Physical activity changes the deposited fractions of particles in the respiratory tract of adults and children

Exposure to ambient air pollution can cause a numberof health problems and may be particularly dangerous to susceptible population groups such as children. Health effects caused by air pollution are criticallydependent on both the deposited fraction (DF) of the inhaled particles and in what region of the respiratory tract the deposition takes place. With increasing physical activity, the breathing pattern is altered and the airflow in the respiratory tract increase, this affects the DF and deposition site. In this study we investigated changes in DF at increasing physical activity for three population groups: ~5 and 10 year-old children, and adults.Our results indicate that the variation in total DF with physical activity is minor, but that the DF for the UFPs increase in the AI region at higher activity levels. This is important since the removal of particles in the AI region is not effective and UFPs are believed to pose a specific health risk. Therefore, activity patterns and DF of different population groups need to be considered when estimating particle dose and evaluating health risks

Aerosol formation and emissions from realistic compartment fires

Firefighters are occupationally exposed to a large number of toxic compounds (IARC 2010). The occupational exposure of firefighters has been classified as potentially carcinogenic (class 2B, IARC; (Straif K. et al. 2007)). Poorly quantified emission factors and low understanding of when various aerosol emissions are likely to form during a fire event (initiation, combustion, extinguishing) inhibit efforts to reduce exposure by interventions to the firefighting strategy. The study was designed to evaluate firefighters’ exposure to air pollutants and to allow identification of how aerosol emissions respond to burning conditions and interventions of the firefighting. The study was conducted at the MSB firefighter training facility in Revinge outside Lund, Sweden. Eight small (5x3x2 m) sheds were built to imitate small compartment environments: apartment, bedroom, workshop, etc. These sheds were ignited under realistic fire scenarios (e.g., accident, arson) and later used for training new fire investigators (forensic police). Firefighter students and teachers monitored and extinguished the fires in similar procedures to real fire events. A supervisor monitored the combustion conditions, allowing or restricting fresh-air flow into the fire by opening or closing of the main door.Fire emissions were extracted from the fire through a 10 m (Ø 6 mm) stainless steel pipe, diluted ~1:50 with HEPA and active charcoal filtered air. The diluted emissions were monitored with a battery of aerosol monitoring instruments. Instrumentation included an aerosol mass spectrometer (Aerodyne SP-AMS, Billerica USA), an aethalometer (AE33, Magee Sci. USA), a differential mobility spectrometer (DMS500, Cambustion, UK), CO2 monitor (LI-COR, USA), and a NO/NO2 monitor (2BTech, USA). Complementary background measurements were positioned downwind or sidewind of the fires. With this equipment we collected data with the aim to resolve relationships between combustion conditions and pollution formation during different phases of a fire response. The results showed that total particle mass (PM1) emissions correlated with CO2 emissions and thus fire intensity. The emissions were speciated according to equivalent black carbon (eBC), organic aerosol (OA) and polycyclic aromatic hydrocarbon (PAH) derived from AMS data. When speciated, different particle emissions were found to depend on activities of the firefighting and the supervisor responsible for allowing or restricting fresh air into the combustion environment. Most evidently, we found that restricting the access to O2 by closing the door resulted in a sharp increase of OA and even more pronounced, PAH. PAH increased by several orders of magnitude, suggesting that PAH exposure-risks may increase drastically when fires become under-ventilated. Extinguishing the fire with water quickly decreased all particle emissions. The results described are illustrated in Figure 1.Further analysis involves additional off-line analyses, derivation of emission factors, time-resolved speciated emission analysis and evaluation of relationships between emissions, burning conditions and firefighting strategies

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encourage

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Exposure of zinc oxide nanoparticles on lung epithelium: A comparison between submerged and air-liquid interface cultures

Zinc oxide nanoparticles (ZnO NPs) are often used in sunscreen and other cosmetic products with sun protection. They are also candidate to be used for various biological applications such as drug delivery, or in material science in for example solar cells. ZnO NPs are produced as liquid suspensions but also as dry powders, which increases the risk of exposure via the air. In this master’s thesis, the effects of aerosolized ZnO NP exposure on lung epithelial cells were examined and compared to the effects of exposure to particles suspended in liquid. Immortalized human alveolar type II-like A549 cells were used as a model for the lung. Cell cultures were cultured on insert membranes in 24- or 6-well plates, either submerged (SUB (24) and SUB (6), respectively) in growth media or at the air-liquid interface (ALI) with air on one side. The cells were exposed to suspended particles in isotonic solution (containing 9 mg/ml sodium chloride) or growth media and to aerosol particles in the NACIVT system (nano aerosol chamber for in vitro toxicity). ALI and SUB (24) cultures showed similar responses for the lower doses used, while SUB (24) cultures seemed more affected than ALI cultures by the higher doses. This was probably due to that larger particles were present in the isotonic solution used to expose ALI cultures. Generally, SUB (6) cultures showed greater responses than both ALI and SUB (24) cultures. Cultures exposed to aerosol particle doses comparable to the two lowest doses in exposures to particles suspended in liquid, had a significantly higher metabolic activity than the untreated negative controls 3 hours after the exposure. They also showed a lower metabolic activity 24 hours after the exposure. This indicates that aerosolized ZnO NPs affect the cellular metabolism in low doses

Stadsluftens hälsobelastning på barn

Resultaten från denna studie tyder på påtagliga skillnader för de barn som växer upp i större städer jämfört med barn som växer upp ruralt eller i medelstora/mindre orter när det kommer till exponering för luftföroreningar samt den faktiska inandade dosen av dessa. Barn vid förskolor i Malmö exponeras för nästan dubbelt så höga nivåer partikulära luftföroreningar (PM2,5) jämfört med barn vid förskolorna utanför Malmö. Denna skillnad i exponering är även tydlig för den dos av partiklar som barnen bedöms andas in, där barnen i Malmö i genomsnitt, andas in en dubbelt så hög dos varje minut som barnen på förskolorna utanför Malmö. Motsvarande exponeringstrend går även att se för sot och kvävedioxider där barnens exponering för sot i Malmö oftast är dubbelt så hög och deras exponering för kvävedioxid kunde vara upp till tre gånger så hög som för förskolebarnen utanför Malmö. Det är dock viktigt att här poängtera att ingen av förskolorna i studien överskred rådande miljökvalitetsnormer eller miljömålet ”Frisk Lufts” gränsvärden. Sett till WHO:s skärpta riktlinjer för luftföroreningar överskrider däremot tre av fem förskolor i Malmö samt förskolan i Staffanstorp gränsvärdet avseende PM2,5 och tre av fem förskolor i Malmö överskrider också gränsvärdet avseende kvävedioxider. Resultaten från studien tyder även på att exponeringen på några av förskolorna, främst i Malmö, skulle kunna minskas genom att schemalägga barnens vistelsetid utomhus till tidpunkter då emissioner och trafikintensitet kring förskolorna och deras gårdar är lägre. Dock riskerar detta att ytterligare begränsa Malmöbarnens möjligheter till att vistas utomhus vilken redan ligger 20% lägre i genomsnitt jämfört med barnen på förskolorna utanför Malmö. Studien visar också att urbana mätstationer och gaturumsmätningar kan både över- och underskatta uppmätta halter på barnens förskolegårdar vilket är viktigt att ha i åtanke vid planering av barns utemiljöer i större städer samt belyser behovet av att inte enbart förlita sig på generella mätningar och modelleringar

Preschool Children’s Inhalation Rates Estimated from Accelerometers—A Tool to Estimate Children’s Exposure to Air Pollution

Children are particularly sensitive to air pollution exposure, and their personal exposures may differ significantly from those of adults. One key factor for understanding the personal inhaled dose of air pollutants is the respiratory minute ventilation (Ve). To estimate the amount of particles circulated through the lungs, 24 h averages of Ve are often used. These averages poorly capture variations in Ve during the day, and between individuals. We here develop and implement a concept to assess individual Ve of children, with minimal impact on their natural activity and movement pattern by using ActiGraph GT3X+ accelerometers. Activity of 136 preschool children in the ages 3 to 5 years was logged using accelerometers while the children attended their preschools during a week. A linear regression equation is developed and used for estimating Ve from the accelerometer data retrieved for each individual child. The results show large variations in weekly average Ve between individuals, ranging from 0.33 to 0.48 L min–1 kg–1. Over the days the averages of the individuals’ 1st and 3rd quartiles were 0.28 and 0.48 L min–1 kg–1, respectively. Outdoor activities resulted in a 17% higher Ve than indoor activities, which may be important to consider when estimating the inhaled dose of air pollutants since pollution levels and particle toxicities can be different indoors and outdoors. The observations motivate the use of individual values of Ve in exposure assessments and suggest that accelerometers are a suitable tool for estimating children’s individual Ve in their natural environment. Combined with time resolved local air pollution monitoring, these measurements can provide the basis of a more precise estimate of children’s inhaled dose of air pollutants

Toxicological effects of zinc oxide nanoparticle exposure: an in vitro comparison between dry aerosol air-liquid interface and submerged exposure systems

Engineered nanomaterials (ENMs) are increasingly produced and used today, but health risks due to their occupational airborne exposure are incompletely understood. Traditionally, nanoparticle (NP) toxicity is tested by introducing NPs to cells through suspension in the growth media, but this does not mimic respiratory exposures. Different methods to introduce aerosolized NPs to cells cultured at the air-liquid-interface (ALI) have been developed, but require specialized equipment and are associated with higher cost and time. Therefore, it is important to determine whether aerosolized setups induce different cellular responses to NPs than traditional ones, which could provide new insights into toxicological responses of NP exposure. This study evaluates the response of human alveolar epithelial cells (A549) to zinc oxide (ZnO) NPs after dry aerosol exposure in the Nano Aerosol Chamber for In Vitro Toxicity (NACIVT) system as compared to conventional, suspension-based exposure: cells at ALI or submerged. Similar to other studies using nebulization of ZnO NPs, we found that dry aerosol exposure of ZnO NPs via the NACIVT system induced different cellular responses as compared to conventional methods. ZnO NPs delivered at 1.0 mg/cm2 in the NACIVT system, mimicking occupational exposure, induced significant increases in metabolic activity and release of the cytokines IL-8 and MCP-1, but nodifferences were observed using traditional exposures. While factors associated with the method of exposure, such as differing NP aggregation, may contribute toward the different cellular responses observed, our results further encourage the use of more physiologically realistic exposure systems for evaluating airborne ENM toxicity