Antioxidant airway responses following experimental exposure to wood smoke in man

Background: Biomass combustion contributes to the production of ambient particulate matter (PM) in rural environments as well as urban settings, but relatively little is known about the health effects of these emissions. The aim of this study was therefore to characterize airway responses in humans exposed to wood smoke PM under controlled conditions. Nineteen healthy volunteers were exposed to both wood smoke, at a particulate matter (PM2.5) concentration of 224 +/- 22 mu g/m(3), and filtered air for three hours with intermittent exercise. The wood smoke was generated employing an experimental set-up with an adjustable wood pellet boiler system under incomplete combustion. Symptoms, lung function, and exhaled NO were measured over exposures, with bronchoscopy performed 24 h post-exposure for characterisation of airway inflammatory and antioxidant responses in airway lavages. Results: Glutathione (GSH) concentrations were enhanced in bronchoalveolar lavage (BAL) after wood smoke exposure vs. air (p = 0.025), together with an increase in upper airway symptoms. Neither lung function, exhaled NO nor systemic nor airway inflammatory parameters in BAL and bronchial mucosal biopsies were significantly affected. Conclusions: Exposure of healthy subjects to wood smoke, derived from an experimental wood pellet boiler operating under incomplete combustion conditions with PM emissions dominated by organic matter, caused an increase in mucosal symptoms and GSH in the alveolar respiratory tract lining fluids but no acute airway inflammatory responses. We contend that this response reflects a mobilisation of GSH to the air-lung interface, consistent with a protective adaptation to the investigated wood smoke exposure

Acute Cardiovascular Effects of Controlled Exposure to Dilute Petrodiesel and Biodiesel Exhaust in Healthy Volunteers: A Crossover Study

Abstract Background Air pollution derived from combustion is associated with considerable cardiorespiratory morbidity and mortality in addition to environmental effects. Replacing petrodiesel with biodiesel may have ecological benefits, but impacts on human health remain unquantified. The objective was to compare acute cardiovascular effects of blended and pure biodiesel exhaust exposure against known adverse effects of petrodiesel exhaust (PDE) exposure in human subjects. In two randomized controlled double-blind crossover studies, healthy volunteers were exposed to PDE or biodiesel exhaust for one hour. In study one, 16 subjects were exposed, on separate occasions, to PDE and 30% rapeseed methyl ester biodiesel blend (RME30) exhaust, aiming at PM10 300 μg/m3. In study two, 19 male subjects were separately exposed to PDE and exhaust from a 100% RME fuel (RME100) using similar engine load and exhaust dilution. Generated exhaust was analyzed for physicochemical composition and oxidative potential. Following exposure, vascular endothelial function was assessed using forearm venous occlusion plethysmography and ex vivo thrombus formation was assessed using a Badimon chamber model of acute arterial injury. Biomarkers of inflammation, platelet activation and fibrinolysis were measured in the blood. Results In study 1, PDE and RME30 exposures were at comparable PM levels (314 ± 27 μg/m3; (PM10 ± SD) and 309 ± 30 μg/m3 respectively), whereas in study 2, the PDE exposure concentrations remained similar (310 ± 34 μg/m3), but RME100 levels were lower in PM (165 ± 16 μg/m3) and PAHs, but higher in particle number concentration. Compared to PDE, PM from RME had less oxidative potential. Forearm infusion of the vasodilators acetylcholine, bradykinin, sodium nitroprusside and verapamil resulted in dose-dependent increases in blood flow after all exposures. Vasodilatation and ex vivo thrombus formation were similar following exposure to exhaust from petrodiesel and the two biodiesel formulations (RME30 and RME100). There were no significant differences in blood biomarkers or exhaled nitric oxide levels between exposures. Conclusions Despite differences in PM composition and particle reactivity, controlled exposure to biodiesel exhaust was associated with similar cardiovascular effects to PDE. We suggest that the potential adverse health effects of biodiesel fuel emissions should be taken into account when evaluating future fuel policies. Trial registration ClinicalTrials.gov, NCT01337882 /NCT01883466. Date of first enrollment March 11, 2011, registered April 19, 2011, i.e. retrospectively registered

Photocatalytic Decomposition of Formic Acid on Mo2C-Containing Catalyst

Soluble components in the peripheral blood from experimental exposure of 14 healthy subjects to filtered air and wood smoke. Samples were collected before (pre), at 24 h and 44 h after exposure, to air and wood smoke. Data are given as medians with interquartile range. (DOCX 62 kb

Effect of wood smoke exposure on vascular function and thrombus formation in healthy fire fighters

Background: Myocardial infarction is the leading cause of death in fire fighters and has been linked with exposure to air pollution and fire suppression duties. We therefore investigated the effects of wood smoke exposure on vascular vasomotor and fibrinolytic function, and thrombus formation in healthy fire fighters. Methods: In a double-blind randomized cross-over study, 16 healthy male fire fighters were exposed to wood smoke (~1 mg/m3 particulate matter concentration) or filtered air for one hour during intermittent exercise. Arterial pressure and stiffness were measured before and immediately after exposure, and forearm blood flow was measured during intra-brachial infusion of endothelium-dependent and -independent vasodilators 4–6 hours after exposure. Thrombus formation was assessed using the ex vivo Badimon chamber at 2 hours, and platelet activation was measured using flow cytometry for up to 24 hours after the exposure. Results: Compared to filtered air, exposure to wood smoke increased blood carboxyhaemoglobin concentrations (1.3% versus 0.8%; P &lt; 0.001), but had no effect on arterial pressure, augmentation index or pulse wave velocity (P &gt; 0.05 for all). Whilst there was a dose-dependent increase in forearm blood flow with each vasodilator (P &lt; 0.01 for all), there were no differences in blood flow responses to acetylcholine, sodium nitroprusside or verapamil between exposures (P &gt; 0.05 for all). Following exposure to wood smoke, vasodilatation to bradykinin increased (P = 0.003), but there was no effect on bradykinin-induced tissue-plasminogen activator release, thrombus area or markers of platelet activation (P &gt; 0.05 for all). Conclusions: Wood smoke exposure does not impair vascular vasomotor or fibrinolytic function, or increase thrombus formation in fire fighters. Acute cardiovascular events following fire suppression may be precipitated by exposure to other air pollutants or through other mechanisms, such as strenuous physical exertion and dehydration.Originally included in thesis in manuscript form.</p

Particulate and gaseous emissions from residential biomass combustion

Biomass is considered to be a sustainable energy source with significant potentials for replacing electricity and fossil fuels, not at least in the residential sector. However, present wood combustion is a major source of ambient concentrations of hydrocarbons (e.g. VOC and PAH) and particulate matter (PM) and exposure to these pollutants have been associated with adverse health effects. Increased focus on combustion related particulate emissions has been seen concerning the formation, characteristics and implications to human health. Upgraded biomass fuels (e.g. pellets) provide possibilities of more controlled and optimized combustion with less emission of products of incomplete combustion (PIC´s). For air quality and health impact assessments, regulatory standards and evaluations concerning residential biomass combustion, there is still a need for detailed emission characterization and quantification when using different fuels and combustion techniques. This thesis summarizes the results from seven different papers. The overall objective was to carefully and systematically study the emissions from residential biomass combustion with respect to: i) experimental characterization and quantification, ii) influences of fuel, appliance and operational variables and iii) aspects of ash and trace element transformations and aerosol formation. Special concern in the work was on sampling, quantification and characterization of particulate emissions using different appliances, fuels and operating procedures. An initial review of health effects showed epidemiological evidence of potential adverse effect from wood smoke exposure. A robust whole flow dilution sampling set-up for residential biomass appliances was then designed, constructed and evaluated, and subsequently used in the following emission studies. Extensive quantifications and characterizations of particulate and gases emissions were performed for residential wood and pellet appliances. Emission factor ranges for different stoves were determined with variations in fuel, appliance and operational properties. The emissions of PIC´s as well as PMtot from wood combustion were in general shown to be considerably higher compared to pellets combustion. PAHtot emissions were determined in the range of 1300-220000 µg/MJ for wood stoves and 2-300 µg/MJ for pellet stoves with phenantrene, fluoranthene and pyrene generally found as major PAH´s. The PM emissions from present residential appliances was found to consist of significant but varying fractions of PIC´s, with emissions in the range 35-350 mg/MJ for wood stoves compared to 15-45 mg/MJ for pellet stoves. Accordingly, the use of up-graded biomass fuels, combusted under continuous and controlled conditions give advantageous combustion conditions compared to traditional batch wise firing of wood logs. The importance of high temperature in well mixed isothermal conditions was further illustrated during pellets combustion to obtain complete combustion with almost a total depletion of PIC´s. Fine (100-300 nm) particles dominated in all studied cases the PM with 80-95% as PM1. Beside varying fractions of carbonaceous material, the fine PM consisted of inorganic volatilized ash elements, mainly found as KCl, K3Na(SO4)2 and K2SO4 with mass concentrations at 15-20 mg/MJ during complete combustion. The importance of the behavior of alkali elements for the ash transformation and fine particle formation processes was further shown, since the stability, distributions and compositions also directly control the degree of volatilization. In addition to the alkali metals, zinc was found as an important element in fine particles from residential biomass combustion. Finally, the behaviour of volatile trace elements, e.g. Zn and Cd, during pellets production and combustion were studied. A significant enrichment in the pellet fuel during the drying process was determined. The magnitude and importance of the enrichment was, however, relative small and some alternative measures for prevention were also suggested

Gör mig delaktig i min vård! : En litteraturstudie om bedsiderapportering

Bakgrund: Personcentrerad omvårdnad är något som läggs stor vikt vid i dagens sjukvård. I och med detta får sjuksköterskor större ansvar genom att sätta patienten i fokus. Traditionella överrapporteringar utförs utan patientens närvaro samtidigt som det finns en rapporteringsmetod som istället inkluderar patienten, vilket är bedsiderapportering. Bedsiderapportering är relativt nytt och forskning har främst undersökt sjuksköterskornas perspektiv. Dessutom är traditionella överrapporteringar inte i enlighet med de lagar som styr vården idag. Syfte: Syftet var att belysa patientens upplevelse av bedsiderapportering inom slutenvården. Metod: En litteraturstudie med 10 kvalitativa studier, som kvalitetsgranskades. Resultatanalysen gjordes med hjälp av en kvalitativ metod. Resultat: Generellt upplevde patienter en aktiv delaktighet samtidigt som önskan även framkom om mera delaktighet medan andra uppskattade en mer passiv roll. Språket som sjuksköterskor använde under överrapporteringen upplevdes som svårförståeligt. Bedsiderapportering möjliggjorde för patienter att få mer kunskap om sin vård och om sjuksköterskornas arbete. Patienter upplevde att sjuksköterskor skyddade deras integritet, samtidigt som andra patienter upplevde att sjuksköterskor inte uppmärksammade patienten som en person. Patienter förklarade att de kände sig mer trygga med sin vård då de visste att informationen från föregående sjuksköterska hade överlämnats till den kommande sjuksköterskan. Patienter upplevde att de behandlades som en person i första hand och en patient i andra hand. Slutsats: Eftersom patienter upplevde bedsiderapportering som inkluderande så kan metoden för överrapportering mellan sjuksköterskor ses som ett alternativ till den traditionella för att vården ska vara uppdaterad i enlighet med Patientlagen. Patienter upplevde inte att integriteten var ett bekymmer, vilket tidigare forskning har spekulerat som problematiskt. Mera forskning behövs utifrån patientens upplevelse av bedsiderapportering då forskning saknas.Background: Person-centered nursing is something that attaches great importance to today's healthcare. With this, nurses become more responsible by focusing on the patient. Traditional nursing handovers are performed without the patient's attendance while there is a reporting method that includes the patient, which is bedside nursing handover. Bedside nursing handover is relatively new and research has primarily examined the nurses' perspective. In addition, traditional nursing handover are not in accordance with the laws governing health care today. Aim: The aim was to illuminate the patient's experience of bedside nursing handover in the field of primary care. Method: A literature study with 10 qualitative studies was used, which was quality-reviewed. The results analysis was done using a qualitative method. Results: Generally, the patients experienced active participation, while also wishing to see more involvement while others appreciated a more passive role. The language that nurses used during the handover were perceived as difficult to understand. Bedside nursing handover enabled patients to gain more knowledge about their care and the nurses' work. Patients perceived that nurses protected their privacy while other patients experienced that nurses did not pay attention to the patient as a person. Patients explained that they felt more secure with their care as they knew that the information from the previous nurse had been handed over to the oncoming nurse. Patients felt that they were treated as a person primarily and a patient secondly. Conclusion: Since patients experienced bedside nursing handover as inclusive, the method of handover between nurses can be seen as an alternative to the traditional nursing handover in care since it is updated in accordance with the Patient Act. Patients did not experience integrity as a concern, as previous research has speculated as problematic. More research on the patient's experience of bedside nursing handover is needed as research is lacking