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Daube C, Herndon SC, Krechmer JE, Johnson D, Clark N, Footer TL, Thoma ED. Quantification of natural gas and other hydrocarbons from production sites in northern West Virginia using tracer flux ratio methodology. Atmos Environ X 2023; 19:1-8. [PMID: 37538994 PMCID: PMC10394683 DOI: 10.1016/j.aeaoa.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Tracer flux ratio (TFR) methodology performed downwind of 15 active oil and natural gas production sites in Ohio County, West Virginia sought to quantify air pollutant emissions over two weeks in April 2018. In coordination with a production company, sites were randomly selected depending on wind forecasts and nearby road access. Methane (CH4), ethane (C2H6), and tracer gas compounds (acetylene and nitrous oxide) were measured via tunable infrared direct absorption spectroscopy. Ion signals attributed to benzene (C6H6) and other volatile gases (e.g., C7 - C9 aromatics) were measured via proton-transfer reaction time-of-flight mass spectrometry. Short-term whole facility emission rates for 12 sites are reported. Results from TFR were systematically higher than the sum of concurrent on-site full flow sampler measurements, though not all sources were assessed on-site in most cases. In downwind plumes, the mode of the C2H6:CH4 molar ratio distribution for all sites was 0.2, which agreed with spot sample analysis from the site operator. Distribution of C6H6:CH4 ratios was skew but values between 1 and 5 pptv ppbv-1 were common. Additionally, the aromatic profile has been attributed to condensate storage tank emissions. Average ratios of C7 - C9 to C6H6 were similar to other literature values reported for natural gas wells.
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Affiliation(s)
- Conner Daube
- Aerodyne Research, Inc., 45 Manning Road, Billerica, MA 01821, United States
| | - Scott C. Herndon
- Aerodyne Research, Inc., 45 Manning Road, Billerica, MA 01821, United States
| | - Jordan E. Krechmer
- Aerodyne Research, Inc., 45 Manning Road, Billerica, MA 01821, United States
| | - Derek Johnson
- West Virginia University, Mechanical & Aerospace Engineering, PO Box 6106, Morgantown, WV 26506, United States
| | - Nigel Clark
- West Virginia University, Mechanical & Aerospace Engineering, PO Box 6106, Morgantown, WV 26506, United States
| | - Tracey L. Footer
- Eastern Research Group, Inc., 601 Keystone Park Drive, Suite 700, Morrisville, NC 27560, United States
| | - Eben D. Thoma
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711, United States
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2
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Duff D, Lennard C, Li Y, Doyle C, Edge KJ, Holland I, Lothridge K, Johnstone P, Beylerian P, Spikmans V. Portable gas chromatography-mass spectrometry method for the in-field screening of organic pollutants in soil and water at pollution incidents. Environ Sci Pollut Res Int 2023; 30:93088-93102. [PMID: 37501027 PMCID: PMC10447289 DOI: 10.1007/s11356-023-28648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Environmental pollution incidents generate an emergency response from regulatory agencies to ensure that the impact on the environment is minimised. Knowing what pollutants are present provides important intelligence to assist in determining how to respond to the incident. However, responders are limited in their in-field capabilities to identify the pollutants present. This research has developed an in-field, qualitative analytical approach to detect and identify organic pollutants that are commonly detected by regulatory environmental laboratories. A rapid, in-field extraction method was used for water and soil matrices. A coiled microextraction (CME) device was utilised for the introduction of the extracted samples into a portable gas chromatography-mass spectrometry (GC-MS) for analysis. The total combined extraction and analysis time was approximately 6.5 min per sample. Results demonstrated that the in-field extraction and analysis methods can screen for fifty-nine target organic contaminants, including polyaromatic hydrocarbons, monoaromatic hydrocarbons, phenols, phthalates, organophosphorus pesticides, and organochlorine pesticides. The method was also capable of tentatively identifying unknown compounds using library searches, significantly expanding the scope of the methods for the provision of intelligence at pollution incidents of an unknown nature, although a laboratory-based method was able to provide more information due to the higher sensitivity achievable. The methods were evaluated using authentic casework samples and were found to be fit-for-purpose for providing rapid in-field intelligence at pollution incidents. The fact that the in-field methods target the same compounds as the laboratory-based methods provides the added benefit that the in-field results can assist in sample triaging upon submission to the laboratory for quantitation and confirmatory analysis.
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Affiliation(s)
- Denise Duff
- School of Science, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Chris Lennard
- School of Science, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Yarong Li
- Department of Planning and Environment, Environment Protection Science Branch, Building 1, 480 Weeroona Road, Lidcombe, NSW, 2141, Australia
| | - Christopher Doyle
- Department of Planning and Environment, Environment Protection Science Branch, Building 1, 480 Weeroona Road, Lidcombe, NSW, 2141, Australia
| | - Katelyn J Edge
- New South Wales Environment Protection Authority, Incident Management and Environmental Health Branch, Locked Bag 5022, Parramatta, NSW, 2124, Australia
| | - Ian Holland
- New South Wales Environment Protection Authority, Incident Management and Environmental Health Branch, Locked Bag 5022, Parramatta, NSW, 2124, Australia
| | - Kevin Lothridge
- Global Forensic and Justice Center @ Florida International University, 8285 Bryan Dairy Road. Suite 125, Largo, FL, 33777, USA
| | - Paul Johnstone
- Operations Capability Directorate, Fire & Rescue NSW, 1 Amarina avenue, Greenacre, NSW, 2190, Australia
| | - Paul Beylerian
- Operations Capability Directorate, Fire & Rescue NSW, 1 Amarina avenue, Greenacre, NSW, 2190, Australia
| | - Val Spikmans
- School of Science, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Kim NG, Jeong SB, Jin HC, Lee J, Kim KH, Kim S, Park Y, Choi W, Kwak KH, Lee H, Kang G, Kim C, Woo SH, Lee S, Kim W, Ahn K, Lee KY, Lee SB. Spatial and PMF analysis of particle size distributions simultaneously measured at four locations at the roadside of highways. Sci Total Environ 2023:164892. [PMID: 37327901 DOI: 10.1016/j.scitotenv.2023.164892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023]
Abstract
In urban areas, particulate matter emitted from vehicles directly affects the health of citizens near roads. Thus, in this study, particle size distribution was measured by the horizontal and vertical distances along a highway road with heavy traffic to characterize the dispersion phenomena of particulate matter emitted from vehicles. In addition, the contribution of pollution sources was analyzed using a source-receptor model. A concentration gradient was observed in which the concentration decreased with the increase in the distance from the road when the wind blew from the road to the monitoring locations. The concentration was slightly higher within 50 m of the road when the wind blows parallel to the road, and similar concentrations were found at the other monitoring locations further away from the roads. In particular, the higher the turbulence intensity of the wind, the lower is the concentration gradient coefficient because of the more enhanced mixing and dispersion. A positive matrix factorization (PMF) model with the measured particle size distribution data in the range of 9-300 nm resulted in a contribution of about 70 % (number) and 20 % (mass) to particle concentrations because of six types of vehicles including LPG, two gasoline vehicles (GDI, MPI), and three diesel vehicles with 3rd, 4th, and 5th emission classes. It showed a decrease in the vehicular contribution as the distance from the road increased. Particle number concentrations decreased with increasing altitude up to 30 m above the ground. The results of this study can be useful in deriving generalized gradient equations of particle concentrations exposed by distance and wind direction at the roadside using traffic and meteorological conditions and for establishing environmental policies, such as roadside exposure assessment, in the future. A CAPSULE ABSTRACT: Dispersion of particles emitted from vehicles on a busy highway was characterized by roadside measurements of horizontal and vertical profiles of particle size distributions measured at four locations. The source profiles and contributions were estimated by major sources using a source-receptor model such as PMF.
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Affiliation(s)
- Nam Geon Kim
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea; Graduate School of Energy and Environment (KU-KIST GREEN SCHOOL), Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sang Bin Jeong
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Hyoun Cher Jin
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Jiwon Lee
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Kyung-Hwan Kim
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - San Kim
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea; Graduate School of Energy and Environment (KU-KIST GREEN SCHOOL), Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yongmi Park
- Division of Earth Environmental System Sciences, Pukyong National University, Busan 48547, Republic of Korea
| | - Wonsik Choi
- Division of Earth Environmental System Sciences, Pukyong National University, Busan 48547, Republic of Korea
| | - Kyung-Hwan Kwak
- School of Natural Resources and Environmental Science, Kangwon National University, Kangwondaehak-gil 1, Chuncheon-si, Gangwon-do 24341, Republic of Korea
| | - Hyunho Lee
- Department of Atmospheric Science, Kongju National University, Gongjudaehak-ro 56, Gongju-si, Chungcheongnam-do 32588, Republic of Korea
| | - Giwon Kang
- School of Civil and Environmental Engineering, Pusan National University, Busan 46241, Republic of Korea
| | - Changhyuk Kim
- School of Civil and Environmental Engineering, Pusan National University, Busan 46241, Republic of Korea
| | - Sang-Hee Woo
- Environment System Research Division, Korea Institute of Machinery and Materials, 156, Gajeongbuk-ro, Yuseong-gu, Daejeon 34103, Republic of Korea
| | - Seokhwan Lee
- Environment System Research Division, Korea Institute of Machinery and Materials, 156, Gajeongbuk-ro, Yuseong-gu, Daejeon 34103, Republic of Korea
| | - Wooyung Kim
- Department of Mechanical Engineering, Hanyang University, Hanyangdeahak-ro 55, Sangnok-gu, Ansan, Gyeonggi-do 15588, Republic of Korea
| | - Kangho Ahn
- Department of Mechanical Engineering, Hanyang University, Hanyangdeahak-ro 55, Sangnok-gu, Ansan, Gyeonggi-do 15588, Republic of Korea
| | - Kwan-Young Lee
- Graduate School of Energy and Environment (KU-KIST GREEN SCHOOL), Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea; Department of Chemical and Biological Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Seung-Bok Lee
- Center for Sustainable Environment Research, Korea Institute of Science and Technology, Hwarangro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea; Graduate School of Energy and Environment (KU-KIST GREEN SCHOOL), Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
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Lepistö T, Barreira LMF, Helin A, Niemi JV, Kuittinen N, Lintusaari H, Silvonen V, Markkula L, Manninen HE, Timonen H, Jalava P, Saarikoski S, Rönkkö T. Snapshots of wintertime urban aerosol characteristics: Local sources emphasized in ultrafine particle number and lung deposited surface area. Environ Res 2023; 231:116068. [PMID: 37149021 DOI: 10.1016/j.envres.2023.116068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 05/08/2023]
Abstract
Urban air fine particles are a major health-relating problem. However, it is not well understood how the health-relevant features of fine particles should be monitored. Limitations of PM2.5 (mass concentration of sub 2.5 μm particles), which is commonly used in the health effect estimations, have been recognized and, e.g., World Health Organization (WHO) has released good practice statements for particle number (PN) and black carbon (BC) concentrations (2021). In this study, a characterization of urban wintertime aerosol was done in three environments: a detached housing area with residential wood combustion, traffic-influenced streets in a city centre and near an airport. The particle characteristics varied significantly between the locations, resulting different average particle sizes causing lung deposited surface area (LDSA). Near the airport, departing planes had a major contribution on PN, and most particles were smaller than 10 nm, similarly as in the city centre. The high hourly mean PN (>20 000 1/cm3) stated in the WHO's good practices was clearly exceeded near the airport and in the city centre, even though traffic rates were reduced due to a SARS-CoV-2-related partial lockdown. In the residential area, wood combustion increased both BC and PM2.5, but also PN of sub 10 and 23 nm particles. The high concentrations of sub 10 nm particles in all the locations show the importance of the chosen lower size limit of PN measurement, e.g., WHO states that the lower limit should be 10 nm or smaller. Furthermore, due to ultrafine particle emissions, LDSA per unit PM2.5 was 1.4 and 2.4 times higher near the airport than in the city centre and the residential area, respectively, indicating that health effects of PM2.5 depend on urban environment as well as conditions, and emphasizing the importance of PN monitoring in terms of health effects related to local pollution sources.
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Affiliation(s)
- Teemu Lepistö
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland.
| | - Luis M F Barreira
- Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, 00101, Finland
| | - Aku Helin
- Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, 00101, Finland
| | - Jarkko V Niemi
- Helsinki Region Environmental Services Authority HSY, Helsinki, 00066, Finland
| | - Niina Kuittinen
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland
| | - Henna Lintusaari
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland
| | - Ville Silvonen
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland
| | - Lassi Markkula
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland
| | - Hanna E Manninen
- Helsinki Region Environmental Services Authority HSY, Helsinki, 00066, Finland
| | - Hilkka Timonen
- Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, 00101, Finland
| | - Pasi Jalava
- Inhalation Toxicology Laboratory, Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - Sanna Saarikoski
- Atmospheric Composition Research, Finnish Meteorological Institute, Helsinki, 00101, Finland
| | - Topi Rönkkö
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Tampere, 33014, Finland
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Järvi L, Kurppa M, Kuuluvainen H, Rönkkö T, Karttunen S, Balling A, Timonen H, Niemi JV, Pirjola L. Determinants of spatial variability of air pollutant concentrations in a street canyon network measured using a mobile laboratory and a drone. Sci Total Environ 2023; 856:158974. [PMID: 36174693 DOI: 10.1016/j.scitotenv.2022.158974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Urban air pollutant concentrations are highly variable both in space and time. In order to understand these variabilities high-resolution measurements of air pollutants are needed. Here we present results of a mobile laboratory and a drone measurements made within a street-canyon network in Helsinki, Finland, in summer and winter 2017. The mobile laboratory measured the total number concentration (N) and lung-deposited surface area (LDSA) of aerosol particles, and the concentrations of black carbon, nitric oxide (NOx) and ozone (O3). The drone measured the vertical profile of LDSA. The main aims were to examine the spatial variability of air pollutants in a wide street canyon and its immediate surroundings, and find the controlling environmental variables for the observed variability's. The highest concentrations with the most temporal variability were measured at the main street canyon when the mobile laboratory was moving with the traffic fleet for all air pollutants except O3. The street canyon concentration levels were more affected by traffic rates whereas on surrounding areas, meteorological conditions dominated. Both the mean flow and turbulence were important, the latter particularly for smaller aerosol particles through LDSA and N. The formation of concentration hotspots in the street network were mostly controlled by mechanical processes but in winter thermal processes became also important for aerosol particles. LDSA showed large variability in the profile shape, and surface and background concentrations. The expected exponential decay functions worked better in well-mixed conditions in summer compared to winter. We derived equation for the vertical decay which was mostly controlled by the air temperature. Mean wind dominated the profile shape over both thermal and mechanical turbulence. This study is among the first experimental studies to demonstrate the importance of high-resolution measurements in understanding urban pollutant variability in detail.
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Affiliation(s)
- Leena Järvi
- Institute for Atmospheric and Earth System Research/Physics, Faculty of Science, University of Helsinki, P.O. Box 64, Helsinki 00014, Finland; Helsinki Institute of Sustainability Science, University of Helsinki, P.O. Box 4, Helsinki 00014, Finland.
| | - Mona Kurppa
- Kjeller Vindteknikk, Tekniikantie 14, Espoo 02150, Finland
| | - Heino Kuuluvainen
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, P.O. Box 692, Tampere 33014, Finland
| | - Topi Rönkkö
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, P.O. Box 692, Tampere 33014, Finland
| | - Sasu Karttunen
- Institute for Atmospheric and Earth System Research/Physics, Faculty of Science, University of Helsinki, P.O. Box 64, Helsinki 00014, Finland
| | - Anna Balling
- Institute for Atmospheric and Earth System Research/Physics, Faculty of Science, University of Helsinki, P.O. Box 64, Helsinki 00014, Finland
| | - Hilkka Timonen
- Atmospheric Composition Research, Finnish Meteorological Institute, P.O. Box 503, Helsinki 00101, Finland
| | - Jarkko V Niemi
- Helsinki Region Environmental Services Authority, Ilmalantori 1, Helsinki 00240, Finland
| | - Liisa Pirjola
- Institute for Atmospheric and Earth System Research/Physics, Faculty of Science, University of Helsinki, P.O. Box 64, Helsinki 00014, Finland; Department of Automotive and Mechanical Engineering, Metropolia Applied University, P.O. Box 4071, Vantaa 01600, Finland
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Bacchus P, Nissen K, Berg J, Bråve A, Gyll J, Larsson C, Muradrasoli S, Tellström A, Salaneck E. Civil-Military Collaboration to Facilitate Rapid Deployment of a Mobile Laboratory in Early Response to COVID-19: A High-Readiness Exercise. Health Secur 2021; 19:488-497. [PMID: 34542343 DOI: 10.1089/hs.2021.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rapid and adaptable diagnostic capabilities are of great importance in the face of emerging infectious diseases. In an outbreak, timely establishment of diagnostic routines is crucial to identifying cases and preventing the spread of the disease, especially when faced with high-consequence pathogens. In this article, we describe a multiagency exercise including the rapid deployment and diagnostic adaptation of the Swedish Armed Forces mobile laboratory (biological field analysis laboratory) in the context of COVID-19. This deployment was initiated as a high-readiness exercise at the end of January 2020, when the global development of the outbreak was still uncertain. Through collaboration with the Public Health Agency of Sweden and a civilian hospital, a real-time reverse transcriptase polymerase chain reaction method specific to SARS-CoV-2 was made available and adapted to the mobile laboratory, and the team established and evaluated a functional and efficient diagnostic asset along with a logistical support chain. We also organized and evaluated mobile testing teams, and the method was later used in large-scale, national, cross-sectional COVID-19 surveys in several regions of Sweden. In this article, we focus on the challenges of overbridging the civil-military interface in this context and identifying lessons learned and added values to the response during the early pandemic. We propose that the experiences from this exercise and governmental agency collaboration are valuable in preparation for future outbreaks.
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Affiliation(s)
- Philip Bacchus
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Karolina Nissen
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Johanna Berg
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Andreas Bråve
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Jenny Gyll
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Christer Larsson
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Shaman Muradrasoli
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Andreas Tellström
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
| | - Erik Salaneck
- Philip Bacchus, MSci, is a Commander, Swedish Navy; Johanna Berg is a Specialist, Infectious Diseases; Jenny Gyll, MSci, is a Biology Expert; and Christer Larsson, PhD, and Andreas Tellström, MSci, are Laboratory Engineers; all at the Swedish Armed Forces National CBRN Defence Centre, Umeå, Sweden. Karolina Nissen, MD, is a Specialist, Infectious Diseases, and Erik Salaneck, MD, PhD, is an Associate Professor; both in the Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Andreas Bråve, PhD, is Deputy Head of Department and Shaman Muradrasoli, PhD, is Head of Unit; both at the Public Health Agency of Sweden, Solna, Sweden. Erik Salaneck is also Associate Professor, Swedish Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
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Affara M, Lagu HI, Achol E, Karamagi R, Omari N, Ochido G, Kezakarayagwa E, Kabatesi F, Nkeshimana A, Roba A, Ndia MN, Abudo MU, Kabanda A, Mpabuka E, Mwikarago EI, Kutjok PE, Samson DD, Deng LL, Moremi N, Kelly ME, Mkama PBM, Magesa A, Balinandi SK, Pimundu G, Nabadda SN, Puradiredja DI, Hinzmann J, Duraffour S, Gabriel M, Ruge G, Loag W, Ayiko R, Sonoiya SS, May J, Katende MJ, Gehre F. The East African Community (EAC) mobile laboratory networks in Kenya, Burundi, Tanzania, Rwanda, Uganda, and South Sudan-from project implementation to outbreak response against Dengue, Ebola, COVID-19, and epidemic-prone diseases. BMC Med 2021; 19:160. [PMID: 34238298 PMCID: PMC8266482 DOI: 10.1186/s12916-021-02028-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers and various bacterial diseases. A major challenge is that epidemics mostly happen in remote areas, where infrastructure for Biosecurity Level (BSL) 3/4 laboratory capacity is not available. As samples have to be transported from the outbreak area to the National Public Health Laboratories (NPHL) in the capitals or even flown to international reference centres, diagnosis is significantly delayed and epidemics emerge. MAIN TEXT The East African Community (EAC), an intergovernmental body of Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan, received 10 million € funding from the German Development Bank (KfW) to establish BSL3/4 capacity in the region. Between 2017 and 2020, the EAC in collaboration with the Bernhard-Nocht-Institute for Tropical Medicine (Germany) and the Partner Countries' Ministries of Health and their respective NPHLs, established a regional network of nine mobile BSL3/4 laboratories. These rapidly deployable laboratories allowed the region to reduce sample turn-around-time (from days to an average of 8h) at the centre of the outbreak and rapidly respond to epidemics. In the present article, the approach for implementing such a regional project is outlined and five major aspects (including recommendations) are described: (i) the overall project coordination activities through the EAC Secretariat and the Partner States, (ii) procurement of equipment, (iii) the established laboratory setup and diagnostic panels, (iv) regional training activities and capacity building of various stakeholders and (v) completed and ongoing field missions. The latter includes an EAC/WHO field simulation exercise that was conducted on the border between Tanzania and Kenya in June 2019, the support in molecular diagnosis during the Tanzanian Dengue outbreak in 2019, the participation in the Ugandan National Ebola response activities in Kisoro district along the Uganda/DRC border in Oct/Nov 2019 and the deployments of the laboratories to assist in SARS-CoV-2 diagnostics throughout the region since early 2020. CONCLUSIONS The established EAC mobile laboratory network allows accurate and timely diagnosis of BSL3/4 pathogens in all East African countries, important for individual patient management and to effectively contain the spread of epidemic-prone diseases.
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Affiliation(s)
- Muna Affara
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,East African Community (EAC), Arusha, Tanzania
| | | | | | | | - Neema Omari
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,East African Community (EAC), Arusha, Tanzania
| | - Grace Ochido
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,East African Community (EAC), Arusha, Tanzania
| | - Eric Kezakarayagwa
- National Institute of Public Health, Ministry of Health and Fight Against AIDS, Bujumbura, Burundi
| | - Francine Kabatesi
- National Institute of Public Health, Ministry of Health and Fight Against AIDS, Bujumbura, Burundi
| | - Anatole Nkeshimana
- National Institute of Public Health, Ministry of Health and Fight Against AIDS, Bujumbura, Burundi
| | - Abdi Roba
- National Public Health Laboratories, Ministry of Health, Nairobi, Kenya
| | | | - Mamo U Abudo
- National Public Health Laboratories, Ministry of Health, Nairobi, Kenya
| | - Alice Kabanda
- National Reference Laboratory Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Etienne Mpabuka
- National Reference Laboratory Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Emil Ivan Mwikarago
- National Reference Laboratory Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Philip Ezekiel Kutjok
- Public Health Laboratory and National Blood Transfusion Centre, Ministry of Health, Juba, South Sudan
| | - Donald Duku Samson
- Public Health Laboratory and National Blood Transfusion Centre, Ministry of Health, Juba, South Sudan
| | - Lul Lojok Deng
- Public Health Laboratory and National Blood Transfusion Centre, Ministry of Health, Juba, South Sudan
| | - Nyambura Moremi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.,National Health Laboratory, Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Maria Ezekiely Kelly
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.,National Health Laboratory, Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Peter Bernard Mtesigwa Mkama
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.,National Health Laboratory, Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Alex Magesa
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.,National Health Laboratory, Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | | | - Godfrey Pimundu
- National Health Laboratory and Diagnostic Services (NHLDS), Ministry of Health, Kampala, Uganda
| | - Susan Ndidde Nabadda
- National Health Laboratory and Diagnostic Services (NHLDS), Ministry of Health, Kampala, Uganda
| | - Dewi Ismajani Puradiredja
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Julia Hinzmann
- Virology Department, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Sophie Duraffour
- Virology Department, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Martin Gabriel
- Virology Department, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Gerd Ruge
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Wibke Loag
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | | | | | - Juergen May
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Tropical Medicine II, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Florian Gehre
- Department for Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany. .,East African Community (EAC), Arusha, Tanzania.
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8
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Abstract
Mobile laboratories provide diagnostic capabilities for routine surveillance and patient identification during an outbreak. In either situation, they face many challenges including identification of the appropriate assay(s) to employ, logistical arrangements, and providing for the health and safety of the laboratory staff. Great strides have been made over the last decade in the development of mobile laboratories with assays that require minimal infrastructure and technical experience. This knowledge and expertise have been developed in partnership with many researchers and public health officials who live in regions prone to infectious disease outbreaks. Mobile laboratories should now also be used in the evaluation of novel vaccines and therapeutics in remote locations. Clinical mobile laboratories will include similar diagnostic capabilities as outbreak response mobile labs, but will also include additional point-of-care instruments operated under Good Clinical Practice guidelines. They will also operate rigorous data management plans so that the data collected will satisfy regulatory agencies during the licensure process. Failure to deploy an adequate clinical mobile laboratory when administering a novel biological product in a remote location is a significant limitation to any collected scientific data that could ultimately undermine clinical development and availability of life-saving interventions.
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Affiliation(s)
- Trina Racine
- Department of Medical Microbiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval , Québec City , Québec , Canada
| | - Gary P Kobinger
- Department of Medical Microbiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Centre de Recherche en Infectiologie, Centre Hospitalier Universitaire de Québec, Université Laval , Québec City , Québec , Canada.,Department of Immunology, University of Manitoba , Winnipeg , Manitoba , Canada.,Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine , Philadelphia , PA , USA
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9
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Goudeau V, Daniel B, Dubot D. Mobile laboratories: An innovative and efficient solution for radiological characterization of sites under or after decommissioning. J Environ Radioact 2019; 196:194-198. [PMID: 28438425 DOI: 10.1016/j.jenvrad.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
During the operation and the decommissioning of a nuclear site the operator must assure the protection of the workers and the environment. It must furthermore identify and classify the various wastes, while optimizing the associated costs. At all stages of the decommissioning radiological measurements are performed to determine the initial situation, to monitor the demolition and clean-up, and to verify the final situation. Radiochemical analysis is crucial for the radiological evaluation process to optimize the clean-up operations and to the respect limits defined with the authorities. Even though these types of analysis are omnipresent in activities such as the exploitation, the monitoring, and the cleaning up of nuclear plants, some nuclear sites do not have their own radiochemical analysis laboratory. Mobile facilities can overcome this lack when nuclear facilities are dismantled, when contaminated sites are cleaned-up, or in a post-accident situation. The current operations for the characterization of radiological soils of CEA nuclear facilities, lead to a large increase of radiochemical analysis. To manage this high throughput of samples in a timely manner, the CEA has developed a new mobile laboratory for the clean-up of its soils, called SMaRT (Shelter for Monitoring and nucleAR chemisTry). This laboratory is dedicated to the preparation and the radiochemical analysis (alpha, beta, and gamma) of potentially contaminated samples. In this framework, CEA and Eichrom laboratories has signed a partnership agreement to extend the analytical capacities and bring on site optimized and validated methods for different problematic. Gamma-emitting radionuclides can usually be measured in situ as little or no sample preparation is required. Alpha and beta-emitting radionuclides are a different matter. Analytical chemistry laboratory facilities are required. Mobile and transportable laboratories equipped with the necessary tools can provide all that is needed. The main advantage of a mobile laboratory is its portability; the shelter can be placed in the vicinity of nuclear facilities under decommissioning, or of contaminated sites with infrastructures unsuitable for the reception and treatment of radioactive samples. Radiological analysis can then be performed without the disadvantages of radioactive material transport. This paper describes how this solution allows a fast response and control of costs, with a high analytical capacity.
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Affiliation(s)
- V Goudeau
- CEA French Commission for Alternative Energies and Atomic Energy, 18 Route du Panorama, 92265 Fontenay-aux-Roses, France.
| | - B Daniel
- Eichrom Laboratories, Rue Maryse Bastié, 35170 Bruz, France
| | - D Dubot
- CEA French Commission for Alternative Energies and Atomic Energy, 18 Route du Panorama, 92265 Fontenay-aux-Roses, France
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10
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Nicastri E, Castilletti C, Biava M, Fusco FM, Petrosillo N, Puro V, Lauria FN, Capobianchi MR, Di Caro A, Ippolito G. Enabling Rapid Response to the 2014-2016 Ebola Epidemic: The Experience and the Results of the National Institute for Infectious Diseases Lazzaro Spallanzani. Adv Exp Med Biol 2017; 972:103-22. [PMID: 27864803 DOI: 10.1007/5584_2016_134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The unprecedented epidemic of Ebola virus disease (EVD) in West Africa highlighted the need for stronger systems for disease surveillance, response, and prevention worldwide. Tackling an epidemic event today requires a broader view, not only limited to medical management of the patients, but which also includes heroic efforts by clinicians and public health personnel.Since its foundation in 1936, INMI has been devoted to the prevention, diagnosis and care for infectious diseases. In 2009, INMI became a WHO collaborative center for clinical care, diagnosis, response and training on Highly Infectious Diseases. This paper is aimed to present the activities and the challenging issues encountered by INMI during the 2014-2015 EVD outbreak in terms of preparedness and response to the epidemiological, clinical, diagnostic and research controversial aspects of EVD, both in Italy and in the field.
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Woo SH, Kwak KH, Bae GN, Kim KH, Kim CH, Yook SJ, Jeon S, Kwon S, Kim J, Lee SB. Overestimation of on-road air quality surveying data measured with a mobile laboratory caused by exhaust plumes of a vehicle ahead in dense traffic areas. Environ Pollut 2016; 218:1116-1127. [PMID: 27622843 DOI: 10.1016/j.envpol.2016.08.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 06/06/2023]
Abstract
The unintended influence of exhaust plumes emitted from a vehicle ahead to on-road air quality surveying data measured with a mobile laboratory (ML) at 20-40 km h-1 in dense traffic areas was investigated by experiment and life-sized computational fluidic dynamics (CFD) simulation. The ML equipped with variable sampling inlets of five columns by four rows was used to measure the spatial distribution of CO2 and NOx concentrations when following 5-20 m behind a sport utility vehicle (SUV) as an emitter vehicle equipped with a portable emission monitoring system (PEMS). The PEMS measured exhaust gases at the tailpipe for input data of the CFD simulations. After the CFD method was verified with experimental results of the SUV, dispersion of exhaust plumes emitted from a bus and a sedan was numerically analyzed. More dilution of the exhaust plume was observed at higher vehicle speeds, probably because of eddy diffusion that was proportional to turbulent kinetic energy and vehicle speed. The CO2 and NOx concentrations behind the emitter vehicle showed less overestimation as both the distance between the two vehicles and their background concentrations increased. If the height of the ML inlet is lower than 2 m and the ML travels within 20 m behind a SUV and a sedan ahead at 20 km h-1, the overestimation should be considered by as much as 200 ppb in NOx and 80 ppm in CO2. Following a bus should be avoided if possible, because effect of exhaust plumes from a bus ahead could not be negligible even when the distance between the bus and the ML with the inlet height of 2 m, was more than 40 m. Recommendations are provided to avoid the unintended influence of exhaust plumes from vehicles ahead of the ML during on-road measurement in urban dense traffic conditions.
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Affiliation(s)
- Sang-Hee Woo
- Center for Environment, Health and Welfare Research, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea; Department of Mechanical Engineering, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Kyung-Hwan Kwak
- School of Natural Resources and Environmental Science, Kangwon National University, Kangwondaehak-gil 1, Chuncheon-si, Gangwon-do 24341, Republic of Korea
| | - Gwi-Nam Bae
- Center for Environment, Health and Welfare Research, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Kyung Hwan Kim
- Center for Environment, Health and Welfare Research, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Chang Hyeok Kim
- Center for Environment, Health and Welfare Research, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea
| | - Se-Jin Yook
- Department of Mechanical Engineering, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Sangzin Jeon
- Transportation Pollution Research Center, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22755, Republic of Korea
| | - Sangil Kwon
- Transportation Pollution Research Center, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22755, Republic of Korea
| | - Jeongsoo Kim
- Transportation Pollution Research Center, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22755, Republic of Korea
| | - Seung-Bok Lee
- Center for Environment, Health and Welfare Research, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Republic of Korea.
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12
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Leon-Justel A, Noval-Padillo JA, Alvarez-Rios AI, Mellado P, Gomez-Bravo MA, Álamo JM, Porras M, Barrero L, Hinojosa R, Carmona M, Vilches-Arenas A, Guerrero JM. Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome. Clin Chim Acta 2015; 446:277-83. [PMID: 25916692 DOI: 10.1016/j.cca.2015.04.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 04/11/2015] [Accepted: 04/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT). METHODS We performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups. RESULTS Transfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2-8] to 3 [0-5] (p < 0.001), plasma from 2 [0-4] to 0 (p < 0.001), and platelets from 1 [0-4] to 0 [0-1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications. CONCLUSIONS A haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.
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Affiliation(s)
- Antonio Leon-Justel
- Laboratory Medicine Department, Huelva University Hospital (Institute of Biomedicine of Seville, Seville University), Spain.
| | - Jose A Noval-Padillo
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
| | - Ana I Alvarez-Rios
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
| | - Patricia Mellado
- Department of Anaesthesiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Miguel A Gomez-Bravo
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Jose M Álamo
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Manuel Porras
- Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Lydia Barrero
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Rafael Hinojosa
- Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Magdalena Carmona
- Department of Haematology and Haemotherapy, Virgen del Rocío University Hospital, Seville, Spain
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, University of Seville, Spain
| | - Juan M Guerrero
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
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