Arctic amplification-induced decline in West and South Asia dust warrants stronger antidesertification toward carbon neutrality

Dust loading in West and South Asia has been a major environmental issue due to its negative effects on air quality, food security, energy supply and public health, as well as on regional and global weather and climate. Yet a robust understanding of its recent changes and future projection remains unclear. On the basis of several high-quality remote sensing products, we detect a consistently decreasing trend of dust loading in West and South Asia over the last two decades. In contrast to previous studies emphasizing the role of local land use changes, here, we attribute the regional dust decline to the continuous intensification of Arctic amplification driven by anthropogenic global warming. Arctic amplification results in anomalous mid-latitude atmospheric circulation, particularly a deepened trough stretching from West Siberia to Northeast India, which inhibits both dust emissions and their downstream transports. Large ensemble climate model simulations further support the dominant role of greenhouse gases induced Arctic amplification in modulating dust loading over West and South Asia. Future projections under different emission scenarios imply potential adverse effects of carbon neutrality in leading to higher regional dust loading and thus highlight the importance of stronger anti-desertification counter-actions such as reforestation and irrigation management.

Developing Dry Powder Inhaler Formulations

This section aims to provide a concise and contemporary technical perspective and reference resource covering dry powder inhaler (DPI) formulations. While DPI products are currently the leading inhaled products in terms of sales value, a number of confounding perspectives are presented to illustrate why they are considered surprisingly, and often frustratingly, poorly understood on a fundamental scientific level, and most challenging to design from first principles. At the core of this issue is the immense complexity of fine cohesive powder systems. This review emphasizes that the difficulty of successful DPI product development should not be underestimated and is best achieved with a well-coordinated team who respect the challenges and who work in parallel on device and formulation and with an appreciation of the handling environment faced by the patient. The general different DPI formulation types, which have evolved to address the challenges of aerosolizing fine cohesive drug-containing particles to create consistent and effective DPI products, are described. This section reviews the range of particle engineering processes that may produce micron-sized drug-containing particles and their subsequent assembly as either carrier-based or carrier-free compositions. The creation of such formulations is then discussed in the context of the material, bulk, interfacial and ultimately drug-delivery properties that are considered to affect formulation performance. A brief conclusion then considers the future DPI product choices, notably the issue of technology versus affordability in the evolving inhaler market.

A Screening Approach to the Safe-and-Sustainable-by-Design Development of Advanced Insulation Materials

Herein, a Safe-and-Sustainable-by-Design (SSbD) screening strategy on four different inorganic aerogel mats and two conventional mineral wools for ranking purposes is demonstrated. Given that they do not consist of particles, the release is first simulated, addressing three occupational exposure scenarios, realistic for their intended use as building insulators. No exposure to consumers nor to the environment is foreseen in the use phase, however, aerosols may be released during mat installation, posing an inhalation risk for workers. All four aerogel mats release more respirable dust than the benchmark materials and 60% thereof deposits in the alveolar region according to modelling tools. The collected aerogel dust allows for subsequent screening of hazard implications via two abiotic assays: 1) surface reactivity in human blood serum; 2) biodissolution kinetics in lung simulant fluids. Both aerogels and conventional insulators show similar surface reactivity. Differences in biodissolution are influenced by the specifically designed organic and inorganic structural modifications. Aerogel mats are better-performing insulators (2-fold lower thermal conductivity than the benchmark) However, this work demonstrates how investment decisions can be balanced with safety and sustainability aspects. Concepts of analogy and similarity thus support easily accessible methods to companies for safe and economically viable innovation with advanced materials.

Microscopy of Woven and Nonwoven Face Covering Materials: Implications for Particle Filtration

A suite of natural, synthetic, and mixed synthetic-natural woven fabrics, along with nonwoven filtration layers from a surgical mask and an N95 respirator, was examined using visible light microscopy, scanning electron microscopy, and micro-X-ray computed tomography (µXCT) to determine the fiber diameter distribution, fabric thickness, and the volume of solid space of the fabrics. Nonwoven materials exhibit a positively skewed distribution of fiber diameters with a mean value of ≈3 μm, whereas woven fabrics exhibit a normal distribution of diameters with mean values roughly five times larger (>15 μm). The mean thickness of the N95 filtration material is 1093 μm and is greater than that of the woven fabrics that span from 420 to 650 μm. A new procedure for measuring the thickness of flannel fabrics is proposed that accounts for raised fibers. µXCT allowed for a quantitative nondestructive approach to measure fabric porosity as well as the surface area/volume. Cotton flannel showed the largest mean isotropy of any fabric, though fiber order within the weave is poorly represented in the surface electron images. Surface fabric isotropy and surface area/volume ratios are proposed as useful microstructural quantities to consider for future particle filtration modeling efforts of woven materials.

Mysteriously rapid rise in Legionnaires' disease incidence correlates with declining atmospheric sulfur dioxide

Legionnaires' disease (LD) is a severe form of pneumonia (∼10-25% fatality rate) caused by inhalation of aerosols containing Legionella, a pathogenic gram-negative bacteria. These bacteria can grow, spread, and aerosolize through building water systems. A recent dramatic increase in LD incidence has been observed globally, with a 9-fold increase in the United States from 2000 to 2018, and with disproportionately higher burden for socioeconomically vulnerable subgroups. Despite the focus of decades of research since the infamous 1976 outbreak, substantial knowledge gaps remain with regard to source of exposure and the reason(s) for the dramatic increase in LD incidence. Here, we rule out factors indicated in literature to contribute to its long-term increases and identify a hitherto unexplored explanatory factor. We also provide an epidemiological demonstration that the occurrence of LD is linked with exposure to cooling towers (CTs). Our results suggest that declining sulfur dioxide air pollution, which has many well-established health benefits, results in reduced acidity of aerosols emitted from CTs, which may prolong the survival duration of Legionella in contaminated CT droplets and contribute to the increase in LD incidence. Mechanistically associating decreasing aerosol acidity with this respiratory disease has implications for better understanding its transmission, predicting future risks, and informed design of preventive and interventional strategies that consider the complex impacts of continued sulfur dioxide changes.

Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review

Objective

Children who start in day-care have 2-4 times as many respiratory infections compared to children who are cared for at home, and day-care staff are among the employees with the highest absenteeism. The extensive new knowledge that has been generated in the COVID-19 era should be used in the prevention measures we prioritize. The purpose of this narrative review is to answer the questions: Which respiratory viruses are the most significant in day-care centers and similar indoor environments? What do we know about the transmission route of these viruses? What evidence is there for the effectiveness of different non-pharmaceutical prevention measures?

Design

Literature searches with different terms related to respiratory infections in humans, mitigation strategies, viral transmission mechanisms, and with special focus on day-care, kindergarten or child nurseries, were conducted in PubMed database and Web of Science. Searches with each of the main viruses in combination with transmission, infectivity, and infectious spread were conducted separately supplemented through the references of articles that were retrieved.

Results

Five viruses were found to be responsible for ≈95% of respiratory infections: rhinovirus, (RV), influenza virus (IV), respiratory syncytial virus (RSV), coronavirus (CoV), and adenovirus (AdV). Novel research, emerged during the COVID-19 pandemic, suggests that most respiratory viruses are primarily transmitted in an airborne manner carried by aerosols (microdroplets).

Conclusion

Since airborne transmission is dominant for the most common respiratory viruses, the most important preventive measures consist of better indoor air quality that reduces viral concentrations and viability by appropriate ventilation strategies. Furthermore, control of the relative humidity and temperature, which ensures optimal respiratory functionality and, together with low resident density (or mask use) and increased time outdoors, can reduce the occurrence of respiratory infections.

Single Liquid Aerosol Microparticle Electrochemistry on a Suspended Ionic Liquid Film

Liquid aerosols are ubiquitous in nature, and several tools exist to quantify their physicochemical properties. As a measurement science technique, electrochemistry has not played a large role in aerosol analysis because electrochemistry in air is rather difficult. Here, a remarkably simple method is demonstrated to capture and electroanalyze single liquid aerosol particles with radii on the order of single micrometers. An electrochemical cell is constructed by a microwire (cylindrical working electrode) traversing a film of ionic liquid (1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide) that is suspended within a wire loop (reference/counter electrode). An ionic liquid is chosen because the low vapor pressure preserves the film over weeks, vastly improving suspended film electroanalysis. The resultant high surface area allows the suspended ionic liquid cell to act as an aerosol net. Given the hydrophobic nature of the ionic liquid, aqueous aerosol particles do not coalesce into the film. When the liquid aerosols collide with the sufficiently biased microwire (creating a complex boundary: aerosol|wire|ionic liquid|air), the electrochemistry within a single liquid aerosol particle can be interrogated in real-time. The ability to achieve liquid aerosol size distributions for aerosols over 1 µm in radius is demonstrated.

Prenatal Nicotine Exposure Raises Male Blood Pressure via FTO-Mediated NOX2/ROS Signaling

BACKGROUND

Cigarette smoking/nicotine exposure in pregnancy shows an increased risk of hypertension in offspring, but the mechanisms are unclear. This study tested the hypothesis that m6A RNA hypomethylation epigenetically regulates vascular NOX (NADPH oxidase) and reactive oxygen species production, contributing to the fetal programming of a hypertensive phenotype in nicotine-exposed offspring.

METHODS

Pregnant rats were exposed to episodic chronic intermittent nicotine aerosol (CINA) or saline aerosol control from gestational day 4 to day 21, and experiments were performed in 6-month-old adult offspring.

RESULTS

Antenatal CINA exposure augmented Ang II (angiotensin II)-stimulated blood pressure response in male, but not female offspring. Moreover, CINA increased vascular NOX2 expression and superoxide production exclusively in male offspring. Inhibition of NOX2 with gp91ds-tat, both ex vivo and in vivo, mitigated the CINA-induced elevation in superoxide production and blood pressure response. Notably, CINA enhanced the expression of vascular m6A demethylase FTO (fat mass and obesity-associated protein), while reducing the total vascular m6A abundance and specific m6A methylation of the NOX2 gene. Additionally, ex vivo inhibition of FTO with FB23-2 attenuated CINA-induced increases in vascular NOX2 expression. In vitro experiments using human umbilical vein endothelial cells demonstrated that nicotine dose-dependently upregulated FTO and NOX2 protein abundance, which were reversed by treatment with the FTO inhibitor FB23-2 or FTO knockdown using siRNAs.

CONCLUSIONS

This study uncovers a new mechanism: m6A demethylase FTO-mediated epigenetic upregulation of vascular NOX2 signaling in CINA-induced hypertensive phenotype. This insight could lead to a therapeutic target for preventing and treating developmental hypertension programming.

Shape Anisotropy-Governed High-Performance Nanomagnetosol for In Vivo Magnetic Particle Imaging of Lungs

Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19) has shown extensive lung manifestations in vulnerable individuals, putting lung imaging and monitoring at the forefront of early detection and treatment. Magnetic particle imaging (MPI) is an imaging modality, which can bring excellent contrast, sensitivity, and signal-to-noise ratios to lung imaging for the development of new theranostic approaches for respiratory diseases. Advances in MPI tracers would offer additional improvements and increase the potential for clinical translation of MPI. Here, a high-performance nanotracer based on shape anisotropy of magnetic nanoparticles is developed and its use in MPI imaging of the lung is demonstrated. Shape anisotropy proves to be a critical parameter for increasing signal intensity and resolution and exceeding those properties of conventional spherical nanoparticles. The 0D nanoparticles exhibit a 2-fold increase, while the 1D nanorods have a > 5-fold increase in signal intensity when compared to VivoTrax. Newly designed 1D nanorods displayed high signal intensities and excellent resolution in lung images. A spatiotemporal lung imaging study in mice revealed that this tracer offers new opportunities for monitoring disease and guiding intervention.

Compartmentalized SARS-CoV-2 replication in upper versus lower respiratory tract after intranasal inoculation or aerosol exposure

Non-human primate models are essential for the development of vaccines and antivirals against infectious diseases. Rhesus macaques are a widely utilized infection model for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We compared cellular tropism and virus replication in rhesus macaques inoculated with SARS-CoV-2 via the intranasal route, or via exposure to aerosols. Intranasal inoculation results in replication in the upper respiratory tract and limited lower respiratory tract involvement, whereas exposure to aerosols results in infection throughout the respiratory tract. In comparison to multi-route inoculation, the intranasal and aerosol inoculation routes result in reduced SARS-CoV-2 replication in the respiratory tract.

Analysis of aerosol generation during Er:YAG laser-assisted caries treatment: A randomized clinical trial

BACKGROUND

Maintaining biosafety in dental practice involves the effective elimination of aerosols produced during dental treatment.

OBJECTIVES

To assess the quantity of aerosols and aerobic bacteria in the air during the treatment of caries.

MATERIAL AND METHODS

The study involved 60 patients with a total of 60 molar teeth (n = 60) in the mandible who were divided into 2 groups based on caries treatment method. Group 1 (G1, n = 30) received treatment with a conventional dental turbine (W&H Synea TA-98LC; W&H, Burmoos, Austria), while group 2 (G2, n = 30) underwent treatment with an Er:YAG (erbium-doped yttrium aluminium garnet) laser (LightWalker, Fotona, Slovenia). Measurements of aerosol particles between 0.3 Ęm and 10.0 Ęm near the operatorfs mouth were taken using the PC200 laser particle counter (Trotec GmbH, Schwerin, Germany). The number of aerobic bacteria in the air was determined using 60 Petri plates with a microbiological medium (Columbia agar with 5% sheep blood) and the sedimentation method. A control group (G3) was established to measure initial aerosol levels and initial total number of bacteria colony-forming units (CFUs) before each treatment.

RESULTS

In G1 (dental turbine), the median value of aerosol particles was 57,021 (42,564.67,568), while in G2 (Er:YAG laser), it was significantly lower at 33,318 (28,463.35,484) (p < 0.001). The median total bacteria count per cubic meter of air in G1 (conventional dental turbine + high volume evacuator (HVE)), G2 (Er:YAG laser + HVE) and G3 (control group before caries treatment) were 734 (420.988), 158 (96.288) and 48 (32.74), respectively, with a statistically significant difference between the groups (p < 0.001).

CONCLUSIONS

The use of Er:YAG laser during caries treatment resulted in a 41.6% reduction in aerosol amounts and a 78.5% decrease in the total bacterial count (TBC) compared to treatment with a dental turbine.

Design and validation of an exposure system for efficient inter-animal SARS-CoV-2 airborne transmission in Syrian hamsters

IMPORTANCE

The main route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is airborne. However, there are few experimental systems that can assess the airborne transmission dynamics of SARS-CoV-2 in vivo. Here, we designed, built, and characterized a hamster transmission caging and exposure system that allows for efficient SARS-CoV-2 airborne transmission in Syrian hamsters without contributions from fomite or direct contact transmission. We successfully measured SARS-CoV-2 viral RNA in aerosols and demonstrated that SARS-CoV-2 is transmitted efficiently at either a 1:1 or 1:4 infected index to naïve recipient hamster ratio. This is meaningful as a 1:4 infected index to naïve hamster ratio would allow for simultaneous comparisons of various interventions in naïve animals to determine their susceptibility to infection by aerosol transmission of SARS-CoV-2. Our SARS-CoV-2 exposure system allows for testing viral airborne transmission dynamics and transmission-blocking therapeutic strategies against SARS-CoV-2 in Syrian hamsters.

The Role of the Biosafety Cabinet in Preventing Infection in the Clinical Laboratory

Clinical laboratories are essential in healthcare to better diagnose, treat, and track medical diseases. However, handling infectious organisms and possibly infectious materials in these laboratories puts the safety of laboratory workers and the general public at risk. By controlling the distribution of infectious substances and stopping the spread of diseases, biosafety cabinets (BSCs) have become crucial tools in guaranteeing laboratory safety. The prevention of infections is most important in medical and laboratory settings. In clinical laboratories, biological and infectious agents are handled, posing threats to healthcare workers and the general public. To avoid infections, proper training of the BSC is essential. Laboratory employees are instructed in aseptic procedures, proper hand posture, and efficient personal protection when working in the cabinet. These instructions decrease the chance of contaminating the surrounding area. Additionally, user ergonomics are taken into account while designing BSC, reducing operator fatigue, and guaranteeing that staff can execute tasks precisely for extended periods. This review highlights the importance of biosafety cabinets in maintaining a secure laboratory environment and explains their crucial function in infection control.

Aerosol Emissions from Heated Tobacco Products: A Review Focusing on Carbonyls, Analytical Methods, and Experimental Quality

We provide an extensive review of 17 independent and industry-funded studies targeting carbonyls in aerosol emissions of Heated Tobacco Products (HTPs), focusing on quality criteria based on the reproducibility of experiments, appropriate analytic methods, and puffing regimes. Most revised studies complied with these requirements, but some were unreproducible, while others failed to consider analytical variables that may have affected the results and/or produced unrealistic comparisons. We also provide a review of the literature on the physicochemical properties of heated tobacco and HTP aerosols, as well as the evaluation of HTPs by regulatory agencies, addressing various critiques of their relative safety profile. The outcomes from the revised studies and regulatory evaluations tend to agree with and converge to a general consensus that HTP aerosols expose users to significantly lower levels of toxicity than tobacco smoke.

Characterization and Toxic Potency of Airborne Particles Formed upon Waste from Electrical and Electronic Equipment Waste Recycling: A Case Study

Manual dismantling, shredding, and mechanical grinding of waste from electrical and electronic equipment (WEEE) at recycling facilities inevitably lead to the accidental formation and release of both coarse and fine particle aerosols, primarily into the ambient air. Since diffuse emissions to air of such WEEE particles are not regulated, their dispersion from the recycling plants into the adjacent environment is possible. The aim of this interdisciplinary project was to collect and characterize airborne WEEE particles smaller than 1 μm generated at a Nordic open waste recycling facility from a particle concentration, shape, and bulk and surface composition perspective. Since dispersed airborne particles eventually may reach rivers, lakes, and possibly oceans, the aim was also to assess whether such particles may pose any adverse effects on aquatic organisms. The results show that WEEE particles only exerted a weak tendency toward cytotoxic effects on fish gill cell lines, although the exposure resulted in ROS formation that may induce adverse effects. On the contrary, the WEEE particles were toxic toward the crustacean zooplankter Daphnia magna, showing strong effects on survival of the animals in a concentration-dependent way.

Does doffing the FEES Box generate a significant cloud of particles after aerosol-generating procedures? A proof-of-concept study

PURPOSE

The spread of airborne diseases, including coronaviruses, remains a widespread public health concern. Published studies outline the use of protective barriers to limit the spread of pathogenic particles and droplets resulting from coughing, sneezing, and talking. The findings suggest a role for these barriers during aerosol-generating procedures, such as flexible endoscopic evaluation of swallowing (FEES). However, the question remains of whether doffing a protective barrier will create a concentrated cloud of particles that will increase health professionals' exposure.

METHOD

We simulated four clinical scenarios of coughing and sneezing, talking, eating and drinking, and delivering supplemental oxygen to test whether doffing the FEES Box protective barrier would result in a particle cloud.

RESULT

For all scenarios simulated, doffing the FEES Box did not result in a significant increase in mean particle count. Further, the manner of FEES Box removal did not significantly influence mean particle counts on a consistent basis.

CONCLUSION

These results suggest that doffing the FEES Box does not increase exposure to airborne particles. Although more research is needed to confirm these findings, FEES Box usage should be considered during aerosol-generating procedures, to protect and reassure healthcare professionals who work with patients with COVID-19 or other airborne diseases.

Inhalation of vaccines and antiviral drugs to fight respiratory virus infections: reasons to prioritize the pulmonary route of administration

Many of the current pandemic threats are caused by viruses that infect the respiratory tract. Remarkably though, the majority of vaccines and antiviral drugs are administered via alternative routes. In this perspective, we argue that the pulmonary route of administration deserves more attention in the search for novel therapeutic strategies against respiratory virus infections. Firstly, vaccines administered at the viral portal of entry can induce a broader immune response, employing the mucosal arm of the immune system; secondly, direct administration of antiviral drugs at the target site leads to superior bioavailability, enabling lower dosing and reducing the chance of side effects. We further elaborate on why the pulmonary route may induce a superior effect compared to the intranasal route of administration and provide reasons why dry powder formulations for inhalation have significant advantages over standard liquid formulations.

Differences of airborne and mural microorganisms in a 1,500-year-old Xu Xianxiu's Tomb, Taiyuan, China

Background

Microbial colonization represents one of the main threats to the conservation of subterranean cultural heritage sites. Recently, the microbial colonization on murals in tombs has gradually attracted attention.

Methods

In this study, a total of 33 samples, including 27 aerosol samples and 6 mural painting samples, were collected from different sites of Xu Xianxiu's Tomb and analyzed using culture-dependent methods. We compared the diversities of culturable bacteria and fungi isolated from the air and murals and explored the potential impacts of microorganisms on the biodeterioration of the murals.

Results

Phylogenetic analyses revealed that the culturable bacteria belonged to Bacillus, Microbacterium, Lysobacter and Arthrobacter. And the most of fungal belonged to the Penicillium, Cladosporium and Aspergillus genera. The composition and structure of airborne bacteria and fungi outside the tomb were both significantly different from that inside the tomb. The variation trends of airborne bacterial and fungal concentrations at different sampling sites were remarkably similar. Bacillus frigoritolerans, Bacillus halotolerans, Bacillus safensis, Exiguobacterium mexicanum, Microbacterium trichothecenolyticum, and Micrococcus yunnanensis were bacterial species commonly isolated from both the mural and air environments. Fungal species commonly isolated from aerosol samples and mural painting samples were Alternaria alternata, Cladosporium cladosporioides, Penicillium brevicompactum, and Peyronellaea glomerata. The prediction of the ecological functions of the bacteria revealed that chemoheterotrophy or aerobic_chemoheterotrophy accounted for substantial relative proportions in all sample types.

Conclusion

These results suggest that the aerosol circulation between the inside and outside environments of the tomb was weak and that the outside environment had yet to have an impact on the air microbial community inside the tomb. Selective colonization of microorganisms, which is mediated by interaction between microorganisms and special microenvironmental factors, is an important reason for the biodeterioration of murals.

Inactivation mechanisms of influenza A virus under pH conditions encountered in aerosol particles as revealed by whole-virus HDX-MS

Multiple respiratory viruses, including influenza A virus (IAV), can be transmitted via expiratory aerosol particles, and aerosol pH was recently identified as a major factor influencing airborne virus infectivity. Indoors, small exhaled aerosols undergo rapid acidification to pH ~4. IAV is known to be sensitive to mildly acidic conditions encountered within host endosomes; however, it is unknown whether the same mechanisms could mediate viral inactivation within the more acidic aerosol micro-environment. Here, we identified that transient exposure to pH 4 caused IAV inactivation by a two-stage process, with an initial sharp decline in infectious titers mainly attributed to premature attainment of the post-fusion conformation of viral protein haemagglutinin (HA). Protein changes were observed by hydrogen-deuterium exchange coupled to mass spectrometry (HDX-MS) as early as 10 s post-exposure to acidic conditions. Our HDX-MS data are in agreement with other more labor-intensive structural analysis techniques, such as X-ray crystallography, highlighting the ease and usefulness of whole-virus HDX-MS for multiplexed protein analyses, even within enveloped viruses such as IAV. Additionally, virion integrity was partially but irreversibly affected by acidic conditions, with a progressive unfolding of the internal matrix protein 1 (M1) that aligned with a more gradual decline in viral infectivity with time. In contrast, no acid-mediated changes to the genome or lipid envelope were detected. Improved understanding of respiratory virus fate within exhaled aerosols constitutes a global public health priority, and information gained here could aid the development of novel strategies to control the airborne persistence of seasonal and/or pandemic influenza in the future. IMPORTANCE It is well established that COVID-19, influenza, and many other respiratory diseases can be transmitted by the inhalation of aerosolized viruses. Many studies have shown that the survival time of these airborne viruses is limited, but it remains an open question as to what drives their infectivity loss. Here, we address this question for influenza A virus by investigating structural protein changes incurred by the virus under conditions relevant to respiratory aerosol particles. From prior work, we know that expelled aerosols can become highly acidic due to equilibration with indoor room air, and our results indicate that two viral proteins are affected by these acidic conditions at multiple sites, leading to virus inactivation. Our findings suggest that the development of air treatments to quicken the speed of aerosol acidification would be a major strategy to control infectious bioburdens in the air.

Host and viral determinants of airborne transmission of SARS-CoV-2 in the Syrian hamster

It remains poorly understood how SARS-CoV-2 infection influences the physiological host factors important for aerosol transmission. We assessed breathing pattern, exhaled droplets, and infectious virus after infection with Alpha and Delta variants of concern (VOC) in the Syrian hamster. Both VOCs displayed a confined window of detectable airborne virus (24-48 h), shorter than compared to oropharyngeal swabs. The loss of airborne shedding was linked to airway constriction resulting in a decrease of fine aerosols (1-10μm) produced, which are suspected to be the major driver of airborne transmission. Male sex was associated with increased viral replication and virus shedding in the air. Next, we compared the transmission efficiency of both variants and found no significant differences. Transmission efficiency varied mostly among donors, 0-100% (including a superspreading event), and aerosol transmission over multiple chain links was representative of natural heterogeneity of exposure dose and downstream viral kinetics. Co-infection with VOCs only occurred when both viruses were shed by the same donor during an increased exposure timeframe (24-48 h). This highlights that assessment of host and virus factors resulting in a differential exhaled particle profile is critical for understanding airborne transmission.

Effect of open windows on airborne contamination and its topographical distribution in the dental operatory

Aerosols produced by dental handpieces represent a permanent risk of disease transmission in the dental environment. The current study evaluated the effects of natural ventilation (open windows) on Streptococcus mutans airborne contamination by dental handpieces in simulated clinical conditions. A dental phantom was placed on a dental chair at a standard university dental clinic operatory. An S. mutans suspension was infused into the phantom's mouth while an operator performed standardized dental procedures using low (contra-angle) and high speed (turbine) dental handpieces or an ultrasonic scaler, with windows open or closed. Selective medium Petri dishes were placed in 18 sites of the operatory environment to evaluate contamination topographically. Sites were clustered as: wall, floor, ceiling, dental chair, and cabinet. Contamination was expressed as log10 CFU/cm2 . A linear mixed model analysis was used, nesting the sites within each ventilation and handpiece combination. Open windows significantly reduced contamination. The high-speed handpiece provided the highest contamination, followed by the ultrasonic scaler and the low-speed handpiece. Contamination values were much smaller at the ceiling, and much larger at the chair. Opening windows produced more homogeneous contamination of the operatory compared to closed windows. Natural ventilation during dental procedures decreases contamination and affects its topographical distribution.

A simple approach to analysing trace metals in aerosols produced by e-cigarettes

Electronic cigarettes are a relatively new alternative to cigarettes, which have been marketed as being safer for users than conventional cigarettes. However, they may still result in inhalation of potentially toxic or carcinogenic substances, including metals produced by the heating element. This study looked at the levels of trace metals being produced by different atomizers used in e-cigarettes using a sample introduction technique based on the collection of aerosols produced by e-cigarettes in nitric acid, using glass midget impingers. Collected metals were then identified using an inductively coupled plasma-mass spectrometer (ICP-MS), which allowed detection in the low ppb range. Results obtained showed considerable variation in the levels of metals between both manufacturers of atomizers and also between different batches of coils. This variation is likely to be even greater if the ability of users to customise some types of e-cigarettes is considered. Although there are limitations in terms of possible interferences from other metallic components in the e-cigarettes, the findings suggest the proposed method could be of use in investigating the risk of inhalation of toxic metals from e-cigarette use.

Effects of Anthropogenic Disturbance and Seasonal Variation on Aerobiota in Highly Visited Show Caves in Slovenia

Aerosols in caves are natural tracers and, together with climatic parameters, provide a detailed insight into atmospheric conditions, responses to climatic changes and anthropogenic influences in caves. Microbiological air monitoring in show caves is becoming increasingly useful to understand changes in cave ecosystems and to implement and review measures for sustainable cave use and tourism development. In 2017 and 2018, air along tourist trails in caves Postojnska jama and Škocjanske jame (Slovenia) was sampled before and after tourist visits. Samples were analysed using culture-dependent methods, flow cytometry, detection of β-D-glucan and lipopolysaccharide and compared with CO2 and temperature data to measure anthropogenic influences and seasonality on aerobiota. While the presence of tourists significantly increased concentrations of airborne microorganisms (p < 0.05), β-D-glucan and CO2 did not show such a trend and were more dependent on seasonal changes. Locally, concentrations of cultivable microorganisms above 1000 CFU/m3 were detected, which could have negative effects on the autochthonous microbiota and possibly on human health. A mixture of bacteria typically associated with humans was found in the air and identified with MALDI-TOF MS. Using MALDI-TOF MS, we achieved a 69.6% success rate in identification. Micrococcus luteus, Streptococcus mitis, Staphylococcus epidermidis and Moraxella spp. were recognized as good indicators of cave anthropisation.

Long-Term Analysis of Aerosol Concentrations Using a Low-Cost Sensor: Monitoring African Dust Outbreaks in a Suburban Environment in the Canary Islands

This study presents the results of the long-term monitoring of PM10 and PM2.5 concentrations using a low-cost particle sensor installed in a suburban environment in the Canary Islands. A laser-scattering Nova Fitness SDS011 sensor was operated continuously for approximately three and a half years, which is longer than most other studies using this type of sensor. The impact of African dust outbreaks on the aerosol concentrations was assessed, showing a significant increase in both PM10 and PM2.5 concentrations during the outbreaks. Additionally, a good correlation was found with a nearby reference instrument of the air quality network of the Canary Islands' government. The correlation between the PM10 and PM2.5 concentrations, the effect of relative humidity, and the stability of the sensor were also investigated. This study highlights the potential of this kind of sensor for long-term air quality monitoring with a view to developing extensive and dense low-cost air quality networks that are complementary to official air quality networks.

Single-Layer and Double-Layer Filtration Materials Based on Polyvinylidene Fluoride-Co-hexafluoropropylene Nanofibers Coated on Melamine Microfibers

In this work, we demonstrate selected optimization changes in the simple design of filtration masks to increase particle removal efficiency (PRE) and filter quality factor by combining experiments and numerical modeling. In particular, we focus on single-layer filters fabricated from uniform thickness fibers and double-layer filters consisting of a layer of highly permeable thick fibers as a support and a thin layer of filtering electrospun nanofibers. For single-layer filters, we demonstrate performance improvement in terms of the quality factor by optimizing the geometry of the composition. We show significantly better PRE performance for filters composed of micrometer-sized fibers covered by a thin layer of electrospun nanofibers. This work is motivated and carried out in collaboration with a targeted industrial development of selected melamine-based filter nano- and micromaterials.

Monodisperse Fluorescent Polystyrene Microspheres for Staphylococcus aureus Aerosol Simulation

Staphylococcus aureus (SA) is one of the most common causes of hospital-acquired infections and foodborne illnesses and is commonly found in nature in air, dust, and water. The spread and transmission of SA aerosols in the air has the potential to cause epidemic transmission among humans and between humans and animals. To effectively provide the timely warning of SA aerosols in the atmosphere, the identification and detection of SA aerosol concentrations are required. Due to their homogeneous physicochemical properties, highly monodisperse submicron polystyrene (PS) microspheres can be used as one of the simulants of SA aerosols. In this study, 800 nm monodisperse fluorescent PS (f-PS) microspheres with fluorescence spectra and particle size distribution similar to those of SA were prepared. The 800 nm monodisperse f-PS microspheres had a fluorescence characteristic peak at 465 nm; in aerosols, 800 nm monodisperse f-PS microspheres with a similar particle size distribution to that of SA were further verified, mainly in the range of 500 nm-1000 nm; finally, it was found that the f-PS microspheres still possessed similar fluorescence characteristics after 180 days. The f-PS microspheres prepared in this study are very close to SA in terms of particle size and fluorescence properties, providing a new idea for aerosol analogs of SA.

Detection of influenza virus and Streptococcus pneumoniae in air sampled from co-infected ferrets and analysis of their influence on pathogen stability

Secondary infection with Streptococcus pneumoniae has contributed significantly to morbidity and mortality during multiple influenza virus pandemics and remains a common threat today. During a concurrent infection, both pathogens can influence the transmission of each other, but the mechanisms behind this are unclear. In this study, condensation air sampling and cyclone bioaerosol sampling were performed using ferrets first infected with the 2009 H1N1 pandemic influenza virus (H1N1pdm09) and secondarily infected with S. pneumoniae strain D39 (Spn). We detected viable pathogens and microbial nucleic acid in expelled aerosols from co-infected ferrets, suggesting that these microbes could be present in the same respiratory expulsions. To assess whether microbial communities impact pathogen stability within an expelled droplet, we performed experiments measuring viral and bacterial persistence in 1 µL droplets. We observed that H1N1pdm09 stability was unchanged in the presence of Spn. Further, Spn stability was moderately increased in the presence of H1N1pdm09, although the degree of stabilization differed between airway surface liquid collected from individual patient cultures. These findings are the first to collect both pathogens from the air and in doing so, they provide insight into the interplay between these pathogens and their hosts.IMPORTANCEThe impact of microbial communities on transmission fitness and environmental persistence is under-studied. Environmental stability of microbes is crucial to identifying transmission risks and mitigation strategies, such as removal of contaminated aerosols and decontamination of surfaces. Co-infection with S. pneumoniae is very common during influenza virus infection, but little work has been done to understand whether S. pneumoniae alters stability of influenza virus, or vice versa, in a relevant system. Here, we demonstrate that influenza virus and S. pneumoniae are expelled by co-infected hosts. Our stability assays did not reveal any impact of S. pneumoniae on influenza virus stability, but did show a trend towards increased stability of S. pneumoniae in the presence of influenza viruses. Future work characterizing environmental persistence of viruses and bacteria should include microbially complex solutions to better mimic physiologically relevant conditions.

Multidrug Aerosol Delivery During Mechanical Ventilation

Background: In the critically ill, pulmonary vasodilators are often provided off label to intubated patients using continuous nebulization. If additional aerosol therapies such as bronchodilators or antibiotics are needed, vasodilator therapy may be interrupted. This study assesses aerosol systems designed for simultaneous delivery of two aerosols using continuous nebulization and bolus injection without interruption or circuit disconnection. Methods: One i-AIRE dual-port breath-enhanced jet nebulizer (BEJN) or two Aerogen® Solo vibrating mesh nebulizers (VMNs) were installed on the dry side of the humidifier. VMN were stacked; one for infusion and the second for bolus drug delivery. The BEJN was powered by air at 3.5 L/min, 50 psig. Radiolabeled saline was infused at 5 and 10 mL/h with radiolabeled 3 and 6 mL bolus injections at 30 and 120 minutes, respectively. Two adult breathing patterns (duty cycle 0.13 and 0.34) were tested with an infusion time of 4 hours. Inhaled mass (IM) expressed as % of initial syringe activity (IM%/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were measured by calibrated ratemeter. Results: IM%/h during continuous infusion was linear and predictable, mean ± standard deviation (SD): 2.12 ± 1.45%/h, 2.47 ± 0.863%/h for BEJN and VMN, respectively. BEJN functioned without incident. VMN continuous aerosol delivery stopped spontaneously in 3 of 8 runs (38%); bolus delivery stopped spontaneously in 3 of 16 runs (19%). Tapping restarted VMN function during continuous and bolus delivery runs. Bolus delivery IM% (mean ± SD): 20.90% ± 7.01%, 30.40% ± 11.10% for BEJN and VMN, respectively. Conclusion: Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization.

Size-Dependent Diffusion and Dispersion of Particles in Mucin

Mucus, composed significantly of glycosylated mucins, is a soft and rheologically complex material that lines respiratory, reproductive, and gastrointestinal tracts in mammals. Mucus may present as a gel, as a highly viscous fluid, or as a viscoelastic fluid. Mucus acts as a barrier to the transport of harmful microbes and inhaled atmospheric pollutants to underlying cellular tissue. Studies on mucin gels have provided critical insights into the chemistry of the gels, their swelling kinetics, and the diffusion and permeability of molecular constituents such as water. The transport and dispersion of micron and sub-micron particles in mucin gels and solutions, however, differs from the motion of small molecules since the much larger tracers may interact with microstructure of the mucin network. Here, using brightfield and fluorescence microscopy, high-speed particle tracking, and passive microrheology, we study the thermally driven stochastic movement of 0.5-5.0 μm tracer particles in 10% mucin solutions at neutral pH, and in 10% mucin mixed with industrially relevant dust; specifically, unmodified limestone rock dust, modified limestone, and crystalline silica. Particle trajectories are used to calculate mean square displacements and the displacement probability distributions; these are then used to assess tracer diffusion and transport. Complex moduli are concomitantly extracted using established microrheology techniques. We find that under the conditions analyzed, the reconstituted mucin behaves as a weak viscoelastic fluid rather than as a viscoelastic gel. For small- to moderately sized tracers with a diameter of lessthan 2 μm, we find that effective diffusion coefficients follow the classical Stokes-Einstein relationship. Tracer diffusivity in dust-laden mucin is surprisingly larger than in bare mucin. Probability distributions of mean squared displacements suggest that heterogeneity, transient trapping, and electrostatic interactions impact dispersion and overall transport, especially for larger tracers. Our results motivate further exploration of physiochemical and rheological mechanisms mediating particle transport in mucin solutions and gels.

Advances in soft mist inhalers

INTRODUCTION

Soft mist inhalers (SMIs) are propellant-free inhalers that utilize mechanical power to deliver single or multiple doses of inhalable drug aerosols in the form of a slow mist to patients. Compared to traditional inhalers, SMIs allow for a longer and slower release of aerosol with a smaller ballistic effect, leading to a limited loss in the oropharyngeal area, whilst requiring little coordination of actuation and inhalation by patients. Currently, the Respimat® is the only commercially available SMI, with several others in different stages of preclinical and clinical development.

AREAS COVERED

The primary purpose of this review is to critically assess recent advances in SMIs for the delivery of inhaled therapeutics.

EXPERT OPINION

Advanced particle formulations, such as nanoparticles which target specific areas of the lung, Biologics, such as vaccines, proteins, and antibodies (which are sensitive to aerosolization), are expected to be generally delivered by SMIs. Furthermore, repurposed drugs are expected to constitute a large share of future formulations to be delivered by SMIs. SMIs can also be employed for the delivery of formulations that target systemic diseases. Finally, digitalizing SMIs would improve patient adherence and provide clinicians with fundamental insights into patients' treatment progress.

The Spontaneous Electron-Mediated Redox Processes on Sprayed Water Microdroplets

Water is considered as an inert environment for the dispersion of many chemical systems. However, by simply spraying bulk water into microsized droplets, the water microdroplets have been shown to possess a large plethora of unique properties, including the ability to accelerate chemical reactions by several orders of magnitude compared to the same reactions in bulk water, and/or to trigger spontaneous reactions that cannot occur in bulk water. A high electric field (∼10⁹ V/m) at the air-water interface of microdroplets has been postulated to be the probable cause of the unique chemistries. This high field can even oxidize electrons out of hydroxide ions or other closed-shell molecules dissolved in water, forming radicals and electrons. Subsequently, the electrons can trigger further reduction processes. In this Perspective, by showing a large number of such electron-mediated redox reactions, and by studying the kinetics of these reactions, we opine that the redox reactions on sprayed water microdroplets are essentially processes using electrons as the charge carriers. The potential impacts of the redox capability of microdroplets are also discussed in a larger context of synthetic chemistry and atmospheric chemistry.

Preparation of Co-Amorphous Levofloxacin Systems for Pulmonary Application

Addressing antimicrobial resistance requires new approaches in various disciplines of pharmaceutical sciences. The fluoroquinolone levofloxacin (LEV) plays an important role in the therapy of lung infections. However, its effectiveness is limited by its severe side effects involving tendinopathy, muscle weakness and psychiatric disturbance. Therefore, there is a need for the development of an effective formulation of LEV with reduced systemic drug concentrations, thereby also reducing the consumption and excretion of antibiotics or metabolites. This study aimed for the development of a pulmonary-applicable LEV formulation. Co-amorphous LEV-L-arginine (ARG) particles were prepared by spray drying and characterised by scanning electron microscopy, modulated differential scanning calorimetry, X-ray powder diffraction, Fourier-transform infrared spectroscopy and next generation impactor analysis. Co-amorphous LEV-ARG salts were produced independently of varying process parameters. The use of 30% (v/v) ethanol as a solvent led to better aerodynamic properties compared to an aqueous solution. With a mass median aerodynamic diameter of just over 2 µm, a fine particle fraction of over 50% and an emitted dose of over 95%, the product was deemed suitable for a pulmonary application. The created process was robust towards the influence of temperature and feed rate, as changing these parameters did not have a significant influence on the critical quality attributes, indicating the feasibility of producing pulmonary-applicable co-amorphous particles for sustainable antibiotic therapy.

Aerosols, airflow, and more: examining the interaction of speech and the physical environment

We describe ongoing efforts to better understand the interaction of spoken languages and their physical environments. We begin by briefly surveying research suggesting that languages evolve in ways that are influenced by the physical characteristics of their environments, however the primary focus is on the converse issue: how speech affects the physical environment. We discuss the speech-based production of airflow and aerosol particles that are buoyant in ambient air, based on some of the results in the literature. Most critically, we demonstrate a novel method used to capture aerosol, airflow, and acoustic data simultaneously. This method captures airflow data via a pneumotachograph and aerosol data via an electrical particle impactor. The data are collected underneath a laminar flow hood while participants breathe pure air, thereby eliminating background aerosol particles and isolating those produced during speech. Given the capabilities of the electrical particle impactor, which has not previously been used to analyze speech-based aerosols, the method allows for the detection of aerosol particles at temporal and physical resolutions exceeding those evident in the literature, even enabling the isolation of the role of individual sound types in the production of aerosols. The aerosols detected via this method range in size from 70 nanometers to 10 micrometers in diameter. Such aerosol particles are capable of hosting airborne pathogens. We discuss how this approach could ultimately yield data that are relevant to airborne disease transmission and offer preliminary results that illustrate such relevance. The method described can help uncover the actual articulatory gestures that generate aerosol emissions, as exemplified here through a discussion focused on plosive aspiration and vocal cord vibration. The results we describe illustrate in new ways the unseen and unheard ways in which spoken languages interact with their physical environments.

Risk Assessment and Source Apportionment of Metals on Atmospheric Particulate Matter in a Suburban Background Area of Gran Canaria (Spain)

Concentration levels of 11 heavy metals were analyzed in PM10 and PM2.5 samples from a suburban area frequently affected by Saharan dust in which is located a school. The heavy metals risk assessment was carried out by the 2011 U.S. Environmental Protection Agency method, estimating the chronic and carcinogenic hazard levels both in adults and children. The highest level of chronic hazard was reached for Cr, with values of approximately 8 (PM10, adulthood), 2 (PM10, childhood) and 1.5 (PM2.5, adult age), significantly exceeding the limit value (equal to 1). Regarding the carcinogenic risk level, it was also high for Cr, with values between 10-3 and 10-1 for both study populations and particle size. For the rest of the studied metals, no health risk levels of concern were obtained. The positive matrix factorization method was used for the estimation of heavy metal emission sources apportionment. Non-exhaust vehicle emissions were the main source of Cr emissions under PM2.5, while industrial processes were the main source for PM10. Mineral dust and marine aerosol were common emission sources for both particles sizes-with different contributions. Vehicle emissions, construction and agricultural activities were the main emission sources for PM10, and fossil fuel combustion, road dust re-suspension and ammonium sulfate were for PM2.5. The results obtained in this study support the need to continue applying mitigation measures in suburban areas which are affected by nearby anthropogenic emissions, causing the consequent emission of materials hazardous to human health.

Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination

The dental setting is regarded as a high-risk environment for aerosol concentrations and transmission of respiratory infectious agents, especially in relation to the COVID-19 pandemic. Although a number of approaches and practices have evolved to reduce the spread of pathogens in the dental setting, the risk of airborne infection remains a concern. Several new extraoral suction (EOS) devices have been marketed recently; further investigation is warranted to determine their clinical effectiveness. The aim of this study was to evaluate the efficacy of a chairside EOS device (PAX 2000 Extraoral Dental Suction System) in reducing aerosol contamination from patients receiving ultrasonic scaling by a registered hygienist as a part of initial or supportive periodontal therapy. The number of colony-forming units (CFUs) was measured with agar plates before, during, and after ultrasonic scaling at 3 different locations in the dental operatory (instrument table, patient chest area, and patient foot area). Forty subjects were randomly allocated into 2 test groups (n = 20) in which ultrasonic scaling was performed with or without the use of the EOS device. The CFUs retrieved after incubation were quantified and identified by their bacterial or fungal taxon. The use of the EOS device reduced the number of CFUs during scaling at all 3 locations, but the difference was only statistically significant (P = 0.018; Mann-Whitney U test) at the patient's chest area, where the highest number of CFUs was present. The aerosols consisted of 74 different taxa of human origin. The results suggest that the tested EOS system may reduce aerosol contamination in the clinical dental setting, especially in proximity to the patient's head, where most aerosols are generated.

Electronic Nicotine Delivery Systems and Cardiovascular/Cardiometabolic Health

The use of electronic nicotine delivery systems, specifically electronic cigarettes (e-cig), has risen dramatically within the last few years; the demographic purchasing these devices is now predominantly adolescents that are not trying to quit the use of traditional combustible cigarettes, but rather are new users. The composition and appearance of these devices has changed since their first entry into the market in the late 2000s, but they remain composed of a battery and aerosol delivery system that is used to deliver breakdown products of propylene glycol/vegetable glycerin, flavorings, and potentially nicotine or other additives. Manufacturers have also adjusted the type of nicotine that is used within the liquid to make the inhalation more palatable for younger users, further affecting the number of youth who use these devices. Although the full spectrum of cardiovascular and cardiometabolic consequences of e-cig use is not fully appreciated, data is beginning to show that e-cigs can cause both short- and long-term issues on cardiac function, vascular integrity and cardiometabolic issues. This review will provide an overview of the cardiovascular, cardiometabolic, and vascular implications of the use of e-cigs, and the potential short- and long-term health effects. A robust understanding of these effects is important in order to inform policy makers on the dangers of e-cigs use.

[Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease]

AIM

Investigate inhalation techniques using different inhalers types and their effect on the course of disease.

MATERIALS AND METHODS

This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and performed spirometry.

RESULTS

80.9% of patients used metered-dose inhaler, 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler, 22.7% - soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 2±1.6, single-dose powder inhaler -1.5±1.3, multiple-dose dry powder inhaler - 1.25±1.4, soft-mist inhaler - 0.68±0.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction, asthma control, severity of dyspnea by mMRC score, exacerbation rate.

CONCLUSION

Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.

Air filtration mitigates aerosol levels both during and after endoscopy procedures

Objectives

Upper gastrointestinal endoscopies are aerosol-generating procedures, increasing the risk of spreading airborne pathogens. We aim to quantify the mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable high-efficiency particulate air (HEPA) filters, during and after upper gastrointestinal endoscopies.

Methods

This observational study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room with 15-17 air changes per hour, a standard endoscopy room with a portable HEPA filtration unit, and a laminar flow theatre with 300 air changes per hour. A particle counter (diameter range 0.3 μm-25 μm) took measurements 10 cm from the mouth. Three analyses were performed: whole procedure particle counts, event-based counts, and air clearance estimation using post-procedure counts.

Results

Compared to a standard endoscopy room, for whole procedures we observe a 28.5x reduction in particle counts in laminar flow (p < 0.001) but no significant effect of HEPA filtration (p = 0.50). For event analysis, we observe for lateral flow theatres reduction in particles >5 μm for oral extubation (12.2x, p < 0.01), reduction in particles <5 μm for coughing/gagging (6.9x, p < 0.05), and reduction for all sizes in anesthetic throat spray (8.4x, p < 0.01) but no significant effect of HEPA filtration. However, we find that in the fallow period between procedures HEPA filtration reduces particle clearance times by 40%.

Conclusions

Laminar flow theatres are highly effective at dispersing aerosols immediately after production and should be considered for high-risk cases where patients are actively infectious or the supply of personal protective equipment is limited. Portable HEPA filers can safely reduce the fallow time between procedures by 40%.

Efficacy of Surgical Masks Versus N95 Respirators for the Prevention of COVID-19 in Dental Settings: A Systematic Review

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2). It spreads mainly through saliva droplets or nasal discharge. Dentists are among the professionals with the greatest risk of contracting and transmitting COVID-19. We compared the efficacy of surgical masks versus N95 respirators in preventing COVID-19 infection in dental settings. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched. Search terms corresponded to a predefined PICOS (patient/population, intervention, comparison, and outcomes) question. The risk of bias was evaluated using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2), ROBIS (Risk of Bias in Systematic Reviews), and Health Evidence tools. A total of 191 articles were screened, and nine of them were further evaluated for eligibility, of which five articles (fulfilled the selection criteria) and were included in this study. Two studies concluded that surgical masks could provide equivalent protection to N95 respirators. Another study found that N95 respirators were superior to surgical masks. The fourth study found that better protection can be achieved when using surgical masks by the aerosol source than when the recipient uses an N95 respirator, while the last study concluded that surgical masks or N95 respirators alone do not provide full protection. Thus, according to this systematic review, N95 respirators provide better protection against COVID-19 infection compared to surgical masks.

Estimates of Future New Particle Formation under Different Emission Scenarios in Beijing

New particle formation (NPF) is a leading source of particulate matter by number and a contributor to particle mass during haze events. Reductions in emissions of air pollutants, many of which are NPF precursors, are expected in the move toward carbon neutrality or net-zero. Expected changes to pollutant emissions are used to investigate future changes to NPF processes, in comparison to a simulation of current conditions. The projected changes to SO₂ emissions are key in changing future NPF number, with different scenarios producing either a doubling or near total reduction in sulfuric acid-amine particle formation rates. Particle growth rates are projected to change little in all but the strictest emission control scenarios. These changes will reduce the particle mass arising by NPF substantially, thus showing a further cobenefit of net-zero policies. Major uncertainties remain in future NPF including the volatility of oxygenated organic molecules resulting from changes to NO_x and amine emissions.

Virus Inactivation Based on Optimal Surfactant Reservoir of Mesoporous Silica

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) caused a pandemic in 2019 and reaffirmed the importance of environmental sanitation. To prevent the spread of viral infections, we propose the application of a mesoporous silica (MS)-based virus-inactivating material. MS is typically synthesized using a micellar surfactant template; hence, the intermediate before removal of the surfactant template is expected to have a virus-inactivating activity. MS-CTAC particles filled with cetyltrimethylammonium chloride (CTAC), a cationic surfactant with an alkyl chain length of 16, were used to test this hypothesis. Plaque assays revealed that the MS-CTAC particles inactivated the enveloped bacteriophage φ6 by approximately 4 orders of magnitude after a contact time of 10 min. The particles also indicated a similar inactivation effect on the nonenveloped bacteriophage Qβ. In aqueous solution, CTAC loaded on MS-CTAC was released until the equilibrium concentration of loading and release on MS was reached. The released CTAC acted on viruses. Thus, MS is likely a good reservoir for the micellar surfactant. Surfactant readsorption also occurred in the MS particles, and the highest retention rate was observed when micellar surfactants with alkyl chain lengths appropriate for the pore size were used. The paper containing MS-CTAC particles was shown to maintain stable viral inactivation for at least three months in a typical indoor environment. Applying this concept to indoor wallpaper and air-conditioning filters could contribute to the inactivation of viruses in aerosols. These findings open possibilities for mesoporous materials with high surface areas, which can further develop into virus inactivation materials.

Size-Resolved Field Performance of Low-Cost Sensors for Particulate Matter Air Pollution

Particulate matter (PM) air pollution is a major health hazard. The health effects of PM are closely linked to particle size, which governs its deposition in (and penetration through) the respiratory tract. In recent years, low-cost sensors that report particle concentrations for multiple-sized fractions (PM_1.0, PM_2.5, PM₁₀) have proliferated in everyday use and scientific research. However, knowledge of how well these sensors perform across the full range of reported particle size fractions is limited. Unfortunately, erroneous particle size data can lead to spurious conclusions about exposure, misguided interventions, and ineffectual policy decisions. We assessed the linearity, bias, and precision of three low-cost sensor models, as a function of PM size fraction, in an urban setting. Contrary to manufacturers' claims, sensors are only accurate for the smallest size fraction (PM₁). The PM_1.0-2.5 and PM_2.5-10 size fractions had large bias, noise, and uncertainty. These results demonstrate that low-cost aerosol sensors (1) cannot discriminate particle size accurately and (2) only report linear and precise measures of aerosol concentration in the accumulation mode size range (i.e., between 0.1 and 1 μm). We recommend that crowdsourced air quality monitoring networks stop reporting coarse (PM_2.5-10) mode and PM₁₀ mass concentrations from these sensors.

Enhanced Filtration Efficiency of Natural Materials with the Addition of Electrospun Poly(vinylidene fluoride-co-hexafluoropropylene) Fibres

Pollutants and infectious diseases can spread through air with airborne droplets and aerosols. A respiratory mask can decrease the amount of pollutants we inhale and it can protect us from airborne diseases. With the onset of the COVID-19 pandemic, masks became an everyday item used by a lot of people around the world. As most of them are for a single use, the amount of non-recyclable waste increased dramatically. The plastic from which the masks are made pollutes the environment with various chemicals and microplastic. Here, we investigated the time- and size-dependent filtration efficiency (FE) of aerosols in the range of 25.9 to 685.4 nm of five different natural materials whose FE was enhanced using electrospun poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF) fibres. A scanning electron microscope (SEM) was used to determine the morphology and structure of the natural materials as well as the thickness of the PVDF fibres, while the phase of the electrospun fibres was determined by Raman spectroscopy. A thin layer of the electrospun PVDF fibres with the same grammage was sandwiched between two sheets of natural materials, and their FE increased up to 80%. By varying the grammature of the electrospun polymer, we tuned the FE of cotton from 82.6 to 99.9%. Thus, through the optimization of the grammage of the electrospun polymer, the amount of plastic used in the process can be minimized, while achieving sufficiently high FE.

Biorisk Management Features of a Temporary COVID-19 Hospital

Introduction

Yale University designed and constructed a temporary field hospital for 100 COVID-19 symptomatic patients. Conservative biocontainment decisions were made in design and operational practices. Objectives of the field hospital included the safe flow of patients, staff, equipment and supplies, and obtaining approval by the Connecticut Department of Public Health (CT DPH) for opening as a field hospital.

Methods

The CT DPH regulations for mobile hospitals were used as primary guidance for the design, equipment, and protocols. References for BSL-3 and ABSL-3 design from the National Institutes of Health (NIH) and Tuberculosis isolation rooms from the United States Centers for Disease Control and Prevention (CDC) were also utilized. The final design involved an array of experts throughout the university.

Results and Conclusion

Vendors tested and certified all High Efficiency Particulate Air (HEPA) filters and balanced the airflows inside the field hospital. Yale Facilities designed and constructed positive pressure access and exit tents within the field hospital, established appropriate pressure relationships between zones, and added Minimum Efficiency Reporting Value 16 exhaust filters. The BioQuell ProteQ Hydrogen Peroxide decontamination unit was validated with biological spores in the rear sealed section of the biowaste tent. A ClorDiSys Flashbox UV-C Disinfection Chamber was also validated. Visual indicators were placed the doors of the pressurized tents and spaced throughout the facility to verify airflows. The plans created to design, construct and operate the field hospital provide a blueprint for recreating and reopening a field hospital in the future if ever needed at Yale University.

Detection of Influenza virus and Streptococcus pneumoniae in air sampled from co-infected ferrets and analysis of their influence on pathogen stability

Secondary infection with Streptococcus pneumoniae has contributed significantly to morbidity and mortality during multiple influenza virus pandemics and remains a common threat today. During a concurrent infection, both pathogens can influence the transmission of each other, but the mechanisms behind this are unclear. In this study, condensation air sampling and cyclone bioaerosol sampling were performed using ferrets first infected with the 2009 H1N1 pandemic influenza virus (H1N1pdm09) and secondarily infected with S. pneumoniae strain D39 (Spn). We detected viable pathogens and microbial nucleic acid in expelled aerosols from co-infected ferrets, suggesting that these microbes could be present in the same respiratory expulsions. To assess whether microbial communities impact pathogen stability within an expelled droplet, we performed experiments measuring viral and bacterial persistence in 1 μL droplets. We observed that H1N1pdm09 stability was unchanged in the presence of Spn. Further, Spn stability was moderately increased in the presence of H1N1pdm09, although the degree of stabilization differed between airways surface liquid collected from individual patient cultures. These findings are the first to collect both pathogens from the air and in doing so, they provide insight into the interplay between these pathogens and their hosts.

Importance

The impact of microbial communities on transmission fitness and environmental persistence is under-studied. Environmental stability of microbes is crucial to identifying transmission risks and mitigation strategies, such as removal of contaminated aerosols and decontamination of surfaces. Co-infection with S. pneumoniae is very common during influenza virus infection, but little work has been done to understand whether S. pneumoniae alters stability of influenza virus, or vice versa, in a relevant system. Here, we demonstrate that influenza virus and S. pneumoniae are expelled by co-infected hosts. Our stability assays did not reveal any impact of S. pneumoniae on influenza virus stability, and a trend towards increased stability of S. pneumoniae in the presence of influenza viruses. Future work characterizing environmental persistence of viruses and bacteria should include microbially-complex solutions to better mimic physiologically relevant conditions.

Toxicological Assessment of Particulate and Metal Hazards Associated with Vaping Frequency and Device Age

Electronic nicotine delivery systems (ENDS) aerosols are complex mixtures of chemicals, metals, and particles that may present inhalation hazards and adverse respiratory health risks. Despite being considered a safer alternative to tobacco cigarettes, metal exposure levels and respiratory effects associated with device aging and vaping frequency have not been fully characterized. In this study, we utilize an automated multi-channel ENDS aerosol generation system (EAGS) to generate aerosols from JUUL pod-type ENDS using tobacco-flavored e-liquid. Aerosol puff fractions (1-50) and (101-150) are monitored and sampled using various collection media. Extracted aerosols are prepared for metal and toxicological analysis using human primary small airway epithelial cells (SAEC). ENDS aerosol-mediated cellular responses, including reactive oxygen species (ROS), oxidative stress, cell viability, and DNA damage, are evaluated after 24 h and 7-day exposures. Our results show higher particle concentrations in later puff fractions (0.135 mg/m3) than in initial puff fractions (0.00212 mg/m3). Later puff fraction aerosols contain higher toxic metal concentrations, including chromium, copper, and lead, which elicit increased levels of ROS followed by significant declines in total glutathione and cell viability. Notably, a 30% increase in DNA damage was observed after 7 days because of later puff fraction exposures. This work is consistent with ENDS aerosols becoming more hazardous across the use of pre-filled pod devices, which may threaten respiratory health.

A quantitative evaluation of aerosol generation during awake tracheal intubation

Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645-1245 [120-48,948]) vs. 1460 (390-2506 [40-12,280]) particles.l^-1 respectively, p = 0.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907-166,774 [390-557,817]) particles.l^-1 which was significantly greater than volitional coughs (p < 0.001). For 38 nasendoscopies in 12 participants, the aerosol concentrations were relatively low, 180 (120-525 [0-9552]) particles.l^-1 , however, five nasendoscopies generated peak aerosol concentrations greater than a volitional cough. Awake tracheal intubation and nasendoscopy can generate high concentrations of respiratory aerosol. Specific risks are associated with lidocaine spray of the larynx, instrumentation of the vocal cords, procedural coughing and deep breaths. Given the proximity of practitioners to patient-generated aerosol, airborne infection control precautions are appropriate when undertaking awake upper airway endoscopy (including awake tracheal intubation, nasendoscopy and bronchoscopy) if respirable pathogens cannot be confidently excluded.

Nocturnal Transpiration May Be Associated with Foliar Nutrient Uptake

Aerosols can contribute to plant nutrition via foliar uptake. The conditions for this are best at night because the humidity is high and hygroscopic, saline deposits can deliquesce as a result. Still, stomata tend to be closed at night to avoid unproductive water loss. However, if needed, nutrients are on the leaf surface, and plants could benefit from nocturnal stomatal opening because it further increases humidity in the leaf boundary layer and allows for stomatal nutrient uptake. We tested this hypothesis on P-deficient soil by comparing the influence of ambient aerosols and additional foliar P application on nocturnal transpiration. We measured various related leaf parameters, such as the foliar water loss, minimum leaf conductance (g_min), turgor loss point, carbon isotope ratio, contact angle, specific leaf area (SLA), tissue element concentration, and stomatal and cuticular characteristics. For untreated leaves grown in filtered, aerosol-free air (FA), nocturnal transpiration consistently decreased overnight, which was not observed for leaves grown in unfiltered ambient air (AA). Foliar application of a soluble P salt increased nocturnal transpiration for AA and FA leaves. Crusts on stomatal rims were shown by scanning electron microscopy, supporting the idea of stomatal uptake of deliquescent salts. Turgor loss point and leaf moisture content indicated a higher accumulation of solutes, due to foliar uptake by AA plants than FA plants. The hypothesis that deliquescent leaf surface salts may play a role in triggering nocturnal transpiration was supported by the results. Still, further experiments are required to characterize this phenomenon better.