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Introduction: Wildland firefighters are exposed through the lungs and skin to particulate matter, fumes, and vapors containing polycyclic aromatic hydrocarbons (PAH). Wearing respiratory protection should reduce pulmonary exposure, but there is uncertainty about the most effective and acceptable type of mask., Methods: Firefighters from 6 unit crews working with the British Columbia Wildfire Service were approached and those consenting were randomly allocated within each crew to a "no mask" control group or to use 1 of 3 types of masks: X, half-face respirator with P100/multi gas cartridge; Y, cloth with alpaca filter; Z mesh fabric with a carbon filter. Crews were followed for 3 consecutive firefighting days. The mask allocated was constant for each firefighter throughout. All participants completed a brief questionnaire at the start and end of each day, giving information on mask use, respiratory symptoms, and assessment of mask qualities. Spot urine samples were collected pre and post shift to assess 1-hydroxypyrene (1-HP) concentration as an indicator of total PAH absorption. Skin wipe samples from the hands and throat were collected pre and post shift and analyzed for PAH concentration. On each day monitored, 4 participants carried sampling pumps to measure total particulates and PAHs on particles and in vapor phase. The primary outcome was the concentration of urinary 1-HP at the end of the fire day. Secondary outcomes were changes in respiratory and eye symptoms during the course of the shift, reported mask use, and perception of mask qualities. The analysis used a 3-level random intercept regression model that clustered observations within individuals and crews. We aimed to detect any relation of allocated mask type to the 4 outcomes, having allowed for estimated exposure., Results: Information was collected from 89 firefighters, including 14 women: 49% (37/75) of male firefighters were bearded. Nineteen fire days were monitored for a total of 263 firefighter × days, 64 to 68 for each intervention group. The end of shift 1-HP was higher than the start of the shift. Urinary 1-HP was more strongly related to PAHs on the skin than in the breathing zone. Men with beards had higher end-of-shift urinary log 1-HP/creat (ng/g) than other firefighters. None of the groups allocated a mask had lower 1-HP than the no-mask group, either in the study group overall or when stratified by beard-wearing. Among those without either beards or a failed fit-test, Mask Z reduced at the end of shift 1-HP where airborne PAH concentration was high. End-of-shift symptoms were related to particle mass in the breathing zone but was not mitigated by any of the masks. Hours electing not to wear a mask increased from the first to third shift for all mask types. Mask Z was rated as more comfortable than other types. Mask X was rated highest on fit and perceived protection. Mask Y gained the lowest ratings on fit, comfort and feelings of protection., Conclusions: Allocated masks did not provide protection overall, but the results highlighted the need for a wider understanding of the circumstances in which wearing efficient protection is well-advised., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

There is insufficient research on bioaerosols in hospital waste decontamination stations. This study aimed to investigate the effect of three-layer and N95 masks in reducing the inhalation risk of bacterial bioaerosols in a waste decontamination station at a teaching hospital. Active sampling was conducted on five different days at three locations: the yard, resting room, and autoclave room in three different modes: without a mask, with a three-layer mask, and with an N95 mask. Bacterial bioaerosols passing through the masks were identified using biochemical tests and polymerase chain reaction (PCR). The median concentration and interquartile range (IQR) of bacterial bioaerosols was 217.093 (230.174) colony-forming units per cubic meter (CFU/m 3 ), which is higher than the recommended amount by Pan American Health Organization (PAHO). The resting room had high contamination levels, with a median (IQR) of 321.9 (793.529) CFU/m 3 of bacterial bioaerosols. The maximum concentration of bioaerosols was also recorded in the same room (2443.282 CFU/m 3 ). The concentration of bacterial bioaerosols differed significantly between using a three-layer or N95 mask and not using a mask (p-value < 0.001). The non-carcinogenic risk level was acceptable in all cases, except in the resting room without a mask (Hazard Quotient (HQ) = 2.07). The predominant bacteria were Gram-positive cocci (33.98%). Micrococci (three-layer mask = 51.28%, N95 mask = 50%) and Coagulase-negative Staphylococci (three-layer mask = 30.77%, N95 mask = 31.82%) were the most abundant bioaerosols passing through the masks. The results obtained are useful for managerial decisions in hospital waste decontamination stations to reduce exposure to bioaerosols and develop useful guidelines., (© 2024. The Author(s).)

This systematic review explores the release and health outcomes of exposure to chalk particles in classrooms. A literature search was conducted on Scopus, Google Scholar, and the Web of Science. Chalk particles contribute significantly to poor indoor air quality in classrooms. Higher concentrations of PM 2.5 chalk particles were found in the front row (14.25 µg/m 3 ) and near the chalkboard (19.07 µg/m 3 ). Inhalation and dermal are significant exposure routes; hence, teachers and learners are at risk of developing respiratory and skin disorders. Inhalation of chalk particles correlates with reduced lung function in teachers and learners. The release and size of chalk particles depend on the activities, type of chalk sticks, and texture of the chalkboards. Wiping the chalkboard releases more chalk particles of smaller size (3.85-9.3 µm) than writing (10.57-92.91 µm). A shift from chalk sticks and chalkboards in classrooms is necessary to mitigate the associated health risks.

Introduction: Respirable crystalline silica (RCS) exposures in tanzanite gem mining have been linked to tuberculosis and silicosis among miners. We conducted a plot study to assess RCS exposures and to introduce safer mining practices in one small-scale underground tanzanite mine., Materials and Methods: Personal and area air samples for RCS were collected during tanzanite mining operations before and after improved work practices employed to reduce exposures and analyzed using X-ray diffraction. Area samples were collected at the rest area, located approximately 300 m underground and 100 m from other work activities. Improved practices included the use of wet drilling methods and drilling with new bits., Results: A total of 33 personal and 4 area air samples were collected. Pre-intervention, mean exposures for all operations, drilling operations, non-drilling activities, and area samples were 122 mg/m3, 247 mg/m3, 34.3 mg/m3, and 1.95 mg/m3, respectively which exceeded the U.S. OSHA Permissible Exposure Limit (PEL) by 2,440 times for all operations, by 4,946 times for drilling operations, by 686 times for non-drilling activities and 39 times for area samples collected at an underground rest area. The post-intervention results showed a 99% reduction of RCS exposures for wet drilling operations, 98.5% reduction for non-drilling activities, and 36% reduction for area samples. Despite improvements, post-intervention RCS exposures during drilling had a mean of 2.08 mg/m3 or more than 41 times the OSHA PEL., Conclusions: We successfully piloted a program to work with small-scale tanzanite miners to reduce RCS exposures and raise awareness about the occupational health risks of RCS, though additional measures are recommended to further reduce RCS exposures. Similar programs should be taken to scale throughout underground mining sites in Tanzania and other countries., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Face-to-face meetings on a conference table are a frequent form of communication. The short-range exposure risk of aerosol disease transmission is high in the scenario of susceptible facing the infectious person over the table. We propose a mitigation methodology using the air curtain to reduce direct exposure to virus-laden aerosols. A numerical model was validated with experimental data to simulate the dispersion of aerosols. A dynamic mesh was adopted to consider the head movement of a 3D thermal manikin model. Results show that nodding head increase the potential risk by 74 % compared to motionless. Subsequently, for a single air curtain, placing it in the middle of the table is more effective in preventing risks than on the sides. For double air curtains, increasing the distance between them has a greater risk reduction effect than a shorter distance. Increasing the air velocity or width is more effective than increasing the number of air curtains. A moderate velocity (1 m s -1 ) works well to reduce the risk of nasal breathing. A higher velocity (2 m s -1 ) is needed for the coughing scenario. For similar indoor environments, the air curtains on the table can offer active precautions without changing the current ventilation system., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Airborne respirable crystalline silica (RCS) has been a widely recognized hazard in the United States for nearly 100 years, yet it continues to pose a risk to construction tradespersons, among others. RCS exposures vary widely depending on site conditions and tools and materials used. The proper use of engineering, administrative, and personal protective equipment (PPE) controls can effectively reduce exposure to RCS. Historically, others have reviewed available RCS exposure data among construction trades and reported that there were considerable data gaps and variability that needed to be addressed. This current assessment aimed to synthesize available peer-reviewed exposure studies to determine potential RCS exposures during the use of common construction materials and evaluate to what extent data gaps and variability persist. Twenty-eight studies were identified that reported RCS exposure during construction tasks. After conversion to the unit of µg/m 3 , reported measurements from samples collected for varying durations ranged from 6.0 to 75,500 µg/m 3 for work with concrete, 80 to 4,240 µg/m 3 for work with brick, <59 to 10,900 µg/m 3 for work with mortar, 90 to 44,370 µg/m 3 for work with engineered stone, and 70 to 380 µg/m 3 for work with roof tile. To better facilitate pooling data across studies, future researchers should report their sample duration, clarify how time-weighted average (TWA) exposure data are calculated, report the silica content of the material being manipulated, and specify whether samples were collected while the task was performed in isolation or on a worksite where other silica-containing materials were also actively handled. When reporting results as respirable quartz, it is important to note whether any other polymorphic forms of silica were detected. It is ultimately the employer's responsibility to train employees and monitor and control RCS exposures on construction worksites. To do this effectively, it is important to have a clear understanding of the tasks, materials, and site conditions where intervention is most urgently needed.

An increasing number of silicosis cases have been reported related to the use of silica agglomerates. Many studies agree on the severity of this disease, which often presents with severe clinical forms in young workers and after a short latency period. Are there differences in the composition of dust generated by cutting and polishing with silica agglomerates versus granite and marble? Does the use of water injection reduce the risk associated with the use of these materials? We carried out a comparative observational-analytical study, measuring the concentration of dust generated during different machining operations on three different materials: granite, marble, and silica agglomerates. The effect of water injection on dust generation was evaluated. Personal sampling pumps were used, connected to a cyclone with polyvinyl chloride filters. The flow rate of the pumps was adjusted using a piston flowmeter. Measurements with a cascade impactor were made to assess the size distribution of respirable crystalline silica particles within the respirable fraction. In addition, environmental measurements with a spectrometer were made. 10 tests were carried out on granite and silica agglomerates for each procedure. In the case of marble, with very low silica content, only 2 tests of each type were carried out. Duration of each measurement was between 6 and 25 min. Cleaning times were set for each of the operations. The amount of dust collected in the respirable fraction was 70.85, 32.50 and 35.78 mg/m 3 for dry cutting; 6.50, 3.75 and 3.95 mg/m 3 for wet cutting; and 21.35, 13.68 and 17.50 mg/m 3 for dry polishing, for granite, marble, and silica agglomerates respectively. Dry procedures in marble, silica agglomerates and granite showed higher dust concentration of particles smaller than 0.5 μm. Silica agglomerates showed higher concentrations of respirable crystalline silica particles than granite and marble, mainly with dry procedures. The greater production of small particles in dry and wet procedures with silica agglomerates shows that water injection is an insufficient preventive measure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Halfmask air-purifying respirators are used by millions of workers to reduce inhaling air contaminants, both chemical (e.g., asbestos, styrene) and biological (e.g., SARS-CoV-2, Mycobacterium tuberculosis). In 2006, the federal Occupational Safety and Health Administration (OSHA) promulgated a standard that gave halfmask respirators an assigned protection factor (APF) of 10. This signified that OSHA assumes a fit-tested and trained wearer will experience a 10% maximum total inward leakage of contaminated air into the facepiece. To derive APF = 10, OSHA analyzed data from 16 workplace studies of the efficacy of halfmask respirators worn against particulate contaminants. In this commentary, I contend that, in considering the data, OSHA made several errors that overstated halfmask respirator efficacy. The errors were (i) failing to properly account for within-wearer and between-wearer variability in respirator efficacy; (ii) ignoring the effect of particle deposition in the respiratory tract; (iii) aggregating unbalanced data within and between studies, and effectively double-counting the data in some studies; and (iv) ignoring the effect that particle size exerts in penetrating respirator facepiece leak paths. The net result is that OSHA's APF = 10 can lead to excessive toxicant exposure for many workers., (© 2024 The New York Academy of Sciences.)

Wearing masks to prevent infectious diseases, especially during the COVID-19 pandemic, is common. However, concerns arise about inhalation exposure to microplastics (MPs) when disposable masks are improperly reused. In this study, we assessed whether disposable masks release inhalable MPs when reused in simulated wearing conditions. All experiments were conducted using a controlled test chamber setup with a constant inspiratory flow. Commercially available medical masks with a three-layer material, composition comprising polypropylene (PP in the outer and middle layers) and polyethylene (PE in the inner layer), were used as the test material. Brand-new masks with and without hand rubbing, as well as reused medical masks, were tested. Physical properties (number, size, and shape) and chemical composition (polymers) were identified using various analytical techniques such as fluorescence staining, fluorescence microscopy, and micro-Fourier Transform Infrared Spectroscopy (μFTIR). Scanning Electron Microscopy (SEM) was used to scrutinize the surface structure of reused masks across different layers, elucidating the mechanism behind the MP generation. The findings revealed that brand-new masks subjected to hand rubbing exhibited a higher cumulative count of MPs, averaging approximately 1.5 times more than those without hand rubbing. Fragments remained the predominant shape across all selected size classes among the released MPs from reused masks, primarily through a physical abrasion mechanism, accounting for >90 % of the total MPs. The numbers of PE particles were higher than PP particles, indicating that the inner layer of the mask contributed more inhalable MPs than the middle and outer layers combined. The released MPs from reused masks reached their peak after 8 h of wearing. This implies that regularly replacing masks serves as a preventive measure and mitigates associated health risks of inhalation exposure to MPs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Despite efforts to apply administrative and engineering controls to minimize worker exposure to aerosols, filtering facepiece respirators (FFRs) continue to be an important form of personal protective equipment in hard-to-control settings such as healthcare, agriculture, and construction. Optimizing the performance of FFRs can be advanced with the use of mathematical models that incorporate the forces that act on particles during filtration as well as those filter characteristics that influence filter pressure drop. However, a thorough investigation of these forces and characteristics using measurements of currently available FFRs has not been undertaken. Filter characteristics such as fiber diameter and filter depth were measured from samples taken from six currently-available N95 FFRs from three manufacturers. A filtration model was developed that included diffusion, inertial and electrostatic forces to estimate the filtration of an aerosol with a Boltzmann charge distribution. The diameter of the filter fibers was modeled as either a single "effective" diameter or as a lognormal distribution of diameters. Both modeling schemes produced an efficiency curve that simulated efficiency measurements made over a range of particle diameters (0.01 - 0.3 µm) with the use of a scanning mobility particle sizer in the region where efficiency is at a minimum. However, the method using a distribution of fiber diameters produced a better fit for particles > 0.1 µm. The coefficients associated with a simple form of the diffusion equation constituting a power law incorporating the Peclet number were adjusted to enhance model accuracy. Likewise, the fiber charge of the electret fibers was also adjusted to maximize model fit but remained within levels reported by others. A filter pressure drop model was also developed. Results demonstrated the need for a pressure drop model applicable to N95s relative to existing models developed with the use of fibers with larger diameters than those used in current N95 FFRs. A set of N95 FFR characteristics are provided that can be used to develop models of typical N95 FFR filter performance and pressure drop in future studies.

The present report describes exposure to respirable silica and dust in the construction industry, as well as means to manage them. The average exposure in studied work tasks ( n = 148) amounted to 64% of the Finnish OEL value of 0.05 mg/m 3 . While 10% of exposure estimates exceeded the OEL, the 60% percentile was well below 10% of the OEL, as was the median exposure. In other words, exposure was low in more than half of the tasks. Work tasks where exposure was low included construction cleaning, work management, installation of concrete elements, rebar laying, driving work machines equipped with cabin air intake filtration, and landscaping, in addition to some road construction tasks. Excessive exposure (>OEL) was related to not using respiratory protection at all or not using it for long enough after the dusty activity ceased. Excessive exposures were found in sandblasting, dismantling facade elements, diamond drilling, drilling hollow-core slabs, drilling with a drilling rig, priming of explosives, tiling, use of cabinless earthmoving machines, and jackhammering, regardless of whether the hammering took place in an underpressurized compartment or not. Even in these tasks, it was possible to perform the work safely, following good dust prevention measures and, when necessary, using respiratory protection suitable for the job. Furthermore, in all tasks with generally low exposure, one could be significantly exposed through the general air or by making poor choices in terms of dust control.

National Institute for Occupational Safety and Health (NIOSH) researchers continue to study worker exposure to respirable crystalline silica (RCS) and develop interventions to reduce these exposures. Occupational overexposures to RCS continue to cause illness and deaths in many industries and RCS has been identified as a serious exposure risk associated with hydraulic- fracturing operations during oil and gas extraction. In 2016 the Occupational Safety and Health Administration (OSHA) reduced the permissible exposure limit (PEL) to 0.05 milligrams of silica per cubic meter of air, averaged over an 8-hour day. This mandate requires hydraulic-fracturing operations to implement dust controls and safer work methods to protect workers from silica exposures above this PEL by June 23, 2021. At hydraulic-fracturing sites utilizing sand movers, pneumatic transfer of fracking sand is the primary source of aerosolized RCS. Currently, there are limited commercially available engineering controls for the collection of dust emitted from thief hatches on sand movers. The goal of this research is to develop a robust, cost-effective, weather resistant, portable, self-cleaning dust collection system that can be retrofitted onto sand mover thief hatches. A prototype was designed, built, and tested, and it was determined that the system could handle flows in the range of 600 to 1300 cfm with loading/cleaning cycle times of 40 and 5 minutes respectively and demonstrated operating efficiencies of 97-99%. Further development of this NIOSH prototype is being done in collaboration with an industry partner with the goal of developing a commercially viable, cost-effective solution to reduce RCS at hydraulic-fracturing sites around the world. Implications : This research has verified that airborne dust created by pneumatic transfer of fracking sand can be effectively collected using a passive cartridge filter system, and that the filters can be cleaned using blasts of air. Mounting these units to the thief hatches of sand movers will significantly reduce dust emissions from sand movers on hydraulic fracturing sites. Thus, this system offers the Oil and Gas Industry a method to reduce worker exposure to RCS on hydraulic fracturing sites that utilize sand movers. The success of this prototype has led researchers to devise a modified version for collecting dust at conveyor transfer points.

Inexpensive cloth masks are widely used to reduce particulate exposures, but their use became ubiquitous after the outbreak of COVID-19. A custom experimental setup (semiactive at 5.1 m/s airflow rate) was fabricated to examine the efficiency of different types of commercial facemasks collected randomly from street vendors. The sample ( N  = 27) including ( n  = 16) cloth masks (CMs), ( n  = 7) surgical masks (SMs), and ( n  = 4) N95 filtering facepiece respirators (FFRs), of which SMs and N95 FFRs taken as a standard for efficiency comparison were all tested against ambient aerosols (PM 2.5 and PM 10   μ g/m 3 ). The prototype cloth masks (PTCMs) ( N  = 5) design was tailored, and their performance was assessed and compared with that of standard commercial masks. The filtering efficiency tested against ambient coarse particulates (PM 10 ) ranged from (5% to 34%) for CMs with an average of 16%, (37% to 46%) for SMs with an average of 42%, (59% to 72%) for PTCMs with an average of 65%, and (70% to 75%) for N95 FFRs with an average of 71%, whereas against fine particulates (PM 2.5 ), efficacy ranged from (4% to 29%) for CMs with an average of 13%, (34% to 44%) for SMs with an average of 39%, (53% to 68%) for PTCMs with an average of 60%, and (68% to 73%) for N95 FFRs with an average of 70%, respectively. The efficiency followed the order N95 FFRs > PTCMs > SMs > CMs showing poor exposure reduction potential in CMs and high exposure reduction potential in N95 FFRs and PTCMs. Amendment in existing CMs using eco-friendly cotton fabric with better facial adherence can protect human health from exposure to fine particulates <2.5  μ m and can reduce the risk of micro-plastic pollution caused by polypropylene (PP) facemasks., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Prasidha R. Neupane et al.)

With the advent of new sensing technologies and robust field-deployable analyzers, monitoring approaches can now generate valuable hazard information directly in the workplace. This is the case for monitoring respirable dust and respirable crystalline silica concentration levels. Estimating the quartz amount of a respirable dust sample by nondestructive analysis can be carried out using portable Fourier transform infrared spectroscopy (FTIR) units. Real-time respirable dust monitors, combined with small video cameras, allow advanced assessments using the Helmet-CAM methodology. These two field-based monitoring approaches, developed by the National Institute for Occupational Safety and Health (NIOSH), have been trialed in a sandstone quarry. Twenty-six Helmet-CAM sessions were conducted, and forty-one dust samples were collected around the quarry and analyzed on-site during two events. The generated data generated were used to characterize concentration levels for the monitored areas and workers, to identify good practices, and to illustrate activities that could be improved with additional engineered control technologies. Laboratory analysis of the collected samples complemented the field finding and provided an assessment of the performance of the field-based techniques. Only a fraction of the real-time respirable dust monitoring sessions data could be corrected with laboratory analysis. The average correction factor ratio was 5.0. Nevertheless, Helmet-CAM results provided valuable information for each session. The field-based quartz monitoring approach overestimated the concentration by a factor of 1.8, but it successfully assessed the quartz concentration trends in the quarry. The data collected could be used for the determination of a quarry calibration factor for future events. The quartz content in the dust was found to vary from 14% to 100%, and this indicates the need for multiple techniques in the characterization of respirable dust and quartz concentration and exposure. Overall, this study reports the importance of the adoption of field-based monitoring techniques when combined with a proper understanding and knowledge of the capabilities and limitations of each technique.

Background: Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers., Methods: We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m 3 ); exposures above the permissible exposure limit (PEL; 50 μg/m 3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database., Results: We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m 3 ; range = 50.7-670.7 μg/m 3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation., Conclusions: Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure., (© 2022 Wiley Periodicals LLC.)

How to ensure adequate protection., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Decades of air pollution regulation have yielded enormous benefits in the United States, but vehicle emissions remain a climate and public health issue. Studies have quantified the vehicle-related fine particulate matter (PM 2.5 )-attributable mortality but lack the combination of proper counterfactual scenarios, latest epidemiological evidence, and detailed spatial resolution; all needed to assess the benefits of recent emission reductions. We use this combination to assess PM 2.5 -attributable health benefits and also assess the climate benefits of on-road emission reductions between 2008 and 2017. We estimate total benefits of $270 (190 to 480) billion in 2017. Vehicle-related PM 2.5 -attributable deaths decreased from 27,700 in 2008 to 19,800 in 2017; however, had per-mile emission factors remained at 2008 levels, 48,200 deaths would have occurred in 2017. The 74% increase from 27,700 to 48,200 PM 2.5 -attributable deaths with the same emission factors is due to lower baseline PM 2.5 concentrations (+26%), more vehicle miles and fleet composition changes (+22%), higher baseline mortality (+13%), and interactions among these (+12%). Climate benefits were small (3 to 19% of the total). The percent reductions in emissions and PM 2.5 -attributable deaths were similar despite an opportunity to achieve disproportionately large health benefits by reducing high-impact emissions of passenger light-duty vehicles in urban areas. Increasingly large vehicles and an aging population, increasing mortality, suggest large health benefits in urban areas require more stringent policies. Local policies can be effective because high-impact primary PM 2.5 and NH 3 emissions disperse little outside metropolitan areas. Complementary national-level policies for NO x are merited because of its substantial impacts-with little spatial variability-and dispersion across states and metropolitan areas., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

There is strong evidence associating the indoor environment with transmission of SARS-CoV-2, the virus that causes COVID-19. SARS-CoV-2 can spread by exposure to droplets and very fine aerosol particles from respiratory fluids that are released by infected persons. Layered mitigation strategies, including but not limited to maintaining physical distancing, adequate ventilation, universal masking, avoiding overcrowding, and vaccination, have shown to be effective in reducing the spread of SARS-CoV-2 within the indoor environment. Here, we examine the effect of mitigation strategies on reducing the risk of exposure to simulated respiratory aerosol particles within a classroom-style meeting room. To quantify exposure of uninfected individuals (Recipients), surrogate respiratory aerosol particles were generated by a breathing simulator with a headform (Source) that mimicked breath exhalations. Recipients, represented by three breathing simulators with manikin headforms, were placed in a meeting room and affixed with optical particle counters to measure 0.3-3 µm aerosol particles. Universal masking of all breathing simulators with a 3-ply cotton mask reduced aerosol exposure by 50% or more compared to scenarios with simulators unmasked. While evaluating the effect of Source placement, Recipients had the highest exposure at 0.9 m in a face-to-face orientation. Ventilation reduced exposure by approximately 5% per unit increase in air change per hour (ACH), irrespective of whether increases in ACH were by the HVAC system or portable HEPA air cleaners. The results demonstrate that mitigation strategies, such as universal masking and increasing ventilation, reduce personal exposure to respiratory aerosols within a meeting room. While universal masking remains a key component of a layered mitigation strategy of exposure reduction, increasing ventilation via system HVAC or portable HEPA air cleaners further reduces exposure.

Face masks are a primary preventive measure against airborne pathogens. Thus, they have become one of the keys to controlling the spread of the COVID-19 virus. Common examples, including N95 masks, surgical masks, and face coverings, are passive devices that minimize the spread of suspended pathogens by inserting an aerosol-filtering barrier between the user's nasal and oral cavities and the environment. However, the filtering process does not adapt to changing pathogen levels or other environmental factors, which reduces its effectiveness in real-world scenarios. This paper addresses the limitations of passive masks by proposing ADAPT, a smart IoT-enabled "active mask". This wearable device contains a real-time closed-loop control system that senses airborne particles of different sizes near the mask by using an on-board particulate matter (PM) sensor. It then intelligently mitigates the threat by using mist spray, generated by a piezoelectric actuator, to load nearby aerosol particles such that they rapidly fall to the ground. The system is controlled by an on-board micro-controller unit that collects sensor data, analyzes it, and activates the mist generator as necessary. A custom smartphone application enables the user to remotely control the device and also receive real-time alerts related to recharging, refilling, and/or decontamination of the mask before reuse. Experimental results on a working prototype confirm that aerosol clouds rapidly fall to the ground when the mask is activated, thus significantly reducing PM counts near the user. Also, usage of the mask significantly increases local relative humidity levels., (© 2021. The Author(s).)

The ongoing worldwide outbreak of COVID-19 has set personal protective equipment in the spotlight. A significant number of countries impose the use of facemasks in public spaces and encourage it in the private sphere. Even in countries where relatively high vaccination rates are achieved at present, breakthrough infections have been frequently reported and usage of facemasks in certain settings has been recommended again. Alternative solutions, including community masks fabricated using various materials, such as cotton or jersey, have emerged alongside facemasks following long-established standards (e.g., EN 149, EN 14683). In the present work, we present a computational model to calculate the ability of different types of facemasks to reduce the exposure to virus-laden respiratory particles, with a focus on the relative importance of the filtration properties and the fitting on the wearer's face. The model considers the facemask and the associated leakage, the transport of respiratory particles and their accumulation around the emitter, as well as the fraction of the inhaled particles deposited in the respiratory system. Different levels of leakages are considered to represent the diversity of fittings likely to be found among a population of non-trained users. The leakage prevails over the filtration performance of a facemask in determining the exposure level, and the ability of a face protection to limit leakages needs to be taken into account to accurately estimate the provided protection. Filtering facepieces (FFP) provide a better protection efficiency than surgical and community masks due to their higher filtration efficiency and their ability to provide a better fit and thus reduce the leakages. However, an improperly-fitted FFP mask loses a critical fraction of its protection efficiency, which may drop below the protection level provided by properly-worn surgical and community masks., (© 2021. The Author(s).)

Background: The precaution of airborne transmission of viruses, such as influenza, SARS, MERS, and COVID-19, is essential for reducing infection. In this study, we applied a zero-valent nanosilver/titania-chitosan (nano-Ag 0 /TiO 2 -CS) filter bed, whose broad-spectrum antimicrobial efficacy has been proven previously, for the removal of viral aerosols to minimize the risk of airborne transmission. Methods: The photochemical deposition method was used to synthesize the nano-Ag 0 /TiO 2 -CS antiviral material. The surface morphology, elemental composition, and microstructure of the nano-Ag 0 /TiO 2 -CS were analyzed by a scanning electron microscopy/energy dispersive X-ray spectroscopy and a transmission electron microscopy, respectively. The MS2 bacteriophages were used as surrogate viral aerosols. The antiviral efficacy of nano-Ag 0 /TiO 2 -CS was evaluated by the MS2 plaque reduction assay (PRA) and filtration experiments. In the filtration experiments, the MS2 aerosols passed through the nano-Ag 0 /TiO 2 -CS filter, and the MS2 aerosol removal efficiency was evaluated by an optical particle counter and culture method. Results and Conclusions: In the MS2 PRA, 3 g of nano-Ag 0 /TiO 2 -CS inactivated 97% of MS2 bacteriophages in 20 mL liquid culture (2 ± 0.5 × 10 16 PFU/mL) within 2 hours. The removal efficiency of nano-Ag 0 /TiO 2 -CS filter (thickness: 6 cm) for MS2 aerosols reached up to 93%. Over 95% of MS2 bacteriophages on the surface of the nano-Ag 0 /TiO 2 -CS filter were inactivated within 20 minutes. The Wells-Riley model predicted that when the nano-Ag 0 /TiO 2 -CS filter was used in the ventilation system, airborne infection probability would reduce from 99% to 34.6%. The nano-Ag 0 /TiO 2 -CS filter could remain at 50% of its original antiviral efficiency after continuous operation for 1 week, indicating its feasibility for the control of the airborne transmission.

Introduction: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission., Methods: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison., Results: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05)., Conclusion: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.

Purpose: This study was to evaluate the occupational health risks of infection from Gram-negative bacteria and Staphylococcus aureus bioaerosols to temporary entrants and staffs equipped with various grade personal protection equipment (PPE) related to wastewater treatment plants (WWTPs)., Methods: This study determined the emission concentrations of Gram-negative bacteria and Staphylococcus aureus bioaerosols from two WWTPs under various aeration modes. Then, a strict quantitative microbial risk assessment (QMRA) was performed on several exposure scenarios associated with occupational health risks of temporary entrants (researchers, visitors, and inspectors) and staffs (field engineer and laboratory technician)., Results: Although the bioaerosol concentrations were generally regarded as safe according to existing standards, these bioaerosols' health risks were still unacceptable. The microbial bioaerosols posed considerable infection health risks in WWTPs. These risks were generally above the WHO and US EPA benchmarks. The health risks of females were always smaller than those of male of grown-up age group. Staffs that had been exposed to bioaerosols for a long time were found to have higher health risks compared with temporary entrants. In addition, field engineers equipped with PPE rendered low health risks, thus revealing that wearing PPE could effectively reduce the occupational health risks., Conclusion: This study provided novel data and enriched the knowledge of microbial bioaerosol emission's health risks from various aeration modes in WWTPs. Management decisions could be executed by authorities on the basis of the results of QMRA for field engineers equipped with PPE to reduce the related occupational health risks., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Abstract: This work considers the implications of cloth masks due to the COVID-19 pandemic on suspected plutonium inhalations and dose assessment. In a plutonium inhalation scenario, the greater filtration efficiency for large particles exhibited by cloth masks can reduce early fecal excretion without a corresponding reduction in dose. For plutonium incidents in which cloth masks are worn, urinary excretion should be the preferred method of inferring dose immediately after the inhalation, and fecal excretion should be considered unreliable for up to 10 days., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Health Physics Society.)

The transmission of airborne pathogens represents a major threat to worldwide public health. Ultraviolet light irradiation can contribute to the sanification of air to reduce the pathogen transmission. We have designed a compact filter for airborne pathogen inactivation by means of UVC LED sources, whose effective irradiance is enhanced thanks to high reflective surfaces. We used ray-tracing and computational fluid dynamic simulations to model the device and to maximize the performance inside the filter volume. Simulations also show the inhibition of SARS-Cov-2 in the case of high air fluxes. This study demonstrates that current available LED technology is effective for air sanification purposes.

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has claimed many victims worldwide due to its high virulence and contagiousness. The person-to-person transmission of SARS-Cov-2 when in close contact is facilitated by respiratory droplets containing the virus particles, and by skin contact with contaminated surfaces. However, the large number of COVID-19 infections cannot be explained only by droplet deposition or contact contamination. It seems very plausible that aerosols are important in transmitting SARS-Cov-2. It has been demonstrated that SARS-CoV-2 remains viable in aerosols for hours, facilitating rapid distribution of the virus over great distances. Aerosols may, therefore, also be responsible for so-called super-spreader events. Indirect evidence points to a correlation between ventilation and the transmission and spread of SARS-Cov-2, supporting ventilation as an important factor in preventing airborne transmission. Further actions to avoid transmission of COVID-19 include social distancing, hygiene measures, and barrier measures, such as face-coverings. Professional masks offer better protection than cloth masks. These protection measures are especially relevant to health care workers, when performing endotracheal intubation, but the risk from non-invasive ventilation and nebulizing treatment seems to be moderate., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Background: Informal sector electronic waste (e-waste) recovery produces toxic emissions resulting from burning e-waste to recover valuable metals., Objectives: To identify high-risk worker groups by measuring relative levels of personal inhalation exposure to particulate matter (PM) of fine (≤2.5 µm) and coarse (2.5-10 µm) fractions (PM 2.5 and PM 2.5-10, respectively) across work activities among e-waste workers, and to assess how wind conditions modify levels of PM by activity and site location., Methods: At the Agbogbloshie e-waste site, 170 partial-shift PM samples and time-activity data were collected from participants (N = 105) enrolled in the GeoHealth cohort study. Personal sampling included continuous measures of size-specific PM from the worker's breathing zone and time-activity derived from wearable cameras. Linear mixed models were used to estimate changes in personal PM 2.5 and PM 2.5-10 associated with activities and evaluate effect modification by wind conditions., Results: Mean (±standard deviation) personal PM 2.5 and PM 2.5-10 concentrations were 80 (±  81) and 123 (± 139) µg m -3 , respectively. The adjusted mean PM 2.5 concentration for burning e-waste was 88 µg m -3 , a 28% increase above concentrations during non-recovery activities (such as eating). Transportation-related and burning activities were associated with the highest PM 2.5-10 concentrations. Frequent changes in wind direction were associated with higher PM 2.5 concentrations when burning, and high wind speeds with higher PM 2.5-10 concentrations when dismantling e-waste downwind of the burning zone., (© 2021 Wiley Periodicals LLC.)

Natural window ventilation is frequently employed in schools in Europe and often leads to inadequate levels of human bioeffluents. However, intervention studies that verify whether recommended ventilation targets can be achieved in practice with reasonable ventilation regimes and that are also suitable for countries with cold winters are practically non-existent. To explore the initial situation in Switzerland we carried out carbon dioxide (CO 2 ) measurements during the winter in 100 classrooms, most of which (94%) had natural window ventilation. In more than two thirds of those, the hygienic limit value of 2000 ppm specified for CO 2 in the Swiss Standard SN 520180 (2014) was exceeded. To improve ventilation behavior, an intervention was implemented in 23 classrooms during the heating season. Ventilation was performed exclusively during breaks (to avoid discomfort from cold and drafts), efficiently, and only for as long as was necessary to achieve the ventilation objective of compliance with the hygienic limit value (strategic ventilation). The intervention included verbal and written instructions, awareness-raising via a school lesson and an interactive tool for students, which was also used to estimate the required duration of ventilation. CO 2 exposure was significantly reduced in pilot classes (Wilcoxon signed-rank test, p = 3.815e -06 ). Median CO 2 levels decreased from 1600 ppm (control group) to 1097 ppm (intervention group), and the average proportion of teaching time at 400-1400 ppm CO 2 increased from 40% to 70%. The duration of ventilation was similar to spontaneous natural window ventilation (+5.8%). Stricter ventilation targets are possible. The concept of the intervention is suitable for immediate adoption in schools with natural window ventilation for a limited period, pending the installation of a mechanical ventilation system. The easy integration of this intervention into everyday school life promotes compliance, which is particularly important during the COVID-19 pandemic., (Copyright © 2021 Federal Office of Public Health, Berne, Switzerland. Published by Elsevier GmbH.. All rights reserved.)

Masks constructed of a variety of materials are in widespread use due to the COVID-19 pandemic, and people are exposed to chemicals inherent in the masks through inhalation. This work aims to survey commonly available mask materials to provide an overview of potential exposure. A total of 19 mask materials were analyzed using a nontargeted analysis two-dimensional gas chromatography (GCxGC)-mass spectrometric (MS) workflow. Traditionally, there has been a lack of GCxGC-MS automated high-throughput screening methods, resulting in trade-offs with throughput and thoroughness. This work addresses the gap by introducing new machine learning software tools for high-throughput screening (Floodlight) and subsequent pattern analysis (Searchlight). A recursive workflow for chemical prioritization suitable for both manual curation and machine learning is introduced as a means of controlling the level of effort and equalizing sample loading while retaining key chemical signatures. Manual curation and machine learning were comparable with the mask materials clustering into three groups. The majority of the chemical signatures could be characterized by chemical class in seven categories: organophosphorus, long chain amides, polyethylene terephthalate oligomers, n -alkanes, olefins, branched alkanes and long-chain organic acids, alcohols, and aldehydes. The olefin, branched alkane, and organophosphorus components were primary contributors to clustering, with the other chemical classes having a significant degree of heterogeneity within the three clusters. Machine learning provided a means of rapidly extracting the key signatures of interest in agreement with the more traditional time-consuming and tedious manual curation process. Some identified signatures associated with plastics and flame retardants are potential toxins, warranting future study to understand the mask exposure route and potential health effects.

Background: The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network., Design: Randomised control pilot trial over a 6-month study follow-up time period. The study was undertaken from May 2017 to -May 2018. Once monthly follow-up visits occurred over the 6-month study period., Setting: Baltimore City, Maryland, USA., Participants: We grouped 135 participants into 45 triads (asthmatic child (2-12 years of age), maternal caregiver and social network member). Triads were assigned in a 1:1 allocation ratio. The maternal caregiver and social network members were active smokers and contributed to paediatric TSE., Interventions: Triads were randomised to receive either usual care (TSE education and quitline referrals) or usual care plus financial incentives. Cash incentives up to $1000 were earned by caregivers and designated social network participants. Incentives for either caregivers or social network participants were provided contingent on their individual reduction of tobacco usage measured by biomarkers of tobacco usage. Study visits occurred once a month during the 6-month trial., Main Outcome Measures: The main outcome measure was mean change in monthly paediatric cotinine levels over 6 months of follow-up interval and was analysed on an intention-to-treat basis., Results: The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI -0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort's caregivers (difference in slope (control-intervention)=3.30 ng/mL/month, CI -7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control-intervention)=-1.59 ng/mL/month, CI -3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group., Conclusions: Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels., Trial Registration Number: NCT03099811., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There is increasing concern among hospital personnel about potential secondary exposure when treating chemically contaminated patients., Objective: To assess which circumstances and chemicals require the use of Level C Personal Protective Equipment (chemical splash suit and air-purifying respirator), to prevent secondary contamination of hospital personnel treating a chemically contaminated patient., Methods: The US National Library of Medicine PubMed database was searched for the years 1985 to 2020 utilizing combinations of relevant search terms. This yielded 557 papers which were reviewed by title and abstract. After excluding papers on biological or radiological agents, or those not related to hospital personnel, 38 papers on chemicals remained. After a full-text review, 13 papers without an in-depth discussion on the risk for secondary contamination were omitted, leaving 25 papers for review. The references of these papers were searched and this yielded another seven additional citations, bringing the total to 32 papers., Incidence of Secondary Toxicity: Secondary toxicity in hospital personnel is rare: a large-scale inventory of 120,000 chemical incidents identified only nine cases, an occurrence of 0.0075%., Skin Contact as a Secondary Exposure Route: Skin exposure is rare under normal hygienic working conditions, reflected by the very small number of cases reported in the literature: two cases with corrosive effects due to unprotected contact and one case of presumed skin absorption., Inhalation as a Secondary Exposure Route: Most case reports described secondary toxicity as a result of inhalation. The chemicals involved were irritating solid particles (capsaicin spray/CS), toxic gases formed in the stomach of patients (arsine/hydrazoic acid/phosphine) and vapours from volatile liquids (solvents)., Features of Secondary Toxicity: Reported symptoms after secondary inhalation were generally mild and reversible (mostly irritation of eyes and respiratory tract, nausea, headache, dizziness/light-headedness) and did not require treatment. In many cases, special circumstances increased exposure: treatment/decontamination of multiple patients, regurgitation of the chemical agent from the stomach, or inadequate room ventilation., Use of More Than Standard Personal Protective Equipment: Normal hygienic precautions prevent direct skin contact from exposure to common chemical agents. When solid particle contamination is extensive, a mask and eye protection should be applied. Splash proof outer clothing (splash suit) and eye protection is preferred if (partial) wet decontamination is performed on single patients. Adequate ventilation, careful removal of clothing in case of solid particles contamination and adequate disposal of gastric content reduces exposure. Hospital staff can be rotated if symptoms occur, which can be odour-mediated. The use of more elaborate personal protective equipment with an air-purifying respirator (Level C) is only necessary in exceptional cases of contamination with highly toxic volatile chemicals (e.g., sarin). It should also be considered when decontaminating a large number of patients., Conclusions: The risk of secondary contamination and subsequent toxicity in hospital personnel decontaminating or treating chemically contaminated patients is small. Normal hygienic precautions (gloves and water-resistant gown) will adequately protect hospital staff when treating the majority of chemically contaminated patients. More extensive protection is only necessary infrequently and there is no reason to delay critical care, even if more elaborate protection is not immediately available.

There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) ( p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield ( p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks ( p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm-0.3 to 0.5 µm-0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

Simple plastic face shields have numerous practical advantages over regular surgical masks. In light of the spreading COVID-19 pandemic, the potential of face shields as a substitution for surgical masks was investigated. In order to determine the efficacy of the protective equipment we used a cough simulator. The protective equipment considered was placed on a manikin head that simulated human breathing. Concentration and size distribution of small particles that reached the manikin respiration pathways during the few tens of seconds following the cough event were monitored. Additionally, water sensitive papers were taped on the tested protective equipment and the manikin face. In the case of frontal exposure, for droplet diameter larger than 3 μm, the shield efficiency in blocking cough droplets was found to be comparable to that of regular surgical masks, with enhanced protection for portions of the face that the mask does not cover. Additionally, for finer particles, down to 0.3 µm diameter, a shield blocked about 10 times more fine particles than the surgical mask. When exposure from the side was considered, the performance of the shield was found to depend dramatically on its geometry. While a narrow shield allowed more droplets and aerosol to penetrate in comparison to a mask under the same configuration, a slightly wider shield significantly improved the performance. The source control potential of shields was also investigated. A shield, and alternatively, a surgical mask, were placed on the cough simulator, while the breathing simulator, situated 60 cm away in the jet direction, remained totally exposed. In both cases, no droplets or particles were found in the vicinity of the breathing simulator. Conducted experiments were limited to short time periods after expiratory events, and do not include longer time ranges associated with exposure to suspended aerosol. Thus, additional evidence regarding the risk posed by floating aerosol is needed to establish practical conclusions regarding actual transmittance reduction potential of face shields and surgical face masks.

&lt;b&gt;Background and Objective:&lt;/b&gt; COVID-19 is a fast-spreading worldwide pandemic caused by SARS-CoV-2. The World Health Organization recommended wearing face masks. Masks have become an urgent necessity throughout the pandemic, the study's goal was to track the impact of wearing masks on immunological responses. &lt;b&gt;Materials and Methods:&lt;/b&gt; This study was conducted on 40 healthy people who were working in health care at Nineveh Governorate Hospitals from September-December, 2020. They wore face masks at work for more than 8 months for an average of 6 hrs a day. The control sample included 40 healthy individuals, who wore masks for very short periods. All samples underwent immunological and physiological tests to research the effects of wearing masks for extended periods within these parameters. &lt;b&gt;Results:&lt;/b&gt; The results showed a significant decrease in total White Blood Count and the absolute number of neutrophils, lymphocytes, monocytes and phagocytic activity. However, there was a significant increase in the absolute number of eosinophils in participants compared with the control. The results also suggested there were no significant differences in IgE, haemoglobin concentration and blood O&lt;sub&gt;2 &lt;/sub&gt;saturation in participants who wore masks for more than 6 hrs compared to the control group. The results showed a significant increase in pulse rate in participants who wore masks for more than 6 hrs compared to the control group. The results also showed a strong correlation coefficient between the time of wearing masks and some immunological, haematological parameters. &lt;b&gt;Conclusion:&lt;/b&gt; Wearing masks for long periods alters immunological parameters that initiate the immune response, making the body weaker in its resistance to infectious agents.

The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.

Background: Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19., Methods: Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator. Aerosols were modeled using a commercially available fog machine, and droplets were modeled with fluorescein dye. Both particles were propelled by the cough simulator in a simulated intubation environment. Data were captured by high-speed flash photography, and aerosol and droplet dispersion were assessed qualitatively with and without a barrier in place., Results: Droplet contamination after a simulated cough was seemingly contained by both barrier devices. Simulated aerosol escaped the barriers and flowed toward the head of the bed. During barrier removal, simulated aerosol trapped underneath was released and propelled toward the HCW at the head of the bed. Usage of the intubation sheet concentrated droplets onto a smaller area. If no barrier was used, positioning the patient in slight reverse Trendelenburg directed aerosols away from the HCW located at the head of the bed., Conclusions: Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.

Background: Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required., Aims: To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage., Methods: A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison., Results: The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be 'just right' to prevent facial trauma. Facial barrier creams are an infection risk., Conclusions: Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose of Review: We reviewed recent peer-reviewed literature on three categories of individual- and household-level interventions against air pollution: air purifiers, facemasks, and behavior change., Recent Findings: High-efficiency particulate air/arresting (HEPA) filter air purifier use over days to weeks can substantially reduce fine particulate matter (PM 2.5 ) concentrations indoors and improve subclinical cardiopulmonary health. Modeling studies suggest that the population-level benefits of HEPA filter air purification would often exceed costs. Well-fitting N95 and equivalent respirators can reduce PM 2.5 exposure, with several randomized crossover studies also reporting improvements in subclinical cardiovascular health. The health benefits of other types of face coverings have not been tested and their effectiveness in reducing exposure is highly variable, depends largely on fit, and is unrelated to cost. Behavior modifications may reduce exposure, but there has been little research on health impacts. There is now substantial evidence that HEPA filter air purifiers reduce indoor PM 2.5 concentrations and improve subclinical health indicators. As a result, their use is being recommended by a growing number of government and public health organizations. Several studies have also reported subclinical cardiovascular health benefits from well-fitting respirators, while evidence of health benefits from other types of facemasks and behavior changes remains very limited. In situations when emissions cannot be controlled at the source, such as during forest fires, individual- or household-level interventions may be the primary option. In most cases, however, such interventions should be supplemental to emission reduction efforts that benefit entire communities.

Several societies have raised the risk of viral transmission of SARS-Cov-2 due to surgical smoke during laparoscopic procedures in infected patients. We propose to discuss this issue and to describe specific measures during laparoscopic procedures and a new homemade closed filtration system for smoke evacuation. Since the outbreak of COVID-19, performing a laparoscopy should meet multi-modal requirements. Surgical smoke evacuation device may be an effective tool in reducing exposure to surgical smoke and aerosols., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID-19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life-threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID-19 outbreak., (© 2020 Wiley Periodicals LLC.)

Face masks wearing during the coronavirus disease 2019 (COVID-19) pandemic became ubiquitous. The aim of our study was to assess the use of face masks among young adults during the current viral pandemic. The survey was based on specially created Google Forms and posted on numerous Facebook groups for young people in Poland. Seven days were considered as a recall period. A total of 2315 answers were obtained, 2307 were finally analysis, as eight questionnaires were removed because of data incompleteness. 60.4% of responders declared using the face masks. Those who reported an atopic predisposition wore face masks significantly (P = .007) more commonly (65.5% and 57.7%, respectively). Cloth masks (46.2%) appeared to be most popular ones, followed by surgical masks (39.2%), respirators (N95 and FFP) (13.3%), half-face elastomeric respirators (0.8%) and full-face respirators (0.4%). Females significantly more frequently (P = .0001) used cloth masks; respirators, half-face elastomeric respirators and full-face respirators were used more commonly by males (P < .0001, P = .001 and P = .001, respectively). 23.9% of responders who used single-use mask wore it again. Moreover, 73.6% participants declared mask decontamination; however, the procedures were not always appropriate. We suggest that our results may be of help in construction of general public education campaigns on the proper use of face masks., (© 2020 Wiley Periodicals LLC.)

Purpose: During patient transport from operating room to post-operative recovery area, anesthesia staff are at increased risk of particle aerosolization from patients despite wearing face shields. Current single-use face shields do not provide anesthesia staff from adequate protection from bioaerosolized particles expired during a patient's cough, particularly during transfer from the operating room to the post-anesthesia recovery unit. In this study, we compare the efficacy of single-use face shield currently available at our institution to a newly designed face shield that provides better protection while still maintaining cost-effectiveness and the ease-of-use of a disposable device., Materials and Methods: A patient actor, simulated movements from a patient post-procedure, during transport from operating room to postoperative recovery area. Patterns of exposure of bioaerosolized particles produced from a cough between different face shields was evaluated using fluorescein dye., Main Results: More extensive coverage of the lower face, as provided by the Enhanced Protection Face Shield, offers improved droplet protection from bioaerosolized particles emitted from a cough., Conclusions: Transfer from the operating room to the post-operative recovery unit is a hands-on process and involves managing multiple aspects of patient care physically. Current single-use face shields are convenient and cost-effective, but do not provide adequate protection from droplet aerosolization by patients during transfer. Other masks that provide adequate coverage are costly and are not designed to be single-use. A single-use disposable face shield that offers improved coverage of the lower face provides improved protection for anesthesia staff while maintaining cost-effectiveness, ease-of-use, and infection control., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Asthma and other inhaled allergies are some of the most common paediatric diseases. The association of exposure to allergens with induction and exacerbation of symptoms has been proven. The majority of allergens are permanently or periodically suspended in the air, which leads to impaired quality of life for sensitive patients. Therefore, many methods of prevention and therapy of allergic diseases have been developed. The method of allergen exposure avoidance is often the first and the most significant measure. The present research has been conducted to evaluate, based on scientific data, which measures have the most reliable evidence of effectiveness. Environmental allergen avoidance methods, despite limited evidence supporting their clinical efficacy, are listed as the main therapeutic approaches in most recommendations. The significance of the holistic approach is also emphasised: only simultaneous introduction of several avoidance methods can bring possibly beneficial effects for the patient., (Copyright © 2019 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.)

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.

Brass wind instruments with long sections of cylindrical pipe, such as trumpets and trombones, sound "brassy" when played at a fortissimo level due to the generation of a shock front in the instrument. It has been suggested that these shock fronts may increase the spread of COVID-19 by propelling respiratory particles containing the SARS-CoV-2 virus several meters due to particle entrainment in the low pressure area behind the shocks. To determine the likelihood of this occurring, fluorescent particles, ranging in size from 10-50 μm, were dropped into the shock regions produced by a trombone, a trumpet, and a shock tube. Preliminary results indicate that propagation of small airborne particles by the shock fronts radiating from brass wind instruments is unlikely.