the growth of the fungal contaminants on laboratory media. G. candidum caused a significant inhibition of the fungal contaminants on Camembert cheese. The results indicate that G. candidum plays an important role in competition with undesirable microorganisms in mould fermented cheeses. Among the starters, P. nalgiovense caused the largest reduction in secondary metabolite production of the fungal contaminants on the laboratory medium. On Camembert cheese no significant changes in metabolite production of the fungal contaminants was observed in the presence of the starters.

Fungicidal effect of 15 disinfectants against 25 fungal contaminants commonly found in bread and cheese manufacturing.

Resistance of 19 mold and 6 yeast species to 15 commercial disinfectants was investigated by using a suspension method in which the fungicidal effect and germination time were determined at 20 degrees C. Disinfectants containing 0.5% dodecyldiethylentriaminacetic acid, 10 g of chloramine-T per 1, 2.0% formaldehyde, 0.1% potassium hydroxide, 3.0% hydrogen peroxide, or 0.3% peracetic acid were ineffective as fungicides. The fungicidal effect of quaternary ammonium compounds and chlorine compounds showed great variability between species and among the six isolates of Penicillium roqueforti var. roqueforti tested. The isolates of P roqueforti var. carneum, P. discolor, Aspergillus versicolor, and Eurotium repens examined were resistant to different quaternary ammonium compounds. Conidia and vegetative cells were killed by alcohols, whereas ascospores were resistant. Resistance of ascospores to 70% ethanol increased with age. Both P. roqueforti var. roqueforti and E. repens showed great variability of resistance within isolates of each species.

Colony interaction and secondary metabolite production of cheese-related fungi in dual culture.

Interactions between fungi used as starter cultures (Penicillium roqueforti, Penicillium camemberti, Penicillium nalgiovense, and Geotrichum candidum) and fungal contaminants associated with cheese were investigated on agar medium at two temperatures, 18 and 25 degrees C. Mutual inhibition on contact was the most common interaction observed. The only other interaction observed was inhibition of the contaminant, while the starter continued to grow, especially in dual cultures involving G. candidum as the starter culture. Dual cultures involving G. candidum showed inhibition of production of the mycotoxins mycophenolic acid, roquefortin C, chaetoglobosin A, and cyclopiazonic acid produced by the contaminants. An unknown metabolite was detected in considerably larger quantity in dual cultures involving G. candidum compared to detection in single cultures. There was no correlation between detection of this metabolite and the observed interactions. The results show that G. candidum plays a major role in interactions between fungi on cheese.

Biological control of Botrytis cinerea growth on apples stored under modified atmospheres.

The combined effect of modified-atmosphere packaging and the application of a bacterial antagonist (Erwinia sp.) on Botrytis cinerea growth on apples (cv. 'Golden Delicious') was investigated. Inoculated apples were stored in polyethylene bags at 5 degrees C. The initial gas composition in each bag was set according to a central composite experimental design involving five levels of O2 (1 to 15%) and CO2 (0 to 15%). Control samples under ambient conditions were also included. Without the antagonist, measurements of mold colony diameter over time showed that O2 had no effect on the growth of B. cinerea, while increased CO2 levels delayed its growth by about 4 days. Application of the antagonist resulted in a significant interaction between O2 and CO2. At low O2 levels, CO2 had no effect on mold growth, but at high O2, CO2 enhanced mold growth. O2 and the antagonist worked synergistically to reduce mold growth by about 6 days at low levels of CO2. However, at high CO2 levels, O2 had no effect. The strongest antagonistic effect was observed under ambient conditions. Overall, results showed that high CO2 atmospheres can slow the growth of B. cinerea and that Erwinia sp. was an effective antagonist against B. cinerea growth on apples, particularly under ambient conditions.

Observing and quantifying airflows in the infection control of aerosol- and airborne-transmitted diseases: an overview of approaches.

With concerns about the potential for the aerosol and airborne transmission of infectious agents, particularly influenza, more attention is being focused on the effectiveness of infection control procedures to prevent hospital-acquired infections by this route. More recently a number of different techniques have been applied to examine the temporal-spatial information about the airflow patterns and the movement of related, suspended material within this air in a hospital setting. Closer collaboration with engineers has allowed clinical microbiologists, virologists and infection control teams to assess the effectiveness of hospital isolation and ventilation facilities. The characteristics of human respiratory activities have also been investigated using some familiar engineering techniques. Such studies aim to enhance the effectiveness of such preventive measures and have included experiments with human-like mannequins using various tracer gas/particle techniques, real human volunteers with real-time non-invasive Schlieren imaging, numerical modelling using computational fluid dynamics, and small scale physical analogues with water. This article outlines each of these techniques in a non-technical manner, suitable for a clinical readership without specialist airflow or engineering knowledge.