Composition of Culturable Microorganisms in Dusts Collected from Sport Facilities in Finland during the COVID-19 Pandemic

Sport facilities represent extreme indoor environments due to intense cleaning and disinfection. The aim of this study was to describe the composition of the cultivated microbiota in dust samples collected in sport facilities during the COVID-19 pandemic. A dust sample is defined as the airborne dust sedimented on 0.02 m² within 28 d. The results show that the microbial viable counts in samples of airborne dust (n = 9) collected from seven Finnish sport facilities during the pandemic contained a high proportion of pathogenic filamentous fungi and a low proportion of bacteria. The microbial viable counts were between 14 CFU and 189 CFU per dust sample. In seven samples from sport facilities, 20-85% of the microbial viable counts were fungi. Out of 123 fungal colonies, 47 colonies belonged to the potentially pathogenic sections of Aspergillus (Sections Fumigati, Nigri, and Flavi). Representatives of each section were identified as Aspergillus fumigatus, A. flavus, A. niger and A. tubingensis. Six colonies belonged to the genus Paecilomyces. In six samples of dust, a high proportion (50-100%) of the total fungal viable counts consisted of these potentially pathogenic fungi. A total of 70 isolates were considered less likely to be pathogenic, and were identified as Aspergillus section Nidulantes, Chaetomium cochliodes and Penicillium sp. In the rural (n = 2) and urban (n = 7) control dust samples, the microbial viable counts were >2000 CFU and between 44 CFU and 215 CFU, respectively, and consisted mainly of bacteria. The low proportion of bacteria and the high proportion of stress tolerant, potentially pathogenic fungi in the dust samples from sport facilities may reflect the influence of disinfection on microbial communities.

Aspergillus Was the Dominant Genus Found during Diversity Tracking of Potentially Pathogenic Indoor Fungal Isolates

Viable airborne pathogenic fungi represent a potential health hazard when exposing vulnerable persons in quantities exceeding their resilience. In this study, 284 indoor fungal isolates from a strain collection of indoor fungi were screened for pathogenic potential through the ability to grow in neutral pH at 37 °C and 30 °C. The isolates were collected from 20 locations including 14 problematic and 6 non-problematic ordinary buildings. Out of the screened isolates, 170 isolates were unable to grow at 37 °C, whereas 67 isolates growing at pH 7.2 at 37 °C were considered as potential opportunistic pathogens. Forty-seven isolates growing at 30 °C but not at 37 °C were considered as less likely pathogens. Out of these categories, 33 and 33 strains, respectively, were identified to the species level. The problematic buildings included known opportunistic pathogens: Aspergillus calidoustus, Trichoderma longibrachiatum, Rhizopus arrhizus and Paecilomyces variotii, as well as less likely pathogens: Aspergillus versicolor, Chaetomium cochliodes, Chaetomium globosum and Chaetomium rectangulare. Opportunistic pathogens such as Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and Aspergillus tubingensis and less likely pathogens such as Aspergillus westerdijkiae, Chaetomium globosum and Dichotomopilus finlandicus were isolated both from ordinary and from problematic buildings. Aspergillus was the dominant, most diverse genus found during screening for potentially pathogenic isolates in the indoor strain collection. Studies on Aspergillus niger and Aspergillus calidodoustus revealed that tolerance to cleaning chemicals may contribute to the adaptation of Aspergillus species to indoor environments.

The effects of paints and moisture content on the indoor air emissions from pinewood (Pinus sylvestris) boards

The emissions of volatile organic compounds (VOCs) from building materials may significantly contribute to indoor air pollution, and VOCs have been associated with odor annoyance and adverse health effects. Wood materials together with coatings are commonly used indoors for furniture and large surfaces such as walls, floors, and ceilings. This leads to high surface-to-volume ratios, and therefore, these materials may participate remarkably to the VOC levels of indoor environment. We studied emissions of VOCs and carbonyl compounds from pinewood (Pinus sylvestris) boards of 10% and 16% moisture contents (MC) with three paints using small-scale test chambers (27 L). The emissions from uncoated pinewood and paints (on a glass substrate) were tested as references. The 28-day experiment showed that the VOC emissions from uncoated pinewood were lower from sample with 16% MC. Painted pinewood samples showed lower emissions compared to paints on glass substrate. Additionally, paints on 16% MC pinewood exhibited lower emissions than on drier 10% MC wood. The emissions from painted pinewood samples were dominated by paint-based compounds, but the share of wood-based compounds increased over time. However, we noticed differences between the paints, and wood-based emissions were clearly higher with the most permeable paint.

Melinacidin-Producing Acrostalagmus luteoalbus, a Major Constituent of Mixed Mycobiota Contaminating Insulation Material in an Outdoor Wall

Occupants may complain about indoor air quality in closed spaces where the officially approved standard methods for indoor air quality risk assessment fail to reveal the cause of the problem. This study describes a rare genus not previously detected in Finnish buildings, Acrostalagmus, and its species A. luteoalbus as the major constituents of the mixed microbiota in the wet cork liner from an outdoor wall. Representatives of the genus were also present in the settled dust in offices where occupants suffered from symptoms related to the indoor air. One strain, POB8, was identified as A. luteoalbus by ITS sequencing. The strain produced the immunosuppressive and cytotoxic melinacidins II, III, and IV, as evidenced by mass spectrometry analysis. In addition, the classical toxigenic species indicating water damage, mycoparasitic Trichoderma, Aspergillus section Versicolores, Aspergillus section Circumdati, Aspergillus section Nigri, and Chaetomium spp., were detected in the wet outdoor wall and settled dust from the problematic rooms. The offices exhibited no visible signs of microbial growth, and the airborne load of microbial conidia was too low to explain the reported symptoms. In conclusion, we suggest the possible migration of microbial bioactive metabolites from the wet outdoor wall into indoor spaces as a plausible explanation for the reported complaints.

Human exposure to air contaminants in sports environments

The aim of this review was to investigate human exposure to relevant indoor air contaminants, predictors affecting the levels, and the means to reduce the harmful exposure in indoor sports facilities. Our study revealed that the contaminants of primary concern are the following: particulate matter in indoor climbing, golf, and horse riding facilities; carbon dioxide and particulate matter in fitness centers, gymnasiums, and sports halls; Staphylococci on gymnasium surfaces; nitrogen dioxide and carbon monoxide in ice hockey arenas; carbon monoxide, nitrogen oxide(s), and particulate matter in motor sports arenas; and disinfection by-products in indoor chlorinated swimming pools. Means to reduce human exposure to indoor contaminants include the following: adequate mechanical ventilation with filters, suitable cleaning practices, a limited number of occupants in fitness centers and gymnasiums, the use of electric resurfacers instead of the engine powered resurfacers in ice hockey arenas, carefully regulated chlorine and temperature levels in indoor swimming pools, properly ventilated pools, and good personal hygiene. Because of the large number of susceptible people in these facilities, as well as all active people having an increased respiratory rate and airflow velocity, strict air quality requirements in indoor sports facilities should be maintained.

Corrigendum: Structural Diversity and Bioactivities of Peptaibol Compounds From the Longibrachiatum Clade of the Filamentous Fungal Genus Trichoderma

[This corrects the article DOI: 10.3389/fmicb.2019.01434.].

Exposure to indoor air contaminants in school buildings with and without reported indoor air quality problems

Reported indoor air quality (IAQ) complaints are common even in relatively new or renovated school buildings in Finland. However, detecting the causes for complaints with commonly used indoor air measurements is difficult. This study presents data on perceived and measured IAQ in six comprehensive school buildings in Finland. The aim of this study was to discover the possible differences of perceived and measured IAQ between schools with reported IAQ complaints and schools without reported IAQ complaints. The initial categorisation of schools with ('problematic schools') and without ('comparison schools') complaints was ensured via a validated indoor climate survey and a recently developed online questionnaire, which were completed by 186 teachers and 1268 students from the six schools. IAQ measurements of physical parameters, gaseous pollutants, particulate matter and bioaerosols were conducted in four problematic school buildings (26 classrooms) and two comparison school buildings (12 classrooms). Using air sampling as well as exhaust air filters and classroom settled dust to detect the presence of elevated concentrations of airborne cultivable microbes and pathogenic, toxigenic and mycoparasitic Trichoderma strains were the most indicative methods in distinguishing problematic schools from comparison schools. Other IAQ-related measurements did not detect clear differences between problematic and comparison schools, as the concentration levels were very low. The results indicate that the complaints reported by occupants could have been related to excess moisture or mould problems that had not been found or repaired. Ventilation pressure condition investigations and simultaneous exhaust and supply air filter dust culture should be addressed precisely in future studies.

Emissions of DEHP-free PVC flooring

Degrading 2-ethylhexyl-containing PVC floorings (eg DEHP-PVC floorings) and adhesives emit 2-ethylhexanol (2-EH) in the indoor air. The danger of flooring degradation comes from exposing occupants to harmful phthalates plasticisers (eg DEHP), but not from 2-EH as such. Since the EU banned the use of phthalates in sensitive applications, the market is shifting to use DEHP-free and alternative types of plasticisers in PVC products. However, data on emissions from DEHP-free PVC floorings are scarce. This study aimed at assessing the surface and bulk emissions of two DEHP-free PVC floorings over three years. The floorings were glued on the screed layer of concrete casts at 75%, 85%, and 95% RH. The volatile organic compounds (VOCs) were actively sampled using FLEC (surface emissions) and micro-chamber/thermal extractor (µ-CTE, bulk emissions) onto Tenax TA adsorbents and analyzed with TD-GC-MS. 2-EH, C9-alcohols, and total volatile organic compound (TVOC) emissions are reported. Emissions at 75% and 85% RH were similar. As expected, the highest emissions occurred at 95% RH. 2-EH emissions originated from the adhesive. Because the two DEHP-free floorings tested emitted C9-alcohols at all tested RH, it makes the detection of flooring degradation harder, particularly if the adhesive used does not emit 2-EH.

Human exposure to NO2 in school and office indoor environments

BACKGROUND

Although nitrogen dioxide (NO₂) is one of the most common air pollutants encountered indoors, and extensive literature has examined the link between NO₂ exposure and duration causing adverse respiratory effects in susceptible populations, information about global and local exposure to NO₂ in different indoor environments is limited. To synthesize the existing knowledge, this review analyzes the magnitude of and the trends in global and local exposure to NO₂ in schools and offices, and the factors that control exposure.

METHODS

For the literature review, Web of Science, SCOPUS, Google Scholar, and PubMed were searched using 42 search terms and their combinations to identify manuscripts, reports, and directives published between 1971 and 2019. The search was then extended to the reference lists of relevant articles.

RESULTS

The calculated median, as well as the mean, concentration of NO₂ in school (median 21.1 μg/m³; mean 29.4 μg/m³) and office settings (median 22.7 μg/m³; mean 25.1 μg/m³) was well below the World Health Organization (WHO) guideline of 40 μg/m³ for the annual mean NO₂ concentration. However, a large range of average concentrations of NO₂ were reported, from 6.00 to 68.5 μg/m³ and from 3.40 to 56.5 μg/m³ for school and office environments, respectively, indicating situations where the WHO guidelines are exceeded. Outdoor levels of NO₂ are a reliable predictor of indoor NO₂ levels across seasons, with mean and median Indoor/Outdoor (I/O) ratios of 0.9 and 0.7 in school and 0.9 and 0.8 in office environments, respectively. The absence of major indoor NO₂ emission sources and NO₂ sinks, including chemical reactions and deposition, are the reasons for lower indoor NO₂ concentrations. During the winter, outdoor NO₂ concentrations are generally higher than during the summer. In addition, various building and indoor environment characteristics, such as type of ventilation, air exchange rates, airtightness of the envelope, furnishing and surface characteristics of the building, location of the building (urban versus suburban and proximity to traffic routes), as well as occupants' behavior (such as opening windows), have been statistically significantly associated with indoor NO₂ levels in school and office environments.

CONCLUSIONS

Indoor exposure to NO₂ from the infiltration of ambient air can be significant in urban areas, and in the case of high traffic volume. Although reducing transportation emissions is challenging, there are several easier means to reduce indoor NO₂ concentrations, including a ventilation strategy with suitable filters; location planning of new schools, classrooms, and ventilating windows or intakes; traffic planning (location and density); and reducing the use of NO₂-releasing indoor sources.

An atypical Bacillus anthracis infection in a bull-A potential occupational health hazard

Bacillus anthracis infecting cattle is usually identified based on the typical symptom: sudden death. Bacillus anthracis causing atypical symptoms may remain undiagnosed and represent a potential occupational health hazard for, that is veterinarians and producers, butchers and tanners. In the year 2004, one case of sudden death in a dairy farm in southern Finland was diagnosed as bovine anthrax. Four years later 2008, an atypical case of anthrax was diagnosed in the same holding. The bull was taken to the Production Animal Hospital of the Faculty of Veterinary Medicine, University of Helsinki because of fever, loss of appetite and a symmetrically swollen scrotal sac. Penicillin treatment cured the fever but not the swollen scrotum. Before the intended therapeutic castration, a punctuate consisting of 10 ml fluid collected into a syringe from the scrotal sac was cultivated on blood agar at 37°C. After 24 hr, an almost pure culture of a completely non-hemolytic Bacillus cereus-like bacteria was obtained. The strain was identified as B. anthracis using Ba-specific primers by the Finnish Food Safety Authority (RUOKAVIRASTO). After the diagnosis, the bull was euthanized and destroyed, the personnel were treated with prophylactic antibiotics and the clinic was disinfected. In this particular case, treatment with water, Virkon S and lime seemed to be effective to eliminate endospores and vegetative cells since no relapses of anthrax have occurred in 10 years. This case is the last reported anthrax case in Finland.

Penicillium expansum strain isolated from indoor building material was able to grow on gypsum board and emitted guttation droplets containing chaetoglobosins and communesins A, B and D

Aims

Emission of toxic metabolites in guttation droplets of common indoor fungi is not well documented. The aims of this study were (i) to compare mycotoxins in biomass and guttation droplets from indoor fungi from a building following health complaints among occupants, (ii) to identify the most toxic strain and to test if mycotoxins in guttation liquids migrated trough air and (iii) to test if toxigenic Penicillium expansum strains grew on gypsum board.

Methods and Results

Biomass suspensions and guttation droplets from individual fungal colonies representing Aspergillus, Chaetomium, Penicillium, Stachybotrys and Paecilomyces were screened toxic to mammalian cells. The most toxic strain, RcP61 (CBS 145620), was identified as Pen. expansum Link by sequence analysis of the ITS region and a calmodulin gene fragment, and confirmed by the Westerdijk Institute based on ITS and beta‐tubulin sequences. The strain was isolated from a cork liner, was able to grow on gypsum board and to produce toxic substances in biomass extracts and guttation droplets inhibiting proliferation of somatic cells (PK‐15, MNA, FL) in up to 20 000‐fold dilutions. Toxic compounds in biomass extracts and/or guttation droplets were determined by HPLC and LC‐MS. Strain RcP61 produced communesins A, B and D, and chaetoglobosins in guttation droplets (the liquid emitted from them) and biomass extracts. The toxins of the guttation droplets migrated c. 1 cm through air and condensed on a cool surface.

Conclusions

The mycotoxin‐containing guttation liquids emitted by Pen. expansum grown on laboratory medium exhibited airborne migration and were >100 times more toxic in bioassays than guttation droplets produced by indoor isolates of the genera Aspergillus, Chaetomium, Stachybotrys and Paecilomyces.

Significance and Impact of the Study

Toxic exudates produced by Pen. expansum containing communesins A, B and D, and chaetoglobosins were transferable by air. This may represent a novel mechanism of mycotoxin dispersal in indoor environment.

Structural Diversity and Bioactivities of Peptaibol Compounds From the Longibrachiatum Clade of the Filamentous Fungal Genus Trichoderma

This study examined the structural diversity and bioactivity of peptaibol compounds produced by species from the phylogenetically separated Longibrachiatum Clade of the filamentous fungal genus Trichoderma, which contains several biotechnologically, agriculturally and clinically important species. HPLC-ESI-MS investigations of crude extracts from 17 species of the Longibrachiatum Clade (T. aethiopicum, T. andinense, T. capillare, T. citrinoviride, T. effusum, T. flagellatum, T. ghanense, T. konilangbra, T. longibrachiatum, T. novae-zelandiae, T. pinnatum, T. parareesei, T. pseudokoningii, T. reesei, T. saturnisporum, T. sinensis, and T. orientale) revealed several new and recurrent 20-residue peptaibols related to trichobrachins, paracelsins, suzukacillins, saturnisporins, trichoaureocins, trichocellins, longibrachins, hyporientalins, trichokonins, trilongins, metanicins, trichosporins, gliodeliquescins, alamethicins and hypophellins, as well as eight 19-residue sequences from a new subfamily of peptaibols named brevicelsins. Non-ribosomal peptide synthetase genes were mined from the available genome sequences of the Longibrachiatum Clade. Their annotation and product prediction were performed in silico and revealed full agreement in 11 out of 20 positions regarding the amino acids predicted based on the signature sequences and the detected amino acids incorporated. Molecular dynamics simulations were performed for structural characterization of four selected peptaibol sequences: paracelsins B, H and their 19-residue counterparts brevicelsins I and IV. Loss of position R6 in brevicelsins resulted in smaller helical structures with higher atomic fluctuation for every residue than the structures formed by paracelsins. We observed the formation of highly bent, almost hairpin-like, helical structures throughout the trajectory, along with linear conformation. Bioactivity tests were performed on the purified peptaibol extract of T. reesei on clinically and phytopathologically important filamentous fungi, mammalian cells, and Arabidopsis thaliana seedlings. Porcine kidney cells and boar spermatozoa proved to be sensitive to the purified peptaibol extract. Peptaibol concentrations ≥0.3 mg ml⁻¹ deterred the growth of A. thaliana. However, negative effects to plants were not detected at concentrations below 0.1 mg ml⁻¹, which could still inhibit plant pathogenic filamentous fungi, suggesting that those peptaibols reported here may have applications for plant protection.

An Evaluation of Boar Spermatozoa as a Biosensor for the Detection of Sublethal and Lethal Toxicity

A novel, objective, and rapid computed motility inhibition (CMI) assay was developed to identify and assess sublethal injury in toxin-exposed boar spermatozoa and compared with a subjective visual motility inhibition (VMI) assay. The CMI values were calculated from digital micrographic videos using a custom MATLAB^® script by contrasting the motility index values of each experiment with those of the background and control experiments. Following a comparison of the CMI and VMI assays results, it was determined that their agreement depended on the shape of the dose-response curve. Toxins that exhibited a steep slope were indicative of good agreement between the assays. Those depicted by a gentle decline in the slope of the dose-response curve, the CMI assay were shown to be two times more sensitive than the VMI assay. The CMI assay was highly sensitive to the inhibition of mitochondrial function and glucose transport activity by sublethal doses of toxins and to disruption of cellular cation homeostasis by carrier ionophoric toxins, when compared to the cytotoxicity and lethal toxicity assays (i.e., that evaluated the inhibition of cell proliferation in somatic cell lines (FL, PK-15, and MNA cells)) and disruption to spermatozoa membrane integrity. The CMI assay recognized subtle sublethal toxicity changes in metabolism, manifested as a decrease in boar spermatozoa motility. Thus, it was feasible to effectively compare the objectively-measured numerical values for motility inhibition using the CMI assay against those reflecting lethal damage in the spermatozoa cells and somatic cell lines using a cytotoxicity assay.

Human exposure to ozone in school and office indoor environments

BACKGROUND

Although it is recognized that ozone causes acute and chronic health effects and that even trace amounts of ozone are potentially deleterious to human health, information about global and local exposures to ozone in different indoor environments is limited. To synthesize the existing knowledge, this review analyzes the magnitude of and the trends in global and local exposure to ozone in schools and offices and the factors controlling the exposures.

METHODS

In conducting the literature review, Web of Science, SCOPUS, Google Scholar, and PubMed were searched using 38 search terms and their combinations to identify manuscripts, reports, and directives published between 1973 and 2018. The search was then extended to the reference lists of relevant articles.

RESULTS

The calculated median concentration of ozone both in school (8.50 μg/m³) and office (9.04 μg/m³) settings was well below the WHO guideline value of 100 μg/m³ as a maximum 8 h mean concentration. However, a large range of average concentrations of ozone was reported, from 0.8-114 μg/m³ and from 0 to 96.8 μg/m³ for school and office environments, respectively, indicating situations where the WHO values are exceeded. Outdoor ozone penetrating into the indoor environment is the main source of indoor ozone, with median I/O ratios of 0.21 and 0.29 in school and office environments, respectively. The absence of major indoor ozone sources and ozone sinks, including gas-phase reactions and deposition, are the reasons for lower indoor than outdoor ozone concentrations. However, there are indoor sources of ozone that are of significance in certain indoor environments, including printers, photocopiers, and many other devices and appliances designed for indoor use (e.g., air cleaners), that release ozone either intentionally or unintentionally. Due to significantly elevated outdoor ozone concentrations during summer, summer indoor concentrations are typically elevated. In addition, the age of a building and various housing aspects (carpeting, air conditioning, window fans, and window openings) have been significantly associated with indoor ozone levels.

CONCLUSIONS

The existing means for reducing ozone and ozone reaction products in school and office settings are as follows: 1) reduce penetration of outdoor ozone indoors by filtering ozone from the supply air; 2) limit the use of printers, photocopiers, and other devices and appliances that emit ozone indoors; 3) limit gas-phase reactions by limiting the use of materials and products (e.g. cleaning chemicals) the emissions of which react with ozone.

Effects of Ventilation Improvement on Measured and Perceived Indoor Air Quality in a School Building with a Hybrid Ventilation System

Ventilation system design and operation may significantly affect indoor air quality (IAQ). The aims of this case study were to investigate the functionality of a supply air fan-assisted hybrid ventilation system in a newly built school building with reported IAQ problems and to determine the effects of ventilation improvement on measured and perceived IAQ. The ventilation system function was researched simultaneously with IAQ measurements, with an analysis of total volatile organic compounds (TVOC), single volatile organic compounds (VOCs), and indoor mycobiota, and with questionnaires about perceived IAQ. At the baseline, an operational error of the ventilation system was found, which prevented the air from coming into the classrooms, except for short periods of high carbon dioxide (CO₂) concentrations. After the ventilation operation was improved, a significant change in indoor mycobiota was found; the dominant, opportunistic human pathogenic species Trichoderma citrinoviride found in settled dust in the classroom before the improvement was no longer detected. In addition, the concentrations of CO₂, TVOC, and some single VOCs, especially toluene and decamethylcyclopentasiloxane, decreased. The analysis of the questionnaire results indicated that the perceptions of unpleasant odors and stuffy air decreased, although a statistically significant improvement in perceived IAQ was not observed. The results provided evidence that the properly controlled hybrid ventilation system operating in mechanical supply mode provided adequate ventilation and was effective in decreasing the concentrations of some indoor-generated pollutants. With simple ventilation adjustments, microbiological exposure from building structures might be prevented.

Association between Four-Level Categorisation of Indoor Exposure and Perceived Indoor Air Quality

The aim of this study was to develop and test a tool for assessing urgency of indoor air quality (IAQ) measures. The condition of the 27 buildings were investigated and results were categorized. Statistical test studied the differences between the categories and the employees’ complaints about their work environment. To study the employees’ experiences of the work premises, a validated indoor air (IA) questionnaire was used. This study reveals a multifaceted problem: many factors affecting IAQ may also affect perceived IAQ, making it difficult to separate the impurity sources and ventilation system deficiencies affecting to employee experiences. An examination of the relationship between the categories and perceived IAQ revealed an association between the mould odour perceived by employees and mould detected by the researcher. A weak link was also found between the assessed categories and environmental complaints. However, we cannot make far-reaching conclusions regarding the assessed probability of abnormal IA exposure in the building on the basis of employee experiences. According to the results, categorising tool can partly support the assessment of the urgency for repairs when several factors that affect IAQ are taken into account.

Microbial growth in building material samples and occupants' health in severely moisture-damaged homes

There is no commonly approved approach to detect and quantify the health-relevant microbial exposure in moisture-damaged buildings. In 39 single-family homes with severe moisture damage, we studied whether concentrations of viable microbes in building material samples are associated with health among 71 adults and 68 children, and assessed with symptoms questionnaires, exhaled NO, and peak expiratory flow (PEF) variability. Symptoms were grouped into three scores: upper respiratory symptoms, lower respiratory symptoms, and general symptoms. The homes were divided into three groups based on viable counts of fungi, actinomycetes, and total bacteria cultivated from building material samples. Highest group of actinomycete counts was associated with more general symptoms, worse perceived health, and higher daily PEF variability (aOR 12.51; 1.10-141.90 as compared to the lowest group) among adults, and with an increase in lower respiratory symptoms in children, but the confidence intervals were wide. We observed significant associations of fungal counts and total microbial score with worse perceived health in adults. No associations with exhaled NO were observed.

Usability evaluation (IEQ survey) in hospital buildings

Purpose

As hospital operations are undergoing major changes, comprehensive methods are needed for evaluating the indoor environment quality (IEQ) and usability of workspaces in hospital buildings. The purpose of this paper is to present a framework of the characteristics that have an impact on the usability of work environments for hospital renovations, and to use this framework to illustrate the usability evaluation process in the real environment.

Design/methodology/approach

The usability of workspaces in hospital environments was evaluated in two hospitals, as an extension of the IEQ survey. The evaluation method was usability walk-through. The main aim was to determine the usability characteristics of hospital facility workspaces that support health, safety, good indoor air quality, and work flow.

Findings

The facilities and workspaces were evaluated by means of four main themes: orientation, layout solution, working conditions, and spaces for patients. The most significant usability flaws were cramped spaces, noise/acoustic problems, faulty ergonomics, and insufficient ventilation. Due to rooms being cramped, all furnishing directly caused functionality and safety problems in these spaces.

Originality/value

The paper proposes a framework that links different design characteristics to the usability of hospital workspaces that need renovation.

The impact of flood and post-flood cleaning on airborne microbiological and particle contamination in residential houses

In January 2011, Brisbane, Australia, experienced a major river flooding event. We aimed to investigate its effects on air quality and assess the role of prompt cleaning activities in reducing the airborne exposure risk. A comprehensive, multi-parameter indoor and outdoor measurement campaign was conducted in 41 residential houses, 2 and 6 months after the flood. The median indoor air concentrations of supermicrometer particle number (PN), PM10, fungi and bacteria 2 months after the flood were comparable to those previously measured in Brisbane. These were 2.88 p cm(-3), 15 μg m(-3), 804 cf um(-3) and 177 cf um(-3) for flood-affected houses (AFH), and 2.74 p cm(-3), 15 μg m(-3), 547 cf um(-3) and 167 cf um(-3) for non-affected houses (NFH), respectively. The I/O (indoor/outdoor) ratios of these pollutants were 1.08, 1.38, 0.74 and 1.76 for AFH and 1.03, 1.32, 0.83 and 2.17 for NFH, respectively. The average of total elements (together with transition metals) in indoor dust was 2296 ± 1328 μg m(-2) for AFH and 1454 ± 678 μg m(-2) for NFH, respectively. In general, the differences between AFH and NFH were not statistically significant, implying the absence of a measureable effect on air quality from the flood. We postulate that this was due to the very swift and effective cleaning of the flooded houses by 60,000 volunteers. Among the various cleaning methods, the use of both detergent and bleach was the most efficient at controlling indoor bacteria. All cleaning methods were equally effective for indoor fungi. This study provides quantitative evidence of the significant impact of immediate post-flood cleaning on mitigating the effects of flooding on indoor bioaerosol contamination and other pollutants.

Endotoxins in indoor air and settled dust in primary schools in a subtropical climate

Endotoxins can significantly affect the air quality in school environments. However, there is currently no reliable method for the measurement of endotoxins, and there is a lack of reference values for endotoxin concentrations to aid in the interpretation of measurement results in school settings. We benchmarked the "baseline" range of endotoxin concentration in indoor air, together with endotoxin load in floor dust, and evaluated the correlation between endotoxin levels in indoor air and settled dust, as well as the effects of temperature and humidity on these levels in subtropical school settings. Bayesian hierarchical modeling indicated that the concentration in indoor air and the load in floor dust were generally (<95th percentile) <13 EU/m(3) and <24,570 EU/m(2), respectively. Exceeding these levels would indicate abnormal sources of endotoxins in the school environment and the need for further investigation. Metaregression indicated no relationship between endotoxin concentration and load, which points to the necessity for measuring endotoxin levels in both the air and settled dust. Temperature increases were associated with lower concentrations in indoor air and higher loads in floor dust. Higher levels of humidity may be associated with lower airborne endotoxin concentrations.

A critical analysis of postoperative complications of antebrachium TEN-nailing in 35 children

BACKGROUND

Unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing.

AIM

Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (TEN) in a pediatric cohort.

MATERIAL AND METHODS

This retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at Tampere University Hospital during the time period from January 2001 to December 2005. All the fractures were classified according to OTA. Thirty-five children (mean age 12.3 years) were treated by TEN-nailing. Twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. In all but one patient both forearm bones were fractured. Twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. In 29 cases both bones were fixed with TEN-nail. In the four patients with re-fracture in both ulna and radius only the radius was TEN-nailed. In one case radius was fixed with TEN-nail and ulna with K-wire and in another case radius was fixed with TEN-nail and ulna with plate. Fracture pattern, mode of reduction, surgical approach, short- and long-term complications and outcome were recorded.

RESULTS

Twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. Twelve patients with postoperative complication were followed up 31-74 (median of 54) months. Eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a Volkmann's ischemic contracture. Five of complicated patients had more than one problem. Immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures.

DISCUSSION

Despite various minor complications, TEN-nailing is considered suitable treatment for unstable forearm shaft fractures. Most of the problems were related to poor technical performance in nailing.

Renovation of a "sick building": the challenge of attaining the confidence of occupants

BACKGROUND

This case study focused on the renovation of a building with severe mold and HVAC problems. The users did not trust the success of the planned remedies, and the situation became conflict-prone. The aims of the study were to improve communication and cooperation between experts participating in the renovation process and the future users of the building and monitor the success of the remedies.

METHODS

An intervention was implemented with the aim of making the renovation easily understood by the future users of the building and preventing the escalation of unnecessary concern among them. The follow-up methods comprised a questionnaire study, technical inspections, quality measurements of the indoor air, structural follow-up measurements, and interviews of key persons.

RESULTS

The renovation itself seems to have been successful, and the model to improve communication and cooperation appears to be a promising one. The confidence of the future users was attained, and the relocation took place as planned.

CONCLUSIONS

In order to succeed in the renovation of a "sick building," both technical expertise and investment in information and communication are needed.

Volatile organic compounds and formaldehyde as explaining factors for sensory irritation in office environments

This study's database comprised results of volatile organic compound (VOC) measurements from 176 office buildings. In 23 of the 176 buildings, formaldehyde measurements were also conducted. It was suspected that the buildings had indoor air problems, but a walk-through inspection did not reveal any clear, abnormal contaminant sources. The 50 most abundant VOCs and their concentrations in 520 air samples were analyzed. The irritation potency was estimated for 33 out of the 50 common VOCs and their mixtures, as well as for formaldehyde. This information was used to calculate the recommended indoor air levels (RILs) for the VOCs. The RILs were considerably higher than the measured mean indoor air concentrations in the buildings. However, the RIL for formaldehyde was exceeded in most of the 23 buildings studied. According to the evaluation of irritation potency, formaldehyde was a more likely cause of sensory irritation than the mixture of common nonreactive VOCs at the concentrations that occurred in the buildings without abnormal indoor sources. Furthermore, environmental symptoms of office workers were characterized in 20 office buildings (including the database of 176 office buildings) with the aid of an indoor air questionnaire. The most frequent symptoms related to the indoor environment were involved the upper respiratory tract. However, no relationship could be shown between the reported symptoms and the occurrence of VOC and formaldehyde concentrations in these buildings. Generally, the study results indicated that formaldehyde was the more likely agent causing sensory irritation than the mixture of the common nonreactive VOCs at the concentrations occurring in the buildings without abnormal indoor sources.

Use of spot measurements for assessing residential ELF magnetic field exposure: a validity study

The purpose of this study was to evaluate residential short term "spot" measurements as surrogates for long term personal magnetic field (MF) exposure. In an epidemiological study on birth weight and pregnancy delay, MF exposure was assessed by taking five spot measurements in each room. For a subsample of 30 subjects 24 h personal MF measurements were made, and the following exposure metrics were calculated: 24 h arithmetic mean, 24 h median, percentage of time above 0.15 microT, and percentage of time above 0.29 microT. The 24 h exposure metrics were used as gold standards, when evaluating the validity of various summary measures calculated from spot measurements for assessing personal exposure. Based on Spearman correlation coefficient (r), specificity and sensitivity, the average of the spot measurements of a residence resulted in least exposure measurement error (misclassification). Also the above bed spot value correlated better with the 24 h metrics than any room average. Spot measurements performed about equally well in predicting different types of exposure metrics.

The paradoxical effect of smoking in preeclamptic pregnancies: smoking reduces the incidence but increases the rates of perinatal mortality, abruptio placentae, and intrauterine growth restriction

OBJECTIVES

Smoking is associated with a reduced risk of preeclampsia, but what is the outcome of pregnancy when preeclampsia develops in women who smoke?

STUDY DESIGN

Single births in Sweden from 1987 through 1993 to nulliparous women aged 15 to 34 years (N = 317,652) were included. Poisson regression analyses were used to calculate adjusted relative risks and rates of adverse pregnancy outcomes.

RESULTS

Maternal smoking was associated with significantly reduced risks of mild and severe preeclampsia (relative risks = 0.6 and 0.5, respectively). In pregnancies with severe preeclampsia, smoking at least 10 cigarettes per day was associated with increased rates of perinatal mortality (from 24 to 36 per 1000), abruptio placentae (from 31 to 67 per 1000), and being small for gestational age (from 28% to 68%), whereas the corresponding smoking-related increases in rates in nonhypertensive pregnancies were considerably less.

CONCLUSIONS

Smokers in whom preeclampsia develops have very high risks of perinatal mortality, abruptio placentae, and small-for-gestational-age infants.