Do "brassy" sounding musical instruments need increased safe distancing requirements to minimize the spread of COVID-19?

Brass wind instruments with long sections of cylindrical pipe, such as trumpets and trombones, sound "brassy" when played at a fortissimo level due to the generation of a shock front in the instrument. It has been suggested that these shock fronts may increase the spread of COVID-19 by propelling respiratory particles containing the SARS-CoV-2 virus several meters due to particle entrainment in the low pressure area behind the shocks. To determine the likelihood of this occurring, fluorescent particles, ranging in size from 10-50 μm, were dropped into the shock regions produced by a trombone, a trumpet, and a shock tube. Preliminary results indicate that propagation of small airborne particles by the shock fronts radiating from brass wind instruments is unlikely.

Conducting an evaluation of CBRN canister protection capabilities against emerging chemical and radiological hazards

In the event of a chemical, biological, radiological, or nuclear (CBRN) hazard release, emergency responders rely on respiratory protection to prevent inhalation of these hazards. The National Institute for Occupational Safety and Health's (NIOSH) CBRN Statement of Standard calls for CBRN respirator canisters to be challenged with 11 different chemical test representative agents (TRAs) during certification testing, which represent hazards from 7 distinct Chemical Families; these 11 TRAs were identified during the original 2001 CBRN hazard assessment. CBRN hazards are constantly evolving in type, intent of use, and ways of dissemination. Thus, new and emerging hazards must be identified to ensure CBRN canisters continue to provide protection to emergency responders against all hazards that would most likely be used in an intentional or unintentional event. The objectives are to: (1) update the CBRN list of hazards to ensure NIOSH-approved CBRN canisters continue to provide adequate protection capabilities from newly emerging chemical and radiological hazards and (2) identify the need to update NIOSH TRAs to ensure testing conditions represent relevant hazards. These objectives were accomplished by reviewing recent hazard assessments to identify a list of chemical and radiological respiratory hazards, evaluate chemical/physical properties and filtration behavior for these hazards, group the hazards based on NIOSH's current Chemical Families, and finally compare the hazards to the current TRAs based on anticipated filtration behavior, among other criteria. Upon completion of the evaluation process, 237 hazards were identified and compared to NIOSH's current CBRN TRAs. Of these 237 hazards, 203 were able to be categorized into one of NIOSH's current seven Chemical Families. Five were identified for further evaluation. Based on reviewing key chemical/physical properties of each hazard, NIOSH's current 11 TRAs remain representative of the identified respiratory CBRN hazards to emergency responders and should continue to be used during NIOSH certification testing. Thus, NIOSH's CBRN Statement of Standard remains unchanged. The process developed standardizes a methodology for future hazard evaluations.

Effect of speech volume on respiratory emission of oral bacteria as a potential indicator of pathogen transmissibility risk

Respiratory droplets emitted during speech can transmit oral bacteria and infectious viruses to others, including COVID-19. Loud speech can generate significantly higher numbers of potentially infectious respiratory droplets. This study assessed the effect of speech volume on respiratory emission of oral bacteria as an indicator of potential pathogen transmission risk. Loud speech (average 83 dBA, peak 94 dBA) caused significantly higher emission of oral bacteria (p = 0.004 compared to no speech) within 1 ft from the speaker. N99 respirators and simple cloth masks both significantly reduced emission of oral bacteria. This study demonstrates that loud speech without face coverings increases emission of respiratory droplets that carry oral bacteria and may also carry other pathogens such as COVID-19.

Identifying airborne transmission as the dominant route for the spread of COVID-19

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.

Identifying airborne transmission as the dominant route for the spread of COVID-19

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.

A technique to measure respirator protection factors against aerosol particles in simulated workplace settings using portable instruments

The aim of this study was to develop a new method to measure respirator protection factors for aerosol particles using portable instruments while workers conduct their normal work. The portable instruments, including a set of two handheld condensation particle counters (CPCs) and two portable aerosol mobility spectrometers (PAMSs), were evaluated with a set of two reference scanning mobility particle sizers (SMPSs). The portable instruments were mounted to a tactical load-bearing vest or backpack and worn by the test subject while conducting their simulated workplace activities. Simulated workplace protection factors (SWPFs) were measured using human subjects exposed to sodium chloride aerosols at three different steady state concentration levels: low (8x10³ particles/cm³), medium (5x10⁴ particles/cm³), and high (1x10⁵ particles/cm³). Eight subjects were required to pass a quantitative fit test before beginning a SWPF test for the respirators. Each SWPF test was performed using a protocol of five exercises for 3 min each: (1) normal breathing while standing; (2) bending at the waist; (3) a simulated laboratory-vessel cleaning motion; (4) slow walking in place; and (5) deep breathing. Two instrument sets (one portable instrument {CPC or PAMS} and one reference SMPS for each set) were used to simultaneously measure the aerosol concentrations outside and inside the respirator. The SWPF was calculated as a ratio of the outside and inside particles. Generally, the overall SWPFs measured with the handheld CPCs had a relatively good agreement with those measured with the reference SMPSs, followed by the PAMSs. Under simulated workplace activities, all handheld CPCs, PAMSs, and the reference SMPSs showed a similar GM SWPF trend, and their GM SWPFs decreased when simulated workplace movements increased. This study demonstrated that the new design of mounting two handheld CPCs in the tactical load-bearing vest or mounting one PAMS unit in the backpack permitted subjects to wear it while performing the simulated workplace activities. The CPC shows potential for measuring SWPFs based on its light weight and lack of major instrument malfunctions.

Secondhand Smoke Exposure in Public Places and Support for Smoke-Free Laws in Japan: Findings from the 2018 ITC Japan Survey

Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to implement this important health measure. This study examines baseline levels of smoking and SHS exposure in public places and support for smoking bans in Japan prior to the implementation of the 2018 national smoke-free law. Data are from the International Tobacco Control (ITC) Japan Wave 1 Survey (Feb-Mar 2018), a web survey of adult cigarette smokers, heated tobacco product users, dual users, and non-users (total N = 4684). Measures included prevalence of smoking (whether respondents noticed people smoking inside restaurants and bars at their last visit, and workplaces in the last month), and support for complete smoking bans in these venues. Smoking prevalence in each venue was high overall in 2018 (49% of workplaces, 55% of restaurants, and 83% of bars), even higher than in China, the country with the greatest toll of SHS. Support for complete smoking bans was very high overall (81% for workplaces, 78% for restaurants, and 65% for bars). Non-users were less likely to be exposed to SHS and had higher support for smoking bans than tobacco users. These findings point to the ineffectiveness of partial smoke-free laws in Japan and reinforce the call for comprehensive smoke-free laws, which even smokers would support at higher levels than in many other ITC countries.

Assessment of aloe vera for qualitative fit testing of particulate respirators: a logistic regression approach

Fit testing procedure is required for filtering facepiece respirators (FFRs) to ascertain an acceptable fit between the skin and facepiece sealing surface. The present study seeks to compare the efficacy of Aloe vera (A. vera) and commercial BitrexTM as challenge agents of qualitative fit testing of particulate respirators. An herbal solution consisting of A. vera at seven different concentrations was developed. Threshold Screening Tests (TSTs) of A. vera solutions were compared to BitrexTM. To do so, solutions were administered randomly on a total of 62 participants. A placebo was also tested to ensure the taste response being valid. Statistical analysis was performed using R 3.2.5.0 software. There were no statistically significant differences between the A. vera (41.7, 58.3, 75, and 91.7 mg/ml) and BitrexTM threshold tests. Therefore, the minimum concentration of A. vera to develop the threshold solution was considered to be 41.7 mg/ml. When commercial products are expensive and unavailable, a cost-effective technique would be to replace A. vera solution with a commercial product as a challenge agent of qualitative fit testing of respirators.

Masks for the Reduction of Methyl Methacrylate Vapor Inhalation

BACKGROUND

Exposure to methyl methacrylate vapor (MMA) presents an occupational risk to orthopedic surgeons and ancillary personnel in the operating room. The purpose of this study was to identify a disposable face mask to reduce MMA organic vapor inhalation in the operative suite.

METHODS

First, the effectiveness of MMA vapor filtration was determined in the laboratory. A section of activated carbon impregnated filter face mask (Model 8514, 3M Inc.) was exposed to 150 ppm MMA vapor and MMA ppm of filtered air was monitored until MMA vapor was detectable. The face mask was then worn as directed in the operating room during routine cement mixing during total knee arthroplasty to determine the exposure to MMA vapors during the procedure both with and without the activated carbon impregnated filter face mask.

RESULTS

The activated carbon impregnated face mask was effective in reducing MMA vapor inhalation to non-detectable levels for up to 40 minutes in the laboratory at steady-state exposure of 150 ppm MMA vapor as well as throughout cement mixing and curing in the operative suite during routine total knee arthroplasty.

CONCLUSIONS

An activated carbon impregnated face mask offers a solution for the orthopedic surgeon and supporting personnel who wish to limit their exposure to MMA vapors due to health concerns.Level of Evidence: III.

A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children

Children are more vulnerable to the risks of air pollution, including susceptibility to acquiring chronic diseases in their developing lungs. Despite these, there are no specific masks designed for and tested in children that are available to protect our young from the common particulate air pollutants today. We evaluated safety, fit and comfort of a specially designed paediatric N95 mask with an optional micro ventilator (micro fan, MF) in healthy children aged 7-14 years, in a randomized, two-period crossover design. The subjects' cardiorespiratory physiological measurements were assessed in different states of physical activity under different interventions (mask without and with MF). A total of 106 subjects were recruited between July-August 2016. The use of the mask without MF increased the End-Tidal CO2 (ETCO2) and Fractional concentration of Inspired CO2 (FICO2) at rest and on mild exertion, as expected. The use of the mask with MF brought FICO2 levels comparably closer to baseline levels without the mask for both activities. The mask, with or without the MF, was found to be well fitting, comfortable and safe for use in children at rest and on mild exertion. The N95 mask tested offers a promising start for more studies in the paediatric population.

Acute Blood Pressure and Cardiovascular Effects of Near-Roadway Exposures With and Without N95 Respirators

BACKGROUND

The risk for cardiovascular events increases within hours of near-roadway exposures. We aimed to determine the traffic-related air pollution (TRAP) and biological mechanisms involved and if reducing particulate matter <2.5 µm (PM2.5) inhalation is protective.

METHODS

Fifty healthy-adults underwent multiple 2-hour near-roadway exposures (Tuesdays to Fridays) in Ann Arbor during 2 separate weeks (randomized to wear an N95 respirator during 1 week). Monday both weeks, participants rested 2 hours in an exam room (once wearing an N95 respirator). Brachial blood pressure, aortic hemodynamics, and heart rate variability were repeatedly measured during exposures. Endothelial function (reactive hyperemia index [RHI]) was measured post-exposures (Thursdays). Black carbon (BC), total particle count (PC), PM2.5, noise and temperature were measured throughout exposures.

RESULTS

PM2.5 (9.3 ± 7.7 µg/m3), BC (1.3 ± 0.6 µg/m3), PC (8,375 ± 4,930 particles/cm3) and noise (69.2 ± 4.2 dB) were higher (P values <0.01) and aortic hemodynamic parameters trended worse while near-roadway (P values<0.15 vs. exam room). Other outcomes were unchanged. Aortic hemodynamics trended towards improvements with N95 respirator usage while near-roadway (P values<0.15 vs. no-use), whereas other outcomes remained unaffected. Higher near-roadway PC and BC exposures were associated with increases in aortic augmentation pressures (P values<0.05) and trends toward lower RHI (P values <0.2). N95 respirator usage did not mitigate these adverse responses (nonsignificant pollutant-respirator interactions). Near-roadway outdoor-temperature and noise were also associated with cardiovascular changes.

CONCLUSIONS

Exposure to real-world combustion-derived particulates in TRAP, even at relatively low concentrations, acutely worsened aortic hemodynamics. Our mixed findings regarding the health benefits of wearing N95 respirators support that further studies are needed to validate if they adequately protect against TRAP given their growing worldwide usage.

Cleaning workers' exposure to volatile organic compounds and particulate matter during floor polish removal and reapplication

The floor polish removal (FPR) and reapplication (FPA) are important cleaning tasks in public buildings that have hard floor surfaces. Usually, the FPR and FPA are conducted once or twice a year, during the periodic cleaning of these buildings. The FPR can be performed either chemically (CFPR) or by using dry scrubber (DFPR), when the polish is ground from the floor. In this study, cleaning workers' exposure to volatile organic compounds (VOCs) and particulate matter (PM) during the FPR and FPA, and the differences in the exposures between the two FPR methods were investigated. In total, three buildings located in Central Finland were included, and total of six cleaning workers (two per building) participated in the study. In Buildings 1 and 2, the CFPR and FPA were performed and in Building 3, the DFPR was conducted. TVOC (total volatile organic compounds) concentrations in the breathing zone of the workers during the CFPR were 8,740 and 390 µg/m³ (SD 3,290 and 180 µg/m³) for Buildings 1 and 2, respectively. During the DFPR in Building 3, the average TVOC concentration was 400 µg/m³ (SD 180 µg/m³, stationary sampling). The TVOC concentrations during the FPA were high, 1,640 and 2,170 µg/m³ on average (SD 1,570 and 930 µg/m³) for Buildings 1 and 2, respectively. Glycol ethers were the most prominent VOCs during the CFPR and FPA, whereas carboxylic acids were the most common during the DFPR. The inhalable dust concentrations in the workers' breathing zone were noticeably higher during the DFPR (1.55 mg/m³ on average, SD 0.01 mg/m³) than the CFPR (0.24 mg/m³ on average, SD 0.05 mg/m³). Finnish occupational exposure limit value for organic inhalable dust is 5 mg/m³. As the products used during the CFPR and FPA contain glycol ethers and ethanolamines that are absorbed via the skin as well, the use of skin protection is recommended. Whereas the use of FFP3 respirators and skin protection are recommended during the DFPR to prevent the PM exposure.

Turbulent Aggregation and Deposition Mechanism of Respirable Dust Pollutants under Wet Dedusting using a Two-Fluid Model with the Population Balance Method

In this paper, a mathematical model based on the two-fluid (Euler–Euler) frame model for wet dedusting process is proposed. The model considers in detail the aggregation of particles and droplets caused by turbulence and Brownian diffusion as well as the gravitational deposition process. The population balance model (PBM) is used to describe the spatiotemporal evolution of particle size distribution (PSD) for the dust particle and the water droplet. The wet dedusting process under different conditions is simulated and compared with the detailed experimental data. The results show that the experimental data and simulation results are within the allowable range of error (about 32.3–61.2% in dedusting efficiency for respirable dust by experimental data and about 47.3–57.9% in it by simulation results). This model can be used to predict the effect of PSD of the dust particle, spray flow, and ventilation rate on dedusting efficiency of wet dedusting. The parameter analysis shows that dedusting efficiency decreases as particle size decreases. In order to ensure high capture efficiency of respirable dust, the diameter of droplets should be controlled to between 15 μm and 70 μm. The ratio of droplet volume flow to dust volume flow increases from 2.0 to 12.0, while dedusting efficiency only increases from 39.2% to 54.7%, so it is clear that for spray quantity to dedusting efficiency, larger is not necessarily better. Besides this, the speeds of both spray droplets and ventilation also have great influence on dedusting efficiency, and the related formulas are given.

Evaluation of filtration characteristics and microbial recovery rates of commercial filtering facepiece respirators against airborne bacterial particles

Many brands of filtering facepiece respirators are used against air pollution, including bioaerosols; however, studies have explored exposure to bioaerosols from the inside surfaces of respirators. We evaluated the filtration efficiencies and microbial recovery rates of commercial filtering facepiece respirators against bioaerosols. Eight filtering facepiece respirators and one surgical mask were selected, all with high market shares in the Republic of Korea and certified by national or international standards. The tested filtering facepiece respirators were installed on the head of a mannequin under various airflow velocity and relative humidity (RH) conditions. The filtration efficiency against Staphylococcus epidermidis and Escherichia coli bioaerosols, the pressure drop of the filter, and the relative recovery rates for the bacteria were evaluated. The filtration efficiency of each filtering facepiece respirator ranged from 82% to 99%, depending on the filtration grade. The pressure drop was significantly affected by variations in the surrounding RH. The mean relative recovery rates of all filtering facepiece respirators were 14 ± 4.8% and 9 ± 4.7% for S. epidermidis and E. coli, respectively. These results indicate that airborne microorganisms can survive and accumulate on the surfaces of filtering facepiece respirators, which may lead to harmful health outcomes. Our findings will be useful as background information for the development of commercial filtering facepiece respirators while considering their biological properties and reliable guidance to users.

Motivational Interviewing: A High-Yield Interactive Session for Medical Trainees and Professionals to Help Tobacco Users Quit

Introduction

Motivational interviewing (MI) is a collaborative patient-focused counseling technique that is effective in promoting smoking cessation but is not consistently taught/practiced in training.

Methods

This training session was implemented in a pediatric residency training program and also given four times to pediatric practitioners as part of a 2-day tobacco training sponsored by the American Academy of Pediatrics (AAP). Pediatric residents (N = 33) participated in a 1-hour interactive session focused on addressing tobacco. Knowledge was assessed with pre- and 6-month postsurveys. Retention of skills was evaluated between 6 and 9 months posttraining by resident performance on two scenarios with standardized patients, which was scored utilizing the Behavior Change Counseling Index (BECCI), by two MI-trained physicians. AAP trainees (N = 115) participated in tobacco trainings with a session dedicated to MI; sessions were evaluated by pre- and posttests.

Results

Residents who completed the session (n = 12) performed significantly better on eight of 10 items of the BECCI and on the overall BECCI score (p < .001) compared with those who had not completed the session (n = 12). Feedback on AAP training sessions (N = 115) indicated that practitioners felt able to perform MI and incorporate MI into practice. The percentage of trainees who felt comfortable counseling about tobacco doubled from pre- to posttraining.

Discussion

A hands-on MI training session provided pediatric residents and practicing clinicians with knowledge and skills to address tobacco use with patients/families. The session is easily incorporated into different training environments.

A pilot study of minimum operational flow for loose-fitting powered air-purifying respirators used in healthcare cleaning services

The objective of this pilot study was to determine the minimum operational flow for loose-fitting powered air-purifying respirators (PAPR) used in healthcare cleaning services. An innovative respiratory flow recording device was worn by nine healthcare workers to obtain the minute volume (MV, L/min), mean inhalation flow (MIF, L/min), and peak inhalation flow (PIF, L/min) while performing "isolation unit work" (cleaning and disinfecting) of a patient room within 30 min. The MV and PIF were compared with the theoretical values obtained from an empirical formula. The correlations of MV, MIF, and PIF with subjects' age, weight, height, body surface area (A_Du), and body mass index (BMI) were analyzed. The average MV, MIF, and PIF were 33, 74, and 107 L/min, with maximal airflow rates of 41, 97, and 145 L/min, respectively, which are all below the current 170 L/min minimum operational flow for NIOSH certified loose-fitting PAPRs.

A Control Banding Framework for Protecting the US Workforce from Aerosol Transmissible Infectious Disease Outbreaks with High Public Health Consequences

Recent high-profile infectious disease outbreaks illustrate the importance of selecting appropriate control measures to protect a wider range of employees, other than those in healthcare settings. In such settings, where routine exposure risks are often high, control measures may be more available, routinely implemented, and studied for effectiveness. In the absence of evidence-based guidelines or established best practices for selecting appropriate control measures, employers may unduly rely on personal protective equipment (PPE) because of its wide availability and pervasiveness as a control measure, circumventing other effective options for protection. Control banding is one approach that may be used to assign job tasks into risk categories and prioritize the application of controls. This article proposes an initial control banding framework for workers at all levels of risk and incorporates a range of control options, including PPE. Using the National Institutes of Health (NIH) risk groups as a surrogate for toxicity and combining the exposure duration with the exposure likelihood, we can generate the risk of a job task to the worker.

Inactivation of airborne bacteria using different UV sources: Performance modeling, energy utilization, and endotoxin degradation

Airborne bacteria-containing bioaerosols have attracted increased research attention on account of their adverse effects on human health. Ultraviolet germicidal irradiation (UVGI) is an effective method to inactivate airborne microorganisms. The present study models and compares the inactivation performance of three UV sources in the UVGI for aerosolized Escherichia coli. Inactivation efficiency of 0.5, 2.2 and 3.1 logarithmic order was obtained at an exposure UV dose of 370 J/m³ under UVA (365 nm), UVC (254 nm) and UVD (185 nm) sources, respectively. A Beer-Lambert law-based model was developed and validated to compare the inactivation performances of the UV sources, and modeling enabled prediction of inactivation efficiency and analysis of the sensitivity of several parameters. Low influent E. coli concentrations and high UV doses resulted in high energy consumption (EC). The change in airborne endotoxin concentration during UV inactivation was analyzed, and UVC and UVA irradiation showed no marked effect on endotoxin degradation. By contrast, both free and bound endotoxins could be removed by UVD treatment, which is attributed to the ozone generated by the UVD source. The results of this study can provide a better understanding of the air disinfection and airborne endotoxin removal processes.

Pilot study on the efficiency of water-only decontamination for firefighters' turnout gear

Firefighters are exposed to toxic environments upon entering burning structures. Many structures contain synthetic materials which release toxic chemicals when on fire. These chemicals can enter the body through multiple routes of exposure, including inhalation and skin absorption. Thus, according to the fire departments included in this study, firefighters now conduct on-site decontamination procedures to remove hazardous chemicals, including polycyclic aromatic hydrocarbons (PAHs) from the surface of firefighter turnout gear. Several methods are being practiced at the local level, including decontamination with soap and water, and decontamination with water alone. The water-only decontamination method requires less time and supplies yet has not been investigated as a suitable method for removing polycyclic aromatic hydrocarbons from turnout gear. Therefore, we evaluated the efficiency of this method by measuring PAH concentration levels before and after water-only decontamination. The calculated efficiency displays the percentage of PAHs removed (or not removed) at post-decontamination in relation to the initial sample collected at pre-decontamination. The turnout gear was sampled after live residential structure fires. Firefighter turnout gear was worn throughout Attack, Overhaul Search and Rescue, and Rescue from Fire operations. All firefighters came to a central location for sampling after completing their job responsibilities. Water only decontamination did not appear to be effective, resulting in an overall 42% increase in PAH contamination. The unexpected increase may have been due to disparate pre- and post-decontamination sampling sites on turnout gear.

Exposure to airborne nano-titanium dioxide during airless spray painting and sanding

The objectives of the study were to measure and characterize exposure to airborne nanoscale titanium dioxide during airless spraying and sanding of a nano-enabled paint, and to evaluate the effectiveness of dust capture methods in reducing airborne nanoparticle concentrations. A tradesperson performed the work activities in an environmentally controlled chamber. Samples were collected in the tradesperson's breathing zone and in surrounding areas to assess bystander exposure. Filter-based samples were analyzed using gravimetric methods, scanning electron microscopy, and energy dispersive spectroscopy. Differential particle count data were obtained by means of a scanning mobility particle sizer. Local exhaust ventilation provided statistically significant reductions of airborne nanoparticle concentrations during sanding. Sanding the paint after drying with a handheld power sander generated relatively low levels of airborne titanium dioxide. In contrast, task-based exposure measurements collected during the initial airless spray application of the nano-enabled paint suggested a potential for occupational exposures to exceed the time-weighted average exposure limit for ultrafine titanium dioxide recommended by the National Institute for Occupational Safety and Health. Painters applying nano-enabled coatings may have little recourse but to rely, in some instances, on lower tiers of the hierarchy of controls, such as personal protective equipment. In light of these findings, employers and industrial hygienists should characterize exposures and implement the hierarchy of controls to ensure painters are sufficiently protected.

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

IMPORTANCE

Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear.

OBJECTIVES

To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018.

EXPOSURES

Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]).

MAIN OUTCOMES AND MEASURES

Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods.

RESULTS

Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia).

CONCLUSIONS AND RELEVANCE

In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.