Characterizing particle resuspension from mattresses: chamber study

Aerosolization of fungal spores in indoor environments

Fungi in indoor environments can cause adverse health effects through inhalation and epidermal exposure. The risk of fungal exposure originates from the aerosolization of fungal spores. However, spore aerosolization is still not well understood. This paper provides a review of indoor fungal contamination, especially the aerosolization of fungal spores. We attempted to summarize what is known today and to identify what more information is needed to predict the aerosolization of fungal spores. This paper first reviews fungal contamination in indoor environments and HVAC systems. The detachment of fungal spores from colonies and the spore aerosolization principle are then summarized. Based on the above discussion, prediction methods for spore aerosolization are discussed. This review further clarifies the current situation and future efforts required to accurately predict spore aerosolization. This information is useful for forecasting and controlling the aerosolization of fungal spores.

Phthalates in Chinese vehicular environments: Source emissions, concentrations, and human exposure

Phthalates are typical air pollutants in vehicular environment since numerous synthetic materials that might contain phthalates are widely used to fabricate vehicle interiors (e.g., seat cushions, floor mats and dashboards). Hitherto, the importance of phthalate pollution in vehicular environment is not well-recognized because people spend only a small portion (around 8%) of their time in vehicles. In this study, the mass fractions of six phthalates in nine materials commonly used in Chinese vehicles (floor mats and seat cushions) were measured. Two phthalates, di-n-butyl phthalate (DnBP) and di-2-ethylhexyl phthalate (DEHP), were identified in most materials (the other phthalates were not detected). The emission characteristics of DnBP and DEHP from these materials were further investigated. The measured emission parameters were used as input for a mass-transfer model to estimate DnBP and DEHP concentrations in cabin air. Finally, the ratios between human exposures (via inhalation and dermal absorption from the gas phase) in vehicular environment and the total exposures in typical indoor environments (e.g., residences and offices) were estimated to be up to 110% and 20% for DnBP and DEHP, respectively. Based on these results, the vehicular environment might be a considerable site for human exposure to airborne phthalates.

Indoor concentrations of particulate matter 2.5 in a pediatric emergency service

Objective:

To evaluate air quality in the waiting room of a pediatric emergency service considering the serial concentrations of particulate matter (PM_2.5), and to determine if the number of people present in the room can have an influence on the pollutant concentrations.

Methods:

Cross-sectional study, carried out in the waiting room of a reference pediatric hospital in the city of Porto Alegre, conducted in a one-year period, in a continuous-time sample including all of the four seasons of the year. The monitoring of PM_2.5 was performed using a real-time aerosol monitor (DustTrak II). The number of people in the room was determined every hour and the climatic characteristics per daily mean. The concentration of PM2.5 and the number of people were expressed by mean and standard deviation. The means were compared by Analysis of Variance and Pearson's correlation coefficient.

Results:

There was a significant increase in the concentration of PM_2.5 in the autumn, when compared to other seasons (p<0.001). The pollutant increase, in this season, was accompanied by the higher number of people in the emergency room (p=0.026). The association between PM_2.5 and the number of people is confirmed by the positive correlation between these two variables (r=0.738; p<0.001).

Conclusions:

The pediatric emergency waiting room showed elevated PM_2.5 in all seasons. The number of people in the room had a positive correlation with the concentration of the pollutant in the environment.

The investigation of the influence of thermal plume and breathing on sleeping microenvironment

Most of humans' lifetime was spent indoor, especially in bedroom. Thus, understanding the characteristics of the sleep microenvironment is a prerequisite for better control and improvement of our sleeping environment. This study investigated the temperature and velocity field above the heads of sleeping people with supine postures, and explored the interactions between the thermal plume and the breathing airflow, where both the thermal manikins and real human subjects were used in our experiment settings. Three different breathing modes were considered in this study, where the non-breathing mode was used to investigate the characteristics of the thermal plume, and the synergy of the mouth and nose breathing mode on the thermal plume was also investigated. The results showed that the thermal plume of a supine posture person was not strong compared to that of a standing or sitting person, and the breathing airflow could influence the development of the thermal plume. Over the head of a sleeping person, the velocity of the thermal plume could be increased by both of the breathing modes, but no significant difference in the velocity and temperature field was found for the two breathing modes. It was also found that pollutants near the bed surface could be brought to the breathing zone with low velocity airflow, but could be blocked by the nasal exhalation jet. The findings in this study could provide theoretical support and guidance to improve the air quality in the breathing zone.

Particle Resuspension Dynamics in the Infant Near-Floor Microenvironment

Carpet dust contains microbial and chemical material that can impact early childhood health. Infants may be exposed to greater quantities of resuspended dust, given their close proximity to floor surfaces. Chamber experiments with a robotic infant were integrated with a material balance model to provide new fundamental insights into the size-dependency of infant crawling-induced particle resuspension and exposure. The robotic infant was exposed to resuspended particle concentrations from 10⁵ to 10⁶ m^-3 in the near-floor (NF) microzone during crawling, with concentrations generally decreasing following vacuum cleaning of the carpets. A pronounced vertical variation in particle concentrations was observed between the NF microzone and bulk air. Resuspension fractions for crawling are similar to those for adult walking, with values ranging from 10^-6 to 10^-1 and increasing with particle size. Meaningful amounts of dust are resuspended during crawling, with emission rates of 0.1 to 2 × 10⁴ μg h^-1. Size-resolved inhalation intake fractions ranged from 5 to 8 × 10³ inhaled particles per million resuspended particles, demonstrating that a significant fraction of resuspended particles can be inhaled. A new exposure metric, the dust-to-breathing zone transport efficiency, was introduced to characterize the overall probability of a settled particle being resuspended and delivered to the respiratory airways. Values ranged from less than 0.1 to over 200 inhaled particles per million settled particles, increased with particle size, and varied by over 2 orders of magnitude among 12 carpet types.

Is using nanosilver mattresses/pillows safe? A review of potential health implications of silver nanoparticles on human health

Human exposure to engineered nanoparticles has become inevitable in today's extensive commercial use and large-scale production of engineered nanoparticles. Even though several studies have characterised the exposure to nanomaterials during wakeful state (related to occupational exposures and exposures from commercially available particles), very few studies on human exposure during sleep exist. As the study of exposure to all possible nanomaterials during sleep is extensive, this study focuses on exposure to specifically silver nanoparticles which are present in beddings and mattresses. The reasoning behind the use of silver nanoparticles in bedding and related materials, possible routes of entry to various population groups in several sleep positions, exposure characterisation and toxicity potential of such silver nanoparticles are reviewed in this study. The toxicity potential of silver nanoparticles in vivo tests with relation to mammals and in vitro tests on human cells has been tabulated to understand the risks associated during oral, dermal and inhalation exposure to silver nanoparticles. The exposure to humans with regard to dermal absorption and oral intake has been summarised. Although potential inhalation exposure to silver nanoparticles is increasing, only a few studies address the possible toxic effect of inhaled silver particles. Determination of exposure to silver nanoparticles in beddings is a topic that has been less researched, and this review aims to provide background information for future research and help establish a comprehensive risk assessment during sleep in the times of increasing usage of nanoparticles in our daily activities. Despite the current limitations of our understanding, risk assessments must utilise the available data and apply extrapolation procedures in the face of uncertainty, in order to address the needs of regulatory programs. This would enable safe use of the antimicrobial properties of silver nanoparticles without negatively impacting human health. Until then, it would be better to adopt a conservative approach on the usage of silver nanoparticles in daily used commercial items.

Storage mite concentrations are underestimated compared to house dust mite concentrations

Dwellings are increasingly well insulated to save energy and this leads to higher humidity and temperature, which improves conditions for mites. Dermatophagoides antigens are the main allergens involved and tested in atopic asthma. We developed three new species-specific quantitative PCR (qPCR) methods for house dust mites (Dermatophagoides pteronyssinus and D. farinae) and storages mites (Acarus siro, Glycyphagus domesticus, Lepidoglyphus destructor). We sampled dust with electrostatic dust collectors, in the bedrooms, under beds and in the kitchens of patients with allergies (n = 24) and healthy controls (n = 18). Mite quantification was carried out with the three new qPCRs and the qPCR previously described for the Dermatophagoides genus. The qPCRs were highly specific and efficient for house dust mite species and the storage mites. Storage mite concentrations were higher than house dust mite concentrations and were higher in dwellings of patients with allergies. Consequently, allergists should test more often patients against the storage mite antigens by prick tests or IgE serology. Dampness is a major factor in storage mite development and the presence of effective mechanical ventilation can reduce storage mite concentrations four-fold. In addition, to limit exposure to dust mites, treatments should be used throughout dwellings and not only in patients' bedrooms.

Jumping on the bed and associated increases of PM10, PM2.5, PM1, airborne endotoxin, bacteria, and fungi concentrations

Jumping on the bed is a favorite behavior of children; however, no study has investigated the increased air pollutants resulting from jumping on the bed. Therefore, we aimed to investigate the elevated concentrations of particulate matter (PM) and bioaerosols from jumping on the bed and making the bed. Simulation of jumping on the bed and making the bed was performed at sixty schoolchildren's houses in Taiwan. PM₁₀, PM_2.5, PM₁ (PM with aerodynamic diameter less than 10, 2.5, and 1 μm, respectively) and airborne bacteria, fungi and endotoxin concentrations were simultaneously measured over simulation and background periods. Our results show the increase of PM₁₀, PM_2.5, PM₁, airborne bacteria and fungi through the behavior of jumping on the bed (by 414 μg m-3, 353 μg m-3, 349 μg m-3, 6569 CFU m-3 and 978 CFU m-3, respectively). When making the bed, the PM₁₀, PM_2.5, PM₁, airborne bacteria and fungi also significantly increased by 4.69 μg m-3, 4.09 μg m-3, 4.15 μg m-3, 8569 CFU m-3, and 779 CFU m-3, respectively. Airborne endotoxin concentrations significantly increased by 21.76 EU m-3 following jumping on the bed and making the bed. Moreover, when jumping on the bed, higher PM_2.5 and PM₁ concentrations in houses with furry pets rather than no furry pets, and less airborne fungi in apartments than in townhouses were found. For making the bed, lower airborne fungi was found in houses using essential oils rather than no essential oils using. The airborne endotoxin concentrations were positively associated with furry pets and smokers in the homes and negatively correlated to the home with window opening with a statistical significance during the periods of jumping on the bed and making the bed. In conclusion, significant increases of PM and bioaerosols during jumping on the bed and making the bed may need to be concerned.

Bedroom Allergen Exposure Beyond House Dust Mites

PURPOSE OF REVIEW

The review provides insight into recent findings on bedroom allergen exposures, primarily focusing on pet, pest, and fungal exposures.

RECENT FINDINGS

Large-scale studies and improved exposure assessment technologies, including measurement of airborne allergens and of multiple allergens simultaneously, have extended our understanding of indoor allergen exposures and their impact on allergic disease. Practical, streamlined methods for exposure reduction have shown promise in some settings, and potential protective effects of early-life exposures have been further elucidated through the investigation of specific bacterial taxa. Advances in molecular allergology have yielded novel data on sensitization profiles and cross-reactivity. The role of indoor allergen exposures in allergic disease is complex and remains incompletely understood. Advancing our knowledge of various co-exposures, including the environmental and host microbiome, that interact with allergens in early life will be crucial for the development of efficacious interventions to reduce the substantial economic and social burden of allergic diseases including asthma.

Bedroom exposure to airborne allergens in the Chicago area using a patient-operated sampling device

BACKGROUND

In current practice, allergens in vacuum-collected dust are used as surrogates for inhalable allergens. We developed an air-sampling device that can be used by patients for direct measurement of airborne allergen concentrations in their own homes.

OBJECTIVE

To demonstrate the use of this device to establish allergen concentration reference ranges in a target population and to evaluate associations between patient-reported information and measured allergen concentrations.

METHODS

Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaires, informed consent forms, and samplers to run for 5 days in their bedrooms. Samples were collected from cartridges and assayed by multiplex immunoassays for 12 common household allergens and enzyme-linked immunosorbent assay for ragweed.

RESULTS

Unique allergen profiles were obtained for 102 patient homes. Samples with allergen concentrations above the limit of detection were as follows: total dust mite, 28%; cat, 61%; dog, 64%; mouse, 12%; rat, 0%; cockroach, 4%; Alternaria, 6%; Aspergillus, 21%; birch pollen 1%; grass, 8%; and ragweed, 5%. Of those, 75 completed questionnaires, providing meta-data for further analysis. Pet allergens correlated significantly with number of pets owned. Humidity correlated with dust mite allergens, open windows with Alternaria and mouse allergens, and high-efficiency particulate air filter use with reduced levels of several allergens. Many other variables showed no significant correlations.

CONCLUSION

The combination of ease of use, high air-sampling rate, and sensitive immunoassays permitted the measurement of airborne allergen concentrations in homes and establishment of reference ranges. Patient-reported information permitted identification of factors that could relate to allergen concentrations and suggested remedial measures.

Clothing as a transport vector for airborne particles: Chamber study

Strong evidence suggests that clothing serves as a reservoir of chemical pollutants and particles, including bioaerosols, which may have health significance. However, little is known about the role that clothing may play as a transport vector for inhaled airborne particles. Here, we contribute toward bridging the knowledge gap by conducting experiments to investigate clothing release fraction (CRF), determined as the size-dependent ratio of released to deposited particulate matter in the diameter range 0.5-10 μm. In a fully controlled chamber with low background particle levels, we deployed a programmable robot to reproducibly quantify the size-dependent CRF as a function of motion type and intensity, dust loadings, and activity duration. On average, 0.3%-3% of deposited particles were subsequently released with fabric motion, confirming that clothing can act as a vehicle for transporting airborne particles. The CRF increased with the vigor of movement and with dust loading. Rubbing and shaking the fabric were more effective than fabric stretching in resuspending particles. We also found that most of the release happened quickly after the onset of the resuspension activity. Particle size substantially influenced the CRF, with larger particles exhibiting higher values.

Window/door opening-mediated bedroom ventilation and its impact on sleep quality of healthy, young adults

This work examined window/door opening as means of bedroom ventilation and the consequent effect upon occupants' sleep, using data from 17 healthy volunteers. Bedroom CO₂ level, temperature, and relative humidity were measured over 5 days, for two cases: open window or door (internal, bedroom door), and closed window and door. Participant filled questionnaires and sleep diary provided subjective measure of sleep quality. Actigraphy objectively monitored the participants during sleep. Additionally, a FlexSensor, placed under pillows of participants, detected movement during sleep. Average CO₂ level for the Open conditions was 717 ppm (SD = 197 ppm) and for Closed conditions was 1150 ppm (SD = 463 ppm). Absolute humidity levels were similar for both conditions, while Open conditions were slightly cooler (mean = 19.7°C, SD = 1.8°C) than Closed (mean = 20.1°C, SD = 1.5°C). Results showed significant correlations (P < .001) between actigraphy data and questionnaire responses for: sleep latency (r = .45), sleep length (r = .87), and number of awakenings (r = .28). Of all analyzed sleep parameters, questionnaire-based depth of sleep (P = .002) and actigraphy-based sleep phase (P = .003) were significantly different between Open and Closed conditions.

Infant and Adult Inhalation Exposure to Resuspended Biological Particulate Matter

Human-induced resuspension of floor dust is a dynamic process that can serve as a major indoor source of biological particulate matter (bioPM). Inhalation exposure to the microbial and allergenic content of indoor dust is associated with adverse and protective health effects. This study evaluates infant and adult inhalation exposures and respiratory tract deposited dose rates of resuspended bioPM from carpets. Chamber experiments were conducted with a robotic crawling infant and an adult performing a walking sequence. Breathing zone (BZ) size distributions of resuspended fluorescent biological aerosol particles (FBAPs), a bioPM proxy, were monitored in real-time. FBAP exposures were highly transient during periods of locomotion. Both crawling and walking delivered a significant number of resuspended FBAPs to the BZ, with concentrations ranging from 0.5 to 2 cm^-3 (mass range: ∼50 to 600 μg/m³). Infants and adults are primarily exposed to a unimodal FBAP size distribution between 2 and 6 μm, with infants receiving greater exposures to super-10 μm FBAPs. In just 1 min of crawling or walking, 10³-10⁴ resuspended FBAPs can deposit in the respiratory tract, with an infant receiving much of their respiratory tract deposited dose in their lower airways. Per kg body mass, an infant will receive a nearly four times greater respiratory tract deposited dose of resuspended FBAPs compared to an adult.

Bedroom allergen exposures in US households

BACKGROUND

Bedroom allergen exposures contribute to allergic disease morbidity because people spend considerable time in bedrooms, where they come into close contact with allergen reservoirs.

OBJECTIVE

We investigated participant and housing characteristics, including sociodemographic, regional, and climatic factors, associated with bedroom allergen exposures in a nationally representative sample of the US population.

METHODS

Data were obtained from National Health and Nutrition Examination Survey 2005-2006. Information on participant and housing characteristics was collected by using questionnaires and environmental assessments. Concentrations of 8 indoor allergens (Alt a 1, Bla g 1, Can f 1, Fel d 1, Der f 1, Der p 1, Mus m 1, and Rat n 1) in dust vacuumed from nearly 7000 bedrooms were measured by using immunoassays. Exposure levels were classified as increased based on percentile (75th/90th) cutoffs. We estimated the burden of exposure to multiple allergens and used multivariable logistic regression to identify independent predictors for each allergen and household allergen burden.

RESULTS

Almost all participants (>99%) had at least 1 and 74.2% had 3 to 6 allergens detected. More than two thirds of participants (72.9%) had at least 1 allergen and 18.2% had 3 or more allergens exceeding increased levels. Although exposure variability showed significant racial/ethnic and regional differences, high exposure burden to multiple allergens was most consistently associated with the presence of pets and pests, living in mobile homes/trailers and older and rental homes, and living in nonmetropolitan areas.

CONCLUSIONS

Exposure to multiple allergens is common. Despite highly variable exposures, bedroom allergen burden is strongly associated with the presence of pets and pests.

A comparison between tracer gas and aerosol particles distribution indoors: The impact of ventilation rate, interaction of airflows, and presence of objects

The study investigated the separate and combined effects of ventilation rate, free convection flow produced by a thermal manikin, and the presence of objects on the distribution of tracer gas and particles in indoor air. The concentration of aerosol particles and tracer gas was measured in a test room with mixing ventilation. Three layouts were arranged: an empty room, an office room with an occupant sitting in front of a table, and a single-bed hospital room. The room occupant was simulated by a thermal manikin. Monodisperse particles of three sizes (0.07, 0.7, and 3.5 μm) and nitrous oxide tracer gas were generated simultaneously at the same location in the room. The particles and gas concentrations were measured in the bulk room air, in the breathing zone of the manikin, and in the exhaust air. Within the breathing zone of the sitting occupant, the tracer gas emerged as reliable predictor for the exposure to all different-sized test particles. A change in the ventilation rate did not affect the difference in concentration distribution between tracer gas and larger particle sizes. Increasing the room surface area did not influence the similarity in the dispersion of the aerosol particles and the tracer gas.

A Comparison between Temperature-Controlled Laminar Airflow Device and a Room Air-Cleaner in Reducing Exposure to Particles While Asleep

People spend approximately one third of their life sleeping. Exposure to pollutants in the sleep environment often leads to a variety of adverse health effects, such as development and exacerbation of asthma. Avoiding exposure to these pollutants by providing a sufficient air quality in the sleep environment might be a feasible method to alleviate these health symptoms. We performed full-scale laboratory measurements using a thermal manikin positioned on an experimental bed. Three ventilation settings were tested: with no filtration system operated, use of portable air cleaner and use of a temperature-controlled laminar airflow (TLA) device. The first part of the experiment investigated the air-flow characteristics in the breathing zone. In the second part, particle removal efficiency was estimated. Measured in the breathing zone, the room air cleaner demonstrated high turbulence intensity, high velocity and turbulence diffusivity level, with a particle reduction rate of 52% compared to baseline after 30 minutes. The TLA device delivered a laminar airflow to the breathing zone with a reduction rate of 99.5%. During a periodical duvet lifting mimicking a subject's movement in bed, the particle concentration was significantly lower with the TLA device compared to the room air cleaner. The TLA device provided a barrier which significantly reduced the introduction of airborne particles into the breathing zone. Further studies should be conducted for the understanding of the transport of resuspended particles between the duvet and the laying body.

Sources of airborne microorganisms in the built environment

Each day people are exposed to millions of bioaerosols, including whole microorganisms, which can have both beneficial and detrimental effects. The next chapter in understanding the airborne microbiome of the built environment is characterizing the various sources of airborne microorganisms and the relative contribution of each. We have identified the following eight major categories of sources of airborne bacteria, viruses, and fungi in the built environment: humans; pets; plants; plumbing systems; heating, ventilation, and air-conditioning systems; mold; dust resuspension; and the outdoor environment. Certain species are associated with certain sources, but the full potential of source characterization and source apportionment has not yet been realized. Ideally, future studies will quantify detailed emission rates of microorganisms from each source and will identify the relative contribution of each source to the indoor air microbiome. This information could then be used to probe fundamental relationships between specific sources and human health, to design interventions to improve building health and human health, or even to provide evidence for forensic investigations.

Asthma and Wheeze Prevalence among Nursing Professionals in Western Japan: A Cross-Sectional Study

Although adult asthma is attributable to occupational factors, few reports are available on asthma prevalence among health care workers in Japan. The objective of this study was to estimate the prevalence of asthma and wheeze among Japanese nursing professionals. A cross-sectional study was conducted by postal survey using a translated version of the European Community Respiratory Health Survey questionnaire from April to June 2013. The analysis included 4634 nursing professionals (257 men and 4377 women) and the overall response rate was 84.8%. The prevalence of current asthma and wheeze were 10.7% (95% confidence interval (CI), 9.9%-11.7%) and 15.6% (95% CI, 14.5%-16.6%), respectively. More than one year of work experience as a nursing professional and more than one year of experience with bed-making tasks were associated with odds ratios (ORs) of 1.95 (95% CI, 1.12-3.39) and 1.64 (95% CI, 1.15-2.23) for wheeze, respectively. Current smoking was significantly associated with the presence of wheeze, with ORs of 2.27 for men (95% CI, 1.11-4.64) and 2.01 for women (95% CI, 1.54-2.64). Among female nurses, latex allergy was associated with wheeze (OR, 1.87; 95% CI, 1.56-2.23), as was body mass index ≥30 (OR, 2.76; 95% CI, 1.65-4.62). This study has provided the prevalence of asthma and wheeze among Japanese nursing professionals. Employment period, bed-making tasks, latex allergy, obesity, and smoking may be risk factors for prevalent wheeze among nursing professionals.

Testing the near field/far field model performance for prediction of particulate matter emissions in a paint factory

A Near Field/Far Field (NF/FF) model is a well-accepted tool for precautionary exposure assessment but its capability to estimate particulate matter (PM) concentrations is not well studied. The main concern is related to emission source characterization which is not as well defined for PM emitters compared to e.g. for solvents. One way to characterize PM emission source strength is by using the material dustiness index which is scaled to correspond to industrial use by using modifying factors, such as handling energy factors. In this study we investigate how well the NF/FF model predicts PM concentration levels in a paint factory. PM concentration levels were measured during big bag and small bag powder pouring. Rotating drum dustiness indices were determined for the specific powders used and applied in the NF/FF model to predict mass concentrations. Modeled process specific concentration levels were adjusted to be similar to the measured concentration levels by adjusting the handling energy factor. The handling energy factors were found to vary considerably depending on the material and process even-though they have the same values as modifying factors in the exposure models. This suggests that the PM source characteristics and process-specific handling energies should be studied in more detail to improve the model-based exposure assessment.

Emission of phthalates and phthalate alternatives from vinyl flooring and crib mattress covers: the influence of temperature

Emissions of phthalates and phthalate alternatives from vinyl flooring and crib mattress covers were measured in a specially designed chamber. The gas-phase concentrations versus time were measured at four different temperatures, that is, 25, 36, 45, and 55 °C. The key parameter that controls the emissions (y0, gas-phase concentration in equilibrium with the material phase) was determined, and the emissions were found to increase significantly with increasing temperature. Both the material-phase concentration (C0) and the chemical vapor pressure (Vp) were found to have great influence on the value of y0. The measured ratios of C0 to y0 were exponentially proportional to the reciprocal of temperature, in agreement with the van't Hoff equation. A emission model was validated at different temperatures, with excellent agreement between model calculations and chamber observations. In residential homes, an increase in the temperature from 25 to 35 °C can elevate the gas-phase concentration of phthalates by more than a factor of 10, but the total airborne concentration may not increase that much for less volatile compounds. In infant sleep microenvironments, an increase in the temperature of mattress can cause a significant increase in emission of phthalates from the mattress cover and make the concentration in the infant's breathing zone about four times higher than that in the bulk room air, resulting in potentially high exposure.