Effects of ambient temperature, relative humidity and absolute humidity on risk of nasopharyngeal carcinoma in China

Nasopharyngeal carcinoma (NPC) has a unique geographic distribution. It is unknown whether meteorological factors are related to the incidence of NPC. To investigate the effect of ambient temperature, relative humidity (RH), and absolute humidity (AH) on the incidence of NPC, we collected the incidence rate of NPC in 2016 and meteorological data from 2006 to 2016 from 484 cities and counties across 31 provinces in China. Generalized additive models with quasi-Poisson regression and generalized linear models with natural cubic splines were employed respectively to elucidate the nonlinear relationships and specify the partial linear relationships. Subgroup and interactive analysis were also conducted. Temperature (R2 = 0.68, p < .001), RH (R2 = 0.47, p < .001), and AH (R2 = 0.70, p < .001) exhibited nonlinear correlations with NPC incidence rate. The risk of NPC incidence increased by 20.3% (95% confidence intervals [CI]: [18.9%, 21.7%]) per 1°C increase in temperature, by 6.3% (95% CI: [5.3%, 7.2%]) per 1% increase in RH, and by 32.2% (95% CI: [30.7%, 33.7%]) per 1 g/m3 increase in AH, between their the 25th and the 99th percentiles. In addition, the combination of low temperature and low RH was also related to increased risk (relative risk: 1.60, 95% CI: [1.18, 2.17]). Males and eastern or rural populations tended to be more vulnerable. In summary, this study suggests that ambient temperature, RH, and particularly AH are associated with the risk of NPC incidence.

The role of absolute humidity in influenza transmission in Beijing, China: risk assessment and attributable fraction identification

To assess the impact of absolute humidity on influenza transmission in Beijing from 2014 to 2019, we estimated the influenza transmissibility via the instantaneous reproduction number (Rt), and evaluated its nonlinear exposure-response association and delayed effects with absolute humidity by using the distributed lag nonlinear model (DLNM). Attributable fraction (AF) of Rt due to absolute humidity was calculated. The result showed a significant M-shaped relationship between Rt and absolute humidity. Compared with the effect of high absolute humidity, the low absolute humidity effect was more immediate with the most significant effect observed at lag 6 days. AFs were relatively high for the group aged 15-24 years, and was the lowest for the group aged 0-4 years with low absolute humidity. Therefore, we concluded that the component attributed to the low absolute humidity effect is greater. Young and middle-aged people are more sensitive to low absolute humidity than children and elderly.

Association of Ambient Temperature and Absolute Humidity with the Effective Reproduction Number of COVID-19 in Japan

This study aimed to quantify the exposure-lag-response relationship between short-term changes in ambient temperature and absolute humidity and the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Japan. The prefecture-specific daily time-series of newly confirmed cases, meteorological variables, retail and recreation mobility, and Government Stringency Index were collected for all 47 prefectures of Japan for the study period from 15 February 2020 to 15 October 2022. Generalized conditional Gamma regression models were formulated with distributed lag nonlinear models by adopting the case-time-series design to assess the independent and interactive effects of ambient temperature and absolute humidity on the relative risk (RR) of the time-varying effective reproductive number (Rt). With reference to 17.8 °C, the corresponding cumulative RRs (95% confidence interval) at a mean ambient temperatures of 5.1 °C and 27.9 °C were 1.027 (1.016-1.038) and 0.982 (0.974-0.989), respectively, whereas those at an absolute humidity of 4.2 m/g3 and 20.6 m/g3 were 1.026 (1.017-1.036) and 0.995 (0.985-1.006), respectively, with reference to 10.6 m/g3. Both extremely hot and humid conditions synergistically and slightly reduced the Rt. Our findings provide a better understanding of how meteorological drivers shape the complex heterogeneous dynamics of SARS-CoV-2 in Japan.

Delineating the impacts of air temperature and humidity for endurance exercise

NEW FINDINGS

What is the central question of this study? What are the independent effects of air temperature and humidity on performance, physiological and perceptual responses during endurance exercise? What is the main finding and its importance? When examined independently, elevated air temperature increased heat strain and impaired aerobic exercise performance, but to a lesser extent than has been reported previously. These findings highlight the importance of absolute humidity relative to temperature when exercising or working under severe heat stress.

ABSTRACT

Many studies have reported that ambient heat stress increases physiological and perceptual strain and impairs endurance exercise, but effects of air temperature per se remain almost unexamined. Most studies have used matched relative humidity, thereby exponentially increasing absolute humidity (water content in air) concurrently with temperature. Absolute (not relative) humidity governs evaporative rate and is more important at higher work rates and air temperatures. Therefore, we examined the independent effects of air temperature and humidity on performance, thermal, cardiovascular and perceptual measures during endurance exercise. Utilizing a crossover design, 14 trained participants (7 females) completed 45 min fixed-intensity cycling (70%V ̇ O 2 peak ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$ ) followed by a 20-km time trial in each of four environments: three air temperatures at matched absolute humidity (Cool, 18°C; Moderate, 27°C; and Hot, 36°C; at 1.96 kPa, air velocity ∼4.5 m/s), and one at elevated humidity (Hot Humid, 36°C at 3.92 kPa). Warmer air caused warmer skin (0.5°C/°C; P < 0.001), higher heart rate (1 bpm/°C; P < 0.001), sweat rate (0.04 l/h/°C; P < 0.001) and thermal perceptions during fixed-intensity exercise, but minimally affected core temperature (<0.01°C/°C; P = 0.053). Time-trial performance was comparable between Cool and Moderate (95% CI: -1.4, 5.9%; P = 0.263), but 3.6-6% slower in Hot (95% CI: ±2.4%; P ≤ 0.006). Elevated humidity increased core temperature (P < 0.001), perceived temperature and discomfort but not skin temperature or heart rate, and reduced mean blood pressure (P = 0.046) during fixed-intensity exercise. Elevated humidity impaired time-trial performance by 3.4% (95% CI: ±2.2%; P = 0.006). In conclusion, these findings quantify the importance of absolute humidity alongside air temperature when exercising under severe heat stress.

Impact of humidity and flowrate on the thoron measurement sensitivity of electrostatic radon monitors

The accurate measurement of thoron activity concentration is an important issue in both thoron exposure evaluation and in reducing its influence on radon measurement. For radon monitors based on electrostatic collection technique and an alpha spectrometry analyser, air humidity and sampling flowrate are key factors influencing the sensitivity of thoron activity concentration measurement. For the purpose of improving thoron measurement sensitivity and stability, theoretical derivation and experimental studies were systemically performed in this study. The results show that thoron measurement sensitivity decreases as a negative exponential function with absolute humidity increasing, and the sensitivity of thoron is much lower than that of radon under the same conditions, which is mainly caused by the small value of the concentration ratio of thoron inside to outside of the chamber. When the air exchange rate of the measurement chamber (sampling flowrate/inner volume) increases, the measurement sensitivity of thoron gas first increases rapidly and then decreases slowly after reaching its maximum at the air exchange rate of 0.24 s^-1. In practice, in the normal air exchange rate range (for example <0.05 s^-1), increasing the sampling flowrate could greatly improve the thoron measurement sensitivity, which consequently suggests an effective way to update thoron measurement under the present conditions of the monitor.

The Effect of In-Situ-Generated Moisture on Disproportionation of Pharmaceutical Salt

Pharmaceutical salts are ubiquitously present in the market given their benefits in optimizing the critical properties of an active pharmaceutical ingredient (API). Achieving these benefits requires careful selection and understanding of the salt form of choice. Stability is especially critical here, as salts are susceptible to disproportionation. Several studies have shown the impact of moisture on disproportionation, with more focus on external humidity (moisture coming from outside the system). This work, on the other hand, is systematically designed to study the impact of moisture generated in situ (moisture produced within the system). To that end, an in-house developed compound 1 was selected as our salt API, and its disproportionation was studied in blends (binary and prototype) with hydrated model excipient─trisodium phosphate dodecahydrate (TSPD). TSPD possesses 12 water molecules, which could get released when triggered with enough energy (confirmed by thermogravimetric analysis and humidity studies). As a control for this study, similar blends were prepared with anhydrous trisodium phosphate (TSP), which has comparable properties to TSPD but lacks water. Overall, significant disproportionation was observed in TSPD blends exposed to 40 °C or 70 °C in a closed system; while no disproportionation was observed when the system was left open due to the escape of the moisture generated in situ. The API also remained intact for the blends with anhydrous TSP, as expected. Meanwhile, stressing at 40 °C/75%RH condition resulted in significant disproportionation for both TSPD and TSP blends due to the exposure to external humidity. Hydrated excipients are normally used in drug development, and this work stresses the need for probing the impact from within the system when such excipients are utilized with salt API. This will help fully unravel the overall effect of moisture on the drug, which is relevant downstream when selecting processing conditions, packaging, and so forth.

Impact of Selected Meteorological Factors on COVID-19 Incidence in Southern Finland during 2020-2021

We modelled the impact of selected meteorological factors on the daily number of new cases of the coronavirus disease 2019 (COVID-19) at the Hospital District of Helsinki and Uusimaa in southern Finland from August 2020 until May 2021. We applied a DLNM (distributed lag non-linear model) with and without various environmental and non-environmental confounding factors. The relationship between the daily mean temperature or absolute humidity and COVID-19 morbidity shows a non-linear dependency, with increased incidence of COVID-19 at low temperatures between 0 to -10 °C or at low absolute humidity (AH) values below 6 g/m³. However, the outcomes need to be interpreted with caution, because the associations found may be valid only for the study period in 2020-2021. Longer study periods are needed to investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a seasonal pattern similar such as influenza and other viral respiratory infections. The influence of other non-environmental factors such as various mitigation measures are important to consider in future studies. Knowledge about associations between meteorological factors and COVID-19 can be useful information for policy makers and the education and health sector to predict and prepare for epidemic waves in the coming winters.

Monitoring of Heated Wire Humidifier Hygrometric Performances With Heater Plate Temperature

BACKGROUND

Under-humidification and associated complications may occur with heated humidifiers. Hygrometric performances of heated wire humidifiers are reduced by high ambient and high outlet ventilator temperatures. Currently, there is no reliable monitoring tool to evaluate humidification performances of heated wire humidifiers in the daily practice. We sought to demonstrate the relation between humidity delivered by heated wire humidifiers and different parameters that could be used to monitor humidity of gas delivered to subjects.

METHODS

On a bench test, we measured heater plate temperature, inlet chamber temperature, and delivered humidity with MR850 system. Temperature displayed on the humidifier was also recorded. The measurements were performed at different ambient temperatures and five minute ventilation levels (5, 7.5, 10, 12.5, 15 L/min). Inlet chamber temperatures varied from 20-40°C. In each condition, hygrometric measurements with the psychrometric method were performed at steady state.

RESULTS

We performed 279 measurements at steady state including all conditions. We found a good correlation between heater plate temperature and absolute humidity delivered (R² = 0.82). This relationship was hardly affected by ambient temperature, but minute ventilation had more effect. For different minute ventilations, the correlation between heater plate temperature and absolute humidity delivered was very good with coefficient of determination R² from 0.87-0.98. Heater plate temperature > 62°C was a good predictor of absolute humidity delivered > 30 mg H₂O/L (area under the curve = 0.96, sensibility 79%, specificity 94%). No correlation existed between humidity delivered and the outlet chamber temperature (displayed on the humidifier).

CONCLUSIONS

In this bench study, we have shown a good correlation between heater plate temperature and humidity delivered with a heated wire humidifier. This means that a "hidden" hygrometer is built into the heated wire humidifier. Heater plate temperature should be used as a surrogate of humidity to improve the humidification monitoring.

Hygrometric Performances of Different High-Flow Nasal Cannula Devices: Bench Evaluation and Clinical Tolerance

BACKGROUND

High-flow nasal cannula (HFNC) is increasingly used for the management of respiratory failure. Settings include [Formula: see text], total gas flow, and temperature target. Resulting absolute humidity (AH) at the nasal cannula may affect clinical tolerance, and optimal settings with respect to hygrometry remain poorly documented.

METHODS

A bench study was designed to assess AH delivered by 4 HFNC devices (Optiflow, Airvo 2, Precision Flow, and Hydrate) according to flow, ambient temperature, and other available settings. Clinical tolerance of different levels of hygrometry (20, 30, and 40 mg H₂O/L) was evaluated in 15 healthy volunteers.

RESULTS

With [Formula: see text] set at 1.0, normal ambient temperature, and settings made accordingly to the manufacturers' recommendations, mean ± SD AH was 42.2 ± 3.1, 39.5 ± 1.8, 35.7 ± 2.0, and 32.9 ± 2.7 mg H₂O/L for the Airvo 2, Optiflow, Hydrate, and Precision Flow, respectively, (P < .001). AH dropped from -3.5 to -10.7 mg H₂O/L (P <. 001) with high ambient temperature, except for the Precision Flow. Increasing flow did not significantly affect AH except for the Precision Flow (from 36.4 ± 1.6 to 29.8 ± 0.2 mg H₂O/L at 10 and 40 L/min, respectively, [P < .001]). The lowest AH was encountered with the Optiflow set with noninvasive ventilation (NIV) mode, without compensation algorithm, and at high ambient temperature (14.2 ± 1.5 mg H₂O/L). In studied subjects, AH significantly affected breathing comfort, reduced from 7.0 ± 1.0 to 3.0 ± 2.0 at 40 and 20 mg H₂O/L, respectively, (P < .001). Comfort was similar at 30 and 40 mg H₂O/L.

CONCLUSIONS

When used according to manufacturer's recommendations and at normal ambient temperature, all the HFNC devices evaluated achieved satisfactory hygrometric output with respect to breathing comfort evaluated in healthy subjects (≥ 30 mg H₂O/L). Substantial differences exist between devices, and optimal knowledge of their working principles is required as inappropriate usage may dramatically alter efficacy and clinical tolerance.

The Brazilian Cerrado is becoming hotter and drier

The Brazilian Cerrado is a global biodiversity hotspot with notoriously high rates of native vegetation suppression and wildfires over the past three decades. As a result, climate change can already be detected at both local and regional scales. In this study, we used three different approaches based on independent datasets to investigate possible changes in the daytime and nighttime temperature and air humidity between the peak of the dry season and the beginning of the rainy season in the Brazilian Cerrado. Additionally, we evaluated the tendency of dew point depression, considering it as a proxy to assess impacts on biodiversity. Monthly increases of 2.2-4.0℃ in the maximum temperatures and 2.4-2.8℃ in the minimum temperatures between 1961 and 2019 were recorded, supported by all analyzed datasets which included direct observations, remote sensing, and modeling data. The warming raised the vapor pressure deficit, and although we recorded an upward trend in absolute humidity, relative humidity has reduced by ~15%. If these tendencies are maintained, gradual air warming will make nightly cooling insufficient to reach the dew point in the early hours of the night. Therefore, it will progressively reduce both the amount and duration of nocturnal dewfall, which is the main source of water for numerous plants and animal species of the Brazilian Cerrado during the dry season. Through several examples, we hypothesize that these climate changes can have a high impact on biodiversity and potentially cause ecosystems to collapse. We emphasize that the effects of temperature and humidity on Cerrado ecosystems cannot be neglected and should be further explored from a land use perspective.

The Correlation Between COVID-19 Activities and Climate Factors in Different Climate Types Areas

OBJECTIVE

To investigate the epidemiological characteristics of human infection with corona virus disease 2019 (COVID-19) in Moscow, Lima, Kuwait, and Singapore to analyze the effects of climate factors on the incidence of COVID-19.

METHODS

Collect the daily incidence of COVID-19 and related climate data in four areas, construct a negative binomial regression model, and analyze the correlation between the incidence of COVID-19 and meteorological factors.

RESULTS

AH was the climate factor affecting the incidence of COVID-19 in Moscow, Lima, and Singapore; Ta and RH were the climate factors affecting the incidence of COVID-19 in Kuwait.

CONCLUSIONS

The incidence of COVID-19 in four areas were all associated with the humidity, and climate factors should be taken into consideration when epidemic prevention measures are taken, and environment humidification may be a feasible approach to decrease COVID-19 virus transmission.

Seasonal variations in the skin parameters of Caucasian women from Central Europe

BACKGROUND

The human skin is greatly affected by external factors such as UV radiation (UVR), ambient temperature (T), and air humidity. These factors oscillate during the year giving rise to the seasonal variations in the skin properties. The aim of this study was to evaluate the effect of seasons, environmental T, relative and absolute humidity on the skin parameters of Caucasian women, perform a literature review and discuss the possible factors lying behind the found changes.

MATERIALS AND METHODS

We measured stratum corneum (SC) hydration, transepidermal water loss (TEWL), sebum level, erythema index, and elasticity parameters R2 and R7 on the forehead and the cheek of Caucasian women from the Czech Republic throughout the year. We also performed a non-systematic literature review focused on the seasonal variations in these skin parameters.

RESULTS

We confirmed a well-documented low SC hydration and sebum production in winter. In spring, we found the lowest TEWL (on the forehead) and the highest SC hydration but also the highest erythema index and the lowest elasticity presumably indicating skin photodamage. For most of the skin parameters, the seasonal variations probably arise due to a complex action of different factors as we extensively discussed.

CONCLUSION

The data about the seasonal variations in the skin parameters are still highly inconsistent and further studies are needed for better understanding of the normal skin changes throughout the year.

Correlation between COVID-19 Morbidity and Mortality Rates in Japan and Local Population Density, Temperature, and Absolute Humidity

This study analyzed the morbidity and mortality rates of the coronavirus disease (COVID-19) pandemic in different prefectures of Japan. Under the constraint that daily maximum confirmed deaths and daily maximum cases should exceed 4 and 10, respectively, 14 prefectures were included, and cofactors affecting the morbidity and mortality rates were evaluated. In particular, the number of confirmed deaths was assessed, excluding cases of nosocomial infections and nursing home patients. The correlations between the morbidity and mortality rates and population density were statistically significant (p-value < 0.05). In addition, the percentage of elderly population was also found to be non-negligible. Among weather parameters, the maximum temperature and absolute humidity averaged over the duration were found to be in modest correlation with the morbidity and mortality rates. Lower morbidity and mortality rates were observed for higher temperature and absolute humidity. Multivariate linear regression considering these factors showed that the adjusted determination coefficient for the confirmed cases was 0.693 in terms of population density, elderly percentage, and maximum absolute humidity (p-value < 0.01). These findings could be useful for intervention planning during future pandemics, including a potential second COVID-19 outbreak.

Influence of Absolute Humidity, Temperature and Population Density on COVID-19 Spread and Decay Durations: Multi-Prefecture Study in Japan

This study analyzed the spread and decay durations of the COVID-19 pandemic in different prefectures of Japan. During the pandemic, affordable healthcare was widely available in Japan and the medical system did not suffer a collapse, making accurate comparisons between prefectures possible. For the 16 prefectures included in this study that had daily maximum confirmed cases exceeding ten, the number of daily confirmed cases follow bell-shape or log-normal distribution in most prefectures. A good correlation was observed between the spread and decay durations. However, some exceptions were observed in areas where travelers returned from foreign countries, which were defined as the origins of infection clusters. Excluding these prefectures, the population density was shown to be a major factor, affecting the spread and decay patterns, with R² = 0.39 (p < 0.05) and 0.42 (p < 0.05), respectively, approximately corresponding to social distancing. The maximum absolute humidity was found to affect the decay duration normalized by the population density (R² > 0.36, p < 0.05). Our findings indicate that the estimated pandemic spread duration, based on the multivariate analysis of maximum absolute humidity, ambient temperature, and population density (adjusted R² = 0.53, p-value < 0.05), could prove useful for intervention planning during potential future pandemics, including a second COVID-19 outbreak.

Effects of Temperature and Humidity on the Skin Permeation of Hydrophilic and Hydrophobic Drugs

The humidity was a well-known method to hydrate the skin; however, the published data were varied, and systemic experiments in the previous papers were few. Therefore, the in vitro permeation of excised porcine ear skin by drugs with different polarities [aminopyrine (AMP), antipyrine (ANP), methylparaben (MP), and ibuprofen (IP)] was analyzed under a constant skin surface temperature with different temperatures and humidities to reveal the effects of temperature and humidity on the skin permeation enhancement effects. Applied formulations were prepared by mixing the drug and a hydrophilic vehicle containing glycerin. The disposition-distance profiles of water and the humectant glycerin in the stratum corneum were also investigated using confocal Raman microscopy. High absolute humidity (AH) significantly contributed to the high skin penetration of the hydrophilic penetrants AMP, ANP, and MP but not the hydrophobic penetrant IP. An increase in the partition parameter and a decrease in the diffusivity parameter occurred with an increase in AH, independent of drug polarity. Moreover, we found that dew condensation induced by high AH on temperature-controlled skin surface may effectively increase water content and may provide higher glycerin distribution in the skin barrier, the stratum corneum. Increasing the amount of water and hydrophilic vehicles such as glycerin in the stratum corneum may enhance the permeation of hydrophilic penetrants AMP, ANP, and MP. These data suggested a dew condensation on the skin surface induced by high AH at a constant skin surface temperature would be important to enhance hydrophilic penetrants.

Effects of Absolute Humidity, Relative Humidity, Temperature, and Wind Speed on Influenza Activity in Toronto, Ontario, Canada

The occurrence of influenza in different climates has been shown to be associated with multiple meteorological factors. The incidence of influenza has been reported to increase during rainy seasons in tropical climates and during the dry, cold months of winter in temperate climates. This study was designed to explore the role of absolute humidity (AH), relative humidity (RH), temperature, and wind speed (WS) on influenza activity in the Toronto, ON, Canada, area. Environmental data obtained from four meteorological stations in the Toronto area over the period from 1 January 2010 to 31 December 2015 were linked to patient influenza data obtained for the same locality and period. Data were analyzed using correlation, negative binomial regressions with linear predictors, and splines to capture the nonlinear relationship between exposure and outcomes. Our study found a negative association of both AH and temperature with influenza A and B virus infections. The effect of RH on influenza A and B viruses was controversial. Temperature fluctuation was associated with increased numbers of influenza B virus infections. Influenza virus was less likely to be detected from community patients than from patients tested as part of an institutional outbreak investigation. This could be more indicative of nosocomial transmission rather than climactic factors. The nonlinear nature of the relationship of influenza A virus with temperature and of influenza B virus with AH, RH, and temperature could explain the complexity and variation between influenza A and B virus infections. Predicting influenza activity is important for the timing of implementation of disease prevention and control measures as well as for resource allocation.IMPORTANCE This study examined the relationship between environmental factors and the occurrence of influenza in general. Since the seasonality of influenza A and B viruses is different in most temperate climates, we also examined each influenza virus separately. This study reports a negative association of both absolute humidity and temperature with influenza A and B viruses and tries to understand the controversial effect of RH on influenza A and B viruses. This study reports a nonlinear relation between influenza A and B viruses with temperature and influenza B virus with absolute and relative humidity. The nonlinear nature of these relations could explain the complexity and difference in seasonality between influenza A and B viruses, with the latter predominating later in the season. Separating community-based specimens from those obtained during outbreaks was also a novel approach in this research. These findings provide a further understanding of influenza virus transmission in temperate climates.

Accuracy of Delivery and Effects on Absolute Humidity of Low Tidal Volume by ICU Ventilators

BACKGROUND

During extracorporeal membrane oxygenation for ARDS, a range of 1-4 mL/kg predicted body weight tidal volume (V_T) is commonly used. We explored whether such a low V_T could be adequately delivered by ICU ventilators, and whether such low V_Ts prevent the heated humidifier (HH) from reaching the recommended target of 33 mg/L absolute humidity (AH).

METHODS

We attached a lung model to 5 ICU ventilators set in volume controlled mode and body temperature and pressure saturated. We ran 2 protocols over a 100-280 mL V_T range used with adult or neonatal breathing circuit at a breathing frequency (f) of 15 (f15) or 30 (f30) breaths/min. In the first protocol, with the HH off, V_T was measured with a dedicated data logger and expressed in body temperature and pressure saturated. The relationships of measured V_T to set V_T were studied, and the relative error in V_T was analyzed within its 10% boundaries. In the second protocol, the HH was on, and we measured AH using a psychrometric method. The relationship of AH to set V_T was analyzed with linear regression.

RESULTS

For the 5 ventilators used, the slope (95% CI) between measured V_T versus set V_T averaged 0.93 (0.92-0.93), 0.93 (0.93-0.94), 0.91 (0.90-0.91), and 0.91 (0.90-0.91) mL/mL for adult and neonatal circuits at f15 and f30, respectively (P < .05 vs 1 in each instance), indicating a systematic under-delivery of V_T. The V_T relative error fell within the ±10% accuracy range for only 2 ventilators with adult circuits at f15 and f30. AH increased linearly with V_T. The recommended target of 33 mg/L AH was reached with all of the ventilators for the adult circuit at f30 only. The minimum volume that met the recommended threshold for AH was 100, 150, 190, 160, and 100 mL for the G5, Carestation, PB980, Servo-U, and V500 ventilators, respectively, at f30.

CONCLUSION

Low V_T was systematically under-delivered by modern ICU ventilators by roughly 7-9%. To meet the recommended target of 33 mg/L AH, adult circuit at f30 should be used.

Climatic Factors and Influenza Transmission, Spain, 2010-2015

The spatio-temporal distribution of influenza is linked to variations in meteorological factors, like temperature, absolute humidity, or the amount of rainfall. The aim of this study was to analyse the association between influenza activity, and meteorological variables in Spain, across five influenza seasons: 2010–2011 through to 2014–2015 using generalized linear negative binomial mixed models that we calculated the weekly influenza proxies, defined as the weekly influenza-like illness rates, multiplied by the weekly proportion of respiratory specimens that tested positive for influenza. The results showed an association between influenza transmission and dew point and cumulative precipitation. In increase in the dew point temperature of 5 degrees produces a 7% decrease in the Weekly Influenza Proxy (RR 0.928, IC: 0.891–0.966), and while an increase of 10 mm in weekly rainfall equates to a 17% increase in the Weekly Influenza Proxy (RR 1.172, IC: 1.097–1.251). Influenza transmission in Spain is influenced by variations in meteorological variables as temperature, absolute humidity, or the amount of rainfall.

Influenza Herd-Level Prevalence and Seasonality in Breed-to-Wean Pig Farms in the Midwestern United States

Influenza is a costly disease for pig producers and understanding its epidemiology is critical to control it. In this study, we aimed to estimate the herd-level prevalence and seasonality of influenza in breed-to-wean pig farms, evaluate the correlation between influenza herd-level prevalence and meteorological conditions, and characterize influenza genetic diversity over time. A cohort of 34 breed-to-wean farms with monthly influenza status obtained over a 5-year period in piglets prior to wean was selected. A farm was considered positive in a given month if at least one oral fluid tested influenza positive by reverse transcriptase polymerase chain reaction. Influenza seasonality was assessed combining autoregressive integrated moving average (ARIMA) models with trigonometric functions as covariates. Meteorological conditions were gathered from local land-based weather stations, monthly aggregated and correlated with influenza herd-level prevalence. Influenza herd-level prevalence had a median of 28% with a range from 7 to 57% and followed a cyclical pattern with levels increasing during fall, peaking in both early winter (December) and late spring (May), and decreasing in summer. Influenza herd-level prevalence was correlated with mean outdoor air absolute humidity (AH) and temperature. Influenza genetic diversity was substantial over time with influenza isolates belonging to 10 distinct clades from which H1 delta 1 and H1 gamma 1 were the most common. Twenty-one percent of farms had three different clades co-circulating over time, 18% of farms had two clades, and 41% of farms had one clade. In summary, our study showed that influenza had a cyclical pattern explained in part by air AH and temperature changes over time, and highlighted the importance of active surveillance to identify high-risk periods when strategic control measures for influenza could be implemented.

Comparison of the temperature and humidity in the anesthetic breathing circuit among different anesthetic workstations: Updated guidelines for reporting parallel group randomized trials

BACKGROUND

For patients undergoing general anesthesia, adequate warming and humidification of the inspired gases is very important. The aim of this study was to evaluate the differences in the heat and moisture content of the inspired gases with low-flow anesthesia using 4 different anesthesia machines.

METHODS

The patients were divided into 11 groups according to the anesthesia machine used (Ohmeda, Excel; Avance; Dräger, Cato; and Primus) and the fresh gas flow (FGF) rate (0.5, 1, and 4 L/min). The temperature and absolute humidity of the inspired gas in the inspiratory limbs were measured at 5, 10, 15, 30, 45, 60, 75, 90, 105, and 120 minutes in 9 patients scheduled for total thyroidectomy or cervical spine operation in each group.

RESULTS

The anesthesia machines of Excel, Avance, Cato, and Primus did not show statistically significant changes in the inspired gas temperatures over time within each group with various FGFs. They, however, showed statistically significant changes in the absolute humidity of the inspired gas over time within each group with low FGF anesthesia (P < .05). The anesthesia machines of Cato and Primus showed statistically significant changes in the absolute humidity of the inspired gas over time within each group with an FGF of 4 L/min (P < .05). However, even with low-flow anesthesia, the temperatures and absolute humidities of the inspired gas for all anesthesia machines were lower than the recommended values.

CONCLUSION

There were statistical differences in the provision of humidity among different anesthesia workstations. The Cato and Primus workstations were superior to Excel and Avance. However, even these were unsatisfactory in humans. Therefore, additional devices that provide inspired gases with adequate heat and humidity are needed for those undergoing general anesthetic procedures.

Model-based reconstruction of an epidemic using multiple datasets: understanding influenza A/H1N1 pandemic dynamics in Israel

Intensified surveillance during the 2009 A/H1N1 influenza pandemic in Israel resulted in large virological and serological datasets, presenting a unique opportunity for investigating the pandemic dynamics. We employ a conditional likelihood approach for fitting a disease transmission model to virological and serological data, conditional on clinical data. The model is used to reconstruct the temporal pattern of the pandemic in Israel in five age-groups and evaluate the factors that shaped it. We estimate the reproductive number at the beginning of the pandemic to beR= 1.4. We find that the combined effect of varying absolute humidity conditions and school vacations (SVs) is responsible for the infection pattern, characterized by three epidemic waves. Overall attack rate is estimated at 32% (28-35%) with a large variation among the age-groups: the highest attack rates within school children and the lowest within the elderly. This pattern of infection is explained by a combination of the age-group contact structure and increasing immunity with age. We assess that SVs increased the overall attack rates by prolonging the pandemic into the winter. Vaccinating school children would have been the optimal strategy for minimizing infection rates in all age-groups.

A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate

Both temperature and humidity may independently or jointly contribute to the risk of human rhinovirus (HRV) infections, either through altered survival and spread of viruses in the environment or due to changes in host susceptibility. This study examined the relationship between short-term variations in temperature and humidity and the risk of HRV infections in a subarctic climate. We conducted a case-crossover study among conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training and identified 147 HRV cases by real-time PCR. An average temperature, a decline in daily ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods (a week prior and after the onset) were obtained. The average daily temperature preceding HRV infections was −9.9 ± 4.9 °C and the average AH was 2.2 ± 0.9 g/m³. An average (odds ratios (OR) 1.07 (95% confidence interval (CI) 1.00–1.15)) and maximal (OR 1.08 (1.01–1.17)) change in temperature increased the risk of HRV infections by 8% per 1 °C decrease. An average (OR 1.20 (CI 1.03–1.40)) and maximal decrease (OR 1.13 (CI 0.96–1.34)) in AH increased the risk of HRV infection by 13% and 20% per 0.5 g/m³ decrease. A higher average temperature during the three preceding days was positively associated with HRV infections (OR 1.07 (CI 1.00–1.15)). A decrease rather than low temperature and humidity per se during the preceding few days increases the risk of HRV infections in a cold climate. The information is applicable to populations residing in cold climates for appropriate personal protection and prevention of adverse health effects.

Inactivation of Avian Influenza Viruses on Porous and Non-porous Surfaces is Enhanced by Elevating Absolute Humidity

This study was to evaluate the effect of absolute humidity (AH), a combined factor of temperature and relative humidity (RH), on inactivation of avian influenza viruses (AIVs) on surfaces. Suspensions of the H9N2 or H6N2 AIV were deposited onto carrier surfaces that were either porous (pine wood) or non-porous (stainless steel, synthetic rubber and glass). The inoculated carriers were incubated at 23, 35 or 45°C with 25% or 55% RH for up to 28 days. After incubation, virus was recovered and quantified by chicken embryo assays. The time required to obtain a log₁₀ reduction in virus infectivity (D-value) was estimated using a linear regression model. At AH of 5.2 g/m³ (23°C & 25% RH), both viruses survived up to 14 days on the porous surface and for at least 28 days on the non-porous surfaces. The corresponding D-values for H9N2 and H6N2 were 1.49 and 6.90 days on the porous surface and 7.81 and 12.5 days on the non-porous surfaces, respectively. In comparison, at AH of 9.9 g/m³ (35°C & 25% RH) or 11.3 g/m³ (23°C & 55% RH), the D-values for H9N2 and H6N2 dropped to ≤0.76 day on the porous surface and to ≤1.81 days on the non-porous surfaces. As the AH continued to rise from 11.3 to 36.0 g/m³ , the D-value for both viruses decreased further. The relationship between D-value and AH followed a form of y = ax^-b for both viruses. The D-values for H9N2 virus were significantly lower (P < 0.05) than those for H6N2 virus. Exposure to ammonia gas at concentrations of 86 and 173 ppm did not significantly alter test results. The findings give evidence that increasing the AH in poultry buildings following an outbreak of disease could greatly reduce the length of time required for their decontamination.

Inspiratory Tube Condensation During High-Flow Nasal Cannula Therapy: A Bench Study

BACKGROUND

High-flow nasal cannula (HFNC) therapy provides better humidification than conventional oxygen therapy. To allay loss of vapor as condensation, a servo-controlled heating wire is incorporated in the inspiratory tube, but condensation is not completely avoidable. We investigated factors that might affect condensation: thermal characteristics of the inspiratory tube, HFNC flow, and ambient temperature.

METHODS

We evaluated 2 types of HFNC tubes, SLH Flex 22-mm single tube and RT202. Both tubes were connected to a heated humidifier with water reservoir. HFNC flow was set at 20, 40, and 60 L/min, and FIO2 was set at 0.21. Air conditioning was used maintain ambient temperature at close to either 20 or 25°C. We weighed the tubes on a digital scale before (0 h) and at 3, 6, and 24 h after, turning on the heated humidifier, and calculated the amount of condensation by simple subtraction. The amount of distilled water used during 24 h was also recorded.

RESULTS

At 25°C, there was little condensation, but at 20°C and HFNC flow of 20, 40, and 60 L/min for 24 h, the amount of condensation with the SLH was 50.2 ± 10.7, 44.3 ± 17.7, and 56.6 ± 13.9 mg, and the amount with the RT202 was 96.0 ± 35.1, 72.8 ± 8.2, and 64.9 ± 0.8 mg. When ambient temperature was set to 20°C, condensation with the RT202 was statistically significantly greater than with the SLH at all flow settings (P < .001).

CONCLUSIONS

Ambient temperature statistically significantly influenced the amount of condensation in the tubes.

Decline in temperature and humidity increases the occurrence of influenza in cold climate

BACKGROUND

Both temperature and humidity may independently or jointly contribute to the risk of influenza infections. We examined the relations between the level and decrease of temperature, humidity and the risk of influenza A and B virus infections in a subarctic climate.

METHODS

We conducted a case-crossover study among military conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training period and identified 66 influenza A and B cases by PCR or serology. Meteorological data such as measures of average and decline in ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods, prior and after the onset were obtained.

RESULTS

The average temperature preceding the influenza onset was -6.8 ± 5.6°C and AH 3.1 ± 1.3 g/m3. A decrease in both temperature and AH during the hazard period increased the occurrence of influenza so that a 1°C decrease in temperature and 0.5 g decrease per m3 in AH increased the estimated risk by 11% [OR 1.11 (1.03 to 1.20)] and 58% [OR 1.58 (1.28 to 1.96)], respectively. The occurrence of influenza infections was positively associated with both the average temperature [OR 1.10 per 1°C (95% confidence interval 1.02 to 1.19)] and AH [OR 1.25 per g/m3 (1.05 to 1.49)] during the hazard period prior to onset.

CONCLUSION

Our results demonstrate that a decrease rather than low temperature and humidity per se during the preceding three days increase the risk of influenza episodes in a cold climate.

Hygrometric properties of inspired gas and oral dryness in patients with acute respiratory failure during noninvasive ventilation

BACKGROUND

Because noninvasive ventilation (NIV) delivers medical gas at high flow, inadequate humidification may cause oral dryness and patient discomfort. Heated humidification can be used during NIV, but little has been reported about the effects on the hygrometric conditions inside an oronasal mask and oral dryness during 24 hours on NIV.

METHODS

We measured absolute humidity (AH) inside oronasal masks on subjects with acute respiratory failure during 24 hours on NIV. A single-limb turbine ventilator and oronasal mask with an exhalation port were used for NIV. Oral moistness was evaluated using an oral moisture-checking device, and 3 times during the 24 hours the subjects subjectively scored the feeling of dryness on a 0-10 scale in which 10 was the most severe dryness.

RESULTS

Sixteen subjects were enrolled. The mean ± SD AH inside the mask was 30.0 ± 2.6 mg H2O/L (range 23.1-33.3 mg H2O/L). The median oral moistness was 19.2% (IQR 4.4-24.0%), and the median oral dryness score was 5.5 (IQR 4-7). AH and inspired gas leak correlated inversely, both within the subjects (r = -0.56, P < .001) and between the subjects (r = -0.58, P = .02). AH and oral moistness correlated within the subjects (r = 0.39, P = .04). Oral breathing was associated with reduced oral moistness (P = .001) and increased oral dryness score (P = .002).

CONCLUSIONS

AH varied among the subjects, and some complained of oral dryness even with heated humidifier. Oral breathing decreased oral moistness and worsened the feeling of dryness.

In vitro evaluation of heat and moisture exchangers designed for spontaneously breathing tracheostomized patients

BACKGROUND

Heat and moisture exchangers (HMEs) are commonly used in chronically tracheostomized spontaneously breathing patients, to condition inhaled air, maintain lower airway function, and minimize the viscosity of secretions. Supplemental oxygen (O2) can be added to most HMEs designed for spontaneously breathing tracheostomized patients. We tested the efficiency of 7 HMEs designed for spontaneously breathing tracheostomized patients, in a normothermic model, at different minute ventilations (VE) and supplemental O2 flows.

METHODS

HME efficiency was evaluated using an in vitro lung model at 2 VE (5 and 15 L/min) and 4 supplemental O2 flows (0, 3, 6, and 12 L/min). Wet and dry temperatures of the inspiratory flow were measured, and absolute humidity was calculated. In addition, HME efficiency at 0, 12, and 24 h use was evaluated, as well as resistance to flow at 0 and 24 h.

RESULTS

The progressive increase in O2 flow from 0 to 12 L/min was associated with a reduction in temperature and absolute humidity. Under the same conditions, this effect was greater at lower VE. The HME with the best performance provided an absolute humidity of 26 mg H2O/L and a temperature of 27.8 °C. No significant changes in efficiency or resistance were detected during the 24 h evaluation.

CONCLUSIONS

The efficiency of HMEs in terms of temperature and absolute humidity is significantly affected by O2 supplementation and V(E).

Acute health impacts of airborne particles estimated from satellite remote sensing

Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM(2.5) model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM(10)) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM(10) (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM(10) (adjusted by AH) were similar. Additionally, compared to ground PM(10), we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks.

Influence of extreme weather and meteorological anomalies on outbreaks of influenza A (H1N1)

Biological experiments and epidemiological evidence indicate that variations in environment have important effect on the occurrence and transmission of epidemic influenza. It is therefore important to understand the characteristic patterns of transmission for prevention of disease and reduction of disease burden. Based on case records, we analyzed the environmental characteristics including climate variables in Changsha, and then constructed a meteorological anomaly susceptive-infective-removal (SIR) model on the basis of the results of influenza A (H1N1) transmission. The results showed that the outbreak of influenza A (H1N1) in Changsha showed significant correlation with meteorological conditions; the spread of influenza was sensitive to meteorological anomalies, and that the outbreak of influenza A (H1N1) in Changsha was influenced by a combination of absolute humidity anomalous weather conditions, contact rates of the influenza patients and changes in population movements. These findings will provide helpful information regarding prevention strategies under different conditions, a fresh understanding of the emergence and re-emergence of influenza outbreaks, and a new perspective on the transmission dynamics of influenza.

Forecasting seasonal outbreaks of influenza

Influenza recurs seasonally in temperate regions of the world; however, our ability to predict the timing, duration, and magnitude of local seasonal outbreaks of influenza remains limited. Here we develop a framework for initializing real-time forecasts of seasonal influenza outbreaks, using a data assimilation technique commonly applied in numerical weather prediction. The availability of real-time, web-based estimates of local influenza infection rates makes this type of quantitative forecasting possible. Retrospective ensemble forecasts are generated on a weekly basis following assimilation of these web-based estimates for the 2003-2008 influenza seasons in New York City. The findings indicate that real-time skillful predictions of peak timing can be made more than 7 wk in advance of the actual peak. In addition, confidence in those predictions can be inferred from the spread of the forecast ensemble. This work represents an initial step in the development of a statistically rigorous system for real-time forecast of seasonal influenza.