The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

Background: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. Methods: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants’ compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. Discussion: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February–May 2019), a total of 91 children participated in the trial while for the second study period (February–May 2020), another 120 children completed data collection. Recruitment for the third study period (February–May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. Trial registration: ClinicalTrials.gov: NCT03503812, April 20, 2018

Global Air Quality and COVID-19 Pandemic : Do We Breathe Cleaner Air?

The global spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has challenged most countries worldwide. It was quickly recognized that reduced activities (lockdowns) during the Coronavirus Disease of 2019 (COVID-19) pandemic produced major changes in air quality. Our objective was to assess the impacts of COVID-19 lockdowns on groundlevel PM2.5, NO2, and O-3 concentrations on a global scale. We obtained data from 34 countries, 141 cities, and 458 air monitoring stations on 5 continents (few data from Africa). On a global average basis, a 34.0% reduction in NO2 concentration and a 15.0% reduction in PM2.5 were estimated during the strict lockdown period (until April 30, 2020). Global average O-3 concentration increased by 86.0% during this same period. Individual country and continent-wise comparisons have been made between lockdown and business-as-usual periods. Universally, NO2 was the pollutant most affected by the COVID-19 pandemic. These effects were likely because its emissions were from sources that were typically restricted (i.e., surface traffic and non-essential industries) by the lockdowns and its short lifetime in the atmosphere. Our results indicate that lockdown measures and resulting reduced emissions reduced exposure to most harmful pollutants and could provide global-scale health benefits. However, the increased O-3 may have substantially reduced those benefits and more detailed health assessments are required to accurately quantify the health gains. At the same, these restrictions were obtained at substantial economic costs and with other health issues (depression, suicide, spousal abuse, drug overdoses, etc.). Thus, any similar reductions in air pollution would need to be obtained without these extensive economic and other consequences produced by the imposed activity reductions.Peer reviewe

Evaluation of EU air quality standards through modelling and the FAIRMODE benchmarking methodology

We evaluate air quality modeling over the East Mediterranean using the benchmarking methodology developed in the framework of the Forum for Air Quality Modelling in Europe (FAIRMODE). FAIRMODE aims to provide a harmonized approach of model evaluation for regulatory purposes. We test the methodology by assessing the performance of the Weather Research and Forecasting model coupled with chemistry (WRF-Chem) against ground-based air quality observations over Cyprus, a member state of the European Union. Two nested domains are used (at 50- and 10-km horizontal grid spacing) with the comparison performed over the innermost domain. We consider performance indicators reflecting regulations for air quality standards (maximum daily 8-hourly mean ozone, hourly nitrogen dioxide, and daily fine particulate matter concentrations). The WRF-Chem model is found to satisfy the proposed performance objectives regarding ozone and NO2, though it underestimates the latter in urban areas possibly due to uncertainties in emission inventories. Fine particulate matter is well represented by the model, except on days with strong influence from natural sources, highlighting the necessity for fine-tuning dust mobilization and transport in the region. The objectives are fulfilled even though discrepancies exist between model and observations. Our results indicate the need for more stringent performance criteria at relatively low concentrations. Overall, we find that the methodology provides in-depth information and relevant statistical metrics to guide air quality and model assessments for monitoring compliance with the EU Air Quality Directives and other guidelines to limit the impact of air pollution on human health and ecosystems.JRC.C.5-Air and Climat

A new optical-based technique for real-time measurements of mineral dust concentration in PM10 using a virtual impactor

Atmospheric mineral dust influences Earth’s radiative budget, cloud formation, and lifetimehas adverse health effectsand affects air quality through the increase of regulatory PM10 concentrations, making its real-time quantification in the atmosphere of strategic importance. Only few near-real-time techniques can discriminate dust aerosol in PM10 samples and they are based on the dust chemical composition. The online determination of mineral dust using aerosol absorption photometers offers an interesting and competitive alternative but remains a difficult task to achieve. This is particularly challenging when dust is mixed with black carbon, which features a much higher mass absorption cross section. We build on previous work using filter photometers and present here for the first time a highly timeresolved online technique for quantification of mineral dust concentration by coupling a high-flow virtual impactor (VI) sampler that concentrates coarse particles with an aerosol absorption photometer (Aethalometer, model AE33). The absorption of concentrated dust particles is obtained by subtracting the absorption of the submicron (PM1) aerosol fraction from the absorption of the virtual impactor sample (VIPM1 method). This real-time method for detecting desert dust was tested in the field for a period of 2 months (April and May 2016) at a regional background site of Cyprus, in the Eastern Mediterranean. Several intense desert mineral dust events were observed during the field campaign with dust concentration in PM10 up to 45 μg

Towards understanding the characteristics of new particle formation in the Eastern Mediterranean

To quantify the contribution of new particle formation (NPF) to ultrafine particle number and cloud condensation nuclei (CCN) budgets, one has to understand the mechanisms that govern NPF in different environments and its temporal extent. Here, we study NPF in Cyprus, an Eastern Mediterranean country located at the crossroads of three continents and affected by diverse air masses originating from continental, maritime, and desert-dust source areas. We performed 1-year continuous measurements of aerosol particles down to similar to 1 nm in diameter for the first time in the Eastern Mediterranean and Middle East (EMME) region. These measurements were complemented with trace gas data, meteorological variables, and retroplume analysis. We show that NPF is a very frequent phenomenon at this site and has higher frequencies of occurrence during spring and autumn. NPF events were both of local and regional origin, and the local events occurred frequently during the month with the lowest NPF frequency. Some NPF events exhibited multiple onsets, while others exhibited apparent particle shrinkage in size. Additionally, NPF events were observed during the nighttime and during episodes of high desert-dust loadings. Particle formation rates and growth rates were comparable to those in rological variables and trace gases played a role in explaining the intra-monthly variability of NPF events, but they did not explain why summer months had the least NPF frequency. Similarly, pre-existing aerosol loading did not explain the observed seasonality. The months with the least NPF frequency were associated with higher H2SO4 concentrations but lower NO2 concentrations, which is an indicator of anthropogenic influence. Air masses arriving from the Middle East were not observed during these months, which could suggest that precursor vapors important for nucleation and growth are transported to our site from the Middle East. Further comprehensive measurements of precursor vapors are required to prove this hypothesis.Peer reviewe

Temperature and hospital admissions in the Eastern Mediterranean: a case study in Cyprus

Exposure to extreme temperatures can trigger a cascade of adverse cardiovascular and respiratory events. However, in Cyprus, a hotspot of climate change in the Eastern Mediterranean region, little is known about the temperature-related cardiorespiratory morbidity risks. We analyzed daily counts of hospital admissions for cardiovascular and respiratory diseases from four general hospitals in three districts in Cyprus from 2000 through 2019. For each district, we fitted time-series quasi-Poisson regression with distributed lag non-linear models to analyze the associations between daily mean temperature (lag 0–21 d) and hospital admissions for cardiorespiratory, cardiovascular, and respiratory diseases. A random-effects meta-analytical model was then applied to pool the district-specific estimates and obtain the national average associations. We analyzed 20 years of cause-specific hospitalization data with a total of 179 988 cardiovascular and respiratory events. The relationships between cardiorespiratory morbidity and temperature were overall U-shaped. During extreme temperature days, 15.85% (95% empirical CI [eCI]: 8.24, 22.40%) excess cardiovascular hospitalizations and 9.59% (95% eCI: −0.66, 18.69%) excess respiratory hospitalizations were attributable to extreme cold days (below the 2.5th percentile). Extreme hot days (above the 97.5th percentile) accounted for 0.17% (95% eCI: 0.03, 0.29%) excess cardiovascular hospitalizations and 0.23% (95% eCI: 0.07, 0.35%) excess respiratory hospitalizations. We found evidence of increased cardiovascular morbidity risk associated with extreme temperatures in Cyprus. Our study highlights the necessity to implement public health interventions and adaptive measures to mitigate the related temperature effects in an understudied region

Particulate monitoring, modeling, and management: natural sources, long-range transport, and emission control options: a case study of Cyprus

The LIFE+ Project PM3: Particulate Monitoring, Modeling, Management is coordinated by the Department of Labour Inspection in Cyprus and funded in part by LIFE+ Environment Policy & Governance. The project aims at the analysis of dust emissions, transport, and control options for Cyprus, as well as at the identification of “natural” contributions (Directive 2008/50/EC). The ultimate objective is to provide inputs for the design of a dust management plan to improve compliance to EC Directives and minimise impacts to human health and environment. This paper presents a short analysis of historical monitoring data and their patterns as well as a description of a dynamic dust entrainment model. The pyrogenic PM10 emissions combined with the wind driven emissions, are subject to a two phase non-linear multi-criteria emission control optimization procedure. The resulting emission scenarios with an hourly resolution provide input to the Comprehensive Air quality Model with extensions (CAMx) 3D fate and transport model, implemented for the 4,800 km master domain and embedded subdomains (270 km around the island of Cyprus and embedded smaller city domains of up to 30 km down to street canyon modeling). The models test the feasibility of candidate emission control solutions over a range of weather conditions. Model generated patterns of local emissions and long-range transport are discussed compared with the monitoring data, remote sensing (MODIS derived AOT), and the chemical analysis of dust samples

MEDEA randomised intervention study protocol in Cyprus, Greece and Israel for mitigation of desert dust health effects in adults with atrial fibrillation

Introduction Mediterranean countries experience frequent desert dust storm (DDS) events originating from neighbouring Sahara and Arabian deserts, which are associated with significant increase in mortality and hospital admissions, mostly from cardiovascular and respiratory diseases. Short-term exposure to ambient air pollution is considered as a trigger for symptomatic exacerbations of pre-existing paroxysmal atrial fibrillation (AF) and other types of heart arrhythmia. The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches clinical randomised intervention study in adults with AF is funded by EU LIFE+programme to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related heart arrhythmia effects.Methods and analysis The study is performed in three heavily exposed to desert dust regions of the Eastern Mediterranean: Cyprus, Israel and Crete-Greece. Adults with paroxysmal AF and implanted pacemaker are recruited and randomised to three parallel groups: (a) no intervention, (b) interventions to reduce outdoor exposure to desert dust, (c) interventions to reduce both outdoor and indoor exposure to particulate matter during desert dust episodes. Eligible participants are enrolled on a web-based platform which communicates, alerts and makes exposure reduction recommendations during DDS events. Exposure changes are assessed by novel tools (smartwatches with Global Positioning System and physical activity sensors, air pollution samplers assessing air quality inside and outside participant’s homes, etc). Clinical outcomes include the AF burden expressed as the percentage of time with paroxysmal AF over the total study period, the incidence of ventricular arrhythmia episodes as recorded by the participants’ pacemakers or cardioverters/defibrillators and the disease-specific Atrial Fibrillation Effect on QualiTy-of-Life questionnaire.Ethics and dissemination Local bioethics’ authorities approved the study at all sites, according to national legislations (Cyprus: National Bioethics Committee, Data Protection Commissioner and Ministry of Health; Greece, Scientific Committee and Governing Board of the University General Hospital of Heraklion; Israel: Institutional Review Board (‘Helsinki committee’) of the Soroka University Medical Center). The findings will be publicised in peer-reviewed scientific journals, in international conferences and in professional websites and newsletters. A summary of the results and participants’ interviews will be included in a documentary in English, Greek and Hebrew.Trial registration number ClinicalTrials.gov Identifier; NCT03503812

Ambient carbonaceous aerosol levels in Cyprus and the role of pollution transport from the Middle East

International audienceThe geographical origin and source apportionment of submicron carbonaceous aerosols (organic aerosols, OAs, and black carbon, BC) have been investigated here for the first time, deploying high timeresolution measurements at an urban background site of Nicosia, the capital city of Cyprus, in the eastern Mediterranean. This study covers a half-year period, encompassing both the cold and warm periods with continuous observations of the physical and chemical properties of PM 1 performed with an Aerosol Chemical Speciation Monitor (ACSM), an aethalometer, accompanied by a suite of various ancillary offline and online measurements. Carbonaceous aerosols were dominant during both seasons (cold and warm periods), with a contribution of 57 % and 48 % to PM 1 , respectively, and exhibited recurrent intense nighttime peaks (> 20-30 µg m −3) during the cold period, associated with local domestic heating. The findings of this study show that high concentrations of sulfate (close to 3 µg m −3) were continuously recorded, standing among the highest ever reported for Europe and originating from the Middle East region. Source apportionment of the OA and BC fractions was performed using the positive matrix factorization (PMF) approach and the combination of two models (aethalometer model and multilinear regression), respectively. Our study revealed elevated hydrocarbon-like organic aerosol (HOA) concentrations in Nicosia (among the highest reported for a European urban background site), originating from a mixture of local and regional fossil fuel combustion sources. Although air masses from the Middle East had a low occurrence and were observed mostly during the cold period, they were shown to strongly affect the mean concentrations levels of BC and OA in Nicosia during both seasons. Overall, the present study brings to our attention the need to further characterize primary and secondary carbonaceous aerosols in the Middle East, an undersampled region characterized Published by Copernicus Publications on behalf of the European Geosciences Union

Spatio-temporal variability of desert dust storms in Eastern Mediterranean (Crete, Cyprus, Israel) between 2006 and 2017 using a uniform methodology

The characteristics of desert dust storms (DDS) have been shown to change in response to climate change and land use. There is limited information on the frequency and intensity of DDS over the last decade at a regional scale in the Eastern Mediterranean. An algorithm based on daily ground measurements (PM10, particulate matter ≤10 μm), satellite products (dust aerosol optical depth) and meteorological parameters, was used to identify dust intrusions for three Eastern Mediterranean locations (Crete-Greece, Cyprus, and Israel) between 2006 and 2017. Days with 24-hr average PM10 concentration above ~30 μg/m3 were found to be a significant indicator of DDS for the background sites of Cyprus and Crete. Higher thresholds were found for Israel depending on the season (fall and spring: PM10 > 70 μg/m3, winter and summer: PM10 > 90 μg/m3). We observed a high variability in the frequency and intensity of DDS during the last decade, characterized by a steady trend with sporadic peaks. The years with the highest DDS frequency were not necessarily the years with the most intense episodes. Specifically, the highest dust frequency was observed in 2010 at all three locations, but the highest annual median dust-PM10 level was observed in 2012 in Crete (55.8 μg/m3) and Israel (137.4 μg/m3), and in 2010 in Cyprus (45.3 μg/m3). Crete and Cyprus experienced the same most intense event in 2006, with 24 h-PM10 average of 705.7 μg/m3 and 1254.6 μg/m3, respectively, which originated from Sahara desert. The highest 24 h-PM10 average concentration for Israel was observed in 2010 (3210.9 μg/m3) during a three-day Saharan dust episode. However, a sub-analysis for Cyprus (years 2000-2017) suggests a change in DDS seasonality pattern, intensity, and desert of origin. For more robust conclusions on DDS trends in relation to climate change, future work needs to study data over several decades from different locations